Evaluation of the Care of Children Aged 0 to 10 Years Hospitalized for Severe Malaria at the Tambacounda Health Center, Senegal

Introduction: Malaria remains a public health priority in Senegal, particularly in Tambacounda, where it is one of the main causes of child mortality. The objective of this work was to evaluate the care of children under 10 years of age hospitalized at the Tambacounda Health Center and the factors associated with recovery. Methods: An analytical, retrospective, and descriptive cross-sectional study with exhaustive recruitment of children 0 to 120 months hospitalized at the Tambacounda reference health center for severe malaria (according to WHO criteria) between 1 January 2018 and 31 December 2021 was performed. Data collection was done through a questionnaire. Records, hospitalization records, and treatment records were the sources of collection. Data entry and analysis were performed on Epi Info 7.2 and R. Results: A total of 481 children hospitalized with severe malaria were recruited. The highest number of cases was recorded in 2018 (33.05%). In the four years of the study, peaks were always observed between October and November and the highest peak in November 2020 with 95 cases. The mean age was 65.64 months with a standard deviation of 29.28 months and a predominance of male (53.43%). The majority of people were admitted from the outpatient clinic (57.79%) and the rest (42.21%) on the recommendation of a peripheral health post. All hospitalized patients had a positive RDT and/or a positive thick drop. However, the sharp decline at admission or during hospitalization was positive in 93.80% of patients in our series, negative in 5.20% and not achieved in 1.00%. Seizures and severe anemia topped the list of signs of severity with 45.94% and 8.11%, respectively. In terms of evolution, for all hospitalized patients, there were 81.29% recovery, 10.19% referral to the Tambacounda regional hospital center for hospitalization, 4.99% death, 0.83% discharge and 2.70% unknown evolution. There was a statistically significant association between recovery without referral from a health post (OR = 1.85), absence of 2 or more signs of severity (OR = 1.82), absence of seizures (OR = 1.51), prostration (OR = 2.78), cardiovascular shock (OR = 6.67), coma (OR = 7.69), lack of evidence of biological severity (OR = 3.70), and hypoglycemia with blood glucose less than 0.4 g/L (OR = 5.88). Conclusion: In addition to the routine malaria prevention and management strategies implemented in Tambacounda, and the early referral of cases of severe malaria from health posts to the health center, all children hospitalized for severe malaria with certain symptomatology such as coma, prostration, cardiovascular shock, etc. Seizures and/or hypoglycemia should be systematically referred to the regional hospital to increase their chance of recovery.

Clinical and Evolutive Aspects of Severe Acute Malnutrition in Children Aged 0 - 59 Months at Maroua Regional Hospital in Cameroon’s Far North Region

Introduction: Severe acute malnutrition remains one of the most important causes of under-five mortality. In Cameroon, the northern regions have the highest prevalence, with 1.4% in the Far North in 2021. These children are managed at the Internal therapeutic and Nutrional Centre, one of which is located at Maroua Regional Hospital, the third level referral Hospital. We therefore proposed to carry out a study on the clinical and evolutive aspects of these children. Materials and Methods: it was a descriptive, cross-sectional study from January 2020 to December 2022, at the ITNC (CNTI) of Maroua Regional Hospital. The sample size was obtained from the Lorentz formula. Patient records were used for data collection. We excluded all incomplete records and patients with less than 24 hours of admission. Results: Out of the 873 patients we recruited, the prevalence of severe malnutrition was estimated at 18 %. The average age was 14 months, with a male predominance. The main reasons for consultation were fever (42%) and diarrhoea (35%). Marasmus was the predominant clinical form. The major medical complications were sepsis (32.9%) and malaria (16.8%). HIV prevalence was 2.5% and tuberculosis was 4.9%. Most patients had haemoglobin levels between 7 and 10g/dl. 79.3% were cured and 6.5% died. The main causes of death were sepsis and malaria. Conclusion: Severe acute malnutrition remains a major problem in the Far North region. Several joint actions are needed to break this cycle.

