Seasonal Pattern of Hospitalization from Acute Respiratory Infections in Yaounde, Cameroon

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Artesunate-mefloquine combination therapy in acute Plasmodium falciparum malaria in young children: a field study regarding neurological and neuropsychiatric safety

BACKGROUND: Mefloquine-artesunate combination therapy for uncomplicated falciparum malaria is one of the treatments used in African children. Data concerning neurological safety in adults and children treated with mefloquine and artesunate combination therapy is well documented in Asia. Safety data for neurological and neuropsychiatric side effects of mefloquine and artesunate combination therapy in African children are scarce, although WHO recommends this therapy in Africa. METHODS: A phase IV, open label, single arm study was conducted among African children between 10 and 20 kg with acute uncomplicated falciparum malaria. They were treated over three consecutive days with a paediatric fixed-dose combination of artesunate (50 mg/d) and mefloquine (125 mg/d). Parasitological, clinical and neurological examinations and standardized questions about neuropsychiatric symptoms were carried out on days 0, 4, 7, 28 and 63. The primary objective was to assess the neurological and neuropsychiatric safety of artesunate-mefloquine combination therapy in young children. RESULTS: From December 2007 to March 2009, 220 children with uncomplicated Plasmodium falciparum malaria were treated with artesunate and mefloquine. 213 children were analysed according to study protocol. 50 neurological and neuropsychiatric adverse events occurred in 28 patients. Eleven drug-related neurological and neuropsychiatric adverse events occurred in eight patients. Sleeping disorders were present in 2.3%, neurological disorders in 1.4%, neuropsychiatric disorders in 1% and eating disorders in 0.5% of the patients. Adverse events were of mild to moderate intensity and resolved spontaneously. CONCLUSION: African children showed a low percentage of self-limited neurological and neuropsychiatric adverse events, confirming studies on neurological safety in Asian children treated with artesunate and mefloquine. Sleeping disorders were most frequently observed

La dyspasie ectodermique anhydrotique : à propos d’un cas au Centre Mère et Enfant de la Foundation Chantal Biya, Youndé, Cameroun

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Grid-based virtual clinic for medical diagnosis tutoring

Les technologies émergeantes basées sur la grille sont de plus en plus adoptées pour rehausser l\'éducation et fournir de meilleurs services pour l\'apprentissage. Cela se caractérise de part le monde par le développement de systèmes tutoriels largement distribués. Les apprenants, indépendamment de leurs systèmes informatiques peuvent accéder à des connaissances partagées sur des sites répartis. Généralement, les outils d\'enseignement existants sont basés sur le transfert d\'information plutôt que sur une approche synergique centrée sur la construction des connaissances. Dans cet article, nous proposons une clinique virtuelle basée sur la grille comme cadre de formation au diagnostic médical. La réalisation visée est un outil collaboratif d\'enseignement pour les médecins du terrain et les étudiants en médecine au sein d\'une organisation virtuelle.The emerging grid-based technologies are increasingly adopted to enhance education and provide better learning services. This is characterized all over the world, by the development of large scale tutoring systems. Learners, regardless of their different computer systems have access to knowledge across distributed site. Commonly, classical teaching tools are based on information transfer approach rather than a synergic approach focused on knowledge construction. In this paper, we propose a grid-based virtual clinic for medical diagnosis tutoring. The aimed realization is a convenient collaborative training tool for field doctors and medical students within a virtual organization. Keywords: Grid, Système tutoriel, Clinique virtuelle, Diagnostic médical; Grid, Tutoring system, Virtual clinic, Medical diagnosis. Journal des Sciences Pour l\'Ingénieur. Vol. 7 2006: pp. 72-7

L\'antibiotherapie de premiere intention dans le traitement de l\'empyeme pleural de l\'enfant en milieu Africain (Yaoundé-Cameroun).

