Managing acute malnutrition in infants aged less than six months: a qualitative assessment in Niger public hospitals

Quality management of severe acute malnutrition (SAM) in infants < 6 months of age is a key strategy within the “1000 days window of opportunity”. It prevents early child death, secures optimal growth and forms a foundation for full adulthood potentials. Most studies to date on management of SAM in infants relied on informants from Non-Governmental Organizations staff or government public health officials but little is known from hospital practitioners. From June to August 2013, a qualitative appraisal of hospital practitioners’ views on the current quality of care for malnourished infants was conducted in the eight main hospitals of Niger. These eight hospitals included two National Referral Hospitals (Lamordé and Zinder) and six Regional Referral Hospitals (Poudrière, Dosso, Tahoua, Maradi, Diffa and Agadez). Authorization for the review was given by the Ministry of Health of Niger. Health workers (HW) present during surveyors’ visits were included in the study. Two (2) specific objectives were considered: 1) Determine HW perceptions and current use of the Supplemental Suckling Technique (SST) and 2) Collect HW propositions on feasibility to organize outpatient treatment of SAM in infants less than six months. Self-designed interview guide was used. Data were analysed manually and saturation in the occurrence of responses were the criteria used to retain items. The Supplemental Suckling Technique (SST), though firmly recommended by national guidelines to ensure continuation of breastfeeding and adequate nutrients intake from supplemental milks especially in a small infant, was rarely used. Main reasons advanced by staff were work overload, inadequate training, and lack of compliance from mothers. Before being discharged from hospital, mothers were counseled on continuation of treatment, follow up visits at peripheral health center (PHC) and feeding options at home. However, hospital staff had no indication whether mothers were seen at the referred PHC, nor if counseling was practiced at home. The proposed outpatient treatment model for selected cases without medical complications should relieve hospital caseloads, strengthen referral and improve breastfeeding support to mothers after discharge from hospital.Keywords: Malnutrition, infant feeding, inpatient treatment, qualitative assessment, Nige

Composition de la poudre des feuilles sèches de moringa oleifera dans trois régions du Niger

In Niger, the acute and chronic malnutrition constitutes a public health problem among children aged from six to fifty-nine months. The use of local foods was identified in the national protocol of malnutrition management as an alternative for ready to use therapeutic foods that are currently used. Among these local foods, the powder of dried leaves of Moringa oleifera was analyzed in order to know the composition of the powder of dried leaves of Moringa oleifera produced in Niger compared to the available data. To achieve this, four samples from the three main Moringa production regions in Niger namely Tillabéri, Niamey both located in the river basin and southern Maradi of the Sahel-Sudanese zone, were analyzed. The chromatographic analysis hasbeen made in the laboratory of the International Crops Research Institute for the Semi- Arid Tropics. The nitrogen extraction technique was done using H2SO4 digestion + salicylic acid + H2O2 and selenium. It was measured using the calorimetry auto analyzer, based the Bertholet reaction. Total phosphorous, iron, zinc, potassium, calcium, magnesium, sodium and copper was also extracted, using the same method. Phosphorus was measured by calorimetry using the method of molybdo-phosphate reduced to ascorbic acid. The other elements were measured using atomic spectroscopy absorption. The results correspond to the average of two parallel tests. Five standards enabled to make the calibration and a control sample was analyzed in the same conditions. The test is valid if the regression is about 0,9950 - 0,9999. The powder of dried leaves of Moringa produced in Niger turned out be rich in proteins with an average of 24, 8 % (Confidence Interval at 95%: 19, 34-30, 24) with values going from 21,58% in Tillabéri to 28,72% in Niamey and in micronutrients. According to regions, the composition varies for iron between 51,9 and 55,12 mg/100g, 0,45 and 1,58 mg/100g for zinc, 1192,5and 1957,5 mg/100g for calcium, 414,37 and 714,37 mg/100g for magnesium,1587 and 2037 mg/100g for potassium, 207,75 and 326,25 mg/100g for sodium, 32 and 61 mg/100g for phosphorus. These results are close to those revealed by earlier studies.Key words: Moringa oleifera, composition, powder, dry, leaves, different, regions, Nige

Diarrhea is a Major killer of Children with Severe Acute Malnutrition Admitted to Inpatient Set-up in Lusaka, Zambia

