Neural tube defects are rare among black Americans but not in sub-Saharan black Africans: the case of Yaounde - Cameroon.

BACKGROUND: Neural tube defects (NTD) are complex malformations rare in black Americans and Japanese. The incidence related to births or community-based studies have not been published in Cameroon or in black sub-Saharan countries, except one study in the Nigerian middle belt [Airede KI. Neural tube defects in the middle belt of Nigeria. J Trop Pediatr 1992;38 27-30.][corrected]. METHODS: To evaluate the incidence of neural tube defects in Yaounde, the birth record of the maternities was retrospectively exploited during the last ten years period (1997-2006). RESULTS: A total of 52,710 births were recorded in the 03 main hospitals of Yaounde. Ninety eight (98) cases of NTD with an incidence of 1.99 cases per 1000 births were registered. Spina bifida cystica (myelomeningocele, meningocele) represented 71%, followed by encephalocele (21.1%) and anencephaly (5.4%). Periconceptional folic acid was not taken by any of the mothers in our study. Abortion of affected pregnancies is illegal in Cameroon. CONCLUSION: Neural Tube Defects may not be so rare in sub-Saharan black Africans particularly in Yaounde (Cameroon). Spina bifida is the most frequent malformation. The results of this study make a case for periconceptional folic acid supplementation in our communities. The respective contributions of racial (genetic) versus environmental (or nutritional) factors will however have to be studied in order to develop a comprehensive prevention strategy.

Assessment of gestational age in the Cameroonian newborn infant: a comparison of four scoring methods.

A clinical assessment of gestational age using four different methods was performed in the same population of 358 Cameroonian newborn infants with the aim of determining the most applicable in the local context. Method applicability was compared in terms of validity, accuracy, reliability, and ease of administration. The gestational age ranged from 25 to 44 weeks. The infants were evaluated within 72 h from birth, using the scoring methods of Farr (FSM), Dubowitz (DSM), Ballard (New Ballard Score--NBS) and Eregie (ESM). The DSM was the most valid with a 93 per cent agreement within +/-2 weeks of gestational age by dates followed by the ESM with 92.4 per cent. The NBS and the FSM showed lower validity of 85.6 per cent and 78.3 per cent respectively. The ESM was the most accurate with a mean difference (MD) in weeks (+/-1 SD) between gestational age by method and gestational age by dates of 0.259+/-1.376, followed by the NBS with 0.355+/-1.51. The DSM was fairly accurate with a MD of 0.500+/-1.31, and the FSM the least accurate with a MD of 1.228+/-1.495. The DSM was the most reliable with a high correlation coefficient (r) of 0.94. The NBS and the ESM had comparable reliability with correlation coefficient of 0.93 each. The easiest to administer was the ESM, completed in an average of 41 s, followed by the FSM in 1 min 22 s. The NBS was completed in 2 min 48 s and the DSM in 4 min 28 s. We concluded that the Eregie model has comparable validity and reliability to the Dubowitz score but is more accurate, simple, and very easy to administer. It is therefore recommended where the workload is heavy and health personnel limited, as is the case in developing countries.

[Burkitt lymphoma in Cameroon children: descriptive and clinico-anatomical aspects]. / Lymphome de Burkitt chez l'enfant au Cameroun: aspects descriptifs et anatomocliniques.

This retrospective study is armed to indicate the descriptive and pathological aspects of children Burkitt lymphoma in Cameroon. It was performed on a 4 year period between July 1988 and July 1992. Children from 0 to 15-year-old who were hospitalized and who had histologically provern Burkitt lymphoma were included. There were 39 patients, that is 27% of all malignant tumors in children during this period. Twenty-four were boys and 15 were girls; the median age was 90 months (+/-46) (range from 3 to 180 months). All children had Plasmodium falciparum infection. EBV serology was positive in 18 patients out of 25 (72%), 14 (36%) had a good nutritional status, the 25 other patients suffered malnutrition. Tumor localizations were: maxillary in 29 (74%) patients, abdominal in 7 (18%), other in 3 patients. Clinical stages according to Murphy classification were: stage I in 6 (15%) patients, II in 3 (8%), III in 20 (51%) and IV in 10 (26%). It is concluded from this series that clinical aspects and histological pattern in children Burkitt lymphoma in Cameroon are not different from what is observed in other endemic areas.

