The frequency and magnitude of growth failure in a group of HIV-infected children in Cameroon

Background: Growth impairment is a major manifestation of HIV infection in children and has been implicated as a major contributor to both morbidity and mortality. This study the first to be done in this setting, was aimed at comparing the growth of HIV infected children to that of noninfected children in two referral health facilities in Yaoundé, Cameroon. Methods: A prospective case control study was carried out on 39 HIV infected children in two referral hospitals and followed up for a period of 12 months. Anthropometric measurements were taken and the sociodemographic variables of mothers and infants noted. Thirty nine infected children (mean age 45.3 months ± 41.6 SD) were age and sex matched with 39 non-infected children (mean age 44.4 ± 40.7 months). Results: Out of the 39 infected children, 26 (66.7%) had at least one of the three anthropometric indices (weight for height, weight for age, height for age) Z scores less than -2. Throughout follow-up, 20.5% of the infected children were wasted (weight to height Z score < -2) versus none in the control group, 56.4% underweight (weight for age Z score < -2) in the infected versus 2.6% in the control group, and 51.3% stunted (height for age Z score < -2) in contrast to 5.1% in the control group. Conclusion: This study demonstrated that wasting; underweight and stunting are common findings in HIV- infected children, thus stressing the importance of anthropometry in the routine care of these children

Profil clinique et bactériologique des infections néonatales bactériennes à l’Hôpital Laquintinie de Douala, Cameroun

Introduction: L'Organisation Mondiale de la Santé a estimé la survenue globale de décès néonatal à 2,8 millions en 2015, dont 47,6% étaient dues aux infections. Ces infections peuvent survenir chez un nouveau-né de 0 à un mois de vie, pouvant aller jusqu'à 3 mois. Méthodes: C'est une étude prospective allant du 1er mars au 30 juin 2015 au Service de néonatologie de l'Hôpital Laquintinie de Douala. Etaient inclus tout nouveau-né symptomatique avec ou sans critère anamnestique et tout nouveau-né asymptomatique, présentant au moins un risque infectieux et ayant au moins une culture positive ou une anomalie de la numération formule sanguine ou une protéine C réactive positive. Résultats: Des 310 nouveau-nés admis, 300 ont été retenus pour infection néonatale, soit une incidence de 96,8%. Nous avons réalisé 104 cultures dont 25 positives, soit une incidence de l'infection néonatale confirmée de 24%. Les facteurs associés à l'infection étaient la prématurité inexpliquée <35 semaines d'aménorrhée(45,1%) et la réanimation néonatale (34,8%). La fièvre (56%) et les troubles neurologiques (48,8%) étaient les manifestations cliniques les plus fréquentes. Les Gram négatifs étaient les germes les plus fréquents (56%). L'imipenème (95%) et l'amikacine (66,7%) étaient les antibiotiques les plusefficaces. L'évolution était favorable dans 66,4% des cas et le taux de décès était de 33,6%. Conclusion: Cette étude révèle une forte prévalence de l'infection dans cet hôpital. L'écologie bactérienne est dominée par les Gram négatifs, on note une importante résistance aux antibiotiques usuels et une mortalité assez élevée.Pan African Medical Journal 2016; 2

