Disseminated leishmaniasis in a four-year-old child in Yaoundé, Cameroon.

Leishmaniasis is a disease caused by a protozoan parasite of the genus leishmania with worldwide distribution and is transmitted to man by phlebotomine sand flies. The clinical presentation could range from a single cutaneous ulcer to disseminated leishmaniasis. We report the case of a four-year-old boy admitted to our hospital with ulcers, wasting, progressively distending abdomen, and fatigue evolving for about two months. On admission, he was febrile and pale, with diffuse oozing wet ulcers on the limbs and face, hepatosplenomegaly, and enlarged inguinal lymph nodes. The complete blood count revealed pancytopenia with low reticulocyte count, and serum protein electrophoresis showed hypoalbuminemia and hypergammaglobulinemia. Skin biopsy revealed amastigotes in phagocytic cells. The above findings suggested cutaneous and visceral localization of the leishmania; however, the parents absconded with the boy just when treatment was instituted, believing that the child was bewitched. The outcome is expected to be fatal visceral involvement.

Management of neural tube defects in a Sub-Saharan African country: the situation in Yaounde, Cameroon.

BACKGROUND: Neural tube defect is a serious disabling but preventable congenital malformation with an incidence of 1.99 per 1000 births in Yaounde [A.K. Njamnshi, V. d e P. Djientcheu, A. Lekoubou, M. Guemse, M.T. Obama, R. Mbu, S. Takongmo, I. Kago. Neural tube defects are rare among black Americans but not in Sub-Saharan black Africans: The case of Yaounde-Cameroon. Journal of the Neurological Sciences 2008; 270: 13-17]. The management requires highly qualified personnel and a significant social cost. The aim of this study was to evaluate the management of neural tube defect in a resource-limited developing Sub-Saharan nation like Cameroon. METHODS: We reviewed all patients with neural tube defects admitted in the neonatology unit of the Mother and Child Center (Chantal Biya Foundation Yaounde) between January 1st 2000 and December 31st 2006. RESULTS: Sixty-nine (69) patients were enrolled. There was a male predominance (69.57%) in the sample. Myelomeningomecele represented 68.11% of cases, followed by encephalocele (27.54%) and meningocele (4.35%). Antenatal ultrasound examinations were done in 27 cases (32.8%). The prenatal diagnosis was made only in 8 cases. No medical abortion was performed in any of these cases. Medical abortion is illegal in Cameroon (except in certain specific situations) as well as other Sub-Saharan African countries. Hydrocephalus was diagnosed in 40.02% of cases. As most of the patients (62.32%) could not afford modern treatment, only 26.09% of them were operated at birth. The rest sought traditional and other forms of treatment, due to poverty or cultural beliefs. Eight patients (11.59%) died before surgery. Surgery consisted of local closure alone (40%) or local closure associated to CSF shunting (60%). The complications were wound dehiscence (13.69%), shunt infection (1.37%), meningitis (1.37%) and iatrogenic pulmonary oedema (1.37%). CONCLUSION: Neural tube defects are the most frequent and disabling malformations in neonates in the Sub-Saharan African paediatric environment. Prenatal management and outcome at birth are limited by poverty and cultural beliefs. Prevention is possible and may be better than palliative care in developing countries.

[Causes of anaemia in African children aged 5 to 10 years]. / Etiologies de l'anémie chez l'enfant africain de 5 à 10 ans.

This study was conducted among two groups of 105 children in a hospital in Yaoundé, Cameroon, to determine the causes of anaemia in children aged 5- 10-years-old. The study group included children presenting clinical evidence of anaemia while the control group was made of children without anaemia. Both sets of children were matched for neighbourhoods within the city of Yaoundé. Each child had a complete physical examination, full blood count, haemoglobin electrophoresis, reticulocyte counts, and stool samples examined for parasites and hemoparasites. The mean haemoglobin level was 7.77 +/- 1.54 g/dL in the study group and 12.37 +/- 1.23 in the control group. The anaemia was mainly normocytic, normochromic and regenerative in the study group, usually associated with evidence of haemolysis. Patients with homozygous sickle cell disease were found only in the study group (n = 13; 12.3%). Malaria parasites were noted in 89 children (84.7%) in the study group, compared with 34 (32.4%) in the control group (p = 0.0004). Prevalence of intestinal parasites was similar in both groups (50.8%). Protein-calorie malnutrition was rare and was not associated with anemia. We conclude that both malaria and sickle cell anaemia play an important role in anaemia in children aged 5-10 years.

[Diagnosis of maxillo-facial Burkitt's lymphoma by needle puncture and cytologic examination. Experience in Cameroon]. / Diagnostic du lymphome de Burkitt maxillo-facial par ponction à l'aguille et examen cytologique. L'expérience du Cameroun.

The authors report their experience on diagnosis of maxillo-facial Burkitt's lymphoma using needle aspiration and cytology. In all the 21 patients presenting a histological proved Burkitt's lymphoma, the diagnosis was done before with cytology. This method has a 100% sensibility. Thus, cytologic diagnosis of maxillo-facial Burkitt's lymphoma is very reliable. In tropical areas with little revenues and where Burkitt's lymphoma is frequent, needle aspiration and cytology need to be well known and used.