Approche etiologique des anemies severes de l'enfant a partir d'examens paracliniques simples

Les auteurs de ce texte ont eu pour objectif d'etudier l'apport de cinq examens complementaires simples; peu couteux; dans l'approche etiologique des anemies severes de l'enfant. 78 enfants ages de 1 mois a 5 ans ayant un taux d'hemoglobine inferieur a 8g/100ml ont eu une numeration sanguine; une numeration des reticulocytes; une goutte epaisse; une electrophorese de l'hemoglobine. 48 d'entre-eux ont eu un examen parasitologique des selles. Le taux moyen d'hemoglobine etait de 4;5g/100ml. 52 malades (66;7 pour cent) avaient une microcytose et/ou une hypochromie; faisant evoquer une carence martiale isolee ou associee a d'autres causes. 9 (11;5 pour cent) avaient une macrocytose; faisant suspecterune carence en acide folique. 49 (62;8 pour cent) avaient une goutte epaisse positive a Plasmodium falciparum. 51 malades (65;4 pour cent) presentaient un ou plusieurs signes cliniques en faveur d'une hemolyse. 3 enfants seulement sur 48 ayant produit des selles (6;2 pour cent) portaient des parasites intestinaux anemiants (2 cas d'ankylostomes; 1 cas d'entamoeba histolytica). 1 enfant etait drepanocytaire homozygote. Au total; ces anemies severes avaient des etiologies multifactorielles dominees par la carence martiale et l'hemolyse palustre

Morbidite hospitaliere; lesions echoencephalographiques; et etat neurologique d'une population d'anciens petits poids de naissance a la sortie d'hopital

Les auteurs ont etudie; chez 152 anciens petits poids de naissance au moment de leur sortie d'hopital; l'etat neurologique; les lesions echoencephalographiques; et les relations avec la morbidite hospitaliere. Leur poids de naissance moyen etait de 1 685 g; leur age gestationnel moyen de 33 semaines; et leur age corrige moyen de 37;3 semaines. 7 nouveau-nes etaient hypotrophes a terme (4;6 pour cent). 26 etaient prematures et hypotrophes (17;10 pour cent); 119 etaient prematures et eutrophiques (78;30 pour cent). La morbidite hospitaliere etaient dominee par les hypothermies et les infections. Les hemorragies cerebrales etaient les lesions echographiques les plus frequentes (6;23 pour cent). 15 enfants avaient un examen neurologique anormal (9;87 pour cent); dont 5 presentaient une lesion cerebrale a l'echographie. Toutes les lesions hemorragiques etaient survenues chez les prematures d'age gestationnel compris entre 29 et 34 semaines. L'existence d'une lesion cerebrale a l'echographie exposait 7 fois plus a un risque d'anomalie neurologique. En conclusion; de nombreuses pathologies peuvent etre prevenues. Le depistage echographique des lesions doit etre precoce

Aspects cliniques et etiologiques de l'epilepsie du nourrisson et de l'enfant a Yaounde

9392 enfants ages de 0-15 ans ont ete examines aux urgences et consultations de l'hopital central de Yaounde (Cameroun) pendant la periode d'etude. Sur la base des criteres essentiellement cliniques; 174 enfants presentent l'epilepsie qui represente 1;85 pour cent des affections pediatriques a Yaounde. Les convulsions febriles precedent l'epilepsie chez 83 enfants (47;70 pour cent). Les auteurs ont trouve des antecedents personnels probablement en rapport avec l'epilepsie dans les proportions suivantes: antecedents antenataux chez 33 enfants (18;96 pour cent); antecedents perinataux chez 36 enfants (20;68 pour cent); antecedents post-nataux chez 45 enfants (25;86 pour cent). Les differents types d'epilepsie ont ete rencontres; dans des proportions variables

[Cerebral malaria in children in Yaounde, Cameroon. Clinical, paraclinical and developmental aspects]. / Le neuro-paludisme de l'enfant à Yaoundé, Cameroun. Aspects cliniques, paracliniques et évolutifs.

