Manifestations oto-rhino-laryngologiques de la COVID-19 chez l' enfant à Brazzaville / Otorhinolaryngological manifestations of COVID-19 in Children in Brazzaville

Introduction.Les infections respiratoires hautes représentent environ 80% des affections ORL de l'enfant. L'objectif de ce travail était de contribuer à la connaissance des manifestations ORL de la covid-19 chez l'enfant afin d'en améliorer la prise en charge. Patients et méthodes. Il s'est agi d'uneétudedescriptive de 12 mois incluant les dossiers des enfants âgés de moins de 18 ans symptomatiques et testés positifs à la COVID-19 par RT-PCR. Il s'agissait des enfants reçus en consultation dans les services d'otorhinolaryngologie de l'hôpital de Référencede Talangaï et du CHU de Brazzaville. Tous les prélèvements étaient acheminés au laboratoire national de santé publique où le diagnostic était fait par RT-PCR. Résultats.Sur un total de 1080 enfants consultés pour une symptomatologie respiratoire ORL, seuls 21 étaient testés positifs à la COVID-19 représentant une prévalence de 1,9%. L'âge moyen était de 12,6 ans ± 5,7 (extrêmes: 3 ­17 ans) avec un ratio de 0,9 légèrement en faveur des filles. La tranche d'âge de 13 à 18 ans était la plus représentative (n=13, soit 61,8%) suivie de 9 à 13 ans (n=4, soit 19,1%) correspondant aux enfants ayant un antécédent personnel d'atopie (80,9%). La symptomatologie était dominée par l'angine érythémateuse (n=17, soit 80,9%) suivie de la rhinopharyngite (n=3, soit 14,4%) et du syndrome de Marschall (n=1, soit 4,7%). Tous les enfants étaient orientés auprès des services habiletés à la prise en charge mais seuls 13 d'entre eux (61,9%) étaient contre-référés et déclarés guéris après un contrôle RT-PCR négatif. Conclusion.Si l'angine érythémateuse domine la symptomatologie COVID-19 chez l'enfant, il en ressort que le syndrome de Marschall reste une exception clinique.

Introduction. Upper respiratory infections represent about 80% of ENT diseases in children. The objective of this work was to contribute to the knowledge of the ENT manifestations of covid-19 in children in order to improve their management.Patients and methods. This was a 12-month descriptive study including the files of symptomatic children aged 0 to 18 who tested positive for COVID-19 by RT-PCR. These were children seen in consultation in Introduction. Upper respiratory infections represent about 80% of ENT diseases in children. The objective of this work was to contribute to the knowledge of the ENT manifestations of covid-19 in children in order to improve their management. Patients and methods. This was a 12-month descriptive study including the files of symptomatic children aged 0 to 18 who tested positive for COVID-19 by RT-PCR. These were children seen in consultation in the otorhinolaryngology departments of the Talangaï Reference Hospital and the Brazzaville University Hospital. All the samples were sent to the national public health laboratory where the diagnosis was made by RT-PCR. Results. Out of a total of 1080 children consulted for ENT respiratory symptoms, only 21 tested positive for COVID-19, representing a prevalence of 1.9%. The average age was 12.6 years ± 5.7 (extremes: 3 ­17 years) with a ratio of 0.9 slightly in favor of girls. The age group of 13 to 18 years was the most representative (n=13, or 61.9%) followed by 9 to 13 (n=4, or 19%) corresponding to children with a personal history of atopy (80.9%). Symptoms were dominated by erythematous angina (n=17, or 80.9%) followed by nasopharyngitis (n=3, or 14.4%) and Marschall's syndrome (n=1, or 4.7%). All the children were referred to the care services but only 13 of them (61.9%) were cross-referred and declared cured after a negative RT-PCR control. Conclusion. If angina dominates the COVID-19 symptomatology, it emerges as Marschall's syndrome remains a clinical exception the otorhinolaryngology departments of the Talangaï Reference Hospital and the Brazzaville University Hospital. All the samples were sent to the national public health laboratory where the diagnosis was made by RT-PCR. Results. Out of a total of 1080 children consulted for ENT respiratory symptoms, only 21 tested positives for COVID-19, representing a prevalence of 1.9%. The average age was 12.6 years ± 5.7 (extremes: 3 ­17 years) with a ratio of 0.9 slightly in favor of girls. The age group of 13 to 18 years was the most representative (n=13, or 61.9%) followed by 9 to 13 (n=4, or 19%) corresponding to children with a personal history of atopy (80.9%). Symptoms were dominated by erythematous angina (n=17, or 80.9%) followed by nasopharyngitis (n=3, or 14.4%) and Marschall's syndrome (n=1, or 4.7%). All the children were referred to the care services but only 13 of them (61.9%) were cross-referred and declared cured after a negative RT-PCR control. Conclusion. If angina dominates the COVID-19 symptomatology, it emerges as Marschall's syndrome remains a clinical exception.

