Application de pediatric sequential organ failure assessment (pSOFA) chez les enfants diagnostiqués de Sepsis selon les critères SIRS: Une série des cas de l'hôpital Saint Joseph / Application of pediatric sequential organ failure assessment (pSOFA) in children diagnosed with Sepsis according to SIRS criteria: serial case from Saint Joseph hospital

Le fardeau du sepsis utilisant le Pediatric Sequential Organ Failure Assessment (pSOFA) en Afrique subsaharienne n'est pas connu. L'objectif de la présente étude était de déterminer la fréquence du sepsis appliquant le score pSOFA chez les enfants. Méthodes. C'était une série des cas incluant les enfants âgés entre 1 et 15 ans, préalablement suspectés de sepsis au moyen des critères SIRS, en utilisant le score pSOFA (≥ 2), au service des urgences pédiatriques de l'hôpital Saint Joseph / Kinshasa. Résultats. Nonante deux enfants ont été examinés. Le sexe masculin était prépondérant (53,3 %). Leur âge médian était de 4,5 ans. Les signes cliniques à l'admission étaient marqués par la fièvre (97,8 %) et l'asthénie physique (60,8 %). La mise en évidence du sepsis pSOFA a montré que 39,1% des patients avaient sepsis alors que 60,9 % étaient diagnostiqués à tort (pSOFA < 2). La fréquence de sepsis selon pSOFA était de 7,2 % sur l'ensemble d'admission. Conclusion. Le score pSOFA a permis de diagnostiquer le sepsis seulement chez un enfant sur quatre par rapport au score de SIRS qui a tendance à le surestimer.

Child health promotion during the COVID-19 pandemic: A health and welfare sector collaboration

Background: Fragmented service provision and a lack of efficient cooperation between health and welfare sectors serving children and families remain ongoing challenges in South Africa. The coronavirus disease 2019 (COVID-19) pandemic escalated this fragmentation. A community of practice (CoP) was established by the Centre for Social Development in Africa to promote collaboration between the sectors and to assist communities in their environments. Aim: To explore and describe collaboration on child health promotion between professional nurses and social workers, who formed part of the CoP during the COVID-19 pandemic. Setting: The study was conducted in five public schools from four of the seven district regions of the City of Johannesburg, Gauteng province. Methods: A qualitative, exploratory, descriptive research design was employed to conduct psychosocial and health screenings of children and their families. Focus group interviews were conducted, and field notes were used to collect and confirm data from the team. Results: Four themes emerged. Participants shared their positive and negative experiences faced during the fieldwork, their realisation of the value of collaboration between various sectors and their desire and capacity to do more. Conclusion: Participants indicated that collaboration between the health and welfare sectors is vital to support and promote the health of children and their families. The COVID-19 pandemic highlighted the need for collaboration between these sectors in the children and their families' ongoing struggles. Contribution: The importance of these sectors being engaged as a team highlighted the multisectoral influence shaping child development outcomes, supporting children's human rights and advancing social and economic justice.

Tends of "Zero-dose" children aged 12-23 months in Togo from 2000 to 2017 and predictions for 2030

Guided by the principle of leaving no one behind by improving equitable access and use of new and existing vaccines, the Immunization Agenda 2030 aims, among other things, to halve the incidence of "zero-dose" at the national level. This study aimed at studying the tends of the prevalence of "zerodose" children from 2000 to 2017 and making predictions for 2030. The study consisted of secondary data analyses from the Multiple Indicator Cluster Surveys (MICS) conducted in Togo. The study population consisted of children aged 12-23 months surveyed during MICS2 in 2000, MICS3 in 2006, MICS4 in 2010 and MICS6 in 2017. The dependent variable was the "zero-dose" vaccination status (1=Yes vs 0=No). The explanatory variables were related to the child, mother, household and environment. The study generated the overall annual percentage changes (APC) and by the independent variables. As a result, the prevalence of children with "zero-dose" expected for 2030 was estimated using Excel 2013 and Stata 16.0 software. In total, 636, 864, 916 and 952 children aged 12-23 months were included for MICS2, MICS3, MICS4 and MICS7, respectively. The prevalence of "zerodose" children decreased from 37.15% in 2000 to 31.72% in 2006, then 30.10% in 2010 and 26.86% in 2017, with an overall APC= - 1.89%. The highest relative annual decrease was from 2000 to 2006. If the historical rate of decrease remains unchanged, we predict that percentage of "zero-dose" children aged 12-23 months will be 20.96% in 2030, with a decrease of 22% compared to 2017, against a target of 50%. We suggest that strengthening strategies to increase full immunization coverage of children will contribute to reducing the percentage of zero dose children. A prerequisite will be a better understanding of the predictors of the "zero-dose" phenomenon in children

