Impact of the COVID-19 pandemic on pediatricians' clinical activity in Cameroon.

BACKGROUND: The outbreak of COVID-19 has imposed many challenges on health systems. The purpose of this study was to describe the impact of the COVID-19 pandemic on the clinical activity of pediatricians. METHODS: We conducted a cross-sectional and descriptive online survey among pediatricians practicing in Cameroon. Data were collected through an anonymous pre-tested Google Form®. RESULTS: Among the 118 pediatricians eligible for the survey, 101 responded (85.6%), of whom 61.2% were women. The pediatric outpatient consultations dropped significantly from 60.4% of pediatricians seeing more than 30 patients per week before the pandemic to 9.9% during the pandemic (P<0.000). According to the occupancy rate of hospitalisation beds, 45.5% of pediatricians reported having 76-100% of pediatric hospitalisation beds occupied per week before the pandemic but no pediatrician reported a similar rate during the pandemic (P<0.000). There was a significant increase in the use of telehealth, ranging from no pediatrician using telehealth "very frequently" before the pandemic to 23.8% using it during the pandemic (P<0.000). Most of the pediatricians had at their disposal surgical masks (96%), care gloves (80.2%), hydroalcoholic gel (99.0%), and soap and water (86.1%). For the management of children, 90.1% and 71.3% of pediatricians experienced difficulties accessing COVID-19 PCR and chloroquine, respectively, and 74.3% declared difficulties for proper isolation of patients. More than half (65.3%) of the pediatricians interviewed were "very afraid" or "extremely afraid" of being infected with SARS-Cov-2, respectively 45.5% and 19.8%. The most frequent reasons included fear of infecting their relatives (85.1%) and of developing a severe form of the disease (43.6%). The reluctance to consult health services expressed by the parents was due to: fear of being infected when leaving their home and especially in the health facility (96%), strict compliance with confinement (30.7%), and financial difficulties of families (13.9%). CONCLUSION: This work highlights the impact of the coronavirus pandemic on the clinical activity of Cameroonian pediatricians. Since the beginning of the pandemic, there has been a significant drop in the use of health facilities, which probably has a negative impact on children's overall level of health. Although the preventive measures explain this drop in attendance at health facilities, the parents' fear of being infected when leaving the house was the predominant reason likely to explain this drop in attendance at health facilities. This could constitute an axis for developing messages to parents to encourage a gradual return to child health services.

[Prevalence and determinants of anemia in young children in French-speaking Africa. Role of iron deficiency]. / Prévalence et déterminants de l'anémie chez le jeune enfant en Afrique francophone--implication de la carence en fer.

Anemia and iron deficiency are major public health issues worldwide and particularly in Africa. Reliable information about their prevalence and associated factors is required to allow for effective actions. In this study, we used data from recent (2006-2012) large population health surveys, carried out in 11 French-speaking African countries (Benin, Burkina Faso, Cameroon, Congo Brazzaville, Ivory Coast, Gabon, Guinea, Mali, Niger, Democratic Republic of Congo, and Senegal). Hemoglobin (Hb) was assessed and demographic and health-related parameters were obtained from nation-representative samples of children aged 6-59 months. Anemia (Hb<11g/dL) was found in 72.4% of the children (60.2-87.8%), with no gender difference but a slightly lower incidence in older children (62% at age 4-5 years versus 85% at age 9 months), especially for the more severe forms (2.1% versus 8.7%, respectively). Anemia was only slightly but significantly affected by location (75.5% in rural areas versus 67.3% in towns), income (79.8% in lower quintile of income versus 62.3% in higher quintile), or maternal education (74.1% in children from non-educated mothers versus 62.4% in children whose mothers had secondary education). Nearly 50% of women of child-bearing age had anemia. In the countries that report this information, less than 50% (17-65%) of children consumed iron-rich foods regularly and only 12% (7.4-20.5%) received iron supplementation. Infection and parasitism are known to affect some markers of iron status, because of the inflammatory reaction, thereby making the diagnosis of iron deficiency difficult. In the study countries, acute respiratory diseases and diarrhea affected 6.2 and 15.6% of children aged between 6 and 59 months, respectively; their distribution according to age and location is very different from the one of anemia, which is also the case for the distribution of malaria. It is thus likely that a large part of the anemia observed in young children is due to iron deficiency, although further research is needed to confirm this. This fully justifies the nationwide programs of iron fortification of flour, currently undergoing in most countries of French-speaking Africa. Their formal evaluation is still pending but the initial data suggest some efficacy, although far from optimal. It is thus likely that a more holistic approach, including iron fortification, actions against undernutrition and parasitism in children, and actions in favor of improving young women's iron and nutritional status, together with appropriate communication and education objectives, would be more effective.

