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  • A screening tool for psychological difficulties in children aged 6 to 36 months: cross-cultural validation in Kenya, Cambodia and Uganda.

    Nackers, F; Roederer, T; Marquer, C; Ashaba, S; Maling, S; Mwanga-Amumpaire, J; Muny, S; Sokeo, C; Shom, V; Palha, M; Lefebvre, P; Kirubi, BW; Kamidigo, G; Falissard, B; Moro, MR; Grais, RF (BioMed Central, 2019-04-12)
    In low-resource settings, the lack of mental health professionals and cross-culturally validated screening instruments complicates mental health care delivery. This is especially the case for very young children. Here, we aimed to develop and cross-culturally validate a simple and rapid tool, the PSYCa 6-36, that can be administered by non-professionals to screen for psychological difficulties among children aged six to 36 months. A primary validation of the PSYCa 6-36 was conducted in Kenya (n = 319 children aged 6 to 36 months; 2014), followed by additional validations in Kenya (n = 215; 2014) Cambodia (n = 189; 2015) and Uganda (n = 182; 2016). After informed consent, trained interviewers administered the PSYCa 6-36 to caregivers participating in the study. We assessed the psychometric properties of the PSYCa 6-36 and external validity was assessed by comparing the results of the PSYCa 6-36 against a clinical global impression severity [CGIS] score rated by an independent psychologist after a structured clinical interview with each participant. The PSYCa 6-36 showed satisfactory psychometric properties (Cronbach's alpha > 0.60 in Uganda and > 0.70 in Kenya and Cambodia), temporal stability (intra-class correlation coefficient [ICC] > 0.8), and inter-rater reliability (ICC from 0.6 in Uganda to 0.8 in Kenya). Psychologists identified psychological difficulties (CGIS score > 1) in 11 children (5.1%) in Kenya, 13 children (8.7%) in Cambodia and 15 (10.5%) in Uganda, with an area under the receiver operating characteristic curve of 0.65 in Uganda and 0.80 in Kenya and Cambodia. The PSYCa 6-36 allowed for rapid screening of psychological difficulties among children aged 6 to 36 months among the populations studied. Use of the tool also increased awareness of children's psychological difficulties and the importance of early recognition to prevent long-term consequences. The PSYCa 6-36 would benefit from further use and validation studies in popula`tions with higher prevalence of psychological difficulties.
  • The role of pediatric nursing in the provision of quality care in humanitarian settings: a qualitative study in Tonkolili District, Sierra Leone

    Gilday, J; Chantler, T; Gray, N; Treacy-Wong, V; Yillia, J; Pascal Gbla, A; Howard, N; Stringer, B (Innovational Publishers, 2018-12)
  • The Role of Pediatric Nursing in the Provision of Quality Care in Humanitarian Settings: a Qualitative Study in Tonkolili District, Sierra Leone

    Gilday, J; Chantler, T; Gray, N; Treacy-Wong, V; Yillia, J; Gbla, AP; Howard, N; Stringer, B (Innovational Publishers, 2018-12)
    Purpose: Evaluate nurses' and caretakers' perspectives of quality care, barriers to its delivery, and its study in a humanitarian setting. Methods: A qualitative study using semi-structured interviews and direct observation was conducted in the pediatric department of Magburaka Hospital, Tonkolili district, Sierra Leone. Interviews were recorded, transcribed, and inductive coding was used to identify prevalent themes. The observation was used to compare and elaborate on interview findings. Results: Three themes emerged holistic care; the nursing community; and organization and systems of care. For caretakers, holistic care related to their child‟s survival, with quality care described as the availability of free medication, provision for basic needs (food, water, shelter, sanitation), hospital cleanliness, and psychosocial support. For nurses, this involved medication administration, cleanliness, and carrying out nursing tasks (e.g., taking vital signs). Observation revealed caretakers, without nursing involvement, performed the majority of “activities of daily living” (e.g., bathing, toileting). The nursing community describes nursing employment types, attitudes, and how a lack of teamwork impacted quality nursing care. The third theme outlines the importance of organization and systems of care, in which training and a good salary were perceived as prerequisites for quality nursing care, whilst a lack of resources and inadequate operational systems were barriers. Conclusion: Caretakers play an integral role in the delivery of quality care. This and important quality care components outlined by nurses and caretakers identified a patient and family-centered approach could contribute to improving quality nursing care in humanitarian settings.
  • Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection

