Epidemiological and bacteriological profile of neonatal bacterial infections seen in hospital pediatric in Antananarivo

Background: Neonatal bacterial infection is one of the leading causes of new-born morbidity and mortality. Bacterial ecology is not known in our unit, no study has been devoted to this subject. This work aimed to determine the germs responsible for neonatal bacterial infections and their level of sensitivity to the usual antibiotics.Methods: This is a retrospective descriptive study conducted in the Neonatology Department from January 1, 2018 to April 30, 2019 (16 months) including all newborns under 29 days hospitalized during the study period and possessing positive bacteriological results regardless of the site of collection (blood, urine, cerebrospinal fluid).Results: The diagnosis of neonatal infection was confirmed in 47 cases, i.e. 26.1% of suspicions of neonatal bacterial infection hospitalized during the study period. The female predominance was found with a sex ratio of 0.81. The most frequently isolated germs are, in order of frequency, coagulase-negative staphylococci (10 cases), Escherichia coli (7 cases), Enterobacter cloacae (5 cases), Klebsiella pneumoniae (5 cases) and Enterobacter aerogenes (5 cases). Of the 47 cases studied, 16 cases were multidrug-resistant infections including 7 cases i.e. 14.9% of nosocomial infections. The majority of Enterobacteria are strains producing broad spectrum beta lactamases (12 cases to 22). The molecules that remained effective were mainly Imipenem and Amikacin.Conclusions: Neonatal infection remains a real public health problem. The emergence of multi-resistant bacteria complicates the management. The knowledge of bacterial ecology on a wider population is an important asset in its prevention and management

Epidemio-clinical aspects of congenital rubella syndrome in Madagascar

Background: Congenital rubella syndrome is the first congenital defect preventable by vaccination. The purpose of this study was to provide basic information on the extent and epidemiology of congenital rubella syndrome in Madagascar.Methods: A retrospective and descriptive study from January 2013 to May 2019 was conducted in 8 hospitals in 2 provinces of Madagascar, Antananarivo and Toliara. The study included children who attended the services selected during the study period and who had the following conditions: children aged of 0 to 59 months, regardless of vaccination status, meeting the World Health Organization clinical criteria for congenital rubella syndrome with or without biological confirmation.Results: Of the 152,304 cases of children of all ages who visited or were hospitalized during the study period, 112 clinically confirmed cases of congenital rubella syndrome were identified. The age group 0 to 11 months involved 60 children (53.6%). Congenital heart disease was found in 83.0% of cases, mental backwardness in 43.7% and microcephaly in 26.8%. Twenty-three among (20.5%) them died. The death was due to cardiac diseases in 16 children.Conclusions: Findings confirm that the diagnosis of congenital rubella syndrome is underestimated in current pediatric practice in Madagascar. The introduction of the rubella vaccine in the Expanded Program on Immunization and the implementation of an effective and sustainable surveillance system for congenital rubella syndrome in the country is a proved effective tool for the prevention of this disease

Knowledge, attitude, and practice of care providers about congenital rubella syndrome

Background: Behaviour of healthcare providers when facing an illness is an important part of their struggle. The aim of this study was to assess the level of knowledge, the attitude and the practice of health care providers regarding to the Congenital Rubella Syndrome.Methods: Authors did a descriptive study on the knowledge, the attitude and the practice of healthcare providers about Congenital Rubella Syndrome with 161 healthcare providers working in 8 hospitals in Madagascar. A self-introduced survey was used to collect the data.Results: There were 87% of all healthcare providers included in the study, who said that rubella in the first trimester of pregnancy was the cause of this syndrome for child, 87% knew at least 2 of the 3 major signs of Congenital Rubella Syndrome and more than 80% had a good knowledge of the criteria for diagnosing cases (suspected, clinically confirmed, laboratory confirmed). The referral to a hospital or to a specialist was the most proposed for the management of the case of Congenital Rubella Syndrome. The prescription of an IgG avidity for rubella and advising abortion were the main propositions for mothers having a positive test at the first trimester of pregnancy.Conclusions: A fairly satisfactory level of knowledge of healthcare providers was noted

Randomized clinical trial of artemisinin versus non-artemisinin combination therapy for uncomplicated falciparum malaria in Madagascar

<p>Abstract</p> <p>Background</p> <p>Data concerning antimalarial combination treatment for uncomplicated malaria in Madagascar are largely lacking. Randomized clinical trial was designed to assess therapeutic efficacies of chloroquine (CQ), amodiaquine (AQ), sulphadoxine-pyrimethamine (SP), amodiaquine plus sulphadoxine-pyrimethamine combination (AQ+SP) and artesunate plus amodiaquine combination (AQ+AS).</p> <p>Methods</p> <p>287 children between 6 months and 15 years of age, with uncomplicated falciparum malaria, were enrolled in the study. Primary endpoints were the day-14 and day-28 risks of parasitological failure, either unadjusted or adjusted by genotyping.</p> <p>Results</p> <p>All treatment regimens, except for CQ treatment, gave clinical cure rates above 97% by day-14 and 92% by day-28 (PCR-corrected). AQ+SP was as effective as AQ+AS. The risk of new infection within the month after therapy was generally higher for AQ+AS than AQ+SP.</p> <p>Conclusion</p> <p>These findings show that the inexpensive and widely available combination AQ+SP may be valuable in for the treatment of uncomplicated malaria in Madagascar and could have an important role in this country, where much of the drugs administered go to patients who do not have malaria.</p

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa