Baseline demographic, clinical and immunological profiles of HIV-infected children at the Yaounde Gynaeco-Obstetric and Pediatric hospital, Cameroon.

INTRODUCTION: Approximately 2.5 million children below 15 years are infected with the HIV virus, with 90% in sub-Saharan Africa. The Yaounde Gynaeco-obstetric and Pediatric hospital has been a treatment center for HIV since 2006. The aim of this study was to analyze the baseline demographic, clinical and immunologic characteristics of the children with the HIV infection in this hospital. METHODS: It was a retrospective, cross- sectional and analytic study, carried out between January and April 2011 which included 61 HIV positive children aged 0-15 years. The socio-demographic, clinical and immunologic data were obtained from their medical records. RESULTS: Most (52.5%) of the children studied were above 60 months of age with a mean age of 71 months. Most (57.4%) were females. Mother-to-child transmission was the principal mode of contamination in 88.5% of cases. More than half of their mothers (55.7%) did not receive antiretroviral prophylaxis during pregnancy and labor. Common clinical findings included prolonged fever (44.6%), malnutrition (37.6%), lymphadenopathy (34.4%), respiratory tract infections (34.4%) and diarrhea (24.5%). Diagnosis was confirmed by HIV serology for most of the patients (93.4%). Polymerase chain reaction served as method of diagnosis in only 6.6% of the cases. HIV 1 was the predominant viral type. More than half of the children (52.5%) were seen at an advanced stage of the disease. CONCLUSION: HIV screening during pregnancy and prevention of mother-to-child transmission should be reinforced in this context, and fathers of HIV-infected children should be encouraged to go for HIV testing.

Risk factors for neonatal mortality at the yaounde gynaeco-obstetric and pediatric hospital, cameroon.

OBJECTIVE: Neonatal mortality is a major health problem in sub-Saharan Africa and the risk factors are not well established. The objective of this study was to determine the risk factors for neonatal mortality at the Yaounde Gynaeco-Obstetric and Pediatric Hospital. METHODS: We conducted a retrospective and analytic case-control study from the medical records of newborns admitted at the neonatal unit of this hospital between 1(st) March 2003 and 31(st) December 2012. 850 subjects were enrolled; that is 425 cases and 425 controls. Findings : The intra-hospital neonatal mortality rate was 9.83%. The main causes of neonatal mortality were in descending order: neonatal sepsis (60.2%), complications from prematurity (42.6%), birth asphyxia (37.4%), and congenital malformations (11.8%).The most prominent risk factors for neonatal mortality after multivariate analysis with logistic regression were: prolonged membrane rupture (OR: 3.8719, 95% CI: 2.3619-6.3471; P=0.0000), low birth weight (OR: 1.6240, 95% CI: 1.0108-2.6091; P=0.0450), Apgar score less than 7 at the 5th minute (OR: 6.8979, 95% CI: 4.0709-11.6883; P=0.0000), and congenital malformations (OR: 4.3307, 95% CI: 1.6120-11.6347; P=0.0037). Delivery by cesarean section (OR: 0.2644, 95% CI: 0.1478-0.4732; P=0.0000) and being born in this hospital (OR: 0.4409;95% CI: 0.2566-0.7576; P=0.0030) were protective. CONCLUSION: Neonatal mortality was influenced by both maternal and neonatal factors. This could be reduced through sensitization of pregnant women on the need of good quality antenatal visits, and capacitating the health personnel on the adequate management of high risk neonates.

Neonatal mortality in a referral hospital in Cameroon over a seven year period: trends, associated factors and causes.

BACKGROUND: The fourth Millennium Development Goals targets reduction by 2/3 the mortality rate of under-fives by 2015. This reduction starts with that of neonatal mortality representing 40% of childhood mortality. In Cameroon neonatal mortality was 31‰ in 2011. OBJECTIVES: We assessed the trends, associated factors and causes of neonatal deaths at the Yaounde Gynaeco-Obstetric and Pediatric Hospital. METHODS: The study was a retrospective chart review. Data was collected from the hospital records, and included both maternal and neonatal variables from 1st January 2004 to 31st December 2010. RESULTS: The neonatal mortality was 10%. Out-borns represented 49.3% of the deceased neonates with 11.3% born at home. The neonatal mortality rate followed a downward trend dropping from 12.4% in 2004 to 7.2% in 2010. The major causes of deaths were: neonatal sepsis (37.85%), prematurity (31.26%), birth asphyxia (16%), and congenital malformations (10.54%). Most (74.2%) of the deaths occurred within the first week with 35% occurring within 24hours of life. Mortality was higher in neonates with birth weight less than 2500g and a gestational age of less than 37 weeks. In the mothers, it was high in single parenthood , primiparous and in housewives and students. CONCLUSION: There has been a steady decline of neonatal mortality since 2004. Neonatal sepsis, prematurity, birth asphyxia and congenital malformations were the major causes of neonatal deaths. Neonatal sepsis remained constant although at lower rates over the study period.