Child health promotion during the COVID-19 pandemic: A health and welfare sector collaboration

Background: Fragmented service provision and a lack of efficient cooperation between health and welfare sectors serving children and families remain ongoing challenges in South Africa. The coronavirus disease 2019 (COVID-19) pandemic escalated this fragmentation. A community of practice (CoP) was established by the Centre for Social Development in Africa to promote collaboration between the sectors and to assist communities in their environments. Aim: To explore and describe collaboration on child health promotion between professional nurses and social workers, who formed part of the CoP during the COVID-19 pandemic. Setting: The study was conducted in five public schools from four of the seven district regions of the City of Johannesburg, Gauteng province. Methods: A qualitative, exploratory, descriptive research design was employed to conduct psychosocial and health screenings of children and their families. Focus group interviews were conducted, and field notes were used to collect and confirm data from the team. Results: Four themes emerged. Participants shared their positive and negative experiences faced during the fieldwork, their realisation of the value of collaboration between various sectors and their desire and capacity to do more. Conclusion: Participants indicated that collaboration between the health and welfare sectors is vital to support and promote the health of children and their families. The COVID-19 pandemic highlighted the need for collaboration between these sectors in the children and their families' ongoing struggles.

Profil clinique de la surdité de l'enfant à Yaoundé / Clinical profile of child deafness in Yaounde

In Cameroon, the prevalence of deafness in children is 3.6%. The aim of this study was to describe the clinical profile of these hearing impaired children at the time of diagnosis. Patients and methods.This was a descriptive cross-sectional study that took place between November 2020 and June 2021 and involved 127 hearing impaired children. Results.The mean age of these children was 9.2 ± 3.9 years, with extreme values of 1 and 15 years. The sex ratio was 1.3. The average number of children in the siblings was 3.5 ± 1.8 children and 30.7% occupied the 1st rank in their siblings. The average birth weight was 3269 ± 0.685g. The neonatal history was found in 11.81% of the cases while the postnatal history related to 32.28% of the cases. Maternal alcoholism and parental genital infections were found during pregnancy. Familial deafness was found in one of the mothers (0.4%) and in the siblings in 3.1% (n=4). At the time of diagnosis, the median age was between 0 and 24 months, the mode of onset was old and 96.9% of children had bilateral deafness. The absence of reaction to noise and the delay of language were the most found modes of revelation. Moderate and severe deafness were the most represented and were mostly sensory or mixed. Among these deaf children, 4%presented a handicap or an associated pathology. Conclusion.The causes of child deafness in Yaoundé are acquired in perinatal period. This deafness is diagnosed in the perilingual period and remains dominated by bilateral deafness, whether severe or profound

Juvenile otosclerosis: radio-clinical features and outcomes of surgical treatment

Purpose: To review the radio-clinical features and to evaluate the outcomes of surgery approaches for the treatment of otosclerosis in pediatric population. Methods: It's a retrospective study including 12 patients under 18 years of age, diagnosed with otosclerosis and using data over a 24 ­ year ­period (1996-2020). A clinical examination, an audiometric assessment and a computed tomography of the temporal bone (CT-Scan) prior to surgery had been performed in all cases. All patients underwent surgical treatment under general anesthesia. Follow ­up was essentially clinical and audiometric with a mean period of 4years. Results: Mean age of our patients was 15.3 with a ratio of 0.5. Only three of them had a family history of otosclerosis. Major functional sign was hearing loss; tinnitus was noted in only 5 cases. CT-Scan had shown typical radiographic evidence of otosclerosis grade Ia (Veillon classification) in 9 cases, grade Ib in 1 case and no abnormalities in 2 cases. Surgery was performed in all cases: 8 patients underwent stapedotomy and 4 had stapedectomy. The audiometric results were good, air-bone gap closure to within 10 dB was achieved in 84% of cases (10 cases) and to within 20dB in 100% of cases at last follow-up. Conclusion: Audiometric and radiological assessments are essential to guide the diagnosis and the treatment of juvenile otosclerosis. Stapes surgery is a good option for closing the air-bone gap in children with bilateral juvenile otosclerosis

