Epidemiological, Clinical and Evolutionary Aspects of Human African Trypanosomiasis in Children in Nola

Background: Human African trypanosomiasis (HAT) occurs in three historical foci in the Central African Republic. Objective: To describe the morbi-mortality of childhood HAT in rural Central African Republic with the aim of early management. Methods: Descriptive and analytic cross-sectional study conducted from January 1, 2017 to March 30, 2018 at Nola prefectural hospital. This study was included all children seen as outpatients and/or hospitalized in the pediatric wards, in whom the diagnosis of HAT was confirmed. Statistical analysis was performed using Epi-info software. Results: Forty children were included from Bilolo (60%), Nola (30%) and Salo (10%). The sex ratio was 0.66 with a median age of 8.65 ± 12.48 years. Fever (82.5%), nocturnal insomnia (75%), daytime somnolence (67.5%), headache (65%), polyarthralgia (62.5%), convulsions 52.5% (n = 21), tremor (27.5%), trypanidism (7.5%) and delirium (2.5%) were the main functional signs. Examination signs were adenopathy (52.5%), paresthesia (30%), decreased cutaneous-abdominal reflexes (25%) and osteoarticular reflexes (17.5%), hyperesthesia (20%), extrapyramidal hypertonia (15%) and depression (2.5%). The children were in the lymphatic-blood phase in 65% of cases, and meningoencephalitis in 35%. Pentamidine was administered in 65% of cases. Four children died and 6 had neurological sequelae. There was an association between age under 5, Bilolo’s focus, the children’s history and the severity of the disease. Age under 5, gender, household, children’s activity, history and occurrence of sequelae were also associated. Conclusion: HAT remains a permanent threat to Central African children. Any clinical presentation combining long-term infectious signs and unexplained neurological or neuropsychological disorders must be treated with caution.

Epidemiological, Clinical, Bacteriological and Evolutionary Profiles of Bacterial Meningitis in Children in Bangui (CAR)

Background: Bacterial meningitis is a major public health problem worldwide due to its severity. It is a vaccine-preventable disease. Methodology: It was a retrospective descriptive study conducted at the Pediatric Teaching Hospital of Bangui from June 2019 to May 2021. Children aged 1 month to 15 years hospitalized for bacterial meningitis were included in the study. Data were entered and analyzed using Stata/IC version 16.1. Results: Of 2490 patients hospitalized during the study period, 122 (4.9%) had bacterial meningitis. The patients were male in 54.92% of cases with a sex ratio of 1.21. The mean age was 35.95 months ± 49.16. Most of the patients (84.42%) came directly from home. The average consultation delay was 3.4 days ± 2.6. The vaccination coverage was 56.55%. The CSF study isolated germs from 24 patients (19.67%), the main ones being S. pneumoniae (75%) and H. influenzae (16.67%). Ceftriaxone was prescribed alone or in combination in all cases as first-line treatment. The average duration of antibiotic therapy was 8.95 days. The mortality rate was 27.87% and 12.30 % of patients had sequelae. Conclusion: Bacterial meningitis is common in Bangui and still poses a public health problem despite the introduction of new vaccines in the EPI. Improving vaccination coverage and raising awareness for early consultation could improve the situation.

Risk Factors of Early Neonatal Deaths in Pediatric Teaching Hospital in Bangui, Central African Republic

Background: The neonatal mortality rate in the Central African Republic (CAR) is 42.3 per 1000 live births in 2017, indicating that CAR is with the highest number of newborn deaths. Objective: The objective is to clarify the risk factors of neonatal deaths in this area. Methodology: A case-control study with retrospective data collection. Targets were newborns >7 days, hospitalized and dead (cases), and newborns admitted after the respective case during the study period and discharged before the 7th day of life. This study was carried out between 2016 and 2018 in the neonatal unit of the “Complexe Hospitalier Universitaire Pédiatrique de Bangui” (CHUPB), the only national hospital for newborns care in the CAR. Results: We included 902 newborns, with 451 cases of early neonatal death and 451 controls. 4168 newborns were admitted to the neonatology unit with 621 early death cases;a lethality rate of 14.9%. Early neonatal deaths factors were: newborns with low birth weight (OR = 22.59;95% CI [15.93 - 32.04]; P < 0.001);mothers who did not attend antenatal care (OR = 5.54;95% CI [3.95 - 7.79];P < 0.001), home delivery (OR = 0.70;95% CI [0.03 - 0.15];P < 0.001);young maternal age < 25 years (OR = 2.08;95% CI [1.58 - 2.73];P < 0.001);non-medical transport (OR = 2.14;95% CI [1.03 - 4.46];P = 0.03);origin from remote areas (OR = 5.25;95% CI [3.95 - 6.98];P < 0.001);isolated prematurity (P < 0.01);anoxo-ischemic encephalopathy (OR = 12.72;95% CI [6.54 - 34.73];P < 0.01);delivery by cesarean section (OR = 0.59;95% CI [0.41 - 0.84];P < 0.001);preterm delivery (OR = 29.36;95% CI [20.12 - 42.81];P < 0.001), and maternal lower education (OR = 5.65;95% CI [4.08 - 7.81];P < 0.001). Conclusion: The early neonatal mortality rate remains high in this area. Controlling the factors mentioned above might lead to improving the survival of newborns.

