Effect of systematic tuberculosis detection on mortality in young children with severe pneumonia in countries with high incidence of tuberculosis: a stepped-wedge cluster-randomised trial.

BACKGROUND: Tuberculosis diagnosis might be delayed or missed in children with severe pneumonia because this diagnosis is usually only considered in cases of prolonged symptoms or antibiotic failure. Systematic tuberculosis detection at hospital admission could increase case detection and reduce mortality. METHODS: We did a stepped-wedge cluster-randomised trial in 16 hospitals from six countries (Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Uganda, and Zambia) with high incidence of tuberculosis. Children younger than 5 years with WHO-defined severe pneumonia received either the standard of care (control group) or standard of care plus Xpert MTB/RIF Ultra (Xpert Ultra; Cepheid, Sunnyvale, CA, USA) on nasopharyngeal aspirate and stool samples (intervention group). Clusters (hospitals) were progressively switched from control to intervention at 5-week intervals, using a computer-generated random sequence, stratified on incidence rate of tuberculosis at country level, and masked to teams until 5 weeks before switch. We assessed the effect of the intervention on primary (12-week all-cause mortality) and secondary (including tuberculosis diagnosis) outcomes, using generalised linear mixed models. The primary analysis was by intention to treat. We described outcomes in children with severe acute malnutrition in a post hoc analysis. This study is registered with ClinicalTrials.gov (NCT03831906) and the Pan African Clinical Trial Registry (PACTR202101615120643). FINDINGS: From March 21, 2019, to March 30, 2021, we enrolled 1401 children in the control group and 1169 children in the intervention group. In the intervention group, 1140 (97·5%) children had nasopharyngeal aspirates and 942 (80·6%) had their stool collected; 24 (2·1%) had positive Xpert Ultra. At 12 weeks, 110 (7·9%) children in the control group and 91 (7·8%) children in the intervention group had died (adjusted odds ratio [OR] 0·986, 95% CI 0·597-1·630, p=0·957), and 74 (5·3%) children in the control group and 88 (7·5%) children in the intervention group had tuberculosis diagnosed (adjusted OR 1·238, 95% CI 0·696-2·202, p=0·467). In children with severe acute malnutrition, 57 (23·8%) of 240 children in the control group and 53 (17·8%) of 297 children in the intervention group died, and 36 (15·0%) of 240 children in the control group and 56 (18·9%) of 297 children in the intervention group were diagnosed with tuberculosis. The main adverse events associated with nasopharyngeal aspirates were samples with blood in 312 (27·3%) of 1147 children with nasopharyngeal aspirates attempted, dyspnoea or SpO2 less than 95% in 134 (11·4%) of children, and transient respiratory distress or SpO2 less than 90% in 59 (5·2%) children. There was no serious adverse event related to nasopharyngeal aspirates reported during the trial. INTERPRETATION: Systematic molecular tuberculosis detection at hospital admission did not reduce mortality in children with severe pneumonia. High treatment and microbiological confirmation rates support more systematic use of Xpert Ultra in this group, notably in children with severe acute malnutrition. FUNDING: Unitaid and L'Initiative. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.

Acceptability of the Kangaroo Mother Care at the University Hospital of Treichville in Côte d'Ivoire.

Background: Kangaroo Mother Care (KMC) is a low-tech, highimpact intervention for preterm and low-birth-weight newborns. In 2019, Côte d'Ivoire opened its first KMC unit. We wanted to determine KMC's acceptability in Côte d'Ivoire after a year. Methods: This qualitative study used semi-structured interviews in September 2020 at the Teaching Hospital of Treichville's first KMC unit. Mothers of preterm and low birth weight babies who received KMC were studied. Deductive (TFA-driven) framework analysis was performed. Coded using Nvivo 12. Results: KMC was acceptable overall. Mothers knew KMC's goal and benefits, including self-confidence and breastfeeding benefits. Most women reported that the method was easy to implement and were confident in implementing KMC at the unit or in the household, even though some of them found KMC not aligned with their cultural values. Some mothers, especially housewives and self-employed, highlighted the benefits of KMC, but they must have given up. Conclusions: Our study highlighted the need to increase KMC awareness, advocacy, education, and training for pregnant women and the community to reduce preterm and low birth weight infant mortality and morbidity.

Barriers and facilitators to kangaroo mother care implementation in Cote d'Ivoire: a qualitative study.

