Crise vaso-occlusive drépanocytaire sévère: aspects cliniques, étiologiques et thérapeutiques au CHU Sylvanus Olympio de Lomé / Clinical, aetiological and therapeutic features of severe sickle cell related vaso-occlusive crisis at the Sylvanus Olympio University Hospital, Lomé

Introduction: la crise vaso-occlusive (CVO) est la plus fréquente manifestation de la drépanocytose et la première cause d´hospitalisation des enfants atteints. L´objectif de cette étude est de décrire les aspects cliniques des CVO sévères, de déterminer les étiologies des syndromes infectieux qui les accompagnent et de décrire leur prise en charge. Méthodes: il s'agit d'une étude transversale descriptive portant sur 137 drépanocytaires majeurs hospitalisés pour CVO sévères du 1er janvier 2009 au 31 décembre 2011 dans le service de pédiatrie du CHU Sylvanus Olympio. Résultats: les drépanocytaires homozygotes SS étaient les plus nombreux (n=98; 71,5%), suivis des doubles hétérozygotes SC (n=28; 20,5). Le délai moyen de consultation était de 4,7 ± 4,4 jours. Le traitement avant l´admission comportait des antibiotiques (28,5%). Les CVO étaient surtout ostéo-articulaires (70,8%). Dans 98,5% des cas, une infection bactérienne associée a été confirmée (48,9%) ou présumée (49,6%). Les principales étiologies étaient le syndrome thoracique aigu (26,3%), l´ostéomyélite aiguë (10,9%), l´infection urinaire (6,6%), la septicémie (3,6%). Un germe a été isolé chez 14,6% des patients, Escherichia coli (30%) étaient en tête suivi de Klebsiella pneumoniae (25%), Staphylococcus aureus (15%), Salmonella typhi (10%), Streptococcus pneumoniae (5%), le Streptocoque D (5%), l´Enterobacter (5%) et l´Acinetobacter (5%). Le taux de mortalité était de 2,2%. La durée moyenne d´hospitalisation était de 11,4 ± 8,8 jours. Conclusion: les CVO drépanocytaires sévères sont en majorité associées aux infections bactériennes en milieu tropical. Une antibiothérapie adaptée et précoce constitue le moyen thérapeutique indispensable pour prévenir ou traiter ces patients.

Introduction: vaso-occlusive crisis (VOC) is the most common manifestation of sickle cell disease and the leading cause of hospitalization among affected children. The purpose of this study is to describe the clinical features of severe VOCs, to determine the etiologies of infectious syndromes that accompany them and to describe their management. Methods: we conducted a descriptive cross-sectional study of 137 adult patients with sickle cell disease hospitalised for severe VOC in the Paediatric Department of the Sylvanus Olympio University Hospital from 1 January 2009 to 31 December 2011. Results: the majority of patients (n=98; 71.5%) had homozygous sickle cell (SS), followed by double heterozygous SC disease (n=28; 20.5). The median of consultation time was 4.7 ± 4.4 days. Treatment before admission was based on antibiotics (28.5%). VOCs were mainly osteoarticular (70.8%). In 98.5% of cases, an associated bacterial infection was confirmed (48.9%) or suspected (49.6%). The main etiologies included acute chest syndrome (26.3%), acute osteomyelitis (10.9%), urinary tract infection (6.6%) and septicaemia (3.6%). One germ was isolated from 14.6% of patients: Escherichia coli (30%), followed by Klebsiella pneumoniae (25%), Staphylococcus aureus (15%), Salmonella typhi (10%), Streptococcus pneumoniae (5%), Streptococcus D (5%), Enterobacter (5%) and Acinetobacter (5%). Mortality rate was 2.2%. The average length of stay in hospital was 11.4 ± 8.8 days. Conclusion: severe sickle cell related vaso-occlusive crisis is mainly associated with bacterial infections in tropical environments. Appropriate and early antibiotic therapy is the essential therapeutic means to prevent or treat these patients.

Couverture de la chimio ­ prévention du paludisme saisonnier chez les enfants de 3 à 59 mois au Bénin en 2023 / Coverage of seasonal malaria chemoprevention in children from 3 to 59 months of age in Benin in 2023

