1
|
Gutierrez R, Landa M, Sambou M, Bassane H, Dia N, Djalo AS, Domenichini C, Fall G, Faye M, Faye O, Fernandez-Garcia MD, Flevaud L, Loko J, Mediannikov O, Mize V, Ndiaye K, Niang M, Raoult D, Rocaspana M, Villen S, Sall AA, Fenollar F. Aetiology of non-malaria acute febrile illness fever in children in rural Guinea-Bissau: a prospective cross-sectional investigation. Front Epidemiol 2024; 4:1309149. [PMID: 38577653 PMCID: PMC10991789 DOI: 10.3389/fepid.2024.1309149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/06/2024] [Indexed: 04/06/2024]
Abstract
Background With growing use of parasitological tests to detect malaria and decreasing incidence of the disease in Africa; it becomes necessary to increase the understanding of causes of non-malaria acute febrile illness (NMAFI) towards providing appropriate case management. This research investigates causes of NMAFI in pediatric out-patients in rural Guinea-Bissau. Methods Children 0-5 years presenting acute fever (≥38°) or history of fever, negative malaria rapid diagnostic test (mRDT) and no signs of specific disease were recruited at the out-patient clinic of 3 health facilities in Bafatá province during 54 consecutive weeks (dry and rainy season). Medical history was recorded and blood, nasopharyngeal, stool and urine samples were collected and tested for the presence of 38 different potential aetiological causes of fever. Results Samples from 741 children were analysed, the protocol was successful in determining a probable aetiological cause of acute fever in 544 (73.61%) cases. Respiratory viruses were the most frequently identified pathogens, present in the nasopharynx samples of 435 (58.86%) cases, followed by bacteria detected in 167 (22.60%) samples. Despite presenting negative mRDTs, P. falciparum was identified in samples of 24 (3.25%) patients. Conclusions This research provides a description of the aetiological causes of NMAFI in West African context. Evidence of viral infections were more commonly found than bacteria or parasites.
Collapse
Affiliation(s)
- Rui Gutierrez
- Médecins Sans Frontières, Barcelona Athens Operational Centre, Barcelona, Spain
| | - Mariana Landa
- Médecins Sans Frontières, Barcelona Athens Operational Centre, Barcelona, Spain
| | - Masse Sambou
- Vitrome, Aix Marseille Univ, Dakar, Senegal
- Institute de Recherche Pour le Development, IHU Méditerranée Infection, Dakar, Senegal
| | - Hubert Bassane
- Vitrome, Aix Marseille Univ, Dakar, Senegal
- Institute de Recherche Pour le Development, IHU Méditerranée Infection, Dakar, Senegal
| | - Ndongo Dia
- Virology Pole, Institut Pasteur Dakar, Dakar, Senegal
| | - Alfa Saliu Djalo
- Médecins Sans Frontières, Barcelona Athens Operational Centre, Barcelona, Spain
| | - Chiara Domenichini
- Médecins Sans Frontières, Barcelona Athens Operational Centre, Barcelona, Spain
| | - Gamou Fall
- Virology Pole, Institut Pasteur Dakar, Dakar, Senegal
| | - Martin Faye
- Virology Pole, Institut Pasteur Dakar, Dakar, Senegal
| | - Ousmane Faye
- Virology Pole, Institut Pasteur Dakar, Dakar, Senegal
| | | | - Laurence Flevaud
- Médecins Sans Frontières, Barcelona Athens Operational Centre, Barcelona, Spain
| | - Jerlie Loko
- Médecins Sans Frontières, Barcelona Athens Operational Centre, Barcelona, Spain
| | - Oleg Mediannikov
- Vitrome, Aix Marseille Univ, Marseille, France
- Institute de Recherche Pour le Development, IHU Méditerranée Infection, Marseille, France
| | - Valerie Mize
- Médecins Sans Frontières, Barcelona Athens Operational Centre, Barcelona, Spain
| | - Kader Ndiaye
- Virology Pole, Institut Pasteur Dakar, Dakar, Senegal
| | - Mbayame Niang
- Virology Pole, Institut Pasteur Dakar, Dakar, Senegal
| | - Didier Raoult
- Vitrome, Aix Marseille Univ, Marseille, France
- Institute de Recherche Pour le Development, IHU Méditerranée Infection, Marseille, France
| | - Merce Rocaspana
- Médecins Sans Frontières, Barcelona Athens Operational Centre, Barcelona, Spain
| | - Susana Villen
- Médecins Sans Frontières, Barcelona Athens Operational Centre, Barcelona, Spain
| | | | - Florence Fenollar
- Vitrome, Aix Marseille Univ, Marseille, France
- Institute de Recherche Pour le Development, IHU Méditerranée Infection, Marseille, France
| |
Collapse
|
2
|
