Supplementary suckling technique in infants less than 6 months of age with uncomplicated severe acute malnutrition: a prospective hospital-based study in armed conflict Yemen.

BACKGROUND: Globally 3.8 million of children under 6 month of age are severely wasted. In Yemen, around 20% of children under 6 months were affected by malnutrition during the armed conflict in the last 7 years. Supplementary suckling may reestablish exclusive breastfeeding in infant less than 6 months of age with Severe Acute Malnutrition (SAM). This study aimed to determine the outcomes of employing supplementary suckling technique in treatment of uncomplicated SAM infants in a conflict-affected community. METHODS: A prospective hospital-based study was carried out between January to April 19th, 2020 among randomly selected infants less than 6 months of age with SAM following breastfeeding failure. Infants' anthropometric indices were daily measured and recorded. Supplementary sulking technique was used in management with high or low protein milk-based formula supplement. Outcome was recorded as cured, died, defaulter or in nonrecovery state. RESULTS: In this study 108 infants were enrolled with a median (IQR) age of 4 (2.5-5) years and a male: female ratio of 1.4:1. After treatment, 80.6% recovered to cure, 12% defaulters, 6% died, and 2% did not respond to treatment Thirty-four infants (38.8%) gained weight with significantly increased median weight and median weight-for-age z score. The median (IQR) duration of treatment was 9 (7.5-14) days. The means of age and weight-for-length z score were correlated (r = - 0.22, p = 0.025). Duration of treatment was a predictor of outcome (OR = 1.71, 95% CI = 0.05-0.62, p < 0.001). CONCLUSION: Supplementary suckling technique for feeding infant with SAM aged less than 6 months had a positive impact on anthropometric indices with high cure rate. The younger the infant and the longer the duration of treatment, the better the outcome.

Team-Based Learning and Lecture-Based Learning: Comparison of Sudanese Medical Students' Performance.

AIM: Students' performance in TBL compared to LBL needs to be evaluated. This study aimed to compare students' performance in team-based learning and traditional lectures. METHODS: A total of 176 class 4 and 202 class 6 medical students from University of Bahri, Khartoum, Sudan, participated in the study during 2018. Experienced staff were selected to conduct the teaching and assessment of the two groups, using the standard team-based learning procedure (iRAT, gRAT and AppT) in the first topic and the lecture-based learning procedure in the second, within the same time limit for the two methods. RESULTS: The two classes overall mean score has a significant 5.1 points difference (p<0.001; 95% CI: 3.5, 6.0). Separate analysis showed consistency of superiority of TBL to LBL in either gender. A remarkable difference was observed when we compared the two methods in class 6 separately from class 4. Class 6 mean score was high for both TBL and LBL (77.2 and 70.2, respectively), with a significant mean difference of 7.0 (p<0.001; 95% CI: 5.1, 8.9). In class 4, the score was lower for both methods (mean of 62.8 for TBL and 59.9 for LBL). The mean difference of 2.95 points was still significant (p<0.05; 95% CI: 0.46, 5.43). Separate multivariate linear regression for TBL and LBL showed no significant difference in performance of males and females in either method. Controlling for gender in TBL, class 4 had a mean of -14.26 points, (p<0.001; 95% CI: -12.54, -15.98) less than class 6. Similarly, in LBL, class 4 had a mean of -10.18 points (p<0.001, 95% CI: -7.02, -13.35), less than class 6. CONCLUSION: Students' performance using team-based learning was superior to lecture-based learning, irrespective of students' gender, noticeable among senior students.

Clinical presentation of coeliac disease and the effect of sorghum-based diet on anthropometric measurements among Sudanese children.

