Clinical presentation and imaging findings in juvenile-onset back pain: a ten-year hospital-based retrospective analysis in Douala (Cameroon).

Introduction: Studies exploring the clinical and imaging characteristics of juvenile-onset back pain (JOBP) are scarce. The purpose of this study was to assess the clinical presentation, imaging findings, and factors associated with JOBP. Methods: A retrospective record-based study was conducted among all pediatric cases presenting to the Rheumatology unit of the Douala General Hospital, Cameroon, from January 2014 to December 2023. The study did not include children whose back pain began after 16 years of age. Results: Of the 216 records of patients under 18 examined, 67 children (31 girls) were diagnosed with JOBP. The median age was 15 [13-16] years. More than two-third of the children included in this study had chronic pain (n = 46; 68.65%). Pain was mild to moderate in intensity in 48 children (71.6%). Radiculopathy was present in 10 children (14.92%). The most common location of back pain was the lumbar region (n = 64; 95.52%). Some children experienced pain in more than one location. The location of the pain was not associated with gender, duration of the pain, radiculopathy, or practice of a competitive sport (p > 0.05). Musculoskeletal abnormalities on imaging were found in 38 children (62.29%). In multivariate analysis, peripheral joint involvement [aOR = 0.253 (0.073-0.878); p = 0.030] and mild pain intensity [aOR = 0.077 (0.014-0.422); p = 0.003], were independently associated with the presence of musculoskeletal abnormalities on imaging. Conclusion: JOBP affects a third of children and adolescents of our clinic population. The common musculoskeletal abnormalities found on spine imaging are disc diseases and scoliosis.

Predictors of prolonged length of hospital stay and in-hospital mortality in patients aged 1-24 months with acute bronchiolitis in Douala, Cameroon.

INTRODUCTION: In Cameroon, acute bronchiolitis has been reported as the third commonest lower respiratory infection and is usually associated with low mortality. Nonetheless, respiratory distress associated with non-adherence to management guidelines can prolong hospital stay. This study aimed to explore predictors of prolonged hospital stay (≥ 5 days) and mortality in patients aged < 2years hospitalised for acute bronchiolitis. METHODOLOGY: We conducted a retrospective cohort study at three paediatric units in the city of Douala, Cameroon. Factors associated with prolonged hospital stay and mortality were determined using multivariable linear regression model. Threshold for significance was set at p ≤ 0.05. RESULTS: A total of 215 patients with bronchiolitis were included with mean age of 6.94 ± 5.71 months and M/F sex ratio of 1.39/1. Prolonged hospital stay was reported in 46.98% and mortality in 10.70% of patients hospitalised for bronchiolitis. Factors independently associated with prolonged hospital duration were oxygen administration [b = 0.36, OR = 2.35 (95% CI:1.16-4.74), p = 0.017], abnormal respiratory rate [b = 0.38, OR = 2.13 (1.00-4.55), p = 0.050] and patients presenting with cough [b = 0.33, OR = 2.35 (95% CI: 1.22-4.51), p = 0.011], and diarrhoea [b = 0.71, OR = 6.44 (95% CI: 1.6-25.86), p = 0.009] on admission. On the other hand, factors independently associated with mortality were age of the patient [b= -0.07, OR = 0.84 (95% CI: 0.74-0.97), p = 0.014] and oxygen administration [b = 1.08, OR = 9.64 (95% CI:1.16-79.85), p = 0.036] CONCLUSION: Acute bronchiolitis represented 1.24% of admissions and was common in the rainy season, in males and 3-11-month-old patients. Management guidelines were poorly respected. Prolonged length of stay was reported in half of the patients hospitalized and mortality was high, especially in younger patients and in patients receiving oxygen.

Diagnosis and treatment challenges of autism spectrum disorder at a reference hospital in Douala, Cameroon.