Analysis of the Effectiveness of Targeted Nursing in Children with Severe Viral Encephalitis Complicated with Respiratory Failure

Objective:To explore and analyze the effectiveness of targeted nursing in children with severe viral encephalitis complicated with respiratory failure.Methods:From April 2021 to April 2023,74 children with severe viral encephalitis complicated with respiratory failure admitted to the Department of Pediatrics of our hospital were selected as the research objects and divided into the target group(n=37)and the reference group(n=37).Targeted nursing was given to the target group,while general nursing was given to the reference group.Physical rehabilitation,motor scores,and lung function were compared between the groups.Results:The recovery time of limb abnormalities,convulsions,abnormal consciousness,and cranial nerve disorders in the target group was significantly better than that in the reference group(P<0.05).The motor function,joint activity and pain,sensory function,and total score of the target group were significantly lower than those of the reference group(P<0.05).After the intervention,lung function indicators including VC(vital capacity),FVC(forced vital capacity),and MVV(maximum voluntary ventilation)of the target group were better than those of the reference group(P<0.05).Conclusion:Targeted nursing can shorten the recovery period of severe viral encephalitis complicated with respiratory failure in children,speed up the recovery of motor function,and improve lung function.This nursing model has a significant application effect in children with severe viral encephalitis complicated with respiratory failure.

Family functioning mediation in tic severity and quality of life for children with Tourette syndrome

BACKGROUND Tourette syndrome(TS)is recognized as a neurodevelopmental disorder profoundly influenced by familial factors,particularly family functioning.However,the relationship among family functioning,tic severity,and quality of life in individuals with TS during childhood and adolescence remains unclear.We hypothesized that family functioning plays a role in the association between the severity of TS and quality of life in children.AIM To determine the role of family functioning in the relationship between TS severity and quality of life.METHODS This study enrolled 139 children(male/female=113/26)with TS.We assessed tic severity using the Yale Global Tic Severity Scale,quality of life via the Tourette Syndrome Quality of Life Scale,and family functioning through the Family Assessment Device.Our analysis focused on correlating these measures and exploring the mediating role of family functioning in the relationship between tic severity and quality of life.Additionally,we examined if this mediating effect varied by gender or the presence of comorbidity.RESULTS We found that family communication dysfunction had a significant mediating effect between tic severity and both psychological symptoms(indirect effect:Β=0.0038,95%confidence interval:0.0006-0.0082)as well as physical and activities of daily living impairment(indirect effect:Β=0.0029,95%confidence interval:0.0004-0.0065).For vocal tic severity,this mediation was found to be even more pronounced.Additionally,in male participants and those without attention deficit hyperactivity disorder,the mediating effect of family communication dysfunction was still evident.CONCLUSION Our study highlights the impact of family functioning on the tic severity and the quality of life in children.This relationship is influenced by gender and comorbid conditions like attention deficit hyperactivity disorder.

Clinical and Epidemiological Aspects of Severe Acute Malnourished Children from 6 to 59 Months Hospitalized in a Secondary Hospital in Mali

Introduction: Malnutrition acts on the immune system and thus increases susceptibility to infections. Infections can weaken the body and cause malnutrition, so we speak of a vicious circle between malnutrition and infection. Objective: To study the clinical and epidemiological aspects of severe acute malnutrition in children aged 6 to 59 months. Methodology: This was a prospective and descriptive study extending from July 1, 2018 to June 30, 2019. All severely acute malnourished children aged 6 to 59 months were hospitalized at URENI whose parents or careers accepted their participation in the study. Results: Severe acute malnutrition was diagnosed in 398 of the 671 hospitalized children, i.e. 59.3%. The median age was 15.33 months (2 months - 59 months). The sex ratio was 1.03 (M = 50.8 F = 49.2). Eighty-seven percent of mothers were housewives. Parents were uneducated in 49.3% for mothers and 51.8% for fathers. Marasmus represented 93.5% of cases, children diagnosed with HIV+ represented 6.3% with exclusively HIV1 (100%). Pneumopathy was most frequently associated pathology with 33.4%. The duration of hospitalization was less than 7 days in 67.6% of cases and 93.3% of children had been successfully treated. The mortality rate was 4%. Conclusion: Malnutrition still remains a public health problem affecting mainly children aged 13 to 24 months, mainly from low-income families.