Epidemiological, Clinical and Anatomopathological Aspects of Cancers in Central African Republic Children

Objectives: To determine the epidemiological, clinical and anatomopathological aspects of childhood cancer in CAR. Patients and Methods: This was a retrospective study carried out from May 2015 to May 2018, at the Center Hospitalier Universitaire Pédiatrique de Bangui (CHUPB). The study population consisted of patients aged under 15 followed in the UHOPB for malignant tumors on clinical, radiological or ultrasound suspicion of malignancy and confirmed or not by histology or biology. A questionnaire was used to collect the data which was analyzed using SPSS11.0 software. Results: During the study period, we collected 107 cases of childhood cancer. The annual hospital incidence was 1.27% in 2016;1.93% in 2017 and 1.50% in 2018 The average monthly frequency of patients followed is 35.66. The intensity of pain assessed in the 99 patients ranged from 02/10 to 09/10 with an average of 5.41/10. The mean duration of the disease was 3.3 months with extremes at 1.2 months and 36 months. A predominance of comorbidity with HIV is 41.66%. Histologically diagnosed malignant tumors are dominated by 30.4% Burkitt’s lymphoma. Conclusion: Data on cancer incidence are scarce in developing countries and for the most part are hospital statistics. In CAR, it will be important to set up a national register for collecting information.

Neonatal Tetanus at Pediatric Teaching Hospital in Bangui

Background: Despite the Maternal and Neonatal Tetanus (MNT) elimination initiative, neonatal tetanus still persists in some parts of the world. Objectives: To determine hospital prevalence and describe epidemiological, clinical, therapeutic and outcome aspects of neonatal tetanus at the Pediatric Teaching Hospital in Bangui. Methodology: It was the review of hospitalized newborns’ files in the neonatal unit at Pediatric Teaching Hospital in Bangui between January 2016 and December 2019. Newborns discharged with tetanus diagnosis, and whose files were usable were included. The variables studied were: for the newborn: age, sex, birth weight, the reason for transfer, diagnosis, cause and time of death, place and method of delivery;for the mother: age, antenatal care, tetanus vaccine status, parity and geographical provenance. Epi Info 7 software, version 7.1.3.3 was used for data analysis. The chi2 test with the significance level set at p < 0.05 and the odds ratio were used. Résultats: Forty-eight (48) out of 5796 newborns had neonatal tetanus (0.8%). They were newborns to mothers with an average age of 18.8 years of which 68.8% (n = 33) were primipara and 87.5% (n = 42) not vaccinated against tetanus. Childbirth happened at home in 91.7% (n = 44), and the blade was used for sectioning the umbilical cord in 39.6% (n = 19). Newborns were referred from rural area in 47.9% (n = 23). A single antenatal care contact was done in 68.7% (n = 33). Tetanus was classified as severe according to the Dakar prognosis score between 4 and 6 in 89.6% of cases (n = 43). The death occurred in 58.3% (n = 28). Conclusion: The high frequency of neonatal tetanus as well as its severity requires pregnancy follow-up strengthening and childbirth monitoring in order to its elimination. But primary prevention relies on improving individual and general hygiene conditions.

Viral Acute Respiratory Infections in Central African Republic Children: Epidemiological and Clinical Aspects

Background: Acute respiratory infections (ARI) are recognized as an important cause of morbidity, mortality, and hospitalization among children in developing countries. Objectives: To identify the respiratory viruses circulating in Central African children before the SARS-COV2 pandemic and to assess the clinical manifestations. Methodology: This is a cross-sectional, descriptive, multicenter study, run from March 1, 2019, to March 31, 2020. Children aged 28 days to 15 year-old, with respiratory symptoms ≤10 days had been included. Nasopharyngeal swabs were taken and sent to the Institute Pasteur in Bangui (WHO National Referral Center for influenza). Virus research was done by cell and molecular culture techniques. Data were recorded and processed with Access 2019 software, then analyzed with STATA version 14 software. Chi-square test and ANOVA test were used to compare proportions at the p 0.05 threshold. Results: Out of 659 children included during the study period, viruses were identified in 231 children, for an overall positivity rate of 35.05% (231/659). Rhinoviruses (RV) and influenza viruses were found in 66.23% and 16.88% respectively. Virus-virus co-infections were found in 10 (10/231) children (4.32%). Children under 5 years of age were more represented (78.60%). The main reasons for consultation were: fever (96.20%), cough (95.45%), runny nose (78.5%), and breathing difficulty (30.50%). ILI (Influenza-Like Illness) was found in 71.02% versus 28.98% of SARI (Severe Acute Respiratory Infection). There was a statistically significant association between age 5 years and severity of acute respiratory infection (p = 0.001). The outcome was known for the 122 children at the CHUPB site with a mortality rate of 17.21% (n = 21). Conclusion: Viral ARI is common in children in Central African Republic. Care givers should think about it in order to reduce the inappropriate prescription of antibiotics.