Trace elements in foods of children from Cameroon: a focus on zinc and phytate content.

In developing countries, complementary foods are based on local cereal porridges. These foods are poor in trace elements, with a high risk of inducing micronutrient deficiencies-the primary cause of mortality in children under the age of five. Inappropriate feeding of complementary foods is the major factor creating malnutrition and micronutrients deficiencies in Cameroon children, as well as in other developing countries. This study determined the zinc and phytate content of 30 complementary foods that were based on maize or Irish potatoes. The foods were blended or treated by dehusking, fermentation and germination. Zinc was measured by flame atomic absorption spectrophotometry and phytates by high pressure-liquid chromatography; then phytates/zinc molar ratios were calculated. Concentrations (mg/100g dry matter) ranged, respectively, from 0.20 to 2.58 (0.12 ± 0.67) for zinc and from 0.00 to 6.04 (1.87 ± 1.7) for phytates. The phytate/zinc ratio varied from 0.00 to 51.62 (11.12 ± 11.53). It appears that germination and fermentation reduced the level of phytates: however, zinc levels in the samples did not change significantly. The traditional, local complementary foods were not only poor in zinc, but contained very high levels of phytates. These phytates have the potential to considerately reduce the acid extraction of zinc, and could impair its bioavailability.

Bacterial meningitis and pneumococcal serotype distribution in children in cameroon.

Acute bacterial meningitis causes a substantial number of deaths in Cameroon. Among 170 children with acute meningitis, 112 were positive for a bacterial pathogen when tested using polymerase chain reaction amplification, and Streptococcus pneumoniae accounted for 57.1% of cases. Pneumococcal serotype coverage by 13-valent pneumococcal conjugate vaccine was 62.1%. This study shows that in Cameroon, 13-valent pneumococcal conjugate vaccine coverage is less than what is estimated for other African countries.

HIV exposure and related newborn morbidity and mortality in the University Teaching Hospital of Yaoundé, Cameroon.

INTRODUCTION: Few studies have established the role of maternal HIV infection on neonatal disease and death. In order to determine whether neonatal morbidity and mortality were associated to maternal HIV infection, a case-control study was conducted in the neonatal unit of the University Teaching Hospital of Yaoundé from July 2006 to December 2007. METHODS: Babies born from HIV positive mothers were recruited as cases. For each case, two babies born from HIV negative mothers were selected as controls. Informed verbal consent was obtained from the mother before inclusion of the newborn in the study. Information on demographics, history of pregnancy, diseases and outcome of the newborns were extracted from patients' files. The distribution of these parameters between cases and control was analyzed using chi-square. Association of demographics, clinical and paraclinical parameters with mortality was explored using univariate analysis and logistic regression. Data were analyzed using Epi Info version 3.5.1 Windows. RESULTS: Out of 240 newborns enrolled, 80 were cases and were 160 controls. The mean age of cases was 1.69±2.73 days compared to 1.46±2.36 days for controls (p=0.26). Cases significantly differed from controls on mother's marital status (p=0.02), level of education (p<0.001), number of prenatal consultations (p<0.001), anemia chemoprophylaxis (p=0.01) and drug abuse (p<0.001). Cases and controls were similar for prematurity, respiratory distress, sepsis, meningitis and urinary tract infection. The death rate was identical in both groups (p=0.52). Using Univariate analysis, risk factors associated to mortality in both groups were prematurity (p<0.001) and low birth weight (p<0.001). CONCLUSION: This study showed no statistical difference in morbidity and mortality between newborns from HIV positive and HIV negative mothers.

Heat impact on schoolchildren in Cameroon, Africa: potential health threat from climate change.

BACKGROUND: Health impacts related to climate change are potentially an increasing problem in Cameroon, especially during hot seasons when there are no means for protective and adaptive actions. OBJECTIVE: To describe environmental conditions in schools and to evaluate the impact of heat on schoolchildren's health during school days in the Cameroon cities of Yaoundé and Douala. METHODS: Schoolchildren (N = 285) aged 12-16 years from public secondary schools completed a questionnaire about their background, general symptoms, and hot feelings in a cross-sectional study. In Yaoundé, 50 schoolchildren were individually interviewed during school days about hourly symptoms (fatigue, headache, and feeling very hot) and performance. Lascar dataloggers were used to measure indoor classroom temperatures and humidity. RESULTS: There was a significant correlation between daily indoor temperature and the percentages of schoolchildren who felt very hot, had fatigue, and headaches in Yaoundé. A high proportion of schoolchildren felt very hot (48%), had fatigue (76%), and headaches (38%) in Yaoundé. Prevalences (%) were higher among girls than boys for headaches (58 vs 39), feeling 'very hot overall' (37 vs 21), and 'very hot in head' (21 vs 18). Up to 62% were absentminded and 45% had slow writing speed. High indoor temperatures of 32.5°C in Yaoundé and 36.6°C in Douala were observed in school. CONCLUSIONS: Headache, fatigue, and feeling very hot associated with high indoor air temperature were observed among schoolchildren in the present study. Longitudinal data in schools are needed to confirm these results. School environmental conditions should be improved in order to enhance learning.