Etiologies of Neonatal Mortality in a Tertiary Care Hospital in a Resource-Limited Setting

Background: Neonatal mortality remains a major public health problem in low income countries. The survival within the first 28 days of life remains a challenge in such countries. Many strategies have been implemented to reduce deaths in children under five especially in sub-Saharan Africa. Laquintinie Douala Hospital benefits from some of these measures including a perinatal network and an emergency voucher. We aimed to describe the main causes of neonatal deaths at Laquintinie Douala Hospital. Methods: We carried out a cross-sectional study including files of all deceased neonates in the neonatal unit during a 24 months period from January 1st, 2017 to December 31st, 2018. Data collection included socio-demographic characteristics of the mothers and the newborns, clinical and therapeutic data and the evolution of the newborn. We used SPSS 20 software for data analysis with a p-value less than 0.05. Results: We included 270 files with an overall mortality rate of 13.1% and a sex ratio of 1.2. The main causes of death included prematurity (37.8%), neonatal infection (34.1%) and neonatal asphyxia (24.4%). The main factors associated with deaths included informal sector (OR = 5.49;95% CI 0.86 - 34.77;p = 0.07) and a primary level of education for mothers, malaria during pregnancy (OR 2.28;95% CI, 1.44 - 3.12;p = 0.0001), very preterm babies (OR 6.45;95% CI 4.68 - 8.89;p < 0.001) and resuscitation (OR 1.63; 95% CI 1.25 - 2.13;p = 0.0001). Conclusion: Neonatal mortality was lower than data in previous studies but remains high. This highlights the need for caregiver training and improvement of antenatal visits in our setting.

Paediatric Mortality: Aetiologies and Predictors among Children Aged 1 Month to 15 Years in a Tertiary Hospital in Douala, Cameroon

Background: Children and adolescent mortality remains a public health concern in developing countries. This study aimed to describe risk factors and aetiologies of mortality among children and young adolescents at a tertiary hospital in the town of Douala, Cameroon. Methods: We carried out a retrospective cohort study from January 1st to May 31st, 2019 among deceased patients aged 1 month to 15 years admitted to the paediatric ward of the Gynaeco-Obstetric and Paediatric Hospital. Data of interest were collected and analysed. Results: Out of 3088 children admitted, 123 death cases were recorded. The overall hospital mortality rate was 3.98%. Females accounted for 51% of the deceased patients. Fever was the main reason for consultation. Severe malaria was the most common diagnosis. In univariate logistic regression analysis, factors associated with mortality included hyperthermia (OR = 0.24;95% CI 0.80 - 1.33;p = 0.012), coma/impaired consciousness (OR = 0.30;95% CI 0.10 - 0.88;p = 0.029), pneumonia (OR = 3.95;95% CI 1.42 - 10.97;p = 0.008), antipyretic therapy (OR = 0.28;95% CI 0.11 - 0.73;p = 0.009), and no medication (OR = 4.50;95% CI 1.05 - 9.29;p = 0.043). In multivariate regression analysis, coma/impaired consciousness was found to be the only factor associated with mortality (OR = 6.24;95% CI 1.15 - 33.73;p = 0.034). Conclusion: The present study reveals that most of death cases were due to preventable causes, especially infectious diseases. Efficient reduction in children and adolescent mortality could be achieved by adequately addressing these causes.

Cryptoccocal Neuromeningitis in Immunocompetent Infant in Bonassama District Hospital, Douala: A Case Report

Cryptococcosis is rare in children. We report a case of cryptococcal meningitis in an infant whose mother works as a poultry farmer (chicken farm). The infant was received in the context of fever with convulsions. We performed a lumbar puncture and started antibiotic treatment. Cerebrospinal fluid (CSF) analysis was performed including Indian ink staining. CSF results showed the presence of yeast and we replaced antibiotics with fluconazol-based treatment. After the loss of sight and the appearance of a motor deficit, a brain scan was performed showing cerebral edema. Several lumbar punctures were performed for 02 weeks until partial recovery of visual acuity and motor deficit. This case highlights the importance of taking into account the patient’s history when making the diagnosis. In our case, the working conditions and the employment of the mother guided the realization of the Indian ink coloring of the CSF. Treatment with fluconazol continued for 22 weeks with a completely regained visual acuity and gradual improvement in motor deficit despite limited resources.

