Decrease in Hospitalizations and Increase in Deaths during the Covid-19 Epidemic in a Pediatric Hospital, Yaounde-Cameroon and Prediction for the Coming Months.

BACKGROUND: The COVID-19 pandemic reached Cameroon in March, 2020. The aim of this study was to unveil the consequences of this pandemic on hospitalizations and on mortality in a pediatric hospital. Methods: A descriptive and retrospective cross-sectional study was carried out using hospitalization and death statistics collected from a pediatric hospital. We compared the data before and after the pandemic and made predictions for the next 12 months. Results: A drastic drop in hospitalizations was noted coinciding with the partial lockdown in Cameroon. Paradoxically, at the same time, the number of deaths per month doubled though the causes remained the same as in the past. Conclusion: The COVID-19 pandemic was marked by drop in hospitalizations and paradoxically, an increase in child mortality. These deaths were probably due not to SARS-Cov-2 infection, but rather due to the usual illnesses whose management was delayed, a probable consequence of the confinement.

Burden and spectrum of bacterial infections among sickle cell disease children living in Cameroon.

BACKGROUND: Although sickle cell disease (SCD) children are highly susceptible to bacterial infections (BIs), there is a dreadful lack of data related to the burden and spectrum of BIs in sub-Saharan Africa (SSA), the highest affected region with SCD. This study aimed to determine the burden and spectrum of BIs among SCD children hospitalized in a pediatric reference hospital in Cameroon, a SSA country. METHODS: We conducted a retrospective analysis of records of children hospitalized from November 2012 to August 2015 in the SCD unit of the Mother and Child Centre of the Chantal Biya Foundation, Cameroon. We enrolled all known SCD children aged 15 years or less, hospitalized for a suspicion of BI and who presented a positive culture of a body specimen. RESULTS: A total of 987 SCD children were hospitalized during the study period. Cultures were positive for 96 patients (9.7%) among whom 60.4% males. Ages ranged from 6 to 192 months with a median of 53 (Interquartile range (IQR) 21-101) months. For children no more covered by the Expanded Programme on Immunization, only 13 (18.8%) had received the Pneumo 23® and Meningo A&C® antigens, and 12 (17.4%), the Typhim vi® and the Haemophilus influenzae type b antigens; 58 children (84.1%) had received no vaccine. The specimen yielding positive cultures were: blood (70.7%), urine (13.1%), pus (9.1%), synovial fluid (4.1%), cerebrospinal fluid (2.0%), and bone fragment (1.0%). The different types of infection included: urinary tract infections (13.5%), myositis (8.3%), arthritis (6.3%), osteomyelitis (4.2%), and meningitis (2.1%); the site of infection was unidentified in 65.6% of cases. The main bacteria included: Salmonella sp. (28.1%), Staphylococcus sp. (18.8%), Klebsiella pneumoniae (17.7%), Escherichia coli (10.4%), Enterobacter sp. (5.2%), Acinetobacter sp. (4.2%), Streptococcus sp. (4.2%) and Serratia sp. (4.2%). CONCLUSION: This retrospective analysis revealed 9.7% cases of BIs, mainly caused by Salmonella sp. (28.1%), Staphylococcus sp. (18.8%), Klebsiella pneumoniae (17.7%), and Escherichia coli (10.4%).

Premature death of children aged 2 months to 5 years: the case of the Mother and Child Center of the Chantal Biya Foundation, Yaounde, Cameroon.

BACKGROUND: In hospital premature deaths of children less than 5 years of age admitted for different reasons still remains very high in our context warranting study in order to reverse the tendency (using appropriate means). Our study was aimed at describing and analyzing cases of those children aged from 2 months to 5 years who died within the first 48 hours of their admission at the Mother and Child Center of the Chantal Biya Foundation (MCC/CBF). METHODS: It was a retrospective descriptive study. Data were extracted from the clinical records of the patients admitted from 2008 to 2012. Cases of accidental trauma were excluded from the study. Level of statistical significance was set at P<0.05. The approval of the ethical committee of the Université des Montagnes was also obtained. RESULTS: During the period of our study, out of the 14,200 patients aged 2 months and 5 years who were hospitalized 522 premature deaths were registered. This gives an incidence of 4.9%, representing 74.3% of all hospitalized deaths in this age group. Considering the fact that some of the files had very little information, only 373 files were studied. The sex ratio was 1.2. More astonishing was that a majority of the deaths occurred between midnight and 8 am. The most frequent registered cases were patients with severe malaria (42.6%), severe sepsis (20.6%), and acute lower respiratory tract infections (RTI) (16.1%) cases. One third of the patients had a poor nutritional status. CONCLUSIONS: The reinforcement of preventive measures and programs targeting the health of children such as the Integrated Management of Childhood Diseases (IMCD) would be a major priority in proffering a solution to this phenomenon.

