Under-Five Mortality in Buea Health District, Southwest Cameroon: Evidence from a Community-Based Birth Cohort Study of Rate, Causes, and Age-Specific Patterns.

BACKGROUND: Updating the knowledge base on the causes and patterns of under-five mortality (U5M) is crucial for the design of suitable interventions to improve survival of children under five. OBJECTIVES: To assess the rate, causes, and age-specific patterns of U5M in Buea Health District, Cameroon. METHODS: A retrospective cohort study involving 2000 randomly selected households was conducted. Live births registered between September 2004 and September 2009 were recorded. The under-five mortality rate (U5MR) was defined by the number of deaths that occurred on or before 5 years of age per 1000 live births. Causes of death were assigned using the InterVA-4 software. RESULTS: A total of 2210 live births were recorded. There were 92 deaths, and the U5MR was 42 per 1000 live births. The mean age at death was 11 ± 15.9 months. The most frequent causes of death were neonatal causes (37%), malaria (28%), and pneumonia (15%). Deaths during infancy accounted for 64.1% of U5M, with 43.5% neonatal (86% occurring within the first 24 hours of life) and 20.7% postneonatal. The main causes of death in infancy were birth asphyxia (37.5%), pneumonia (17.5%), complications of prematurity (10%), and malaria (10%). Child deaths accounted for 35.8% of U5M. Malaria, pneumonia, and diarrhoeal illnesses accounted for the majority of child deaths. CONCLUSIONS: Almost half of U5M occurred during the neonatal period. Improvements in intrapartum care and the prevention and effective treatment of neonatal conditions, malaria, and pneumonia could considerably reduce U5M in Buea.

Prevalence and determinants of anaemia in children aged 6-59 months in Africa: a protocol for systematic review and meta-analysis.

INTRODUCTION: Anaemia, especially in children aged <5 years, is a global health problem disproportionately affecting populations in low-income and middle-income countries. It is associated with high disability and death rates and has a negative effect on development. This study seeks to evaluate the prevalence and determinants of anaemia in children aged 6-59 months residing in Africa. METHODS AND ANALYSIS: This protocol was prepared using the 2015 Preferred Reporting Items for Systematic Reviews and Meta-analyses for Protocols guidelines. Relevant citations will be identified by searching EMBASE, Web of Science, PubMed, Global Medicus Index and African Journals Online from inception to 30 September 2019 with no language restrictions. Two authors will independently screen and select eligible studies for the review. Random-effect meta-analytic methods will be used to pool study-specific estimates and heterogeneity will be assessed and quantified using the χ2 test on Cochrane's Q and I2 statistics, respectively. Publication bias will be evaluated using funnel plots and Egger's test. Subgroup analysis and multiple meta-regression using backward elimination will be performed to investigate sources of substantial heterogeneity. ETHICS AND DISSEMINATION: No ethical approval is required for this study as it is based on already published data. The findings of the review will be published in a peer-reviewed journal and presented at conferences.

Primary care challenges of an obscure case of "Alice in Wonderland" syndrome in a patient with severe malaria in a resource-constrained setting: a case report.

BACKGROUND: "Alice in Wonderland" syndrome (AIWS) is a rare neurological abnormality characterized by distortions of visual perceptions, body schema and experience of time. AIWS has been reported in patients with various infections such as infectious mononucleosis, H1N1 influenza, Cytomegalovirus encephalitis, and typhoid encephalopathy. However, AIWS occurring in a patient with severe malaria is less familiar and could pose serious primary care challenges in a low-income context. CASE PRESENTATION: A 9-year-old male of black African ethnicity was brought by his parents to our primary care hospital because for 2 days he had been experiencing intermittent sudden perceptions of his parents' heads and objects around him either "shrinking" or "expanding". The visual perceptions were usually brief and resolved spontaneously. One week prior to the onset of the visual problem, he had developed an intermittent high grade fever that was associated with other severe constitutional symptoms. Based on the historical and clinical data that were acquired, severe malaria was suspected and this was confirmed by hyperparasitaemia on blood film analysis. The patient was treated with quinine for 10 days. Apart from a single episode of generalized tonic-clonic seizures that was observed on the first day of treatment, the overall clinical progress was good. The visual illusions completely resolved and no further abnormalities were recorded during 3 months of follow-up. CONCLUSION: Symptoms of AIWS usually resolve spontaneously or after treatment of an underlying cause. In our case, the successful treatment of severe malaria coincided with a complete regression of AIWS whose aetiology was poorly-elucidated given the resource constraints. In any case, the good outcome of our patient aligns with previous reports on acute AIWS that highlight a limited need for excessive investigation and treatment modalities which are, in passing, predominantly unaffordable in resource-limited primary care settings.