Troubles socio-émotionnels de l’enfant en milieu Konzo, un syndrome paralytique de nature épidémique associé à une intoxication cyanhydrique d’origine alimentaire en Afrique sub-saharienne

Introduction: l’objectif de cette étude était d’élucider le profil socio-émotionnel de l’enfant en milieu Konzo, une paralysie toxico-nutritionnelle sévissant en Afrique sub-saharienne. Méthodes: nous avons évalué le profil socio-émotionnel de 210 enfants dont 123 avec konzo et 87 présumés contrôles sains (4-17 ans d’âge) après interview structuré avec les parents lors d’une enquête épidémio-clinique du konzo en 2011 au Congo-Kinshasa. Le profil neurocognitif était documenté par le KABC-II, le BOT-2 et l’indice global des signes neurologiques du Konzo (IGSNK). Les tests associatifs ont été réalisés par le test de Chi-carré, la régression logistique, dans le cas échéant par modèle linéaire généralisé, au seuil de signification de 0,05. Résultats: dans l’ensemble, l’irritabilité, la violence physique ou l’inhibition avec ou sans tristesse étaient respectivement retrouvés dans 46,0%, 30,2%, 18,7%; avec un risque accru pour le Konzo (OR = 2,6; IC95%: 1,4 - 4,8; p = 0,001). Le trouble socio-émotionnel était associé à l’insuffisance pondérale (OR: 0,49; IC95%: 0,31 - 0,78; p = 0,002) et à un IGSNK élevé (OR: 1,33; IC 95%: 1,1-1,63; p=0,019); et par ailleurs aggravait les déficits cognitifs dans le Konzo (interaction statut neurologique χ troubles socio-émotionnels, D = 6,297; p = 0,013). Des performances cognitives élevées étaient observées chez les enfants non-Konzo mais avec troubles socio-émotionnels. La concentration moyenne (écart-type ± ET) de thiocyanate urinaire était plus élevé (554,8 ± 371,6 µmol/l) chez les enfants Konzo avec troubles socio-émotionnels. Conclusion: l’enfant vivant en milieu Konzo présente des troubles socio-émotionnels. Leur nature psychopathologique et l’impact sur la cognition nécessitent des études approfondies

Comparison of major depression diagnostic classification probability using the SCID, CIDI, and MINI diagnostic interviews among women in pregnancy or postpartum: An individual participant data meta‐analysis

OBJECTIVES: A previous individual participant data meta-analysis (IPDMA) identified differences in major depression classification rates between different diagnostic interviews, controlling for depressive symptoms on the basis of the Patient Health Questionnaire-9. We aimed to determine whether similar results would be seen in a different population, using studies that administered the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy or postpartum. METHODS: Data accrued for an EPDS diagnostic accuracy IPDMA were analysed. Binomial generalised linear mixed models were fit to compare depression classification odds for the Mini International Neuropsychiatric Interview (MINI), Composite International Diagnostic Interview (CIDI), and Structured Clinical Interview for DSM (SCID), controlling for EPDS scores and participant characteristics. RESULTS: Among fully structured interviews, the MINI (15 studies, 2,532 participants, 342 major depression cases) classified depression more often than the CIDI (3 studies, 2,948 participants, 194 major depression cases; adjusted odds ratio [aOR] = 3.72, 95% confidence interval [CI] [1.21, 11.43]). Compared with the semistructured SCID (28 studies, 7,403 participants, 1,027 major depression cases), odds with the CIDI (interaction aOR = 0.88, 95% CI [0.85, 0.92]) and MINI (interaction aOR = 0.95, 95% CI [0.92, 0.99]) increased less as EPDS scores increased. CONCLUSION: Different interviews may not classify major depression equivalently

Affects de la mère pendant la grossesse, relation mère-bébé, santé et développement du nourrisson à Kinshasa

Introduction: le rôle de l´affectivité maternelle prénatale dans le développement du nourrisson est peu documenté dans notre milieu. L´objectif de cette étude était de déterminer les liens entre les sentiments de la mère à la connaissance de la grossesse, la peur de l´accouchement, la relation mère-bébé et le développement du nourrisson. Méthodes: en consultations préscolaires à Kinshasa, 120 mères âgées de 28,4 ans (± 12,18 ans), portant des bébés de 1 à 10 mois, ont participé à une étude transversale, par entretien et questionnaire, sur la relation mère-bébé, le comportement, la santé et le développement du bébé et l´affectivité maternelle. Les échelles de dépression maternelle postnatale d´Edimbourg (l´EPDS), de dépression et anxiété de Goldberg et les critères DSM-IV de dépression ont été utilisées. Il y a eu recours aux tests de Khi-carré et Mann-Whitney dans l´analyse statistique. Résultats: l´absence de joie relative à la grossesse était associée à la grossesse non désirée (p<0,001) , l´absence du soutien du père de l´enfant (p=0,011), l´ennui au portage du bébé frustré (p=0,046), la conso labilité difficile du bébé (p<0,001), le comportement non affiliatif du bébé né d´une grossesse désirée (p=0 ,034), la santé infantile moins bonne (p=0 ,010) et la dépression maternelle (EPDS) (p=0,043). La peur de l´accouchement était associée au déficit de réponses aux signaux du bébé (p=0 ,002) et la tension au portage du bébé frustré (p=0,02). Conclusion: les affects négatifs pendant la grossesse prédiraient des troubles de la relation mère-bébé, de la santé et du développement du nourrisson