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disability associated with deficiency in social interaction, unusual development of social communication, and restricted or repetitive behaviors, interests and activities. This study aimed to describe management of pediatric ASD in Cameroon, a resource-constrained Central Africa country. METHODS: A retrospective study was conducted between December 2021 and May 2022 at the Pediatrics department of a reference hospital in the town of Douala. Data of interest of children with ASD were collected through eligible medical records and telephone discussions with their parents/guardians. RESULTS: Medical records of 145 children with ASD aged 2-15 years were included in the study, giving a hospital ASD prevalence of 3.7%. Time delay between parental concerns and hospital management was specified in 69 (47.58%) children, and among them 38 (55.07%) had a mean delay ± SD was less than five months. Children were mainly males (76%) and aged 4-5 years (37.93%), with mean age ± SD of 44.4 ± 22.2 months old. The main consultation reason was delayed language development (100%). Mean time delay between parental concerns and the first medical consultation was 18 months (range 1-60 month). Attention deficit hyperactivity disorder were found in 68.18% of children aged ≥ 6 years old. Neuropsychology (66.2%) was the most frequently used intervention. Some children were treated using traditional medicine. CONCLUSIONS: Management of pediatric ASD is strongly influenced by socioeconomic and cultural context. It is crucial to implement behavioral change campaigns in community, organize training sessions to medical staff on diagnosis and treatment of ASD, and provide specialized centers with skilled staff and equipped material.

Evaluation of CRP as a marker for bacterial infection and malaria in febrile children at the Douala Gyneco-Obstetric and Pediatric Hospital.

BACKGROUND: C reactive protein (CRP), a marker for the presence of inflammation, has been extensively studied for distinguishing bacterial from non-bacterial infection in febrile patients, but its role in excluding malaria in the febrile child has not been thoroughly evaluated. METHOD: This was a cross-sectional study at the Douala Gyneco-Obstetric and Pediatric Hospital which included all patients between the ages of one month and 16 years presenting with fever. Consenting patients received complete clinical examinations, then venous blood samples were collected and tested for CRP values, bacterial infection and malaria. RESULTS: Samples of 220 children were analyzed. 142/220 had viral infections, 50/220 had malaria and 49/220 had bacterial infections. 7/220 had both malaria and bacterial infection. There was no significant difference between mean CRP values in malaria and bacterial infection (p = 1), but CRP means were significantly higher in malaria/bacterial infection than in viral infection (p<0.0001). Area Under the Receiver Operating Characteristics Curve (AUROC) values were 0.94 for malaria and 0.86 for bacterial infection, with a calculated cut-off of 23.6mg/L for malaria and 36.2mg/L for bacterial infection. At these cut-offs, CRP had a Positive Predictive Value (PPV) of 68.75% and 85.00% for malaria and bacterial infection respectively, with a Negative Predictive Value (NPV) of 94.74% and 89.05% respectively. CONCLUSION: CRP can effectively exclude malaria and bacterial infection in febrile children in low-resource settings without the need for additional tests.

[Late presentation of anorectal atresia: a case report]. / Atrésie rectale membraneuse: présentation tardive à propos d'un cas.

Anorectal atresia and rectal stenosis are rare types of anorectal malformations, accounting for only 1-2% of cases. We here report one case of anorectal atresia. The study involved a female newborn baby delivered at term via vaginal birth, weighing 3600g, who was admitted with failure to pass meconium, abdominal bloating and fever on day 6 of life. Clinical examination showed a temperature of 39ºC, distended abdomen, normal anal location and peremeability, with prolapsed pinkish mass and no signs of necrosis. A cannula trocar stylet was inserted between the mass and rectal mucosa and stopped at about 3cm from the anal margin. Abdominal X-ray without treatment showed distended bowels and air-fluid levels, with no evidence of hollow-organ perforation. Due to suspicion of complete anorectal atresia, 16 gauge needle was inserted into the membrane and meconium was collected abundantly with considerable abdominal deflation. Surgical excision of the membrane was then performed. The postoperative course was uneventful and newborn baby was discharged at postoperative day 3. Anal dilatations were performed to treat anal stenosis. At 6-months´ follow-up, functional outcome was satisfactory. Anorectal atresia manifesting as failure to pass meconium associated with mass protruding through the anus has not yet been described in the literature. Membrane puncture confirmed the diagnosis. Membrane was resected with good outcome.

The COVID-19 Prevalence among Children: Hypotheses for Low Infection Rate and Few Severe Forms among This Age Group in Sub-Saharan Africa.

Despite some cases of severe or critical manifestations of the coronavirus disease 2019 (COVID-19) described among children, the prevalence of this infection in the pediatric population is quite low worldwide, particularly in sub-Saharan Africa. Current data suggest indeed that, independent of the population considered overall, severe and critical cases of COVID-19 are rare among children. This observation prompted us to discuss the possible hypotheses which could explain the low prevalence of COVID-19 among children; amongst others, we discuss (1) immunomodulation by the Bacillus Calmette-Guerin vaccine or by some parasitic infections such as malaria, schistosomiasis, and helminthiasis and (2) cross immunization with other coronaviruses commonly found in the sub-Saharan African setting.

