The Tools for Integrated Management of Childhood Illness (TIMCI) study protocol: a multi-country mixed-method evaluation of pulse oximetry and clinical decision support algorithms.

Effective and sustainable strategies are needed to address the burden of preventable deaths among children under-five in resource-constrained settings. The Tools for Integrated Management of Childhood Illness (TIMCI) project aims to support healthcare providers to identify and manage severe illness, whilst promoting resource stewardship, by introducing pulse oximetry and clinical decision support algorithms (CDSAs) to primary care facilities in India, Kenya, Senegal and Tanzania. Health impact is assessed through: a pragmatic parallel group, superiority cluster randomised controlled trial (RCT), with primary care facilities randomly allocated (1:1) in India to pulse oximetry or control, and (1:1:1) in Tanzania to pulse oximetry plus CDSA, pulse oximetry, or control; and through a quasi-experimental pre-post study in Kenya and Senegal. Devices are implemented with guidance and training, mentorship, and community engagement. Sociodemographic and clinical data are collected from caregivers and records of enrolled sick children aged 0-59 months at study facilities, with phone follow-up on Day 7 (and Day 28 in the RCT). The primary outcomes assessed for the RCT are severe complications (mortality and secondary hospitalisations) by Day 7 and primary hospitalisations (within 24 hours and with referral); and, for the pre-post study, referrals and antibiotic. Secondary outcomes on other aspects of health status, hypoxaemia, referral, follow-up and antimicrobial prescription are also evaluated. In all countries, embedded mixed-method studies further evaluate the effects of the intervention on care and care processes, implementation, cost and cost-effectiveness. Pilot and baseline studies started mid-2021, RCT and post-intervention mid-2022, with anticipated completion mid-2023 and first results late-2023. Study approval has been granted by all relevant institutional review boards, national and WHO ethical review committees. Findings will be shared with communities, healthcare providers, Ministries of Health and other local, national and international stakeholders to facilitate evidence-based decision-making on scale-up.Study registration: NCT04910750 and NCT05065320.

Pulse oximetry and clinical decision support algorithms show potential for supporting healthcare providers to identify and manage severe illness among children under-five attending primary care in resource-constrained settings, whilst promoting resource stewardship but scale-up has been hampered by evidence gaps.This study design article describes the largest scale evaluation of these interventions to date, the results of which will inform country- and global-level policy and planning .

[Paediatric digital clinical decision support for global health]. / Systèmes d'aide à la décision clinique pour la pédiatrie en santé globale.

Effective, scalable and sustainable strategies to improve quality of care are needed to address the substantial burden of preventable deaths of children under-five in resource-constrained settings. Clinical decision support systems (CDSS), digital tools which generate recommendations for healthcare providers based on patient-specific information, show promise. By strengthening adherence to evidence-based assessment, diagnosis and management and generating high-quality data, CDSS can improve quality care - care that is effective, safe, people-centered, timely, equitable, integrated and efficient. Designing and implementing CDSS that deliver this impact is a complex and iterative process. We advocate for collaboration on developing and evaluating these tools to guide their implementation for maximal impact.

Des stratégies efficaces pour améliorer la qualité des soins sont nécessaires pour réduire les nombreux décès évitables d'enfants de moins de cinq ans dans des contextes aux ressources limitées. Les systèmes d'aide à la décision clinique (SADC) sont des outils numériques générant des recommandations aux prestataires de soins sur la base des informations du patient. En orientant l'évaluation et la prise en charge de façon méthodique, ils peuvent permettre d'améliorer la qualité des soins et de générer des données de qualité. Ainsi, les soins peuvent être plus sûrs, centrés sur la personne, opportuns, équitables, intégrés et efficients. La conception et la mise en œuvre d'un SADC de manière durable est un processus complexe et continu. Nous plaidons pour la collaboration afin de guider leur mise en œuvre pour un impact maximal.

Height and weight development of low-birth-weight infants at 9 months.

BACKGROUND: Low birth weight (LBW) is defined as a birth weight <2500 g at birth, regardless of the term of pregnancy. The objective of this study was to evaluate the height and weight development of LBW infants from 0 to 9 months of corrected age (CA) in Senegal. METHOD: This was a prospective, descriptive, and analytical cohort follow-up of up to 9 months of CA including all live newborns of LBW hospitalized and followed up from 1 August 2019 to 31 May 2020. World Health Organization growth charts were used to assess height and weight growth. RESULTS: During the study, 136 LBW newborns were included. The mean gestational age was 32 weeks of amenorrhea. At discharge, 46 children (33.82%) were exclusively breastfed. At birth, the mean weight was 1487 g (3rd-10th percentile) and the mean height was 41.52 cm (10th-25th percentile). At 9 months of CA, the mean weight was 8119 g (median) and the mean height was 74 cm (median). The children had achieved satisfactory growth in weight (84%) and height (89%). At 9 months of CA, 27% of the children were behind in one of the four areas of psychomotor development. CONCLUSION: At the end of 9 months of CA, height and weight were normal.