Epidemiological, Clinical and Etiological Aspects of Non-Traumatic Comas in Children at the Pediatric Teaching Hospital in Bangui

Background: Non-traumatic coma is the most common pediatric medical emergency. Its clinical diagnosis is easy. The difficulty lies in finding the etiology. Objective: To determine the prevalence and clinical profiles of non-traumatic Coma at the Centre Hospitalier Universitaire Pédiatrique de Bangui (CHUPB). Methodology: This was a descriptive and analytical cross-sectional study conducted between January 1 and June 31, 2021, at CHUPB. Children aged 1 month to 15 years, admitted to the emergency room with a Glasgow score less than or equal to 8 without any traumatism were included. The variables studied were sociodemographic, clinical and paraclinical. Data were entered and analyzed using SPSS 20.0 statistical software. The statistical test used was Pearson’s chi2, any p-value Results: Of 8551 children hospitalized during the study period, 370 were hospitalized for non-traumatic coma: 4.32%. They were divided into 57.5% (n = 213) boys and 42.44% (n = 157) girls, giving a sex ratio of 1.35. Their mean age was 35.95 ± 27.21 months. Children aged 1 to 24 months represented 54.59% (n = 202) of cases. The mean time to the consultation was 2.91 days ± 1.8. Fever 86.48% (n = 320) and convulsions 80% (n = 296) were the main reasons for consultation. Coma stages II - III and IV represented 52.44% (n = 194), 42.97% (n = 159) and 4.59% (n = 17) respectively. Neuromalaria (29.72%;n = 110), meningitis-meningoencephalitis-encephalitis (30%;n = 111), sepsis (19.72%;n = 73) and acidosis Coma (5.40%;n = 20) were the main etiologies. Conclusion: Non-traumatic coma is common at CHUPB. Infections were the main etiology, particularly cerebral malaria. The reduction of its frequency requires, among others, the strengthening of the national monitoring malaria program. The strengthening of the technical platform for a good etiological diagnosis constitutes the other axis of prevention.

Bronchiolitis Revealing Pyrethroid Poisoning in a 2-Month-Old Infant

Despite the widespread domestic use of pyrethroid insecticides, very few cases of poisoning are reported in the literature, especially in children. The manifestations are generally benign, and the management is controversial. We report a case of severe intoxication in a 2-month-old infant, initially treated as bronchiolitis, which progressed favorably under atropine. This case illustrates on the one hand the importance of looking for the notion of a spray in the sudden onset of respiratory distress in the infant, and on the other hand monitoring any intoxication with pyrethroids in a small infant in order to consider a treatment with atropine sulfate in case of the occurrence of a muscarinic syndrome.

Immunovirological Profile of HIV1 Infection in Children and Adolescents Followed at the Bangui Pediatric University Hospital

History: Pediatric management of HIV infection in children in the Central African Republic began in 2004 with the use of fractionated adult antiretrovirals and Cotrimoxazole. It has evolved over the years with the use of pediatric forms, oral suspensions and dispersible tablets. The transition to Dolutegravir took place in 2020. The active file of our patients will grow from 78 to over 1900 today. Follow-up examinations are carried out to assess adherence to treatment. Objective: To determine the immunovirological profile and factors associated with treatment failure during follow-up of children on ART at the Bangui pediatric university hospital. Patients and Method: This was a cross-sectional, analytical study from May 30 to December 02, 2022. The study sample was drawn from a cohort of HIV-1-infected children followed up at the Bangui pediatric university hospital and on ART for three semesters who met the selection criteria. Results: The prevalence of treatment failure varied from one semester to the next. Thus, the prevalence of therapeutic failure was 20% in the first semester, 10% in the second semester and 7% in the third semester. The prevalence of virological failure was 10.28% in the first half of the year, 6.91% in the second half and 4.98% in the third. Secondly, immunological failure was 0.48% in the first half of the year, 0.32% in the second 0.64% in the third half. Finally, clinical failure was 8.82% in the first half, 4.82% in the second half, 1.92% in the third half. Socio-demographic and clinical factors associated with treatment failure were male gender (p 1000 copies/ml (p Conclusion: The occurrence of treatment failures in children is a major problem, especially in our resource-limited countries, given the challenges facing antiretroviral therapy. It is therefore necessary to carry out a study on resistance genotyping in order to propose correct management protocols, as the future of treatment programs depends on it.