Philippe Hennart

Community-acquired bacteremia among hospitalized children in rural central Africa.

OBJECTIVE To describe the epidemiology of community-acquired bacteremia in children admitted to a rural hospital in central Africa and to identify useful diagnostic signs or symptoms. METHODS On admission, a blood culture was obtained from all children admitted to Childrens Hospital of Lwiro between 1989 and 1990. Clinical and biologic signs of infection and nutritional status were recorded. RESULTS Among the 779 children included in the study, 15.9% were bacteremic on admission. The rate of bacteremia was the highest among children with jaundice (20/56; 35.7%) and fever (119/487; 24.4%). In contrast, children with severe malnutrition had a lower rate of bacteremia (13.2%) than weight growth retarded or well-nourished children (19.5%) (P = 0.046). Fever was the most useful diagnostic criteria (sensitivity and negative predictive value of 96.0% and 97.8%, respectively) even in severely malnourished children (sensitivity and negative predictive value of 96.4% and 99.1%, respectively). Enterobacteriacea, mostly Salmonella spp, caused 73% of the bacteremia. There was a high rate of resistance to ampicillin and chloramphenicol among the responsible organisms. Only 31 (47.7%) of 65 bacteremic children responded to the combination of ampicillin and gentamicin. The presence of bacteremia on admission did not significantly increase the risk of morality during hospitalization (19.4% compared with 13.5%; P = 0.088). Age less than 12 months and jaundice were independent risk factors for deaths in bacteremic children. CONCLUSIONS Community-acquired bacteremia caused by multiresistant Enterobacteriacea is an important problem of hospitalized well-nourished and malnourished children in central Africa. Fever on admission is a sensitive diagnostic sign, even in malnourished children.

A critical comparison of the history of sudden-death infants and infants hospitalised for near-miss for SIDS

To determine whether significant historical differences distinguish the near-miss for Sudden Infant Death from the infants who died of SIDS, we analysed the histories and clinical data from two groups of infants seen in our University Hospital and from collaborative research group. The data were obtained with the use of a standardised questionnaire and consultation of all available medical data.Sixty-five infants were identifed as near-miss for SIDS after they had suffered a severe cardiorespiratory incident during sleep for which no cause could be found despite a complet medical examination. After an autopsy had failed to reveal a cause for the unexpected death 95 cases of SIDS were retained in the study. A series of 353 variables were collected from the parents, the gynaecologists, neonatologists and attending physicians.After statistical analysis, only 15 of the 353 items studied significantly differentiated between the two groups. A stepwise discriminant analysis performed on these items led to the identification of six independent variables: the time of the incident; the circumstances leading to the observation of the child; the childs sleep position; previous minor intestinal problems; the size of the family and the mothers coffee consumption. Most variables indicate that the near-miss infants were discovered and rescued earlier than the infants who died. No other historical information appeared significantly to differentiate between the two groups of infants. These data need confirmation from a prospective epidemiological survey.

The influence of socioeconomic status on the incidence and evolution of obesity during early adolescence

OBJECT: To analyze the influence of socioeconomic status on the prevalence, evolution and incidence of obesity between the ages of 12 y and 15 y in Belgium.DESIGN: Retrospective cohort study.SUBJECTS: 2607 children from five social groups.MEASUREMENTS: The body mass index (BMI) measured during two school medical examinations carried out at an interval of two years between the ages of 12 y and 15 y.RESULTS: Between the ages of 12 y and 15 y the inverse relation between social status and the prevalence of obesity is accentuated in girls. The increasing divergence between social groups was a result both of the greater incidence of new cases of obesity and the reduced improvement rate in obesity already present in adolescents of lower social classes.CONCLUSIONS: Social inequalities in obesity increase during early adolescence. Preventive measures, targeting children of low socioeconomic status, should be put in place at this stage of life.

BREASTFEEDING AND HOSPITAL MORTALITY IN CHILDREN IN RWANDA

Abstract The relation between breastfeeding and mortality among 2339 children under two years old and admitted to hospital with measles, diarrhoeal disease, or acute lower respiratory disease was analysed over a two-year period in Kigali, Rwanda. Case fatality rates were significantly lower in the breastfed than in the completely weaned children for all three diseases. This advantage held for all six month age groups.

Serum levels of prolactin and milk production in women during a lactation period of thirty months.

