Incidence and Predictors of Poor Outcome amongChildhood Tuberculosis in the North of Cameroon

Background. Childhood tuberculosis (TB) has been neglected by TB programs in Sub-Saharan Africa. The aim of this study was to determine the incidence and predictors of poor outcome in children with TB in the North region of Cameroon. Methods.It was a retrospective cohort study based on hospital TB registers and treatment TB forms, in all of the 18 functional diagnosis and therapeutic centers (DTC) in the North region. All children aged 0-15years, on anti-TB treatment between 2010-2016 were enrolled. Logistic regression was used to find independent factors associated to poor outcome. Results. Of the 668 children included [321 (48.1%) boys], the median (25th-75thpercentile) age was 11(6-14) years, with 75.9% children aged >5 years. Pulmonary TB was the most common (62.9%) with 34.3% smear-negative pulmonary TB. Extrapulmonary TB (62.1%) was mostly found in children aged 0-5years. HIV/TB coinfection was 10.3%. Incidence (95%CI) of poor outcome was 4.0 %( 2.5-5.5%). Predictors [OR (95%CI)] of poor outcome were: HIV positivechildren [3.995(1.131-14.112), p=0.031], management in peripheral DTC [32.451(4.211-250.099), p=0.001], and transferred in patients from a peripheral zone toward a 3rdor 4thDTC category [4.602(1.092-19.386), p=0.037]. Conclusion.Incidence of poor outcome of childhood TB was quite low in the North region of Cameroon. HIV, peripheral TDC and transferred in patients were predictors of poor outcome. A better management of HIV, retraining DTC personnel and early reference from peripheral DTC would reduce poor outcome among childhood TB.

Electrocardiographic safety of daily Hydroxychloroquine 400mg plus Azithromycin 250mg as an ambulatory treatment for COVID-19 patients in Cameroon.

ObjectiveTo determine the early electrocardiographic changes in a cohort of ambulatory cameroonian COVID-19 patients treated with hydroxychloroquine and Azithromycin. DesignProspective study. SettingTreatment centres of the city of Yaounde, Cameroon, from May 7th to 24th 2020. ParticipantsWe enrolled 51 consecutive confirmed COVID-19 on RT-PCR who having mild forms of COVID-19 and treated by hydroxychloroquine 200mg twice daily during seven days plus Azithromycin 500 mg the first day and 250 mg the remaining 4 days as per national standard. Main outcomes measuresThe primary end-point was the change in QTc interval between day 0 (D0), day 3 (D3) and day 7 (D7). Secondary endpoints were changes in all other cardiac electrical conductivity patterns and the occurrence of clinical arrhythmic events during the course of treatment. ResultsThe population (29 men and 22 women) was aged 39 {+/-} 11 years (range 17 to 61 years). Mean Tisdale score was 3.35{+/-}0.48. No significant change from baseline (D0) of QTc was observed at D7 (429{+/-}27 ms at D0 versus 396{+/-}26 ms at D7; p=0.27). A reduction of heart rate was observed between the D0 and D7 (75{+/-}13 bpm versus 70{+/-}13 bpm, p = 0.02) with increased QRS duration between D0 and D7 (95{+/-}10 ms versus 102{+/-}17 ms, p = 0.004). No symptomatic arrhythmic events occurred during the treatment course. ConclusionsNo life-threatening modifications of the QT interval was observed in non-severe COVID-19 patients treated ambulatory with hydroxychloroquine and azithromycin. Studies are needed in critical-ill and older patients.