Organisation et le fonctionnement de la surveillance épidémiologique de la rougeole dans le district sanitaire de Yopougon-est, Côte d'Ivoire de janvier 2022 à juin 2022 / NA

La rougeole est une maladie infantile banale, peut être mortelles quand elle est sous-estimée. Nous avons initié cette étude dont l'objectif général est d'analyser le système de surveillance épidémiologique de la rougeole dans le district sanitaire de Yopougon-Est.MéthodesNous avons procédé à une évaluation normative de la surveillance épidémiologique de la rougeole réalisée en 6 (Six) mois dans ledit district sanitaire. Les critères de sélection nous ont permis de sélectionner 30 personnels de santé impliqués dans la surveillance de la rougeole. RésultatsLes médecins étaient les plus représentés (40%), suivi des infirmiers (33,3%). Les agents avaient plus de 3 ans de service (73,3%). Plus de la moitié des agents étaient formés (56%) la moyenne d'année de service était de 5,33 ans.Dans notre étude, 93,3 % des agents connaissaient la définition d'un cas de rougeole. Les seuils d'alerte et épidémique étaient connus par 56,6% des agents enquêtés. La disponibilité des registres de consultation, fiche de notification hebdomadaire de cas au niveau des structures de santé étaient de 86,7 %. Pour la transmission des données, 70% des enquêtés avaient déclarés que les rapports se transmettaient au district hebdomadairement.Les prélèvements de sang avaient été réalisés chez tous les cas suspects (100%). Les cas confirmés de rougeole représentaient 26,8 % des échantillons.ConclusionLa rougeole est une maladie de l'enfance qui est évitable par la vaccination. Cependant à défaut de vaccination, il est impérieux de mettre en place une organisation pour la détection des cas de rougeole afin d'éviter des épidémies

Aspects cliniques de la maladie hémorroïdaire interne à l'hôpital du District de la Commune IV de Bamako (Mali) / Clinical aspects of internal haemorrhoidal disease in the district hospital of Council IV of Bamako (Mali)

Introduction. La maladie hémorroïdaire interne est la plus fréquente des affections proctologiques et constitue un motif extrêmement répandu de consultation en proctologie. L'objectif de ce travail était de décrire les aspects cliniques de la maladie hémorroïdaire interne à l'hôpital du district de la commune IV de Bamako. Patients et méthodes. Nous avons réalisé une étude transversale descriptive sur un groupe de malades vus en consultation à l'unité de Gastro-entérologie de l'hôpital du district de la commune IV de Bamako. Entre le 1er Novembre 2019 et le 31 Octobre 2020, le recrutement des patients a été réalisé. Les variables recueillies étaient les données sociodémographiques (âge, sexe, profession), les symptômes anaux (saignement anal, douleur anale, suintements muco-glaireux, prurit anal), les facteurs de risque (les troubles du transit intestinal, la période du troisième trimestre de la grossesse, l'accouchement, le post-partum immédiat), les stades de la maladie hémorroïdaire interne, les autres pathologies anales associées, les complications, l'hémogramme. Résultats. Durant la période d'étude, 128 patients ont été vus en consultation parmi lesquels 85 avaient une maladie hémorroïdaire interne, soit une fréquence de 66,40%. La procidence hémorroïdaire a été observée chez 18,8% de nos patients. En fonction de son degré, le grade I représentait 34,1%, le grade II 55,3%, le grade III 9,4% et le grade IV 1,2%. Conclusion. Cette première étude réalisée sur la maladie hémorroïdaire interne à l'hôpital du district de la commune IV de Bamako montre que la maladie hémorroïdaire interne est l'affection proctologique la plus fréquente.

Introduction. Internal haemorrhoidal disease is the most common proctological condition and is an extremely common reason of consultation in proctology. The objective of this work was to describe the clinical aspects of internal haemorrhoidal disease in the district hospital of the commune IV of Bamako. Patients and methods. We conducted a descriptive cross-sectional study on a cohort of patients seen in consultation at the Gastroenterology Unit of the District Hospital of Bamako's commune IV. The recruitment was carried out between November 1, 2019 and October 31, 2020. The variables of study were socio-demographic data (age, sex, profession), anal symptoms (anal bleeding, anal pain, muco-glue oozing, anal pruritus), risk factors (intestinal transit disorders, third trimester of pregnancy, childbirth, immediate postpartum), stages of internal haemorrhoidal disease, other associated anal pathologies, complications, blood count. Results. During the study period, 128 patients were seen in consultation, among whom 85 had internal haemorrhoidal disease (66.40%). Hemorrhoidal procidence was found in 18.8% of patients. Concerning the severity, grade I represented 34.1%, grade II 55.3%, grade III 9.4% and grade IV 1.2%. Conclusion. This pioneer study on internal haemorrhoidal disease in the district hospital of commune IV of Bamako (Mali) showed that internal hemorrhoidal disease is the most common proctological condition in Bamako.