[Impact of COVID-19 pandemic on health care activities in the Department of Pediatrics at the Albert Royer National Children's Hospital: preliminary study comparing the first quarter of 2019 and 2020]. / Impact de la pandémie à COVID-19 sur les activités du Service de Pédiatrie du Centre Hospitalier National d´Enfants Albert Royer: étude préliminaire comparant les premiers trimestres des années 2019 et 2020.

INTRODUCTION: the purpose of our study was to assess the impact of COVID-19 on health care activities and prescriptions at the Albert Royer National Children´s Hospital in Dakar, Senegal. METHODS: we conducted a retrospective, descriptive and analytical study comparing outpatient activity, hospitalizations and prescriptions over the first-quarter of 2019 and 2020. RESULTS: an average drop in external consultations of 33% was reported in the first quarter of 2020 (the pandemic period) compared to the first quarter of 2019. An increase in hospitalizations was observed mainly in the months of January and February. However, a drop of 11% was reported in the month of March. The same is true for prescriptions, for which a drop of 10% was reported only in the month of March.Conclusion: the current COVID-19 pandemic has a significant impact on outpatients´ consultations, health care activities and prescriptions at the Albert Royer National Children´s Hospital. Effective measures should be taken to prevent effects on mortality and Hospital activities.

[Effect of COVID-19 on routine immunization schedule in Senegalese hospitals]. / Impact de la COVID-19 sur la vaccination de routine en milieu hospitalier au Sénégal.

INTRODUCTION: the COVID-19 pandemic has pushed the world to implement drastic prevention methods based on limiting population movements that have an impact on public health policies, such as vaccination. The purpose of this work was to assess the effect of these preventive measures on routine immunization schedules in hospitals after the outbreak of this pandemic in Senegal. METHODS: we conducted a retrospective cross-sectional study in the Vaccination Unit of the Abass NDAO hospital center in August 2020. We compared data from the Vaccination Unit over the period March-August of the last three years (2018, 2019 and 2020). The parameter studied was the number of vaccine doses administered in the different periods according to the expanded immunization program. RESULTS: in April, the number of doses of vaccines given at 6 weeks was 36 in 2018, 29 in 2019 and 15 in 2020, reflecting a decrease of 50% compared to March. In July, the number of doses given was 40 in 2018, 35 in 2019 and 15 in 2020, reflecting a reduction of 42% compared to 2019. CONCLUSION: measures to combat this pandemic should not affect routine immunization programmes, especially in our resource-constrained country. It is essential to continue vaccination schedule for children and to identify children who have missed vaccine doses in order to implement catch-up vaccination.

[Heart failure with normal heart revealing complex arteriovenous malformation of the lower limb in a child: case study and literature review]. / Insuffisance cardiaque sur cœur normal révélant une malformation artériole-veineuse complexe du membre inferieur chez un enfant: à propos d'une observation et revue de la littérature.

Arteriovenous malformations (AVM) are congenital high-flow vascular defects. They are very rare in children. Diagnosis and treatment are often delayed due to their atypical place of occurrence and to their variable clinical manifestations. We report the case of a child treated at the National Centre Hospitalier Albert Royer Children, Dakar. A boy aged 9 years was referred from a health facility in rural areas for the treatment of heart failure. Admission clinical examination showed impaired general condition, global heart failure syndrome and voluminous right warm inguinocrural mass extended to the right abdominal wall (iliac fossa and right flank), with poorly defined limits. Auscultation of this mass showed a thrill and diffuse murmur. Cardiac ultrasound showed severe pulmonary arterial hypertension (PAH) with extensive impairement of the heart cavities, without cardiac structural involvement. The diagnosis of AVM was confirmed by doppler ultrasound of the mass complemented by angiography scan. They showed multiple arteriovenous fistulas within the mass. The diagnosis of complex stage IV AVM (according to Schöbinger classification) of the root of the right thigh was retained. Clinical treatment of heart failure was based on furosemide, spironolactone and captopril to obtain hemodynamic stabilization before possible surgical procedure. Arteriovenous malformations of the limbs, in particular of the proximal end of the lower limb in children are still largely unknown, hence frequent diagnostic errors and delays. Their evolution is unpredictable requiring early diagnosis and careful monitoring involving multidisciplinary interaction between pediatrics, surgeons and radiologists.

[Hemolytic-uremic syndrome (HUS) in children at the University Hospital Center in Dakar: about four cases]. / Syndrome hémolytique et urémique de l'enfant au Centre Hospitalier Universitaire (CHU) de Dakar: à propos de quatre observations.