Coeliac disease (CD) is a chronic enteropathy. Sorghum (Sorghum vulgaris) is a common staple in Sudan. The literature on the growth of children with CD following sorghum diet is scanty. The aim of this study was to identify the demographic and clinical characteristics of CD in children and to determine the anthropometric response to a diet based on sorghum. This prospective study included children with probable CD in Ibn Sina Hospital, Khartoum, Sudan, from January 2002 to February 2012. The demographic, anthropometric, clinical and laboratory data were recorded. The CD serology was done, and the diagnosis of CD was based on Marsh criteria. Children who consumed sorghum and their anthropometry were recorded at 3 and 6 months after diagnosis. Children enrolled were 218. The mean ± SD age was 8.2 ± 4.5, median was 7 years and female/male ratio was 1.12/1. CD was common among Nubians and Arabs. The majority (145, 66.5%) presented with gastrointestinal symptoms. Feeding on sorghum diet resulted in a significant increase in weight after 3 and 6 months (21.1 ± 9.8 and 25.1 ± 14.2 kg, respectively) of the initial visit (18.5 ± 9.4 kg), p < 0.001 and p = 0.001, respectively. The mean weight for height had significantly increased at the second compared to the initial visit (0.17 ± 0.05 vs. 0.15 ± 0.5), p < 0.001. There was no association between gaining weight and age, gender, or a family history of CD. In conclusion, Sudanese children with CD presented over 8 years of age. The common presentation was gastrointestinal symptoms. The initial weight and weight-for-height increment were significant on sorghum diet.

Acute severe malnutrition treatment outcomes in children ages 6-59 months admitted to Singa Hospital, Sudan.

BACKGROUND: Acute malnutrition threatens the lives of 50.5 million children <5 y of age. Consequences of malnutrition include death, among other short-term sequelae. This study was conducted from April to October 2018 to determine the outcomes of children 6-59 months of age with acute severe malnutrition admitted to Singa Hospital in central Sudan. METHODS: Clinical information for children with a mid-upper arm circumference (MUAC) <115 mm were collected. We measured children's weight and height and calculated weight-for-height z-scores. Treatment was offered according to World Health Organization (WHO) guidelines. Outcomes were recorded as recovered, discharged against medical advice or died. RESULTS: This study included 376 malnourished children. The median age was 18 months (interquartile range [IQR] 12-24). The male:female ratio was 1:1. Among children with weight-for-height Z-scores of -4 and -3, 103 (27.3%) had oedematous malnutrition. There were 131 (34.8%) children with malaria parasites, 33 (8.7%) with pyuria and 24 (6.3%) with intestinal parasites. The recovery rate was 89.1%. The case fatality rate was 3.7%. Mortality was significantly increased with diarrhoea and dermatoses. There were no significant differences in the median of age (17.5 months [IQR 6-24] vs 18 [6-24], p = 0.595), MUAC (110 mm [IQR 104-111] vs 110 [100-111], p = 0.741) or sex (p = 0.991) between children who died and those who recovered. CONCLUSIONS: The case fatality rate was 3.7% and it was associated with diarrhoea and dermatoses.

Detection and sequencing of rotavirus among sudanese children.

INTRODUCTION: Diarrheal diseases are a big public health problem worldwide, particularly among developing countries. The current study was conducted to detect and characterize group A rotavirus among admitted children with gastroenteritis to the pediatric hospitals, Sudan. METHODS: A total of 755 stool samples were collected from Sudanese children with less than 5 years of age presenting with acute gastroenteritis during the period from April to September 2010. Enzyme-linked immunosorbent assay (ELISA) was used to Detection of Rotavirus antigens. Ribonucleic acid (RNAs) were extracted from rotavirus-positive stool samples using (QIAamp® Viral RNA Mini Kit). (Omniscript® Reverse Transcription kit) was used to convert RNA to complementary Deoxyribonucleic acid (cDNA). The cDNAs were used as template for detection of VP4-P (P for Protease-sensitive) and VP7-G (G for Glycoprotein) genotyping of Rotavirus using nested PCR and sequencing. RESULTS: Out of the 755 stool samples from children with acute gastroenteritis, 121 were positive for rotavirus A. Among 24 samples that were sequenced; the VP7 predominant G type was G1 (83.3%), followed by G9 (16.7%). Out of these samples, only one VP4 P[8] genotype was detected. CONCLUSION: As a conclusion the VP7 predominant G type was G1, followed by G9 whereas only one VP4 genotype was detected and showed similarity to P[8] GenBank strain. It appears that the recently approved rotavirus vaccines in Sudan are well matched to the rotavirus genotypes identified in this study, though more studies are needed.