Prevalence of middle ear effusion among children with adenoid hypertrophy at a national referral hospital in Tanzania

Introduction: Middle ear effusion (MEE) is a common childhood disorder that causes hearing impairment due to the presence of fluid in the middle ear which reduces the middle ear's ability to conduct sound. Temporary or persistent hearing loss as a result of MEE causes speech, language and learning delays in children. There are few studies on MEE in Tanzania despite the huge burden of hearing loss among children with adenoid hypertrophy which is a known risk factor for MEE. Method: A cross-sectional study was conducted among 420 children aged nine years and below having adenoid hypertrophy with or without MEE. The diagnosis of adenoid hypertrophy was confirmed with a lateral view x-ray of the nasopharynx and tympanometry for cases with MEE. The primary objective of the study was to assess the prevalence of MEE among children with adenoid hypertrophy. Results: The prevalence of MEE among children with adenoid hypertrophy was 61.7%, with 218 (51.9%) males and 202 (48.1%) females. The most affected age group was 2-4 years with an incidence 193 (46%) and in this age group, males (53.9%) were more affected than females (46.1%). Generally, males, 134 (51.7%) were more affected by MEE than females, 125 (48.3%) of all 259 children with MEE. In terms of age group predominance by MEE, children aged 3-4 years, 107(41.3%) were more affected than all other age groups. Additionally, 4 (1.5%) children with MEE presented with hearing loss. Conclusion: There is a high prevalence of MEE among children with adenoid hypertrophy but no significant association with hearing loss.

Caractéristiques de l'épilepsie chez les sujets âgés de 65 ans et plus / Characteristics of epilepsy in subjects aged 65 and over

Introduction. L'épilepsie du sujet âgé de 65 ans et plus est une pathologie plus fréquente que chez l'adulte jeune. L'objectif principal de ce travail était de faire la description clinique, étiologique et thérapeutique de l'épilepsie débutante et de l'épilepsie ancienne dans cette population. Méthodes. Il s'agissait d'une étude rétrospective et descriptive. Tout patient de 65 ans et plus, hospitalisé en neurologie ou vu en consultation d'épileptologie au CHU Pontchaillou de Rennes (France), présentant une épilepsie débutante ou une épilepsie ancienne a été inclus du 01 novembre 2018 au 30 avril 2019. Résultats. Nous avons retenu 95 patients. Quatorze patients ont été inclus pour une épilepsie débutante. Les crises focales prédominaient (50%) suivies des crises d'emblée généralisées (28,57%). L'étiologie la plus fréquente était d'origine structurelle dans 57,14% des cas avec 75 % de lésions tumorales et 25 % de lésions neuro-vasculaires. Quatre-vingt et un patients ont été retenus pour une épilepsie ancienne. Les crises focales prédominaient (41,98%) suivies des crises d'emblée généralisées (35,80%). L'étiologie la plus importante était d'origine structurelle (54,78%) avec 38,10% de lésions neuro-vasculaires suivies de lésions tumorales dans 16,68% des cas. Le lé vé tiracé tam était plus utilisé chez les patients ayant une épilepsie débutante et la lamotrigine chez les patients connus épileptiques. Conclusion. L'épilepsie chez le sujet âgé est de diagnostic diffi cile en raison d'un grand polymorphisme des crises et de l'origine souvent plurifactorielle. L'étiologie neuro-vasculaire est dominante dans cette population.

Introduction. Epilepsy in subjects aged 65 and over is a more frequent pathology than in young adults. The main objective of this work was to make the clinical, etiological, and therapeutic description of early epilepsy and old epilepsy in this population. Methods. This was a retrospective and descriptive study. Any patient aged 65 and over, hospitalized in neurology or seen in an epileptology consultation at the CHU Pontchaillou in Rennes (France), presenting with early epilepsy or old epilepsy was included from November 01, 2018, to April 30, 2019. Results. We retained 95 patients. Fourteen patients were included for early epilepsy. Focal seizures predominated (50%) followed by generalized seizures (28.57%). The most common etiology was of structural origin in 57.14% of cases with 75% tumor lesions and 25% neurovascular lesions. Eighty-one patients were selected for old epilepsy. Focal seizures predominated (41.98%) followed by generalized seizures (35.80%). The most important etiology was of structural origin (54.78%) with 38.10% of neurovascular lesions followed by tumor lesions in 16.68% of cases. Levetiracetam was used more in patients with early epilepsy and lamotrigine in patients with known epilepsy. Conclusion. Epilepsy in the elderly is difficult to diagnose due to a large polymorphism of seizures and often multifactorial origin. The neurovascular etiology is dominant in this population.