Outcome after Discharge from Hospital of Children with Complicated Severe Acute Malnutrition and Predictors Factors of Non-Response during Outpatient Treatment, in Senegal

Introduction: Malnutrition is a public health problem. It is responsible for high morbidity and mortality in children aged 6 - 59 months. The aim of this study was to determine the outcome of children with complicated severe acute malnutrition after hospital discharge. Methods: This is a descriptive and analytical cross-sectional study conducted from March 1 to November 31, 2021 at the Albert Royer Children’s Hospital. Children discharged from hospital for complicated severe acute malnutrition were included. Results: A total of 103 children were included. The mean age of children at hospitalization was 16.41 ± 10.11 months and mean duration of follow-up after hospital discharge was 29.63 ± 8.59 months. Three children (2.91%) died after hospital discharge. The mean z-score of the weight-for-current height was -1.34 ± 1.08. Almost a quarter (24.27%) of the children remain acute malnourished with 3.88% of severe acute malnutrition (SAM). The predictors’ factors associated with non-response were weaning before 2 years of age (ORaj: 12.21;95% CI [6.82 - 18.44];p = 0.04) and tuberculosis (ORaj: 21.06;95% CI [12.54 - 41.09];p = 0.03). Conclusion: The rate of recovery of nutritional status in children with complicated severe acute malnutrition is satisfactory. Ablactation before the age of two and the existence of tuberculosis are significantly associated with non-recovery of nutritional status.

Etiology of Diarrhea among Severely Malnourished Infants and Young Children: Observation of Urban-Rural Differences over One Decade in Bangladesh

There is inadequate information on the etiology of diarrhea in severely malnourished (SM) young children. Thus, the study aimed to determine the etiology of diarrhea among severely malnourished (z score ?3.00 SD) children in rural and urban Bangladesh. From the database (2000-2011) of Diarrheal Disease Surveillance Systems (DDSS) at rural Matlab and urban Dhaka hospitals of icddr,b, 2234 and 3109 under-5 children were found severely malnourished (underweight, stunted or wasted) respectively. Two comparison groups [moderately malnourished (MM) and well-nourished (WN)] were randomly selected in a ratio of 1:1:1. Children with all categories of SM were more likely to be infected with Vibrio cholerae (rural—11%;urban—15%), Shigella (16%;9%), Salmonella (1%;2%) and Campylobacter (3%;4%);and less likely to have rotavirus (25%;20%) compared to only one SM category. Isolation rate of Vibrio cholerae was significantly higher among SM both in rural and urban children (7%;13%) than those of MM (5%;10%) and WN (2%;8%) and lower for rotavirus (30%;31%), (34%;43%), (35%;47%) respectively (p 0.01). However, for Shigella it was only higher among rural SM children (11%) [MM (9%), and WN (8%) (p 0.01)]. The isolation rate of Salmonella in SM (2%) was similar to that in MM (2%;p = 0.72) but significantly higher than that in WN (1%;p 0.01) among urban children. Isolation rates of bacterial enteric pathogens were higher but rotavirus was lower in SM children in both rural and urban area with geographical heterogeneity.

Frequency of Hypovitaminosis D in 6 - 59 Month Children with Severe Malaria in the Pediatrics Unit of the Teaching Hospital of Parakou (CHUD/BA) in Benin in 2016

