Humanitarian governance and resilience building: Ethiopia in comparative perspective.

Humanitarian governance is usually understood according to the classic, Dunantist paradigm that accords central importance to international humanitarian agencies. However, this is increasingly paralleled by 'resilience humanitarianism' that focuses, among other things, on including national actors in humanitarian governance. This article views humanitarian governance as emerging through interactions between authorities, implementing agencies and communities. It is based on interactive ethnography in five countries by Partners for Resilience (PfR). Using the Theory of Change (ToC) tool, it analyses the various interpretations and priorities of actors involved in humanitarian problems, solutions and programme governance. For example, PfR had a 'software' focus, aiming to unlock communities' potential for resilience, whereas communities and authorities preferred to receive tangible 'hardware' support. The findings highlight the crucial role of local authorities in shaping humanitarian aid. This is especially pertinent in view of the international agenda to localise aid, which requires the understanding and support of national actors in order to responsibly protect the vulnerable.

[Impact of clinical practice guidelines on the incidence of bloodstream infections related to peripherally inserted central venous catheter in preterm infants]. / Impact d'un protocole de soins sur l'incidence des infections liées aux cathéters veineux épicutanéocaves chez le prématuré

In our neonatal intensive care unit, the incidence density of infections related to central catheters, assessed retrospectively over 2 years, exceeded that described in the literature. To reduce this incidence density, clinical practice guidelines were implemented for the insertion and maintenance of central lines. The purpose of this study was to evaluate the impact of the protocol on the incidence density and the incidence rate of nosocomial bloodborne infections. This was a prospective study in a neonatal intensive care unit of the Fort-de-France University Hospital over 17 months, which included all premature infants with a central line. We studied the adherence to the protocol, possible complications related to the protocol, the characteristics of the population, the incidence rate, and the density of specific central catheter-related infections. There were 111 children, 122 catheters, and 2575 catheter days during period 1 and 101 children, 125 catheters, and 1631 catheter days during period 2. Gestational age and birth weight were significantly lower in period 2 (29.6±2.3 GW vs 27.3±1.9, P=0.001; 1239±379g vs 915±175g, P<0.001) and the catheterization duration differed between the 2 periods (20±11 days vs 13±6 days, P<0.0001). A trend for a lower incidence density of infection was observed in the second period (16 per 1000 catheter days vs 10 per 1000 catheter days, P=0.06). Although the 2 groups' baseline characteristics were different, this study suggests a positive impact of clinical practice guidelines for the insertion and maintenance of central venous catheters on the incidence of nosocomial infections related to central catheters.

[Streptococcus pneumoniae-induced hemolytic uremic syndrome: a serotype-3-associated case]. / Syndrome hémolytique et urémique secondaire àStreptococcus pneumoniae de sérotype 3.

Hemolytic uremic syndrome (HUS) is the primary cause of acute renal failure in children younger than 3 years of age. It usually occurs after a diarrheal illness due to Shiga-toxin-producing Escherichia coli. Streptococcus pneumoniae (SP)-induced HUS remains rare, involving 5% of all cases of HUS in children, but its frequency has increased over the last decade. The incidence of HUS following invasive pneumococcal infections is estimated at 0.4 to 0.6%. We report here the case of a 3.5-year-old child who presented SP serotype-3-associated HUS. The diagnosis was suspected by the patient's multiple organ failure. The pathogenesis involves the activation of the Thomsen-Friedenreich antigen. To prevent transfusion-associated hemolysis, it is recommended that fresh-frozen plasma or unwashed blood products should be avoided when possible. Our patient was transfused with 4 units of unwashed red blood cell and 2 units of fresh-frozen plasma. No special complication was noted. The risk of immediate complications requires close clinical and biological monitoring, and the possibility of starting dialysis immediately. Twenty-five to 35% of SP-HUS patients exhibit long-term renal aftereffects. The acute mortality rate depends on the site of infection. The increased frequency of SP-HUS may be related to the new ecology of serotypes created by widespread Prevenar7(®) vaccination.

[Mortality, morbidity and short-term neurologic outcome of premature infants less than or equal to 32 weeks gestational age in Fort-de-France CHR]. / Mortalité, morbidité et devenir neurologique à court terme des nouveau-nés d'âge gestationnel inférieur ou égal à 32 semaines au CHR de Fort-de-France.