Audit of emergency obstetric referrals at a Tertiary Center in Kano

Introduction: Maternal and perinatal deaths could be prevented if functional referral systems are in place to allow pregnant women to get appropriate services when complications occur. Methodology: The study was a 1-year retrospective study of obstetric referrals in Aminu Kano Teaching hospital, from 1st January to 31st December 2019. Records of all emergency obstetrics patients referred to the hospital for 1 year were reviewed. A structured proforma was used to extract information such as sociodemographic characteristics of the patients, indications for referral, and pre-referral treatment. The care given at the receiving hospital was extracted from the patients' folders. An Audit standard was developed and the findings were compared with the standards in order to determine how the referral system in the study area perform in relation to the standard. Results: There were total of 180 referrals, the mean age of the women was 28.5 ± 6.3 years. Majority (52%) of the patients were referred from Secondary Centres and only 10% were transported with an ambulance. The most common diagnosis at the time of referral was severe preeclampsia. More than half of the patients (63%) had to wait for 30 to 60 minutes before they see a doctor. All the patients were offered high quality care and majority (70%) were delivered via caesarean section. Conclusion: There were lapses in the management of patients before referral; failure to identify high risk conditions, delay in referral, and lack of treatment during transit to the referral centre.

Autodétermination des femmes dans la santé sexuelle et reproductive à Lubumbashi, République Démocratique du Congo / NA

ntroduction.La santé reproductive est caractérisée par une vie sexuelle satisfaisante, sûre et la capacité de se reproduire et de prendre des décisions. La vie de beaucoup de femmes estmarquée par les capacités d'action réduites quant aux décisions portant sur leur propre vie. L'objectif était d'évaluer l'autodétermination des femmes en matière de la santésexuelle et reproductive.Matérieletméthodes.Il s'agit d'une étude descriptive transversale effectuée dans 5 maternités de la ville de Lubumbashi au mois de juillet 2021 au près des 46 accouchées ayant accepté librement de participer à cette étude basée sur le questionnaire préétabli. Résultats.L'analyse des données montre que la moyenne d'âge était de 27,8 ± 3,6 ans avec les extrêmes entre 17 et 41 ans, dont 58,7% d'entre elles avaient le niveau de secondaire et paucipares dans 52,17%. La décision des rapports sexuels revenait au couple dans 58,70%. La décision d'avoir les enfantsrevenait au couple alors que celle de nommer les enfants revenait au mari dans 45,65% et 45,65%. Le nombre d'enfants était déterminé par le couple dans 45,65%. L'espacement des naissances était déterminé par la femme dans 45,65%. Le début de la CPN était décidé par la femme dans 86,6% et le choix du lieu des consultation prénatales(CPN) étaient décidés par la femme dans 89,13%. Le moment de se rendre à la maternité était décidé par la femme dans 73,91%. Le retour à domicile était décidé par le couple dans 39,13% et la décision des rapports sexuels après l'accouchement revenait à l'homme dans 52,17%.Conclusion.La femme congolaise n'a pas toujours une autodétermination maximale dans la santé reproductive. Ainsi des efforts supplémentaires sont nécessairespour laisser la liberté aux femmes de prendre des décisions qui conviennent mieux pour leur santé

Opportunistic Infections and associated factors among HIV infected patients on anti-retroviral treatment at Bombo Hospital in Tanga Region, Tanzania

Background: A substantive number of People Living with HIV (PLHIV) develop Opportunistic Infections (OIs). The introduction of Anti-Retroviral Therapy (ART) in Tanzania led to a significant decline in opportunistic infections and a slower progression to AIDS, but OIs are still prevalent. This study was set to determine the magnitude of OIs and associated factors among HIV/AIDS patients on Anti-Retroviral Therapy (ART) attending care and treatment clinic at Bombo Regional Referral hospital, Tanga region. Materials And Methods: A cross­sectional descriptive study was conducted on HIV/AIDS patients on ART attending Bombo Hospital in Tanga from July to October 2019. A non-probability, consecutive sampling technique was employed to obtain study participants. Data were collected using available data obtained from the patients' files, hospital record books and interviews of study participants by using semi-structured questionnaires. Data were entered into the computer using Excel 2013, cleaned and analysed using Epi Info version 7.2.2.6. Any p-value of < 0.05, at a 95% confidence interval was regarded as statistically significant. Results : The study showed that out of the 360 participants, 126 cases (35.0%) of OIs were reported. Pulmonary Tuberculosis had the highest prevalence of 18.0% among PLHIV while other opportunistic Infections altogether contributed 17.0%. Late ART initiation (OR=10.9, 95% CI: 6.5 ­ 18.3, p-value <0.001), Poor drug adherence (OR=19, 95% CI: 9.0 ­ 39.7, p-value <0.001), female gender (69% vs. 31%), which was however, not statistically significant (p-value ­ 0.904), Informal and Primary School education (OR = 1.6, 95% CI: 1.1 ­ 1.6, p-value 0.04) being married (OR=2.1, 95% CI: 1.3 ­ 3.4, p ­ value 0.004) and widowed/widower (OR=7.7, 95% CI: 1.7 ­ 33.7, p ­ value 0.007) respectively were found to be associated with OIs to PLHIV.CONCLUSION : The rate of OIs still high among PLHIV, Pulmonary Tuberculosis is the leading disease with 18.0% of all OIs symptomatic patients. Delay in ART initiation after positive test results, poor drug adherence and moderate malnutrition have been identified as major risk factors affecting 66.0%, 70.0%, 71%of PLWHA with OIs. We recommend early initiation of ART, Education on ART adherence and refilling of large quantities of ARV drugs to individuals working far from their homes.