We examined 125 pleural fluids collected, 67 cultures that represented 53.6% were positive. The three main germs isolated in order of decreasing frequency were Streptococcus pneumoniae (41.7%), Staphylococcus aureus (35.3%) and Haemophilus influenzae (7.5%). The most active antibiotics against each of these bacteria were : for S. pneumoniae, second and third generation cephalosporins with 100% sensitivity, amoxicilline + clavulinic acid (96.4% sensitivity), first generation cephalosporins (95% sensitivity) and 46.4% resistance to penicilline G; for S. aureus, céfuroxime, vancomycine and pristinamycine with 100% sensitivity, whereas gentamicin and tobramycin had only 91.3% sensitivity, and there was 13.8% resistance to oxacilline ; for H. influenzae, amoxicillin + clavulinic acid, first, second and third generation cephalosporins, and quinolones all showed 100% sensitivity with 100% and 60% resistance to cotrimoxazole and chloramphenicol respectively. To cover all these three germs in our environment, we recommend as first line antibiotherapy for empyema thoracis in children either of the following antibiotic combinations: amoxicillin/clavulinic acid with gentamicin or cefuroxime with gentamicin or vancomycin alone if available, against S. aureus infection.Nous avons prélevé et mis en culture 125 liquides pleuraux dont 67 soit 53,6% ont poussé. Les trois principaux germes isolés étaient dans l'ordre de fréquence décroissante : Streptococcus pneumoniae (41,7%) Staphylococcus aureus (35,3%) et Haemophilus influenzae (7,5% ). Les principaux antibiotiques actifs sur ces différents germes étaient : vis à vis de S. pneumoniae les céphalosporines de 2è et 3è génération (100%), amoxicilline+acide clavulanique (96,4%) les céphalosporines de 1ère génération (95%). La résistance à la pénicilline G était de 46,4% ; vis à vis de S. aureus, le céfuroxime, la vancomycine et la pristinamycine étaient actives à 100% contre 91,3% pour la gentamicine et la tobramycine, alors que l'oxacilline avait une résistance de 13,8% et enfin vis à vis de H. influenzae l'amoxicilline+acide clavulanique, les céphalosporines des trois générations et les quinolones avait une activité de 100% et le cotrimoxazole une résistance de 100% contre 60% pour le choramphénicol. Pour couvrir ces trois germes dans notre environnement nous proposons de prescrire en première intention dans l'empyème pleural de l'enfant l'une des deux associations suivantes : soit amoxicilline + acide clavulanique et gentamicine soit céfuroxime et gentamicine ou alors vancomycine seule en cas de S. aureus si ce dernier antibiotique est disponible. Keywords: Antibiotherapy - Child - Empyema thoracis -Yaounde - Cameroon.Clinics in Mother and Child Health Vol. 4 (1) 2007: pp. 641-64

Clinical presentation of severe malaria in children in two district hospitals in Cameroon

Since efforts to eradicate malaria failed in the 1970's, sub-Saharan African countries have learned to live with malaria and children less than 5 years old carry the largest part of this burden with 3000 deaths daily. Knowledge of the various forms of severe malaria at peripheral hospitals is important in order to better direct available resources for case-management. Hence we set out to describe the clinical and paraclinical presentation at two peripheral hospitals in the Centre province, Cameroon. From January 1st to August 31st 2000, at the Djoungolo and the Mfou district hospitals 148 children aged from 6 to 59 months who presented with at least one feature of severe malaria were recruited by consecutive sampling. The incidence of severe malaria was 21.1%. The male/female ratio was 1.06. The most frequent manifestations of severity on admission were fever (96.6%), confusion or drowsiness (70.3%), convulsions (54.7%), prostration (43.2%), abnormal breathing (deep, in-drawing of chest wall, 34.5%) and severe anaemia (14.9%) in these children who arrived at the hospital 4 days on average after the onset of illness. The paraclincal presentation was marked by a high median parasitaemia at 18000 /mm3. Most (79.7%) children were said to have received antimalarial drugs before admission and chloroquine was the most presumed drug of choice (73.4%). We recommend reinforcement of education of parents / caretakers on the management of malaria at home and the equipment of peripheral referral hospitals with transfusion facilities in order to reduce the number of referrals to the central level of patients requiring transfusion. Keywords: severe malaria, children, WHO criteria, clinical, paraclinical, peripheral hospitals, Cameroon Resume: Depuis l'échec des efforts pour l'éradication du paludisme dans les années 70, les pays de l'Afrique subsaharienne se sont accommodés à vivre avec le paludisme et les enfants de moins de 5 ans paient le plus lourd tribut avec 3000 décès par jour. Pour une meilleure orientation des ressources disponibles dans la prise en charge des cas, il est important de connaître les différentes formes du paludisme grave dans les formations sanitaires périphériques. Ainsi, nous avons entrepris de décrire la présentation clinique du paludisme grave dans deux hôpitaux périphériques de la Province du Centre au Cameroun. Du 1er janvier au 31 août 2000, 148 enfants âgés de 6 à 59 mois, présentant au moins un signe de paludisme grave ont été recrutés par échantillonnage systématique dans les hôpitaux de district de Djoungolo et de Mfou. L'incidence du paludisme grave a été de 21.1%, et le sexe ratio de 1.06 en faveur de garçons. La fièvre (96.6%), la confusion ou le somnolence (70.3%), les convulsions (54.7%), la prostration (43.2%), la respiration anormale (profonde, tirage costal, 34.5%) et l'anémie sévère (14.9%). étaient les signes de gravité les plus fréquemment retrouvés chez ces enfants qui arrivaient à l'hôpital 4 jours en moyenne après le début de la maladie. Le profil paraclinique était marqué par une forte parasitémie à 18 000 parasites/mm3. La plupart (79.7%) des enfants avaient reçu des médicaments avant l'admission, la chloroquine était le médicament le plus utilisé à cet effet (73.4%). Ce traitement avant l'admission n'avait pas d'effet sur la parasitémie initiale. Nous recommandons que l'éducation des parents/tuteurs sur la prise en charge du paludisme soit intensifiée et que les responsables des hôpitaux de district au Cameroun s'organisent pour mettre en place le nécessaire pour la transfusion sanguine, ceci pour diminuer le nombre de cas référés au niveau central pour anémie sévère. Mots cles: paludisme grave, critères OMS, enfants, clinique, para clinique, hôpitaux périphériques, Cameroun Clinics in Mother and Child Health Vol. 2(1) 2005: 239-24