BACKGROUND: Kangaroo Mother Care (KMC) is a high impact, low technology and cost-effective intervention for the care of preterm and low birth weight newborn. Cote d'Ivoire adopted the intervention and opened the first KMC unit in 2019. This study aimed to assess barriers and facilitators of KMC implementation in Cote d'Ivoire, a year after its introduction, as well as proposed solutions for improving KMC implementation in the country. METHOD: This was a qualitative study, using semi-structured interviews, carried out in September 2020 in the first KMC unit opened at the Teaching Hospital of Treichville. The study involved healthcare providers providing KMC and mothers of newborn who were receiving or received KMC at the unit. A thematic analysis was performed using both inductive and deductive (Consolidated Framework for Implementation Research-driven) approaches. NVivo 12 was used to assist with coding. RESULTS: A total of 44 semi-structured interviews were conducted, 12 with healthcare providers and 32 with mothers. The barriers identified were lack of supplies, insufficiency of human resources, lack of space for admission, lack of home visits, lack of food for mothers, lack of collaboration between health services involved in newborn care, increased workload, the beliefs of carrying the baby on the chest, father's resistance, low rate of exclusive breastfeeding, lack of community awareness. Facilitators identified were training of healthcare providers, strong leadership, the low cost of KMC, healthcare providers' perceived value of KMC, mothers-healthcare providers' relationship, mothers' adherence to KMC and the capacity of the KMC unit to network with external organizations. The proposed solutions for improving KMC implementation were volunteer staff motivation, intensifying education and counselling of mothers and families, the recruitment of a psychologist and the involvement of all stakeholders. CONCLUSION: Our study highlighted the challenges to implement KMC in Cote d'Ivoire with unique and specific barriers to implementation. We recommend to researchers and decision makers to respectively design strategies and adopt intervention that specifically address these barriers and facilitators to a better uptake of KMC. Decision makers should also take into account the proposed solutions for a better implementation and scaling up of KMC.

[Rare pancreatic tumor detected unexpectedly in a child in the Ivory Coast]. / Tumeur pancréatique rare de découverte fortuite chez un enfant en Côte d'Ivoire.

Solid pseudopapillary tumor of the pancreas (SPTP) is rare. It most often affects young women. It was first described by Frantz in 1959, but its pathogenesis remains unclear. This tumor has a good prognosis. Treatment is based on radical surgery. We here report the case of a 11-year old girl with SPTP. Symptomatology was acute, including compression syndrome and epigastralgias. Clinical examination showed a solid mass in the left hypochondrium. Scan showed mixed mass structure of the pancreas tail. Left splenopancreatectomy was performed. The diagnosis was confirmed by histological examination using immunohistochemistry. Long-term follow-up showed no recidivism. The study had a follow-up period of two and a half years. This study and literature review aimed to highlight the role of radiological examination in the diagnosis and underline the importance of radical surgery in the treatment of these tumors with a low degree of malignancy.

Plasmodium falciparum malaria in northern Côte d'Ivoire: prevalence in the general hospital of Tanda sanitary district.

Background: Until about 2010, the majority of data collected on malaria in Côte d'Ivoire were based on presumptive cases, particularly in the northern part of the country, where parasitological research had rarely been carried out. Recently, WHO recommended restricting treatment to confirmed malaria cases only. Thus, the purpose of this study determine the actual malaria prevalence amongst presumptive cases admitted to one of the general hospitals in the Northern part of the country, where malaria diagnosis is suboptimal. Materials and methods: A cr oss-sectional study was conducted in the general medicine, maternity and paediatric wards between January and August 2010. Patients of all ages, suspected of having malaria, were included after giving their informed oral consent. Several parameters were investigated: the presence of Plasmodium using thick blood film, HIV/ Plasmodium co-infection, signs of severity, aspects of malaria treatment and other associated factors. Results: Of 379 patients included, with a median age of 4 yrs [range 1 month - 71 yrs], 9% were HIV-positive, 74% were ≤ 15 yrs of age, 60% were urbanised and 23% were using long-lasting insecticide-treated nets. Malaria prevalence was 67.5% and was significantly associated with the rainy season (p < 0.001), age ≤ 5 yrs (p = 0.004) and no cotrimoxazole chemoprophylaxis in HIV-infected patients (p = 0.04). Only P. falciparum was detected, with a mean density of 12,523 trophozoites/µl of blood, but with 12,610 trophozoites/µl of blood in HIV-positive patients and 7,055 trophozoites/µl of blood in HIV-negative patients (p < 0.001). Severe malaria accounted for 77% of cases. Prescribed antimalarial drugs were: IM artemether (56%), quinine (28%), artemether + lumefantrine (10%) and artesunate + amodiaquine (6%). Apyrexia and parasite clearance were observed at day 2-3 post treatment in 87% of patients. Adverse events were reported among 60 patients (17%). The outcome was marked by: a healing rate of 90%, a rate of 5% lost to follow-up and a 7% lethality for severe malaria, significantly associated with the age ≤ 5 yrs (p=0.02), hyperparasitaemia >20% (p=0.004), neurological disorders (p < 0.001) and respiratory distress (p=0.007). Conclusions: Malaria prevalence in the general hospital of Tanda remains high, with a predominance of sever e malaria affecting children under the age of 5 yrs.