Evelyn Mah

Weight-for-Height Z Score and Mid-Upper Arm Circumference as Predictors of Mortality in Children with Severe Acute Malnutrition

Background Mortality associated with severe acute malnutrition (SAM) could be reduced by screening malnourished children for those most vulnerable to death. We compared the weight-for-height Z score (WHZ) and mid-upper arm circumference (MUAC) as predictors of mortality in children with SAM. Methods We conducted a retrospective study spanning over 8 years, using records of children aged 6-59 months, hospitalized for SAM and discharged alive or who died during hospitalization. Results Area under the curve was greater for MUAC [0.809 (95% CI, 0.709-0.911, p = 0.001)] than WHZ [0.649 (95% CI, 0.524-0.774, p = 0.032)]. MUAC predicted death better [sensitivity: 95.5%, specificity: 25.0%, positive likelihood ratio (PLR): 1.27, negative likelihood ratio (NLR): 0.18] than WHZ (sensitivity: 86.4%, specificity: 21.4%, PLR: 1.10, NLR: 0.64). Best MUAC and WHZ cut-offs for predicting death (10.3 cm and -4, respectively) were most accurate in infants aged <12 months, the former being more accurate. Conclusion MUAC predicts death better than WHZ in children with SAM.

Baseline demographic, clinical and immunological profiles of HIV-infected children at the Yaounde Gynaeco-Obstetric and Pediatric hospital, Cameroon.

Introduction Approximately 2.5 million children below 15 years are infected with the HIV virus, with 90% in sub-Saharan Africa. The Yaounde Gynaeco-obstetric and Pediatric hospital has been a treatment center for HIV since 2006. The aim of this study was to analyze the baseline demographic, clinical and immunologic characteristics of the children with the HIV infection in this hospital. Methods It was a retrospective, cross- sectional and analytic study, carried out between January and April 2011 which included 61 HIV positive children aged 0-15 years. The socio-demographic, clinical and immunologic data were obtained from their medical records. Results Most (52.5%) of the children studied were above 60 months of age with a mean age of 71 months. Most (57.4%) were females. Mother-to-child transmission was the principal mode of contamination in 88.5% of cases. More than half of their mothers (55.7%) did not receive antiretroviral prophylaxis during pregnancy and labor. Common clinical findings included prolonged fever (44.6%), malnutrition (37.6%), lymphadenopathy (34.4%), respiratory tract infections (34.4%) and diarrhea (24.5%). Diagnosis was confirmed by HIV serology for most of the patients (93.4%). Polymerase chain reaction served as method of diagnosis in only 6.6% of the cases. HIV 1 was the predominant viral type. More than half of the children (52.5%) were seen at an advanced stage of the disease. Conclusion HIV screening during pregnancy and prevention of mother-to-child transmission should be reinforced in this context, and fathers of HIV-infected children should be encouraged to go for HIV testing.

Evaluation of breastfeeding and 30% glucose solution as analgesic measures in indigenous African term neonates

Objectives: To compare the analgesic effect of breastfeeding and 30% glucose on pain induced in term newborns during a single painful procedure. Study Design and Setting: We conducted an open design trial, from January to October 2013, at the maternity of the Yaounde Gynaeco-Obstetric and Paediatric Hospital. Patients and Methods: We included healthy term newborns of at least 24 h of life; a heel prick was done, using a 23-gauge syringe, after an analgesic with breastfeeding or 30% glucose. The newborns were divided into two groups by drawing of lots. The pain was evaluated using the Neonatal Infant Pain Scale. Results: Fifty newborns were recruited per group. The median (interquartile range [IQR]) pain scores, during pricking, were 2 (1.5–3.5) and 3 (2.5–4.5), in the groups of breastfeeding and 30% glucose respectively, with a significant statistical difference ( P P = 0.02). Conclusion: The analgesic effect of breastfeeding is greater than that of 30% glucose solution, in newborns undergoing a single painful procedure. Term newborns weighing between 2500 and 3000 g express pain more than those weighing more than 3000 g.