Prevalence and correlates of common mental disorders among children and adolescents in Blantyre-Urban, Malawi

The high global prevalence of mental disorders justifies the need to quantify their burden in the sub-Saharan Africa where there is a dearth of information. These mental disorders are linked to different socio-demographic factors. Objective To determine the prevalence of, and factors associated with mental disorders among children and adolescents in Blantyre City, Malawi. Methods: Children and adolescents aged 6 to 17 years were interviewed to determine their socio-demographic characteristics and assess their mental health status using the Strengths and Difficulties Questionnaire (SDQ) and Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Associations between mental disorders and socio-demographic characteristics were tested using Chi-square and logistic regression analysis. Results The prevalence of symptoms of psychopathology on the SDQ was 7.3% (95%CI 4.8-10.5%) while for the K-SADS was 5.9% (95% CI 3.7%-8.9%). The prevalence of mental disorders across the age ranges of 6 to 12 years and 13 to 17 years was 5.4% and 7.9 % respectively. Males had a higher prevalence (7.1%) compared to females (4.7%). Conduct disorder was most prevalent (3.4%), followed by either type of ADHD- Attention Deficit Hyperactive Disorders (2.0%). Having a single parent (p<0.001), staying with a nonbiological guardian (p<0.030), engaging in paid work (p<0.039), not attending school (p<0.019) and having teacher difficulties(p<0.028) were positively associated with a mental disorder. Conclusion The socio-demographic factors associated with the risk of developing mental disorders may be important targets for mental health intervention programs

Assessment of the realisation of the right to adequate food in the Blue Crane Route (Eastern Cape, South Africa)

Objectives: To assess whether the right to adequate food (RtF) is realised by children and primary caregivers and what actions are required to fully realise this right. Design: A cross-sectional, descriptive study was undertaken using a mixed-methods approach. Setting and subjects: Rural and urban primary caregivers of children (one to five years old) were recruited if they had resided in the Blue Crane Route (Eastern Cape) for at least six months. Purposefully selected key informants (KIs) involved in nutrition and food security, health or governance participated in in-depth interviews.Outcome measures: Primary caregivers responded to interviewer-administered questionnaires (IAQ) (N = 161), which investigated various indicators supporting the realisation of the RtF. Statistical analysis of quantitative data examined relationships between urban and rural participants. Significance was considered at p < 0.05. In-depth interviews with key informants (KIs) examined the perceptions of 11 prominent community leaders. Qualitative data were coded deductively and common themes identified. Results: Based on the IAQ, half (51%) of the caregivers had experienced risk of, or food insecurity in the past month. Common themes indicative of suboptimal realisation of the RtF included insufficient employment opportunities, inadequate policies and programme implementation, and inadequate agrarian practices, while the child support grant partially supported the realisation of the RtF. Caregivers felt disempowered by a sense of inability to realise the right themselves without government assistance but KIs suggested that caregivers needed to take responsibility. Conclusion: The RtF of children and their caregivers is not fully realised in the Blue Crane Route. Concerted, multidisciplinary approaches using a rights-based approach to implement policies and programmes are needed, together with the empowerment of the community with necessary skills and resources to further the realisation of the RtF.

Management of community acquired pneumonia (CAP) in children: Clinical practice guidelines by the Paediatric Association of Nigeria (PAN

The Paediatric Association of Nigeria first published management guideline for community-acquired pneumonia in 2015 and covered available evidence at that time. This update represents a review of available recent evidence statements regarding the management of pneumonia in children, while at the same time incorporating relevant materials from the first edition of the guideline. The guideline is developed to assist clinicians in the care of children with CAP. The recommendations provided in this guideline may not be the only approach to management, since there are considerable variations among children in the clinical course of CAP.The goal of this guideline is to reduce morbidity and mortality rate of CAP in children by providing recommendations that may be relevant in assisting clinicians to make timely diagnosis and institute appropriate antibiotic therapy of children with CAP. Summarized below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided and the grade of the recommendation indicated.The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.

