Alarming rates of virological failure and HIV-1 drug resistance amongst adolescents living with perinatal HIV in both urban and rural settings: evidence from the EDCTP READY-study in Cameroon.

OBJECTIVES: Adolescents living with perinatal HIV infection (ALPHI) experience persistently high mortality rates, particularly in resource-limited settings. It is therefore clinically important for us to understand the therapeutic response, acquired HIV drug resistance (HIVDR) and associated factors among ALPHI, according to geographical location. METHODS: A study was conducted among consenting ALPHI in two urban and two rural health facilities in the Centre Region of Cameroon. World Health Organization (WHO) clinical staging, self-reported adherence, HIVDR early warning indicators (EWIs), immunological status (CD4 count) and plasma viral load (VL) were assessed. For those experiencing virological failure (VF, VL ≥ 1000 copies/mL), HIVDR testing was performed and interpreted using the Stanford HIV Drug Resistance Database v.8.9-1. RESULTS: Of the 270 participants, most were on nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens (61.7% urban vs. 82.2% rural), and about one-third were poorly adherent (30.1% vs. 35.1%). Clinical failure rates (WHO-stage III/IV) in both settings were < 15%. In urban settings, the immunological failure (IF) rate (CD4  < 250 cells/µL) was 15.8%, statistically associated with late adolescence, female gender and poor adherence. The VF rate was 34.2%, statistically associated with poor adherence and NNRTI-based antiretroviral therapy. In the rural context, the IF rate was 26.9% and the VF rate was 52.7%, both statistically associated with advanced clinical stages. HIVDR rate was over 90% in both settings. EWIs were delayed drug pick-up, drug stock-outs and suboptimal viral suppression. CONCLUSIONS: Poor adherence, late adolescent age, female gender and advanced clinical staging worsen IF. The VF rate is high and consistent with the presence of HIVDR in both settings, driven by poor adherence, NNRTI-based regimen and advanced clinical staging.

[Access to the management of HIV infected children: Overview of the healthcare supply in Cameroon in 2014]. / Accès à la prise en charge de l'infection VIH pédiatrique ­ État des lieux de l'offre des soins au Cameroun en 2014.

BACKGROUND: In Cameroon in 2012, the proportion (15%) of children eligible for antiretroviral treatment (ART) was one of the lowest among the 21 Global Fund priority countries. The objective of this study was to carry out a situational analysis of the existing care offer for pediatric HIV in Cameroon. METHODS: A descriptive cross-sectional study was conducted over a 4-month period (April to August 2014) in 12 healthcare facilities in 7 regions of Cameroon selected by systematic sampling. The data were collected in a self-administered questionnaire filled out by the caregiving and administrative personnel included in the study. RESULTS: All in all, 142 persons in charge of pediatric HIV treatment were included in the study, of whom 115 were working at the operational level: 59 (51.2%) health personnel, 44 (38.3%) community agents and 12 (10.4%) department heads; the other 27 exercised responsibilities at the regional (19) and the local (8) levels. An overwhelming majority of the caregivers involved in pediatric VIH treatment were nurses, a factor necessitating the delegation of medical tasks institutionalized in Cameroon. Few standardized nationwide documents take into account these treatment modalities. Inadequate dissemination of the documents at all levels of the healthcare pyramid may justify the non-compliance with the care protocols that has been observed in the training programs dedicated to the subject. CONCLUSION: The updating and large-scale dissemination of standardized nationwide documents taking into account the specificities of HIV-infected children are required to improve implementation at the operational level of the Cameroonian healthcare system of the existing guidelines for pediatric HIV treatment.

[12-months efficacy of option B+ for prevention of mother-to-child transmission of HIV in Yaoundé, Cameroon]. / Efficacité à 12 mois de l'option B+ pour prévenir la transmission mère-enfant (PTME) du VIH à Yaoundé, Cameroun.

