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Chelo D, Nguefack F, Enyama D, Nansseu R, Feudjo Tefoueyet G, Mbassi Awa HD, Mekone Nkwelle I, Nguefack-Tsague G, Ndenbe P, Koki Ndombo PO. Impact and projections of the COVID-19 epidemic on attendance and routine vaccinations at a pediatric referral hospital in Cameroon. Arch Pediatr 2021; 28:441-450. [PMID: 34140219 PMCID: PMC8188383 DOI: 10.1016/j.arcped.2021.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 03/05/2021] [Accepted: 05/16/2021] [Indexed: 12/23/2022]
Abstract
Background At the beginning of March 2020, Cameroon experienced its first cases of infection with the new coronavirus (SARS-COV-2). Very quickly, there was a drop in the rate of hospital attendance. The purpose of this study was to observe the variations in the uptake of pediatric consultations and vaccinations in a pediatric hospital. Methods A descriptive and retrospective cross-sectional study was carried out using consultation and vaccination statistics from a pediatric hospital in the city of Yaoundé, political capital of Cameroon, from January 2016 to May 2020. Data were entered in Microsoft Excel and exported to R software (Version 3.3.3) for statistical analysis. First, time series raw data (before and after COVID-19) were plotted and the trend estimated by locally weighted scatterplot smoothing (LOWESS) methods. Then a classic seasonal decomposition was performed to distinguish between seasonal trends and irregular components using moving averages. The Webel–Ollech overall seasonality test (WO test) was also run to formally check for seasonality. The results of the study are presented as narrative tables and graphs. Results Following the partial confinement recommended by the government of Cameroon, the number of pediatric consultations decreased by 52% in April and by 34% in May 2020 compared with rates during the same periods in 2019 (P = 0.00001). For antenatal visits, the rates dropped by 45% and 34%, respectively, in April and May 2020 compared with 2019. The demand for immunization services also declined. As a result, the demand for BCG vaccines, third-dose tracer vaccines (diphtheria, tetanus, pertussis), polio, and MMR in children as well as tetanus vaccines in childbearing women dropped significantly. Conclusion The start of the COVID-19 pandemic was accompanied by a significant drop in consultation and vaccination activities. If no action is taken to correct this phenomenon, the ensuing months could be marked by a considerable increase in patients, sometimes suffering from vaccine-preventable diseases. The death rate could increase considerably in the pediatric population.
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Affiliation(s)
- D Chelo
- Mother and Child Center Chantal BIYA Foundation, Yaoundé, Cameroon; Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
| | - F Nguefack
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - D Enyama
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - R Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - G Feudjo Tefoueyet
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - H D Mbassi Awa
- Mother and Child Center Chantal BIYA Foundation, Yaoundé, Cameroon; Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - I Mekone Nkwelle
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - G Nguefack-Tsague
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - P Ndenbe
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - P O Koki Ndombo
- Mother and Child Center Chantal BIYA Foundation, Yaoundé, Cameroon; Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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Enyama D, Chelo D, Noukeu Njinkui D, Mayouego Kouam J, Fokam Djike Puepi Y, Mekone Nkwele I, Ndenbe P, Nguefack S, Nguefack F, Kedy Koum D, Tetanye E. Impact of the COVID-19 pandemic on pediatricians' clinical activity in Cameroon. Arch Pediatr 2020; 27:423-427. [PMID: 33011025 PMCID: PMC7510582 DOI: 10.1016/j.arcped.2020.