Blood culture contamination in the departments of paediatrics and child health at two tertiary training hospitals in central South Africa

Background. Bloodstream infections are an important cause of mortality in children. Blood cultures (BCs) remain the primary means of identifying organisms and their antibiotic susceptibility profiles. A shortcoming of BCs is that up to 56% of positive cultures will represent contaminants. Poor adherence to standard practices applicable to BC sampling could explain an unacceptable contamination rate. Objectives. To determine: (i) the BC contamination rate in the departments of paediatrics and child health at two tertiary hospitals in central South Africa; and (ii) BC sampling practices among paediatric clinicians. Methods. The author determined the prevalence of BC contamination by analysis of laboratory data for the period 1 May - 27 August 2019, and assessed possible factors contributing to BC contamination by surveying paediatric medical staff with a self-administered BC practices questionnaire. Results. Of the 244 BCs reviewed, 25.4% were positive. The most commonly isolated pathogens were coagulase-negative staphylococci (CoNS) (33.3%), Escherichia coli (22.2%), Enterococcus faecium (16.7%) and Acinetobacter baumannii (11.1%). In total, 15.2% of the BCs yielded contaminants and 2.9% had polymicrobial growth. The most common contaminant was CoNS. Approximately 68% of clinicians were not aware of BC sampling guidelines, and even among those who were aware of the guidelines, non-compliance was reported. Conclusions. The BC contamination rate was higher than internationally accepted rates. Educating clinicians on specific BC sampling guidelines is strongly recommended to decrease the high rate of contamination observed in this study.

Correlates of exclusive breast feeding among nursing mothers attending child health clinic at a general hospital in Rivers State Nigeria

Background: Early initiation of breast feeding and feeding exclusively for six months have great implication for the survival, well-being and growth of new borne. Factors such as maternal age, occupation, religion, spouse age, spouse occupation, parity, antenatal care (ANC) attendance, mode of delivery (MOD) and birth order are significantly associated with exclusive breast feeding (EBF) Methodology: The study is a descriptive cross-sectional study conducted among nursing mothers attending child health clinic in General Hospital Bonny, in Bonny Island, Rivers State, Nigeria. All eligible nursing mother who presented at the clinic were enlisted for the study. Enlistment of eligible participants was done on every child welfare clinic day. Data was collected using a pretested, interviewer administered, structured questionnaire which was adapted and prepared in English Language. Categorical data was analyzed using multinomial logistic regression model with statistical significance set at 0.05. Result: Results from this study identified significant association between EBF and some maternal variables such as age, occupation and religion. Spouse age and occupation were significantly associated with EBF. ANC attendance, gestational age, MOD, parity and birth order were also significant variables associated with EBF. Conclusion: Maternal variables such as age, occupation, religion, parity, MOD, ANC attendance including spouse age and occupation significantly influence EBF of new borne.

Retrospective evaluation of inpatients admitted to a tertiary hospital in Somalia for Pediatric surgery

Objective: The aim is to reflect on the epidemiology of the patient population at a tertiary hospital for pediatric surgery, diagnostic pattern, and mortality in Somalia retrospectively. Methods: In this study, 163 patient who were hospitalized to Pediatric Surgery Clinic of Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital in 2018 were included. Data regarding age, gender, diagnosis, surgical condition, mortality rate and cause of the death were recorded from the patient charts and the institutional digital database Results: Of 163 patients 47 were female (28.8%) and 116 were male (71.2%). The mean age of the patients was 6.4 ± 4.8 years. The main diagnoses were congenital malformation (34.4%), acute abdomen (25.8%), traumatic injury (23.3%), infection (9.8%) and neoplasm (6.1%). Mortality rate was 9.8% and the leading cause of death was sepsis by 87.5%. Perforated appendicitis, intestinal obstruction and intussusception were creating the 68.7% of the diseases that result in death. Conclusions: Our results show that two-thirds of the surgical deaths could be prevented with timely presentation. We think that the health policymakers in Somalia should focus on how to improve the access to surgical care, patient transfer, timely presentation, and training of pediatric surgeons and to overcome the poor surgical outcomes