BACKGROUND: Cameroon has adopted the option B+ for the prevention of mother-to-child transmission (MTCT) program of HIV in August 2014 in order to eradicate MTCT of HIV. OBJECTIVE: To analyze in routine life settings, efficacy of option B+ for PMTCT and associate factors. METHODS: We conducted a cross-sectional study over a 6-month period in the ESSOS hospital center. Study population comprised HIV-positive mothers and their infants aged 0-24 months. Variables included were : moment of HIV maternal testing, timing of commencement of maternal antiretroviral therapy (ART) and self-reported adherence to ART. Efficacy was measured through early and late MTCT rate and associated factors. RESULTS: We included 200 mothers and 124 infants. Under option B+, the rate of transmission was at 4.20% at 6 weeks and 5.83% at 12 months. The rate of HIV transmission in breastfed infants stood at 3.7%. In unadjusted analysis, bottle-feeding, term at birth, early screening and management during pregnancy were associated with lower risk of HIV transmission. After adjustment, term at delivery after 37 weeks adjusted odds ratio (AOR) [0.059; (0.0061; 0.56)] was protective; while lack of prophylaxis was among HIV-exposed infants emerged as the main factor associated with residual transmission of HIV [AOR 117.23 ; (3.55 ; 3874.9)]. CONCLUSION: In this setting of Yaoundé, routine option B+ posted laudable results at 12 months even amongst breastfed children and should therefore be made sustainable.

Assessment of cardiac function in children with congenital adrenal hyperplasia: a case control study in Cameroon.

BACKGROUND: High level of androgens found in congenital adrenal hyperplasia (CAH) seems to have a deleterious effect on heart function. We therefore evaluate cardiac function of children with CAH in comparison with a healthy group. METHODS: We carried out a case-control study in the single endocrinology unit of the Mother and Child Center of Chantal Biya's Foundation. Cases were matched for age and genotypic sex to 2 healthy controls. We analyzed the ejection fraction (LVEF), fractional shortening and left ventricular mass; output and cardiac index; E and A waves velocities, E/A ratio and the mitral deceleration time and diameter of the left atrium; tricuspid annular plane systolic excursion and pulmonary artery systolic pressure were also measured. RESULTS: We included 19 patients with a median age of 6.26 ± 3.75 years and 38 controls stackable distribution. The left ventricular mass of cases was greater than that of controls. A case of reversible cardiomyopathy on hormone replacement therapy was found. For the cases, the average ejection fraction was 71.95 ± 7.88%; the average fractional shortening was 40.67 ± 7.02%. All these values ​​were higher than those of controls, although the difference was not statistically significant. Diastolic left ventricular function was more impaired among the cases. Right ventricular function was similar in both groups. These abnormalities were highly correlated to the late age at diagnosis and duration of treatment. CONCLUSION: This study shows an altered cardiac function in CAH compared to healthy control and highlights importance of an early diagnosis of cases, a tight control of androgens levels and a regular monitoring of cardiac function.

[Visceral leishmaniasis: pediatric case report observed outside the traditional foci in Cameroon]. / Leishmaniose viscérale: une observation pédiatrique en dehors des foyers traditionnels au Cameroun.

The purpose of this report is to describe an autochtonous case of visceral leishmaniasis with cachexia, fever, splenomegaly, ascitis and severe anemia observed in an eight-year-old boy from a region in eastern Cameroon outside the traditional disease foci. Diagnosis was confirmed based on demonstration of Leishmania amastigotes on bone marrow smear. The patient was treated with meglumine antimoniate but died on the 6th day of treatment.

Impact and projections of the COVID-19 epidemic on attendance and routine vaccinations at a pediatric referral hospital in Cameroon.

BACKGROUND: At the beginning of March 2020, Cameroon experienced its first cases of infection with the new coronavirus (SARS-COV-2). Very quickly, there was a drop in the rate of hospital attendance. The purpose of this study was to observe the variations in the uptake of pediatric consultations and vaccinations in a pediatric hospital. METHODS: A descriptive and retrospective cross-sectional study was carried out using consultation and vaccination statistics from a pediatric hospital in the city of Yaoundé, political capital of Cameroon, from January 2016 to May 2020. Data were entered in Microsoft Excel and exported to R software (Version 3.3.3) for statistical analysis. First, time series raw data (before and after COVID-19) were plotted and the trend estimated by locally weighted scatterplot smoothing (LOWESS) methods. Then a classic seasonal decomposition was performed to distinguish between seasonal trends and irregular components using moving averages. The Webel-Ollech overall seasonality test (WO test) was also run to formally check for seasonality. The results of the study are presented as narrative tables and graphs. RESULTS: Following the partial confinement recommended by the government of Cameroon, the number of pediatric consultations decreased by 52% in April and by 34% in May 2020 compared with rates during the same periods in 2019 (P=0.00001). For antenatal visits, the rates dropped by 45% and 34%, respectively, in April and May 2020 compared with 2019. The demand for immunization services also declined. As a result, the demand for BCG vaccines, third-dose tracer vaccines (diphtheria, tetanus, pertussis), polio, and MMR in children as well as tetanus vaccines in childbearing women dropped significantly. CONCLUSION: The start of the COVID-19 pandemic was accompanied by a significant drop in consultation and vaccination activities. If no action is taken to correct this phenomenon, the ensuing months could be marked by a considerable increase in patients, sometimes suffering from vaccine-preventable diseases. The death rate could increase considerably in the pediatric population.

