Test positivity and clinical presentation of COVID-19 in Mozambican infants hospitalized during the second wave of the pandemic in 2021

Introduction: during the second wave of the COVID-19 pandemic in Mozambique, there was a surge in pediatric hospitalizations at a time when there was relatively little evidence, but significant concern about clinical outcomes in African children, particularly in higher-risk infants requiring, and health system capacity to respond. Methods: a retrospective cohort study was conducted for patients 1-12 months of age admitted to the Breastfeeding ward at Hospital Central de Maputo from January-February 2021. All had routine SARS-CoV-2 PCR testing performed. For patients with positive results, hospital charts were retrospectively reviewed. Descriptive analyses were performed. Results: of 209 patients that had SARS-CoV-2 PCR testing performed, 102 (48.8%) received results, of which 37 (36.3%) were positive. Positive results were received prior to discharge for 14 patients (37.8%). Median duration of hospitalization was 3 days. There were two deaths in COVID-positive patients (5.4%), both with complex comorbidities. For the 35 COVID-19 positive patients whose charts were located, the principal admission diagnosis was respiratory for 22 (62.9%), and 14 (40.0%) had oxygen saturation <94% at admission. The white blood cell count was >12.0 x 103cells/mL in 10 patients (28.6%) and the most common abnormal finding on chest radiograph was peribronchial thickening (38.5% of patients with results). Oxygen therapy was needed for 20 patients (57.1%). Conclusion: the majority of infants with COVID-19 had a mild, short-duration respiratory illness that did not exceed ward capacity for care, including oxygen treatment. Laboratory capacity for PCR testing was overwhelmed, delaying the return of results and complicating inpatient infection control measures.

A systematic review of clinical characteristics, co-morbidities and outcomes of COVID-19 in children and adolescents

Background: COVID-19 is a major global health challenge that has affected all age groups and gender, with over 5 million deaths reported worldwide to date. The objective of this study is to assess available information on COVID-19 in children and adolescents with respect to clinical characteristics, co-morbidities, and outcomes, and identify gaps in the literatures for appropriate actions. Methodology: Electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for observational studies such as case series, cross-sectional and cohort studies published from December 2019 to September 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide. Data extracted included (i) patient demography (age and gender), (ii) clinical characteristics including vaccination status and presence of co-morbidities, (iii) clinical management including the use of sequential organ failure assessment (SOFA) scores, oxygen requirement, use of mechanical ventilation, and (iv) disease outcomes including length of hospital and intensive care unit (ICU) admission, recovery, complications with sequelae, or death. Data were analyzed using descriptive statistics. Results: A total of 11 eligible studies were included with a total of 266 children and adolescents; 137 (51.5%) females and 129 (48.5%) males. The mean age of the children was 9.8 years (range of 0 ­ 19 years), and children ≥ 6 years were more affected (40.7%) than age groups 1 ­ 5 years (31.9%) and < 1 year (27.4%). The major co-morbidities were respiratory diseases including pre-existing asthma (3.4%), neurologic conditions (3.4%) and cardiac pathology (2.3%). Majority (74.8%, 199/266) of the patients were discharged without sequelae, 0.8% (2/266) were discharged with sequalae from one study, and mortality of 1.9% (5/266) was reported, also from one study. SOFA scores of patients at admission were not stated in any of the study, while only one study reported patient vaccination status. Conclusion: It is recommended that safe vaccines for children < 1 year of age should be developed in addition to other preventive measures currently in place. SOFA scores should be used to assess risk of COVID-19 severity and monitor prognosis of the disease, and vaccination status of children should be documented as this may impact the management and prognosis of the disease.

Towards 2030 target for hepatitis B and C viruses elimination: assessing the validity of predonation rapid diagnostic tests versus enzyme-linked immunosorbent assay in state hospitals in Kaduna, Nigeria

ntroduction: Sub-Saharan Africa accounts for 25% of the estimated global 325 million people with chronic hepatitis B and C virus infections. Weak blood transfusion systems facilitate the spread of both hepatitis B and C virus infections. This is worsened by the absence of sustainable quality assurance programs and perennial shortage of sensitive screening kits. We aim to compare the validity of rapid diagnostic tests (RDTs) with the World Health Organization-recommended quality-assured enzyme-linked immunosorbent assay (ELISA) screening method for these viruses. Materials and Methods: We conducted a cross-sectional study on consecutive blood donor samples. Two hundred and sixty-four blood donor samples screened for hepatitis B and C viruses using RDTs were retested at a National blood transfusion service, Kaduna, Nigeria. Data were analyzed using OpenEpi version 3.01 to determine the sensitivity, specificity, and predictive values of RDTs versus ELISA. Results: The sensitivities of the RDTs at 95% confidence interval (CI) were low ­ 40% (19.8­64.3) and 50.0% (18.8­81.2) ­ for hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) antibody, respectively. The specificities and 95% CI were high ­ 99.9% (97.8­99.9) and 100.0% (98.5­100) for HBsAg and HCV antibody, respectively. Conclusion: Predonation RDTs screening of blood donor samples for hepatitis B virus and HCV in hospital donation units performed poorly compared to quality-assured ELISA screening in Kaduna. The risk of transmitting viral hepatitis through blood transfusion still exists. We recommend quality-assured ELISA screening of all donated units for HBsAg and HCV antibody to reduce the risk of these transfusion-transmitted infections