Introduction : la Chimioprévention du Paludisme Saisonnier (CPS) est une intervention pouvant réduire la survenue des cas de paludisme chez les enfants de 3 à 59 mois. L'objectif de cette étude était de mesurer la couverture de la CPS chez les enfants de 3 à 59 mois pendant la campagne (juillet à octobre 2023) vivant dans la zone d'intervention au Bénin. Matériels et méthodes : une étude enquête transversale descriptive et analytique a été conduite du 30 novembre au 14 décembre 2023. Un échantillonnage en grappe à trois degrés a permis de tiré au sort 3573 en milieux urbain et rural dans 172 Zones de Dénombrements (ZD) réparties dans les 15 communes d'intervention. Résultats : l'enquête a révélé que 87,3% des enfants ciblés ont été touchés par la campagne de CPS 2023. Sur les quatre passages, la couverture complète était respectivement de 84,4%, 81,7%, 77,7% et 62,2%. La couverture complète pour les douze doses était de 59,8%. Conclusion : la couverture en CPS a diminué au fur et à mesure des doses. Les refus persistent et proviennent des personnes clés des ménages qui décident de l'accès aux soins. Le plan de communication et les stratégies de déploiement de la CPS doit être investigué et renforcé en vue d'améliorer la couverture.

Introduction: Seasonal malaria chemoprevention (SMC) is an intervention that can reduce the occurrence of malaria in children aged 3-59 months. The study aimed to measure the coverage of SMC among children aged 3 to 59 months from July to October 2023 living in the intervention zone in Benin. Materials and methods: A cross-sectional survey was conducted from 30 November to 14 December 2023. Three-stage sampling was used to randomly select 3573 people in urban and rural areas in 172 enumeration zones (ED) in the 15 intervention municipalities. Results: Of the targeted children, 87.3% of had been reached by the 2023 CPS campaign Over the four rounds, full coverage was 84.4%, 81.7%, 77.7% and 62.2% respectively. Full coverage for the twelve doses was 59.8%. Conclusion: The SMC coverage decreased with each dose and varied across areas. The SMC communication plan and implementation needs to be strengthened to improve coverage

Recovering from COVID lockdowns: Routine public sector PHC services in South Africa, 2019 - 2021

Background. In a previous article on the impact of COVID-19, the authors compared access to routine health services between 2019 and 2020. While differential by province, a number of services provided, as reflected in the District Health Information System (DHIS), were significantly affected by the pandemic. In this article we explore the extent to which the third and fourth waves affected routine services. Objectives. To assess the extent to which waves 3 and 4 of the COVID-19 pandemic affected routine health services in South Africa, and whether there was any recovery in 2021.Methods. Data routinely collected via the DHIS in 2019, 2020 and 2021 were analysed to assess the impact of the COVID-19 pandemic and extent of recovery. Results. While there was recovery in some indicators, such as number of children immunised and HIV tests, in many other areas, including primary healthcare visits, the 2019 numbers have yet to be reached ­ suggesting a slow recovery and continuing impact of the pandemic. Conclusions. TheCOVID-19 pandemic continued to affect routine health services in 2021 in a number of areas. There are signs of recovery to 2019 levels in some of the health indicators. However, the impact indicators of maternal and neonatal mortality continued to worsen in 2021, and if interventions are not urgently implemented, the country is unlikely to meet the Sustainable Development Goals targets

Cardiovascular physical examination as a screening tool for congenital heart disease in newborns at a teaching hospital in Ghana

Objectives: To determine the usefulness of cardiovascular physical examination (CPE) as a screening tool in a lowresource setting for detecting congenital heart disease (CHD) in newborns delivered at the Maternity Unit of Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Design: A hospital-based cross-sectional study with a comparison group component. Setting: Maternity Unit of the KBTH, Accra, Ghana. Participants: Over eight months, newborns aged 1-14 days delivered at ≥ 34 weeks' gestation at the Maternity Unit, KBTH, were recruited into the study. Intervention: Each newborn was examined using a set of CPE parameters for the presence of congenital heart disease. Those with suggestive features of CHD had a confirmatory echocardiogram test. Main Outcome Measure: Abnormal CPE features and their corresponding echocardiogram findings. Results: A total of 1607 were screened, with 52 newborns showing signs of CHD on CPE, of which 20 newborns were proven on echocardiogram to have congenital heart disease. Abnormal CPE parameter that was associated with CHD was murmur (P=0.001), dysmorphism (p=0.01), newborns with chest recessions (p=0.01) and lethargy (p=0.02). CPE's sensitivity, specificity, and positive and negative predictive values were 95%, 60.7%, 36.5% and 98,1%, respectively. The most common acyanotic CHD found was isolated atrial septal defect (ASD), followed by patent ductus arteriosus (PDA). The only cyanotic CHD found was a case of tricuspid atresia. Conclusion: Cardiovascular physical examination at birth is an effective and inexpensive screening tool for detecting CHD in newborns, which can easily be utilised in low-resource settings.

