Feasibility of Early Infant Diagnosis of HIV in Resource-Limited Settings: The ANRS 12140-PEDIACAM Study in Cameroon

BACKGROUND: Early infant diagnosis (EID) of HIV is a key-point for the implementation of early HAART, associated with lower mortality in HIV-infected infants. We evaluated the EID process of HIV according to national recommendations, in urban areas of Cameroon. METHODS/FINDINGS: The ANRS12140-PEDIACAM study is a multisite cohort in which infants born to HIV-infected mothers were included before the 8(th) day of life and followed. Collection of samples for HIV DNA/RNA-PCR was planned at 6 weeks together with routine vaccination. The HIV test result was expected to be available at 10 weeks. A positive or indeterminate test result was confirmed by a second test on a different sample. Systematic HAART was offered to HIV-infected infants identified. The EID process was considered complete if infants were tested and HIV results provided to mothers/family before 7 months of age. During 2007-2009, 1587 mother-infant pairs were included in three referral hospitals; most infants (n = 1423, 89.7%) were tested for HIV, at a median age of 1.5 months (IQR, 1.4-1.6). Among them, 51 (3.6%) were HIV-infected. Overall, 1331 (83.9%) completed the process by returning for the result before 7 months (median age: 2.5 months (IQR, 2.4-3.0)). Incomplete process, that is test not performed, or result of test not provided or provided late to the family, was independently associated with late HIV diagnosis during pregnancy (adjusted odds ratio (aOR) = 1.8, 95%CI: 1.1 to 2.9, p = 0.01), absence of PMTCT prophylaxis (aOR = 2.4, 95%CI: 1.4 to 4.3, p = 0.002), and emergency caesarean section (aOR = 2.5, 95%CI: 1.5 to 4.3, p = 0.001). CONCLUSIONS: In urban areas of Cameroon, HIV-infected women diagnosed sufficiently early during pregnancy opt to benefit from EID whatever their socio-economic, marital or disclosure status. Reduction of non optimal diagnosis process should focus on women with late HIV diagnosis during pregnancy especially if they did not receive any PMTCT, or if complications occurred at delivery

Épilepsie et natation en piscine privée dans les pays en voie de développement, une pratique à haut risque vital : une observation clinique: Epilepsy and swimming in private pool in developing countries, a high risk life practice: a case report

Epilepsy is a chronic disease of the brain that affects all segments of the population around the world. It is characterized by recurrent seizures manifested by brief episodes of involuntary tremors affecting one part of the body or the whole body. These seizures are the result of excessive electrical discharges from a neuronal population. According to the World Health Organization, 50 million people are currently living with epilepsy worldwide. Almost 80 % of people with epilepsy live in low-income countries The management of this pathology remains difficult in sub-Saharan Africa for various reasons Sports activities, including swimming, are said to be beneficial in children and adolescents with epilepsy. But the practice of these activities is not without vital risk, it must be regulated accordingto the socio-economic, cultural and medical environment We report here a case of drowning in a 10-year-old adolescent girl, epileptic since earlychildhood and who takes depakine as a background treatment She was drowned while  swimming in a private pool, following an epileptic seizure. The interest of this presentation is tounderline the need to formulate recommendations adapted to sub-Saharan Africa concerning the practice of certain sports activities, such as swimming in a private pool for adolescents with epilepsy. The second objective is to highlight the importance of the chain of survival in the event of drowning, as a guarantee of the vital prognosis. L’épilepsie est une affection chronique du cerveau qui touche toutes les tranches de la population dans le monde Selon l’organisation mondiale de la santé, 50 millions de personnes vivent actuellement avec l’épilepsie dans le monde, près de 80% de personnes souffrant d’épilepsie vivent dans les pays à revenu faible. Sa prise en charge demeure laborieuse en Afrique subsaharienne (ASS). Les activités sportives, parmi lesquelles la natation, seraient  bénéfiques chez les adolescents épileptiques. Mais la pratique de ces activités n’est pas dénuée de risque vital, elle doit être régulée en fonction du contexte socio-economique, culturel et de l’environnement médical. Nous rapportons un cas de noyade chez une adolescente, épileptique depuis la tendre enfance et qui prend la dépakine en traitement de fond Elle a été victime de noyade en piscine privée, à la suite d’une crise d’épilepsie L’intérêt de cette présentation est de souligner la nécessité de formuler des recommandations adaptées à l’ASS au sujet de la pratique de certaines activités sportives à risque, comme la natation en piscine privée pour les adolescents épileptiques Le second objectif est de relever l’importance de la chaine de survie en cas de noyade, comme gage du pronostic vital