COVID-19 and HIV viral load suppression in children andadolescents in Durban, South Africa

Background: The coronavirus disease 2019 (COVID-19) pandemic poses challenges to paediatric and adolescent HIV treatment programme. Modelling exercises raised concerns over potential impact of disruptions. Objectives: To describe the impact of the COVID-19 pandemic on viral load (VL) testing among infants, children and adolescents on antiretroviral treatment (ART) in Durban, South Africa. Method: Routinely collected, aggregated data of monthly VL counts done on all those less than 19 years old from January 2018 to January 2022 was analysed. An interrupted time series analysis using a Prais-Winsten linear regression model, including terms for lockdowns and excess mortality determined VL trends. Results: The unadjusted mean VL was 2166 (confidence interval [CI]: 252.2) and 2016 (CI: 241.9), P = 0.039, and percentage VL suppression rates (72.9%, CI: 2.4% vs 73.6%, CI: 1.8%) across COVID and pre-COVID periods, showing no significant difference, P = 0.262. In the interrupted time series analysis, modelled monthly VL counts did not differ significantly by lockdown level (e.g., level 5 lockdown: ­210.5 VLs, 95% CI: ­483.0 to +62.1, P = 0.138) or excess mortality (­0.1, 95% CI: ­6.3 to 6.1, P = 0.969). A significant downward trend in VL testing over time, including during the pre-COVID-19 period (­6.6 VL per month, 95% CI: ­10.4 to ­2.7, P = 0.002), was identified. Conclusion: Viral load suppression for children and adolescents were not negatively affected by COVID-19. A trend of decrease in VL testing predated COVID-19. What this study adds: Evidence presented that HIV VL testing and suppression rates in children and adolescents in a high burden setting were sustained through the COVID pandemic.

Les malformations congénitales cliniquement visibles / Clinically visible congenital malformations

Contexte. Les malformations congénitales représentent l'une des causes majeures de mortalité infantile. La réduction de cette mortalité passe par la mise en place d'un système de surveillance épidémiologique. Le but de cette étude était d'établir les caractéristiques épidémiologiques et cliniques des malformations congénitales cliniquement visibles. Méthodes. Étude rétrospective descriptive et analytique réalisée entre janvier 2018 et décembre 2019.Elle a concerné les patients de moins de 15 ans présentant une ou plusieurs malformations congénitalescliniquement visibles.Les variables étudiées étaient d'ordre épidémiologique et clinique. Résultats. Cent trois patients présentant une malformation congénitale ont été colligés. Ils représentaient une fréquence de 6,8%. Les malformations ostéoarticulaires représentaient 43% (n=44), et celles de la paroi abdominale 25% (n=26). Les mères étaient paucipares (n=50,48%) et âgées en moyenne de 27,9+/- 2,7 ans. Aucun diagnostic anténatal n'a été fait.Les enfants étaient nés à terme dans 98% (n=101). Ils étaient de sexe masculin dans 60% (n=62).Le taux de décès était de 11%(n=10). Conclusion. les malformations congénitales étaient dominées par les anomalies ostéoarticulaires et celles de la paroi abdominale. Elles sont sous-estimées et nécessitent la mise en place d'un système d'enregistrement pour une maitrise de son épidémiologie.

Prise en charge des plaies pénétrantes de l'abdomen de l'enfant au Centre hospitalier de Treichville / Management Of Penetrating Abdominal Wounds In Children At Treichville Teaching Hospital