Incidence of blood culture-related sepsis in neonates and antibiotics sensitivity of implicated organisms in a secondary healthcare facility in Ghana

Objective: We determined the incidence of blood culture-related sepsis, causative bacteria, and antibiotics sensitivity among newborn babies with suggestive signs of sepsis admitted at the Upper East Regional Hospital in Bolgatanga, Ghana. Design: Prospective cross-sectional study Setting: Newborn Care Unit of the Upper East Regional Hospital, Bolgatanga Participants: Neonates admitted to the Newborn Care Unit from August 2019 to August 2020 with signs of sepsis Main outcome measures: Organisms isolated from blood cultures and sensitivity of isolated organisms to antibiotics. Results: The study included two hundred and seventy-six (276) patients. Laboratory confirmed sepsis was 13.4% (37/276). Early onset sepsis was 3.3% (9/276), while late-onset sepsis was 10.1% (28/276). The most common clinical signs associated with positive culture cases were temperature instability (35.5%), poor feeding (14.5%), neonatal jaundice (11.3%), vomiting (9.7%), and respiratory distress (8.1%). Staphylococcus aureus and Staphylococcus epidermidis were the most common bacterial isolates (46% and 32%, respectively). There was no relationship between independent variables and blood culture confirmed sepsis. Antibiotics to which isolates were most resistant included flucloxacillin 4/4, penicillin 14/15, ampicillin 16/18, and tetracycline 23/28. Bacterial isolates were most sensitive to amikacin 16/16, levofloxacin 5/5, erythromycin 8/8, cefazolin 7/8, and ciprofloxacin 18/24. Conclusion: Late-onset sepsis is a common sepsis category, and the implicated microorganisms are resistant to commonly prescribed antibiotics.

Sociodemographic factors associated with mixed-feeding practices among a cohort of mothers with infants aged 4 - 14 weeks in Tlokwe subdistrict, North West Province, South Africa

Background. Exclusive breastfeeding for the first 6 months of an infant's life is the recommended gold standard for infant feeding; however, mixed feeding (MF) is common in various settings. In South Africa (SA), especially in the Tlokwe subdistrict of North West Province, there is little information on the association between sociodemographic factors and infant MF practices.Objective. To identify the sociodemographic factors associated with MF practices in a cohort of mothers of infants aged 4 - 14 weeks in the Tlokwe subdistrict of North West.Methods. The study setting was 8 health facilities in the Tlokwe subdistrict. Participants comprised postpartum women with infants aged 4 - 14 weeks. Data analysis used SPSS version 25.0. Normal data are presented as means (standard deviation (SD)), skewed data as median values (25th, 75th percentiles) and categorical values as percentages and frequencies.Chi-square tests and logistic regression analysed the association between sociodemographic factors and MF practices at time point 2 (10 - 14 weeks).Results. The majority of the mothers were aged between 25 and 29 years, and 37% had at least 2 live children. MF increased with infant age. There was no significant association between any of the sociodemographic variables and MF practices. Logistic regression analysis showed a significant association between increased parity and MF. There was also a significant association between changes in infant-feeding practices after receiving the child support grant at 10 - 14 weeks. Conclusion. The high proportion of mothers who mixed-fed indicates that it is still the norm, as in other SA contexts. Therefore, strengthened breastfeeding education regarding appropriate infant-feeding choices in the promotion of infant development and survival for the short and long term should be emphasised. S Afr J Child Health 2022;16(4):192-197. https://doi.org/10.7196/SAJCH.2022.v16.i4.1808Sociodemographic factors associated with mixed-feeding practices among a cohort of mothers with infants aged 4 - 14 weeks in Tlokwe subdistrict, North West Province, South Africa N M Semenekane,1 MSc (Nutrition); C B Witten,1,2 PhD (Nutrition); E Swanepoel,3 MSc (Dietetics);H S Kruger,1 PhD Nutrition 1 Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa2 Division of Health Professions Education, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa3 School of Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa

Evaluation de la qualité physico-chimique et microbiologique de quelques farines infantiles locales vendues à Ouagadougou, Burkina Faso / Evaluation of the physicochemical and microbiological quality of some local infant flours sold in Ouagadougou, Burkina Faso