<p>Abstract</p> <p>Introduction</p> <p>Mortality of children with Severe Acute Malnutrition (SAM) in inpatient set-ups in sub-Saharan Africa still remains unacceptably high. We investigated the prevalence and effect of diarrhea and HIV infection on inpatient treatment outcome of children with complicated SAM receiving treatment in inpatient units.</p> <p>Method</p> <p>A cohort of 430 children aged 6-59 months old with complicated SAM admitted to Zambia University Teaching Hospital's stabilization centre from August to December 2009 were followed. Data on nutritional status, socio-demographic factors, and admission medical conditions were collected up on enrollment. T-test and chi-square tests were used to compare difference in mean or percentage values. Logistic regression was used to assess risk of mortality by admission characteristics.</p> <p>Results</p> <p>Majority, 55.3% (238/430) were boys. The median age of the cohort was 17 months (inter-quartile range, IQR 12-22). Among the children, 68.9% (295/428) had edema at admission. The majority of the children, 67.3% (261/388), presented with diarrhea; 38.9% (162/420) tested HIV positive; and 40.5% (174/430) of the children died. The median Length of stay of the cohort was 9 days (IQR, 5-14 days); 30.6% (53/173) of the death occurred within 48 hours of admission. Children with diarrhea on admission had two and half times higher odds of mortality than those without diarrhea; Adjusted OR = 2.5 (95% CI 1.50-4.09, P < 0.001). The odds of mortality for children with HIV infection was higher than children without HIV infection; Adjusted OR = 1.6 (95% CI 0.99-2.48 P = 0.5).</p> <p>Conclusion</p> <p>Diarrhea is a major cause of complication in children with severe acute malnutrition. Under the current standard management approach, diarrhea in children with SAM was found to increase their odds of death substantially irrespective of other factors.</p

Clinical disorders affecting mesopic vision

Vision in the mesopic range is affected by a number of inherited and acquired clinical disorders. We review these conditions and summarize the historical background, describing the clinical characteristics alongside the genetic basis and molecular biological mechanisms giving rise to rod and cone dysfunction relevant to twilight vision. The current diagnostic gold standards for each disease are discussed and curative and symptomatic treatment strategies are summarized

Definition and characterization of localised meningitis epidemics in Burkina Faso: a longitudinal retrospective study

<p>Abstract</p> <p>Background</p> <p>The epidemiology of meningococcal meningitis in the African meningitis belt is characterised by seasonality, localised epidemics and epidemic waves. To facilitate research and surveillance, we aimed to develop a definition for localised epidemics to be used in real-time surveillance based on weekly case reports at the health centre level.</p> <p>Methods</p> <p>We used national routine surveillance data on suspected meningitis from January 2004 to December 2008 in six health districts in western and central Burkina Faso. We evaluated eight thresholds composed of weekly incidence rates at health centre level for their performance in predicting annual incidences of 0.4%and 0.8% in health centre areas. The eventually chosen definition was used to describe the spatiotemporal epidemiology and size of localised meningitis epidemics during the included district years.</p> <p>Results</p> <p>Among eight weekly thresholds evaluated, a weekly incidence rate of 75 cases per 100,000 inhabitants during at least two consecutive weeks with at least 5 cases per week had 100% sensitivity and 98% specificity for predicting an annual incidence of at least 0.8% in health centres. Using this definition, localised epidemics were identified in all but one years during 2004-2008, concerned less than 10% of the districts' population and often were geographically dispersed. Where sufficient laboratory data were available, localised epidemics were exclusively due to meningococci.</p> <p>Conclusions</p> <p>This definition of localised epidemics a the health centre level will be useful for risk factor and modelling studies to understand the meningitis belt phenomenon and help documenting vaccine impact against epidemic meningitis where no widespread laboratory surveillance exists for quantifying disease reduction after vaccination.</p

The effectiveness of community volunteers in counting populations and assessing their nutritional vulnerability during armed conflict: district health in D.R. Congo, Central Africa