Serum prolactin was measured in single blood samples collected from 219 nursing mothers of the Kivu region (Zaïre) during 30 post‐partum months. In addition the number of feeding episodes per day and the amount of milk given to the child in 24 h were recorded. The mean serum prolactin levels remained around 1000 mu/l during the first 15 months of lactation and fell during the next 3 months to 550 mu/l. A decline in milk production per day occurred during the second year, but it was less marked than that of prolactin. This decline seemed to be associated with the decline in suckling frequency as the quantity of milk given per feed remained almost unchanged throughout lactation. The average amount of milk given by mothers with serum prolactin levels in the range of values seen in non‐lactating and non‐pregnant women (about 500 mu/l) is nevertheless of some 35 g per feeding or 260 g per day. These results demonstrate that milk production can be maintained in women with normal levels of prolactin and suggest that prolactin plays a permissive role in established lactation.

Social class and obesity in 12-year-old children in Brussels: Influence of gender and ethnic origin

From their school health files, the body mass index of 2607 children, 1268 boys and 1339 girls, from the Brussels region of Belgium was analysed. The aim was to study the relationship between obesity and social class, gender and nationality. In Belgian girls, the lower their social class, the higher was the prevalence and severity of obesity. There was no such significant relationship in Belgian boys, nor in immigrant children of either sex, although the overall prevalence of obesity was similar in all groups. These results question certain hypotheses proposed to explain the relationship between social class and obesity.ConclusionFrom early adolescence on, social inequality influences the prevalence of obesity in Belgian girls, but not in Belgian boys nor in immigrant children. Prevention of obesity should take into account the influence of gender, social class and ethnic origin.

How useful are anthropometric, clinical and dietary measurements of nutritional status as predictors of morbidity of young children in central Africa?

Summary objective  To identify useful predictors of morbidity of young children in central Africa.

Improvements in nutritional management as a determinant of reduced mortality from community-acquired lower respiratory tract infection in hospitalized children from rural central Africa.

Background: In-hospital mortality from lower respiratory tract infections (LTRI) is unacceptably high in developing countries where LTRI are still a leading cause of death. Objective: To identify new approaches to reduce in-hospital mortality of LRTI through the improvement of its management. Methods: The prospectively collected database of children admitted during an 11-year period with LRTI in a pediatric rural hospital in Central Africa was reviewed to determine the predictors of death and to evaluate the impact on mortality of 4 different protocols for the management of malnutrition. Results: During the study period, 859 children were admitted with a nonmeasles severe LRTI. In the 3-year period during which blood cultures were obtained, 29.0% of the children with LRTI were bacteremic, and multiresistant Enterobacteriaceae were recovered in 81.4% of positive blood cultures. Independent predictors of death in children without edema were age <24 months, dehydration and hepatomegaly with adjusted odds ratios (numbers in parentheses, 95% confidence interval) of 3.47 (1.70–7.08), 4.24 (2.11–8.50) and 2.90 (1.43–5.85), respectively. In those with edema, a significantly increased risk of death was noted for girls [4.31 (1.71–10.90)], in children with z-score of weight to height ≤ −3 [5.45 (1.67–17.79)] and when the serum albumin was <16 g/l [2.58 (1.01–6.58)]. The improvement in the management of malnutrition was followed by a reduction of LRTI-related mortality in children with edema from 32.4 to 8.9% (P < 0.001). In children without edema, the LRTI-related mortality decreased from ~12% to 3.5% when their diet was supplemented with micronutrients. Conclusion: This study indicates that the improvement of the management of underlying nutritional deficiencies is crucial for the reduction of the high in-hospital case fatality rate associated with severe nonmeasles LRTI. The empiric antibiotic regimen should be modified to cover for multiresistant Enterobacteriaceae.

The health of mother and child in rural Central Africa.

In the Great Lakes Region of Central Africa, the population suffers from severe proteo-caloric malnutrition, with adverse affects on maternal and child health. Improvement of maternal nutrition would lead to rapid consecutive pregnancies, reducing the length of time each child could be breastfed and reducing the protein available to each child. Hence, the authors recommend modern birth spacing methods in combination with programs to improve the health of mother and child.

Socioeconomic status and changes in body mass from 3 to 5 years

The influence of social status on the development of body mass was analysed in a retrospective cohort study of 675 Belgian children monitored between the ages of 3 and 5 years by the preventive medical services in Brussels. At age 3, no association between excess weight and social status was observed. Adiposity rebound before age 5 was inversely related to body mass at age 3 and was independent of social status. The social influences on obesity observed in adolescence cannot be explained by a higher frequency of early adiposity rebound in children of low socioeconomic status.