Introduction: la qualité des farines infantiles utilisées pendant la période de diversification alimentaire est d´une grande importance. Malheureusement, les processus de transformation occasionnent des pratiques d'hygiène insuffisantes. L´objectif de cette étude était d´évaluer la qualité physico-chimique et microbiologique des farines infantiles locales vendues à Ouagadougou. Méthodes: les paramètres physico-chimiques et microbiologiques ont été déterminés selon les méthodes standards. Les données ont été traitées sur Excel 2016 et les moyennes comparées sur XLSTAT 2016. Résultats: sur 102 unités de 20 marques de farines infantiles locales analysées, les matières premières de base étaient constituées par les céréales locales, les légumineuses, les enzymes, les minéraux et les vitamines. La teneur en eau variait de 1,92±0,01% à 5,51±0,03% tandis que le pH variait de 5,55±0,01 à 6,36±0,00. La flore totale variait de 2,4.102 UFC/g à 1,1.104 UFC/g, les coliformes totaux de 0 à 2,8.103 UFC/g, les coliformes fécaux de 0 à 5,3.102UFC/g et les levures et moisissures de 4 UFC/g à 1,1.103UFC/g. Aucune colonie confirmée de salmonelles et d´Escherichia coli n´a été détectée. Concernant l´évaluation microbiologique, toutes les farines à cuire ont présenté une flore aérobie totale, des Escherichia coli et des salmonella satisfaisantes, 64,71% ont présenté des coliformes fécaux satisfaisantes et 94,12% ont présenté des levures et moisissures satisfaisantes. Toutes les farines instantanées ont présenté des charges microbiologiques satisfaisantes. Conclusion: globalement, les farines infantiles locales vendues à Ouagadougou sont de qualité physico-chimiques et microbiologiques satisfaisantes à l´exception de quelques farines à cuire.

Introduction: the quality of infant flours used to support dietary diversification is of great importance. Unfortunately, transformation processes result in poor hygiene practices. The purpose of this study was to evaluate the physicochemical and microbiological quality of local infant flours sold in Ouagadougou. Methods: physicochemical and microbiological parameters were determined according to standard methods. Data were processed on Excel 2016 and the averages were compared using XLSTAT 2016. Results: out of the 102 units of 20 local infant flour brands analyzed, the basic raw materials consisted of local cereals, legumes, enzymes, minerals and vitamins. Water content ranged from 1.92±0.01% to 5.51±0.03%, while pH ranged from 5.55±0.01 to 6.36±0.00. Total flora ranged from 2,4.102 CFU/g to 1,1.104 CFU/g, total coliforms from 0 to 2,8.103 CFU/g, fecal coliforms from 0 to 5,3.102 CFU/g, and yeasts and moulds from 4 CFU/g to 1,1.103 CFU/g. No confirmed Salmonella and Escherichia coli colonies were detected. With respect to the microbiological evaluation, all the cooking flours showed satisfactory total aerobic flora, Escherichia ncoli and Salmonella, 64.71% showed satisfactory faecal coliforms and 94.12% showed satisfactory yeasts and moulds. All instant flours had satisfactory microbiological loads. Conclusion: overall, local infant flours sold in Ouagadougou are of satisfactory physicochemical and microbiological quality, with the exception of some cooking flours.

Determinants of developmental milestones among children 0- 23 months at Kabale Hospital, Uganda

BACKGROUND :Approximately 200 million children globally fail to fulfil their development potential due to malnutrition, poor health, and unstimulating environments. Children in Kabale, Uganda, may be at particularly high risk as the rate of malnutrition in the region is likely to impact development. The study aimed to identify possible determinants influencing developmental milestones of breastfed and non-breastfed children aged 0-23 months. MATERIALS AND METHODSThe study was conducted at the young child clinic of Kabale hospital, among 250 children aged 0-23 months and their caregivers, for two months. The study adopted a comparative cross-sectional design, and systematic random sampling was used to select the respondents for the study. The socio-demographic characteristics, nutritional status, and feeding practices were assessed using structured pretested questionnaires. Developmental milestones of the children (communication, motor, fine motor, problem-solving, and social skills) were assessed using the modified ages and stages questionnaires. The data collected was tabulated, analysed statistically, and the results interpreted. RESULTS :Developmental scores were not associated with breastfeeding and minimum meal frequency. A milestone achievement of communication skills was associated with caregiver's education, caregiver's age and length-for-age. Gross motor scores were associated with the caregiver's age, weight-for-age, and length for age. Achievement of fine motor skills was associated with caregiver's education, caregiver's age, child's age, length for age, and children who met the minimum dietary diversity score. Problem-solving scores were associated with child's age, weight for age, length for age, and children who met the minimum dietary diversity. Personal social scores were associated with lower caregiver's age and normal weight for age Conclusion: Developmental scores were not associated with breastfeeding and minimum meal frequency. Development in early childhood was mainly associated with caregiver's age, caregiver's education, child's age, weight for age, length for age, and minimum dietary diversity score. Children under the care of younger caregivers and those who attained normal nutrition status had significantly more developed motor and social skills compared to children with older caregivers and undernourished children, respectively.

