Risk factors and placental histopathological findings of term born low birth weight neonates.

INTRODUCTION: Low birth weight (LBW) is associated with increased neonatal morbidity and mortality. Hence, this condition should be well studied. The aims of this study were to identify the risk factors for term born LBW, as well as the placental histopathological lesions observed. METHODS: This case control study was carried out in the University Teaching Hospital and the Central Maternity, both of Yaoundé, Cameroon, from November 1st, 2013 to April 30th, 2014. Maternal medical records and placentas of term born (≥37 completed weeks) LBW (<2500 g at birth) or normal weight (3000-3500 g) were compared. The main variables recorded included maternal age and parity, maternal height, complications that occurred during pregnancy, maternal pre-gestational body mass index, the number of antenatal visits, the sex and birth weight of the newborn, the umbilical cord length, the placental weight and placental histology. Data were analyzed using Epi info 3.5.4. Fisher exact test, t-test and logistic regression were used for comparison. P < 0.05 was considered statistically significant. RESULTS: and DISCUSSION: A total of 30 cases of LBW and the same number of controls were examined. Significant risk factors for LBW were primiparity (aOR 14.0, 95%CI 2.1-92.7), hypertensive diseases of pregnancy (aOR 18.1, 95%CI 1.02-322.5) and <4 antenatal visits (aOR 9.5, 95%CI 1.3-67.5). Significant placental lesions were placental infarction (aOR 19.5, 95%CI 2.9-130.1) and chronic villitis (aOR 35.9, 95%CI 1.2-1034.3). Our study showed that primiparous women, those with pregnancy-induced hypertensive diseases and those with <4 antenatal visits were more at risk for LBW. Significant placental lesions observed among LBW were placental infarcts and chronic villitis. Since LBW has the tendency to recur, and given that some causes such as placental infarcts are preventable, we recommend that a histological examination of the placenta should always be carried out in cases of LBW.

[Central precocious puberty due to hypothalamic hamartoma in Cameroon]. / Puberté précoce de cause rare au Cameroun: L'Hamartome hypothalamique.

Hypothalamic hamartoma is an uncommon cause of central precocious puberty and sometimes of gelastic epilepsy and delayed development. The purpose of this report is to describe a case of central precocious puberty in an 18-month-old girl who was referred to our department for further investigation of vaginal bleeding that had appeared during the 8th month of life. The patient's puberty was compatible with Tanner stage 3, her psychomotor development was normal, and epilepsy was not observed. Diagnosis was based on abnormal hormonal workup findings and discovery of a hypothalamic hamartoma on brain magnetic resonance imaging. Neurosurgery was not performed. Administration of long-acting gonadotropin releasing hormone analog to slow puberty led to clinical improvement. Hypothalamic hamartoma must always be suspected in case of central precocious puberty. Although magnetic resonance imaging is the most reliable modality, it is not always available nor affordable in low-income countries. Neurosurgery is not indicated in patients without epileptic seizure. Gonadotropin releasing hormone agonists are usually indicated to slow down puberty and improve the adult height. However, the cost is prohibitive in developing countries.

[Severe forms of malaria in children in a general hospital pediatric department in Yaounde, Cameroon]. / Les formes graves du paludisme de l'enfant dans un service de pédiatrie générale à Yaoundé, Cameroun.

Severe forms of malaria in children are responsible for 1 million deaths yearly in young children in hyperendemic areas. The main objective of this study was to identify and compare common manifestations of different forms of severe malaria and to evaluate the prognosis for hospital treatment in an endemic area. 271 files of children admitted into hospital between March 1991 and September 1996 were analysed. These children were confirmed to have Plasmodium falciparum in their peripheral blood. 78 patients (29%) had the severe form of malaria. 43 patients (53%) were under 5 years of age. The 5 severe types identified were characterized by very high temperatures 28 cases (36%), cerebral malaria 20 cases (26%), prostration and weakness 15 cases (19%), severe anaemia 14 cases (18%) and haemoglobinuria 1 case (1.3%). Cerebral malaria and severe anaemia were more common in children under 5 years old. The average parasitemia was 16,366 +/- 1390 parasites per microlitre. Clearance of parasitemia was obtained on day 3 in almost all cases; 6 patients with very high temperatures presented neither sign of visceral complications nor convulsions. The average period in coma for cases of cerebral malaria was 1.7 days; 12 anaemic patients were transfused. There were no deaths. No abnormality was found on physical examination after an average hospitalisation of 5.3 days. An early diagnosis and adequate treatment of severe forms of malaria in children by qualified personnel will usually result in a favourable prognosis in our area.