Risk factors for birth asphyxia in an urban health facility in cameroon.

OBJECTIVE: The World Health Organization (WHO) estimates that 4 million children are born with asphyxia every year, of which 1 million die and an equal number survive with severe neurologic sequelae. The purpose of this study was to identify the risk factors of birth asphyxia and the hospital outcome of affected neonates. MATERIALS & METHODS: This study was a prospective case-control study on term neonates in a tertiary hospital in Yaounde, with an Apgar score of < 7 at the 5th minute as the case group, that were matched with neonates with an Apgar score of ≥ 7 at the 5th minute as control group. Statistical analysis of relevant variables of the mother and neonates was carried out to determine the significant risk factors. RESULTS: The prevalence of neonatal asphyxia was 80.5 per 1000 live births. Statistically significant risk factors were the single matrimonial status, place of antenatal visits, malaria, pre-eclampsia/eclampsia, prolonged labor, arrest of labour, prolonged rupture of membranes, and non-cephalic presentation. Hospital mortality was 6.7%, that 12.2% of them had neurologic deficits and/or abnormal transfontanellar ultrasound/electroencephalogram on discharge, and 81.1% had a satisfactory outcome. CONCLUSION: The incidence of birth asphyxia in this study was 80.5% per1000 live birth with a mortality of 6.7%. Antepartum risk factors were: place of antenatal visit, malaria during pregnancy, and preeclampsia/eclampsia. Whereas prolonged labor, stationary labor, and term prolonged rupture of membranes were intrapartum risk faktors. Preventive measures during prenatal visits through informing and communicating with pregnant women should be reinforced.

Risk factors for premature births: a cross-sectional analysis of hospital records in a Cameroonian health facility.

The aim of this study was to investigate the risk factors for preterm births in the Yaounde Gynaeco-Obstetric and Pediatric Hospital in Cameroon, and to describe their outcomes. We conducted a cross-sectional analytical study of hospital records over eight years. The incidence of prematurity was 26.5 % of admissions over a period of 7 years 7 months. After controlling for confounding factors, we identified attending antenatal care visits in a health centre (Odds ratio [OR] 6.19; 95% Confidence interval [CI] 1.15 - 33.22; p = 0.033), having a urinary tract infection (OR 39.04; 95% CI 17.19 - 88.62; p < 0.001), multiple gestation (OR 3.82; 95% CI 2.68 - 5.43; p <0.001) and congenital malformations (OR 2.78; 95% CI 1.24 - 6.22; p = 0.013) increased the odds of preterm birth. On the other hand being a student mother (OR 0.44; 95% CI 0.20 - 0.98; p = 0.047), being married (OR 0.40 95% CI 0.19 - 0.84; p = 0.016) and more antenatal visits (OR 0.23; 95% CI 0.15 - 0.35; p <0.001) reduced the odds of preterm birth Neonatal mortality in these preterm neonates was 36.6%, in which 69% occurred in the early neonatal period. The main causes of death were neonatal infections (27.6%), neonatal asphyxia (11.9%) and congenital malformations (10.3%). We recommend enhanced prenatal care and management of pathologies which arise during pregnancy.

Bronchiolite aigüe du nourrisson de moins de 24 mois à Yaoundé (à propos de 296 cas)

OBJECTIFS. Décrire les profils épidémiologiques, cliniques et évolutifs de la bronchiolite aiguë du nourrisson à Yaoundé.MÉTHODES. L'étude était rétrospective et descriptive couvrant la période du 1er janvier 2008 au 31 décembre 2011 à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé et incluant 296 dossiers médicaux de nourrissons avec diagnostic de bronchiolite aiguë. Les critères d'inclusion étaient les nourrissons reçus en consultation et/ou admis en hospitalisation pour bronchiolite aiguë (1er ou 2ème épisode) et un âge inférieur ou égal à 24 mois. Les variables étudiées étaient d'ordre épidémiologique, clinique et évolutif. RÉSULTATS La bronchiolite aiguë était la troisième infection respiratoire basse (9,4%) et représentait 1,6% des consultations pédiatriques. Les nourrissons du sexe masculin entre 2 et 4 mois étaient les plus touchés, surtout lors de la grande saison des pluies allant de septembre à novembre avec un pic en octobre. Une prévalence saisonnière significative par rapport aux autres mois de l'année a été notée (P<0,001). Une augmentation significative de l'incidence par année a été observée avec un taux de récidive de 19,6%. Les principaux signes cliniques étaient les râles sibilants, la toux, la fièvre, les râles bronchiques, la rhinorrhée, les signes de lutte et la dyspnée. Le pronostic global était favorable dans 98,9% et une létalité de 1,1% a été notée. CONCLUSION. La bronchiolite aiguë est un problème de santé publique qui touche les jeunes nourrissons avec un pic épidémique lors de la grande saison des pluies. Son incidence est en augmentation et son pronostic globalement favorable

Early outcomes of HIV exposed children in the first district-wide programme using extended regimens for the prevention of mother-to-child transmission of HIV, in Yaounde, Cameroon.

