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Diagnosis of CAH in a Sub Saharan Country: Visible Part of Iceberg

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Open Journal of Pediatrics 2024年第2期14卷 227-233页

作者： Suzanne Sap Ritha Mbono Hélène Kamo Jocelyn Tony charlotte eposse Jeannette Epée Isabelle Mekone Adele Bodieu Gaelle Ntsoli Paul Olivier Koki Mother and Child Center of the Chantal Biya Foundation University of Yaoundé I Yaoundé Cameroon Laquintinie Hospital University of Douala Douala Cameroon Genral Hospital of Garoua University of Garoua Garoua Cameroon Human Reproductive Center and Research on Fertility of Yaoundé University of Yaoundé I Yaoundé Cameroon Yaounde General Hospital University of Yaoundé I Yaoundé Cameroon Yaounde Central Hospital Yaoundé Cameroon Laquintiinie Hospital Douala Cameroon

Introduction :Congenital adrenal hyperplasia (CAH) is the most common cause of primary adrenal insufficiency. It is a rare monogenic recessive disorder. In African setting in absence of neonatal screening, the diagnosis is still late, based on a clinical approach. During this clinical enquiry, information from past history or pedigree of the patient is of a huge importance and may revealed surprises. Patients and Methods: In this observational study, we retrospectively included all patients with a diagnosis of CAH. The diagnosis of CAH was retained based on a high 17 hydroxyprogesterone level in addition to clinical and morphological findings. From patients’ files, we extracted data on family history of disease, pedigree, clinical findings and genetics when available of 39 patients from two endocrinopeadiatric centers. Results: In 13 (30%) families, we found 20 reported deaths of infant less than 12 months. In these 13 families, half of the patients followed had 21 hydroxylase deficiencies and had 11 hydroxylase deficiencies. Unsurprisingly, we suspected adrenal insufficiency in these patients at verbal autopsy even in families with a patient with 11 hydroxylase deficiency. Other non DSD malformations or genetic disorders with apparently no link with CAH were reported in 3 families. The father of a patient reported to have hypospadias. Conclusion: Each diagnosis of CAH made in our context is visible part of an iceberg. Behind a diagnosis of CAH made in our setting, is a long course of care, a dramatic past history revealing access to appropriate care disparity. Neonatal screening should thus be considered as an emergency.

关键词： Congenital Adrenal Hyperplasia

Co-Morbidities Associated with Prematurity in Two Referral Hospitals in Cameroon

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Open Journal of Pediatrics 2024年第4期14卷 738-753页

作者： Diomede Noukeu Njinkui Dominique Enyama Yolande Djike Fokam Cyrelle O. Mefotse Saha Beatrice Moudze Kaptue charlotte eposse Koube Annick A. Tchouamo Sime Christophe Akazong Adjahoung Marthe E. Barla Edgar Mandeng Ma Linwa Seraphin Nguefack Faculty of Medicine and Pharmaceutical Sciences of the University of Dschang Dschang Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Health Sciences University of Mountains Bangangte Cameroon Douala Laquintinie Hospital Douala Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Douala General Hospital Douala Cameroon Faculty of Medicine and Biomedical Sciences University of Yaound I Yaound Cameroon

Introduction: Prematurity is the leading cause of neonatal death in Africa. More than a million children die each year due to co-morbidities related to prematurity. In addition to being one of the causes of neonatal deaths, the health problems associated with prematurity can also lead to severe lifelong impairment in those who survive. Objectives: This paper aims to determine the epidemiology and identify co-morbidities of prematurity in the neonatology units of the Douala General Hospital (DGH) and the Laquintinie Hospital of Douala (LHD). Patients and Methodology: We conducted an analytical retrospective cohort study from January 2015 to January 2018 in the neonatology department of the GDH and the LHD, which are considered reference hospitals for the management of preterm babies in Cameroon. We included all newborns aged less than 37 weeks admitted to the neonatology units of the GDH and the LHD. The descriptive component was based on the analysis of quantitative variables using measures of central tendency. The analytical component was evaluated using Spearman correlations and the Chi-square and Fisher tests. Simple and multiple logistic regressions measured factors predictive of mortality. The Kaplan Meier survival curve used the Log Rank test and significance at p ≤ 0.05. Results: We recorded 908 preterm newborns in neonatal service and 1,124 preterm deliveries in maternity, representing an incidence of 32.5% in neonatal unit and 10.6% in maternity. 51% of whom were girls, given a sex ratio M/F of 0.9. Hypertension was the main prenatal pathology (9.1%), while premature rupture of membranes: PROM (35.5%) and eclampsia/pre-eclampsia (18.6%) were the most common obstetrical pathologies. 75.9% of deliveries were vaginal with 65.2% being performed in our referral hospitals. Gestational age ranged from 22 to 36 weeks, with a mean of 32.4 weeks. Late preterm birth rate was 53.7%, and birth weight varied between 590 and 3200 g with an average of 1747 ± 479 g. The per