Risk Factors for Birth Asphyxia in an Urban Health Facility in Cameroon

How to Cite This Article: Chiabi A, Nguefack S, Mah E, Nodem S, Mbuagbaw L, Mbonda E, Tchokoteu PF, Doh A. Risk Factors for Birth Asphyxia in an Urban Health Facility in Cameroon. Iran J Child Neurol. 2013 Summer; 7(3):46-54.ObjectiveThe World Health Organization (WHO) estimates that 4 million children are born with asphyxia every year, of which 1 million die and an equal number survive with severe neurologic sequelae. The purpose of this study was to identify the risk factors of birth asphyxia and the hospital outcome of affected neonates.Materials & MethodsThis study was a prospective case-control study on term neonates in a tertiary hospital in Yaounde, with an Apgar score of < 7 at the 5th minute as the case group, that were matched with neonates with an Apgar score of ≥ 7 at the 5th minute as control group. Statistical analysis of relevant variables of the mother and neonates was carried out to determine the significant risk factors.ResultsThe prevalence of neonatal asphyxia was 80.5 per 1000 live births. Statistically significant risk factors were the single matrimonial status, place of antenatal visits, malaria, pre-eclampsia/eclampsia, prolonged labor, arrest of labour,prolonged rupture of membranes, and non-cephalic presentation. Hospital mortality was 6.7%, that 12.2% of them had neurologic deficits and/or abnormal transfontanellar ultrasound/electroencephalogram on discharge, and 81.1% hada satisfactory outcome.ConclusionThe incidence of birth asphyxia in this study was 80.5% per1000 live birth with a mortality of 6.7%. Antepartum risk factors were: place of antenatal visit, malaria during pregnancy, and preeclampsia/eclampsia. Whereas prolonged labor, stationary labor, and term prolonged rupture of membranes were intrapartum risk faktors. Preventive measures during prenatal  visits through informing and communicating with pregnant women should be reinforced. References1. World Health Organisation. Perinatal mortality: a listingof available information. WHO/frh/msm/96.7.Geneva: WHO;1996.2. Lawn JE, Cousens S, Zupan J; Lancet Neonatal SurvivalSteering Team. 4 million neonatal deaths: When? Where?Why? Lancet 2005;365;891-900.3. Bryce J, Boschi-Pinto C, Shibuya K, Black RE, WHO Child Health Epidemiology Reference Group. WHO estimates of the causes of death in children. Lancet 2005;365:1147-52.4. United Nations. The Millenium Development Goals Report 2010. New York; 20105. Boog G. La souffrance foetale aigue. J Gynecol ObstetBiol Reprod 2001;30:393-432.6. Zupan-Simunek V. Définition de l’asphyxie intrapartumet conséquences sur le devenir. J Gynecol Obstet BiolReprod 2008;37S: S7-S15.7. McGuire W. Perinatal asphyxia. Available from: http://www.bestpractice.bmj.com/best-practice/evidence/ background/0320.html. (Accessed 2/3/2010).8. De Vries LS, Jongmans MJ. Long-term outcome afterneonatal hypoxic-ischaemic encephalopathy. Arch DisChild Fetal Neonatal Ed 2010;95:F220-F4.9. Dilenge ME, Majnemer A, Shevell MI. Long-term  developmental outcome of asphyxiated term neonates. JChild Neurol 2001;16:781-92.10. Haider BA, Bhutta ZA. Birth asphyxia in developing countries: Current status and public health implications. Curr Probl Pediatr Adolesc Health Care 2006;6:178-88.11. Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O’Sullivan F, Burton PR, et al. Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ 1998;317(7172):1554-8.12. Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O’Sullivan F, Burton PR, et al. Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ 1998;317(7172):1549-53.13. Arniel-Tison C, Ellison P. Birth asphyxia in the full term newborn: early assessment and outcome. Dev Med Child Neurol 1986;28: 671-82.14. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. Arch Neurol 1976;33:696-705. 15. Sullivan KM, Soe MM: Sample size for a cross-sectional, cohort, or clinical trial studies. Available from: http:// www.openepi.com/Documentation/SSCohortdoc.htm.(Accessed 25/4/2011)16. Zupan-Simunek V, Razafimahefa H, Caeymaex L. Pronostic neurologique des asphyxies perinatales à terme. J Gynecol Obstet Biol Reprod 2003;32:85-90.17. Monebenimp F, Tietche F, Eteki N. Asphyxie néonatale au centre hospitalier universitaire de Yaoundé. Clin Mother Child Health 2005;2:335-8. 18. Douba EC. Souffrance cérébrale asphyxique du nouveaunéa terme au Centre Mère-Enfant de Yaoundé. MD thesis. Faculty of Medicine and Biomedical Sciences, University of Yaounde I; 2007.19. Airede AI. Birth asphyxia and hypoxic- ischemic encephalopathy incidence and severity. Ann Trop Pediatr1991;11(4): 331-5.20. Ogunlesi TA, Oseni SB. Severe birth asphyxia in WesleyGuild hospital: A persistent plague!. Niger Med Pract 2008;53(3):40-3.21. Thornberg E, Thiringer K, Odeback A, Milson I. Birth asphyxia: incidence, clinical course and outcome in aSwedish population. Acta Pediatr 1995;84(8):1927-32.22. Gonzales de Dios J, Moya M. Perinatal difference in asphyxic full terms newborn: an epidemiological study. Rev Neurol 1996; 24:812-9.23. Chandra S, Ramji S, Thirupuram S. Perinatal asphyxia: multivariate analysis of risk factors in hospital births. India Pediatr 1997;34(3):206-12.24. Muhammad A. Birth asphyxia. Professional Med J2004;11(4): 416-22.25. Johnston MV, Hagberg H. Sex and the pathogenesis ofcerebral palsy. Dev Med Child Neurol 2007;49:74-8.26. Raatikainen K, Heiskanen N, Heinoven S. Marriage stillprotects pregnancy. BJOG 2003;112(10): 1411-6.27. Houndjahoué GFH. Etude de la mortalité néonatale due àl’asphyxie dans le district sanitaire de Kolokani au Mali (Thèse de Doctorat en Médecine). Faculté de Médecine, de Pharmacie et d’Odonto-Stomatologie. Université de Bamako; 2004.28. Kinoti SN. Asphyxia of the newborn in East, Central andSouthern Africa. East Afr Med J 1993;70(7):422-33.29. Rehana M, Yasmeen M, Farrukh M, Naheed PS, Uzma DM. Risk factors of birth asphyxia. J A M C. 2007;19(3):67-71.30. Diallo S, Kourouma ST, Camara YB. Mortalité néonatale à l’institut de nutrition et de santé de l’enfant (INSE), Conakry-République de Guinée. Med Afr Noire 1998;45(5):326-9.31. Victory R, Penava D, Dasilva O, Natale R, Richardson B. Umbilical cord pH and base excess values in relation to adverse outcome events for infants delivering at term. Am J Obstet Gynecol 2004;191(6):2021-8.32. Meka LR. Evaluation de la prise en charge des nouveaunésen salle de naissance : cas de l’Hôpital Gynéco- Obstétrique et Pédiatrique de Yaoundé (MD Thesis). Faculty of Medicine and Biomedical Sciences. Yaoundé: University of Yaounde I; 2008.33. World Health Organization. WHO Antenatal care randomized trial: manual for the implementation of the new model. Geneva: World Health Organization; 2002.34. Institut National de la Statistique (INS) et ORC Macro.Enquête démographique et de santé du Cameroun. Calverton Maryland, USA : INS et ORC Macro; 200435. Kumari S, Sharma M, Yuadav M, Saraf A, Kabra M,Merha R. Trends in neonatal outcome with low Apgar score. India J Pediatr 1993; 60(3):415-22.36. Boeuf P, Tan A, Romagosa C, Radford J, Mwapasa V, Molyneux ME, et al. Placental hypoxia during placentalmalaria. J Infect Dis 2008;197(5):757-65.37. Brahim BJ, Johnson PM. Placental malaria and preeclampsiathrough the looking glass backwards? J Reprod Immunol 2005; 65(1):1-15.38. Ellis M, Manandhar N, Manandhar DS, Costello AM. Risk factors for neonatal encephalopathy in Kathmandu, Nepal, a developing country: unmatched case-control study. BMJ 2000;320:1229-36