Outcome of severe malaria in children in two district hospitals in Cameroon

Malaria is a major endemic parasitic disease and remains the main cause of morbidity and mortality in sub-Saharan Africa. Children less than 5 years old carry the largest part of this burden with 3000 deaths daily. Case management of severe malaria is a main problem in Cameroon. The regime proposed by the WHO needed to be tested in African countries to prove its effectiveness and efficacy before adoption. This is thus part of a multi-centre study. Our main aim was to describe the evolution and outcome of severe malaria on management following the current WHO treatment guidelines. From January 1st to August 31st 2000, 148 children aged from 6 to 59 months with at least one feature of severe malaria were recruited by consecutive sampling at Djoungolo and Mfou district hospitals. Treatment according to WHO guidelines was implemented and there was rigorous in-patient monitoring and outpatient follow-up. The incidence of severe malaria was 21.1%. The male/female ratio was 1.06. The commonest clinical forms of severe malaria were: generalised convulsions (54.7%), prostration (43.2%) and severe anaemia (14.9%). The case management of severe malaria was effective, for, the mean fever clearance time was 27.9 ± 21.4 hours, the mean coma recovery time was 36.0 ± 17.0 hours, the parasitaemia reduced by 96.5% 48 hours after onset of treatment and haematocrit increased from 26.4% ± 6.7 initially to 33.7% ± 3.7 on day 28. Most children (95.9%) were completely cured, 2.0% died and there was no neurological deficit over 1 month follow-up. We recommend the generalisation of the protocol throughout the national territory in Cameroon and further training of health personnel to facilitate the utilisation of the protocol. Keywords: severe malaria, children, case management, WHO guidelines, evolution, outcome Clinics in Mother and Child Health Vol. 2(1) 2005: 247-25

Cost-efficacy of managing severe malaria in children in two district hospitals in Cameroon

Since efforts to eradicate malaria failed in the 1970's, sub-Saharan African countries have learned to live with malaria, which remains the main cause of morbidity and mortality in children less than 5 years old. There is increasing concern about the cost of health care, because of increasing poverty in the population. Our main aim was to determine the direct cost and efficacy of case-management of severe malaria following the current WHO guidelines in children aged 6 to 59 months. From January 1st to August 31st 2000, 148 children (aged 6 to 59 months, and who presented with at least one feature of severe malaria) were recruited by consecutive sampling, at Djoungolo and Mfou District Hospitals. Treatment according to WHO guidelines was implemented and there was rigorous in-patient monitoring and outpatient follow-up. There were 72 girls and 76 boys; the mean age was 23.1 ± 13.1 months and the commonest clinical forms of severe malaria were: generalised convulsions (54.7%), prostration (43.2%) and severe anaemia (14.9%). Most children (95.9%) were completely cured, 2.0% died and there were no neurological deficits over one month follow-up. We estimate the cost of hospital management of each episode of severe malaria at 26 000 – 36 000 F CFA and the overall direct costs (before and during hospitalisation) at 27 000 – 39 000 F CFA. We conclude that the current WHO guidelines are efficacious, but expensive as compared to the standard of living in Cameroon. Keywords: severe malaria, WHO guidelines, cost-efficacy, children, Cameroon Resume: L'Afrique subsaharienne vit avec le paludisme depuis l'échec des efforts de son éradication dans les années soixante-dix et les enfants en dessous de 5 ans d'âge paient le plus lourd tribut à ce fléau avec 3000 décès par jour. Avec l'appauvrissement continu des populations, on note une préoccupation croissante sur le coût des soins de santé. Notre but est de déterminer le coût direct de prise en charge du paludisme grave selon les recommandations actuelles de l'organisation mondiale de la santé (OMS). Du 1er janvier au 31 août 2000, 148 enfants âgés de 6 à 59 mois, présentant au moins un signe de paludisme grave sont recrutés par échantillonnage systématique dans les hôpitaux de district de Djoungolo et de Mfou. L'incidence du paludisme grave est de 21,1%, et l'age moyen de ces enfants est de 23,1 ± 13,1mois, parmi lesquels 72 filles et 76 garçons. Les formes cliniques du paludisme grave les plus fréquentes ont été les convulsions (54,7%), la prostration (43,2%) et l'anémie sévère (14,9%). Nous avons enregistré 95,9% de guérison complète et 2,0% de décès. Nous n'avons pas observé des séquelles neurologiques pendant un mois de suivie. Le coût de prise en charge hospitalier de chaque épisode de paludisme grave a varié de 26 000 à 36 000 F CFA et le coût direct global (avant et pendant l'hospitalisation) de 27 000 à 39 000 F CFA. Nous concluons que les recommandations actuelles de l'OMS sur la prise en charge du paludisme grave sont efficaces mais chères par rapport au niveau de vie des camerounais. Mots cles: paludisme grave, enfants, traitement, coût, efficacité, Cameroun Clinics in Mother and Child Health Vol. 2(1) 2005: 253-25