Caregivers' perception and determinants of delayed presentation of children with severe malaria in an emergency room in Benin City, Nigeria

Introduction: Severe malaria is a leading cause of mortality due to late presentation to health facilities. Hence, there is a need to identify and mitigate factors promoting delayed presentation with severe malaria. Objective: This study aimed to evaluate determinants of delayed presentation of children with severe malaria in a tertiary referral hospital. Methods: This study adopted a descriptive, cross-sectional design. The participants were children with a diagnosis of severe malaria, based on WHO diagnostic criteria. Delayed presentation was defined as presentation at the referral centre at >3 days of illness. Inferential analyses were done to identify factors associated with delayed presentation. P < 0.05 was considered statistically significant. Results: A total of 126 children with severe malaria participated in the study; their mean (standard deviation) age was 4.2 (5.3) years. The prevalence of delayed presentation in this study is 37.3%. Socio-economic class (P = 0.003); marital status (P = 0.015) and the number of health facilities visited before admission in the referral centre (P = 0.008) were significantly associated with delayed presentation. Children from upper socio-economic class were thrice more likely to present late, compared to those from lower social class (odds ratio [OR] = 3.728, 95% confidence interval [CI]: 1.694­8.208; P = 0.001). Likewise, the Yorubas were more delayed than the Binis (OR = 0.408, 95% CI: 0.180­0.928; P = 0.033). There was a negative correlation between caregivers' perception of treatment (r = −0.113, P = 0.21) of convulsion in severe malaria and timing of presentation. Conclusions: Delayed presentation is common with multifactorial determinants in the setting. Health education of caregivers on the consequences of delayed presentation in severe malaria is desirable.

Profiles of sugar fermenting bacteria of the oral cavity among children with dental caries attending stomatology services at Ruhengeri referral hospital in Musanze District, Northern Rwanda

Background: Dental caries remains a public health threat of concern among children. About 2.3 billion people are affected by dental caries, of which 530 million are children globally. Objective: This study was carried out to identify sugar fermenting bacteria in the oral cavity and their antibiotic susceptibility pattern, assess the association with sugar fermenter bacteria and dental caries and evaluate dental caries outcomes among children. Materials and Methods: This was a cross-sectional study conducted between October 2021 and February 2022 at Ruhengeri Referral Hospital. About 136 oral swab samples were collected from children with and without dental caries at 1:1 ratio. The samples were put in Stuart sterile container and transported to INES-clinical microbiology laboratory for microbial identification. Logistic regression analysis of demographic characteristics was performed to study the relationship between demographic variables and dental caries. Chi-square test was performed for the association between variables. Results: About 67.6% were male, while children of age 7­9 years (64.7%) dominated the age groups. Lactobacilli spp (15.29%) and Streptococcus mutans (12.94%) were the most predominant microorganisms observed in the oral cavity among children with dental caries. The S. mutans (x2 = 27.03, P < 0.00001, 95% confidence interval [CI]=0.2901­0.5785), S. aureus (x2 = 34.59, P < 0.00001, 95% CI = 0.3541­0.6292), Enterobacter aerogenes (x2 = 13.5, P = 0.000239, 95% CI = 0.151­0.4622), Serratia marcescens (x2 = 11.64, P = 0.00645, 95% CI = 0.1275­0.4418) and Klebsiella pneumonia (x2 = 13.51, P = 0.000237, 95% CI = 0.1511­0.4623) were significantly associated with dental caries. Teeth loss (x2 = 51.04, P < 0.00001, 95% CI = 0.4757­0.7205), teeth pain (x2 = 5.05, P = 0.0246, 95% CI = 0.0249­0.33499), and infection (x2 = 4.73, P = 0.02964, 95% CI = 0.0186­0.3441) were dental outcomes associated with tooth decay. Ciprofloxacin, clindamycin, and amoxicillin were the most sensitive antibiotics, while vancomycin and chloramphenicol were the most resistant. Conclusion: Sugar consumption favours the growth of sugar fermenter bacteria that cause dental caries among children. Dental caries is associated with adverse oral health outcomes among children. Oral health education is recommended for children. Parents are advised to reduce the consumption of sugary food for their children for oral health safety.

Referral conditions for severe road traffic injuries and their influence on the occurrence of hospital deaths in Benin

Road traffic accidents are the leading cause of death by trauma. Delays in in first aid due, inter alia, to the long time to transfer traffic accident victims to hospital and the lack of pre-hospital emergency care, contribute to the increase in hospital mortality. This study aims to analyse the referral conditions for severe road traffic injuries and to assess their effect on the occurrence of hospital deaths in Benin. This is an analytical prospective cohort study conducted in road accident victims with a severe injury. Four groups of factors were studied: referral conditions, sociodemographic and victim-specific characteristics, factors related to the accident environment, and factors related to health services. A top-down binary stepwise logistic regression was the basis for the analyses. Nine point eight percent of severe trauma patients died after hospital admission (7.0-13.5). Associated factors were referral time greater than 1 hour (RR=5.7 [1.5-20.9]), transport to hospital by ambulance (RR=4.8 [1.3-17.3]) and by the police or fire department (RR=7.4 [1.8- 29.7]), not wearing protective equipment (RR=4.5 [1.4-15.0]), head injuries (RR=34.8 [8.7-139.6]), and no upper extremity injuries (RR=20.1 [2.3-177.1]). To reduce the risk of hospital death in severe road traffic injuries, it is important to ensure rapid and medicalized referral of severe trauma patients in Benin.