Antenatal HIV prevalence in Yaounde, Cameroon.

From June 1994 to July 1996, 4100 pregnant women living in Yaounde, Cameroon, were tested for human immunodeficiency virus type 1 (HIV-1) and syphilis. The HIV seroprevalence was 4.2% (95% confidence interval (CI): 3.6%-4.8%), and that of antibodies to Treponema pallidum was 17.4% (95% CI: 16.3%-18.6%) (HIV infection was twice as common in women with positive syphilis serology) (7.2% vs 3.6%). Over the study period, the antenatal seroprevalence of syphilis remained stable, while there was an increase in the HIV seroprevalence rate. There was an increase in HIV seropositivity in women uninfected with syphilis between 1994/1995 and 1995/1996 from 2.9% to 4.3%. By the end of the study, HIV infection was no commoner in women with negative compared with positive syphilis serology. It is therefore postulated that HIV infection in Yaounde has entered the general, sexually active female population. We suggest that management of pregnant women in Cameroon should include routine screening for both HIV infection and other sexually transmitted diseases (STDs).

[Burkitt lymphoma in Cameroon children: descriptive and clinico-anatomical aspects]. / Lymphome de Burkitt chez l'enfant au Cameroun: aspects descriptifs et anatomocliniques.

This retrospective study is armed to indicate the descriptive and pathological aspects of children Burkitt lymphoma in Cameroon. It was performed on a 4 year period between July 1988 and July 1992. Children from 0 to 15-year-old who were hospitalized and who had histologically provern Burkitt lymphoma were included. There were 39 patients, that is 27% of all malignant tumors in children during this period. Twenty-four were boys and 15 were girls; the median age was 90 months (+/-46) (range from 3 to 180 months). All children had Plasmodium falciparum infection. EBV serology was positive in 18 patients out of 25 (72%), 14 (36%) had a good nutritional status, the 25 other patients suffered malnutrition. Tumor localizations were: maxillary in 29 (74%) patients, abdominal in 7 (18%), other in 3 patients. Clinical stages according to Murphy classification were: stage I in 6 (15%) patients, II in 3 (8%), III in 20 (51%) and IV in 10 (26%). It is concluded from this series that clinical aspects and histological pattern in children Burkitt lymphoma in Cameroon are not different from what is observed in other endemic areas.

[Pseudotumoral nasopharyngeal sarcoidosis in the child. Apropos of a case]. / Sarcoïdose rhino-pharyngée pseudo-tumorale chez l'enfant. A propos d'une observation.

Rhino-pharyngeal, involvement is rare in sarcoidosis, and exceptional in children. The authors report a case of pseudo-tumoral involvement of the cavum in a 9 year old child, revealed by locoregional complications. Close collaboration between clinicians and the pathologist enabled correct etiological diagnosis.

Quinine pharmacokinetics and pharmacodynamics in children with malaria caused by Plasmodium falciparum.

The aim of the present study was to assess the pharmacokinetics and the efficacy of a shorter than usual 5-day quinine treatment given orally to children in Cameroon with malaria caused by Plasmodium falciparum. Quinine (8.3 mg of base per kg of body weight every 8 h) was administered as a 2% formiate salt syrup for 5 days to 30 children (age range, 0.55 to 6.7 years) with uncomplicated falciparum malaria (initial parasitemia, 1.4 x 10(3) to 1.8 x 10(5)/microl). Quinine concentrations in plasma samples (five to nine per patient) were measured by liquid chromatography on days 1 to 3. Parasitemia was counted on days 0, 1, 2, 3, 4, 7, and 14. Pharmacokinetic and pharmacodynamic data were analyzed by population approaches by using NONMEM and WinBugs, respectively. The kinetics of quinine were best described by a one-compartment model with time-varying protein binding. Clearance and the volume of distribution were positively correlated with body weight and increased over time. Parasitemia was undetectable from day 3 to 14 in all children. The time to a 4-log reduction of the initial level of parasitemia (Ter) was related to the average quinine concentration from 0 to 72 h (Cav) as Ter = Tmin [1 + (C50/Cav)s], where sigmoidicity (s) is equal to 2, Tmin is the time to eradication at infinite Cav, and C50 is the value of Cav for which Ter is twice Tmin. The C50 distribution was unimodal, and all C50 values were less than 8 mg/liter, while Cav ranged from 5.9 to 18.3 mg/liter. The median (10th to 90th percentile) Ter was 47 h (range, 39 to 76 h). The efficacy of a 5-day treatment course should be evaluated in a larger clinical trial.