关键词： Epidemiology Co-Morbidities Prematurity Douala

Suicidal Behaviours in Sickle Cell Patients at the Douala Sickle Cell Care Centre in Cameroon

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Open Journal of Psychiatry 2024年第3期14卷 265-281页

作者： Christian Eyoum Léonce Kengno Kologne charlotte eposse Ekoube Annick Mélanie Magnerou Joséphine Manga Befolo Cindy Laura Ndepa Daniel Gams Massi Aurore Nzesseu Djomo Guy Jonas Basseguin Atchou Guy Calvin Mbongo’O Rihta Mbono Mbekoto Iyawa Hassanatou Fabiola Tchouankeu Kounga Christiane Medi Sike Josiane Essola Jacques Narcisse Doumbe Erero Njiengwe Callixte Kuate Tegueu Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Laquintinie Hospital Douala Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Biomedical Sciences University of Yaound&#233 1 Yaound&#233 Cameroon

Introduction: Sickle cell anaemia is a hereditary disease that combines physical and psychological manifestations, including suicidal tendencies. So far, to our knowledge, no study has been conducted on suicidal behaviours among people with sickle cell disease in Cameroon. This is what justifies our study on the prevalence and factors related to suicidal behaviors in our study population. Methods: We conducted a cross-sectional, analytical study of 171 sickle cell patients aged from 12 years upwards who came to the sickle cell disease care service of the Laquintinie Hospital in Douala, over a period of 6 months, that is, from 1 January to 31 June 2022. Data were collected using a structured questionnaire with questions on suicidal behaviours based on the “MINI” (Mini International Neuropsychiatric Interview). The data were processed using the SPSS 26.0 software. The related factors were studied in both a bivariate and multivariate analysis. Results: Female sickle cell patients accounted for 60.2% of the sample. The mean age was 23.36 ± 8.42 years. Suicidal ideation was prevalent in 56% of cases and 13% attempted suicide. The factors most associated with suicidal ideation were: primary level of education (OR = 0.08 (0.09 - 0.79);p = 0.03), feeling unworthy of life (OR = 0.40 (0.08 - 1.96);p = 0.02), not often being considered by those around them (OR = 2.97 (1.26 - 6.99);p = 0.01), lack of family support (OR = 0.34 (0.15 - 0.77);p = 0.01). Meanwhile, the factors associated with suicide attempts were: the fact of being rarely exposed to suicide-related media (OR = 4.17 (1.40 - 71.80);p = 0.03), and a constant feeling of sadness when returning home (OR = 18.02 (1.59 - 20.55);p = 0.01). Conclusion: More than half of sickle cell patients had had suicidal thoughts and 1/6 had made at least one suicide attempt, women and young adults being the most concerned. It is therefore necessary to ensure optimum psychological care for patients with sickle cell disease.

关键词： Sickle Cell Disease Suicidal Behaviours Self-Harm

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

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Open Journal of Pediatrics 2022年第1期12卷 148-161页

作者： Daniele Kedy Koum Diomede Noukeu Njinkui Monique Carole Magnibou Loick Pradel Kojom Foko charlotte eposse Rhita Mbono Patricia Epée Eboumbou Calixte Ida Penda Department of Clinical Science Faculty of Medicine and Pharmaceutical Sciences The University of Douala Douala Cameroon Department of Pediatrics Deido District Hospital Douala Cameroon Department of Pediatrics Douala Gyneco-Obstetrics and Pediatrics Hospital Douala Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Dschang Dschang Cameroon Department of Animal Organisms Faculty of Science The University of Douala Douala Cameroon Department of Pediatrics Douala General Hospital 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.

