Theory and Clinical Practice in Pediatrics

Bacteriological profile of meningitis in children aged 3 months to 15 years in sub-Saharan Africa: About a systematic review and critical reading of the literature

Véronique Vinick Lumaya — 2024-10-18

Objective : Bacterial meningitis is a serious, urgent, debilitating and fatal disease. It is therefore necessary to have data on bacterial epidemiology and the profile of sensitivity to antibiotics on which the emergency treatment protocol could be based. The objective of this study was to identify the bacteriological profile of meningitis in children aged 3 months to 15 years in sub-Saharan Africa by conducting a systematic review of recent literature.
Methods : This is a systematic review of the literature for which we visited free databases including PubMed, Cochrane, Medline, Google scholar and PMC Free. The key words used were: bacterial meningitis, Sub-Saharan Africa, Acute bacterial meningitis; Culture; Gram stain; Incidence, meningitis; pneumococcus; Haemophilus influenzae. Our research considered articles conducted in sub-Saharan Africa, of all languages, and published since 2004. In total, the search generated 48 studies, which after applying the criteria mentioned above, only 7 studies were retained.
Results : This systematic review showed that the bacterial flora during meningitis in children aged between 3 months to 15 years is essentially dominated by Streptococcus pneumonia in the majority with a weighted frequency of 42.9% (35.2-47. 4) and significant heterogeneity between different authors (p < 0.001). This was followed by Haemophilus influenzae with a weighted frequency of 13.8% (11.3-18.1). Escherichia coli and meningococci were observed in a small proportion. The germs identified were more sensitive to cefotaxime, ceftriaxone, then to amoxicillin, gentamicin and oxacillin.
Conclusion : Studies are necessary to regularly revisit the bacterial flora during meningitis in children in order to adapt the treatment according to the antibiogram and for probabilistic antibiotic therapy to be based on research results, because this flora bacterial infection varies from one period to another and from one country to another.

Social perceptions of childhood diarrhea in Lubumbashi, Democratic Republic of the Congo: A qualitative study

Sidonie Musangu Tshika — 2024-10-01

Introduction: Infantile diarrhea remains a public health problem in the Democratic Republic of the Congo, where infant mortality linked to this disease remains high despite the proven efficacy of oral rehydration therapy. This study aims to understand the social perceptions of childhood diarrhea among mothers in Lubumbashi, by examining how they diagnose and treat the disease through both popular and biomedical representations.
Material and methods: The study was conducted in Lubumbashi, the capital of Haut-Katanga in the DRC, utilizing a qualitative methodology that involved semi-structured interviews with 32 randomly chosen mothers. Selection criteria encompassed the number of children, educational level, religion, and age range (18 to 60). Information was gathered through documents and interviews conducted in Swahili, subsequently translated into French, and analyzed utilizing Jean-Blaise Grize’s ‘natural logic’ to grasp social representations.
Results: The study revealed that the majority of mothers associated diarrhea with physical signs such as dehydration, watery stools, depressed fontanel, and sunken eyes. Several mothers attributed the diarrhea to cultural causes, such as the consumption of certain foods by pregnant women (e.g. “kabambale”) or the practice of breastfeeding by pregnant mothers. Local diseases such as “lukunga” and “kilonda ntumbo” are considered to be specific forms of diarrhea in popular culture. Treatments include traditional remedies such as ash applications and sitz baths.
Conclusion: Perceptions of childhood diarrhea in Lubumbashi reflect a tension between cultural beliefs and biomedical knowledge, where rehydration is often neglected. The study recommends raising community awareness of the effectiveness of ORT while respecting local beliefs.

Anencephaly: A case report and the crucial role of folic acid supplementation and early diagnosis

Girress Katshiemba Mutumbua — 2024-04-26

Anencephaly is a congenital malformation caused by neural tube failure, which can be managed through folic acid intake during pregnancy. Diagnosis is typically prenatal, and termination of pregnancy is often recommended. A newborn born at Kolwezi paediatric clinic was born with a visible congenital malformation. The mother had a low socio-economic background and was 41 years old. An ultrasound scan revealed a progressing pregnancy at 30 weeks gestation with polyhydramnios. No antenatal care monitoring or folic acid prophylaxis was implemented during the periconceptional period and throughout the pregnancy. Anencephaly diagnosis was confirmed, and the newborn died five minutes post-birth. Preventive folic acid treatment has shown a decrease in neural tube defects, and first-trimester ultrasound scans can help identify life-incompatible congenital malformations. Advocating for legislative measures and genetic counselling is crucial to educate parents on recurrence risks and the advantages of folic acid supplementation before subsequent pregnancies.