[Variola or a severe case of varicella? A case of human variola due to monkeypox virus in a child from the Cameroon]. / Variole ou varicelle grave? Un cas de variole humaine à monkeypox virus chez un enfant Camerounais.

Human monkeypox was suspected on clinical grounds in a seven years old child in Cameroon. The diagnosis was confirmed at the Center for Disease Control (CDC) in Atlanta, USA. This condition is rare. The present case is the third in Cameroon. An epidemiological and clinical survey carried out in the family and in the area where the patient lives, did not allow to identify other cases. The clinical evolution of the case was good as in those described elsewhere.

Anthropometric measurements in a newborn population in west Africa: a reliable and simple tool for the identification of infants at risk for early postnatal morbidity.

The predictive value of anthropometric measurements in the identification of infants at risk for early postnatal morbidity was assessed in a cohort of 490 neonates born in Yaoundé, Cameroon. Mid-arm circumference (MAC), head circumference, weight, and length were measured within 6 hours of birth, and the gestational age, individual MAC/head circumference ratio, and individual ponderal index were calculated. A detailed questionnaire on gestational medical history was also obtained from the mothers. All infants were then closely monitored during the first 72 hours after delivery for the appearance of symptoms requiring medical intervention and treated accordingly. Low birth weight (LBW) was observed in 37.75%, prematurity in 25.5%, and small size for gestational age in 14.1% of the neonates. Gestational medical problems were reported by 44.3% of the mothers; malaria was the most frequent. Early postnatal morbidity was observed in 26% of the infants; infection (53%), respiratory distress (26%), hypoglycemia (26%), and convulsions (11.7%) accounted for most of the problems. The MAC correlated best of all variables with birth weight (r = 0.91); a value of less than or equal to 9.5 cm had a 93% sensitivity and a 90.5% specificity in the prediction of LBW. An MAC cutoff value of less than or equal to 9.5 cm was also the best of all variables in the prediction of early postnatal morbidity, and 85.2% sensitivity and 74.3% specificity were achieved. We conclude that in developing countries, where scales are not always available and the overburdened maternity wards cannot allow for medical surveillance of every infant, the MAC can be used in the estimation of birth weight. Moreover, an appropriately calculated cutoff value of MAC may serve as a reliable indicator of LBW and of infants at risk for early postnatal morbidity.

The clinical manifestation of the kwashiorkor syndrome is related to increased lipid peroxidation.

Along with the onset of severe kwashiorkor symptoms, a 20-month-old child showed biochemical signs of markedly increased lipid peroxidation, with a decrease of plasma antioxidants and decreased proportions of polyunsaturated fatty acids in plasma and red cell phospholipids. Additionally, plasma concentrations of the lipid peroxidation products malondialdehyde and hexanal, as well as the urinary excretion of leukotriene E4, were found to be increased. All biochemical alterations normalized along with subsequent clinical improvement. These findings suggest that the extent of lipid peroxidation is strongly related to the severity of the kwashiorkor syndrome.

Initial treatment of bacterial meningitis in Yaounde, Cameroon: theoretical benefits of the ampicillin-chloramphenicol combination versus chloramphenicol alone.

