• 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)
    • 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.
    • 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.
    • Antiretroviral therapy outcomes in resource-limited settings for HIV-infected children <5 years of age.

      Sauvageot, D; Schaefer, M; Olson, D; Pujades-Rodriguez, M; O'Brien, D P; Epicentre, Paris, France. delphsauvageot@hotmail.com (2010-05)
      OBJECTIVE: We describe medium-term outcomes for young children receiving antiretroviral therapy (ART) in resource-limited countries. METHODS: Analyses were conducted on surveillance data for children <5 years of age receiving ART (initiated April 2002 to January 2008) in 48 HIV/AIDS treatment programs in Africa and Asia. Primary outcome measures were probability of remaining in care, probability of developing World Health Organization stage 4 clinical events, rate of switching to second-line ART, and drug toxicity, compared at 6, 12, 24, and 36 months of ART. RESULTS: Of 3936 children (90% in Africa) initiating ART, 9% were <12 months, 50% were 12 to 35 months, and 41% were 36 to 59 months of age. The median time of ART was 10.5 months. Probabilities of remaining in care after 12, 24, and 36 months of ART were 0.85, 0.80, and 0.75, respectively. Compared with children 36 to 59 months of age at ART initiation, probabilities of remaining in care were significantly lower for children <12 months of age. Overall, 55% and 69% of deaths and losses to follow-up occurred in the first 3 and 6 months of ART, respectively. Probabilities of developing stage 4 clinical events after 12, 24, and 36 months of ART were 0.03, 0.06, and 0.09, respectively. Only 33 subjects (0.8%) switched to second-line regimens, and 151 (3.8%) experienced severe drug toxicities. CONCLUSIONS: Large-scale ART for children <5 years of age in resource-limited settings is feasible, with encouraging clinical outcomes, but efforts should be increased to improve early HIV diagnosis and treatment.
    • Association of blood lead level with neurological features in 972 children affected by an acute severe lead poisoning outbreak in zamfara state, northern Nigeria.

      Greig, J; Thurtle, N; Cooney, L; Ariti, C; Ahmed, A O; Ashagre, T; Ayela, A; Chukwumalu, K; Criado-Perez, A; Gómez-Restrepo, C; Meredith, C; Neri, A; Stellmach, D; Sani-Gwarzo, N; Nasidi, A; Shanks, L; Dargan, P I (2014-04-16)
      In 2010, Médecins Sans Frontières (MSF) investigated reports of high mortality in young children in Zamfara State, Nigeria, leading to confirmation of villages with widespread acute severe lead poisoning. In a retrospective analysis, we aimed to determine venous blood lead level (VBLL) thresholds and risk factors for encephalopathy using MSF programmatic data from the first year of the outbreak response.
    • Asymptomatic Plasmodium Infections in Children in Low Malaria Transmission Setting, Southwestern Uganda

      Roh, M E; Oyet, C; Orikiriza, P; Wade, M; Kiwanuka, G N; Mwanga-Amumpaire, J; Parikh, S; Boum, Y (Center for Disease Control, 2016-08-01)
      A survey of asymptomatic children in Uganda showed Plasmodium malariae and P. falciparum parasites in 45% and 55% of microscopy-positive samples, respectively. Although 36% of microscopy-positive samples were negative by rapid diagnostic test, 75% showed P. malariae or P. ovale parasites by PCR, indicating that routine diagnostic testing misses many non–P. falciparum malarial infections.
    • Bridging the gap from knowledge to delivery in the control of Childhood Diarrhoea

      Isanaka, S; Elder, G; Schaefer, M; Vasset, B; Baron, E; Grais, R (2012-09-01)
    • Call for Preventive Care for Rheumatic Heart Disease in Refugee Children

      Rossi, G; Lee, VS (BMJ Publishing Group - We regret that this article is behind a paywall., 2016-04-26)
    • Characteristics and mortality of neonates in an emergency obstetric and neonatal care facility, rural Burundi

      Zuniga, I; Van den Bergh, R; Ndelema, B; Bulckaert, D; Manzi, M; Lambert, V; Zachariah, R; Reid, A J; Harries, A D (International Union Against TB and Lung Disease, 2013-12)
    • Children with Moderate Acute Malnutrition Have Inflammation Not Explained by Maternal Reports of Illness and Clinical Symptoms: a Cross-Sectional Study in Burkina Faso