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/25/2020] [Accepted: 09/11/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND The outbreak of COVID-19 has imposed many challenges on health systems. The purpose of this study was to describe the impact of the COVID-19 pandemic on the clinical activity of pediatricians. METHODS We conducted a cross-sectional and descriptive online survey among pediatricians practicing in Cameroon. Data were collected through an anonymous pre-tested Google Form®. RESULTS Among the 118 pediatricians eligible for the survey, 101 responded (85.6%), of whom 61.2% were women. The pediatric outpatient consultations dropped significantly from 60.4% of pediatricians seeing more than 30 patients per week before the pandemic to 9.9% during the pandemic (P<0.000). According to the occupancy rate of hospitalisation beds, 45.5% of pediatricians reported having 76-100% of pediatric hospitalisation beds occupied per week before the pandemic but no pediatrician reported a similar rate during the pandemic (P<0.000). There was a significant increase in the use of telehealth, ranging from no pediatrician using telehealth "very frequently" before the pandemic to 23.8% using it during the pandemic (P<0.000). Most of the pediatricians had at their disposal surgical masks (96%), care gloves (80.2%), hydroalcoholic gel (99.0%), and soap and water (86.1%). For the management of children, 90.1% and 71.3% of pediatricians experienced difficulties accessing COVID-19 PCR and chloroquine, respectively, and 74.3% declared difficulties for proper isolation of patients. More than half (65.3%) of the pediatricians interviewed were "very afraid" or "extremely afraid" of being infected with SARS-Cov-2, respectively 45.5% and 19.8%. The most frequent reasons included fear of infecting their relatives (85.1%) and of developing a severe form of the disease (43.6%). The reluctance to consult health services expressed by the parents was due to: fear of being infected when leaving their home and especially in the health facility (96%), strict compliance with confinement (30.7%), and financial difficulties of families (13.9%). CONCLUSION This work highlights the impact of the coronavirus pandemic on the clinical activity of Cameroonian pediatricians. Since the beginning of the pandemic, there has been a significant drop in the use of health facilities, which probably has a negative impact on children's overall level of health. Although the preventive measures explain this drop in attendance at health facilities, the parents' fear of being infected when leaving the house was the predominant reason likely to explain this drop in attendance at health facilities. This could constitute an axis for developing messages to parents to encourage a gradual return to child health services.
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Affiliation(s)
- D Enyama
- Faculty of medicine and pharmaceutical sciences, University of Dschang, Dschang, Cameroon.
| | - D Chelo
- Faculty of medicine and biomedical sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - D Noukeu Njinkui
- Faculty of medicine and pharmaceutical sciences, University of Dschang, Dschang, Cameroon
| | - J Mayouego Kouam
- Faculty of medicine and pharmaceutical sciences, University of Dschang, Dschang, Cameroon
| | | | - I Mekone Nkwele
- Faculty of medicine and biomedical sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - P Ndenbe
- Cameroonian Pediatric Association, Yaoundé, Cameroon
| | - S Nguefack
- Faculty of medicine and biomedical sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - F Nguefack
- Faculty of medicine and biomedical sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - D Kedy Koum
- Faculty of medicine and pharmaceutical sciences, University of Douala, Douala, Cameroon
| | - E Tetanye
- Faculty of medicine and biomedical sciences, University of Yaoundé I, Yaoundé, Cameroon
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Chelo D, Nguefack F, Menanga AP, Mbassi Awa HD, Nguefack S, Ngo Um S, Gody JC, Koki Ndombo PO. [Endomyocardial fibrosis in Cameroon: Echocardiographic and clinical description of a pediatric series in Yaoundé]. Arch Pediatr 2015; 23:128-35. [PMID: 26724978 DOI: 10.1016/j.arcped.2015.