Cerebral malaria is one of the major and deadly complications of malaria. In Cameroon, recent reports indicate that severe cases of malaria are increasingly more prevalent, particularly in children. The present study aims at describing the clinical presentation and laboratory findings of cerebral malaria in children in Yaounde. All patients admitted in the paediatric ward of Yaounde Central Hospital with malaria, who presented neurological signs and were tested positive for Plasmodium in their peripheral blood were recruited into the study. 36 cases were enrolled in all, making up 2.7% of all admissions. The patients' median age was 4.5 years. 52.8% were on malaria prophylaxis. Convulsions and coma with preceding hyperthermia were present in more than 90% of the patients. Blood parasites level median was 1.3% on admission. One patient had hypoglycaemia on admission and two others had it later on after admission; 16.7% had neurological sequels at discharge and two children died (5.6%). Delay in diagnosis and initiation of treatment with quinine adversely affected the prognosis of cerebral malaria in the study group.

Facteurs epidemiologiques associes aux anemies severes de l'enfant consultant en urgence a l'Hopital Central de Yaounde (Cameroun)

Dans une etude retrospective couvrant la periode de juillet 1990 a juin 1991; les auteurs etudient chez l'enfant de 1 mois a 15 mois les aspects epidemiologiques des cas d'anemies severes consultant en urgence. Il ressort de cette etude que sur 16.395 enfants qui ont consulte 747 avaient une anemie severe diagnostiquee cliniquement; 78 enfants sont decedes a leur arrivee au service des urgences pediatriques. Il faut dire en definitive que les enfants de moins de 5 ans; de milieu pauvre; etaient les plus affectes

[Neonatal streptococcus group B infection in Yaoundé (Cameroon). Epidemiologic and clinical aspects]. / Infection néonatale à streptocoque du groupe B à Yaoundé (Cameroun). Aspects épidémiologiques et cliniques.

This study was designed to investigate epidemiologic and clinical features of neonatal group B streptococcal infections. Sixty cases seen over a 60-month period were reviewed. Incidence was 0.8% of admissions. Most affected infants were from low-income families (86.7% of mothers were unemployed and 73.5% of homes were without running water). Neonatal infection was delayed in most instances (76.67%). Fetid vaginal discharge (60%) and premature rupture of the membranes (35%) were the main findings upon history taking. Abnormal body temperature regulation (76.7%) was the most prominent clinical manifestation. Respiratory distress developed in 25% of patients. Meningeal involvement occurred in 73.3% of patients. Serotype B III was recovered in 31 of the 34 cases (91%) in which serotype was determined. Mortality rate was 21.7% and permanent sequelae occurred in 8.3% of patients.

[Incidence of peri- and intraventricular hemorrhages in a premature population at the Central Hospital of Yaounde (Cameroon)]. / Incidence des hémorragies péri- et intraventriculaires dans une population de prématurés à l'Hôpital Central de Yaoundé (Cameroun).

In Cameroon, prematurity is common but few studies have been carried out on periventricular and intraventricular hemorrhage in premature neonates. Seventy neonates born between 28 and 34 weeks gestational age were studied by cerebral ultrasonography. Thirty infants (42.8%) showed evidence of periventricular or intraventricular bleeding. This proportion was 58.3% in infants born between 28 and 31 weeks gestational age. All stage III (3 cases) and stage IV (2 cases) hemorrhages were bilateral. Bilateral bleeding was less common among patients with stage I (2 cases) or stage II (2 cases) hemorrhages. Among patients born between 32 and 34 weeks gestational age, only 34.8% had ventricular hemorrhage which was always stage I or II and usually unilateral (two stage I and one stage II bilateral bleeds). The incidence of periventricular and intraventricular hemorrhage is high in Yaoundé. Ultrasonographic evaluation should be routinely performed in infants born before 35 weeks gestational age.