Mortality of children aged 5-15 years in a tertiary care center in Yaoundé, Cameroon.

INTRODUCTION: Although sub-Saharan Africa accounts for only 21% of the global population of children and adolescents aged 5-15 years, 55% of deaths among children in this age group occur in this region. This seems to be related to infectious diseases. We hypothesized that besides infectious diseases, in our context, a chronic underlying condition increases mortality. Our goal was to describe the leading causes of mortality among this age group. PATIENTS AND METHODS: We conducted a retrospective study in a tertiary care center in Yaoundé. We included the medical files of children who died between January 2013 and December 2017. RESULTS: The in-hospital mortality rate was 10.3 per 1000. Coma and/or convulsion was the main cause of death (70.6%), followed by severe anemia (64.7%) and respiratory distress (56.8%). We identified a chronic illness in 62.2% of cases: HIV infection (39.2%) and sickle cell disease (24.5%) were the most prevalent. The main diagnoses were severe malaria, severe sepsis, and meningitis (Cryptococcus sp. included) in 25 (n=35), 16.4 (n=27), and 10.3% (n=17) of cases, respectively. CONCLUSION: HIV infection and sickle cell disease are the most prevalent chronic diseases related to the patients' death in the age group studied. Specific interventions focusing on this age group are recommended including intensification of impregnated bednet usage as well as HIV and sickle cell disease management.

[Endomyocardial fibrosis in Cameroon: Echocardiographic and clinical description of a pediatric series in Yaoundé]. / Fibrose endomyocardique : description clinique et échocardiographique d'une série pédiatrique camerounaise.

BACKGROUND: Endomyocardial fibrosis is a restrictive cardiomyopathy that causes heart failure. It is characterized by the fibrotic thickening of the endocardium, sometimes involving the myocardium as well. The lesion generally lies at the apices or inflow tracts of one or both ventricles, associated with more or less severe alteration of the valves. It is a disease of the intertropical regions but is not well known in Cameroon. In this study we describe the first series seen in a pediatric hospital in Cameroon. PATIENTS AND METHODS: A retrospective study was conducted in a pediatric hospital in Yaoundé involving children who had been diagnosed with endomyocardial fibrosis after echocardiographic investigation. We collected the clinical and paraclinical data from consultation records and medical files. RESULTS: Between January 2006 to December 2013, we registered 1430 patients with a cardiac anomaly in our center. Endomyocardial fibrosis was found in 46 patients. Neither sex predominated. Ages at the time of diagnosis varied between 2 and 17 years. Most of the patients were between 5 and 15 years old (80.4 %), with a median of 10 years (interquartile range, 7-13 years). The main complaints were breathlessness, cough, abdominal distension, abdominal, and loss of appetite. Apart from the hyperpigmentation of the lips observed in all our patients, dyspnea was the most frequent physical sign and the diagnosis was made at a time when signs of heart failure were preponderant. Growth retardation was found in all the children examined. All patients were underweight with a median weight for age found below the 25th percentile of the norms according to the National Health Statistics. Lower limb edema was absent even in the presence of voluminous ascites. All subjects had hyperpigmented lips. Despite the cyanotic appearance of the lips, pulse oximetry always gave a normal oxygen saturation level and no cyanosis was seen elsewhere. None of the patients had nail clubbing. Fibrosis more often affected the right ventricle (45/46 patients). The apical obliteration by fibrotic material was found in 43 (93.5 %) patients. Moreover, 36 (78.3 %) patients had pericardial effusion: mild to moderate in 32 subjects and abundant in four subjects. Hypereosinophilia was noted in 57.5 % of the patients. Atrial fibrillation was found in six out of 15 patients who had an electrocardiogram done. CONCLUSION: The modes of clinical presentation of endomyocardial fibrosis are not sufficiently well known in our context. Despite its insidious progression, certain signs such as weight loss and hyperpigmented lips could be very helpful for screening and easing orientation of parents and heath personnel, thus enabling early referral for appropriate investigation. The presence of bulky ascites without edema of the lower extremities should be viewed as strongly suggestive.

