[Mortality pattern in children aged 3-59 months hospitalized in the Intensive Care Unit at a Paediatric Center in Yaounde-Cameroon]. / Profil des décès survenus chez les enfants âgés de 3 à 59 mois dans l'unité des soins intensifs d'un centre pédiatrique à Yaoundé-Cameroun.

INTRODUCTION: mortality risk is high at the Intensive Care Units (ICU) in developing countries. We here report the deaths occurred in the ICU at the Mother and Child Center in Yaounde, Cameroon. METHODS: we conducted a retrospective study on the clinical, socio-demographic features, the therapeutic strategy as well as some of the factors associated with deaths occurred in 200 patients aged 3-59 months between 2010 and 2014. RESULTS: out of 2675 patients included in the study, 1807 were aged 3-59 months and 303 died. The overall and cause-specific mortality rate in this age group was 11.3% and 16.7% respectively. Most patients (152/200; 76.0%) died within 24 months and the median admission time was 7 days. More than half of patients (57.0%) presented to a health center and only 66 (33.0%) presented to a referral hospital. Severe malaria (41.5%), pneumonia (22.7%) and gastroenteritis (27.8%) were the most common diseases. Malnutrition and HIV/AIDS were the underlying causes of death in 23.0% and 20.5% of patients respectively. Gastroenteritis multiplied the risk of death of approximately 6 times (OR = 5.76; p = 0.000) in patients affected by malnutrition and HIV infection. Deaths mainly occurred (90.0%) within 72 hours of admission. CONCLUSION: despite limited resources, some diseases could have been easily treated avoiding complications which require reanimation. It is essential to intensify the fight against malaria, HIV infection and malnutrition.

Child abuse: an underestimated health problem? A case report from Cameroon.

Physical abuse of children can be of varying nature. Children can be shaken, beaten, burnt, or cut by their parents or guardians. The incidence of trauma inflicted on children is underestimated in many countries, probably because clinical signs are misjudged, as this case report shows. This three-year-old boy was seen in several health facilities of Yaounde, Cameroon. He was treated erroneously for severe malaria and then for meningitis because he presented with neurologic signs, before the diagnosis of child abuse was made. This was confirmed after an imaging work-up revealed fractures of the skull and the leg. The diagnosis was therefore delayed by at least six weeks from the date of the first consultation. This case report demonstrates that child abuse is not well known in our environment, and it is therefore crucial to train those who provide health care to children to recognize it.

Obstetrical, maternal characteristics and outcome of HIV-infected rapid progressor infants at Yaounde: a retrospective study.

BACKGROUND: Rapid progressors are exposed to HIV infection at an early stage of life, and the prognosis is poor without treatment. Reducing the proportion of infants who are rapid progressors, require strengthening strategies to achieve the highest level of performance for the PMTCT program. METHODS: This was a retrospective study carried out on HIV infected infants aged less than 12 months, clinically classified stage 4 (WHO) or having CD4 count <25%. We described maternal and obstetrical characteristics of HIV-infected rapid progressors using univariate and bivariate analysis. Patients' survival was monitored from the inclusion time to the end of the study. We then estimated their probability of survival with or without anti-retroviral (ARV) treatment from birth using the Kaplan-Meier method. RESULTS: The characteristics of the mothers of the 150 rapid progressors infants we included were: low level of education (OR=3.87; P=0.016), CD4 count less than 200/mm(3) (OR=43.3; P=0.000), absence of ARV prophylaxis (OR=6.02; P=0.043), or treatment with HAART (OR=5.74; P=0.000) during pregnancy. In the children, the most important findings were lack of co-trimoxazole prophylaxis (OR=11.61; P=0.000) and antiretroviral prophylaxis (OR=2.70; P=0.0344). The survival rate was 84.3% in infants who were receiving HAART as opposed to 43.3% in those who were not (P<0.05). CONCLUSIONS: HIV infected women who are eligible should start antiretroviral treatment prior to a pregnancy, in order to improve their immunological status. This measure associated to cotrimoxazole prophylaxis and ART could improve their survival.

Premature death of children aged 2 months to 5 years: the case of the Mother and Child Center of the Chantal Biya Foundation, Yaounde, Cameroon.

BACKGROUND: In hospital premature deaths of children less than 5 years of age admitted for different reasons still remains very high in our context warranting study in order to reverse the tendency (using appropriate means). Our study was aimed at describing and analyzing cases of those children aged from 2 months to 5 years who died within the first 48 hours of their admission at the Mother and Child Center of the Chantal Biya Foundation (MCC/CBF). METHODS: It was a retrospective descriptive study. Data were extracted from the clinical records of the patients admitted from 2008 to 2012. Cases of accidental trauma were excluded from the study. Level of statistical significance was set at P<0.05. The approval of the ethical committee of the Université des Montagnes was also obtained. RESULTS: During the period of our study, out of the 14,200 patients aged 2 months and 5 years who were hospitalized 522 premature deaths were registered. This gives an incidence of 4.9%, representing 74.3% of all hospitalized deaths in this age group. Considering the fact that some of the files had very little information, only 373 files were studied. The sex ratio was 1.2. More astonishing was that a majority of the deaths occurred between midnight and 8 am. The most frequent registered cases were patients with severe malaria (42.6%), severe sepsis (20.6%), and acute lower respiratory tract infections (RTI) (16.1%) cases. One third of the patients had a poor nutritional status. CONCLUSIONS: The reinforcement of preventive measures and programs targeting the health of children such as the Integrated Management of Childhood Diseases (IMCD) would be a major priority in proffering a solution to this phenomenon.