In vitro antibiotic susceptibility of bacterial pathogens and risk factors associated with culture positive neonatal sepsis in two hospitals, Katsina metropolis, Nigeria

Background: Neonatal sepsis is one of the most important causes of morbidity and mortality among neonates, particularly in developing countries. This study aimed to determine the risk factors and in vitro antibiotic susceptibility patterns of bacterial pathogens associated with neonatal sepsis in Federal Medical Centre (FMC) and Turai Umaru Yar'adua Maternal and Children Hospital (TUYMCH), Katsina, Nigeria. Methodology: A total of 60 hospitalized neonates evaluated for neonatal sepsis at the special care baby units (SCBU) of the two healthcare facilities whose parents gave informed consent were enrolled for the study between July and December 2020. Blood samples were aseptically collected from the neonates and cultured on BacT/Alert automated platform (BioMérieux, Mercy-Etoile, France) machine. Bacteria were identified from all positive cultures and in vitro susceptibility test was performed on the isolates to determine their minimum inhibitory concentrations (MICs) to eight selected antibiotics using the Vitek-2 compact system. Data were analyzed by SPSS version 22.0. Results: A total of 60 neonates with clinical features suggestive of sepsis were enrolled. The mean age of the neonates is 1.35±0.48 days while the mean weight is 2.13±0.89 kg. Neonates with early onset sepsis (<3 days) constituted 65% while those with late-onset sepsis (>3 days) constituted 35%. Thirty-one (51.7%) neonates were culture positive while 29 (48.3%) were culture negative for bacterial pathogens. Gram-positive bacteria predominated, constituting 80.6% while Gram-negative bacteria constituted 19.4%. The most frequent Gram-positive bacteria were coagulasenegative staphylococci (51.6%, 16/31), with Staphylococcus haemolyticus 5 (16.1%) predominating, while the most frequent Gram-negative bacteria isolate was Escherichia coli 2 (6.5%). A high degree of antibiotic resistance (>50% rate) was exhibited by the isolates against most of the tested antibiotics including third generation cephalosporins and fluoroquinolones. Gentamicin was the only antibiotic effective, with 65.5% of all isolates sensitive to it; 68.0% Gram-positives and 50.0% Gram-negatives. Vancomycin was also effective against Gram-positive bacteria, with 68.0% of the isolates sensitive to it. Previous premature delivery (64.5%, 20/31) and baby delivery at home were respectively the only maternal and neonatal factors significantly associated with culture-positive neonatal sepsis (OR=2.975, 95% CI=1.040-8.510). There was no significant difference between culture positive and negative neonatal sepsis with respect to clinical manifestations such as refusal of feeds, fever, jaundice, fast breathing, convulsion and body temperature (p>0.05). Conclusion: Neonatal sepsis is a substantial cause of mortality and morbidity among neonates admitted at the FMC and TUYMCH, Katsina, Nigeria. There is a need for regular surveillance of the risk factors, causative organisms, and antibiotic susceptibility patterns of isolated pathogens, to inform the choice of empirical antibiotic treatment pending the results of blood cultures

Pratiques alimentaires et état nutritionnel des nourrissons exposés au VIH dans un centre de santé à Abidjan / Feeding practices and nutritional satus of infants exposed to HIV in a health center in Abidjan

Introduction. L'objectif de notre étude était de décrire les pratiques alimentaires des nourrissons nés de mères infectées par le VIH ainsi que leur état nutritionnel. Méthodes. Il s'agit d'une étude transversale à visée descriptive et analytique sur une période de 2 mois (01 juin au 03 Août 2016) portant sur 101 nourrissons nés de mères séropositives âgés de 6 à 24 mois au moment de l'enquête. Des informations sur les pratiques alimentaires et l'état nutritionnel des nourrissons ont été recueillies. Résultats. L'âge moyen des nourrissons était de 14,5 mois et le sex ratio de 0,71. Plus de 3/4 des nourrissons étaient eutrophiques à la naissance (77,2%). Le budget alimentaire des ménages était compris entre 2000 f/CFA et 3000 f/CFA (45,54 %). L'allaitement maternel a été réalisé chez 73,3% des nourrissons. La prévalence de l'AME était de 65,4%. L'âge à l'arrêt de l'allaitement était de 6 mois chez plus de la moitié (52,7%) des nourrissons. la majorité des nourrissons (99,0%) avait une fréquence de repas adaptée à leur âge. L'âge d'introduction d'aliments de complément était inadapté chez un tiers des nourrissons (30,6%), l'âge d'introduction au repas familial était inapproprié chez 64,9 % des nourrissons et plus de la moitié des nourrissons (53,3%) avait une fréquence de repas lactés inadaptée. le score de diversifi cation alimentaire était ≥ 4 aliments chez 18,8% des cas. Les céréales et les tubercules ont été le plus souvent consommés par les nourrissons (97 %) contrairement aux fruits et légumes riches en vitamines A (20%) et aux œufs (14%). Une émaciation a été relevée dans 9,9% des cas. Les pratiques alimentaires associés à la malnutrition étaient l'âge d'introduction d'aliments solides, semis liquides et mous inadapté p=0,001, l'âge d'introduction au repas familial inadapté p=0,015, la fréquence alimentaire minimale inadaptée p=0,001 et le minimum alimentaire acceptable insuffi sant p=0,012. La prévalence du VIH était de 5,9% Conclusion. Les nourrissons nés de mères séropositives sont vulnérables à la malnutrition. Les acteurs des services de PTME doivent insister dans leurs pratiques sur la prise en charge nutritionnelle de ces nourrissons.