Prospective cohort study of referred Malawian children and their survival by hypoxaemia and hypoglycaemia status

Objective To investigate survival in children referred from primary care in Malawi, with a focus on hypoglycaemia and hypoxaemia progression. Methods The study involved a prospective cohort of children aged 12 years or under referred from primary health-care facilities in Mchinji district, Malawi in 2019 and 2020. Peripheral blood oxygen saturation (SpO2) and blood glucose were measured at recruitment and on arrival at a subsequent health-care facility (i.e. four hospitals and 14 primary health-care facilities). Children were followed up 2 weeks after discharge or their last clinical visit. The primary study outcome was the case fatality ratio at 2 weeks. Associations between SpO2 and blood glucose levels and death were evaluated using Cox proportional hazards models and the treatment effect of hospitalization was assessed using propensity score matching. Findings Of 826 children recruited, 784 (94.9%) completed follow-up. At presentation, hypoxaemia was moderate (SpO2: 90­93%) in 13.1% (108/826) and severe (SpO2: < 90%) in 8.6% (71/826) and hypoglycaemia was moderate (blood glucose: 2.5­4.0 mmol/L) in 9.0% (74/826) and severe (blood glucose: < 2.5 mmol/L) in 2.3% (19/826). The case fatality ratio was 3.7% (29/784) overall but 26.3% (5/19) in severely hypoglycaemic children and 12.7% (9/71) in severely hypoxaemic children. Neither moderate hypoglycaemia nor moderate hypoxaemia was associated with mortality. Conclusion Presumptive pre-referral glucose treatment and better management of hypoglycaemia could reduce the high case fatality ratio observed in children with severe hypoglycaemia. The morbidity and mortality burden of severe hypoxaemia was high; ways of improving hypoxaemia identification and management are needed.

Factors associated with reduced foetal movements in Iringa, Tanzania

Introduction: Maternal perception of foetal movement ensures foetal wellbeing. Reduced foetal movement is associated with foetal hypoxia, stillbirths, and intrauterine foetal growth restriction (IUFGR). This study aimed at assessing factors that are associated with maternal perception of reduced foetal movements. Method: This was a cross-sectional study that was conducted at Iringa Regional Referral Hospital from 1st January ­ 30th June 2022. A purposive sampling technique was used, and SPSS version 25 software was used for data analysis. Results: 41.3 % of study participants were aged 24 ­ 34 years, with a mean and SD of 29.08 ±7.53. 75% were not employed, 52.8 % of study participants delivered from 37 ­ 42 weeks of gestational age, 66.1% had a posterior placenta and only 24.0 % had an anterior placenta. Women who delivered at 28 ­ 36 weeks of gestational age were about 4 times more likely to experience reduced foetal movement compared to those who delivered at 37 ­ 42 weeks of gestation (AOR=4.162, 95% CI 2.174 - 7.966, p= =0.0067). Conclusion: Reduced foetal movements are associated with lower gestation age at delivery and decreased antenatal clinic attendance in Iringa, Tanzania. All pregnant women should be encouraged to make early antenatal clinic attendance and should attend adequate visits. Healthcare providers should educate and create awareness on methods of assessing foetal movements.

Twenty years of prevention of mother to child HIV transmission: research to implementation at a national referral hospital in Uganda

Background: Over 90% of new paediatric HIV infections are acquired through mother to child transmission. Prevention of mother to child HIV transmission (PMTCT) research in sub-Saharan Africa informed WHO guidelines which enabled implementation of PMTCT programs globally. Objectives: To describe Makerere University-Johns Hopkins University (MU-JHU) perinatal HIV prevention research and implementation of the Mulago National Referral Hospital (MNRH) PMTCT program. Methods: Perinatal HIV prevention studies conducted at MU-JHU between 1997­2016 were summarized. Program aggregated data was extracted and analyzed using STATA 15. Results: In 1999, the HIVNET 012 study demonstrated that single-dose nevirapine (sdNVP) to the mother at onset of labor and to her newborn, reduced MTCT by nearly 50%. In 2016, the PROMISE study documented the safety and efficacy of ART during pregnancy and breastfeeding period. Program implementation at MNRH started in 2000. Uptake of HIV testing increased from 70% to 99% from 2006 onwards. sd NVP was the initial ARV regimen but by 2012, MOH recommended Option B+(triple therapy). MTCT rates reduced from 16.9% in 2001 to 2.3% in 2020. Conclusion: Perinatal HIV prevention clinical trials conducted at MU-JHU provided evidence to inform WHO PMTCT guidelines. MNRH program evaluation demonstrated the significant decline in MTCT rates over the last two decades.