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 10/27/2015] [Accepted: 11/07/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endomyocardial fibrosis is a restrictive cardiomyopathy that causes heart failure. It is characterized by the fibrotic thickening of the endocardium, sometimes involving the myocardium as well. The lesion generally lies at the apices or inflow tracts of one or both ventricles, associated with more or less severe alteration of the valves. It is a disease of the intertropical regions but is not well known in Cameroon. In this study we describe the first series seen in a pediatric hospital in Cameroon. PATIENTS AND METHODS A retrospective study was conducted in a pediatric hospital in Yaoundé involving children who had been diagnosed with endomyocardial fibrosis after echocardiographic investigation. We collected the clinical and paraclinical data from consultation records and medical files. RESULTS Between January 2006 to December 2013, we registered 1430 patients with a cardiac anomaly in our center. Endomyocardial fibrosis was found in 46 patients. Neither sex predominated. Ages at the time of diagnosis varied between 2 and 17 years. Most of the patients were between 5 and 15 years old (80.4 %), with a median of 10 years (interquartile range, 7-13 years). The main complaints were breathlessness, cough, abdominal distension, abdominal, and loss of appetite. Apart from the hyperpigmentation of the lips observed in all our patients, dyspnea was the most frequent physical sign and the diagnosis was made at a time when signs of heart failure were preponderant. Growth retardation was found in all the children examined. All patients were underweight with a median weight for age found below the 25th percentile of the norms according to the National Health Statistics. Lower limb edema was absent even in the presence of voluminous ascites. All subjects had hyperpigmented lips. Despite the cyanotic appearance of the lips, pulse oximetry always gave a normal oxygen saturation level and no cyanosis was seen elsewhere. None of the patients had nail clubbing. Fibrosis more often affected the right ventricle (45/46 patients). The apical obliteration by fibrotic material was found in 43 (93.5 %) patients. Moreover, 36 (78.3 %) patients had pericardial effusion: mild to moderate in 32 subjects and abundant in four subjects. Hypereosinophilia was noted in 57.5 % of the patients. Atrial fibrillation was found in six out of 15 patients who had an electrocardiogram done. CONCLUSION The modes of clinical presentation of endomyocardial fibrosis are not sufficiently well known in our context. Despite its insidious progression, certain signs such as weight loss and hyperpigmented lips could be very helpful for screening and easing orientation of parents and heath personnel, thus enabling early referral for appropriate investigation. The presence of bulky ascites without edema of the lower extremities should be viewed as strongly suggestive.
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Affiliation(s)
- D Chelo
- Unité de cardiologie pédiatrique, centre mère et enfant de la fondation Chantal BIYA, BP 1936, Yaoundé, Cameroun; Département de pédiatrie, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun.
| | - F Nguefack
- Unité de cardiologie pédiatrique, centre mère et enfant de la fondation Chantal BIYA, BP 1936, Yaoundé, Cameroun; Département de pédiatrie, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - A-P Menanga
- Service de cardiologie, hôpital général, Yaoundé, Cameroun; Département de médecine interne, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - H-D Mbassi Awa
- Unité de cardiologie pédiatrique, centre mère et enfant de la fondation Chantal BIYA, BP 1936, Yaoundé, Cameroun; Département de pédiatrie, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - S Nguefack
- Département de pédiatrie, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun; Hôpital gynéco-obstétrique et pédiatrique de Ngousso, Yaoundé, Cameroun
| | - S Ngo Um
- Unité de cardiologie pédiatrique, centre mère et enfant de la fondation Chantal BIYA, BP 1936, Yaoundé, Cameroun; Département de pédiatrie, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - J-C Gody
- Complexe pédiatrique de Bangui, Bangui, République Centrafricaine
| | - P-O Koki Ndombo
- Unité de cardiologie pédiatrique, centre mère et enfant de la fondation Chantal BIYA, BP 1936, Yaoundé, Cameroun; Département de pédiatrie, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
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Sidze LK, Faye A, Tetang SN, Penda I, Guemkam G, Ateba FN, Ndongo JA, Nguefack F, Texier G, Tchendjou P, Kfutwah A, Warszawski J, Tejiokem MC. Different factors associated with loss to follow-up of infants born to HIV-infected or uninfected mothers: observations from the ANRS 12140-PEDIACAM study in Cameroon. BMC Public Health 2015; 15:228. [PMID: 25886161 PMCID: PMC4358721 DOI: 10.1186/s12889-015-1555-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 02/16/2015] [Indexed: 11/23/2022] Open
Abstract