No Reduction in Hemoglobin Level in Severe Plasmodium falciparum Malaria Treated with Artesunate in Central Sudan.

BACKGROUND: There are few publications on anemia following artesunate treatment. OBJECTIVE: To investigate the hemoglobin in patients with severe Plasmodium falciparum malaria treated with artesunate or quinine. METHODS: Patients with P. falciparum (in Singa, Sudan) were treated by intravenous artesunate or quinine. Hemoglobin was measured initially, at day 14 and day 28. RESULTS: The mean (SD) of the age was 10.3 (10.9) years. The two groups (61 in each arm) were matched in their basic characteristics. Hypotension, convulsions, severe anemia were the main presentations. There was no significant difference in the mean (SD) hemoglobin level at the initial day, day 14 and at day 28 [11.2 (1.8), 11.3 (1.6), 11.5 (1.8), p = 0.170], respectively, in both groups. The hemoglobin did not change significantly from the baseline in any of the group separately. CONCLUSION: There was no difference in hemoglobin concentration in patients with severe malaria after treatment with either artesunate or quinine.

Assessment of Treatment of Community Acquired Severe Pneumonia by Two Different Antibiotics.

INTRODUCTION: Pneumonia is common presentation in the emergency room and is still a cause of morbidity and mortality. The rationale of this study was to test the trend of paediatricians to achieve rapid response facing severe pneumonia, the lack of agreed on plan for the management of community acquired pneumonia (CAP) and the few experiences regarding injectable form of ß-lactam antimicrobial. MATERIALS AND METHODS: This is a prospective case control study, purposive randomized sampling, three patients were excluded since their information was incomplete, 132 patients were randomly divided into groups, one group named control group (penicillin according to the guidelines of WHO 2013), 33 patients; second group treated by ß-lactam inhibitors (Augmentin IV) 50 patients; and third group treated by 3(rd) generation cephalosporin (ceftriaxone) 49 patients. The study was conducted at the main tertiary care and paediatrics teaching hospital in Khartoum capital of Sudan. The study was completed within the duration from 2010 to 2011. RESULTS: Both group showed more or less similar results regarding response, as well as the failure rate however, the Augmentin and ceftriaxone groups showed a little bit better survival than the control group. CONCLUSION: Antibiotics decrease the mortality rate among the pneumonia patients provided that it is given early in the disease.

Clinical and Laboratory Potential Predictors of Blood Culture Positivity in Under Five Children with Clinically Severe Pneumonia - Khartoum -Sudan.

BACKGROUND: Blood culture is necessary for appropriate management of clinically severe pneumonia in children under five years of age. However, in limited resource countries it might be unduly costly and waste of valuable time because of the high negative culture rate. OBJECTIVES: This study aims to identify clinical and laboratory parameters that potentially predict a positive blood culture in cases of severe pneumonia. MATERIALS AND METHODS: A hospital based study, enrolled 189 cases satisfying the WHO definition of severe pneumonia. Age, gender, clinical history, physical examination, temperature, complete blood count, C-reactive protein, blood culture and Chest X Ray for all the patients were recorded. RESULTS: Forty one patients had positive blood culture giving a prevalence of 21.7%. All variables were used in a dichotomous manner. White Blood Count (WBC) more than 20 000, very high C-reactive protein (C-RP ≥8mg/L) and Temperature more than 40(o)C, had a positive predictive value of 46.1%, 44.3% and 40.0% respectively for a positive culture as well as a Negative Predictive Value of 91.1%, 91.6% and 91.7% respectively. The WBC more than 20 000 and temperature above 40(o)C had a significant association with a positive blood culture. Their adjusted Odds Ratios were 3.9 (95% CI: 1.4-10.90) and 3.1 (95% CI: 1.2-8.4) respectively. This was not the case for C-RP (Odds Ratio=2.2, 95% CI: 0.7-2.2) or positive Chest X Ray (Odds Ratio=1.5, 95% CI: 0.6-3.6). CONCLUSION AND RECOMMENDATION: Temperature of more than 40(o)C, Very high C-RP and WBC of more than 20 000 are good indicators of a potential positive blood culture. It is therefore recommended that further research be undertaken to refine these predictors as screening tools before resorting to blood culture. It is also recommended that antibiotic treatment may be initiated on the basis of the high temperature and WBC, while waiting for the culture results.