    Kemigisha, E; Nanjebe, D; Boum, Y; Langendorf, Céline; Aberrane, S; Nyehangane, D; Nackers, F; Mueller, Y; Charrel, R; Murphy, RA; Page, AL; Mwanga-Amumpaire, J (PLoS One, 2018-10-09)
    Acute central nervous system (CNS) infections in children in sub-Saharan Africa are often fatal. Potential contributors include late presentation, limited diagnostic capacity and inadequate treatment. A more nuanced understanding of treatment practices with a goal of optimizing such practices is critical to prevent avoidable case fatality. We describe empiric antimicrobial treatment, antibiotic resistance and treatment adequacy in a prospective cohort of 459 children aged two months to 12 years hospitalised for suspected acute CNS infections in Mbarara, Uganda, from 2009 to 2012. Among these 459 children, 155 had a laboratory-confirmed diagnosis of malaria (case-fatality rate [CFR] 14%), 58 had bacterial infections (CFR 24%) and 6 children had mixed malaria and bacterial infections (CFR 17%). Overall case fatality was 18.1% (n = 83). Of 219 children with laboratory-confirmed malaria and/or bacterial infections, 182 (83.1%) received an adequate antimalarial and/or antibiotic on the day of admission and 211 (96.3%) within 48 hours of admission. The proportion of those receiving adequate treatment was similar among survivors and non-survivors. All bacterial isolates were sensitive to ceftriaxone except one Escherichia coli isolate with extended-spectrum beta-lactamase (ESBL). The observed high mortality was not a result of inadequate initial antimicrobial treatment at the hospital. The epidemiology of CNS infection in this setting justifies empirical use of a third-generation cephalosporin, however antibiotic resistance should be monitored closely.
  • Delivering paediatric critical care in humanitarian settings

    Umphrey, L; Brown, A; Hiffler, L; Lafferty, N; Garcia, DM; Morton, N; Ogundipe, O (Elsevier, 2018-10-05)
  • Navigating a Mid-Level Gap in Neonatal Resuscitation

    Umphrey, L; Blennow, M; Breindahl, M; Brown, A; Roehr, CC; Saugstad, OD; Thio, M; Trevisanuto, D (Karger Publishers, 2018-08-22)
  • When Helping Babies Breathe Is Not Enough: Designing a Novel, Mid-Level Neonatal Resuscitation Algorithm for Médecins Sans Frontières Field Teams Working in Low-Resource Hospital Settings

    Umphrey, L; Breindahl, M; Brown, A; Saugstad, OD; Thio, M; Trevisanuto, D; Roehrg, CC; Blennow, M (Karger Publishers, 2018-05-25)
    Neonatal resuscitation (NR) combines a set of life-saving interventions in order to stabilize compromised newborns at birth or when critically ill. Médecins Sans Frontières/Doctors Without Borders (MSF), as an international medical-humanitarian organization working particularly in low-resource settings (LRS), assisted over 250,000 births in obstetric and newborn care aid projects in 2016 and provides thousands of newborn resuscitations annually. The Helping Babies Breathe (HBB) program has been used as formal guidance for basic resuscitation since 2012. However, in some MSF projects with the capacity to provide more advanced NR interventions but a lack of adapted guidance, staff have felt prompted to create their own advanced algorithms, which runs counter to the organization's aim for standardized protocols in all aspects of its care.
  • A Nosocomial Outbreak of Clinical Sepsis in a Neonatal Care Unit (NCU) in Port-Au-Prince Haiti, July 2014 - September 2015

    Lenglet, A; Faniyan, O; Hopman, J (Public Library of Science, 2018-03-21)
    Between July 2014 and September 2015, a neonatal care unit (NCU) in Port Au Prince, Haiti, experienced an outbreak of sepsis, most probably due to nosocomial transmission of Extended Beta Lactamase (ESBL) producing gram negative bacteria, included Klebsiella pneumoniae.
  • Infant formula in Iraq: part of the problem and not a simple solution - Authors' reply

    Haidar, MK; Alayyan, A; Farhat, JB; Saim, M; Defourny, I (Elsevier, 2018-02-09)
  • 2nd Doctors Without Borders Pediatric Days, Dakar December 15-16, 2017