White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children

Background. Acute appendicitis (AA) is the most common acute surgical condition of the abdomen, and the most commonly misdiagnosed.Objective. To analyse the white blood cell count (WBCC) and C-reactive protein (CRP) contribution to the diagnosis of AA in children.Methods. This was a retrospective study of 943 consecutive patients operated on with the preoperative diagnosis of AA, in whom preoperative WBCC and CRP had both been measured. Postoperatively, the patients were divided into three groups: normal appendix (no AA), simple AA and complicated AA.Results. Of the 943 patients, 616 (65.3%) had simple AA. The mean (standard deviation (SD)) age for this group was 9.8 (3.2) years (p<0.01 v. complicated AA), the mean WBCC was 16.5 (5.0) × 109/L (p<0.01 v. complicated AA and no AA), and the mean CRP level was 304.8 (409.5) nmol/L (p<0.01 v. complicated AA). The mean age of the patients with complicated AA (283/943, 30.0%) was 7.9 (3.7) years, the mean WBCC was 17.7 (6.2) × 109/L (p<0.01 v. no AA) and the mean CRP level was 1 076.2 (923.8) nmol/L (p<0.01 v. no AA). The mean age of the patients with no AA (44/943, 4.7%) was 8.8 (3.2) years, the mean WBCC was 13.1 (5.3) × 109/L and the mean CRP was 361.9 (447.6) nmol/L. The WBCC was normal in 113/899 patients with appendicitis (12.6%) and CRP in 139 (15.5%). Both the WBCC and CRP were normal in 17 patients with appendicitis (1.9%). The best receiver operating characteristic (ROC) curve was obtained for WBCC when comparing all AA with no AA: cut-off point 15.0 × 109/L, sensitivity 65%, specificity 68%, area under the curve 0.70. The best ROC curve for CRP was obtained when comparing simple AA with complicated AA: cut-off point 361.9 nmol/L, sensitivity 74%, specificity 74%, area under the curve 0.81.Conclusions. The WBCC is helpful in diagnosing simple AA and CRP in diagnosing complicated AA. If both are normal, AA is very unlikely. Together the WBCC and CRP are useful tools in diagnosing and staging AA

From caution to urgency: the evolution of HIV testing and counselling in Africa

Objective:To describe recent changes in policy on provider-initiated testing and counselling (PITC) for human immunodeficiency virus (HIV) infection in African countries and to investigate patients' experiences of and views about PITC. Methods A review of the published literature and of national HIV testing policies; strategic frameworks; plans and other relevant documents was carriedout. Findings Of the African countries reviewed; 42 (79.2) had adopted a PITC policy. Of the 42; all recommended PITC for the prevention of mother-to-child HIV transmission; 66.7recommended it for tuberculosis clinics and patients; and 45.2for sexually transmitted infection clinics. Moreover; 43.6adopted PITC in 2005 or 2006. The literature search identified 11 studies on patients' experiences of and views about PITC in clinical settings in Africa. The clear majority regarded PITC as acceptable. However; women in antenatal clinics were not always aware that they had the right to decline an HIV test. Conclusion Policy and practice on HIV testing and counselling in Africa has shifted from a cautious approach that emphasizes confidentiality to greater acceptance of the routine offer of HIV testing. The introduction of PITC in clinical settings has contributed to increased HIV testing in several of these settings. Most patients regard PITC as acceptable. However; other approaches are needed to reach people who do not consult health-care services

HIV/AIDS stigmatization, the reason for poor access to hiv counseling and testing (HCT) among the youths in Gulu (Uganda)