South African neonates with mild and moderate hypoxic-ischaemic encephalopathy

Background. Clear risk profiles of neonates with mild and moderate hypoxic-ischaemic encephalopathy (HIE) are lacking.Objective. To describe and compare factors associated with mild and moderate HIE in South African neonates. Methods.A prospective, comparative design was used to describe factors among South African neonates with mild (n=13) and moderate (n=33) HIE in an urban tertiary academic hospital. HIE diagnosis and encephalopathy grading were conducted using the modified Sarnat stages. Thompson scores were recorded. Participants' clinical records were reviewed to identify factors. Descriptive data were obtained. Chi-square and Fisher's exact tests were used to compare categorical data, and Mann-Whitney tests were used to compare continuous data between groups. Results. Significant differences were found between groups' admission (p<0.001) and highest Thompson scores (p<0.001). The mild group's APGAR scores were significantly higher than those of the moderate group at five (p=0.012) and ten minutes (p=0.022). Duration of resuscitation (p=0.011) and time to spontaneous respiration (p=0.012) also differed significantly between groups. Significantly more moderate than mild participants received therapeutic hypothermia(TH) (p<0.001).Conclusion. Clinical tests and management factors differed significantly between groups. The findings provided the multidisciplinary team with an increased understanding of the heterogeneous HIE population and add to existing evidence for identifying neonates eligible for TH in resource-limited settings

Infections respiratoires aigües virales chez les enfants de moins de 15 ans à Conakry: étiologies et prise en charge / Acute viral respiratory infections of children aged 0-15 years in the city of Conakry: aetiologies and management

Introduction. Les infections respiratoires aiguës (IRA) sont des pathologies ubiquitaires très fréquentes, touchant aussi bien les adultes que les enfants. L'inclusion des vaccins conjugués, contre les pneumocoques et l'Haemophilus influenzae type B a modifié l'épidémiologie en réduisant la prévalence de ces bactéries dans les atteintes infectieuses respiratoires, la prédominance virale est devenue la règle. Notre travail avait pour objectif d'identifier les principaux virus responsables d'IRAS chez les enfants au service de pédiatrie de Donka de décrire la prise en charge des enfants. Patients et méthodes. Étude descriptive prospective de 6 mois allant du 01 Avril au 30 Septembre 2022 incluant les enfants admis au service pour IRAS dont une PCR a été réalisée sur prélèvement nasopharyngé. Résultats. Une proportion de 3,3% des 1584 enfants avaient une IRA virale. 51,1% avaient moins de 5 ans. La proportion des filles était de 63,05% et 76,09% des enfants étaient vaccinés selon le programme élargi de vaccination (PEV). Les motifs de consultation les plus fréquents étaient : fièvre, difficulté respiratoire, asthénie physique, myalgie et toux. La bronchiolite était le diagnostic le plus fréquent. Le diagnostic clinique et radiologique était dominé par la bronchiolite, la bronchopneumonie et la pneumonie. La PCR était positive dans 3,26% des cas dont 2/3 pour le virus influenza et 1/3 pour le coronavirus. Le paracétamol, l'oxygénation, l'antibiothérapie et le sérum physiologique dominaient le traitement. Conclusion. La prévalence des IRA reste élevée avec une faible implication virale. Une étude plus poussée comprenant la microbiologie des prélèvements nasopharyngés et la PCR est nécessaire