Prevalence and Clinical Characteristics of Primary Epstein-Barr Virus Infection Among Children Presented with Cervical Lymphadenopathy.

INTRODUCTION: Epstein-Barr virus is a known cause of childhood cervical lymphadenopathy. In practice this infection is not sought as a cause in low-resources settings. The virus among children with cervical lymphadenopathy was not studied before in this country. The aims of this study were to estimate the prevalence of primary EBV infection and to describe clinical characteristics of children presenting with cervical lymphadenopathy. MATERIALS AND METHODS: A cross-sectional study was conducted among children presented with cervical lymphadenopathy to Khartoum Children Emergency Hospital during the period from February 2009 to January 2010. Eighty-two children were randomly selected. Demographic and clinical data were recorded. Routine laboratory values were determined and children's sera were analysed for anti- viral capsid antigens IgM Epstein-Barr virus ELISA tests. Mean and SD were calculated. Regression analysis was to identify association between demographic, clinical and laboratory variables and IgM seropositivity of EBV. RESULTS: Epstein-Barr virus infection was diagnosed in 13 (15.9%) children with cervical adenopathy (n=82). The average age of these children was 7.5 (SD±3.3) years. The male to female ratio was 1.6. The most frequent symptoms were fever, loss of appetite and cough. The anterior cervical group of lymph nodes was most commonly implicated. All affected patients had mobile lymph nodes and the majority, 12 (92.3%), of patient had firm nodes. The lymph node number ranged from 2-6 nodes; with a mean of 3.5 nodes and average size of 3.6 cm. Splenomegaly and pharyngo-tonsillitis were found in 30.8% and 23.1% of patients respectively and leukocytosis was noted in 3 (23.1%). The odds of IgM seropositivity decreased with age ≤ 9 years (OR 0.15, 95% CI 0.03-0.78, p=0.023). CONCLUSION: EBV infection is not an uncommon cause of childhood cervical lymphadenopathy. The commonest symptoms are fever, loss of appetite and cough. Anterior cervical nodes are the most affected. Younger children (age ≤ 9 years) are less likely to be sero-positive.

Pattern of bacterial colonization of atopic dermatitis in saudi children.