Behavioural intervention for adolescent uptake of family planning: a randomized controlled trial, Uganda

Objective:To evaluate the impact of a peer-referral and clinic welcome programme for reducing barriers to adolescents' uptake of family planning services in Uganda. Methods: We developed an intervention using behavioural design and carried out a stratified, randomized controlled evaluation of the intervention in girls aged 15­19 years. Sexual and reproductive health clinics were randomized into control (56 clinics) and intervention groups (60 clinics). All intervention clinics received the core intervention (materials to create an adolescent-friendly environment and referral cards to give to friends), while a subset of clinics additionally received training in youth-friendly service provision. We collected clinics' routine data on monthly numbers of visits by adults and adolescents over a 15-month baseline and 6-month intervention period, 2018­2020.Findings:In multivariate regression analysis we found significant effects of the intervention on primary outcomes in the pooled intervention group compared with control. Mean monthly visits by adolescents increased by 45% (incidence rate ratio, IRR: 1.45; 95% confidence interval, CI: 1.14­1.85), or over five additional adolescent clients per clinic per month. The mean adolescent proportion of total clients improved by 5.3 percentage points (95% CI: 0.02­0.09). Within treatment arms, clinics receiving the training in youth-friendly service provision showed the strongest effects: a 62% increase (IRR: 1.62; 95% CI: 1.21­2.17) in adolescent clients, or over seven additional adolescents per clinic per month, relative to the control group.Conclusion: A behavioural change intervention designed to target identified barriers can increase adolescents' uptake of family planning counselling and services.

Cost of treatment among self-referred outpatients in referral hospitals compared to primary health care facilities in East Wollega, western Ethiopia: a comparative cross-sectional study

Patient self-referral is a condition when patients refer themselves to higher level health facilities without having to see anyone else first. Despite the expansion in the number of health facilities, it has been seen when patients routinely accessed referral hospitals without a formal referral. The study aims to evaluate cost of treatment among self-referred outpatients at referral hospitals compared to primary health care facilities. Comparative cross-sectional study design was used and the required sample size for the study was determined by using formula of double populations mean comparison cost of treatment for diseases leading to outpatient visits. A total of 794 participants (397 from referral hospital and 397 from primary health facilities) were included in the study. Data was collected using face-to-face interview from December 1 to 30, 2017. Data entry and analysis were made using SPSS version 20. Descriptive statistics and independent samples t-test were performed. A total of 783 outpatients responded to the interview of the study and 391 of them were from referral hospital and 392 from primary health facilities. The mean of outpatient visit cost per visit for the treatment of diseases leading to outpatient visits was significantly higher at referral hospitals compared to primary health facilities [95% CI=6.13 (5.07-7.18)] USD. The mean cost of outpatient visits for the treatment of all type of diseases leading to outpatient visits was significantly higher at referral hospitals and at least two times of primary level health facilities. Health care providers should create awareness in the community about referral linkages to inform patients and their families the additional costs they incur when they bypass the proximal primary health facilities

Caregivers of children with diabetes mellitus: challenges of caring for and perceptions of consultations in a South African public sector context

Background: Understanding caregivers' challenges in caring for children with diabetes mellitus (DM) and their perceptions of consultations with the multidisciplinary team (MDT) may be valuable in assisting in achieving control. Methods: Using a qualitative descriptive design, anonymised, transcribed recorded data from semi-structuredinterviews with a purposive sample of caregivers were thematically analysed in three areas: (a) challenges experienced in caring for their child, (b) feelings around MDT consultations pertaining to helpfulness, support and diabetes education, and (c) suggestions for clinic improvement. University of KwaZulu-Natal ethics committee approval and informed consent were obtained.Results: All caregivers (n = 14) were female with a mean age of 38 years. Total diabetes caring experience was 47.4 years. The primary caregiver was the mother in nine interviews. Ten interviewees were unemployed. The children's ages ranged from 3 to 15 years with mean age at diagnosis of 6.7 years. Caregivers' challenges in caring were reflected in two global themes: 'DM care is difficult' and needs a 'process of adjustment' over time to accept and meet demands. These included emotional, practical, financial, behavioural and social challenges. Caregivers' feelings regarding overall consultations were mostly positive, including satisfaction. The MDT's helpfulness and support were perceived as patient-centred and meeting education and care needs. Negative feelings were frustration and boredom. Clinic improvement suggestions included shorter waiting times and seeing the same doctor for continuity of care.Conclusion: Caregivers in South Africa experienced caring for children with DM as difficult, requiring an adjustment process. Perceptions of consultations were mostly positive. Relevant clinic improvements were suggested

Prevalence and determinants of self-directed referrals amongst patients at hospitals in eThekwini District, KwaZulu-Natal 2015