Impact of Therapeutic Education on the Viral Load of HIV Infected Children and Adolescents on Antiretroviral Therapy at the Douala Laquintinie Hospital, Cameroon

Introduction: One of the biggest challenges for HIV-infected adolescents on antiretroviral therapy (ART) is the long-term maintenance of viral suppression, which is the third 90% goal of UNAIDS. Therapeutic Education (TE), process of acquiring abilities and skills that help the patient to live optimally with his illness is one of the strategies that contribute to the achievement of viral suppression through the therapeutic adhesion contract and the follow-up of the patient. The aim of this study was to evaluate the impact of TE on the virologic response of children and adolescents aged 8 - 19 under ART and followed up at the Laquintinie Hospital of Douala (LHD). Method: A cross-sectional study was conducted at the Pediatric Unit of the HIV/AIDS Accredited Treatment Center (ATC) at LHD from February to May 2016. Children and adolescents aged 8 to 19 years on ART, followed in ATC/LHD whose parents had agreed to participate in the study, and who had achieved at least one viral load before and after initiation of TE, were recruited consecutively during routine medical follow-up. Data were collected from patients’ medical records and questionnaires administered to study participants. Results: A total of 198 children and adolescents were included in this study with an average age of 14 years (&plusmn;3). In this study population, 86.1% of children aged 8 - 10 years had acquired knowledge of the importance of taking medications, 95.4% and 97.3% of adolescents aged 11 - 14 years and 15 - 19 years had knowledge of medication schedules respectively. Among children and adolescents with undetectable viral load prior to initiation of TE, 76.5% maintained an undetectable viral load after initiation of TE. In addition, 72.3% of those whose viral load was detectable before initiation of TE had acquired an undetectable or decreasing viral load after initiation of TE. The only exposure factor significantly associated with maintaining undetectable viral load after initiation of TE was having less than 10 TE sessions (p = 0.02). Conclusion: The virologic response appears to be better in subjects who acquire skills faster through TE and therefore require fewer learning sessions to adapt. In addition, TE effectively contributes to achieving the third 90% goal of UNAIDS.

Neonatal Transfer Situation Following Implementation of a Perinatal Network: An Analysis in Douala, Cameroon

Background: Postnatal transfer (PT) is interhospital transport of care-needing newborns. In 2016, a perinatal network was implemented to facilitate PT in the town of Douala, Cameroon. The network was supposed to improve PT-related care standards. This study aimed at determining characteristics of PT five years following the implementation of this network. Methods: A cross-sectional study was carried out from February to May 2021 at neonatology wards of six hospitals in Douala. Medical records of newborns transferred to the hospitals were scrutinized to document their characteristics. Parents were contacted to obtain information on PT route and itinerary. Data were analyzed using Epi Info software and summarized as percentages, mean and odds ratio. Results: In total, 234 of the 1159 newborns admitted were transferred, giving a PT prevalence of 20.2% (95% CI 17.9% - 22.6%). Male-to-female ratio of the transferred newborns was 1.3. Neonatal infection (26.5%), prematurity (23.5%) and respiratory distress (15.4%) were the main reasons for transfer. Only 3% of the PT was medicalized while only 2% of the newborns were transferred through perinatal network. On admission, hypothermia and respiratory distress were found in 31% and 35% of the newborns, respectively. The mortality rate among babies was 20% and these had a two-fold risk of dying (95% CI 1.58 - 3.44, p Conclusion: PT and the perinatal network are lowly organized and implemented in Douala. Sensitization of medical staff on in utero transfer, creating center for coordination of the network, and implementation of neonatal transport system could improve the quality of PT.