[Serum procalcitonin: a reliable tool for the diagnosis and follow-up of neonatal bacterial infections in Sub-Saharan Africa]. / Intérêt du dosage de la procalcitonine sérique dans le diagnostic et le suivi des infections néonatales d'origine bactérienne à Yaoundé, Cameroun.

BACKGROUND AND AIM: Neonatal infection (NNI) is a public health problem in developing countries where pediatricians and specifically neonatologists encounter many diagnostic difficulties. Having a precise and easily measurable biological marker, with a high sensitivity and a high negative predictive value, that can rapidly detect NNI, remains a great challenge. The aim of this study was to determine the place of serum procalcitonin (PCT) in the diagnosis and follow-up of bacterial NNI in resource-limited contexts. METHODS: We carried out a cross-sectional study from October 2009 to February 2010 at the Mother and Child Centre of the Chantal Biya Foundation, Cameroon. We included all neonates born at term, suspected of NNI, and hospitalized in the Neonatal Care Unit of the aforementioned centre during the study period. We measured PCT levels at entry and 48h later, and determined its sensitivity, specificity, and positive and negative predictive values. RESULTS: Twenty-five out of the 98 neonates enrolled presented with a confirmed diagnosis of NNI. PCT was positive in 92.4% of cases. Contrariwise, serum C-reactive protein was positive in 84.6% of patients with a cut-off point at 6mg/L, and remained positive in only 38.4% of cases when the cut-off point was raised to 20mg/L. The sensitivity, specificity, and positive and negative predictive values of PCT were 96.0%, 77.7%, 85.3%, and 93.3%, respectively. Six deaths were recorded, five of which exhibited very high PCT levels (≥10ng/mL). All neonates with negative PCT levels had a good clinical outcome as none of them died. If PCT were to be considered as a diagnostic tool of NNI, only 43 (43.9%) neonates would have benefited from a justified antibiotic therapy exceeding 48h, with a significant reduction in duration of hospitalization (9.1±3.3 vs 5.1±4.6 days; P<0.05). CONCLUSION: PCT may be an early and reliable indicator of bacterial NNI. Its course throughout hospitalization may reflect the therapeutic response, and elevated levels of PCT may be highly suggestive of a poor clinical prognosis. PCT could therefore serve as a useful tool for the screening, diagnosis, and follow-up of neonates suspected of bacterial NNI in resource-poor settings.

[Neonatal septicemia and meningitis caused by gram-negative bacilli in Yaondé: clinical, bacteriological and prognostic aspects]. / Les septicémies et méningites néonatales a bacilles gram négatifs a Yaoundé: aspects cliniques, bactériologiques et pronostiques.

Based on 139 cases collected in 36 months, the authors show that neonatal sepsis and meningitis with Gram negative bacilli represent 62.33% of confirmed neonatal sepsis (223 cases out of 6,784 neonatal hospitalisations). 53.96% of cases are manifest within the first 72 hours of life. 35.25% of these infants are preemies. The principal predisposing factors are: foul-smelling leukorrhea (45.23%), prolonged rupture of membranes (26.62%) and notion of resuscitation (36.69%). The most important clinical signs are: thermal dysregulation (47.48%), tonus disturbances (35.97%) and respiratory distress (25.90%). Sepsis make up 85.61% of cases; the principal germs isolated being: Acinetobacter (21.58%), Pseudomonas (15.83%), Escherichia coli (14.39%), Enterobacter (12.95%), Klebsiella (11.51%). Of the germs isolated, 27.78% were resistant to initial treatment with the association ampicillin gentamicin. Mortality rate was 46.76%.