关键词： Postnatal Transfer Perinatal Network Characterization Douala

Outcome of Very Premature Newborns in a Referral Hospital in a Resource-Limited Setting

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Open Journal of Pediatrics 2023年第6期13卷 934-946页

作者： Diomede Noukeu Njinkui Dominique Enyama Yolande Djike Fokam Victorine Eyidi Pongo charlotte eposse Ekoube Arielle Annick Sime Tchouamo Paul Olivier Koki Ndombo Daniele-Christiane Kedy Koum Faculty of Medicine and Pharmaceutical Sciences University of Dschang Dschang Cameroon Douala Gynaeco-Obstetric and Pediatric Hospital Douala Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon

Background: In Cameroon, prematurity is considered among the first cause of neonatal mortality and the main cause of sequelae in children under 5 years old. Although some local teams have studied the causes of neonatal deaths, the survival of the very preterm babies in our context remains poorly known. Patients and Methods: We conducted a hospital-based cross-sectional study with both a retrospective and prospective data collection, covering a period of 5 years and 8 months, including 120 participants who presented with very preterm birth. Socio-demographic, anamnestic, and outcome features were studied. The assessment of the child’s psychomotor development was evaluated trough gross motor skills, fine motor skills, language and social contact. We calculated the development quotient (DQ) by dividing the developmental age (DA) by the actual age (RA) of the patient. Qualitative variables were expressed as numbers and percentages and quantitative variables as means ± standard deviations. Results: At the clinic, 23.8% of the children developed cerebral palsy, 3.1% had cerebral palsy with mental delay, and 6.6% had praxis disorders. Hearing impairment was observed in 6.3% of the survivors, visual impairment in 9%, and swallowing disorders in 7.6%. The mean developmental quotient was (89.98 ± 19.7) with a median of 93. A delay in developmental milestones was observed in 10.8%, speech disorder in 57%, severe malnutrition in 7.7%. The mortality rate was 48.5%. Conclusion: Very preterm birth is associated with a higher risk of neonatal death. Cognitive and motor disorders should not be underestimated. The harmonised management of very premature babies is highly recommended in our context for early diagnosis of sequelae.

关键词： Very Preterm Birth Cerebral Palsy Psychomotor Development Sensory Development

Parent-Reported Reasons for Loss-to-Follow Up in Patients Hospitalized at the Neonatology Unit at Laquintinie

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Open Journal of Pediatrics 2024年第4期14卷 686-699页

作者： eposse Ekoube charlotte Puepi Djike Yolande Hassanatou Iyawa Mandeng Ma Linwa Edgar Epée Patricia Mbonjo Bitsie Dora Kedy Mangamba Koum Daniele-Christiane Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Paediatric Unit Douala Laquintinie Hospital Douala Cameroon Faculty of Sciences University of Douala Douala Cameroon

Introduction: Despite the known benefits of newborn follow-up clinics, attendance has historically been difficult. Infants with reported follow-up difficulty have a greater incidence of severe sensorimotor and cognitive deficits and poorer access to early intervention programs. Our objective was to determine the parent-reported reasons for loss-to-follow up in patients hospitalised at the neonatology unit of Laquintinie Hospital. Methodology: We carried out a cross-sectional study through phone interviews with parents/caregivers of patients hospitalised at Laquintinie over a 2-year period from 1st January 2021 to 31st December 2022. A non-standardised structured interview guide was used for data collection. Loss-to-follow up referred to absence to at least one visit as recorded in the neonatal follow-up chart. All necessary administrative and ethical considerations were duly respected. Results: Most neonates were born through vaginal delivery (n = 313, 69.45%). The neonates were admitted at a median gestational age of 33 weeks (Q1-Q3;32 - 35) and the median duration of hospitalisation was 12 days (Q1 - Q3;8 - 18). A total of 23 neonates had died at the time of interview giving a mortality rate of 5.1%. The three most reported reasons for loss-to-follow-up was lack of money (n = 310, 68.13%), assumption that follow-up had ended (n = 37, 8.13%), and newborn that died (n = 23, 5.1%). Conclusion: This study highlights the significant impact of financial constraints and absence of a robust follow-up system on poor uptake of neonatal follow-up post-discharge in resource limited settings like Cameroon. Our results serve as advocacy for national health insurance especially in neonates.

关键词： Loss-to-Follow Up Cameroon Neonates

“FISH VERTEBRA” about 3 Sickle Cell Patients Followed at Laquintinie Hospital, Douala

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Open Journal of Rheumatology and Autoimmune Diseases 2024年第1期14卷 20-25页

作者： Same Bebey Francine Mbono Betoko Ritha Eloundou Onomo Paul Mantho Fopa Pauline eposse Ekoube charlotte Megne Tamo Estelle Ebene Mbende Romain Singwe Ngandeu Madeleine Rheumatology Unit Laquintinie Hospital Douala Douala Cameroon Paediatric Unit Laquintinie Hospital Douala Douala Cameroon La Cite Verte Hospital Yaounde Yaounde Cameroon Paediatric Surgery Unit Laquintinie Hospital Douala Douala Cameroon La Cite des palmiers Hospital Douala Douala Cameroon Rheumatology Unit Central Hospital Yaounde Yaounde Cameroon