      Cichon, B; Fabiansen, C; Yameogo, C; Rytter, MJH; Ritz, C; Briend, A; Christensen, VB; Michaelsen, KF; Oummani, R; Filteau, S; Ashorn, P; Shepherd, S; Friis, H (BioMed Central, 2016-08-30)
      Morbidity plays an important role in the development of and recovery from malnutrition. Morbidity in children with moderate acute malnutrition (MAM) has not been described in detail and it is unclear how morbidity compares to serum levels of acute phase proteins (APPs) which indicate systemic inflammation and which can impede response to therapeutic nutritional interventions. The objective of this study was to describe morbidity in children with MAM and to assess to what extent maternally reported and clinically diagnosed morbidity explain the variation in APPs.
    • Cholera in Haiti: please do not forget zinc.

      Rossi, G; Zachariah, R; Draguez, B; Van Herp, M (2011-05-21)
    • 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)
    • Description of 3,180 Courses of Chelation with Dimercaptosuccinic Acid in Children ≤5 y with Severe Lead Poisoning in Zamfara, Northern Nigeria: A Retrospective Analysis of Programme Data

      Thurtle, N; Greig, J; Cooney, L; Amitai, Y; Ariti, C; Brown, M J; Kosnett, M J; Moussally, K; Sani-Gwarzo, N; Akpan, H; Shanks, L; Dargan, P I (Public Library of Science, 2014-10-07)
      In 2010, Médecins Sans Frontières (MSF) discovered extensive lead poisoning impacting several thousand children in rural northern Nigeria. An estimated 400 fatalities had occurred over 3 mo. The US Centers for Disease Control and Prevention (CDC) confirmed widespread contamination from lead-rich ore being processed for gold, and environmental management was begun. MSF commenced a medical management programme that included treatment with the oral chelating agent 2,3-dimercaptosuccinic acid (DMSA, succimer). Here we describe and evaluate the changes in venous blood lead level (VBLL) associated with DMSA treatment in the largest cohort of children ≤5 y of age with severe paediatric lead intoxication reported to date to our knowledge.
    • 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.
    • Diagnostic and Prognostic Value of Procalcitonin and C-Reactive Protein in Malnourished Children

      Page, A-L; de Rekeneire, N; Sayadi, S; Aberrane, S; Janssens, A-C; Dehoux, M; Baron, E (American Academy of Pediatrics, 2014-01-20)
      Early recognition of bacterial infections is crucial for their proper management, but is particularly difficult in children with severe acute malnutrition (SAM). The objectives of this study were to evaluate the accuracy of C-reactive protein (CRP) and procalcitonin (PCT) for diagnosing bacterial infections and assessing the prognosis of hospitalized children with SAM, and to determine the reliability of CRP and PCT rapid tests suitable for remote settings.
    • Different methodological approaches to the assessment of in vivo efficacy of three artemisinin-based combination antimalarial treatments for the treatment of uncomplicated falciparum malaria in African children.

      Ashley, E A; Pinoges, L; Turyakira, E; Dorsey, G; Checchi, F; Bukirwa, H; van den Broek, I; Zongo, I; Urruta, P P P; van Herp, M; Balkan, S; Taylor, W R J; Olliaro, P; Guthmann, J P; Epicentre, Paris, France. elizabeth.ashley@epicentre.msf.org (2008-08-09)
      BACKGROUND: Use of different methods for assessing the efficacy of artemisinin-based combination antimalarial treatments (ACTs) will result in different estimates being reported, with implications for changes in treatment policy. METHODS: Data from different in vivo studies of ACT treatment of uncomplicated falciparum malaria were combined in a single database. Efficacy at day 28 corrected by PCR genotyping was estimated using four methods. In the first two methods, failure rates were calculated as proportions with either (1a) reinfections excluded from the analysis (standard WHO per-protocol analysis) or (1b) reinfections considered as treatment successes. In the second two methods, failure rates were estimated using the Kaplan-Meier product limit formula using either (2a) WHO (2001) definitions of failure, or (2b) failure defined using parasitological criteria only. RESULTS: Data analysed represented 2926 patients from 17 studies in nine African countries. Three ACTs were studied: artesunate-amodiaquine (AS+AQ, N = 1702), artesunate-sulphadoxine-pyrimethamine (AS+SP, N = 706) and artemether-lumefantrine (AL, N = 518).Using method (1a), the day 28 failure rates ranged from 0% to 39.3% for AS+AQ treatment, from 1.0% to 33.3% for AS+SP treatment and from 0% to 3.3% for AL treatment. The median [range] difference in point estimates between method 1a (reference) and the others were: (i) method 1b = 1.3% [0 to 24.8], (ii) method 2a = 1.1% [0 to 21.5], and (iii) method 2b = 0% [-38 to 19.3].The standard per-protocol method (1a) tended to overestimate the risk of failure when compared to alternative methods using the same endpoint definitions (methods 1b and 2a). It either overestimated or underestimated the risk when endpoints based on parasitological rather than clinical criteria were applied. The standard method was also associated with a 34% reduction in the number of patients evaluated compared to the number of patients enrolled. Only 2% of the sample size was lost when failures were classified on the first day of parasite recurrence and survival analytical methods were used. CONCLUSION: The primary purpose of an in vivo study should be to provide a precise estimate of the risk of antimalarial treatment failure due to drug resistance. Use of survival analysis is the most appropriate way to estimate failure rates with parasitological recurrence classified as treatment failure on the day it occurs.
    • The dynamics of measles in sub-Saharan Africa.