Introduction: Vitamin D’s action outside of bone, especially on immunity, is widely reported in the international scientific literature over the last years. Objective: Calculate the frequency of hypovitaminosis D in children aged 6 to 59 months suffering from severe malaria in the CHUD-P pediatric unit in 2016. Setting and Methods: This research work is a cross-sectional study with descriptive and analytical purposes. Data gathering was prospective. The study involved children aged 6 to 59 months hospitalized for severe malaria in the CHUD-P pediatric unit. The said children were HIV-uninfected, eutrophic and had not received vitamin D supplementation during the last 6 months. Vitamin D dose was measured using the High Performance Liquid Chromatography (HPLC) technique. Results: A total of 80 subjects were involved in the survey. Mean age was 26.08 months, sex ratio was 0.8 and average weight was 10.80 kg. Hypovitaminosis D frequency was 83.8% (67 cases out of 80 children investigated during the survey) with an average plasma concentration of vitamin D estimated at 21.57 ng/ml ± 7.34 with two extremes (11.24 - 42.32) ng/ml. The minimum parasitaemia was 202 P/μl and the maximum was 580,000 P/μl. Conclusion: Hypovitaminosis D is common in children suffering from severe malaria;this result suggests conducting a large-scale community-based study to decide on vitamin D inclusion in national supplementation policies and severe malaria management.

Empirical Study on the Empowerment of Families Raising Children with Severe Motor and Intellectual Disabilities in Japan: The Association with Positive Feelings towards Child Rearing

Background: “Children with severe motor and intellectual disabilities” refers to children with markedly limited activity due to severe overlapping of physical and intellectual disabilities. The physical and mental burden placed on families raising severely disabled children, particularly the primary caregivers, is great in home settings. For families to effectively utilize services and over-come child rearing problems, the families themselves need the “strength” to cooperate with others for the purpose of raising a severely disabled child. The ultimate goal of family support is to enable such families to achieve satisfaction and self-growth in child rearing. Methods: We used a questionnaire to survey 75 primary caregivers to empirically elucidate the empowerment and positive feelings towards child rearing of families raising children with severe motor and intellectual disabilities and the related factors. The t-test and Spearman’s rank correlation coefficient were used to examine the association with bivariates. A multiple regression analysis was conducted for empowerment and positive feelings. Results: Results revealed that life events, livelihood, awareness of social support and the child’s sleep problems were factors related to empowerment. Of these, awareness of social support from outside of the family was found to contribute the most to empowerment. Furthermore, improvement and maintenance of positive feelings towards child rearing reaffirmed the existence of empowerment in addition to reducing negative feelings towards child rearing and ensuring social support. Conclusions: Raising children with severe motor and intellectual disabilities requires specialist knowledge and skills. Support from professionals to empower the entire family is therefore important in order to strengthen positive feelings towards child rearing.

Research Progress of Continuous Blood Purification in the Treatment of Severe Sepsis in Children

Pediatric sepsis is the most common disease in pediatric critical illness,because the main reason for the disease is that children's immune level is not high or the immune system is not perfect,when children's lung,abdominal cavity and blood system are infected,it will cause systemic inflammation and immune dysfunction.Early clinical symptoms are mainly irregular and intermittent fever.When the disease develops to severe sepsis,the children will suffer from acute heart failure,oliguria,respiratory alkalosis and even multiple organ failure.The incidence of death is high.It is reported that the incidence rate of sepsis in children can reach 0.3%,and the mortality rate is 50%.High incidence rate,high mortality rate and high treatment cost are the biggest problems in the pediatric field.In the past,the clinical hope of clearing away heat and toxin,promoting blood circulation and removing stasis,strengthening inflammation and other methods in traditional Chinese medicine,but the treatment effect is not ideal.With the improvement of modem medical understanding of sepsis,continuous blood purification therapy is introduced into the treatment of children with severe sepsis.In order to further explore the effect of continuous blood purification in the treatment of children with severe sepsis,the author summarizes the clinical practice experience and relevant literature,hoping to provide reference for relevant medical staff。

Impact of Anemia on Mortality and Nutritional Recovery among Hospitalized Severely Malnourished Children in Burkina Faso