Reviewing the Insights of Confinement and Social Distancing as Measures Involved in the Prevention of the COVID-19 Pandemic

Confinement and social distancing have been widely used in the prevention of the COVID-19 pandemic, as interventions consisting in reducing physical contact between individuals to prevent the spread of the disease. In order to demonstrate the pattern of these measures, we did a review of pertinent articles on the subject available online. We found that though confinement and social distancing significantly contributed to the mitigation of the COVID-19 infection in a number of countries worldwide, there however exist a dilemma in choosing between the expected benefits and adverse effects, especially when applied on a large scale. Thus considerations with regards to socio-anthropological and politico-economic impacts should be considered in order to protect citizens, especially the vulnerable. Besides, population information, education and communication helps to increase adherence and observation of recommendations. However, further improvements need to be implemented in other to render these measures more bearable and less restrictive while ameliorating their efficacy

From administrative hospital management to performancebased management: Paradigm shift at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital, Cameroon

The Yaoundé Gynaeco-Obstetric and Pediatric Hospital (YGOPH) faced challenges of high debts and sub-optimal care delivery. Performance-Based-Management (PBM) provides an environment of checks and balances, increased transparency, competition and autonomy, thereby improving clinical as well as financial indicators. We describe the transition from resource-based to PBM at the YGOPH over a seven-year period. There was an increase of 4.5% in OB/GYN and 8.1% in prenatal consultations, 8.4% in C-sections, 6.1% of children vaccinated, and 30.5% of women seen for family planning, 51.1% of people living with the Human Immunodeficiency Virus on treatment and 29.4% of indigent patients. These results occurred in spite of a 14% reduction in staff. Annual revenue increased by 5.75%. The share of hospital income from care on overall hospital revenue increased from 55.11% to 60.00%. With this self-financing PBM model, the hospital remains a social, humane and financially viable structure delivering improved quality care

Monitoring the Efficacy and Safety of Artemisinin-Based Combination Therapies: A Review and Network Meta-analysis of Antimalarial Therapeutic Efficacy Trials in Cameroon