Urethral Duplication with a Cystic Phallic Urethra Associated with a Uterus Didelphys, Partial Agenesis of the Tibia, and an Equinovarus Foot

Urethral duplication is a rare congenital malformation, especially in females. It may be associated with complex urogenital malformations, but the association with a cystic phallic urethra and a uterus didelphys is exceptional. We report a case of a newborn with urethral duplication, with the accessory urethra exteriorized by a large cyst, associated with a uterus didelphys and bone malformations. We discuss the clinical, radiographic, and therapeutic aspects as well as a literature review.

Evaluation of short-term growth in very low birth weight preterm infants at a tertiary hospital in Cameroon

Aim: This retrospective cohort study describes the short-term growth of very low birth weight (VLBW), preterm babies. We hypothesized that catch-up with term infants occurs by 6 months of chronologic age. Patients and Methods: A total of 113 VLBW preterm babies were discharged alive from the neonatology unit of the Yaounde Gyneco-Obstetric and Pediatric Hospital. Sixty-six of the infants respected their monthly appointments for at least 6 months and were included in the study. The weight was taken daily, while the length and head circumference were taken weekly during postnatal hospitalization period and monthly after discharge. Results: The median birth weight was 1390 g. The mean daily weight gain from the 2nd week of hospitalization was 17.35 g/kg/day. By the 6th month of life, the weights of all the infants were comparable to term babies. The median length at birth was 40 cm, an average monthly increase of 3 cm/month for females, and 3.43 cm/month for males. Babies with length at birth above the 85th percentile reached the growth corridor of term infants by 6 months of life. The median head circumference at birth was 28 cm. The head increased at a rate of 2.5 cm/month for males and 2 cm/month for females. Only those with a head circumference above the 50th percentiles were comparable to term infants at 6 months. Conclusions: VLBW preterm infants caught up in weight with term infants by 6 months of age. Growth in length and head circumference lagged behind.

Protection Against Malaria in Man: a Probe into Some of the Implicated Mechanisms in Sub-Saharan Africa

Malaria is amongst the most common parasitic infections in the world. In Africa it causes one in every five childhood deaths, with one child dying of malaria every 30 seconds. People living in malaria endemic areas appear to have protective immune mechanisms, which may be naturally occurring or acquired from exposure to the malaria parasite. These protective factors play an important role in reducing morbidity and mortality from malaria. This review is aimed at exploring and explaining the mechanisms for a selection of the main protective factors to malaria in man. Using an exten- sive literature review of prominent articles, this paper identifies and summarizes these mechanisms which may be ac- quired or genetic. The challenge for the future will be to translate these notions into the development of interventions for the prevention and treatment of malaria.

Epilepsy and skin anomalies in tuberous sclerosis complex: Report of five cases and review of the sub-Saharan African literature

Tuberous sclerosis complex (TSC) is a multi-organ disease characterized by hamartomatous involvement of several organs notably the brain, skin, eye, kidneys, heart and lungs. This rare disorder (incidence is estimated between 1/5,800 and 1/10,000 births) results from mutation of the TSC1 gene on chromosome 9q34 or from mutation of the TSC2 gene on chromosome 16q13. In 80% of cases, it is a consequence of a de novo mutation while in the remaining cases its transmission follows an autosomal dominant pattern. Epilepsy is the main neurological complication associated with TSC, with 80 to 90% of patients having epilepsy in their lifetime while skin anomalies are seen in 60 to 70% of cases. There have been few reports on TSC from sub-Saharan Africa and to the best of our knowledge none has focused specifically on neurological complications mainly epilepsy and specificities of skin abnormalities in the sub-Saharan black Africans. Five cases of TSC with characteristics skin lesions and drug resistant epilepsy are reported. Children presenting with epilepsy, especially focal epilepsy should have a careful dermatological examination. Similarly, all suspected cutaneous lesions must be evaluated with imaging study for the detection of signs of TSC. An earlier management of epilepsy may prevent cognitive impairment associated with frequent epileptic seizures.