Background Loss to follow-up (LTFU) is a cause of potential bias in clinical studies. Differing LTFU between study groups may affect internal validity and generalizability of the results. Understanding reasons for LTFU could help improve follow-up in clinical studies and thereby contribute to goals for prevention, treatment, or research being achieved. We explored factors associated with LTFU of mother-child pairs after inclusion in the ANRS 12140-Pediacam study. Methods From November 2007 to October 2010, 4104 infants including 2053 born to HIV-infected mothers and 2051 born to HIV-uninfected mothers matched individually on gender and study site were enrolled during the first week of life in three referral hospitals in Cameroon and scheduled for visits at 6, 10 and 14 weeks of age. Visits were designated 1, 2 and 3, in chronological order, irrespective of the child’s age at the time of the visit. Mother-child pairs were considered lost to follow-up if they never returned for a clinical visit within the first six months after inclusion. Uni- and multivariable logistic regression were adjusted on matching variables to identify factors associated with LTFU according to maternal HIV status. Results LTFU among HIV-unexposed infants was four times higher than among HIV-exposed infants (36.7% vs 9.8%, p < 0.001). Emergency caesarean section (adjusted Odds Ratio (aOR) = 2.46 95% Confidence Interval (CI) [1.47-4.13]), young maternal age (aOR = 2.29, 95% CI [1.18-4.46]), and absence of antiretroviral treatment for prophylaxis (aOR = 3.45, 95% CI [2.30-5.19]) were independently associated with LTFU among HIV-exposed infants. Factors associated with LTFU among HIV-unexposed infants included young maternal age (aOR = 1.96, 95% CI [1.36-2.81]), low maternal education level (aOR = 2.77, 95% CI [1.95-3.95]) and housewife/unemployed mothers (aOR = 1.56, 95% CI [1.16-2.11]). Conclusion Failure to return for at least one scheduled clinical visit is a problem especially among HIV-unexposed infants included in studies involving HIV-exposed infants. Factors associated with this type of LTFU included maternal characteristics, socio-economic status, quality of antenatal care and obstetrical context of delivery. Enhanced counselling in antenatal and intrapartum services is required for mothers at high risk of failure to return for follow-up visits. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1555-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Larissa Kamgue Sidze
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun. .,ISPED, Université Victor Segalen, Bordeaux II, France.
| | - Albert Faye
- Assistance Publique des Hôpitaux de Paris, Pédiatrie Générale, Hôpital Robert Debré, Paris, France. .,Université Paris 7 Denis Diderot, Paris Sorbonne Cité, Paris, France.
| | | | - Ida Penda
- Hôpital de Jour, Hôpital Laquintinie, Douala, Cameroun. .,Faculté de Médecine et des Sciences Pharmaceutiques, Université de Douala, Douala, Cameroun.
| | - Georgette Guemkam
- Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé, Cameroun.
| | | | | | - Félicité Nguefack
- Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé, Cameroun. .,Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun.
| | - Gaëtan Texier
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun. .,SESSTIM (UMR 912), Université Aix-Marseille, Marseille, France.
| | - Patrice Tchendjou
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun. .,ISPED, Université Victor Segalen, Bordeaux II, France.
| | - Anfumbom Kfutwah
- Service de Virologie, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun.
| | - Josiane Warszawski
- Equipe 4 (VIH et IST) - INSERM U1018 (CESP), Le Kremlin Bicêtre, Paris, France. .,Assistance Publique des Hôpitaux de Paris, Service d'Epidémiologie et de Santé Publique, Hôpital de Bicêtre, Le Kremlin Bicêtre, Paris, France. .,Université de Paris Sud 11, Paris, France.
| | - Mathurin Cyrille Tejiokem
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun. .,Equipe 4 (VIH et IST) - INSERM U1018 (CESP), Le Kremlin Bicêtre, Paris, France.
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Njua CVM, Nguefack F, Chelo D, Tejiokem M, Kago I, Kobela M. Rappels vaccinaux hors programme élargi de vaccination dans deux écoles de l’éducation de base de Yaoundé, Cameroun. Pan Afr Med J 2011. [DOI: 10.4314/pamj.v10i0.72230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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