Sociodemographic characteristics of children born to HIV-infected mothers in Western French Guiana.

BACKGROUND: French Guiana is the French department most affected by HIV. The situation in Western French Guiana is complicated by the transborder context and isolation of many patients. This study aims to describe the epidemiological characteristics of children born to mothers living with HIV followed in Western French Guiana. METHODS: This was a retrospective and descriptive study. All children born to HIV-infected mothers between 2014 and 2018 were included. Data were collected using a survey sheet to generate an Excel database. RESULTS: We recorded 177 newborns exposed to maternal HIV, four of whom (2.26 %) were infected. The majority of women (87 %) were of foreign origin, and only 7 % had conventional health insurance coverage. The infection was discovered during pregnancy in 20 % of women. Overall 21.71 % of newborns were preterm and 22.5 % hypotrophic. All neonates had received antiretroviral prophylaxis for four weeks, either as monotherapy (AZT) (67.43 %) or triple therapy (AZT/3TC/NVP) (25.71 %). Twenty-two neonates had at least one neonatal illness: transient respiratory distress (9 cases), asphyxia (3 cases), hyaline membrane disease (8 cases), and there were two cases with birth defects: clubfoot (1 case) and heart disease (1 case). The follow-up rate at 24 months was 65 % and 35 % of cases were lost to follow-up. The most common biological anomalies were anemia (69.14 %), hyperlacticaemia (23 %), and neutropenia (9.14 %). CONCLUSION: The prevalence of mother-to child transmission of HIV was high; a quarter of maternal infections were discovered during pregnancy. The mother's socio-economic situation was often precarious and follow-up interruptions common.

About the need to address pediatric health inequalities in French Guiana : a scoping review.

INTRODUCTION: French Guiana is a French overseas territory in South America, marked by poverty and inequalities. Access to different services, including healthcare, is unequal depending on where people live. Several studies showed that among adults, the most precarious individuals had greater incidences of chronic and infectious diseases. Although the median age of the population living in this territory is 25, there is no specific focus on the pediatric population although it is documented that socioeconomic inequalities have an impact on child health. The objective of this scoping review is to shed light on health challenges concerning children living in French Guiana. METHODS: A literature search was performed on PubMed to identify relevant articles, and additional references were added if within the scope of this review. RESULTS: A total of 106 publications were reviewed. Perinatal health issues were linked to a high rate of teenage pregnancies with poor medical follow-up leading to complications such as preterm deliveries and congenital malformations and abnormalities. Infectious diseases were a significant burden with worrisome vaccination coverage figures for some bacterial infections, partly explaining a high mortality rate attributable to infectious diseases. Herbicide poisoning with paraquat was reported in children, and environment-related concerns such as wild animal attacks as well as lead and mercury exposure were reported. Some children living in remote Amerindian communities had a higher suicide rate than in mainland France, and chronic diseases such as sickle cell disease were reported to have more transfusion-related complications. CONCLUSION: Children living in French Guiana have worse pediatric health indicators in comparison with children from mainland France.

Training of pediatricians in infectious diseases in France: survey among pediatricians enrolled in the French infectious diseases training program: Training of pediatricians in infectious diseases in France.

The French infectious diseases (ID) program was accessible to all medical trainees enrolled in postgraduate training for other specialties until 2017, when it became an independent specialty. Therefore, the national ID training is no longer accessible to pediatricians, and a specific program for pediatric ID (PID) is under development. We conducted a survey among French pediatric trainees enrolled in the former ID training to assess their satisfaction and describe the barriers they may have faced during the training. A questionnaire was sent in October 2018 to all pediatricians enrolled in this curriculum. Among the 17 trainees who replied, almost half (8/17) described the ID training as being hardly accessible to pediatricians, and six reported difficulties in finding a mandatory one-year position in an ID department to complete their training. Future training in PID should address these issues.

Drug compliance among parents and guardians of children in Accra, Ghana.

Through a structured questionnaire, 523 parents and guardians who received prescription to collect medicine for their wards at the pharmacy of the Department of Child Health, Korle Bu Teaching Hospital were interviewed during the months of March and April, 1993. The objectives were to determine to what extent they remembered prescription instructions for their wards and to find out any other factors that contributed to drug non-compliance. A large percentage (about 80%) were able to recount instructions given correctly. It was however worrying, that quite a sizeable number could not recount instructions given. This obviously contributed to non-compliance. Other factors that were found and which could have contributed to non-compliance were: poor economic standing, non-availability of drugs at the hospital pharmacy, availability of similar drugs at home and patients getting well before the scheduled period of treatment is over. Of particular concern was the response by some parents/guardians that they would double the dosage to their wards to make up for a missed one should they forget any of the scheduled doses. Workers at pharmacy shops need to use simple practical means of giving prescription instructions, especially to illiterate patients.

Traditional birth attendants and maternal mortality in Ghana.

