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Aim: To study comorbidities in children with cerebral palsy (CP). Methods: This cross-sectional study was conducted over a period of four months, from December 10, 2019 to March 24, 2020 in 88 children with CP aged 6 months to 15 years without other associated chronic pathologies. All data were collected through parental interviews, medical records and physical examination. To assess motor impairment, Gross Motor Function Classification System score (GMFCS) was used. The association between the etiologies of CP, the types of CP, the level of disability and comorbidities were analysed. Results: The most common morbidity of CP was intellectual impairment in 84 (95.5%), microcephaly in 66 (75%), epilepsy in 61 (69.3%) and nutritional disorders in 48 (54.6%) of which 40 (83.3%) of the patients had stunting, 36 (75%) were underweight, 9 (18.75%) were acutely malnourished and 3 (6.2%) were obese. Digestive disorders were seen in 33 cases of which 31 (93.9%) had constipation, 13 (39.39%) had dysphagia, 6 (18.2%) had gastroesophageal reflux and 22 (66.7%) had oro-facial dyspraxia. Visual impairment was present in 18 cases of which strabismus was present in 10 (55.5%), nystagmus in 6 (33.3%) and blindness in 7 (38.9%) children. Respiratory tract infections were present in 17 (19.3%), urinary tract infections were present in 8 (9%). Orofacial dyspraxia [OR=4.93(95% CI 1.74-13.94)] and nutritional disorders [OR=7.2 (95% CI (2.65-19.57)] were associated with GMFCS V. Intellectual impairment was mild in GMFCS I and severe in GMFCS V (p=0.001). Those with a GMFCS II [OR= 9.44(95% CI (1.99-44.81)] were more likely to have a respiratory infection. Conclusion: Cerebral palsy is associated with higher prevalence of comorbidities. Improved preventive strategy through adequate perinatal care may reduce incidence of CP. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the quality of life of epileptic children. Methods and Material: This descriptive cross-sectional study was undertaken from 1st January 2014 to 1st May 2014 in children aged 3-16 years with epilepsy who followed up in the pediatric neurology unit of the Yaounde Gynaeco-Obstetrics and Pediatric Hospital in Yaounde in Cameroon. Parents responded to the quality of life questionnaire for children with epilepsy. Results: Eighty-six patients with a mean age of 8.8 ± 4.2 years were included in the study. Epilepsy was associated with poor quality of life in 18 (20.9%) patients and was mainly in children with non-idiopathic generalized epilepsy, behavioral disorders, and cognitive deficits. Social, behavioral, cognitive and depressive disorders were noted in 43 (50%), 17 (19.8%), 23 (26.7%) and 55 (63.9%), respectively. In 17 (19.8%) children, clinical examination was abnormal. Twenty (23%) children were not attending school. Conclusion: Epileptic children have a decline in their quality of life, and this is multifactorial, and controlling epileptic seizures alone does not appear to be a sufficient factor to improve the quality of life of these children. [ABSTRACT FROM AUTHOR]

Background: Severe malaria is a leading cause of morbidity and mortality in under-fives in sub-Saharan Africa. Recently quinine has been replaced by artesunate as the first-line drug in the treatment of severe malaria in Cameroon. Artesunate has been shown to be cost-effective in African children, but whether these findings are transferable to Cameroonian children remains to be explored. Objectives: To conduct a cost-analysis of four different regimens used in the treatment from the perspective of the healthcare payer. Methods: An economic evaluation alongside a randomized comparative study was conducted in children aged 3 months to 15 years, admitted at the Ebolowa Regional Hospital with severe malaria due to Plasmodium falciparum. Patients were randomized to receive one of the four treatment alternatives. Group 1 (ARTES) received parenteral artesunate at 2.4 mg/kg at H0, H12, H24 and then once daily; Group 2 (QLD) received a loading dose of quinine base at 16.6 mg/kg followed 8 h later by an 8-hourly maintenance dose of 8.3 mg/kg quinine base; Group 3 (QNLD3) received 8.3 mg/kg quinine base every 8 h, and Group 4 (QNLD2) received 12.5 mg/kg quinine base every 12 h. The main