[Variola or a severe case of varicella? A case of human variola due to monkeypox virus in a child from the Cameroon]. / Variole ou varicelle grave? Un cas de variole humaine à monkeypox virus chez un enfant Camerounais.

Human monkeypox was suspected on clinical grounds in a seven years old child in Cameroon. The diagnosis was confirmed at the Center for Disease Control (CDC) in Atlanta, USA. This condition is rare. The present case is the third in Cameroon. An epidemiological and clinical survey carried out in the family and in the area where the patient lives, did not allow to identify other cases. The clinical evolution of the case was good as in those described elsewhere.

Anthropometric measurements in a newborn population in west Africa: a reliable and simple tool for the identification of infants at risk for early postnatal morbidity.

The predictive value of anthropometric measurements in the identification of infants at risk for early postnatal morbidity was assessed in a cohort of 490 neonates born in Yaoundé, Cameroon. Mid-arm circumference (MAC), head circumference, weight, and length were measured within 6 hours of birth, and the gestational age, individual MAC/head circumference ratio, and individual ponderal index were calculated. A detailed questionnaire on gestational medical history was also obtained from the mothers. All infants were then closely monitored during the first 72 hours after delivery for the appearance of symptoms requiring medical intervention and treated accordingly. Low birth weight (LBW) was observed in 37.75%, prematurity in 25.5%, and small size for gestational age in 14.1% of the neonates. Gestational medical problems were reported by 44.3% of the mothers; malaria was the most frequent. Early postnatal morbidity was observed in 26% of the infants; infection (53%), respiratory distress (26%), hypoglycemia (26%), and convulsions (11.7%) accounted for most of the problems. The MAC correlated best of all variables with birth weight (r = 0.91); a value of less than or equal to 9.5 cm had a 93% sensitivity and a 90.5% specificity in the prediction of LBW. An MAC cutoff value of less than or equal to 9.5 cm was also the best of all variables in the prediction of early postnatal morbidity, and 85.2% sensitivity and 74.3% specificity were achieved. We conclude that in developing countries, where scales are not always available and the overburdened maternity wards cannot allow for medical surveillance of every infant, the MAC can be used in the estimation of birth weight. Moreover, an appropriately calculated cutoff value of MAC may serve as a reliable indicator of LBW and of infants at risk for early postnatal morbidity.

[Purulent meningitis in children in Yaounde (Cameroon). Survey of complications using echoencephalography]. / Méningites purulentes de l'enfant à Yaoundé (Cameroun). Recherche des complications par l'échoencéphalographie.

Sixty-one infants aged 0 to 12 months with documented purulent meningitis underwent transfontanellar ultrasonography at the Yaounde Central Hospital. Twenty-eight (45.90%) infants had evidence of complications including communicating hydrocephalus (20 patients; 71.43%), ventriculitis (5; 17.86%), abscess with ventriculitis (2; 7.14%), and cerebral atrophy (1; 3.57%). An analysis of the main epidemiological, bacteriological and clinical parameters found no correlation between the presence of ultrasound evidence of complications and age, sex, or color of the CSF. Conversely, a close correlation was found with both the time elapsed between onset and initiation of treatment and the severity of clinical manifestations (coma, seizures). The authors, recommend routine ultrasound encephalography in infants with meningitis, improved information of parents, and close collaboration between pediatric radiologists and neurosurgeons.

[Neonatal septicemia and meningitis caused by gram-negative bacilli in Yaondé: clinical, bacteriological and prognostic aspects]. / Les septicémies et méningites néonatales a bacilles gram négatifs a Yaoundé: aspects cliniques, bactériologiques et pronostiques.