A prospective 6-month study in Yaounde evaluated 49 children aged from 2 months to 8 years, hospitalized with bacterial meningitis. They were randomly assigned to one of two initial treatment groups, either an ampicillin-chloramphenicol combination (group A) or chloramphenicol alone (group B). The majority of patients were infected with Haemophilus influenzae, and the majority of deaths were caused by Streptococcus pneumoniae. Altogether, 17.9% of Haemophilus influenzae isolates were ampicillin-resistant and 3.6% chloramphenicol-resistant. We found no isolate resistant to both antibiotics. Response to both treatments was similar in both groups. The theoretical risk of treatment failure with ampicillin was higher than with the ampicillin-chloramphenicol combination (p less than 0.05). There was no statistically significant difference between the risk of treatment failure with the ampicillin-chloramphenicol combination and the risk with chloramphenicol alone (p less than 0.05), but the latter was increased by the occurrence of chloramphenicol-resistant isolates of Streptococcus pneumoniae (11.1%). Although treatment with an ampicillin-chloramphenicol combination is four times more expensive than treatment with chloramphenicol alone, costwise it is also one-quarter the price of a third-generation cephalosporin (moxalactam). At present, the ampicillin-chloramphenicol combination can be suggested as the first choice for initial treatment considering both the epidemiological data and the cost/efficiency ratio in the area of Yaounde.

[Cerebral malaria in children in Yaounde, Cameroon. Clinical, paraclinical and developmental aspects]. / Le neuro-paludisme de l'enfant à Yaoundé, Cameroun. Aspects cliniques, paracliniques et évolutifs.

Cerebral malaria is one of the major and deadly complications of malaria. In Cameroon, recent reports indicate that severe cases of malaria are increasingly more prevalent, particularly in children. The present study aims at describing the clinical presentation and laboratory findings of cerebral malaria in children in Yaounde. All patients admitted in the paediatric ward of Yaounde Central Hospital with malaria, who presented neurological signs and were tested positive for Plasmodium in their peripheral blood were recruited into the study. 36 cases were enrolled in all, making up 2.7% of all admissions. The patients' median age was 4.5 years. 52.8% were on malaria prophylaxis. Convulsions and coma with preceding hyperthermia were present in more than 90% of the patients. Blood parasites level median was 1.3% on admission. One patient had hypoglycaemia on admission and two others had it later on after admission; 16.7% had neurological sequels at discharge and two children died (5.6%). Delay in diagnosis and initiation of treatment with quinine adversely affected the prognosis of cerebral malaria in the study group.

[Neonatal streptococcus group B infection in Yaoundé (Cameroon). Epidemiologic and clinical aspects]. / Infection néonatale à streptocoque du groupe B à Yaoundé (Cameroun). Aspects épidémiologiques et cliniques.

This study was designed to investigate epidemiologic and clinical features of neonatal group B streptococcal infections. Sixty cases seen over a 60-month period were reviewed. Incidence was 0.8% of admissions. Most affected infants were from low-income families (86.7% of mothers were unemployed and 73.5% of homes were without running water). Neonatal infection was delayed in most instances (76.67%). Fetid vaginal discharge (60%) and premature rupture of the membranes (35%) were the main findings upon history taking. Abnormal body temperature regulation (76.7%) was the most prominent clinical manifestation. Respiratory distress developed in 25% of patients. Meningeal involvement occurred in 73.3% of patients. Serotype B III was recovered in 31 of the 34 cases (91%) in which serotype was determined. Mortality rate was 21.7% and permanent sequelae occurred in 8.3% of patients.

Chloroquine self-treatment and clinical outcome of cerebral malaria in children.

Chloroquine is widely used as self-medication for presumptive treatment of malaria despite the existence of parasite resistance to the drug. Recent studies suggest that tumour necrosis factor-alpha (TNF-alpha) overproduction probably has a causal association with poor outcome in cerebral malaria. In addition, chloroquine has been shown to have inhibitory action on TNF-alpha synthesis. The present study aimed at evaluating chloroquine/TNF-alpha interaction in 90 children hospitalized for severe malaria in a malaria-endemic zone. TNF-alpha and chloroquine varied in the same range on admission, but there was an inverse correlation between the two: the higher the chloroquine level, the lower the TNF-alpha level. Parasite resistance to chloroquine in vitro was high. The clinical course in the patients was uneventful, save for two fatal cases and one survivor with neurological sequela. The above data suggest beneficial effects of chloroquine self-medication with respect to anti-TNF-alpha action. Rational use of this tool should be encouraged.