The paucity of pediatric emergency medicine fellowship training programs in Africa.

Sub-Saharan Africa has the highest burden of childhood and adolescent mortality in the world. The leading causes of mortality in pediatric populations in Africa include preterm birth complications, pneumonia, malaria, diarrheal diseases, HIV/AIDS, and road injuries. These causes of childhood and adolescent mortality often lead to emergency room utilization due to critical presentation, placing emphasis on the importance of pediatric emergency services in Africa. Despite the criticality of pediatric emergency medicine (PEM) in the region, there is a paucity of PEM training programs in Africa. Ongoing interventions focused on addressing the poor access to PEM training and services include isolated efforts to provide PEM-specific training to nonemergency medicine (EM)-trained practitioners and expand current EM training to include PEM piloted in a single center in Kenya. Sustainable efforts require organized efforts with government and graduate medical education bodies. We discuss the existing infrastructure that can be utilized in promoting the establishment of PEM training programs and urge local governments' investment as well as other stakeholders, including graduate medical education, to address the issue of childhood mortality in Africa through the improved provision and access to PEM training.

Résumé L'Afrique subsaharienne a le plus grand fardeau de la mortalité infantile et des adolescents dans le monde. Les principales causes de mortalité dans les populations pédiatriques en Afrique comprennent les complications prématurées, la pneumonie, le paludisme, les maladies diarrhéiques, le VIH / sida et les lésions routières. Ces causes de mortalité infantile et des adolescents conduisent souvent à l'utilisation des salles d'urgence en raison de la présentation critique, mettant l'accent sur l'importance des services d'urgence pédiatriques en Afrique. Malgré la criticité de la médecine d'urgence pédiatrique (PEM) dans la région, il y a un manque de programmes de formation PEM en Afrique. Les interventions en cours axées sur la lutte contre le mauvais accès à la formation et aux services PEM comprennent des efforts isolés pour fournir des formation spécifiques au PEM aux praticiens de médecine non urgente (EM) et étendre la formation actuelle EM pour inclure le PEM piloté dans un seul centre au Kenya. Les efforts durables nécessitent des efforts organisés avec le gouvernement et les organismes de formation médicale diplômés. Nous discutons de l'infrastructure existante qui peut être utilisée dans la promotion de la création de programmes de formation PEM et exhorte les investissements des gouvernements locaux ainsi que d'autres parties prenantes, y compris l'enseignement médical diplômé, pour résoudre la question de la mortalité infantile en Afrique grâce à l'amélioration de la fourniture et de l'accès à Formation PEM Mots-clés: Bourse, santé mondiale, éducation médicale diplômée, médecine d'urgence pédiatrique.

Cardiopulmonary Arrest and Pulmonary Hypertension in an Infant with Pertussis Case Report.

Pertussis is a vaccine-preventable disease with an incidence that has been trending upwards in the United States over the last two decades. This is evident by an increase in the incidence from 10,100 cases in 1974 to a peak of >48,000 cases noted in the last decade. Pertussis disease severity ranges from mild to severe, with resultant complications capable of causing significant morbidity and mortality. We report a case of pertussis in a 5-week-old female infant who presented with fever, paroxysms of cough, apnea, and seizures leading to cardiopulmonary arrest. Cardiopulmonary resuscitation lasted 11 minutes before the return of spontaneous circulation. She was transferred to our tertiary facility and admitted to the pediatric intensive care unit. Complete blood count revealed significant leukocytosis, chest X-ray revealed bilateral pulmonary edema with pleural effusion, and echocardiogram demonstrated pulmonary hypertension. Bordetella pertussis infection was confirmed on respiratory polymerase chain reaction. She was treated with antibiotics, ventilatory management, and other supportive care. She was discharged on room air after a hospital course of 7 weeks with care coordination between her primary care provider, pulmonologist, and neurologist. Despite the positive outcome in this case, it is important to note that managing severe pertussis involves multidisciplinary care, and the morbidity and cost implications can be mitigated on a population scale through vaccine optimization strategies.