UNLABELLED: The mortality and neurodevelopmental outcome of premature infants born between 25 and 33 weeks of gestational age in Fort-de-France (Martinique, French West Indies) is reported. POPULATION: The preterm cohort included 214 infants born during the years 1992 to 1995. RESULTS: The mortality rate during the hospitalization was 20%, but was only 14% when the birth weight was more than 1,000 g. The main neonatal problems were: hyaline membrane disease (34%), bronchopulmonary dysplasia (6.5%), necrotizing enterocolitis (6%), intraventricular hemorrhage (9%) and periventricular leucomalacia (2%). Twenty infants (13.5%) showed abnormal neurodevelopmental outcome, with only three having major handicap. CONCLUSION: This study shows a notable improvement in the prognosis of premature infants in Fort-de-France. Nevertheless, a strong effort must be made in very low gestational ages and very low birth weight infants.

[Hydrops fetalis and G-6-PD deficiency]. / Anasarque foetoplacentaire et déficit en G-6-PD.

BACKGROUND: Antenatal manifestation of glucose-6-phosphate dehydrogenase deficiency is uncommon. CASE REPORT: A male was born by caesarian section at 34 weeks of GA for hydrops fetalis (HF). Fetal ultrasonography showed hydrops fetalis for the first time at 24 weeks of GA. All investigations were normal, except moderate anemia (Hb: 11.5 g/dl) and important erythroblastosis (67%) in the fetal blood sampling at 25 weeks. HF spontaneously resolved, until caesarian section at 34 weeks for recurrence of HF. Hydrops and neonatal anemia were successfully treated with pleural and peritoneal aspiration and blood transfusion. At the age of 4 months, investigations showed low levels of G-6-PD activity. At the age of 12 months, the child's growth and development appeared to be appropriate. CONCLUSIONS: Diagnosis of G-6-PD deficiency must be suspected when HF due to anemia occurs in a population at risk; it could be confirmed by an enzyme study of fetal red blood cells.

[Brachial plexus neuropathy following pyogenic cervical adenophlegmon]. / Névralgie brachiale amyotrophiante au décours d'un adénophlegmon cervical à pyogènes.

BACKGROUND: Brachial plexopathy is rare in children; it may follow a non-specific respiratory infection or occur after a specific viral disease or immunization. CASE REPORT: An 8 year-old girl was admitted suffering from presuppurative acute cervical adenitis. She was given penicillin V, netilmicin and corticosteroids. The adenitis gradually resolved over a period of ten days. There was no evidence of a specific bacterial infection. The patient suffered from pain localized to her right shoulder 15 days after admission; this pain was resolved within 3-4 days but was followed by paralysis affecting the upper brachial roots without sensory signs. EMG performed 15 days later showed signs of denervation. Amyotrophy set in rapidly but recovery under physiotherapy was complete 5 months later. CONCLUSION: This plexopathy resembling the Parsonage-Turner syndrome could be allergic in pathogenesis although similar cases after bacterial, possibly streptococcal, infection remain to be confirmed.

[Development of the mortality in premature infants from 32 weeks gestation and below in Fort-de-France]. / Evolution de la mortalité des prématurés de 32 semaines et moins d'âge gestationnel à Fort-de-France.

The mortality rate of prematures of gestational age less than or equal to 32 weeks during hospitalization in the neonatal intensive care unit of the University Hospital in Fort-de-France (Martinique, French Caribbeans) decreased from 69% in 1980 to 32% in 1987-1988 and to 20% in 1989. The mortality of small for gestational age children during the cumulated years 1987-1988-1989 was twice that of babies with normal birth weight. The various factors responsible for these facts were reviewed: caesarean section rates increased from 15% in 1980 to 42% in 1989, percentage of children submitted to assisted ventilation increased from 35% in 1980 to 78% in 1989 and mortality rate related to hyaline membrane disease decreased from 100% in 1980 to 33% in 1989. The comparison with a survey performed in 1985 in the Paris area showed no significant difference with the mortality rate of premature infants of gestational age greater than or equal to 27 weeks born in the University Hospital in Fort-de-France. Therefore an important effort remains necessary concerning mostly children under 27 weeks of gestational age.