Introduction. Acute respiratory infections (ARI) are very common ubiquitous pathologies, affecting both adults and children. The inclusion of conjugate vaccines, against pneumococci and Haemophilus influenzae type b, has changed the epidemiology by reducing the prevalence of these bacteria in respiratory infectious diseases, viral predominance has become the rule. The aim of our study was to identify the main viruses responsible for ARI in children at the Donka Pediatric Department and to secribe the management of patients. Patients and methods. This was a prospective descriptive study of 6 months from 01 April to 30 September 2022 including children admitted to the service for IRAS whose PCR was performed on nasopharyngeal swab. Results. A proportion of 3.3% of the 1584 children had viral SARI. 51.1% were under 5 years of age. The proportion of girls was 63.05% and 76.09% of children were vaccinated according to the EPI. The most common reasons for consultations were fever, difficulty breathing, physical asthenia, myalgia and cough. Bronchiolitis was the most common diagnosis, Clinical and radiological diagnosis was dominated by bronchiolitis, bronchopneumonia and pneumonia. PCR was positive in 3.26% of cases including 2/3 for influenza virus and 1/3 for coronavirus. Paracetamol, oxygenation, antibiotic therapy and saline dominated treatment. Conclusion. The prevalence of SARI remains high with low viral involvement. Further study including bacteriology of nasopharyngeal specimens and PCR is needed

Establishing communities of practice to improve health policy, systems and reproductive, maternal, newborn, child and adolescent health in West Africa

Objectives: To explore and analyse factors that facilitate and inhibit the initiation and functioning of a national and transnational Community of Practice (CoP) for health policy and systems (HPS) and Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) in West Africa and to identify lessons for CoP interventions in similar multilingual low and middle-income contexts. Design: A case study, with the case defined as processes, enablers and barriers to the initiation and functioning of a national and transnational CoP for HSP and RMNCAH in West Africa and drawing on a review and analysis of secondary data from the program, workshop, country team and project reports, and training sessions. Setting: The Economic Community of West African States (ECOWAS). Participants: Professionals from two Anglophone (Ghana and Sierra Leone) and four Francophone (Burkina Faso, Cote d'Ivoire, Niger e Senegal) ECOWAS countries. Interventions: Training and mentoring of multi-disciplinary country teams supported by small research grants to undertake formative evaluation and advocacy of priority HPS and RMNCAH issues; support for CoP development within and across country teams. Results: The desire to learn from peers and mentors was a major enabler of the process. Human and financial resource availability, competing demands for time, communication in the context of a Francophone-Anglophone official language divide and the arrival of COVID-19 were all constraints. Conclusions: This study highlights the processes, achievements, and challenges of establishing country-level and transnational CoPs in West Africa. CoPs require sustained human and financial resource investments, communication and medium-to-long-term implementation support for sustainability and impact.

The characterization of a hospitalized population at the pediatric emergency service of mother and child hospital, Marrakech, Morocco

Introduction: the pediatric emergency department is the first contact between the population and the hospital. Consequently, its dysfunction influences the quality of general health care. However, any successful policy must first be based on convincing results hence the need to better explore this service, diagnose the various dysfunctions, and survey disease trends to identify the needs of the local population. In this perspective, we propose to describe the epidemiological profile of children hospitalized at the emergency service of the Mother-Child hospital, University Hospital Centre Marrakech, and establish the prevalence table for childhood pathologies. Methods: a retrospective study was carried out in pediatric emergency services for 1658 hospitalized patients between March 2015 and December 2018. The collected data concerns mainly the socio-demographic, clinical profile, evolution status, mode of admission, and medical history. Results: the characterization of the studied population by sex and age showed a predominance of Male with a sex ratio of 1.36, infants with 625 patients. Concerning the final diagnosis, the most frequent pathologies affected the respiratory system in 28% of cases, then the digestive system (11.3%), while infectious pathologies represented 10.7% of admissions. The death rate in the emergency department was 7.4%. Multivariate analysis of the data showed a statistically significant relationship between the final diagnosis (16 diseases by a system according to The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) and age, season, and weight. Thus, for the association between Diseases of the digestive system and weight (aOR=1.052, 95% CI= 1.019-1.086, p=0.02). While for Diseases of the skin and subcutaneous tissue and the autumn season (aOR=11.37, 95% CI= 1.272-<101.777, p=0.03) and age has a negative significance for most diseases. Conclusion: the epidemiological profile study will allow knowledge of patient´s pathologies typology for a well-supported and better definition of needs.

Prioritising maternal mental health and infant neurodevelopment research in Africa ­ A call for action amidst the backdrop of the COVID­19 pandemic

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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.