Based on 139 cases collected in 36 months, the authors show that neonatal sepsis and meningitis with Gram negative bacilli represent 62.33% of confirmed neonatal sepsis (223 cases out of 6,784 neonatal hospitalisations). 53.96% of cases are manifest within the first 72 hours of life. 35.25% of these infants are preemies. The principal predisposing factors are: foul-smelling leukorrhea (45.23%), prolonged rupture of membranes (26.62%) and notion of resuscitation (36.69%). The most important clinical signs are: thermal dysregulation (47.48%), tonus disturbances (35.97%) and respiratory distress (25.90%). Sepsis make up 85.61% of cases; the principal germs isolated being: Acinetobacter (21.58%), Pseudomonas (15.83%), Escherichia coli (14.39%), Enterobacter (12.95%), Klebsiella (11.51%). Of the germs isolated, 27.78% were resistant to initial treatment with the association ampicillin gentamicin. Mortality rate was 46.76%.

[Gastroduodenal ulcers in children in Cameroon. Apropos of 28 cases diagnosed by endoscopy]. / Ulcères gastroduodénaux de l'enfant camerounais. A propos de vingt-huit cas de diagnostic endoscopique.

This study was undertaken to describe the epidemiology and clinical features of peptic ulcer in children on the basis of twenty-eight endoscopically documented cases. Mean age was 11,5 years (range 4-16 years). Twenty-five percent of patients had a positive family history for peptic ulcer and 32% had risk factors. Two-thirds of patients had abdominal pain, occasionally accompanied with bleeding. Duodenal ulcers were slightly more common (15 versus 13). The ulcer was chronic or primary in seventeen cases, whereas endoscopic findings showed that eleven cases were acute or secondary.

Cerebral complications of purulent meningitis in children assessed by transfontanellar ultrasonography in Yaounde (Cameroon).

Sixty-one children, aged 0 to 12 months, all having meningitis confirmed by bacteriological and biochemical studies of CSF, were subjected to transfontanellar US exploration and clinical follow-up. Thirty-three (54.1%) children were normal, and 28 (45.9%) presented cerebral complications: hydrocephalus 20 cases (71.4%), ventriculitis 5 cases (17.9%), abscess and ventriculitis 2 cases (7.1%) and cerebral atrophy 1 case (3.6%). 36.1% of patients with purulent or turbid CSF presented with complications. 24.6% of complications were due to unidentified bacteria and 11.4% due to pneumococcus group. 90.9% patients with coma, and 76.4% with convulsion showed cerebral complications. The authors recommend routine us exploration of children with confirmed meningitis in tropical milieu.

Initial treatment of bacterial meningitis in Yaounde, Cameroon: theoretical benefits of the ampicillin-chloramphenicol combination versus chloramphenicol alone.

A prospective 6-month study in Yaounde evaluated 49 children aged from 2 months to 8 years, hospitalized with bacterial meningitis. They were randomly assigned to one of two initial treatment groups, either an ampicillin-chloramphenicol combination (group A) or chloramphenicol alone (group B). The majority of patients were infected with Haemophilus influenzae, and the majority of deaths were caused by Streptococcus pneumoniae. Altogether, 17.9% of Haemophilus influenzae isolates were ampicillin-resistant and 3.6% chloramphenicol-resistant. We found no isolate resistant to both antibiotics. Response to both treatments was similar in both groups. The theoretical risk of treatment failure with ampicillin was higher than with the ampicillin-chloramphenicol combination (p less than 0.05). There was no statistically significant difference between the risk of treatment failure with the ampicillin-chloramphenicol combination and the risk with chloramphenicol alone (p less than 0.05), but the latter was increased by the occurrence of chloramphenicol-resistant isolates of Streptococcus pneumoniae (11.1%). Although treatment with an ampicillin-chloramphenicol combination is four times more expensive than treatment with chloramphenicol alone, costwise it is also one-quarter the price of a third-generation cephalosporin (moxalactam). At present, the ampicillin-chloramphenicol combination can be suggested as the first choice for initial treatment considering both the epidemiological data and the cost/efficiency ratio in the area of Yaounde.