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.

Prevalence and factors associated with hypertension in primary school children, in the centre region of Cameroon.

BACKGROUND: There has been a progressive increase in hypertension among children and adolescents over the years. Hypertension in childhood is influenced by various risk factors including; childhood obesity, lifestyle and hereditary factors. This study is aimed at assessing the prevalence of hypertension and elevated blood pressure (BP); as well as the associated factors to hypertension among primary school children in a rural setting in the, Centre Region of Cameroon. METHODS: A cross sectional study was carried out from November 2017 to May 2018 in 13 primary schools in Mbankomo subdivision. A two staged cluster sampling technique was used to select participants: the first stage we conveniently selected 13 out of 71 (18%) primary schools in the study area by probability proportionate to size since the subdivision does not have an equal number of primary schools in the rural and semi-urban areas. In the second stage, we also used probability proportional to size to randomly select participants from the 13 clusters because the classes did not have equal number of students. We randomly selected 13% pupils enrolled in each class of the 13 schools. BP and anthropometric measurements were taken, together with socio-demographic characteristics, lifestyle and past history. RESULTS: The overall prevalence of hypertension among the 822 pupils sampled was 1.6% (with 1.5% in stage I and 0.1% in stage II) and that of elevated BP was 8.1%, with a systolic predominance of 1.6%. SBP and DBP had a significant positive correlation with age (r=0.17; P=0.000 and r=0.07; P=0.000 respectively) and BMI (r=0.18; P=0.000 and r=0.11; P=0.000 respectively). The associated risk factors for hypertension were: the pupil's age >10 years (95% CI: 1.2581-33.1841; P=0.0254), family history of overweight (95% CI: 1.6906-32.9401; P=0.008), and excess weight (95% CI: 2.5094-40.7063; P=0.0011), and being born at term (P=0.0004) as a protecting factor. CONCLUSIONS: This study revealed a high prevalence of hypertension among primary school children in rural areas, with a number of preventable risk factors. Considering the risk factors found, children should be educated on proper nutrition, and the need for physical exercises at home and in school to avoid overweight and obesity.

Outcomes of protease inhibitor-based antiretroviral therapy amongst children and associated-factors in Yaoundé, Cameroon.

BACKGROUND: There are limited data on protease inhibitor (PI)-based antiretroviral therapy (ART) amongst children in resource-limited settings, for informing on optimal paediatric regimens. OBJECTIVE: To evaluate therapeutic response to PI-based ART amongst HIV-infected Cameroonian children. METHODS: A retrospective study was conducted amongst children aged 2-18 years receiving a PI-based ART at the Essos Hospital Centre (EHC), Yaounde, Cameroon. Primary end points were therapeutic success on PI-based ART, defined as clinical success (WHO I/II clinical stage), immunological success (CD4 ≥ 500/mm3) and viral suppression (viral load [VL]<1000 copies/ml). Factors associated with therapeutic success were assessed in uni- and multivariate analysis using SPSS software v.2.0; with p<0.05 considered statistically significant. RESULTS: A total of 71 eligible children on PI-based ART were enrolled (42 on initial and 29 on substituted regimens), with a median age of 8 [IQR: 5-12] years and mean duration on ART of 7 years. Following therapeutic responses, all (100%) experienced clinical success, 95.2% experienced immunological success (91.7% on initial and 97.2% on substituted PI/r-based regimens) and 74.7% viral suppression. In univariate analysis, viral suppression was associated with: younger age (p<0.0001), living with parents as opposed to guardians (p = 0.049), and the educational level (p<0.0001). In multivariate analysis, only the age ranges of 10-14 years (OR: 0.22 [0.07-0.73]) and 15-18 years (OR: 0.08 [0.02-0.57]), were determinants of poor viral suppression. CONCLUSION: Among these Cameroonian children, PI-based ART confers favourable clinical and immunological outcomes. The poor rate of viral suppression was mainly attributed to adolescence (10-18 years).

Obstetrical, maternal characteristics and outcome of HIV-infected rapid progressor infants at Yaounde: a retrospective study.

BACKGROUND: Rapid progressors are exposed to HIV infection at an early stage of life, and the prognosis is poor without treatment. Reducing the proportion of infants who are rapid progressors, require strengthening strategies to achieve the highest level of performance for the PMTCT program. METHODS: This was a retrospective study carried out on HIV infected infants aged less than 12 months, clinically classified stage 4 (WHO) or having CD4 count <25%. We described maternal and obstetrical characteristics of HIV-infected rapid progressors using univariate and bivariate analysis. Patients' survival was monitored from the inclusion time to the end of the study. We then estimated their probability of survival with or without anti-retroviral (ARV) treatment from birth using the Kaplan-Meier method. RESULTS: The characteristics of the mothers of the 150 rapid progressors infants we included were: low level of education (OR=3.87; P=0.016), CD4 count less than 200/mm(3) (OR=43.3; P=0.000), absence of ARV prophylaxis (OR=6.02; P=0.043), or treatment with HAART (OR=5.74; P=0.000) during pregnancy. In the children, the most important findings were lack of co-trimoxazole prophylaxis (OR=11.61; P=0.000) and antiretroviral prophylaxis (OR=2.70; P=0.0344). The survival rate was 84.3% in infants who were receiving HAART as opposed to 43.3% in those who were not (P<0.05). CONCLUSIONS: HIV infected women who are eligible should start antiretroviral treatment prior to a pregnancy, in order to improve their immunological status. This measure associated to cotrimoxazole prophylaxis and ART could improve their survival.

Cardiac anomalies in a group of HIV-infected children in a pediatric hospital: an echocardiographic study in Yaounde, Cameroon.

BACKGROUND: Cardiac manifestations associated with the HIV infection are known adversely prognosis in adults and children, even at the infraclinical stage. Although cardiac complications of HIV infection are well described in adults, there are few reports in the paediatric age group. We performed echocardiography on a group of HIV-infected children in order to describe the spectrum of the anomalies associated with the HIV infection. METHODS: We carried out a cross-sectional descriptive study on a cohort of HIV-infected children followed-up in a children's out-patient clinic. All had a thorough clinical evaluation and transthoracic echocardiography with Doppler flux analysis. The data collected were analyzed with SPPS 18.0, IBM, Chicago. Statistical significance was set at P value <0.05. RESULTS: One hundred children (52 males and 48 females) were studied. Their ages ranged from 1 to 15 years with a mean of 7 years. Forty four (44%) and 33 (33%) of the children were in World Health Organization (WHO) clinical stage III and IV respectively. Fifty seven (57%) did not have any significant immune depression. The mean age at diagnosis of HIV infection was 3 years. Ninety one percent of the participants were on highly active antiretroviral therapies (HAART). At least one cardiac abnormality was found in 89% of the participants; right ventricular (RV) dilatation in 76%, LV diastolic dysfunction in 32%, LV hypertrophy in 12%, pericardial effusion in 11% and LV systolic dysfunction in 2%. These abnormalities were more prevalent in late stages of the infection. CONCLUSIONS: Cardiac abnormalities are frequent in HIV-infected children, most of which remain asymptomatic. Routine echocardiography in HIV infected children will aid prompt diagnosis.