OBJECTIVE: Report on the early outcomes achieved in the prevention of mother-to-child transmission (PMTCT) programme in the Djoungolo Health District using more effective antiretroviral PMTCT regimens. METHODS: Observational cohort of HIV exposed infants. MAIN OUTCOME MEASURE: early infant HIV status and 3-month mortality rate. RESULTS: From March 2008 to March 2010, 587 HIV-positive mother-baby pairs were enrolled and classified according to the following maternal antiretroviral regimen: Group 1: highly active antiretroviral therapy (HAART), Group 2: dual therapy, Group 3: no treatment. 484/587 (82%) underwent HIV-early infant diagnosis at a median age of 7 weeks; 4.5% (95% CI 2.65-6.34) were HIV-infected. HIV transmission rate differed by maternal prophylaxis: 1.7% for HAART, 2.7% for dual therapy and 15.7% for Group 3 (p < 0.001), but not by feeding method (2.74%)-exclusive breastfeeding vs. 5.34% formula (NS). The 3-month mortality rate stands at 1%. CONCLUSIONS: The 4.5% MTCT-rate of HIV-1 reported, confirms the feasibility and effectiveness of a district wide PMTCT programme using HAART in low-income settings.

The empiric use of palm kernel oil in neonatal skin care: justifiable or not?

Palm kernel oil is a vegetable oil derived from Elaeis guineensis and widely used in neonatal settings for skin care. It is a good emollient with a beneficial effect in moisturizing the skin and preventing transdermal heat and water loss. However, it's putative roles in the prevention or treatment of fatty acid defificiency is still controversial. So is its function in the improvement of neurological development from its longchain polyunsaturated fatty acids? We set out in this review to verify whether its empiric use in this context has any scientific justification and is recommendable. Although there is evidence that it has emollient and moisturizing properties necessary for softening the skin and restoring elasticity, controversy subsists on its other nutritional and neurodevelopmental properties.

The clinical and bacteriogical spectrum of neonatal sepsis in a tertiary hospital in yaounde, cameroon.

OBJECTIVE: Sepsis is an important cause of morbidity and mortality in neonates especially in developing countries where identification of the germs and treatment is often unsatisfactory. The aim of the study was to assess the clinical presentation, and bacteriological profile of neonatal infections, and the sensitivity of the causative germs to antibiotics. METHODS: We carried out a prospective analytic study in the Yaounde Gynaeco-Obstetric and Pediatric Hospital in Cameroon over a 6 months period from 18(th) November 2008 to 18(th) May 2009. On the basis of history and/or clinical findings and paraclinical investigations, 218 neonates out of a total of 628 admissions were investigated and managed for neonatal infection. FINDINGS: The most frequent symptoms were fever (44.95%), refusal to feed/irritability (32.11%), and respiratory distress/cough (28.90%). Premature birth and prolonged rupture of membranes were the most frequent risk factors. Klebsiella spp, Escherichia coli and Enterobacter spp were the most frequent germs identified in respectively 28.6%, 21.4% and 14.3% of the positive samples. Overall sensitivity of the cultures to ampicillin, netilmicin and gentamycin was poor at 29.4%, 31.4% and 18.9% respectively, whereas imipenem, ofloxacin, ciprofloxacin and ceftazidime had the best sensitivities in 91.7%, 90%, 85.3% and 69.4% of the cultures respectively. The mortality rate was 22%, and low birth weight, premature birth and septicemia were significant risk factors for death. CONCLUSION: Mortality from neonatal sepsis in this context is still high and there is an upsurge of multi-resistant germs to currently used antibiotics, calling for the need for rational use of antibiotics in the management of these infections.

Conjoined twins in Cameroon: issues inherent in diagnosis and management in the African context.

Conjoined twins represent one of the rarest forms of congenital abnormalities. We present a case of conjoined twins delivered at born in the Yaounde Gynaeco-Obstetric and Pediatric Hospital in Cameroon. They were joined at the chest and abdomen, and had one functional heart. The outcome was fatal on the seventh day of life, despite appropriate reanimation measures. This case highlights the difficulties inherent in the diagnosis and management of conjoined twins in low resource settings.