    Kadir, A; Hiffler, L; Nejat, S; Garcia, DM (John Libbey Eurotext, 2018-02-01)
  • Impact of War on Child Health in Northern Syria: the experience of Médecins Sans Frontières

    Meiqari, L; Hoetjes, M; Baxter, L; Lenglet, A (Springer Verlag, 2017-12-19)
    Few data are available to evaluate the impact of Syrian war on civilian population; to describe this impact on child health, this article uses data from Médecins Sans Frontières-Operational Centre Amsterdam's activities in Tal-Abyad and Kobane cities, northern Syria (2013-2016). Data were obtained from routine medical datasets and narrative reports, for out-patient clinics, immunisation, nutritional monitoring and assessments, and in-patient care, and were analysed quantitatively and qualitatively. Infections were the largest contributor to morbidity. The proportion of < 5 year out-patient consultations of infectious diseases that are listed for outbreak monitoring in emergencies was 15% in 2013, 51% in 2014, 75% in 2015 and 70% in 2016. Thalassemia was recorded in 0.5% of 2014 < 5 year out-patient consultations and 3.4% of 2013-2014 < 18-year in-patient admissions. Measles immunisation activities and routine Extended Programme for Immunisation were re-activated across northern Syria; however, immunisation coverage could not be calculated. Results from our routine data must be compared cautiously, due to differences in settings and disease categories.
  • A Novel Electronic Algorithm using Host Biomarker Point-of-Care tests for the Management of Febrile Illnesses in Tanzanian children (e-POCT): A randomized, controlled non-inferiority trial

    Keitel, K; Kagoro, F; Samaka, J; Masimba, J; Said, Z; Temba, H; Mlaganile, T; Sangu, W; Rambaud-Althaus, C; Gervaix, A; Genton, B; D'Acremont, V (Public Library of Science, 2017-10-23)
    The management of childhood infections remains inadequate in resource-limited countries, resulting in high mortality and irrational use of antimicrobials. Current disease management tools, such as the Integrated Management of Childhood Illness (IMCI) algorithm, rely solely on clinical signs and have not made use of available point-of-care tests (POCTs) that can help to identify children with severe infections and children in need of antibiotic treatment. e-POCT is a novel electronic algorithm based on current evidence; it guides clinicians through the entire consultation and recommends treatment based on a few clinical signs and POCT results, some performed in all patients (malaria rapid diagnostic test, hemoglobin, oximeter) and others in selected subgroups only (C-reactive protein, procalcitonin, glucometer). The objective of this trial was to determine whether the clinical outcome of febrile children managed by the e-POCT tool was non-inferior to that of febrile children managed by a validated electronic algorithm derived from IMCI (ALMANACH), while reducing the proportion with antibiotic prescription.
  • Paediatric Care in Relation to the 2014-2015 Ebola Outbreak and General Reporting of Deaths in Sierra Leone

    Sesay, T; Denisiuk, O; Shringarpure, K; Wurie, B; George, P; Sesay, M; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2017-06-21)
    Setting: All peripheral health units countrywide in Sierra Leone and one hospital in Port Loko. Objectives: Sierra Leone was severely affected by the 2014-2015 Ebola outbreak, whose impact on paediatric care and mortality reports merits assessment. We sought to compare the periods before, during and after the Ebola outbreak, the countrywide trend in morbidities in children aged < 5 years and exit outcomes in one district hospital (Port Loko). During the Ebola outbreak period, gaps in district death reporting within the routine Health Management Information System (HMIS) were compared with the Safe and Dignified Burials (SDB) database in Port Loko. Design: This was a retrospective records analysis. Results: The average number of monthly consultations during the Ebola outbreak period declined by 27% for malaria and acute respiratory infections and 38% for watery diarrhoea, and did not recover to the pre-Ebola levels. For measles, there was an 80% increase during Ebola, which multiplied by 6.5-fold post-Ebola. The number of unfavourable hospital exit outcomes was 52/397 (13%) during Ebola, which was higher than pre-Ebola (47/496, 9%, P = 0.04). Of 6565 deaths reported in the Port Loko SDB database, only 2219 (34%) appeared in the HMIS, a reporting deficit of 66%. Conclusion: The Ebola disease outbreak was associated with reduced utilisation of health services, and appears to have triggered a measles epidemic. Almost 70% of deaths were missed by the HMIS during the Ebola outbreak period. These findings could guide health system responses in future outbreaks.
  • Where Technology Does Not Go: Specialised Neonatal Care in Resource-Poor and Conflict-Affected Contexts