Maternal mortality is high in most African countries, particularly in rural areas where access to formal health care is limited. The sociopolitical and economic environment complicates the medical factors directly responsible for this high rate. Since the 1970s many African countries have addressed this problem by training traditional birth attendants (TBAs) in health promotion and in the basics of safe delivery and referral. The Danfa Rural Health Project in Ghana has trained and supervised TBAs since 1973. It is located relatively close to the health services of the capital city of Accra, providing an ideal environment for the practice of trained TBAs. Thirty-seven trained TBAs currently practice in the area. Most provide patient education and encourage women to go to the health center for preventive services. However, many report routinely performing the high risk deliveries that they have been taught to refer to higher level care and that when they do refer, their patients may not go. Reasons for referral refusal frequently cited by TBAs include financial limitation or lack of transportation and the patients fear of disrespectful or painful treatment from medical personnel. In the rural environment, the trained TBA's greatest contribution to lower maternal mortality rates may lie in the area of health promotion rather than disease intervention.

Pediatric cerebral malaria in Accra, Ghana.

Characteristics of pediatric cerebral malaria, including specificity of clinical diagnosis, efficacy of antimalarial regimens, and the influence of drug resistance remain poorly defined in many parts of the world. The utility of the Glasgow coma scale and quantitative assessment of parasitaemia levels as diagnostic and prognostic indices in cerebral malaria were determined in this study. Thirty-one pediatric patients with admission diagnoses of cerebral malaria in the emergency ward at Korle Bu Hospital, Accra, Ghana were evaluated. Mean age was 4.8 years. The initial diagnosis of malaria was confirmed in 65 per cent of patients; 16 per cent ultimately received another diagnosis including pneumonia, meningitis or encephalitis. In 19 per cent the diagnoses were inconclusive. Mean initial blood parasitaemia level was 10(4.6) parasites per mm3, and mean initial Glasgow coma score was 10.4. The initial Glasgow score was a better predictor of length of stay (Pearson correlation coefficient r = 0.66) than initial parasitaemia level (r = 0.17). For most treated patients parasitaemia levels decreased a mean of 1.3 logs per day of therapy; however, in 33 per cent parasitaemia continued to rise or fluctuate. High parasitaemia levels were associated with deep levels of coma, but only when both parameters were assessed throughout the hospital stay. Both deaths in this series occurred in patients who had persistently negative blood smears for malaria parasites, but showed autopsy findings consistent with cerebral malaria.

Drug use before clinic attendance

Drug use before clinic attendance was studied in nine hundred and sixty two consecutive patients attending the Central Dansoman Clinic over a six month period. Those who had received such pre-treatment were asked to indicate what drugs they had received. The results showed that 803 (83.5 per cent) of the patients had received or taken some medication before reporting. The major drugs used were Paracetamol which was used by 93.8 per cent of respondents; Chloroquine by 77.8 per cent; Daga (73.5 per cent); Vit. Bco (56.7 per cent); Multivite (49.8 per cent) and Amodiaquine (43 per cent). No drug toxicity was observed. However; the need to interview patients for any such pre-treatment before giving prescription has been stressed

Yaws in rural Accra.

Thanks to a yaws control programme launched in Ghana in 1956, yaws morbidity decreased to below 0.2% in all the Regions of Ghana except the Eastern Region and some districts of the Western Region by 1962. However, there has since been progressive growth in yaws morbidity up to a present level of 0.6%, and this trend, should it continue, causes concern. Questionnaire forms were used to collect data on three most heavily affected villages and were completed for 20% of the adult population (above 15 years of age). Doubtful cases were referred to the author for verification directly, but the author also checked all evident cases detected by local examiners. Out of a total population of 1641, 443 persons were examined and given questionnaires. It was evident that the majority of the respondents (about 90%) were families with yaws; most of them had seen the disease but did not know its cause. Out of the 443 respondents, 235 (53%) said the cause was not known to them, 154 (34.7%) said it was dirt and 54 (12.2%) attributed yaws to a natural cause. The majority of the respondents were in agreement that, no matter what its cause, the disease can be transmitted by social contact. Yaws control programmes should be included in primary health programmes, so that the pertinent sanitary instruction, epidemiological surveillance and treatment could be freed of their heavy dependence on transport.

Endemic pyoderma in Ghana: a survey in rural villages.

The prevalence and characteristics of pyoderma in a randomly sampled rural population in Ghana has been studied. Findings are compared with studies reported in recent literature which describe pyoderma in other countries. In the present study, conducted in 1975 as part of the Danfa Project's Village Health Survey, pyoderma was diagnosed in 19.4% of villagers examined. Peak rates occurred in the five to nine-year-old age group, and pyoderma was more prevalent among males and unskilled labourers and farmers than among those engaged in more sedentary occupations. Non-bullous impetigo was most common (72% of lesions) and, in contrast to other studies, non-group A-streptococci predominated in these lesions (82% of streptococcal lesions were Group G, 18% Group C). Current knowledge of transmission and control of pyoderma is discussed.