[Arnold-Chiari malformation. Contribution of cerebral echography in the pretherapeutic evaluation]. / Malformation d'Arnold-Chiari. Apport de l'échographie cérébrale dans le bilan préthérapeutique.

From August 1988 to August 1989, we performed pre-operative sonographic examinations on eleven children who had Arnold-Chiari malformation (ACM). All children presented with myelomeningocele. ACM was the leading cause of hydrocephalus in infants and newborns. For eight children, hydrocephaly was particular by the discrepancy between the dilated atrium and the relatively small temporal horns. Two children have associated extra-neurologic malformations. Five patients were operated upon, with poor results in four. In our experience, ultrasonography was found very useful in patients presenting with myelomeningocele.

[Upper digestive system hemorrhages in Cameroon (apropos of 172 cases examined via endoscopy)]. / Les hémorragies digestives hautes au Cameroun (à propos de 172 cas explorés par endoscopie).

172 cases of upper gastrointestinal bleeding were explored endoscopically from 01 March 1987 to 15 May 1989 in 3 centers in Cameroon. The patients comprised 124 men and 48 women with an average age of 39.64 years. Haematemesis with resultant melena constituted the most frequent presentation (42.36%) while haematemesis and melena was the unique presentation in 37.22% and 17.91% of cases respectively. The aetiologic factors encountered were: duodenal ulcers (33.64%), acute gastric bleeding (22.08%) gastric ulcer (13.44%), ruptured gastroesophageal varices (13.92%). Predisposing factors included the ingestion of gastric irritant medication, spices and alcohol. The authors review the literature and in its light, discuss the epidemiology and aetiology of gastrointestinal bleeding in Cameroon.

[Feeding practices in 6-to-24-month-old children in Yaoundé, Cameroon: relationship with their nutritional status]. / Pratique de la diversification alimentaire chez les enfants de 6 à 24 mois à Yaoundé : relation avec leur état nutritionnel.

INTRODUCTION: Shifting from breastfeeding to solid food is known as the complementary feeding period. When complementary feeding is inadequate, malnutrition results in most cases. These practices differ depending on cultural and religious backgrounds as well as geographical location. Ruel and Menon studied the relationship between feeding practices during diversification and nutritional status of children at 6 and 36 months, using a score called the Infant and Child Feeding Index (ICFI). This ICFI scored feeding practices such as breastfeeding, bottle-feeding, food diversity, and meal frequency, which has never been studied in Cameroon. OBJECTIVE: The aim of this study was to describe actual feeding practices in children in our context as well as to investigate their relationship with children's nutritional status. PATIENTS AND METHODS: We carried out a cross-sectional study throughout the month of January 2011 at the Chantal-Biya Foundation. Mothers completed a questionnaire on how their infants were fed at birth, the initiation of complementary food, and feeding practices for the 3 days before the survey. The children's anthropometric parameters were noted. All mothers coming for vaccination or vitamin A supplementation for their children aged between 6 and 24 months were enrolled in the study. RESULTS: We enrolled 197 mothers and their infants. Breastfeeding was the main feeding method at birth, but was exclusive until 6 months for only 15 % of the infants. Three-quarter of nursing mothers started adding complementary food at age 4-6 months, using pap. Half of the children did not receive animal products, fruits, or vegetables. When applying the ICFI to these practices, it appeared that the various diversification practices scored less than 8 for 50% of the population. A positive association was noted between the ICFI and nutritional status, as expressed by height-of-age Z-score (HAZ) and the weight-for-age Z-score (WAZ). CONCLUSION: We concluded that the codified feeding practices with respect to Ruel and Menon's ICFI are associated with the nutritional status of children between 6 and 24 months in Yaounde, Cameroon.

Ectopia cordis. A report of two cases in Cameroon.

We report two cases of ectopia cordis in two children aged one day and twenty months respectively. A one day old newborn had complete thoracic ectopia cordis associated with an internal cardiac defect and severe thoracic and abdominal wall malformations. Our centre does not have the facilities to manage complex congenital defects and prior to being transferred to a cardiac centre, the neonate died on the second day of admission. A 20-month old baby had partial ectopia of the heart and a defect in the abdominal wall. He had no major congenital cardiac defect and has remained clinically stable with no life threatening symptoms.