    Dörnemann, J; van den Boogaard, W; Van den Bergh, R; Takarinda, K; Martinez, P; Bekouanebandi, J; Javed, I; Ndelema, B; Lefèvre, A; Khalid, G; Zuniga, I (International Union Against Tuberculosis and Lung Disease, 2017-06-21)
    Setting: Although neonatal mortality is gradually decreasing worldwide, 98% of neonatal deaths occur in low- and middle-income countries, where hospital care for sick and premature neonates is often unavailable. Médecins Sans Frontières Operational Centre Brussels (MSF-OCB) managed eight specialised neonatal care units (SNCUs) at district level in low-resource and conflict-affected settings in seven countries. Objective: To assess the performance of the MSF SNCU model across different settings in Africa and Southern Asia, and to describe the set-up of eight SNCUs, neonate characteristics and clinical outcomes among neonates from 2012 to 2015. Design: Multicentric descriptive study. Results: The MSF SNCU model was characterised by an absence of high-tech equipment and an emphasis on dedicated nursing and medical care. Focus was on the management of hypothermia, hypoglycaemia, feeding support and early identification/treatment of infection. Overall, 11 970 neonates were admitted, 41% of whom had low birthweight (<2500 g). The main diagnoses were low birthweight, asphyxia and neonatal infections. Overall mortality was 17%, with consistency across the sites. Chances of survival increased with higher birthweight. Conclusion: The standardised SNCU model was implemented across different contexts and showed in-patient outcomes within acceptable limits. Low-tech medical care for sick and premature neonates can and should be implemented at district hospital level in low-resource settings.
  • Aetiology and Outcomes of Suspected Infections of the Central Nervous System in Children in Mbarara, Uganda

    Page, A; Boum Ii, Y; Kemigisha, E; Salez, N; Nanjebe, D; Langendorf, C; Aberrane, S; Nyehangane, D; Nackers, F; Baron, E; Charrel, R; Mwanga-Amumpaire, J (Nature Publishing Group, 2017-06-02)
    Infections of the central nervous system (CNS) are severe conditions, leading to neurological sequelae or death. Knowledge of the causative agents is essential to develop guidelines for case management in resource-limited settings. Between August 2009 and October 2012, we conducted a prospective descriptive study of the aetiology of suspected CNS infections in children two months to 12 years old, with fever and at least one sign of CNS involvement in Mbarara Hospital, Uganda. Children were clinically evaluated on admission and discharge, and followed-up for 6 months for neurological sequelae. Pathogens were identified from cerebrospinal fluid (CSF) and blood using microbiological and molecular methods. We enrolled 459 children. Plasmodium falciparum (36.2%) and bacteria in CSF (13.3%) or blood (3.3%) were the most detected pathogens. Viruses were found in 27 (5.9%) children. No pathogen was isolated in 207 (45.1%) children. Patterns varied by age and HIV status. Eighty-three (18.1%) children died during hospitalisation, and 23 (5.0%) during follow-up. Forty-one (13.5%) children had neurological sequelae at the last visit. While malaria remains the main aetiology in children with suspected CNS infections, no pathogen was isolated in many children. The high mortality and high rate of neurological sequelae highlight the need for efficient diagnosis.
  • Myocardial and Haemodynamic Responses to Two Fluid Regimens in African Children with Severe Malnutrition and Hypovolaemic Shock (AFRIM study)

    Obonyo, N; Brent, B; Olupot-Olupot, P; Boele van Hensbroek, M; Kuipers, I; Wong, S; Shiino, K; Chan, J; Fraser, J; van Woensel, JBM; Maitland, K (Elsevier, 2017-05-03)
    Fluid therapy in severely malnourished children is hypothesized to be deleterious owing to compromised cardiac function. We evaluated World Health Organization (WHO) fluid resuscitation guidelines for hypovolaemic shock using myocardial and haemodynamic function and safety endpoints.
  • Deuterium Dilution Technique for Body Composition Assessment: Resolving Methodological Issues in Children with Moderate Acute Malnutrition