      Ferrari, M J; Grais, R; Bharti, N; Conlan, A J K; Bjørnstad, O N; Wolfson, L J; Guerin, P J; Djibo, A; Grenfell, B T; Center for Infectious Disease Dynamics, The Pennsylvania State University, University Park, Pennsylvania 16802, USA. mferrari@psu.edu (Macmillan, 2008-02-07)
      Although vaccination has almost eliminated measles in parts of the world, the disease remains a major killer in some high birth rate countries of the Sahel. On the basis of measles dynamics for industrialized countries, high birth rate regions should experience regular annual epidemics. Here, however, we show that measles epidemics in Niger are highly episodic, particularly in the capital Niamey. Models demonstrate that this variability arises from powerful seasonality in transmission-generating high amplitude epidemics-within the chaotic domain of deterministic dynamics. In practice, this leads to frequent stochastic fadeouts, interspersed with irregular, large epidemics. A metapopulation model illustrates how increased vaccine coverage, but still below the local elimination threshold, could lead to increasingly variable major outbreaks in highly seasonally forced contexts. Such erratic dynamics emphasize the importance both of control strategies that address build-up of susceptible individuals and efforts to mitigate the impact of large outbreaks when they occur.
    • Effectiveness of blood transfusions and risk factors for mortality in children aged from 1 month to 4 years at the Bon Marche Hospital, Bunia, Democratic Republic of Congo

      Mueller, Y; Bastard, M; Ehounou, G; Itama, J; Quéré, M; de la Tour, R; Vala, L; Etard, J-F; Bottineau, M-C; Epicentre, Paris, France  Médecins Sans Frontières, Geneva, Switzerland  National Program for Blood Transfusion, Bunia, Democratic Republic of the Congo. (2012-10-11)
      Objective  To assess the effectiveness of blood transfusions in a hospital of north-eastern Democratic Republic of the Congo. Methods  Prospective study of children admitted for severe anaemia. During admission, data were collected on clinical condition and haemoglobin levels, before and after blood transfusion. A linear regression model was built to explore factors associated with haemoglobin level after transfusion. Risk factors for mortality were explored through multivariate logistic regression. Results  Haemoglobin level (Hb) was below 4 g/dl in 35% (230/657), between 4 and 6 g/dl in 58% (348/657) and at least 6 g/dl in another 6% (43/657) of the transfused children. A transfusion of 15 ml/kg of whole blood increased the Hb from 4.4 to 7.8 g/dl. Haemoglobin level after transfusion was associated with baseline Hb, quantity of delivered blood and history of previous transfusions. Overall case-fatality rate was 5.6% (37/657). Risk factors for deaths were co-morbidities such as chest infection, meningitis or malnutrition, Hb ≥ 6 g/dl, impaired consciousness or jugular venous distention on admission, and provenance. Conclusion  Transfusion was a frequent practice, the use of which could clearly have been rationalised. While indications should be restricted, quantities of transfused blood should be adapted to needs.
    • Enteric bacterial pathogens in children with diarrhea in niger: diversity and antimicrobial resistance

      Langendorf, C; Le Hello, S; Moumouni, A; Gouali, M; Mamaty, A-A; Grais, R; Weill, F-X; Page, A-L (Public Library of Science, 2015-03-23)
      Although rotavirus is the leading cause of severe diarrhea among children in sub-Saharan Africa, better knowledge of circulating enteric pathogenic bacteria and their antimicrobial resistance is crucial for prevention and treatment strategies.