Epidemiology and characteristics of febrile seizures in children

peer reviewedRésumé : Les convulsions fébriles (CF), malgré leur bénignité, font toujours l’objet de discussions concernant les investigations à entreprendre et l’attitude thérapeutique à adopter. Notre étude vise à faire l’inventaire des éléments cliniques et paracliniques présents lors de survenue des CF et susceptibles d’en influencer la prise en charge. 275 épisodes de CF admis aux Urgences Pédiatriques du CHR sur une période de 5 ans ont été analysés rétrospectivement sur la base des circonstances de survenue, des caractéristiques cliniques, des examens paracliniques et de la prise en charge immédiate. Les CF représentent 1,4% des admissions pédiatriques. Un antécédent familial a pu être retrouvé dans 31,3 % des épisodes. 9% des crises étaient latéralisées, 11,7% étaient répétitives et 12,3% ont duré plus de 10 minutes. Les infections des voies respiratoires supérieures et otorhinolaryngologiques d’origine virale étaient les plus incriminées: 69,5%. Les explorations paracliniques étaient normales dans plus de 90 % des cas. L’évolution était spontanément favorable dans 73,8% des cas. Un anticonvulsivant a été nécessaire pour les 26,2 % restants. Notre travail confirme le caractère bénin de la majorité des CF et leur évolution favorable. La réalisation des examens complémentaires et l’indication d’un traitement antiépileptique doit reposer principalement sur l’analyse des signes de gravité.Summary : Febrile Seizures (FS), despite their usual benign clinical course, are still subject of controversies regarding the need for further investigation and treatment with anti-epileptic drugs (AEDs). Our study aimed to inventory the clinical findings, laboratory and imaging data associated with FS and eventually influencing their management. 275 episodes admitted with FS at the emergency ward of the Liège CHR over a 5 year period were retrospectively analyzed regarding precipitating factors; clinical features; laboratory, electroencephalographic, and imaging studies; as well as treatment response. FS represented 1.4% of admissions to the pediatric service. 31.3% of patients had a family history of seizure disorder. 9% percent of seizures were focal, 11.7% recurrent, and 12.3% prolonged (greater than 10 minutes). Upper respiratory tract and otorhinolaryngologic viral infections were the most often implicated provoking factors, occurring in 69.5% of patients. Laboratory, electroencephalographic and radiographic studies were normal in more than 90% of cases. 73.8% of seizures resolved without intervention. An AED was required to manage the remaining 26.2%. This study confirms the favorable outcomes of FS as demonstrated in previous studies. This happens without requiring AEDs for resolution, and without recurrence. Laboratory, electroencephalographic and imaging studies, as well as initiation of AEDs should be based primarily on clinical severity

“The Peer Educator Is the Game-Changer of My Life”: Perceptions of Adolescents Living with HIV in DR Congo on Involving Peer Educators in the Process of HIV Disclosure

Several approaches to the disclosure of HIV status to children and adolescents have been described. Each of these places particular emphasis on the role of parents and health care workers (HCWs) to mitigate the impact of disclosure on the adolescent without exploring the possible roles that other individuals might play in the process of disclosure. This article assesses the perceptions of adolescents living with HIV (ALHIV) about disclosure done by parents, guardians, HCWs, peer educators in the role of peer supporters, accidentally or by self-discovery, and the subsequent effects of disclosure method on their mental health. We used a qualitative study to conduct semi-structured interviews with 73 ALHIV at the Kalembelembe Paediatric Hospital, in DR Congo disclosed to by parents, guardians, HCWs, and/or peer educators, respectively, or disclosed to accidentally or by self-discovery. Microsoft Excel analysis matrix was used to organize the qualitative data. The majority of ALHIV whose disclosure involved a peer educator unanimously acknowledged the important role of the peer in accepting their HIV status, in their ART adherence, and their development of self-esteem. However, most ALHIV disclosed without involving peers declared that they had accepted their situation after a relatively long period followed by contact with the peer and integration in the self-support group. We found that the peer approach is the game-changer of the HIV status disclosure process that would allow ALHIV to accept their HIV status with minimum distress, it builds resilience, and allows them to adhere to treatment.publishedVersio

Profils evolutifs a court terme des convulsions associees a la fievre chez le nourrisson et le jeune enfant en milieu de soins de sante primaires a Kinshasa

Description Le pronostic immédiat des convulsions fébriles (CF) est un sujet de préoccupation pour le clinicien et les familles.Objectif Notre étude vise à étudier les facteurs pertinents pour l’établir au travers de l’analyse du profil évolutif endéans les 24 heures de patients admis pour CF.Méthodes Cent quarante-huit enfants, entre 5 à 71 mois, ont été incorporés prospectivement suite à leur admission pour CF dans 2 centres pédiatriques de référence à Kinshasa entre le 10 février et le 10 mai 2008. Leur évolution au cours des 24 premières heures a été analysée en fonction des caractéristiques cliniques de la crise initiale.Résultats Quatre-vingts pourcent des patients étaient âgés de moins de 3 ans. Huit groupes ont été identifiés sur base d’une présentation clinique différente. Les 2 groupes caractérisés par l’absence (groupe 1) ou la présence (groupe 8) de 3 facteurs de gravité identifiés diffèrent significativement par l’évolution durant les premières 24 heures (p<0,05). Le groupe 8 rassemble les enfants ayant présenté les plus mauvaises évolutions : récidive de crise, déficit neurologique voire décès. Celles-ci apparaissent significativement reliées au caractère focal, prolongé et répétitif des crises à l’analyse univariée, mais seulement au caractère répétitif à l’analyse multivariée (OR ajusté = 4,4; IC 2,0-9,6).Conclusion Les CF présentent un polymorphisme sémiologique pouvant avoir une valeur pronostique à court terme. Indépendamment de l’étiologie sous-jacente, la reconnaissance de facteurs de risque de mauvaise évolution doit conduire à la mise en place de mesures de surveillance et de traitement préventifs appropriés