outcome measure for effectiveness of treatment was the parasite reduction rate. Based on a healthcare perspective, an evaluation of direct medical costs was done, including costs of anti-malarials, nursing care materials, adjuvant treatment, laboratory investigations, hospitalisation and professional fees. Guided by a cost minimalization approach, the relative costs of these treatment alternatives was compared and reported. Results: Overall cost was higher for ARTES group at $65.14 (95% CI $57.68-72.60) than for quinine groups ($52.49-$62.40), but the difference was not statistically significant. Cost of the anti-malarial drug was significantly higher for artesunate-treated patients than for quinine-treated patients, whereas cost of hospitalization was significantly lower for artesunate-treated patients than for quinine-treated patients. Incremental analysis of ARTES against QLD as a baseline resulted in an ICER of $46.8/PRR24 and suggests ARTES as the most cost effective of all four treatment options. Conclusion: Artesunate is a cost effective malaria treatment option relative to quinine alternatives with the lowest incremental cost per unit of effectiveness. Trial registration clinicaltrials.gov identifier: NCT02563704. Registered 19 September 2015, retrospectively registered [ABSTRACT FROM AUTHOR]

Background: Severe malaria is a leading cause of morbidity and mortality in under-fives in sub-Saharan Africa. Recently quinine has been replaced by artesunate as the first-line drug in the treatment of severe malaria in Cameroon. Artesunate has been shown to be cost-effective in African children, but whether these findings are transferable to Cameroonian children remains to be explored. Objectives: To conduct a cost-analysis of four different regimens used in the treatment from the perspective of the healthcare payer. Methods: An economic evaluation alongside a randomized comparative study was conducted in children aged 3 months to 15 years, admitted at the Ebolowa Regional Hospital with severe malaria due to Plasmodium falciparum. Patients were randomized to receive one of the four treatment alternatives. Group 1 (ARTES) received parenteral artesunate at 2.4 mg/kg at H0, H12, H24 and then once daily; Group 2 (QLD) received a loading dose of quinine base at 16.6 mg/kg followed 8 h later by an 8-hourly maintenance dose of 8.3 mg/kg quinine base; Group 3 (QNLD3) received 8.3 mg/kg quinine base every 8 h, and Group 4 (QNLD2) received 12.5 mg/kg quinine base every 12 h. The main outcome measure for effectiveness of treatment was the parasite reduction rate. Based on a healthcare perspective, an evaluation of direct medical costs was done, including costs of anti-malarials, nursing care materials, adjuvant treatment, laboratory investigations, hospitalisation and professional fees. Guided by a cost minimalization approach, the relative costs of these treatment alternatives was compared and reported. Results: Overall cost was higher for ARTES group at $65.14 (95% CI $57.68-72.60) than for quinine groups ($52.49-$62.40), but the difference was not statistically significant. Cost of the anti-malarial drug was significantly higher for artesunate-treated patients than for quinine-treated patients, whereas cost of hospitalization was significantly lower for artesunate-treated patients than for quinine-treated patients. Incremental analysis of ARTES against QLD as a baseline resulted in an ICER of $46.8/PRR24 and suggests ARTES as the most cost effective of all four treatment options. Conclusion: Artesunate is a cost effective malaria treatment option relative to quinine alternatives with the lowest incremental cost per unit of effectiveness. Trial registration clinicaltrials.gov identifier: NCT02563704. Registered 19 September 2015, retrospectively registered [ABSTRACT FROM AUTHOR]