The study assessed the ability of community volunteers, working with district health officials, to conduct a local census to count the population in their villages and assess their nutritional vulnerability. The study involved organizing community volunteers in village nutrition committee and assigning them to count the village population in a Kivu rural health district (D.R.Congo) and assess their vulnerability in terms of nutrition. The study took place in March and April 2003, during armed conflict in the region. Community volunteers supervised by district health officials collected data, presented here as median proportions (with their Max and Min), by age category. The results show that community volunteers were able to conduct this census with reliable results. The population distribution by age category was similar to the national model from a survey by experts. The community volunteers estimated a median of 22.2 % (6.2-100 %) of households in each village in the eastern DR Congo were vulnerable and required foreign aid. Community volunteers can contribute accurately to the collection of demographic data to be used in health programme planning, thus allowing these data to be followed even during instability and armed conflicts.Objectif : Evaluer la capacité des relais communautaires opérant dans le domaine de la nutrition à contribuer au dénombrement de la population de leurs villages respectifs sous la coordination du district sanitaire. Méthodologie : Une étude quasi expérimentale, consistant à organiser les relais communautaires en comités villageois de nutrition et à les responsabiliser dans le dénombrement de la population de leurs villages respectifs, a été mise sur pied dans un district sanitaire rural du Kivu (RD Congo). L’étude a été réalisée de mars à avril 2003 dans une situation de conflit armé. La collecte des données de la population a été assuée par les relais communautaires. Les médianes (minimum et maximum) des proportions observées par catégories d’âge ont été présentées. Résultats : Les relais ont été capables de faire un dénombrement de la population avec des résultats fiables. Les proportions de la population par catégorie d’âge observées se sont révélées similaires à celles du modèle national issu d’une enquête réalisée par des experts. Pour les relais communautaires, un pourcentage médian de 22,2 % (6,2-100 %) des ménages par village a été considéré comme vulnérables dans le contexte de l’Est de la RD Congo, nécessitant par conséquent une aide extérieure. Conclusion : Les relais communautaires peuvent contribuer à la récolte de données démographiques fiables pouvant permettre de planifier des programmes de santé publique, et le suivi de l’évolution démographique même dans une situation d’instabilité et de conflit armé

Clinical aspects and outcome of suspected severe pediatric malaria

Objective: The authors had for aim to evaluate diagnosis and treatment practices applied to children with clinically suspected severe malaria, in two referral hospitals of Kisangani. Patients and methods: A prospective study was carried out between January 1, 2010 and February 28, 2011 including all children admitted for clinically suspected severe malaria, with at least one of the WHO severity criteria. Results: One thousand one hundred and fifty-four children were admitted in the two hospitals, 427 (37.0%, n=. 1.154) for clinically suspected severe malaria: 155 (36.3%, n=. 427) had a positive thick drop examination (TDE), 198 (46.4%, n=. 427) a negative one, and 74 (17.3%, n=. 427) without thick blood smear examination. Prostration (48.0%) and anemia (40.3%) were the most common severity criteria, while 14.5% and 9.8% presented with convulsions and impaired consciousness respectively. The etiological treatment was quinine infusion. The case specific fatality rate was 19.4% (. n=. 427), 7.7% (. n=. 155) in confirmed cases, 9.6% (. n=. 198) in patients with negative thick blood smear, and 70.3% (. n=. 74) in patients without any TDE (. P <. 0.001). Conclusion: Poor technical support and inadequate organization of the patient circuit can result in underestimating the metabolic complications of severe malaria and of other severe infections of early childhood. This is detrimental to the patients, even when effective drugs are available. © 2012 .SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Serum albumin concentration, arm circumference, and oedema and subsequent risk of dying in children in central Africa.

OBJECTIVE--To measure the prognostic value of clinical, anthropometric, and biological indicators of protein energy malnutrition in hospitalised children. DESIGN--Hospital based follow up study from admission to discharge or death of a cohort of children. SETTING-Paediatric hospital in Zaire. SUBJECTS--1129 children consecutively admitted between August 1986 and October 1988. MAIN OUTCOME MEASURES--Height, weight, arm circumference, skinfold thicknesses, serum albumin concentration, and mortality. RESULTS--Mortality was higher in wasted children and in those with a mid-upper arm circumference < 125 mm, a serum albumin concentration < 16 g/l, and oedema. After multivariate analysis, serum albumin concentration was the best predictor of subsequent risk of dying. Mid-upper arm circumference and oedema, however, still contributed considerably to evaluation of mortality. CONCLUSIONS--In this specific environment of central Africa an isolated clinical sign such as oedema is not enough to detect children with a high risk of dying among those admitted to paediatric wards with severe protein energy malnutrition. Measurement of additional indicators such as arm circumference and serum albumin concentration seems to be of crucial importance