Perceptions and experiences of Congolese midwives implementing a low-cost battery-operated heart rate meter during newborn resuscitation

Background 900,000 newborns die from respiratory depression each year; nearly all of these deaths occur in low- and middle-income countries. Deaths from respiratory depression are reduced by evidence-based resuscitation. Electronic heart rate monitoring provides a sensitive indicator of the neonate's status to inform resuscitation care, but is infrequently used in low-resource settings. In a recent trial in the Democratic Republic of the Congo, midwives used a low-cost, battery-operated heart rate meter (NeoBeat) to continuously monitor heart rate during resuscitations. We explored midwives' perceptions of NeoBeat including its utility and barriers and facilitators to use. Methods After a 20-month intervention in which midwives from three facilities used NeoBeat during resuscitations, we surveyed midwives and conducted focus group discussions (FGDs) regarding the incorporation of NeoBeat into clinical care. FGDs were conducted in Lingala, the native language, then transcribed and translated from Lingala to French to English. We analyzed data by: (1) coding of transcripts using Nvivo, (2) comparison of codes to identify patterns in the data, and (3) grouping of codes into categories by two independent reviewers, with final categories determined by consensus. Results Each midwife from Facility A used NeoBeat on an estimated 373 newborns, while each midwife at facilities B and C used NeoBeat an average 24 and 47 times, respectively. From FGDs with 30 midwives, we identified five main categories of perceptions and experiences regarding the use of NeoBeat: (1) Providers' initial skepticism evolved into pride and a belief that NeoBeat was essential to resuscitation care, (2) Providers viewed NeoBeat as enabling their resuscitation and increasing their capacity, (3) NeoBeat helped providers identify flaccid newborns as liveborn, leading to hope and the perception of saving of lives, (4) Challenges of use of NeoBeat included cleaning, charging, and insufficient quantity of devices, and (5) Providers desired to continue using the device and to expand its use beyond resuscitation and their own facilities. Conclusion Midwives perceived that NeoBeat enabled their resuscitation practices, including assisting them in identifying non-breathing newborns as liveborn. Increasing the quantity of devices per facility and developing systems to facilitate cleaning and charging may be critical for scale-up

Delayed and Interrupted Ventilation with Excess Suctioning after Helping Babies Breathe with Congolese Birth Attendants

There is a substantial gap in our understanding of resuscitation practices following Helping Babies Breathe (HBB) training. We sought to address this gap through an analysis of observed resuscitations following HBB 2nd edition training in the Democratic Republic of the Congo. This is a secondary analysis of a clinical trial evaluating the effect of resuscitation training and electronic heart rate monitoring on stillbirths. We included in-born, liveborn neonates ≥28 weeks gestation whose resuscitation care was directly observed and documented. For the 2592 births observed, providers dried/stimulated before suctioning in 97% of cases and suctioned before ventilating in 100%. Only 19.7% of newborns not breathing well by 60 s (s) after birth ever received ventilation. Providers initiated ventilation at a median 347 s (>five minutes) after birth; no cases were initiated within the Golden Minute. During 81 resuscitations involving ventilation, stimulation and suction both delayed and interrupted ventilation with a median 132 s spent drying/stimulating and 98 s suctioning. This study demonstrates that HBB-trained providers followed the correct order of resuscitation steps. Providers frequently failed to initiate ventilation. When ventilation was initiated, it was delayed and interrupted by stimulation and suctioning. Innovative strategies targeting early and continuous ventilation are needed to maximize the impact of HBB

Institutional capacity for health systems research in East and Central African schools of public health: knowledge translation and effective communication

BACKGROUND: Local health systems research (HSR) provides policymakers and practitioners with contextual, evidence-based solutions to health problems. However, producers and users of HSR rarely understand the complexities of the context within which each operates, leading to the “know–do” gap. Universities are well placed to conduct knowledge translation (KT) integrating research production with uptake. The HEALTH Alliance Africa Hub, a consortium of seven schools of public health (SPHs) in East and Central Africa, was formed to build capacity in HSR. This paper presents information on the capacity of the various SPHs to conduct KT activities. METHODS: In 2011, each member of the Africa Hub undertook an institutional HSR capacity assessment using a context-adapted and modified self-assessment tool. KT capacity was measured by several indicators including the presence of a KT strategy, an organizational structure to support KT activities, KT skills, and institutional links with stakeholders and media. Respondents rated their opinions on the various indicators using a 5-point Likert scale. Averages across all respondents for each school were calculated. Thereafter, each school held a results validation workshop. RESULTS: A total of 123 respondents from all seven SPHs participated. Only one school had a clear KT strategy; more commonly, research was disseminated at scientific conferences and workshops. While most respondents perceived their SPH as having strong institutional ties with organizations interested in HSR as well as strong institutional leadership, the organizational structures required to support KT activities were absent. Furthermore, individual researchers indicated that they had little time or skills to conduct KT. Additionally, institutional and individual links with policymakers and media were reported as weak. CONCLUSIONS: Few SPHs in Africa have a clear KT strategy. Strengthening the weak KT capacity of the SPHs requires working with institutional leadership to develop KT strategies designed to guide organizational structure and development of networks with both the media and policymakers to improve research uptake.DFI