Contexte. La prise en charge des plaies pénétrantes de l'abdomen chez l'enfant ne fait pas l'objet de consensus. Le dogme de laparotomie d'emblée est remis en cause au profi t d'un traitement conservateur à appliquer selon des critères précis. Notre objectif était de caractériser les aspects épidémiologiques, cliniques et thérapeutiques des plaies pénétrantes de l'abdomen afi n de proposer un algorithme de prise en charge. Méthodes. Etude rétrospective de Janvier 2009 à décembre 2019, au service de chirurgie pédiatrique du CHU de Treichville.Huit cas ont été colligés dans les dossiers de patients retrouvés et complets. L'analyse statistique a été faite par le test de Fisher. Résultats. L'âge médian était de 9 avec des extrêmes de 2 et 15 ans. Tous les patients étaient de sexe masculin. Quatre patients présentaient un tableau de péritonite.Tous nos patients étaient hémodynamiquement stables.La radiographie de l'abdomen sans préparation (ASP) a été faite chez 5 patients (62,5 %) avec un pneumopéritoine chez 3 patients.Il a été réalisé4 (50%) laparotomies d'emblée et 4 traitements conservateurs.Le test exact de Fisher était statistiquement signifi catif pour p<0,05. Aucune laparotomie secondaire n'a été réalisée après le traitement conservateur. La mortalité a été nulle Conclusion. Les critères de réalisation du traitement conservateur reposent sur la clinique et un plateau technique disponible.

Background: The management of penetrating wounds of the abdomen in children is not the subject of consensus. The dogma of surgical exploration from the outset is called into question in favor of a conservative treatment. This treatment, however, must be applied according to precise criteria. The aim of this study was to characterize the epidemiological, clinical and therapeutic aspects of penetrating abdominal wounds in order to propose an accurate management algorithm.Methods. We performed a retrospective study from January 2009 to December 2019, in the pediatric surgery department of the Teaching Hospital of Treichville. Eightcases were collected.The statistical analysis was done using Fisher's test.Results. The median age was 9 with extremes of 2 years and 15 years. All patients were male. All our patients were hemodynamically stable. Four presented a peritonitis.Abdomen X-ray (ASP) was performed in 5 patients (62.5%) with pneumoperitoneum in 3 patients (37.5%). Four laparotomies (50%) were performed immediately and 4 conservative treatments.Fisher's exact test was statistically signifi cant for p<0.05. No secondary laparotomy was performed after conservative treatment. Mortality was zero. Conclusion. The criteria for performing conservative treatment are based on clinical elements and a technical platform available.

COVID-19 in children: a case series from Nigeria

Introduction: the global spread of COVID-19 remains unabated in the past few months with a rise in the number of available literature on the novel virus. There are very few paediatric studies and are mainly from developed countries with a paucity of information on the clinical manifestation of COVID-19 disease in African children, including Nigeria. Methods: we described the clinical presentation, laboratory findings, treatment and outcome in a group of five Nigerian children managed at a COVID-19 isolation and treatment centre in Nigeria. Results: we managed a total of five children with an age range of 3 months to 8 years in the last four weeks (16th April to 15th May 2020). Three of the five children were males. All the children had close contact with family members that tested positive for COVID-19. Out of the five children, one had moderate disease, three had mild symptomatic disease, and one was asymptomatic. Two out of the five children had lymphocytosis. Out of the four children who had chest radiograph, two had features of pneumonia. Conclusion: COVID-19 is not uncommon in Nigerian children, and all had a confirmed family member with COVID-19. Besides, contrary to leucopaenia with lymphopaenia observed in the adult's population, we found lymphocytosis in this cohort and about 50.0% had pneumonic changes on chest radiograph

Descriptive epidemiology of anaemia among pregnant women initiating antenatal care in rural Northern Ghana

Background: Anaemia in pregnancy is associated with adverse obstetric outcomes. When detected early in pregnancy, it can be treated; however, information on its prevalence and associated factors is limited in rural Ghana. Aim: The aim of this study was to determine the prevalence and maternal factors associated with anaemia in pregnancy at first antenatal care (ANC) visits. Setting: The study was conducted in the Navrongo War Memorial Hospital, a secondary referral facility in the Kassena-Nankana district in rural northern Ghana. Methods: A retrospective analysis of antenatal clinic records of pregnant women collected from January to December 2014. All pregnant women initiating antenatal clinic, who had initial haemoglobin (Hb) levels measured, were included in the study. Logistic regression analyses were carried out to determine factors associated with anaemia at the initiation of ANC. Results: We analysed data from 506 women with median Hb of 11.1 g/dL (IQR 7.31­13.8). The median gestational age at booking was 14 weeks (5­36 weeks). The prevalence of anaemia was 42.7%, with 95% confidence interval (CI) [38.4­47.1], and was high among teenage mothers (52% [34.9­67.8]), mothers who booked in the third trimester (55% [33.6­74.7]) and grand multiparous women (58% [30.7­81.6]). Factors associated with anaemia included grand multiparity (odds ratio [OR] = 1.94 with 95% CI [1.58­2.46]), booking during the third trimester (OR = 2.06 [1.78­2.21]) and mother who were underweight compared to those with normal weight (OR = 3.17 [1.19­8.32]). Conclusion: Burden of anaemia in pregnancy is still high in rural northern Ghana. We advocate further strengthening of the primary health care system to improve early access to ANC delivery