This study aimed to analyze the impact of anemia on mortality rate and nutritional recovery, during severely malnourished inpatient treatment. Material and Methods: This was a retrospective cohort study conducted from data of severely malnourished children hospitalized at a feeding the rapeutic center. Pearson’s Chi square test, General linear model, Mortality relatives risks, Kaplan-Meir survival curves have been used. Results: At admission, 85.3% of included malnourished children had anemia (Hb ≤ 11 g/dl) and 10.6% severe anemic (Hb 6 g/dl). Mortality rate did not differed significantly from severely malnourished children with anemia (12.4%) and without anemia (22.2%), p = 0.12. Kaplan Meir survival curves did not differed significantly between the two groups, (p Log Rank = 0.11). From admission to discharge, anthropometric Z-scores means evolution did not differed significantly between severely malnourished children with and without anemia at admission. But anthropometric Z-scores means evolution differed significantly within each group’s subjects: WHZ (between groups: p = 0.74;within subjects: p 0.001), and WAZ (between groups: p = 0.54;within subjects: p 0.001). Conclusion: With a strong respect of current recommendation of anemia treatment of inpatient severely malnutrition management, there is no increased mortality rate in SAM anemic group;and nutritional recovery is significant within subjects of SAM anemic and non anemic children, without difference between groups.

Socioeconomic Indices Performance for HIV Diagnostic on Severely Malnourished Children in Burkina Faso

Children living with HIV should be diagnosed as early as possible and linked to antiretroviral treatment. The costs of HIV virological testing, individual and social implications of the disease require critical quality of the medical approach to diagnostic strategy. Socioeconomic data can be used to refine the medical decision. The objective of this analysis was to determine informative capacity of socioeconomic indices in the diagnosis and approach of HIV in severely malnourished children using receiver operating characteristic (ROC) curves. Materials and Methods: This was a test performance analysis conducted from data of severely malnourished children at an inpatient feeding therapeutic center in Ouagadougou. Anthropometric and social indices have been used as tests;their sensitivity, specificity and predictive values have been calculated. ROC curves and areas under curves were obtained. Medical decision aid scheme has been validated from severely malnourished children data. Results: Socioeconomic indices showed high performance to discriminate severely malnourished HIV infected and uninfected children, with high area under ROC curves. The medical decision aid scheme specificity reached 97.6% with predictive values close to 85%. Conclusion: This approach can help for expanding ART for children in low income countries and achieve the maximum ART benefits in child socioeconomic kneed context.

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.

The Determinants of Fatal Outcomes during Severe Malaria in Children at the HKM University Teaching Hospital of Cotonou-Benin

Introduction: Malaria particularly affects children in sub-Saharan African countries. This study aimed to investigate the factors associated with death in cases of severe childhood malaria to better understand the determinants of death in these children. Patients and Methods: This cohort, descriptive and analytical study was conducted from April 1 to August 15, 2015, at the CNHU-HKM pediatric clinic in Cotonou. Recruitment was exhaustive for all patients under 15 years of age who were admitted for severe malaria, as confirmed by thick smear microscopy. Results: Among the 1774 admitted patients, 449 had severe malaria caused by Plasmodium falciparum (i.e., a hospital frequency of 25.31%). The age group most affected consisted of children younger than 60 months of age (73%);female predominance was noted. The lethality rate of malaria was 13.1% (n = 59). The factors associated with death were coma (p = 0.032), poor convulsive status epilepticus (p = 0.08) and bacterial co-infection by gram negative bacteria (p = 0.021) with respectively correlations coefficient of 0.003, 3.940 and 2.424. Conclusion: Reduction of the malaria mortality rates in Benin hospitals will depend on appropriate management of poor prognostic factors, such as coma, bacterial co-infection and convulsive illness.

Assessment of Quality of Life, Family Function and Family Empowerment for Families Who Provide Home Care for a Child with Severe Motor and Intellectual Disabilities in Japan

