A cross sectional study of growth of children with sickle cell disease, aged 2 to 5 years in Yaoundé, Cameroon.

INTRODUCTION: Growth of children affected by Sickle Cell Disease (SCD) is not well described in sub-Saharan Africa despite the high prevalence of the disease. Few data are available in this context and on the issue using the World Health Organization growth norms. We therefore conduct the present study with the aim of describing the growth of affected children aged less than 5 years. We also assessed correlation of anthropometric parameters with disease severity criteria. METHODS: A cross-sectional study was conducted during a period of 8 months, at the Mother and Child Center of Yaoundé. The sample included 77 children with SCD aged 2 to 5 years old in steady state. Anthropometric measurements and socio-demographic data were collected and analyzed. All statistical tests were two-tailed with p<0.05 considered significant. RESULTS: Median age of study population was 3.67 years. Low weight, height and weight for height Z-scores (<-2SD) were observed in 4%, 4%, and 5% of children, respectively. Projection of these parameters were stackable on WHO curves. Regression analysis indicated an association of low height-for-age and of low Body Mass Index (BMI)-for-age with age. CONCLUSION: This study demonstrates unexpectedly lower mean Z-score for weight, height and weight for height than reported while using WHO norms.

A hidden face of migration: Diabetic ketoacidosis in a severely malnourished refugee.

Besides violence, the risk of under nutrition and infection, migrant children with noncommunicable chronic diseases face serious challenges in the management of their conditions. Management of diabetic ketoacidosis in a severely malnourished patient includes careful hydration, therapeutic feeding, and monitoring.

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%).

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.

Pediatres et diabete de l'enfant au Cameroun

OBJECTIFS. Dans un contexte dans lequel les maladies infectieuses sont majoritaires; certaines maladies non transmissibles de l'enfant telles que le diabete; sont peu prises en compte dans le systeme sante. De ce fait un enfant atteint a une courte esperance de vie en absence de prise en charge appropriee. Malgre des initiatives d'approvisionnement a faible cout ou gratuitement de l'insuline dans les pays en voie de developpement d'Afrique subsaharienne; la prise en charge des enfants demeure difficile; les donnees sur le sujet restent rares et les actions de plaidoyer quasi absentes. Nous questionnons dans le present article l'implication des pediatres camerounais dans la prise en charge de cette affection en decrivant leurs attitudes et en evaluant leur interet sur la question. METHODOLOGIE. Pour ce faire; un questionnaire leur a ete adresse par internet portant sur le nombre de patients vus et suivis par an; leur attitude devant un nouveau patient. Nous avons egalement; en cotant sur une echelle de 1 a 5; evalue leur interet sur la question et leur avis sur la place a occuper par le diabete de l'enfant dans le systeme de sante des enfants. RESULTATS. Sur les 100 pediatres inscrits au registre de la Societe Camerounaise de Pediatrie; 36 ont rempli le questionnaire en septembre 2013 et 3 ont ete exclus de l'analyse. La majorite travaillait dans les 2 principales villes du pays avec plus de 10 ans d'experience professionnelle. Dans 70% des cas; ils recevaient moins de 5 patients diabetiques par an; et tous ou presque n'en suivaient regulierement aucun. Apres prise en charge d'urgence; les patients etaient dans 36% des cas referes a un endocrinologue d'adulte. Leur interet pour la question etait evalue a 3;5/5 et a 3;7/5 etait la place a accorder au diabete dans le systeme de soins des enfants. Les principales suggestions pour l'amelioration de la qualite de la prise en charge etaient la formation ou recyclage des equipes pediatriques et leur approvisionnement en materiel d'auto surveillance glycemique.CONCLUSION. ce travail montre que les pediatres au Cameroun sont interesses par le diabete de l'enfant mais manquent d'aptitudes adequates. Ils peuvent prendre en charge cette pathologie et leur implication pourrait entrainer des prises de decisions pour l'amelioration des soins des enfants atteints