HIV/AIDS-related stigma still exists in many communities in Uganda. Stigma perpetuates discrimination and this may be a key contributor to the spread of HIV/AIDS in this country. Right from the beginning; HIV/AIDS epidemic has been accompanied with fear; ignorance and denial; leading to stigmatization and discrimination against people living with HIV/AIDS and their families. A study conducted by Uganda AIDS Commission (UAC) in Uganda indicated that 64 of the people who tested for HIV/AIDS did not disclose status to their partners due to fear of stigmatization. A cross-sectional study was conducted in Gulu District; Pece sub County among the youths 15 to 35 years old. A structured questionnaire was administered to 86 consented youths who were consecutively selected. Ethical approval was obtained from Gulu Hospital. Most youths (90) practiced stigmatization; (93.1) respondents had adequate knowledge on HIV counseling and testing (HCT). However; only (36.1) had undertaken HCT and the majority did not do because of fear of stigmatization. There is sufficient knowledge; a positive attitude but a poor practice to HCT. There is high level of HIV/AIDS stigmatization among the youths.nef Gene Products; Human Immunodeficiency Virus bAdolescent Medicine cDiscrimination

Accuracy of an Immunochromatographic Diagnostic Test (ICT Malaria Combo Cassette Test) Compared to Microscopy among under Five-Year-Old Children when Diagnosing Malaria in Equatorial Guinea

Conventional malaria diagnosis based on microscopy raises serious difficulties in weak health systems. Cost-effective and sensitive rapid diagnostic tests have been recently proposed as alternatives to microscopy. In Equatorial Guinea; a study was conducted to assess the reliability of a rapid diagnostic test compared to microscopy. The study was designed in accordance with the directives of the Standards for Reporting Diagnostic Accuracy Initiative (STARD). Peripheral thick and thin films for the microscopy diagnosis and a rapid immunochromatographic test (ICT Malaria Combo Cassette Test) were performed on under five-year-old children with malaria suspicion. The ICT test detected Plasmodium spp. infection with a sensitivity of 81.5and a specificity of 81.9while P. falciparum diagnosis occurred with a sensitivity of 69.7and a specificity of 73.7. The sensitivity of the ICT test increased with higher parasitemias. The general results showed little concordance between the ICT test and microscopy (kappa = 0.28; se: 0.04). In Equatorial Guinea; the ICT Malaria Combo Cassette Test has proven to be an acceptable test to detect high P. falciparum parasitemias. However; the decrease of sensitivity at medium and low parasitemias hampers that ICT can replace properly performed microscopy at present in the diagnosis of malaria in children

Factors Contributing to the Decision by Pregnant Women to be Tested for HIV

The objective of this study was to explore and describe the factors that influence the decision by pregnant women to be tested for HIV. This was achieved through a qualitative research study that was exploratory; descriptive and contextual in nature. A sample of 13 pregnant women participated. Data obtained from semi-structured interviews was analysed according to a protocol based on a combination of methods of analysis. The three main themes; namely factors that contribute to the decision by pregnant women to be tested for HIV; factors that contribute to the decision by pregnant women not to be tested for HIV and organisational factors that influence the decision by pregnant women to be tested for HIV; were divided into nine subthemes. Conclusions and recommendations to promote counselling to pregnant women being tested for HIV are provided

Ethical scrutiny of HIV testing in the ante-natal clinic of a secondary health care facility in Rivers State; Nigeria

Background: HIV testing has been shown to be a crucial gateway to treatment; prevention; and support services; hence the urgent need to swiftly scale-up testing in a wide range of clinical encounters; as a means of controlling the pandemic. Fears have however been expressed that such swift scale-ups might result in unethical practices; espe- cially in developing countries without strong civil institutions and legal protection. Aim: To carry out an ethical scrutiny of HIV testing; in a secondary health care facility; in an urban community in south-south Nigeria. Methods: The study was carried out in March 2006; in Omoku General Hospital; a secondary health care facility; with the full comple- ment of staff and facilities. In-depth interviews were held with the relevant staff of the hospital; to ascertain the HIV testing procedure in the ante-natal clinic of the hospital. These were corroborated with exit interviews of women attending the clinic. Results: The HIV testing procedure showed several ethical breaches. The women that attended the ante-natal clinic had mandatory HIV test; were inadequately counselled; and tested without proper linkage with prevention; care and treatment facilities. Conclusion: Most of the ethical breaches stemmed from poor funding; and improper linkage with other services. Funding of HIV testing programmes must go beyond the provision of test kits

L'evaluation des tests de diagnostic : quels indices peut-on calculer?

L'evaluation de tests diagnostiques se pose en termes differents selon que l'on dispose ou non au depart de certitudes sur le statut des sujets vis-a-vis de la maladie. Si l'on dispose d'un test de reference permettant de distinguer les malades des non malades; l'evaluation est relativement simple et l'on peut calculer facilement les principaux indices descriptifs de la performance diagnostique du test etudie. Si l'on ne dispose pas de test de reference ou si le nouveau test est destine a devenir la reference; l'evaluation consistera a comparer entre eux ces deux tests car les indices classiques ne peuvent plus etre interpretes facilement