Background: About 70% of Japanese children with severe motor and intellectual disabilities (SMID) live at home, and the number is increasing. Family members have an enormous burden of daily physical care for these children. A top priority is to understand quality of life (QoL), family function, and family empowerment to effectively support these families. We aimed to assess current living situations of families with a SMID child, and to reveal the relationships between QoL, family function, and family empowerment. Methods: Sixty-five family members from 34 families with a SMID child participated in this study. We assessed 5 parameters using the Japanese versions of the following instruments: World Health Organization Quality of Life 26 (WHOQOL26), Kinder Lebensqualitats Fragebogen (KINDL), Family Assessment Device (FAD), Family Adaptability and Cohesion Evaluation Scale KG-4 (FACESKG-4), and Family Empowerment Scale (FES). Correlation and multiple regression analyses were conducted;QoL score was the objective variable. Results: Participants included 54 parents (34 mothers, 20 fathers) and 11 siblings. The mean age of SMID children was 10.4 ± 5.03 years. Twenty-two children needed multiple types of medical care. The mean age of parents and siblings was 41.5 ± 6.16 years and 15.5 ± 2.35 years, respectively. The mean QoL score (3.28 ± 0.5) was similar to the Japanese average. The mean KINDL score (77.2 ± 12.1) was higher than those of previous studies. The mean FAD score was 1.97 ± 0.32. For FACEKG-4, the score of adaptability was correlated with WHOQOL score (r = 0.459, p < 0.05). The mean score of FES was 113.6 ± 14. As the result of multiple regression analysis, lower family FAD scores ([sb] = ?0.61, p < 0.01) indicated higher family function and greater age of participants (sb = 0.495, p < 0.01) was correlated with higher WHOQOL scores (F = 15.208, p < 0.01). Conclusions: Our results indicated that the individual QoL depended on the age of participants (equals the years of experience caring for a SMID child) and the recognition of family function as a whole. Thus, to improve family members’ QoL, we should focus on individuals and also approach the family as a whole.

Management of Severe Acute Malnutrition in a Senegalese Paediatric Hospital

Malnutrition is a global health problem. It is very common in developing countries where it contributes to an increase in morbidity and mortality, especially among children under five years of age. The main objective of this study was to describe the management of severe acute malnutrition (SAM) in children six months to five years of age hospitalized at Diamniadio Children’s Hospital (DCH). This was an epidemiological, retrospective, descriptive and cross-sectional study of children aged six to 59 months hospitalized at DCH for SAM. The study took place over a 12-month period (from January 1, 2018 to December 31, 2018). During the study period, 67 children were admitted for SAM, representing a hospital prevalence of 8.4%. The majority (88%) children were less than 24 months old. Reasons for consultations were dominated by diarrhea (57.5%) vomiting (38.8%). Complications related to SAM were mainly: anaemia (74.6%), infections (85%) and severe acute dehydration (40.3%). Factors associated with SAM were young age (infants under 24 months of age), poverty, the first four children of a sibling, poor behaviour of food diversification. The average length of hospitalization was 12 days. The nutritional recovery rate was 73.1% and lethality was 3%. Conclusion: The prevention of malnutrition must involve the fight against poverty, an optimal and well-diversified diet, monitoring the nutritional status of children up to five years of age.

Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Background: The community based management of severe acute malnutrition (CMAM) was introduced in Ghana in 2008 to manage cases of severe acute malnutrition (SAM) recorded at the community level. This study estimated the economic cost of the CMAM programme for children under-five in the Agona west municipality of Ghana. Methods: A retrospective cross sectional study that used a cost analysis design was employed to estimate the economic cost of the programme from the societal perspective. Household cost data from caregivers were obtained using a semi-structured questionnaire. That of programme cost data was obtained from document reviews as well as the use of semi-structured questionnaires and subsequent discussions with key personnel of the Ghana Health Service, Food and Nutrition Technical Assistance and UNICEF. One and multi-way sensitivity analyses were conducted to test how sensitive the cost estimates are to certain variations in the cost profiles. Results: The economic household cost of CMAM was estimated as $1905.32 ($47.63 per household) of which 79% was attributed to direct cost while the remaining 21% made up indirect cost. Programme economic cost of CMAM was estimated as $27633.5 (96% recurrent and 4% capital), with refresher training constituting majority of the cost (34%). The constituents of the total economic cost of the programme, estimated as $32214.56 are programme cost (86%), household costs (6%) and community volunteer cost (8%). Therefore, the economic cost of treating one SAM case using the CMAM protocol was estimated as $805.36. Conclusion: Although CMAM has proven to be an effective tool for the management of SAM, its associated costs are quite enormous when coverage levels (geographic) are high yet small number of cases are detected and treated. Therefore, it is prudent to implement several cost saving strategies such as a reduction in the number of days spent on trainings in order to reduce these costs.