Foetal macrosomia in Cameroon: prevalence, risk factors and complications.

102 neonates weighing 4000 g and above were compared to a control group with similar characteristics except for the weight. The sex distribution was 74.19% males and 25.81% females. The prevalence of macrosomia was 6.41%. Maternal risk factors were: age above 30 years (p < 0.05); grand multiparity P > 5(p < 0.05); post term (p = 0.001); height above 1.65 m (p < 0.001); term weight of 90 Kg and above (p < 0.001); pregnancy weight gain of 15 Kg and above (p < 0.001). Macrosomic neonates had the following complications: foetal distress, shoulder dystocia, respiratory distress and hypoglycaemia.

Childhood leukemia is still a deadly disease in Yaounde, Cameroon: a report of 14 cases.

In the Pediatric Unit of the University Teaching Hospital Center of Yaounde, 58 of 2,900 (2%) hospitalized children aged 0 to 15 years who had a malignancy were studied. Fourteen (24.1%) had acute leukemia based on morphologic and cytochemical studies. Acute lymphoblastic leukemia was encountered in 11 of these patients (78.6%). The male to female ratio was 1.3 to 1. Nine of the 11 children (64.3%) were 5 years of age or younger. Eleven (78.6%) died of disease progression and its complications.

[Cerebral malaria in the child. A study of 11 cases with good prognosis at CHU of Yaoundé, Cameroon]. / Le paludisme cérébral de l'enfant. Une étude de 11 cas de bon pronostic au CHU de Yaoundé, Cameroun.

From January to December 1993, 11 cases of cerebral malaria out of a total of 106 cases of malaria were admitted in the paediatric unit of the Yaounde University Teaching Hospital. These 11 patients were comprised of 6 boys and 5 girls aged 6 months to 10 years with a mean of 4.24 years. Convulsions and coma were the main clinical manifestation in 9 and 11 patients respectively. 10 patients had fever with 1 case of hyperpyrexia, whereas splenomegaly was noted in 6 patients and hepatomegaly in 2. Parasitemia was between 0.02 and 4 %. Chemoprophylaxis was irregular in 2 patients and absent in 9. The average hospital stay was 5.5 days and no death was noted in our series.

Comparison of Edmonston-Zagreb, Connaught and Schwarz measles vaccines in Cameroonian infants aged 3-8 months.

Eighty-five Cameroonian infants aged between 3 and 8 months were vaccinated with a high-dose Edmonston-Zagreb (EZ) strain (10(5.6) TDIC50), 81 with a low-dose Connaught strain (10(3) TCID50) and 74 with a medium-dose Schwarz strain (10(4) TCID50). Side-effects were mild (less than 32% of infants) and were not significantly different among the groups, nor were postvaccination anti-measles antibody levels. Postvaccination seropositivity and seroconversion rates were respectively 91.6% and 69% for EZ, 85.3% and 67.7% for Connaught and 75.6% and 62.2% for Schwarz. In the light of concerns regarding high-titre measles vaccines, the overall performance of the Connaught strain warrants its wider evaluation in young infants.

[Cerebral malaria in children in Cameroon. Apropos of 11 cases]. / Neuropaludisme de l'enfant au Cameroun. A propos de 11 cas.

Eleven cases of cerebral malaria were observed among 106 hospitalized malarian children. A brief recall of pathophysiology is given, including its immunological aspect. Symptomatology and course of this severe form are evoked. All children were treated by IV then oral quinine and recovered without any neurological sequelae. The importance of a very early treatment is strongly emphasized.

Stroke in children in Yaounde, Cameroon.

Thirty five children aged 5 months to 15 years suffering from stroke were studied from August 1984 to July 1990 from two hospitals in order to determine the incidence, the etiological factors and the short term outcome of the stroke. The average annual incidence was 1.85 per 1000 pediatric hospitalizations. There was a progressive rise in the number of cases from 1985, with a peak in 1990. Motor impairment of one half of the body was the commonest clinical feature seen in 97.1% of the cases. Other clinical signs were: facial paralysis (62.9%) and aphasia (28.6%). The main etiological factors were: homozygous sickle cell disease (31.4%), heart disease (17.1%), cerebral malaria (14.3%) and meningitis (14.3%). No causative factor was identified in 7 patients (20%). The mortality rate was low (2.9%) and all the children had neurological deficit after a mean hospital stay of 15 days. Laboratory investigations including lipid analysis, platelet count, and skull X-rays proved to be of no diagnostic value. However, computed tomography (CT) scan confirmed the diagnosis of ischemic stroke whenever it could be done.