Aim: This retrospective cohort study describes the short-term growth of very low birth weight (VLBW), preterm babies. We hypothesized that catch-up with term infants occurs by 6 months of chronologic age. Patients and Methods: A total of 113 VLBW preterm babies were discharged alive from the neonatology unit of the Yaounde Gyneco-Obstetric and Pediatric Hospital. Sixty-six of the infants respected their monthly appointments for at least 6 months and were included in the study. The weight was taken daily, while the length and head circumference were taken weekly during postnatal hospitalization period and monthly after discharge. Results: The median birth weight was 1390 g. The mean daily weight gain from the 2nd week of hospitalization was 17.35 g/kg/day. By the 6th month of life, the weights of all the infants were comparable to term babies. The median length at birth was 40 cm, an average monthly increase of 3 cm/month for females, and 3.43 cm/month for males. Babies with length at birth above the 85th percentile reached the growth corridor of term infants by 6 months of life. The median head circumference at birth was 28 cm. The head increased at a rate of 2.5 cm/month for males and 2 cm/month for females. Only those with a head circumference above the 50th percentiles were comparable to term infants at 6 months. Conclusions: VLBW preterm infants caught up in weight with term infants by 6 months of age. Growth in length and head circumference lagged behind. [ABSTRACT FROM AUTHOR]

Aim: Seizures are common in the pediatric age group and occur in approximately 10% of children. Parents often experience anxiety and fear if seizures in the child occur in their presence at home. Parental response is mostly determined by their knowledge on seizures. The aim of this study was to assess the knowledge and attitudes of mothers towards the first seizure of their children in the Cameroonian context. Material and Methods: A cross sectional and descriptive study was conducted in Yaounde in Cameroon, over a period of six months. Included in the study, were mothers whose children were hospitalized for seizures. The seizure had to be the very first in the child, and had never occurred in the other siblings. Results: A total of 100 mothers were interviewed. Most mothers (88%) had heard of convulsions, and the main source of information was mothers and/or relatives in 89.8% of the mothers. Upward eye deviation was the most common description in 35.1% of the mothers. According to the mothers, the main causes of seizures were high fever (47%) and malaria. However, 20.9% had no idea whatsoever of the cause. The main consequences according to the mothers were, death (32.1%), and mental disorders (22.9%). Besides some mothers admitted they had no idea (20.2%). As to their knowledge on the management of seizures only, 20.9% admitted they will rush the child to a hospital for urgent treatment. Almost all (98%) were frightened during the seizures, and the main reason for this fear was that the child might die (91%). Conclusion: Parental knowledge on seizures was insufficient which explains their inappropriate attitudes. Parents should therefore be well educated on seizures with emphasis on the importance of appropriate home responses. [ABSTRACT FROM AUTHOR]

Objectives: To compare the analgesic effect of breastfeeding and 30% glucose on pain induced in term newborns during a single painful procedure. Study Design and Setting: We conducted an open design trial, from January to October 2013, at the maternity of the Yaounde Gynaeco-Obstetric and Paediatric Hospital. Patients and Methods: We included healthy term newborns of at least 24 h of life; a heel prick was done, using a 23-gauge syringe, after an analgesic with breastfeeding or 30% glucose. The newborns were divided into two groups by drawing of lots. The pain was evaluated using the Neonatal Infant Pain Scale. Results: Fifty newborns were recruited per group. The median (interquartile range [IQR]) pain scores, during pricking, were 2 (1.5-3.5) and 3 (2.5-4.5), in the groups of breastfeeding and 30% glucose respectively, with a significant statistical difference (P < 0.001). We found a median (IQR) pain score of 3 (2.5-4), in newborns weighing between 2500 and 3000 g, against 2 (1-3) in those weighing above 3000 g with a significant statistical difference (P = 0.02). Conclusion: The analgesic effect of breastfeeding is greater than that of 30% glucose solution, in newborns undergoing a single painful procedure. Term newborns weighing between 2500 and 3000 g express pain more than those weighing more than 3000 g. [ABSTRACT FROM AUTHOR]