Endomyocardial fibrosis in Sub Saharan Africa: The geographical origin, socioeconomic status, and dietary habits of cases reported in Yaounde, Cameroon.

BACKGROUND: Endomyocardial fibrosis (EMF) is a neglected heart condition of the inter-tropical regions. Numerous hypotheses suggest a relationship between its geographical distribution in the affected regions and other etio-pathogenic factors such as dietary habits, infectious causes, and geochemical causes. Knowledge of its epidemiology in Cameroon remains limited, which is why we decided to describe the profile of a paediatric series of EMF in Yaoundé. PATIENTS AND METHODS: A retrospective study was carried out on EMF in 54 patients diagnosed from 1 January 2006-31 December 2014 in a Paediatric Centre of Yaoundé. Diagnosis was mainly echocardiographic. We compiled data on the geographic origins of the patients, their dietary habits and the socioeconomic profile of their families. RESULTS: The patients' ages ranged from 2 to 17 years, most of whom (83.3%) were between 5 and 15 years. For geographical distribution, all came from three tropical forest zones where they have lived since their childhood. These were Center (32/54), South (12/54), and East (10/54). All families had a moderate income, consumed tubers at least twice a week especially cassava (43/54) and had low sources of proteins. CONCLUSION: Apart from geographical similarities all patients of our series shared the same dietary habits. Our study was conducted in a hospital setting; therefore a screening of the disease in the whole national territory would enable a more reliable mapping.

The Acute Chest Syndrome in Cameroonian children living with sickle cell disease.

BACKGROUND: Although sub-Saharan Africa (SSA) is particularly affected by sickle cell disease (SCD), there is dearth of research on this topic in the region, specifically targeting the magnitude of SCD-related complications. We therefore conducted this study to determine the burden of acute chest syndrome (ACS) and describe its clinical and therapeutic aspects among SCD children in Cameroon, a SSA country. METHODS: This was a retrospective study carried-out from September 2013 to June 2014 at the SCD unit of the Mother and Child Centre of the Chantal Biya Foundation, a pediatric reference centre in Yaoundé, Cameroon. We enrolled all SCD children with confirmed diagnosis of ACS, and recorded their clinical presentation at admission along with their evolution during hospitalization. RESULTS: Twenty one cases of ACS were identified during the study period, from 338 hospitalizations of children with SCD. Ages ranged from 11 months to 16 years with a mean (standard deviation) of 5.5 (3.4) years, and a male/female sex ratio of 3.2/1. We noticed relatively low levels of HbF, from 6.4 to 21.9% with a mean of 14.6% (6.0%). The three main symptoms at admission were fever (90.5%), cough (81%) and chest pains (28.6%). Two patients (9.5%) developed ACS 2 days after admission. The mean values of leukocytes, neutrophils, serum CRP, serum LDH and hemoglobin were respectively 32479.4 (17862.3)/mm(3), 23476 (11543.7)/mm(3), 228.2 (132.6) mg/l, 3452.3 (2916.3) IU/l and 6.5 (1.2) g/dl. The main localizations of radiological alveolar consolidations were the lower lobes (90.5%). Treatment associated broad-spectrum antibiotics (100%), hydration (100%), analgesics (43.2%), whole blood transfusion (66.7%), and oxygen supplementation (33.3%). Blood transfusion significantly improved hemoglobin level (p = 0.039). The duration of hospitalization, the mean of which was 6.8 (3.1) days, was influenced by none of the tested variables (all p values > 0.05). CONCLUSION: ACS is frequent among SCD children in our milieu. Its etiologies seem to be multifactorial. Patients' parents should be educated to recognize early signs and symptoms of the disease, and consult rapidly. Additionally, clinicians must be trained to diagnose ACS, and manage it promptly and efficiently to avoid its related catastrophic consequences.