The negative impact of poverty on the health of women and children

This article is based on "The Negative Impact of Poverty on the Health of Women and Children" and discusses the association between poverty and poor health. Poverty is high on the international development agenda. World conferences and summits have paid attention to the increasing levels of poverty of billions of the world's peoples. The poor die in young age and they usually suffer from communicable diseases, maternal and perinatal conditions, and nutritional deficiencies. They are not only at risk from diseases of the poor but they also suffer from lifestyle health problems that are often found among affluent communities. Unfortunately, in many communities, the most affected are women and children

Comparative evaluation of carotid intima media thickness in paediatric type 1 diabetic children and healthy children in Ibadan and Lagos, Nigeria

Patients with type 1 diabetes are at greater risk of cardiovascular disease and atherosclerosis. Carotid in-tima­media thickness (CIMT) measured by ultrasound is a marker of atherosclerosis and can predict future cardiovascular events.The aim of this study was to measure the CIMT in paediatric type 1 diabetes patients in Ibadan and Lagos and compare results with the CIMT of non-diabetic healthy control children. Carotid ultrasound was performed and CIMT measured in 70 subjects (35 diabetic patients and 35 non-diabetic controls matched for age and sex). Mean age was 12.8±3.2 years. A slightly higher, but non-significant mean CIMT was seen in diabetic cases: mean values in type 1 diabetes patients were 0.475±0.068 and 0.476±0.069 (right and left respectively) while in controls, mean values were 0.467±0.064 and 0.468±0.054 (p=0.618 and 0.575 respectively). The CIMT in both groups correlated positively with age and body mass index (BMI). Significantly higher mean CIMT values were seen in males with type 1 diabetes on both sides. However, there was no significant correlation between CIMT and duration of illness, insulin dosage, or blood pressure. CIMT is a safe and convenient measurement, which may be helpful in predicting an increased risk of future cardiovascular disease in children with type 1 diabetes

Assessing the utilization of a child health monitoring tool

Objective: The study assessed the implementation of growth monitoring and promotion, immunisation, vitamin A supplementation, and deworming sections of the Road-to-Health Booklet. Caregivers and health care workers knowledge, attitudes and practices were investigated as well as health care workers perceptions of barriers undermining implementation.Methods: A cross-sectional descriptive study was conducted on a proportional sample of randomly selected Primary Health Care facilities across six health districts (35%; n=143) in the Western Cape Province. Health care workers involved in the implementation of the Road-to-Health Booklet, children (0-36 months) and CGs were included. Information was obtained through scrutiny of the Road-to-Health Booklet, observation of consultations and structured questionnaires.Results: A total of 2442 children, 2481 caregivers and 270 health care workers were recruited. Weight (94.7%) measurements were performed routinely. Less than half (40.2%) of caregivers reported that their child's growth was explained. Sixty-eight percent of health care workers correctly identified criteria for underweight, whereas only 55% and 39% could do so for stunting and wasting respectively. Road-to-Health Booklet sections were completed adequately for immunization (89.3%), vitamin A supplementation (94.6%) but not for deworming (48.8%). Most health care workers (94%) knew the correct regimes for vitamin A supplementation and deworming, but few caregivers knew when treatment was due for vitamin A supplementation (16.4%) and deworming (26.2%). Potential barriers identified related to inadequate training, staff shortages and limited time.Conclusion: Focussed effort and resources should be channelled towards health care workers training and monitoring regarding growth monitoring and promotion to optimize utilization of the Road-to-Health Booklet. Mobilisation of community health workers is needed to strengthen community awareness of preventative health interventions