Use of WhatsApp®, for distance teaching during COVID-19 pandemic: Experience and perception from a sub-Saharan African setting.

BACKGROUND: In the midst of the COVID-19 pandemic, to palliate to the lockdown and cover academic programs, the faculty of medicine and pharmaceutical sciences (FMPS) of the university of Dschang (UDs) in Cameroon has implemented e-learning using WhatsApp®. AIM: Describe the opinion of students and lecturers after its implementation of e-learning at the FMPS of UDs. METHODS: We designed a uniform teaching scheme using WhatsApp® during the university lockdown. Students and members of the teaching staff of the FMPS of UDs were enrolled after receiving clear information on the study implementation. At the end of the online-teaching period of two and a half months, we surveyed our students and teaching staff. Sociodemographic characteristics and opinions about e-learning were collected using a standard questionnaire. RESULTS: We enrolled 229 students and 40 lecturers of the FMPS. Students reported a decremented quality of internet connection (p < 0.001, p-homogeneity < 0.001) despite an increased expenditure related to internet use. Electronic devices were broadly used before the implementation of mobile learning. The use of course materials was significantly more challenging among students because of the size/format of lecture notes and internet connection/cost (all p < 0.05). Perception of discipline compared to classroom-based lessons was not significantly different among students compared to lecturers (all p > 0.05). While lecturers were mainly more comfortable conveying the contents of their lectures, students tended to be less prone to actively participate. The motivation and satisfaction of the latter group toward e-learning were modest compared to classroom-based lectures while their feedback about the organization was positive. CONCLUSIONS: E-learning using WhatsApp® could be an effective alternative to conventional classroom-based lessons in the context of COVID-19 pandemic. The use of a blended-learning program including classroom-based sessions could help improve its limitations.

Prevalence and factors associated with low back pain in schoolchildren in Cameroon, sub-Saharan Africa.

BACKGROUND: Data on the prevalence and factors associated with low back pain (LBP) in schoolchildren are scarce in Africa, particularly in sub-Saharan Africa. OBJECTIVES: To assess the prevalence and factors associated with LBP in schoolchildren in Cameroon. PATIENTS AND METHODS: We performed a cross-sectional study in 10 randomly selected schools (public and private) in Douala, Cameroon. Using a self-administrated questionnaire, sociodemographic, usual physical activity, and clinical data were collected and all the schoolbags were weighted. Informed consent was obtained from the parents. Statistical significance was established at P < .05. Logistic regression was performed to identify factors associated with LBP. RESULTS: We included 1075 schoolchildren (543 boys, 50.5%). The prevalence of LBP was 12.3% (132 children: 81 girls and 51 boys). The mean age was 11 ± 1 years (range, 8-14 years). Body mass index was normal in 110 schoolchildren (83.4%). Sixteen schoolchildren had already met a physician for LBP. Among the factors evaluated, those associated with LBP were female gender, doing competitive sport, sitting position, and LBP in at least 1 parent. The mean weight of the schoolbags was 4.9 ± 1.9 kg. We had 99 children with LBP and a schoolbag weight ≥10% of their body weight. No association was found between the weight of schoolbag and LBP. CONCLUSION: LBP is common in Cameroonian schoolchildren, where 12.3% suffer from it. The weight of schoolbags was not associated with LBP. However, female gender, competitive sport, sitting position, and parental history of LBP were significantly associated with its occurrence.

Decrease in Hospitalizations and Increase in Deaths during the Covid-19 Epidemic in a Pediatric Hospital, Yaounde-Cameroon and Prediction for the Coming Months.

BACKGROUND: The COVID-19 pandemic reached Cameroon in March, 2020. The aim of this study was to unveil the consequences of this pandemic on hospitalizations and on mortality in a pediatric hospital. Methods: A descriptive and retrospective cross-sectional study was carried out using hospitalization and death statistics collected from a pediatric hospital. We compared the data before and after the pandemic and made predictions for the next 12 months. Results: A drastic drop in hospitalizations was noted coinciding with the partial lockdown in Cameroon. Paradoxically, at the same time, the number of deaths per month doubled though the causes remained the same as in the past. Conclusion: The COVID-19 pandemic was marked by drop in hospitalizations and paradoxically, an increase in child mortality. These deaths were probably due not to SARS-Cov-2 infection, but rather due to the usual illnesses whose management was delayed, a probable consequence of the confinement.