International audienc

The Clinical and Bacteriogical Spectrum of Neonatal Sepsis in a Tertiary Hospital in Yaounde, Cameroon

Objective: Sepsis is an important cause of morbidity and mortality in neonates especially in developing countries where identification of the germs and treatment is often unsatisfactory. The aim of the study was to assess the clinical presentation, and bacteriological profile of neonatal infections, and the sensitivity of the causative germs to antibiotics. Methods: We carried out a prospective analytic study in the Yaounde Gynaeco-Obstetric and Pediatric Hospital in Cameroon over a 6 months period from 18th November 2008 to 18th May 2009. On the basis of history and/or clinical findings and paraclinical investigations, 218 neonates out of a total of 628 admissions were investigated and managed for neonatal infection. Findings: The most frequent symptoms were fever (44.95%), refusal to feed/irritability (32.11%), and respiratory distress/cough (28.90%). Premature birth and prolonged rupture of membranes were the most frequent risk factors. Klebsiella spp, Escherichia coli and Enterobacter spp were the most frequent germs identified in respectively 28.6%, 21.4% and 14.3% of the positive samples. Overall sensitivity of the cultures to ampicillin, netilmicin and gentamycin was poor at 29.4%, 31.4% and 18.9% respectively, whereas imipenem, ofloxacin, ciprofloxacin and ceftazidime had the best sensitivities in 91.7%, 90%, 85.3% and 69.4% of the cultures respectively. The mortality rate was 22%, and low birth weight, premature birth and septicemia were significant risk factors for death. Conclusion: Mortality from neonatal sepsis in this context is still high and there is an upsurge of multi-resistant germs to currently used antibiotics, calling for the need for rational use of antibiotics in the management of these infections

Vaccination of infants aged 0 to 11 months at the Yaounde Gynaeco-obstetric and pediatric hospital in Cameroon: how complete and how timely?

Abstract Background Vaccination is a major, but simple and cost effective public health intervention in the prevention of infectious diseases, especially in children. Nowadays, many children still miss scheduled vaccines in the Extended Program of Immunization (EPI) or are being vaccinated after the recommended ages.This study was aimed at assessing vaccination completeness and timeliness in children aged 0 to 11 months attending the vaccination clinic of the Yaounde Gynaeco-Obstetric and Pediatric Hospital. Methods This was an observational cross-sectional study over a period of 3 months (1st February to 30th April 2016). 400 mothers were interviewed and their children’s vaccination booklets analyzed. Information on the children and the parents was collected using a pretested questionnaire. Data analysis was done using SPSS version 20 software. Bivariate and multivariate analysis with logistic regression was done to assess the determinants of completeness and timeliness. Results A total of 400 mother-infant pairs were sampled. The vaccination completeness rate was 96.3%. This rate varied between 99.50% for BCG and 94.36% for IPV. Most of the children were born at the Yaounde Gynaeco-Obstetric and Pediatric hospital where they were regularly receiving their vaccines. The proportion of correctly vaccinated infants was 73.3%. The most differed vaccines were BCG, PCV13 and IPV. Factors influencing immunization completeness were the father’s profession and the mother’s level of education. Conclusions Despite the high immunization coverage, some children did not complete their EPI vaccines and many of them took at least one vaccine after the recommended age

Les jumeaux siamois au Cameroun : Problèmes qui se rattachent au diagnostic et à la prise en charge dans le contexte africain

Conjoined twins represent one of the rarest forms of congenital abnormalities. We present a case of conjoined twins delivered at born in the Yaounde Gynaeco-Obstetric and Pediatric Hospital in Cameroon. They were joined at the chest and abdomen, and had one functional heart. The outcome was fatal on the seventh day of life, despite appropriate reanimation measures. This case highlights the difficulties inherent in the diagnosis and management of conjoined twins in low resource settings (Afr J Reprod Health 2009; 13[3]:127-135).Les jumeaux siamois représentent une des très rares malformations congénitales. Nous présentons un cas des jumeaux siamois nés à l’hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé au Cameroun. Leur fusion se situait au niveau du thorax et de l’abdomen et ils avaient un coeur fonctionnel, l’autre étant resté vestigeale. L’issue a été fatale au septième jour de vie, malgré les mesures d’animation appropriées qui ont été mises en oeuvre. Ce cas illustre les difficultes liées au diagnostic et à la prise en charge des jumeaux siamois dans les pays en voie de développement (Afr J Reprod Health 2009; 13[3]:127-135)