Short term outcome of seizures associated with fever in children in primary health care in Kinshasa

peer reviewedRESUME 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.ABSTRACT Background The immediate prognosis of febrile convulsions is a subject of importance to both clinicians and families. Aim Our study aims to analyse the factors that establish the clinical course in the first 24 hours in children admitted with febrile convulsion Methods 148 children, aged between 5 and 71 months, were prospectively enrolled at their admission for febrile convulsions in two paediatric reference centres in Kinshasa between 10th February and 10th May, 2008. The clinical course over 24 hours was documented and analysed with regard to the clinical features of the initial crisis. Results: 80% of children were less than 3 years old. Based on the clinical presentations, 8 subgroups were distinguished. The 2 groups characterized by the absence (Group 1) or presence (Group 8) of the three identified prognostic factors had significantly different clinical courses over 24 hours (p<0.05). Group 8 contained children with the worst clinical course, characterised by seizure recurrence, neurological deficits and death. Focal type seizures, prolonged seizures and recurrent seizures were all associated with a worse outcome on univariate analysis, but on multivariate analysis, only recurrent seizures predicted a significantly worse prognosis (OR 4.4, CI 2.0-9.6). Conclusion Febrile convulsions present with different clinical characteristics and these have short term prognostic value. Regardless of the underlying cause, recognition of these poor prognostic factors should allow the establishment of appropriate surveillance and preventative treatment measures

SHORT TERM OUTCOME OF SEIZURES ASSOCIATED WITH FEVER IN CHILDREN IN PRIMARY HEALTH CARE IN 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 approprié

Prevalence and comorbidities of autism among children referred to the outpatient clinics for neurodevelopmental disorders

Autism spectrum disorders (ASD) is a neurodevelopmental disorder that has been rarely diagnosed in Sub-Saharan Africa. Although a proportion of children do present features of ASD in the Democratic Republic of Congo (DRC), little is known about it prevalence. Often, the co-morbidities constitute the upfront symptoms and therefore may it recognition and management difficult, aggravating as such the prognosis. The present study therefore aimed at studying the clinical profile of autism spectrum disorder (ASD) and the associated morbidities among children and adolescents in outpatient clinics in Kinshasa, the Democratic Republic of Congo.status: publishe

Lead exposure and early child neurodevelopment among children 12–24 months in Kinshasa, the Democratic Republic of Congo

Childhood lead exposure remains a problem in developing countries, and little is known about its effects on early child neurodevelopment and temperament in the Democratic Republic of Congo (DRC). We, therefore, conducted this study to determine the association between lead exposure and the neurodevelopment and behaviour of children aged 12–24 months in Kinshasa, DRC. A cross-sectional study was conducted between February and June 2012, and parents of 104 children were invited to participate. Blood lead levels (BLLs) of each child were tested using the flame atomic spectrophotometry method. All children were subject to a clinical examination and assessed with two selected early child neurodevelopmental tools, the Gensini–Gavito and the baby characteristics questionnaire, to measure their neurodevelopment and temperament. Detectable BLLs ranged from 1 to 30 μg/dl with a geometric mean of 6.9 (SD 4.8) μg/dl. BLLs at 5–9 and ≥10 μg/dl were significantly associated with the child temperament (p <0.05). Perinatal and maternal factors did not seem to affect early child neurodevelopment and temperament. Children exposed to lead were reported with more temperament difficulties at even blood lead levels <10 μg/dl, suggesting the need for preventive and intervention measures to reduce lead exposure among children in Kinshasa, DRC

Prevalence and comorbidities of autism among children referred to the outpatient clinics for neurodevelopmental disorders