The neonatal transfer process through the lens of neonatologists at public hospitals in South Africa

Background: Neonatal care is provided by various levels of healthcare facilities in South Africa. Intensive care for neonates is only provided at the higher levels, hence the need for transfers from lower-level to higher-level facilities (e.g. primary hospitals to tertiary hospitals) or across levels of facilities, particularly when life-threatening situations arise (e.g. cardiac deterioration, respiratory deterioration and desaturation). Aim: The aim of the study was to explore neonatologists' views regarding the neonatal transfer process and to describe the preparedness of advanced life support (ALS) paramedics to undertake such transfers. Setting: The setting consisted of neonatologists from three provinces i.e. KwaZulu-Natal, Gauteng and Western cape. Method: A qualitative descriptive design was utilised in this study. Semistructured interviews were conducted on the public health hospitals in three provinces (N = 9; n = 3) with neonatologists (N = 7; n = 7) who were involved in the transfers of critically ill neonates. The process of thematic analysis was used. Results: The themes that emerged in this study were: an awareness of local contextual realities related to neonatal transfers, challenges evident within the context of neonatal transfers, decision-making around the transfer of ill neonates, ALS paramedic preparedness for transfers and good clinical governance Conclusion: The study found that there was a need to be aware of local contextual realities confronting neonatal transfers, a need for greater preparedness for paramedics to undertake these transfers, a need for a sound referral processes and a need for coordinated transfer effort between paramedics, hospital staff and transport team members for the successful transfer of critically ill neonates. Contribution: The findings highlight the challenges confronting the neonatal transfer process in South Africa through the lens of neonatologist at public hospitals. Hence, the study reinforces the preparedness and coordination of the transfer process, along with more efficient communication between paramedics, hospital staff and the transfer team.

Parenting amid COVID­19: Challenges and supports for families with young children in South Africa

Background. National response mechanisms, including lockdown regulations and financial and food aid, have exacerbated adversity and provided support. They have also exposed existing inequalities, with individuals and families able to cope and recover to varying degrees. Families with young children, specifically those under the age of 5, are rarely the focus of outreach, although they care for the most vulnerable group in our society. Objective. To rapidly gather as much nationally representative information as possible on the challenges experienced by families with children under 5 years of age and the support they most urgently require. Methods. A short online survey was launched in late 2020 on a zero­cost mobile application reaching over 2 million users. A total of 15 912 individuals were eligible for participation and 13 224 parents (caring for 18 858 children under 5 years) were included in the analytic sample. Outcomes were grouped by (a) negative impacts of the pandemic, including disruptions in childcare, missed clinic visits, feeding challenges, difficulties in showing affection, behavioural challenges, and violence in the home; and (b) support received and required by the family. Chi­squared tests examined outcomes across the socio­demographic variables and standardised adjusted residuals were calculated to measure strength of differences. Results. Fathers made up 30% of the sample. Just over half of parents cared for one child under 5 and 41% for 2 ­ 3 children under 5. More than three­quarters (82%) of parents reported experiencing at least one challenge, with the most common being disruptions in childcare (69%), difficulties feeding their child (50%) and showing affection (41%). The main underlying factors were fear of infection, lack of money and negative affect in the household including stress, tension and a sense of hopelessness and depression. Fathers and families living in rural areas reported the most challenges. They were more likely to report difficulties showing affection, struggles in providing meals for young children, and higher levels of violence towards children in the home. Although needs considerably outweighed support received, government compared with civil society organisations and communities had the highest penetration of support to families, reaching between a quarter and a third of families. Conclusion. Families with young children face many challenges with little outside support for their material and psychosocial needs. It is essential that those mandated with ensuring the wellbeing of young children understand the needs of families and have the capacity to reach them in general, and particularly during times of crisis.

Childhood immunization during the COVID-19 pandemic: experiences in Haiti, Lesotho, Liberia and Malawi

Objective: To examine changes in vaccination of children younger than 1 year during the coronavirus disease 2019 (COVID-19) pandemic (March 2020-August 2021) in Haiti, Lesotho, Liberia and Malawi. Methods: We used data from health management information systems on vaccination of children aged 12 months or younger in districts supported by Partners In Health. We used data from January 2016 to February 2020 and a linear model with negative binomial distribution to estimate the expected immunization counts for March 2020-August 2021 with 95% prediction intervals, assuming no pandemic. We compared these expected levels with observed values and estimated the immunization deficits or excesses during the pandemic months. Findings: Baseline vaccination counts varied substantially by country, with Lesotho having the lowest count and Haiti the highest. We observed declines in vaccination administration early in the COVID-19 pandemic in Haiti, Lesotho and Liberia. Continued declines largely corresponded to high rates of COVID-19 infection and discrete stock-outs. By August 2021, vaccination levels had returned to close to or above expected levels in Haiti, Liberia and Lesotho; in Malawi levels remained below expected. Conclusion: Patterns of childhood immunization coverage varied by country over the course of the pandemic, with significantly lower than expected vaccination levels seen in one country during subsequent COVID-19 waves. Governments and health-care stakeholders should monitor vaccine coverage closely and consider interventions, such as community outreach, to avoid or combat the disruptions in childhood vaccination.