Paediatric endocrine disorders as seen at the University of Benin Teaching Hospital over a ten-year period

Background: In most developing countries, data on the prevalence and distribution of paediatric endocrine disorders is lacking.Objective: To describe the pattern of endocrine disorders seen in the Department of Child Health, University of Benin Teaching Hospital (UBTH), Benin City, Nigeria between 2004 to 2013.Methods: In this retrospective study, the case files of children seen in the paediatric endocrinemetabolic clinic and those admitted into the wards at the UBTH, Benin City from January, 2004 to December, 2013 were audited.Information obtained included age at presentation, gender, principal complaints, and final diagnosis. For those who were admitted, theoutcome was noted. The hospital’s paediatric clinic register was examined to obtain the total number of new cases seen during the period under review.Results: A total of 13,735 new cases were seen in the Department of Child Health, UBTH during the ten-year period under review and 99 (0.72%) of these had endocrine disorders. The frequencies of the four leading groups of endocrine disorders seen were as follows: diabetes mellitus 17.2%; disorders  of sex development 13.8%; disorders of the thyroid gland  12.1%; and disorders of energy balance 11.2%. Short stature was a rarepresenting complaint.Conclusion: Diabetes mellitus and disorders involving sex development,thyroid gland, energy balance and pubertal development were the five leading groups of childhood endocrine disorders encountered in our clinical practice in UBTH.Key words: endocrine disorders, clinical pattern, children, hospital, Nigeria

Hypoglycaemia at point of hospital admission of under-five children with acute diarrhoea: Prevalence and risk factors

Background: Hypoglycaemia is one of life-threatening immediate  complications of acute diarrhoea among under-five children but its diagnosis may be overlooked because all the symptoms may be mimicked by severe dehydration.Objective: To determine the prevalence of hypoglycaemia at the point of hospital admission of under-five children with acute diarrhoea and identify some of the risk factors.Methods: At the point of hospital admission, venous blood sample was collected into an appropriate sample bottle (fluoride-oxalate bottle) from 201 under-five children with acute diarrhoea for blood glucose  determination. The blood samples were analysed using the glucose-oxidase method. One of the authors administered a questionnaire to each of the caregiver to obtain information on the socio-demographic  characteristics and the clinical profile (e.g., presence or absence of vomiting, duration of acute diarrhoea, time of last meal of the patients, and administration of ORS at home. Hypoglycaemia was defined asblood glucose value below 2.6 mmol/L.Results: At the point of hospital admission, 7.7% (14 of 183; CI =3.7-11.7) under-five children with acute diarrhoea had hypoglycaemia(blood glucose < 2.6 mmol/L) but dropped to 4.9% (CI=2.9-6.9)when a cutoff point of < 2.2 mmol/L was applied. The risk factors forhypoglycaemia were the presence of severe dehydration (p<0.001),hypernatraemia and acidosis (p<0.001). The prevalence of hypoglycaemia was 7 times higher in children whose time of last meal was . 8 hours compared with their counterparts whose time of last meal was < 8 hours. Mortality rate was significantly higher in children with acute diarrhoea and hypoglycaemia compared with their counterparts with normoglycaemia(p<0.01).Conclusion: In acute diarrhea, hypoglycaemia is an important comorbidityamong children aged below 36 months and the significant associated risk factors for hypoglycaemia are severe dehydration, hypernatraemia andacidosis. Under-five children presenting with acute diarrhoea and hypoglycaemia at point of hospitalization are at a significantly greater risk of death.Key words: Acute diarrhoea, hypoglycaemia, hypernatraemia

Step-wedge cluster-randomised community-based trials: An application to the study of the impact of community health insurance

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.BACKGROUND: We describe a step-wedge cluster-randomised community-based trial which has been conducted since 2003 to accompany the implementation of a community health insurance (CHI) scheme in West Africa. The trial aims at overcoming the paucity of evidence-based information on the impact of CHI. Impact is defined in terms of changes in health service utilisation and household protection against the cost of illness. Our exclusive focus on the description and discussion of the methods is justified by the fact that the study relies on a methodology previously applied in the field of disease control, but never in the field of health financing. METHODS: First, we clarify how clusters were defined both in respect of statistical considerations and of local geographical and socio-cultural concerns. Second, we illustrate how households within clusters were sampled. Third, we expound the data collection process and the survey instruments. Finally, we outline the statistical tools to be applied to estimate the impact of CHI. CONCLUSION: We discuss all design choices both in relation to methodological considerations and to specific ethical and organisational concerns faced in the field. On the basis of the appraisal of our experience, we postulate that conducting relatively sophisticated trials (such as our step-wedge cluster-randomised community-based trial) aimed at generating sound public health evidence, is both feasible and valuable also in low income settings. Our work shows that if accurately designed in conjunction with local health authorities, such trials have the potential to generate sound scientific evidence and do not hinder, but at times even facilitate, the implementation of complex health interventions such as CHI

The Health and Demographic Surveillance System (HDSS) in Nouna, Burkina Faso, 1993–2007

The Nouna Health and Demographic Surveillance System (HDSS) is located in rural Burkina Faso and has existed since 1992. Currently, it has about 78,000 inhabitants. It is a member of the International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), a global network of members who conducts longitudinal health and demographic evaluation of populations in low- and middle-income countries. The health facilities consist of one hospital and 13 basic health centres (locally known as CSPS). The Nouna HDSS has been used as a sampling frame for numerous studies in the fields of clinical research, epidemiology, health economics, and health systems research. In this paper we review some of the main findings, and we describe the effects that almost 20 years of health research activities have shown in the population in general and in terms of the perception, economic implications, and other indicators. Longitudinal data analyses show that childhood, as well as overall mortality, has significantly decreased over the observation period 1993–2007. The under-five mortality rate dropped from about 40 per 1,000 person-years in the mid-1990s to below 30 per 1,000 in 2007. Further efforts are needed to meet goal four of the Millennium Development Goals, which is to reduce the under-five mortality rate by two-thirds between 1990 and 2015