Vertebral involvement in particular is common in sickle cell patients. We report 3 cases of “fish vertebra” fractures in sickle cell patients aged 16, 18, and 24 years old respectively at Laquintinie Hospital, Douala. When the vertebral fractures were diagnosed, the 3 patients had back pain and kyphosis deformities of the dorsal spine. Treatment with an infusion of biphosphonates (zoledronic acid at a dose of 0.5 mg·per·kg) was offered to all three patients. Two out of three patients received treatment with biphosphonates with a successful outcome. Profound vitamin D deficiency is associated with increased bone remodeling and a history of fractures. In sickle cell anemia, vertebral fractures may also result from bone fragility, which is often overlooked as aseptic osteonecrosis and osteomyelitis, which are very often suspected.

关键词： Vertebral Fractures Sickle Cell Anemia Vertebral Bone Fragility

Neurodevelopmental Outcome of Newborns Aged More than 34 Weeks Gestational Age Managed for Birth Asphyxia in Douala (Cameroon): A Single Hospital-Based Study

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Open Journal of Pediatrics 2023年第6期13卷 838-851页

作者： Diomède Noukeu Njinkui Dominique Enyama Yolande Djike Fokam Danie L. Nanga Mewolo Christelle Annick Ngo Kana Sylvain Raoul Simeni Njonnou charlotte eposse Ekoube Arielle Annick Sime Tchouamo Paul Olivier Koki Ndombo Danièle-Christiane Kedy Koum Faculty of Medicine and Pharmaceutical Sciences University of Dschang Dschang Cameroon Douala Gynaeco-Obstetric and Pediatric Hospital Douala Cameroon Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Yaoundé Gynaeco-Obstetric and Pediatric Hospital Yaoundé Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon

Background: Perinatal asphyxia is a common cause of mortality and of morbidity including motor and neurodevelopmental abnormalities. The aim of this study was to evaluate the post-hospital outcome of neonates treated for perinatal asphyxia at the Douala Gynaeco-Obstetric and Pediatric Hospital (DGOPH) in Cameroon. Patients and Methods: We conducted a hospital-based cross-sectional study with both a retrospective and prospective data collection, conducted over a period of 3 months and involving neonates above 34 weeks of gestational age who were managed for perinatal asphyxia at DGOPH from August 2015 to February 2020. Socio-demographic, perinatal, motor, nutritional and neuro-developmental out-of-hospital data were recorded. The assessment of the child’s psychomotor development was evaluated through gross motor skills, fine motor skills, language and social contact. We calculated the development quotient (DQ) by dividing the developmental age (DA) by the actual age (RA) of the patient. The data were entered and analyzed using excel and Stata version 15 software. Results: Among the 58 newborns included in our study, males were the most represented (59%). The mean age was 36.5 ± 14.16 months (Extremes: 12 months and 66 months). The majority of patients were born at term (79%), had a birth weight between 2500 and 4000 grams (69%), were resuscitated (95%), and had an Apgar score th minute of life (67%). SARNAT stages II and III counted for 48%. Neurodevelopmental abnormalities were found in 25.5% of patients with gross motor delay (mainly tetraparesis) representing 23.5%, fine motor delay 27.5%, impairment in social contact 31% language speech delay. The majority of the children had a normal development quotient (78.4%). Conclusion: The short-term and long-term outcome of newborns who experienced perinatal asphyxia in our setting is marked by numerous impairments in developmental milestones leading to disability.

关键词： Perinatal Asphyxia Newborn Neurological Outcome Cameroon

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

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Open Journal of Pediatrics 2021年第4期11卷 810-815页

作者： Patricia Epée Eboumbou Yanelle Wandji Ritha Mbono Betoko Hassanatou Iyawa charlotte eposse Danielle Kedy Koum Calixte Ida Penda Clinical Sciences Department Faculty of Medicine and Pharmaceutical Sciences of Douala Douala Cameroun Pediatric Service Bonassama District Hospital Douala Cameroun Clinical Sciences Department Faculty of Health Sciences University of Buea Buea Cameroun Pediatric Service Laquintinie Hospital Douala Douala Cameroun Deido District Hospital Douala Cameroun General Hospital Douala Douala Cameroun

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.

关键词： Cryptococcis Meningitis Immunocompetent Infant