BACKGROUND: Atopic dermatitis is an inflammatory skin disorder. Although it is not a life threatening condition, it may become infected with microorganisms, especially in children. OBJECTIVES: The aim of this study was to determine bacterial colonisation in children with atopic dermatitis. METHODS: A total of 80 children were randomly included in this study. Two swabs were taken from each child, one from the eczematous skin lesion and the other from apparently healthy skin, as a control. Bacteria were isolated and identified on the basis of the colonial morphology, gram staining and the Vitek System. RESULTS: The mean age of children in this study was 1.4 years, with no gender difference (p=0.98) (n=80). A total of 240 bacterial colonies were grown from atopic dermatitis lesions in contrast to 193 colonies from non-lesional skin. Gram-positive cocci were found in 78 (97.5%) lesions and in 77 (96.2%) non-lesional skin. Staphylococci species were significantly detected in the lesions than in the non-lesional skin. Ent. Faecalis, Ent. Faecium, Ent. gallinarium and C. minutissium were significantly isolated from lesions as compared to non-lesional skin, whereas C. xerosis was insignificantly found to be more in the lesions (p=0.21). Gram-negative bacteria were isolated from 7(8.8%) lesions, but none were isolated from non-lesional skin. Recovered species were Pantoea agglomerans, Enterobacter cloacae, Chryseobacterium indologenes and Acinetobacter Iwoffii. CONCLUSION: Atopic dermatitis in children is complicated with streptococcal and gram-negative bacterial colonisations and the latter was correlated with the severity of the lesions. Enterococci and Corynebacterium species were significant residents. S. aureus remained the chief inhabitant. No causal relationship could be established between the skin microbiota and atopic dermatitis.

Rotavirus infection among Sudanese children younger than 5 years of age: a cross sectional hospital-based study.

INTRODUCTION: In Sudan, rotavirus has been one of the important causative agents of diarrhea among children. Rotavirus A is well known as the leading cause of diarrhea in young children worldwide. It was estimated to account for 41% of hospitalized cases of acute gastroenteritis among children in Sub-Saharan Africa. This study aimed to determine the prevalence and the common clinical presentations of rotavirus A infection among Sudanese children with gastroenteritis seeking management in hospitals. METHODS: 755 Sudanese children less than 5 years of age suffering from acute gastroenteritis in hospital settings were included. The positive stool specimens for rotavirus A was used for extract Ribonucleic acid (RNA) and the RNA product was loaded on formaldehyde agarose gel and visualized under UV illumination. RESULTS: Of the 755 children, 430(57%) were males while 325(43%) were female. The age of children ranged from 1 to 60 months. There were 631 (84%) children who were less than 24 months of age. Out of the 755 stool samples, 121(16%) were positive for rotavirus. Of the 121 infected children with rotavirus, 79(65.3%) were male and 42(34.7%) were female and the highest infection rate was seen among 91(75.2%) of children up to 12 months of age. Children of illiterate parents were more infected with rotavirus than children of educated parents. Severe dehydration present among 70% of infected children with rotavirus. CONCLUSION: Since this study is hospital-based, the 16% prevalence rate may not reflect the true prevalence among Sudanese children, thus a community-based surveillance is needed.

Etiology and clinical pattern of cervical lymphadenopathy in Sudanese children.

Cervical lymphadenopathy (CLA) is a common childhood problem in clinical practice which poses diagnostic difficulties to pediatricians. The aims of this study were to determine the causes of CLA in Sudanese children and to evaluate the value of routine laboratory tests in determining the etiology. Demographic and clinical data were prospectively collected from eighty children with palpable cervical nodes. Children were then subjected to complete blood count, ESR, Mantoux test, aspiration cytology of a lymph node and serological tests for HIV agglutination test, ELISA for Epstein-Barr virus and toxoplasma gondii. The age ranged 1-13 years with a mean of 5.8 ±3.1SD years with no gender difference. Specific etiologies of CLA were determined in 62.5% of patients. Ninety five percent of the causes were due to non-specific reactive hyperplasia of lymph nodes (NSRH) (37.5%), toxoplasmosis (27.5%), infectious mononucleosis due Epstein-Barr virus (13.8%), tuberculous adenitis (10%), acute adenitis (6.2%), whereas malignancy (Hodgkin's lymphoma) constituted 5% of causes of CLA. The clinical characteristics were insignificantly associated with the causes of lymphadenopathy (p>0.05). However, mobile lymph nodes were significantly associated with inflammatory conditions (P<0.05). Inflammatory causes accounted for the majority of the etiologies whereas Hodgkin's lymphoma was the only identified malignancy. Laboratory tests such as, ESR, TWBC, hemoglobin and Mantoux test should be used in adjunct with cytology and serology for diagnosis.