Background: Non-compliance with designated referral pathways has ramifications such as increased patient waiting time,overburdening of higher levels of care and increasing healthcare costs on patients and the healthcare system. The purposeof this study was to assess the determinants of self-directed referrals amongst patients attending hospitals in the eThekwini district of KwaZulu-Natal.Methods: An analytic, cross-sectional study was conducted at the Medical Outpatient Departments across five district hospitals in eThekwini using interviewer-administered questionnaires. Descriptive statistics were used to determine the proportion and the most frequent factors contributing towards patient self-referral. The likelihood of patients to self-refer was tested using chisquare (X2) and a multivariate regression model.Results: There were 315 patients interviewed with 35% (n = 109/315) having self-referred. The majority (51%; 55/107) of selfreferrals were male and were of African race (74%; n = 80/107). Five institutional factors, namely:availability of medication at the pharmacy (98%); quality of care at the facility (93%); waiting time at facility (92%); services provided (90%); and attitude of healthcare workers (87%), were ranked as the main drivers of self-referral. Multivariate logistic regression established a significant positive association between patient self-referral and male gender (OR 1.73; CI 1.04­2.87, p < 0.05). Age < 39 years (OR 0.96; CI 0.94­0.99, p < 0.05); and patient awareness of a referral letter (OR 0.28; CI 0.09­0.86, p < 0.05) emerged as protective factor against self-referrals.Conclusion: Males patients tend to bypass the referral pathway whilst younger patients and patients who were aware of a referral letter were less likely to bypass the referral system. In addition to addressing the systemic challenges of waiting times, quality of care and availability of medication, a patient-oriented approach that comprises education, encouragement and increased patient awareness is an important strategy to improve referral pathway compliance

Orthopaedic referrals using a smartphone app: uptake, response times and outcome

Background. It is well established that South Africa (SA) suffers an immense burden of violence and injuries. The responsibility of providing care for these injuries falls mainly on public health services, resulting in overloading of the health system. Prior to a recent intervention, the large burden had been exacerbated by limitations in the traditional referral system that highlighted the need for a better referral system. Vula's smartphone app was introduced at Tygerberg Hospital in August 2016. This study evaluated the uptake, response times and outcomes using this app.Objectives. The main objectives of the study were to describe: (i) the number of referrals; (ii) referral response times; (iii) referring facilities; and (iv) referral outcomes. Secondary objectives were to: (i) evaluate whether the referral outcome pathway was appropriate; and (ii) assess professional conduct and evidence of upskilling.Methods. This retrospective, descriptive study investigated Vula app referrals to the Division of Orthopaedic Surgery at Tygerberg Hospital between 1 August 2016 and 31 March 2017. Vula was advertised to key facilities in the hospital's referral network. All referrals to the division during the study period were systematically included in the analysis of operational outcomes, although some were excluded from the subsequent referral outcome analysis. Operational outcomes included the number of referrals, referring facilities and referral response times. Referral outcome analysis included the clinical diagnosis, referral pathway, whether the referral was used for upskilling and whether it was conducted in a professional manner.Results. A total of 2 275 referrals from 39 different facilities were received during the study period from 238 individual users; 50% of referrals received a response within 11 minutes, while a small percentage received no response. Clinical and demographic characteristics of 1 985 patients included in the referral outcome analysis indicated that the majority of trauma and emergency referrals involved males, with closed fractures being the most frequent clinical presentation. Although the most common referral outcome was immediate transfer, one-third of the patients were treated at the referring hospital with advice only.Conclusions. The large volume of orthopaedic referrals received through the Vula app suggests that Vula represents a successful alternative to traditional referral methods. Referrals managed by advice only could suggest that Vula facilitates some relief for the overburdened trauma services. Future research could further explore Vula's role in strengthening the public health system, including interventions for high-volume referral areas and upskilling of referring health workers

Knowledge and utilization of referral system among health care workers in selected primary health care centres in Oyo State, Nigeria

Background: Referral system is one of the strategies in place across all levels of health care settings for adequate use of health care resources and services. This study assessed the knowledge and utilization of referral system among health care workers in selected Primary Health Care (PHC) centers in Ibadan, Oyo State, Nigeria. Methods: This study was a descriptive study that utilized structured questionnaire to collect data. Simple random sampling was used to select eighty-eight health workers from thirteen selected Primary Health Care Centers. Data were analyzed using descriptive statistics.Results: Sixty-six (75.0%) of the respondents indicated that there are three levels of health care system. Sixty­two (93.2%) health care workers knew that referral system can be from lower to higher level of care and 61 (69.3%) knew that referral system can be from higher to lower level of care. Only 21 (23.9%) of the respondents refer patients frequently and 66 (75.1%) of them mostly refer to secondary health care facility. Factors identified by respondents as influencing utilization of referral system included distance of one facility to another 74 (84.1%) social support 71 (80.7%) and availability of referral forms 70 (79. 6%).Conclusion: Good knowledge of referral system was demonstrated by the participants; however, the implementation of the process was poor. It is vital that future studies should explore identified factors since a functional referral system is vital for effective health care system