Background: Severe malaria is a medical emergency with high mortality in children below 5 years of age especially in sub-Saharan Africa. Recently, quinine has been replaced by artesunate as the first-line drug in the treatment of severe malaria in Cameroon. No local data are yet available on the efficacy of artesunate with respect to the different quinine regimens used in this setting. This study was undertaken at the Ebolowa Regional Hospital (ERH), which is located in a region of perennial transmission of malaria. Methods: This was a randomized, open-label trial in children aged 3 months to 15 years, admitted in the hospital with severe malaria due to Plasmodium falciparum confirmed on microscopy after informed parental consent. Patients were randomized into four groups. Group 1 (ARTES) received parenteral artesunate at 2.4 mg/kg at H0, H12, H24 and then once daily; Group 2 (QLD) received a loading dose of quinine base at 16.6 mg/kg followed 8 hours later by an eight-hourly maintenance dose of 8.3 mg/kg quinine base; Group 3 (QNLD3) received 8.3 mg/kg quinine base every 8 hours; and, Group 4 (QNLD2) received 12.5 mg/kg quinine base every 12 h. All patients invariably received a minimum of 24 h parenteral treatment, then, oral drugs were prescribed. The endpoints were fever clearance time, time to sit unsupported, time to eat, parasite clearance time, and parasitaemia reduction rate at H24. Survival analysis was used to compare the outcomes. Results: One-hundred and sixteen patients completed the study: 29 in ARTES arm, 28 in QLD arm, 30 in QNLD3 arm, and 29 in QNLD2 arm. There was no major differences in baseline characteristics in the treatment groups. On analysis of endpoints, fever clearance time and parasite clearance time were significantly shorter for artesunate-treated patients than for quinine-treated patients. Parasitaemia reduction rate at H24 was also significantly higher for artesunate. Time to sit unsupported and time to eat were shorter with artesunate, but the difference was not statistically significant. Conclusion: Artesunate is more effective than quinine in the treatment of severe malaria in Cameroonian children. [ABSTRACT FROM AUTHOR]

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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 1st March 2003 to 31st 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: West syndrome (WS) is an epileptic syndrome of the infant occurring between the 3rd and 12th months of life and characterized by the triad: infantile spasms in flexion, extension or mixed; global developmental delay; and hypsarrythmia on the electroencephalogram (EEG). Its incidence varies between 2.9 and 4.5 per 10,000 live births. West syndrome is caused by a brain dysfunction whose origins can be prenatal, neonatal and postnatal. Sometimes the aetiology is genetic or unknown. Purpose: To determine the main clinical, aetiological and major evolutive aspects of West syndrome in child neurology unit in a university-affiliated hospital in Yaoundé. Materials and Methods: It was a retrospective descriptive study conducted from September 2011 to January 2012 in the child neurology unit of the Yaoundé gynaeco-obstetric and paediatric hospital. The medical records of 68 children followed for West syndrome (WS) in the service during the period from February 2008 to January 2012 (48 months) were used. All infants of 1- to 16-month-old with the diagnosis of WS were included. The diagnosis of WS was based on clinical evidence of spasm in flexion and/or in extension with global development delay, and EEG evidence of hypsarythmia or focal/multifocal epileptic abnormalities when hypsarythmia is absent. For each included infant, relevant medical history and complete physical examination were performed. The following data were collected and reported on a standardized questionnaire: prenatal, perinatal and postnatal past histories, age at onset of spasms, age at diagnosis, semiology of spasms, psychomotor development, the EEG and CT aspects and the evolutive modes of WS under treatment. Psychomotor development was assessed using the Denver developmental screening test (DDST) which assesses the mental age compared to chronological age. Results: The age of onset of spasms varied between 1 and 16 months with a mean of 4.69 (±1.98) months. Males were highly represented with a sex ratio of 1.72. Flexion spasms were the most common clinical presentation (79.41%). 