[Role of transfontanel cerebral echography in the cerebral exploration in infants from Yaoundé, Cameroun]. / Place de l'échographie cérébrale transfontanellaire dans l'exploration cérébrale du nourrisson à Yaoundé, Cameroun.

During a one year period, central nervous system (CNS) lesions were diagnosed by transfontanella cranial sonography (TCS) in 46 infants at the university medical centre of Yaoundé, Cameroun. The most frequent features were hydrocephaly (22 cases) and perinatal vascular pathology (17 cases). Because of its very low cost/efficacy ratio TCS should be more largely used in the African hospitals for the diagnosis of brain damages in infants.

[Incidence of cerebral hemorrhage in newborn infants diagnosed by echography in Yaoundé, Cameroon]. / Incidence de l'hémorragie cérébrale du nouveau-né diagnostiquée par échographie à Yaoundé, Cameroun.

Among 84 at-risk neonates studied over a 1-year period, 15 presented with cerebral hemorrhage (CH) detected by ultrasound. The incidence of CH was 46% in premature infants with a gestational age less than or equal to 35 weeks and 5% in neonates with a gestational age greater than 35 weeks. In 12 cases, CH was subependymal and the totally regressed. In 3 cases, the bleeding was more severe. There were 3 deaths among the 15 infants. This study underlines the high frequency of CH among the neonates in Yaoundé, and justifies systematic screening for it in the high-risk population and points out areas in which perinatal care could be improved upon and premature birth prevented.

[Sensitivity of a strain of Schistosoma intercalatum from Loum (Cameroon) and is natural hybrid to treatment with praziquantel. Preliminary results]. / Etude de la sensibilité de la souche de Schistosoma intercalatum de Loum (Cameroun) et de son hybride naturel au traitement par le praziquantel. Résultats préliminaires.

At Loum, S. intercalatum infection still occurs in its pure form. The infection, however, is regressing while S. haematobium and hybrid forms between the two species are developing. A single oral dose of 2-cyclo-hexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a]isoquinolin-4-o ne(praziquantel, EMBAY 8440, Biltricide), 40 mg/kg body weight, is a very effective treatment of the disease. Forty days after treatment eggs no longer occurred in the faeces of ten children voiding S. intercalatum eggs in their stools before they were cured. Five children voiding hybrid bilharzia eggs in their urine were no longer passing eggs after treatment.

[Incidence of peri- and intraventricular hemorrhages in a premature population at the Central Hospital of Yaounde (Cameroon)]. / Incidence des hémorragies péri- et intraventriculaires dans une population de prématurés à l'Hôpital Central de Yaoundé (Cameroun).

In Cameroon, prematurity is common but few studies have been carried out on periventricular and intraventricular hemorrhage in premature neonates. Seventy neonates born between 28 and 34 weeks gestational age were studied by cerebral ultrasonography. Thirty infants (42.8%) showed evidence of periventricular or intraventricular bleeding. This proportion was 58.3% in infants born between 28 and 31 weeks gestational age. All stage III (3 cases) and stage IV (2 cases) hemorrhages were bilateral. Bilateral bleeding was less common among patients with stage I (2 cases) or stage II (2 cases) hemorrhages. Among patients born between 32 and 34 weeks gestational age, only 34.8% had ventricular hemorrhage which was always stage I or II and usually unilateral (two stage I and one stage II bilateral bleeds). The incidence of periventricular and intraventricular hemorrhage is high in Yaoundé. Ultrasonographic evaluation should be routinely performed in infants born before 35 weeks gestational age.

[Child victims of sexual abuse in Cameroon]. / Les enfants victimes de sévices sexuels au Cameroun.

Reports of sexual abuse in children are infrequent in the French-speaking nations of black Africa. This study was undertaken to determine the incidence of sexual abuse in children in Yaounde, describe the profile of victims, and identify factors associated with sexual abuse. Seventeen female rape or attempted rape victims were enrolled over an 8-month period. Most (57.05%) were 7 to 15 years of age and lived in underprivileged neighborhoods. Genital bleeding (12 cases), hymenal tears (14 cases) and/or perineal tears were the main lesions found. Most of the rapists were young adults (19-45 years old in 70.5% of cases) who were neighbors, relatives or friends of the family, and single (58.82%). The motivations of the rapists were unclear. This medicosocial reality which is new in Cameroon needs attention.