Effects of information, education, and communication campaign on a community-based health insurance scheme in Burkina Faso

Objective : The study analysed the effect of Information, Education, and Communication (IEC) campaign activities on the adoption of a community-based health insurance (CHI) scheme in Nouna, Burkina Faso. It also identified the factors that enhanced or limited the campaign's effectiveness. Design : Complementary data collection approaches were used. A survey was conducted with 250 randomly selected household heads, followed by in-depth interviews with 22 purposively selected community leaders, group discussions with the project management team, and field observations. Bivariate analysis and multivariate logistic regression models were used to assess the association between household exposure to campaign and acquisition of knowledge as well as household exposure to campaign and enrolment. Results : The IEC campaign had a positive effect on households’ knowledge about the CHI and to a lesser extent on household enrolment in the scheme. The effectiveness of the IEC strategy was mainly influenced by: 1 frequent and consistent IEC messages from multiple media channels (mass and interpersonal channels), including the radio, a mobile information van, and CHI team, and 2 community heads’ participation in the CHI scheme promotion. Education was the only significantly influential socio-demographic determinant of knowledge and enrolment among household heads. The relatively low effects of the IEC campaign on CHI enrolment are indicative of other important IEC mediating factors, which should be taken into account in future CHI campaign evaluation. Conclusion : The study concludes that an IEC campaign is crucial to improving the understanding of the CHI scheme concept, which is an enabler to enrolment, and should be integrated into scheme designs and evaluations

Epidemiological and Pathological Aspects of Cervical Cancer in Ivory Coast

Abstract: Cervical cancer is the most common and the leading cause of women death in developing countries. Purpose: To specify the epidemiological and pathological characteristics of cervical cancers in Ivory Coast. Material and methods: This was a retrospective and descriptive study on the cervical cancers histologically confirmed and identified from the registers for recording laboratory of pathological anatomy of Abidjan teaching hospital. The study period was 24 years (January 1984 to December 2007). The parameters analyzed were: frequency, age, sociodemographic status, macroscopic and histological aspects and the prognosis. Results: The cervical cancer represented 78.78% (2064 cases) of gynecological cancers, 42.71% of woman cancer and 17.41% of all cancers. The average age was 48.36 years ranging from 2 to 88 years and a peak incidence between 45-54 years (29%). Multiparity was observed 57.04% (n = 231) and the low socioeconomic level was predominant (70.41%). Concerning pathological examination, the tumor lesions were predominantly budding (51.52%). Squamous cell carcinomas (92.88%) were the most frequent of histological types with 95.1% (n = 1823) of invasive carcinomas. The average age of patients with squamous cell carcinoma was 49 years with 41.5 years for intraepithelial carcinomas and 46.8 years for invasive carcinomas. At the prognosis, squamous cell carcinomas were diagnosed most often in stage pT2 (57.41%) and with extra-cervical represented 66.4% (n = 519). Conclusion: Cervical cancer is the most common cancer in Ivory Coast taking into account male and female together. Its poor prognosis associated with late diagnosis should encourage the establishment of a cytology screening program

Safety and Efficacy of Methylene Blue Combined with Artesunate or Amodiaquine for Uncomplicated Falciparum Malaria: A Randomized Controlled Trial from Burkina Faso

Besides existing artemisinin-based combination therapies, alternative safe, effective and affordable drug combinations against falciparum malaria are needed. Methylene blue (MB) was the first synthetic antimalarial drug ever used, and recent studies have been promising with regard to its revival in malaria therapy. The objective of this study was to assess the safety and efficacy of two MB-based malaria combination therapies, MB-artesunate (AS) and MB-amodiaquine (AQ), compared to the local standard of care, AS-AQ, in Burkina Faso.Open-label randomised controlled phase II study in 180 children aged 6-10 years with uncomplicated falciparum malaria in Nouna, north-western Burkina Faso. Follow-up was for 28 days and analysis by intention-to-treat. The treatment groups were similar in baseline characteristics and there was only one loss to follow-up. No drug-related serious adverse events and no deaths occurred. MB-containing regimens were associated with mild vomiting and dysuria. No early treatment failures were observed. Parasite clearance time differed significantly among groups and was the shortest with MB-AS. By day 14, the rates of adequate clinical and parasitological response after PCR-based correction for recrudescence were 87% for MB-AS, 100% for MB-AQ (p = 0.004), and 100% for AS-AQ (p = 0.003). By day 28, the respective figure was lowest for MB-AS (62%), intermediate for the standard treatment AS-AQ (82%; p = 0.015), and highest for MB-AQ (95%; p<0.001; p = 0.03).MB-AQ is a promising alternative drug combination against malaria in Africa. Moreover, MB has the potential to further accelerate the rapid parasite clearance of artemisinin-based combination therapies. More than a century after the antimalarial properties of MB had been described, its role in malaria control deserves closer attention.ClinicalTrials.gov NCT00354380

Assessment of factors associated with complete immunization coverage in children aged 12-23 months: a cross-sectional study in Nouna district, Burkina Faso

This study identifies specific factors associated with immunization status in Nouna health district (Burkina Faso) in order to advance improved intervention strategies in this district and in those with similar environmental and social contexts. While comprehensive communication may improve understanding about immunization, local interventions should also take into account religious specificities and critical economic periods. Communication problems need to be examined; for instance, many respondents did not understand what the health workers wanted; and or they assumed their child was already totally immunized. Particular approaches that take into consideration local distinctions need to be applied