Introduction: autism spectrum disorders (ASD) is a neurodevelopmental disorder that has been rarely diagnosed in Sub-Saharan Africa. Although a proportion of children do present features of ASD in the Democratic Republic of Congo (DRC), little is known about it prevalence. Often, the co-morbidities constitute the upfront symptoms and therefore may it recognition and management difficult, aggravating as such the prognosis. The present study therefore aimed at studying the clinical profile of autism spectrum disorder (ASD) and the associated morbidities among children and adolescents in outpatient clinics in Kinshasa, the Democratic Republic of Congo. Methods: we conducted a cross sectional study in the three outpatients centers receiving patients referred for neurodevelopmental disorders in Kinshasa, DRC, from June 2008 to June 2010. A total of 450 subjects aged from 1-18 years old were referred and included in the study. The clinical diagnosis for ASD was made using the DSM-IV-R and the ADIR. Co-morbidities were identified using DSM-IV-R criteria together with an extensive clinical interview and observation. All patients were subject to an intellectual quotient evaluation and an electroencephalogram reporting. Results: of the 450 subjects referred, 120 (29.3%) received the diagnosis of ASD, with boys outnumbering girls (OR 3:1. The mean age was 7.9 years (SD 3.4) (p&lt; 0.001). Intellectual disability (75.83 %) and epilepsy (72.50%) were the main co-morbidities significantly associated with autism (p&lt; 0.001). It was also found that co-morbidities were most frequent in subjects with an IQ&lt;70 (p=0.05). Conclusion: ASD is frequent among patients referred for neurodevelopmental disorders in the three outpatients’ centers for neurodevelopmental disorders in Kinshasa. Males seem to be more affected than female. The main co-morbidities were epilepsy and intellectual disabilities. Our findings suggest that it is important to screen for ASD and co-morbidities among all subjects referred for neurodevelopmental disorders and to undertake survey on ASD in various structures of rejected children from the society in Kinshasa DRC. This will help to identify and manage ASD and associated co-morbidities at an early stage for a better prognosis.The Pan African Medical Journal 2016;2

Comparison of major depression diagnostic classification probability using the SCID, CIDI, and MINI diagnostic interviews among women in pregnancy or postpartum: An individual participant data meta-analysis

Objectives A previous individual participant data meta-analysis (IPDMA) identified differences in major depression classification rates between different diagnostic interviews, controlling for depressive symptoms on the basis of the Patient Health Questionnaire-9. We aimed to determine whether similar results would be seen in a different population, using studies that administered the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy or postpartum. Methods Data accrued for an EPDS diagnostic accuracy IPDMA were analysed. Binomial generalised linear mixed models were fit to compare depression classification odds for the Mini International Neuropsychiatric Interview (MINI), Composite International Diagnostic Interview (CIDI), and Structured Clinical Interview for DSM (SCID), controlling for EPDS scores and participant characteristics. Results Among fully structured interviews, the MINI (15 studies, 2,532 participants, 342 major depression cases) classified depression more often than the CIDI (3 studies, 2,948 participants, 194 major depression cases; adjusted odds ratio [aOR] = 3.72, 95% confidence interval [CI] [1.21, 11.43]). Compared with the semistructured SCID (28 studies, 7,403 participants, 1,027 major depression cases), odds with the CIDI (interaction aOR = 0.88, 95% CI [0.85, 0.92]) and MINI (interaction aOR = 0.95, 95% CI [0.92, 0.99]) increased less as EPDS scores increased. Conclusion Different interviews may not classify major depression equivalently

Probability of major depression classification based on the SCID, CIDI, and MINI diagnostic interviews: A synthesis of three individual participant data meta-analyses

Introduction: Three previous individual participant data meta-analyses (IPDMAs) reported that, compared to the Structured Clinical Interview for the DSM (SCID), alternative reference standards, primarily the Composite International Diagnostic Interview (CIDI) and the Mini International Neuropsychiatric Interview (MINI), tended to misclassify major depression status, when controlling for depression symptom severity. However, there was an important lack of precision in the results. Objective: To compare the odds of the major depression classification based on the SCID, CIDI, and MINI. Methods: We included and standardized data from 3 IPDMA databases. For each IPDMA, separately, we fitted binomial generalized linear mixed models to compare the adjusted odds ratios (aORs) of major depression classification, controlling for symptom severity and characteristics of participants, and the interaction between interview and symptom severity. Next, we synthesized results using a DerSimonian-Laird random-effects meta-analysis. Results: In total, 69,405 participants (7,574 [11%] with major depression) from 212 studies were included. Controlling for symptom severity and participant characteristics, the MINI (74 studies; 25,749 participants) classified major depression more often than the SCID (108 studies; 21,953 participants; aOR 1.46; 95% confidence interval [CI] 1.11-1.92]). Classification odds for the CIDI (30 studies; 21,703 participants) and the SCID did not differ overall (aOR 1.19; 95% CI 0.79-1.75); however, as screening scores increased, the aOR increased less for the CIDI than the SCID (interaction aOR 0.64; 95% CI 0.52-0.80). Conclusions: Compared to the SCID, the MINI classified major depression more often. The odds of the depression classification with the CIDI increased less as symptom levels increased. Interpretation of research that uses diagnostic interviews to classify depression should consider the interview characteristics.</p