Antibiotics prescribed to febrile under-five children outpatients in urban public health services in Burkina Faso

Appropriate use of antibiotics remains critical for success in achieving MDG4. The aim of this study was to investigate antibiotics prescribing practices to febrile under-five children outpatients in urban public health services in a low income country. Methods: From March to April 2013, a cross-sectional epidemiological study of care facilities visit by under-five age, for febrile illness, was carried out in urban health services in Bobo-Dioulasso, Burkina Faso. Patient demographics, diagnoses and medications were recorded. We calculated for each diagnoses several indicators for antibiotics use. Results: Our study showed an over-prescription of antibiotics at the university teaching hospital (78.08%) and at the first level facilities (57.71%) for under-five outpatients for febrile illness. There was evidence of high antibiotic prescription in children with diarrhea (more than 9 on 10 at university teaching hospital of diarrhea cases and 60% at the first level facilities), in children with Upper respiratory tract infections (respectively 60% and 85.2% of cases at university teaching hospital and at the first level facilities) and in children with malaria (respectively 47.5% and 17.6% of cases at university teaching hospital and at the first level facilities). Overuse, misuse and inappropriately prescribed antibiotic coexisted in our results: at university teaching hospital 90.9% of diarrhea cases, 60% of URTI cases,?47.5% of malaria cases received antibiotic prescription;at first level heath care facilities 85.2% of URTI, 17.6% of malaria cases received an prescribed antibiotic and 11.8% of LRTI did not received a prescribed antibiotic. Developing countries have poor access to newer antibiotics and irrational antibiotics use remains a global problem. Overuse and misuse of antibiotics combat, rigorous infectious diseases diagnosis, antimicrobial resistance consequences education of users and health professional’s prescribers, and improved surveillance of antimicrobial resistance, must be strengthened.

Impact of multivitamin and mineral supplements on mortality and nutritional status of hospitalized severely malnourished HIV/AIDS infected children

Micronutrient deficiencies, in HIV/AIDS infected children, are common and associated with disease progression and increased mortality. There is no evidence to support specific recommendation for in-patient treatment of severely malnourished HIV/AID infected children. We analyzed the impact of daily oral multivitamin and mineral supplementation on nutritional status and on mortality rate, of severely malnourished HIV/AIDS infected infants, hospitalized in a feeding therapeutic center. Children were randomized at admission in one of the two treatment groups: WHO standard group or additional dose group. The trial has been approved by the national health research ethics committee. Case fatality rate was high in each group. There was no difference in mortality rate between WHO standard group (mortality rate = 16.9%) and “additional dose” group (mortality rate = 17.6%). Kaplan Meir survival curves did not differ between the two groups, (p Log Rank = 0.87). During the inpatient follow-up, the median weight gain (g/kg/d) was low in groups and did not differ between WHO standard group (8.88g/kg/d Min = 4.70, Max = 17.23) and “additional dose” group (10.50g/kg/d, Min = 3.29 Max = 17.81) (Wilcoxon test p-value = 0.10). From admission to discharge, anthropometric Z-scores means evolution did not differ between the two groups: WHZ (p = 0.74), WAZ (p = 0.79) and MUAC (p = 0.73). In this randomized trial among severely malnourished HIV/AIDS infected children, we found no evidence that the provision of daily additional micro-nutrient dose during inpatient treatment, compared to WHO standard, improves nutritional status or reduces case fatality rate. Rigorous malnutrition inpatient treatments, including effective HIV/AIDS management, improve nutritional status of severely mal-nourished HIV infected children.

Impact of HIV/AIDS on mortality and nutritional recovery among hospitalized severely malnourished children before starting antiretroviral treatment

In low income countries, severe acute malnutrition remains a major problem for HIV-infected children and an important risk factor for mortality. This study aims to analyze HIV impact on mortality rate and nutritional recovery among severely malnourished HIV/AIDS uninfected and infected children. This was a retrospective cohort study conducted from data of 521 hospitalized severely malnourished children. We used Pearson’s Chi square test to compare proportions;and Student’s independent t-test to compare means;general linear model to analyze repeated measurements. We used mortality relative risk with confidence interval (CI 95%), Kaplan-Meir survival curves and Cox proportional hazard models to analyze the HIV impact on mortality rate. Case fatality rate differed significantly from SAM HIV uninfected (10.7%) and HIV infected children (39.7%), p < 0.001. Mortality relative risk was 3.71, 95% IC [2.51 - 5.47] for HIV infected children. Kaplan-Meir survival curves differed significantly between the two groups, (p Log Rank < 0.001). Cox regression adjusted mortality relative risk of HIV infected children was 4.27, CI: 2.55 - 7.15, p < 0.001. Mean weight gain differed significantly among infected children, p < 0.001. Anthropometric Z-scores means evolution differed significantly between HIV infected and uninfected children and within each group’s subjects for WHZ (p < 0.001) and WAZ (p < 0.001). Mortality relative risk was 3.71 times higher for HIV infected children. Multiples infections and metabolic complications have synergism on death occurrence in sever acute malnutrition;when associated to HIV infection, case fatality rate increases many times. Weight gain and anthropometrics index evolution were very slow for SAM HIV infected children, and specific diet may be needed for more nutritional recovery. Effective interventions, updated and adapting to local country context, to improve survival of severely malnourished HIV/AIDS infected children in HIV and SAM prevalent settings are urgently needed in the area of SAM’s community-based treatment approach.