Exploring quality of life disparities among 177 families with children affected by cleft lip and/or palate: A comprehensive analysis using the Impact on Family Scale

Médard Kakule Kabuyaya — 2024-04-25

Objective: This study aimed to assess the quality of life (QoL) of parents/caregivers of children with cleft lip and palate (CLP) using the Impact on Family Scale (IOFS).
Methods: Families of children requiring primary or secondary CLP repair were recruited based on the inclusion criteria. The IOFS questionnaire was utilized to assess perceived QoL. Multiple logistic regression was employed to determine factors linked to impacted QoL.
Results: Out of the 192 families contacted, 177 participated (92.2%). The patients had a mean age of 8.9 ± 5.4 months, with a majority of families residing in rural areas (67.2%). The questionnaires assessed QoL before surgery, revealing a mean total QoL score of 68.8 ± 19.4, with 49.7% of families experiencing affected QoL. The analysis demonstrated a significant association between the female sex of parents/caregivers and a more impacted QoL (p = 0.018), as well as between the absence of a history of CLP in the family and a more affected QoL (adjusted odds ratio = 3.0; 95% CI: 1.3 – 6.7; p = 0.008).
Conclusion: Caring for a child with CLP significantly decreases parents/caregivers’ QoL in all domains. The results emphasize the significance of considering the family history of CLP and the gender of the parents in the comprehensive care of affected families.

Impact of feeding practices on nutritional status of infants aged 12 to 23 months in Lubumbashi, DRC: A community based cross-sectional study

Carrel Zalula Mavuta — 2022-11-04

Purpose: In the Democratic Republic of the Congo (DRC), malnutrition remains a public health problem despite interventions to improve the nutritional status of children. The objective of this study is to determine the degree of association between dietary practices and malnutrition among infants aged 12 to 23 months in Lubumbashi (DRC).
Methods: We conducted a community-based cross-sectional study of 574 infants between 12 and 23 months of age from urban and semi-urban areas. Door to door survey was done to collect data. Nutritional status was assessed and compared with feeding practices. A multivariate analysis was conducted to evaluate the association between dietary practices and malnutrition in these children.
Results: Bottle feeding before 6 months (adjusted odds ratio [aOR] = 1.8 [1.2-2.8]; p = 0.006), introduction of solid, semi-solid or soft foods before 6 months (aOR = 2.1 [1.0-4.3]; p = 0.042), and insufficient minimum dietary diversity (aOR=2.3 [1.6-3.5]; p < 0.0001) were independently associated with stunting. Late breastfeeding initiation (aOR = 2.4 [1.1-5.0]; p = 0.023) increases the risk of wasting.
Conclusion: Infant malnutrition is sometimes a reflection of inappropriate eating practices from the early stages of a child’s life. Adherence to sufficient nutritional recommendations at birth can reduce this burden in developing countries.

Brief review: Psychological health and life quality of cerebral palsy

Nita Bhatt — 2022-04-26

Cerebral palsy is the most common cause of disability that develops in infancy. This complex disorder affects adult life in a powerful way. Challenges include performing motor skills and achieving physical capabilities. The majority of individuals also report lifelong psychosocial stressors. Furthermore, mental health issues occur more commonly in this patient subset, as do struggles with employment and education. Often the severity of challenges correlates to the severity of the cerebral palsy. The prognosis of individuals with cerebral palsy has improved over the last three decades, although it continues to be a lifelong condition. In order to promote healthy aging across their lifespan, intervention programs should be considered to improve physical well-being, and care should be taken to maintain mental health.

Neonatal sepsis: A review of the literature

Adonis Muganza Nyenga — 2021-11-22

Neonatal sepsis contributes significantly to neonatal morbidity and mortality and is a major public health challenge around the world. Depending on the mode of occurrence, a distinction is made between maternal-transmitted infection and that acquired in the postnatal period. Although the etiologies maternally transmitted diseases are well understood, those of postnatal acquired infections are variable depending on the epidemiology of each hospital environment. On the one hand, risk factors for maternal-transmitted infections are maternal sepsis, prolonged premature rupture of membranes, chorioamnionitis, and bacteriuria in the mother during pregnancy. On the other hand, risk factors for postnatal acquired infections are prematurity, low birth weight, lack of hygiene, and invasive therapeutic interventions. The diagnosis is based on a series of anamnestic, clinical and biological features. Although the positive diagnosis is based on the isolation of the germ by culture on a body sample (blood, cerebrospinal fluid, urine, etc.); its low sensitivity leads to the use of markers of the acute phase of inflammation such as C-reactive protein, procalcitonin and interleukins. New molecular biology techniques are promising and offer precise diagnosis with rapid results. Empirical management is a function of microbial ecology while definitive treatment is guided by the results of microbial culture. This article presents the essential elements for understanding neonatal sepsis and discusses new diagnosis and therapeutic management. It offers a thorough reading based on the issue of infections in newborns.