[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.

[Purulent meningitis due to flavobacterium meningosepticum in Cameroonian children]. / Méningites purulentes à flavobacterium meningosepticum chez l'enfant camerounais.

Following a number of reports of purulent CSF specimens positive for Flavobacterium meningosepticum in pediatric patients in Yaoundé, a prospective study was carried out in the Department of Pediatrics of the Central Yaoundé Hospital from December 1988 through December 1989. The goals of this study were to determine the incidence of Flavobacterium meningosepticum among infants and children with purulent meningitis, to discover the origin of this pathogen, and to examine its susceptibility to antimicrobial agents. Flavobacterium meningosepticum (18.4% of cases) was second by order of incidence, after pneumococci (50%). Incidences were low for the other pathogens usually described in purulent meningitis (H. influenzae, meningococcus...). All the pneumococcus strains recovered were susceptible to ampicillin. In contrast, 21.43% of strains of Flavobacterium meningosepticum were resistant to both ampicillin and chloramphenicol (the combination currently used as first line therapy in the Department), and 14.25% of strains were resistant to cefotaxime. The origin of the Flavobacterium meningosepticum strains found remains to be discovered. The low incidence of H. influenzae deserves to be reevaluated over the next few years.

[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.

[Gastroduodenal ulcers in children in Cameroon. Apropos of 28 cases diagnosed by endoscopy]. / Ulcères gastroduodénaux de l'enfant camerounais. A propos de vingt-huit cas de diagnostic endoscopique.

This study was undertaken to describe the epidemiology and clinical features of peptic ulcer in children on the basis of twenty-eight endoscopically documented cases. Mean age was 11,5 years (range 4-16 years). Twenty-five percent of patients had a positive family history for peptic ulcer and 32% had risk factors. Two-thirds of patients had abdominal pain, occasionally accompanied with bleeding. Duodenal ulcers were slightly more common (15 versus 13). The ulcer was chronic or primary in seventeen cases, whereas endoscopic findings showed that eleven cases were acute or secondary.

Plasma renin activity studies in a group of African neonates and children.

Plasma Renin Activity (PRA) was determined in a group of 50 Cameroonian newborns and 50 Cameroonian children aged 1-15 years under resting conditions in order to establish baseline values, and also to investigate the relationship between PRA distribution, and blood pressure levels, age, or body weight. Mean PRA values were 0.98 +/- 0.78 ng/ml/h at birth and 1.17 +/- 0.92 ng/ml/h in older children. These values did not correlate with birth weight, age, or blood pressure levels. These results are lower than figures reported in comparable groups of American white and black children, and also in European or Asian children.

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.

Multiple sclerosis in a black Cameroonian woman.

Multiple Sclerosis (MS) has never been described in Bantu South Africans whereas it does exist in mixed race South Africans. The authors report a case of MS in a Semi-Bantu black woman from Cameroon (Central Africa) who presented with a typical remitting and relapsing course with MRI and CSF findings consistent with MS.

Blood pressure profiles of a group of African children in the first year of life.

Systolic blood pressure was measured at birth, every week till 6 months, then every month till 12 months in normal Cameroonian neonates in the two Yaounde teaching hospitals. Systolic arterial pressure in awake babies rose from a mean of 65.1 +/- 1.30 mmHg at birth to 80.59 +/- 2.16 mmHg at 6 weeks; 94.39 mmHg at 12 months. The majority of this rise (7 mmHg) took place during the first 2 weeks of life. Systolic blood pressure increased by an average 2.5 mmHg weekly in the first 6 weeks, 0.5 mmHg weekly from 6 weeks to 6 months, and 0.6 mmHg monthly from 6 to 12 months. Relationships between systolic blood pressure and various parameters, and systolic blood pressures trends are analysed. Systolic blood pressure was not influenced by birth weight, sex of children, or tribe of parents. There was a weak correlation between systolic blood pressure and body weight between 6 weeks and 6 months. Systolic blood pressure measurements taken at different ages were not correlated.

Chondroectodernal dysplasia in an African child: a case report.

Chondroectodermal dysplasia is a rare autosomal recessive disorder characterized by short extremities, short stature, polydactyly, and nail hypoplasia. Dental abnormalities, congenital heart defects, and thoracic abnormalities impending respiration are seen in many patients. Virtually all previous reports of the classic disorder have been in Caucasians. In the following case report, chondroectodermal dysplasia is described in a black Cameroonian infant.