82.83% of the patients had a global developmental delay on the onset of spasms. Structural causes or symptomatic West syndrome was the most frequent presentation (77.94%). Perinatal aetiologies were highly represented (73.58%) with the main cause being neonatal asphyxia (55.88%). A hypsarrythmic tracing was found on the electroencephalogram (EEG) in 73.53% of cases. The most frequent CT abnormality was cortico-subcortical atrophy (38.24%). At the end of our study, global developmental delay persisted in 89.72%. Conclusion: The main aetiologies of West syndrome in our context are the sequelae of neonatal asphyxia and viral embryofoetopathies. There is a high incidence of associated global developmental delay. More prevention methods on risk factors for foetal distress and proper monitoring of deliveries to minimize severe neonatal asphyxia are indispensable. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The burden of these neurological diseases is higher in developing countries. However, there is a paucity and scarcity of literature on neurological diseases in sub-Saharan Africa. This study was therefore undertaken to determine the pattern of neurological diseases in this setting and then, compare to those elsewhere in the African continent and also serve as a baseline for planning and care for neurological disorders in Cameroon. Methods: The study was conducted at the Clinique Bastos, in Yaoundé, city capital of Cameroon, centre region. Over a period of six years, all medical records were reviewed by a neurologist and neurological diagnoses classified according to ICD-10. Results: Out of 4526 admissions 912 patients (20.15%) were given a neurological diagnosis. The most frequent neurological disorders were headache (31.9%), epilepsy (9.86%), intervertebral disc disorder (7.67%), followed by lumbar and cervical arthrosis, polyneuropathy, stroke, Parkinson disease and dementia. According to ICD-10 classification, Episodic and paroxysmal disorders (headaches, epilepsy, cerebrovascular, sleep disorders) were observed on 424 (46.48%) patients; followed by nerve, nerve root and plexus disorders in 115 (12.6%) patients. Conclusion: The above data emphasizes that neurological disease contributes substantially to morbidity in an urban African hospital. Headaches, epilepsy and intervertebral disc disorders are major causes of morbidity. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: This study describes the epidemiological patterns of hydrocephalus in toddlers in our setting in order to determine the proportion of those who could benefit from endoscopic third ventriculostomy (ETV). Methods: This prospective and descriptive study included all toddlers operated on for hydrocephalus from 1 March 2008 to 31 March 2010 at the Yaounde Central Hospital. Results: Forty-six toddlers were included representing 72% of all hydrocephalus cases managed at the Neurosurgery Unit during the study period. The mean age was 6.9 ± 1.6 months. The delay before treatment varied from 5 days to 15.8 months (mean = 3.7 ± 0.5 months). The commonest clinical presentation was macrocrania (78.3%). Of the toddlers, 58.7% presented with a probable blindness (loss of ocular pursuit); dilated and non-reactive pupils were found in nine patients (19.6%). The diagnosis was based on transfontanellar echography (TFE), CT scan or combined TFE and CT scan. Identified aetiologies were aqueduct stenosis (28.7%), haemorrhage (18%), Dandy-Walker's syndrome (14.3%), meningitis (10.8%), myelomeningocele (10.8%), agenesis of Monro's foramen (3.6%), brain abscess (3.2%) and posterior fossa tumour (3.6%). No specific cause was found in 7% of cases. The treatment was ventriculoperitoneal shunting in 42 cases (91.3%) and ETV in two cases (4.3%). Infections (11.1%) and shunts' obstruction (5.4%) were the main complications. Conclusion: Cases of hydrocephalus in toddlers are frequent in our setting. Regardless of the patient's age, the most prevailing aetiologies (infections, haemorrhage, myelomeningocele) and technological conditions (neuroendoscope) are less favourable for ETV. The use of ETV in the treatment of hydrocephalus in sub-Saharan Africa is still marginal and needs to be encouraged in selected cases. The prevention of non-tumoral hydrocephalus is of critical importance. [ABSTRACT FROM AUTHOR]