Deuil et infection à COVID-19 : à propos d'un cas dans un centre de crise de Yaoundé

Le personnel soignant en première ligne dans la riposte contre l'infection à COVID-19 et les familles des défunts au COVID-19 vivent pour certains des troubles anxieux, des burn-outs et des troubles dépressifs caractérisés, suite à la perte soit d'un patient soit un proche. Ces troubles sont relevés dans la littérature mondiale. Le sujet africain vit dans un environnement culturel plus communautaire qu'individualiste. Il peut donc souffrir davantage lorsqu'il est privé de ses commémorations culturelles au cours de la mise en terre des morts, dans un contexte de mesures barrières physiques et communautaires des gouvernements. Notre cas clinique se propose de montrer une autre affection « psychiatrique » étiquetée de deuil pathologique, qui pourrait se développer dans notre continent, contrairement à d'autres dans les mois avenir. Nous montrerons ainsi l'intérêt de l'accompagnement psychologique à long terme dans les centres de crise

Le tetanos chez le grand enfant dans un hopital pediatrique a Yaounde; Cameroun

Le tetanos est evitable par la vaccination; mais peut survenir en cas d'une immunisation incomplete. Nous avons mene une etude sur les dossiers medicaux des enfants admis pour tetanos entre 2008-2009 au Centre Mere et Enfant de la Fondation Chantal BIYA a Yaounde. Le but etait d'analyser les circonstances de survenue et les manifestations cliniques du tetanos chez le grand enfant; afin de proposer des strategies de prevention adaptees au contexte camerounais. Le statut vaccinal etait inconnu chez un patient; les autres (80) n'avaient pas recu de rappel vaccinal. Les portes d'entree etaient les plaies aux membres; l'une etait secondaire a une injection medicamenteuse. Tous ont presente le tetanos generalise. Le deces etait survenu chez un patient. Le tetanos n'est pas rare chez le grand enfant au Cameroun. Il se degage ainsi la problematique des rappels vaccinaux

Croissance staturo-ponderale des enfants souffrant d'infirmite motrice cerebrale a Yaounde; Cameroun

Introduction: l'infirmite motrice cerebrale (IMC) designe un ensemble de troubles permanents de la posture et du mouvement lie a une atteinte cerebrale non progressive survenue sur le cerveau en developpement du feotus ou du nourrisson. Les troubles de la croissance sont frequents chez les enfants souffrant d'infirmite motrice cerebrale et sont lies a des problemes nutritionnels et non nutritionnels. Methodes: nous avons mene une etude transversale analytique dans l'unite de neuropediatrie de l'Hopital Gyneco-Obstetrique et Pediatrique de Yaounde (HGOPY) du 02 janvier 2014 au 30 juin 2014. Ce travail comportait deux volets; d'une part comparer les differents indices anthropometriques des enfants en fonction du type d'IMC et d'autre part; comparer la croissance staturo-ponderale du groupe d'enfants atteints d'IMC a celle d'un groupe d'enfants temoins apparies selon le sexe et l'age. Les mesures anthropometriques etaient realisees suivant les recommandations de l'OMS. Les moyennes de z-score des differents indices anthropometriques etaient calculees et comparees dans les deux groupes. Resultats: au total 134 cas et 134 temoins repondant aux criteres d'inclusion ont ete recrutes. Le sexe ratio etait de 1;62. L'age moyen des enfants etait de 2;65 (SD 2;5) ans. La tetraparesie spastique etait la forme clinique la plus representee; 55;2% des cas presentaient des troubles de l'alimentation. Quatorze (12;3%) cas souffraient d'emaciation contre 2;7% des temoins; 29 (22;2%) des cas souffraient d'insuffisance ponderale contre 4 (3%) temoins; 42 (31;3%) des cas souffraient de retard statural contre 1 (0;7%) dans le groupe temoin. L'insuffisance ponderale et le retard de croissance statural etaient plus marques chez les enfants presentant la forme mixte d'IMC; tandis que l'emaciation predominait chez les enfants atteints de la forme choreoathetosique. Les differents indices anthropometriques etaient d'autant plus abaisses que le niveau d'invalidite etait eleve. Conclusion: la malnutrition est donc tres frequente dans la population d'enfants souffrant d'IMC. Cette croissance sous optimale est plus marquee chez les patients presentant la forme mixte de paralysie cerebrale et la tetraparesie spastique ainsi que chez ceux presentant un deficit moteur severe et des troubles nutritionnels. La prise en charge de l'enfant infirme moteur cerebral devrait integrer une prise en charge nutritionnelle