Risk Factors Associated with Under Five Children Mortality in Northeast Nigeria; A Retrospective Analysis of National Demographic and Health Survey Data.

BACKGROUND: Under-five children mortality rate (U5MR) remains a crucial indicator of a nation's child healthcare and socioeconomic development. This study aims to identify and quantify significant maternal, child, family, and environmental risk factors contributing to under-five mortalities in the Northeast geopolitical zone of Nigeria. METHODS: Retrospective analysis of secondary data from the 2018 National Demographic and Health Survey (NDHS) in six northeastern Nigerian states. Maternal factors (age, education, health-seeking behavior), child variables (weight, sex, vaccination status), family factors, and environmental factors (water source, residence, wealth index) were analyzed to determine their association with the under-five mortality rate (U5MR). Logistic regression models and population-attributable risk estimates were used to identify key contributors to U5MR in the region. RESULTS: A total of 26,293 mothers were surveyed, of which the majority (93.6%) were married, employed (70.7%), and had no insurance (99%). Most of the mothers were above 35 years of age, uneducated and with first birth between ages 15-19. Adjusted odds ratios show unmarried mothers 1.67 (P=0.015), small birth size 1.37 (P=0.022), never breastfeeding 1.83 (P=0.000), short birth intervals 1.50 (0.005), higher parity 1.5 (P=0.005), lack of any family planning method 1.43(P=0.040), twin siblings 3.95 (P=0.000) and place of residence 1.21 (P=0.000) were associated with higher U5MR odds ratios. Maternal age 21-25 years showed a protective effect AOR 0.59 (95% CI: 0.36-0.98, P=0.040) and age > 31 years AOR 0.44 (95% CI: 0.24-0.81, P=0.009). CONCLUSION: This study provides crucial insights into the multifaceted determinants of under-5 mortality in Northeast Nigeria. The findings underscore the importance of tailored interventions addressing maternal, child, and family factors to improve child health outcomes in the region.

CONTEXTE: Le taux de mortalité des enfants de moins de cinq ans (U5MR) reste un indicateur crucial des soins de santé pour les enfants et du développement socio-économique d'une nation. Cette étude vise à identifier et à quantifier les facteurs de risque significatifs liés à la mère, à l'enfant, à la famille et à l'environnement, contribuant à la mortalité des enfants de moins de cinq ans dans la zone géopolitique du nord-est du Nigéria. MÉTHODES: Analyse rétrospective des données secondaires de l'Enquête Démographique et de Santé Nationale (EDSN) de 2018 dans six États du nordest du Nigéria. Les facteurs maternels (âge, éducation, comportement de recherche de soins), les variables de l'enfant (poids, sexe, statut vaccinal), les facteurs familiaux et les facteurs environnementaux (source d'eau, résidence, indice de richesse) ont été analysés pour déterminer leur association avec le taux de mortalité des enfants de moins de cinq ans (U5MR). Des modèles de régression logistique et des estimations du risque attribuable à la population ont été utilisés pour identifier les principaux contributeurs à l'U5MR dans la région. RÉSULTATS: Un total de 26 293 mères ont été interrogées, dont la majorité (93,6%) étaient mariées, employées (70,7%) et n'avaient pas d'assurance (99%). La plupart des mères avaient plus de 35 ans, n'étaient pas éduquées et avaient eu leur premier enfant entre 15 et 19 ans. Les ratios de cotes ajustés montrent que les mères non mariées (1,67, P=0,015), la petite taille à la naissance (1,37, P=0,022), l'absence d'allaitement (1,83, P=0,000), les intervalles de naissance courts (1,50, P=0,005), une parité élevée (1,5, P=0,005), l'absence de méthode de planification familiale (1,43, P=0,040), les jumeaux (3,95, P=0,000) et le lieu de résidence (1,21, P=0,000) étaient associés à des ratios de cotes plus élevés de l'U5MR. L'âge maternel de 21 à 25 ans a montré un effet protecteur AOR 0,59 (95% CI : 0,36-0,98, P=0,040) et l'âge > 31 ans AOR 0,44 (95% CI : 0,24-0,81, P=0,009). CONCLUSION: Cette étude fournit des informations cruciales sur les déterminants multifactoriels de la mortalité des enfants de moins de cinq ans dans le nord-est du Nigéria. Les résultats soulignent l'importance d'interventions adaptées abordant les facteurs liés à la mère, à l'enfant et à la famille pour améliorer les résultats de santé des enfants dans la région. MOTS-CLÉS: Mortalité des enfants de moins de cinq ans, Facteurs de risque,Nord-Est du Nigéria, Santé des enfants.

Diagnosis Dilemma of Angioimmunoblastic T-Cell Lymphoma in Tuberculosis Endemic Region.

Angioimmunoblastic T-cell lymphoma (AITL) is a rare hematologic malignancy recognized in the WHO 2016 classification as a clinical and histological entity. It is a very poorly described disease in Africa due to its rarity and diagnostic difficulties, particularly differential diagnosis with tuberculosis. Here, we report a 57-year-old man who presented with fever, weight loss, and lymphadenopathies. The diagnosis of tuberculosis was carried out based on lymph node fine needle aspiration showing the image of tuberculous adenitis and CT images in favor of necrotic lymphadenopathies. The presence of autoantibodies and the failure of tuberculosis treatment led us to perform a biopsy with immunostaining that confirmed pathological features of AITL. The patient was treated by CHOP-based chemotherapy, and complete remission was achieved. This case highlights the difficulty of recognizing AITL and the importance of considering other potential differential diagnoses of tuberculosis in the endemic region.

[Assessment of the availability and use of antivenom in the district of Bamako, Mali, West Africa]. / Évaluation de la disponibilité et l'utilisation du sérum antivenimeux dans le district de Bamako, Mali, Afrique de l'Ouest.

The aim of this study is to describe the difficulties related to problems of supply and use of antivenom serum (SAV) in the district of Bamako. A retrospective study over a span of five years (January 1998-December 2002) and an interview with the staff of various facilities were conducted. The study included 2 wholesalers of pharmaceuticals, 20 private pharmacies, and 2 hospital pharmacies as they were involved in antivenom trades. A market-driving ability survey of driving practice was conducted in 37 community health centers (CHCs) and 4 dispensaries because they performed antivenom treatments during the study period. A total of 3,318 doses of antivenom were bought, including 84.4% by the People Pharmacy of Mali (PPM), a public organization, and 15.6% by Laborex, a private company. These were out of stock in 1999. Three kinds of SAV were ordered: the polyvalent IPSER Africa (1,200 vials or 36.2%), FAV Africa (318 vials or 9.6%), and Sii anti-snake venom polyvalent serum (1,800 vials or 54.2%). Orders from PPM involved IPSER Africa (Pasteur Mérieux Serum & Vaccines) and Sii anti-snake venom polyvalent serum (Serum Institute of India), and those from Laborex involved IPSER Africa and FAVAfrica (Aventis Pasteur). Onehalf of private pharmacies (54.3%) had made at least one order of SAV. The PPM lost 50% of 2,000 vials of SAV in 1996 due to the expiration of vials that were bought. Private pharmacies lost 3.6% of stocks due to expiration. Prices varied depending on the type of service and the point of sale. Costs of vials were 19,440-35,000 CFA francs (29.6-53.4 euros) for Sii antivenom and 50,200-63,000 CFA francs (76.5-96.1 euros) for FAV Africa antivenom. In CHCs, 59.5% of prescribers were unaware of the indications and methods of proper administration of the SAV, 32.3% ignored the existence of SAV, and 30.9% were skeptical about its effectiveness in treatment of envenomation by snakebite.