Hemolytic-uremic syndrome (HUS) is a common cause of organic acute renal failure (ARF) in children. It is a progressive complication of acute gastroenteritis (AGE), especially caused by Escherichia coli in children. This study aimed to describe the clinical, therapeutic and evolutionary aspects of this affection in four children. We collected four cases of HUS. The average age was 10,5 months (5-15mois), exclusively boys. Clinical examination revealed a hemolytic anemia (pallor and jaundice), oligoanuria and edematous syndrome (2 cases), arterial hypertension (1 patient), AGE associated with severe dehydration and hypovolemic shock (2 patients), consciousness disorders. ARF was found in all patients as well as thrombocytopenia and schizocytes smear. Direct Coombs test was negative. Hyperkalemia was found in 3 patients, of whom 1 with hyperkalemia level of more than 9.2 mmol/L, hyponatremia at 129 mmol/l (1 patient) and hypernatremia at 153 mmol/l (1 patient). HUS was secondary to pneumococcal pneumonia (1 patient) while AGE was secondary to E. coli (1 patient). The treatment was mainly symptomatic and included fluid restriction, transfusion of red cell concentrates, diuretics, peritoneal dialysis and hemodialysis. The evolution was marked by the onset of chronic renal failure (1 patient) after 6 months of follow-up and by recovery (1 case). Three patients died. HUS is the most common cause of organic acute renal failure in newborns. Diagnosis is essentially biological, treatment is mostly symptomatic.

[Congenital hypothyroidism in Dakar: about 28 cases]. / Hypothyroïdie congénitale à Dakar: à propos de 28 cas.

Child hypothyroidism has been little studied in Senegal. The aim of this study was to evaluate the epidemiological, diagnostic and evolutionary aspects of congenital hypothyroidism. We conducted a descriptive-analytical retrospective study of all children treated for congenital hypothyroidism at the Albert-Royer National Children's Hospital Center over the period from 2001 to 2014 (14 years). We collected and analyzed socio-demographic, clinical and evolutionary data from patient medical records. A total of 28 patients were included in the study, an average of 2 cases per year. The average age of discovery of hypothyroidism was 54.25 ± 43 months with a female predominance (Sex-ratio 0.47). Only 2 cases of hypothyroidism were diagnosed in the neonatal period. Consanguinity was present in 68% of patients. Clinical signs were dominated by the delay in psychomotor acquisitions (96%), hypothermia (46%), cranio-facial dysmorphia (43%) and goiter (39%). Growth retardation was constant beyond 6 months. The etiologies were dominated by hormonosynthesis disorders (84.21%). During the study period, mean SD of patients had decreased from -3.5 SD to -2.25 SD for a median treatment duration of 28 months. Mental retardation was present in 73% of cases. Growth retardation and mental retardation were more severe as the diagnosis was late. Our results confirm the inadequacy of early management of patients. It is urgent to implement a routine neonatal screening system in order to improve the mental prognosis of this condition.

Evaluation des dysnatremies au cours de la deshydratation aigue de l'enfant au Centre Hospitalier National d'Enfants Albert Royer (CHNEAR) de Dakar

INTRODUCTION : La deshydratation aigue represente une urgence pediatrique courante; generalement secondaire a la diarrhee aigue. L'objectif de cette etude etait d'apprecier; au cours de la deshydratation aigue; la prevalence des dysnatremies; leur impact sur la morbi-mortalite et les implications therapeutiques dans la prise en charge.MATERIEL ET METHODES : Il s'agissait d'une etude retrospective menee sur deux ans (2009 a 2010); au Centre National Hospitalier d'Enfants Albert Royer; incluant tous les enfants de 2 mois a 5 ans; souffrant de deshydratation aigue et ayant eu un ionogramme sanguin. Sur 310 cas de deshydratation recenses; 205 dossiers repondaient aux criteres d'inclusion et ont constitue notre population d'etude. Nous avons recueilli les donnees epidemiologiques; cliniques; biologiques; therapeutiques et evolutives. Nous avons retenu la classification de la deshydratation en legere; moderee et severe qui figurait dans le dossier. L'hyponatremie etait definie par une natremie strictement inferieure a 135 mmol/l; l'hypernatremie par une natremie superieure a 150 mmol/l. L'analyse a ete faite sur Epi info 3.5. Un p 0.05 etait considere comme significatif. RESULTATS : L'incidence de la deshydratation etait de 3;78%. L'age moyen etait de 12.2 mois (2 a 48 mois) et le sex ratio de 1;52 en faveur des garcons. Il y avait deux pics d'hospitalisation; en janvier-fevrier et en septembre. Un trouble digestif (diarrhee ou vomissements) etait present chez 202 enfants (98;5%) et la denutrition chez 35 enfants (17;1%). La gastroenterite aigue (159 cas) representait 77;5% des causes. La deshydratation etait jugee legere dans 20 cas (9;7 %); moderee dans 91 cas (44;4%) et severe [JK1] dans 94 cas (45;8%). [JK2] L'hyponatremie etait presente chez 105 enfants (51;2%) et elle etait severe; inferieure a 125 mmol/l; chez 28 (13;7%). L'hypernatremie etait notee chez 15 enfants (7;3%). Quatre-vingt pour cent des hypernatremies et 51;5% des hyponatremies etaient associees a une deshydratation severe (P