A Severe Form of COVID-19 in an Infant with Underlining Undiagnosed Acute Myeloid Leukemia

The new global pandemic of coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019, in an outbreak of respiratory illness of unknown in China. The virus spread rapidly all over the world, and on March 11, 2020 the World Health Organization (WHO) declared COVID-19 a global pandemic. Although childhood COVID-19 cases appeared early in the outbreak, the disease burden in children is far less than in adults. The clinical presentation in adults ranges from mild illness to severe pneumonia, acute respiratory distress syndrome, acute cardiac failure, and thromboembolic complications. Children experience critical illness far less than adults with lesser degree of admission to the intensive care unit and mortality. Here is reported the case of an 8-month infant who was admitted for a severe form of COVID-19 and contemporaneously was discovered an underlining, unknown before, myelodysplastic disorder. Concerning a child with severe form of COVID-19, a high index of suspicion should be maintained towards underling diseases which compromise the immune system such as the case of acute myeloid leukemia.

Impact of the Covid-19 Pandemic on Severe Childhood Malaria at the University Hospital of Brazzaville

Introduction: Malaria management has been a source of concern for health systems since the advent of the Covid-19 pandemic. Objective: To assess the impact of the Covid-19 pandemic on severe childhood malaria in Brazzaville. Material and Method: A quasi-experimental intervention/non-intervention study was carried out between March and October 2020 in the pediatric departments of the Brazzaville University Hospital. Children aged three months to 15 years hospitalized were the target population. Two groups were formed: the “intervention” group, that of children hospitalized between March and October 2020 and the “control” group that of those hospitalized between January and August 2015. The study variables were epidemiological, clinical, biological and therapeutic. Chi-square and T-Student tests were used. The impact of the intervention was assessed by the absolute risk difference. Results: Of 1392 children hospitalized, 199 (14.6%) had severe malaria with an average age of 6.94 years. These were children under 5 years old n = 95 (47.7%) of low socioeconomic level n = 145 (72.9%) seen on average after 4.6 +/? 2.4 days. Repeated convulsions (56.8%) and anemia (20.1%) were the main reasons for hospitalization. These were isolated forms (n = 146;73.4%) of which n = 84 (42.2%) neurological and n = 62 (31.2%) anemic. The lethality was 13.1%. Delayed consultation, fever, repeated convulsions, pallor, respiratory distress, sickle cell anemia, thrombocytopenia and hypoglycemia are associated with death. The risk difference for signs of severity between the two periods was 16.6 for repeated convulsions;14.3 for severe anemia. The relative risk between the two studies was 1.8. Conclusion: The increase in morbidity and mortality in severe malaria since the beginning of the Covid-19 pandemic encourages the maintenance of the balance between the management of the Covid-19 pandemic and that of other worrying health problems.

Processes through Which the Grandparents of a Child with Severe Motor and Intellectual Disabilities (SMID) May Become Involved in Raising the Child

In Japan, it is common practice to involve grandparents in the care of children with severe motor and intellectual disabilities (SMID), as it may be difficult for nuclear families to handle such children by themselves. This study aimed to explore and describe the process through which the grandparents of children with SMID may be involved in their upbringing. Data were obtained via semi-structured interviews with 13 grandparents who had a grandchild with SMID. The collected data were examined using Yasuhito Kinoshita’s modified grounded theory approach. Altogether, 11 categories were identified from 29 themes. The results revealed two broad patterns concerning the nature of the grandparents’ involvement and their definition of grandparenthood in the context of raising a grandchild with SMID. In one process, grandparents supported the child’s family. They also learned to relate to the child and their family, despite experiencing a lack of responsiveness from the child initially. This ultimately resulted in them being inspired by their grandchild. In the other process, the grandparents left the care of their grandchild to the child’s family and chose to monitor the child’s welfare indirectly. In both the processes, the level of involvement was determined by the extent to which the family chose to ask grandparents for help. The study’s findings can be used to identify the kind of support that grandparents of children with SMID require while highlighting the role of considering the needs and intentions of the children’s families.