Who sleeps better? Sleep patterns and sleep disturbances in adolescents with recurrent abdominal pain or inflammatory bowel disease and healthy controls

Ann-Kristin Manhart — 2021-08-31

Background: Sleep difficulties play an important role in the maintenance and course of chronic abdominal pain disorders (RAP and IBD). Particularly among adolescents with inflammatory bowel diseases (IBD) or recurrent abdominal pain (RAP), adequate sleep seems to be important, as the diseases self and the associated symptoms can cause distress and impair daytime functioning. Hence it seems adequate to take a closer look concerning the sleep difficulties within the different conditions of abdominal pain especially in comparison to a healthy control. To our knowledge no former study compared sleep problems in youths with RAP and IBD as well as healthy controls. Thus the aim of the present study was to 1) evaluate sleep problems in the RAP and IBD and 2) compare the sleep problems of these abdominal pain diseases with a healthy control group.
Methods: 129 adolescents (14-25 years) took part in the online survey, with 58 suffering from IBD, 23 had RAP and 48 healthy controls. Adolescents completed sleep questionnaires as PSQI, SDSC or NEQ. Data was analysed by conducting MANOVAs to test differences between the three groups followed by a post-hoc analyses.
Results: Significant differences between both patient groups and healthy controls regarding sleep quality as well as sleep disturbances were found. Results indicate that especially young IBD patients suffered more often from poor sleep quality, sleep disturbances as well as daily effects of nightmares than the control group. The comparison of adolescents with RAP and healthy controls showed elevated scores concerning sleep disturbances for RAP patients. However, IBD and RAP adolescents did not differ significantly concerning most sleep measurements.
Discussion: The study at hand was the first to compare adolescents with IBD and RAP regarding sleep difficulties. Adolescents with IBD and RAP have an impaired sleep quality as well as a higher rate of sleep disturbances and suffer from daily effects of nightmares than the control group. Therefore sleep disturbances should be also addressed when treating IBD and RAP patients to prevent further impairments.

Sleep as a mediator in the context of emotional problems in adolescents with IBD: A pilot study

Ann-Kristin Manhart — 2021-08-13

Background: Sleep has an impact on daily life. Particularly among adolescents with IBD, adequate sleep seems to be important, as the disease itself and the associated symptoms can cause distress and impair daytime functioning. However, often parental and youth reports differ regarding perceived sleep problems of adolescents. Besides sleep problems, depression and anxiety are often prominent in young IBD patients. To date, the interplay between sleep, anxiety/depression symptoms and IBD is not fully understood. Therefore, the aim of this study was to (1) evaluate sleep problems in adolescents suffering from IBD, (2) compare adolescents’ sleep quality and impairments according to self- and parental reports, and (3) investigate the interaction between IBD symptomatology, emotional problems and sleep disturbances.
Methods: 29 adolescents (age 10 - 22; M = 14.44 , SD = 1.78 ) with IBD and their parents took part in the study. Adolescents and parents completed questionnaires concerning sleep, emotional problems, and IBD symptomatology.
Results: Especially overtiredness, insomnia symptoms, and nightmares play a prominent role regarding sleep problems in youths. Self-rated sleep problems and parental ratings were inconsistent, particularly for nightmares (Z = -2.12; p = 0.034). However, other ratings concerning emotional problems and sleep, especially anxiety and nightmares, were significantly related(r = 0.426, p = 0.034), even though we found no mediation effect for the association between IBD, nightmares and anxiety.
Discussion: The present study revealed the importance of sleep and emotional well-being for adolescents suffering from IBD. Moreover, it became clear that the role of anxiety in youths suffering from IBD and sleep problems is not sufficiently answered yet. Not only emotional behavior but also sleep should be addressed when diagnosing IBD or during treatment of IBD. In addition, these results show the need for further investigation regarding the differences between parental and self-reports concerning sleep problems in young IBD patients.

Risk factors for neonatal sepsis in Lubumbashi, Democratic Republic of Congo: A retrospective case-control study

Adonis Muganza Nyenga — 2021-06-02

Purpose: Neonatal sepsis (NS) is a major cause of neonatal morbidity and mortality, particularly in developing countries. Delays in the identification and treatment of NS are the main contributors to the high mortality. This study aims to identify risk factors for NS in newborns in the two university hospitals in Lubumbashi, in the Democratic Republic of Congo.
Methods: This hospital-based case-control study was carried out on 486 mother-newborn pairs using the systematic sampling method during November 2019 to October 2020. Data were analyzed using STATA software (version 15). Binary and multivariable logistic regression analyses were computed to identify the associated factors at 95% CI.
Results: A total of 162 cases and 324 controls were included in this study. Multiple logistic regression analysis showed that the possible risk factors for NS in this study were low level of education (AOR = 9.16 [2.23-37.67]), maternal genitourinary tract infections (AOR = 42.59 [17.90-101.37]), premature rupture of membranes (AOR = 19.95 [7.27-54.76]), peripartum fever (AOR = 26.25 [2.31-297.83]), prolonged labor (AOR = 14.16 [3.88-51.71]), cesarean section (AOR = 3.57 [1.48-8.61]), obstructed vaginal delivery (AOR = 13.40 [1.32-136.19]), birth weight <1500 grams (AOR = 70.38 [8.64-572.95]), and between 1500-2500 grams (AOR = 7.90 [3.04-20.52]).
Conclusion: The study found that maternal and neonatal factors were strongly associated with the risk of developing NS. The present study suggests the possibility of routine assessment of sepsis in newborns born with the above characteristics.