    Fabiansen, C; Yaméogo, CW; Devi, S; Friis, H; Kurpad, A; Wells, JC (Taylor and Francis, 2017-03-03)
    Childhood malnutrition is highly prevalent and associated with high mortality risk. In observational and interventional studies among malnourished children, body composition is increasingly recognised as a key outcome. The deuterium dilution technique has generated high-quality data on body composition in studies of infants and young children in several settings, but its feasibility and accuracy in children suffering from moderate acute malnutrition requires further study. Prior to a large nutritional intervention trial among children with moderate acute malnutrition, we conducted pilot work to develop and adapt the deuterium dilution technique. We refined procedures for administration of isotope doses and collection of saliva. Furthermore, we established that equilibration time in local context is 3 h. These findings and the resulting standard operating procedures are important to improve data quality when using the deuterium dilution technique in malnutrition studies in field conditions, and may encourage a wider use of isotope techniques.
  • How Do Low Birth Weight Neonates Fare Two Years After Discharge from a Low-Technology Neonatal Care Unit in a Rural District Hospital in Burundi?

    van den Boogaard, W; Zuniga, I; Manzi, M; Van den Bergh, R; Lefevre, A; Nanan-N'zeth, K; Duchenne, B; Etienne, W; Juma, N; Ndelema, B; Zachariah, R; Reid, A (Wiley-Blackwell, 2017-01-31)
    As neonatal care is being scaled up in economically poor settings, there is a need to know more on post-hospital discharge and longer-term outcomes. Of particular interest are mortality, prevalence of developmental impairments and malnutrition, all known to be worse in low-birth-weight neonates (LBW, <2500 grams). Getting a better handle on these parameters might justify and guide support interventions. Two years after hospital discharge, we thus assessed: mortality, developmental impairments, and nutritional status of LBW children.
  • First Newborn Baby to Receive Experimental Therapies Survives Ebola Virus Disease

    Dörnemann, J; Burzio, C; Ronsse, A; Sprecher, A; De Clerck, H; Van Herp, M; Kolié, MC; Yosifiva, V; Caluwaerts, S; McElroy, AK; Antierens, A (Oxford University Press, 2017-01-09)
    A neonate born to an Ebola virus-positive woman was diagnosed with Ebola virus infection on her first day of life. The patient was treated with monoclonal antibodies (ZMapp), a buffy coat transfusion from an Ebola survivor, and the broad-spectrum antiviral GS-5734. On day 20, a venous blood specimen tested negative for Ebola virus by quantitative reverse-transcription polymerase chain reaction. The patient was discharged in good health on day 33 of life. Further follow-up consultations showed age-appropriate weight gain and neurodevelopment at the age of 12 months. This patient is the first neonate documented to have survived congenital infection with Ebola virus.
  • Improved Neonatal Mortality at a District Hospital in Aweil, South Sudan

    Thomson, J; Schaefer, M; Caminoa, B; Kahindi, D; Hurtado, N (Oxford University Press, 2016-10-27)
    Neonatal deaths comprise a growing proportion of global under-five mortality. However, data from the highest-burden areas is sparse. This descriptive retrospective study analyses the outcomes of all infants exiting the Médecins sans Frontières-managed neonatal unit in Aweil Hospital, rural South Sudan from 2011 to 2014. A total of 4268 patients were treated over 4 years, with annual admissions increasing from 687 to 1494. Overall mortality was 13.5% (n = 576), declining from 18.7% to 11.1% (p for trend <0.001). Newborns weighing <2500 g were at significantly increased mortality risk compared with babies ≥2500 g (odds ratio = 2.27, 95% confidence interval = 1.9-2.71, p < 0.001). Leading causes of death included sepsis (49.7%), tetanus (15.8%), respiratory distress (12.8%) and asphyxia (9.2%). Tetanus had the highest case fatality rate (49.7%), followed by perinatal asphyxia (26.5%), respiratory distress (20.4%) and neonatal sepsis (10.5%). Despite increasing admissions, overall mortality declined, indicating that survival of these especially vulnerable infants can be improved even in a basic-level district hospital programme.

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