Pedrero-Tomé R, Marrodán MD, López-Ejeda N, Escruela M, Rocaspana M, Vargas A, Casademont C, Gutiérrez R, Lanusse C. Impact of integrated preventive and curative health package on nutritional status of children under 2 years of age in the health area of Tama, Tahoua region (Niger). Front Nutr 2023; 10:1259706. [PMID: 37941771 PMCID: PMC10629985 DOI: 10.3389/fnut.2023.1259706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Background Niger, relevant in light of current political coup, is one of the countries with the worst human development indicators, characterized by high fertility rates and extremely high infant mortality rates. Food insecurity in the region is alarming, leading to high malnutrition rates in children. This study aimed to evaluate an integral preventive-curative health program targeting children aged under 2 years in the health area of Tama, district of Bouza, Tahoua. Methodology Anthropometric follow-up data of 6,962 children aged under 2 years were included in this study. These children received complete vaccination and malaria chemoprevention, and those older than 6 months received nutritional supplementation with a small quantity of lipid-based nutrient supplements. Fundamental growth indicators (height-for-age, weight-for-height, weight-for-age, and middle-upper arm circumference) and the Composite Index of Anthropometric Failure were calculated at the beginning and end of the program (mean time spent in the program: 14.5 ± 6.6 months) The evolution of these indicators was compared with those of a sample from a vertical vaccination program conducted in the neighboring region of Madarounfa on similar dates. Results The proportion of children without anthropometric failure decreased from 59.5 to 40.2% (p < 0.001), with the categories that included stunting increasing the most. When analyzing the anthropometric indicators according to the months of compliance with the program, there was a slight improvement in the indicators of acute malnutrition, whereas those of chronic malnutrition worsened significantly. However, when compared with the Madarounfa sample, the children in the present study registered a significantly lower worsening in all three indicators: height-age (-0.46 vs. -2.44; p < 0.001), weight-height (+0.31 vs. -0.55; p < 0.001) and weight-age (-0.03 vs. -1.63; p < 0.001) difference. Conclusion The comprehensive preventive-curative health program slightly slows the worsening of cumulative malnutrition in the early years of life in complex contexts, such as southern Niger.
Collapse
Affiliation(s)
- Roberto Pedrero-Tomé
- Research Group in Nutritional Epidemiology (EPINUT), Unit of Physical Anthropology, Department of Biodiversity, Ecology, and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
| | - María Dolores Marrodán
- Research Group in Nutritional Epidemiology (EPINUT), Unit of Physical Anthropology, Department of Biodiversity, Ecology, and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
| | - Noemí López-Ejeda
- Research Group in Nutritional Epidemiology (EPINUT), Unit of Physical Anthropology, Department of Biodiversity, Ecology, and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
| | | | | | - Antonio Vargas
- Department of Nutrition and Health, Action Against Hunger, Madrid, Spain
| | | | | | | |
Collapse
|
3
|
Moretó-Planas L, Sagrado MJ, Mahajan R, Gallo J, Biague E, Gonçalves R, Nuozzi P, Rocaspana M, Fonseca JV, Medina C, Camará M, Nadimpalli A, Alonso B, Llosa AE, Heuvelings L, Burza S, Molina I, Ruby LC, Stratta E, Bélard S. Point-of-care ultrasound for tuberculosis diagnosis in children: a Médecins Sans Frontières cross-sectional study in Guinea-Bissau. BMJ Open 2023; 13:e066937. [PMID: 37208138 DOI: 10.1136/bmjopen-2022-066937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVE Description of tuberculosis (TB)-focused point-of-care ultrasound (POCUS) findings for children with presumptive TB. DESIGN Cross-sectional study (July 2019 to April 2020). SETTING Simão Mendes hospital in Bissau, a setting with high TB, HIV, and malnutrition burdens. PARTICIPANTS Patients aged between 6 months and 15 years with presumptive TB. INTERVENTIONS Participants underwent clinical, laboratory and unblinded clinician-performed POCUS assessments, to assess subpleural nodules (SUNs), lung consolidation, pleural and pericardial effusion, abdominal lymphadenopathy, focal splenic and hepatic lesions and ascites. Presence of any sign prompted a POCUS positive result. Ultrasound images and clips were evaluated by expert reviewers and, in case of discordance, by a second reviewer. Children were categorised as confirmed TB (microbiological diagnosis), unconfirmed TB (clinical diagnosis) or unlikely TB. Ultrasound findings were analysed per TB category and risk factor: HIV co-infection, malnutrition and age. RESULTS A total of 139 children were enrolled, with 62 (45%) women and 55 (40%) aged <5 years; 83 (60%) and 59 (42%) were severely malnourished (SAM) and HIV-infected, respectively. TB confirmation occurred in 27 (19%); 62 (45%) had unconfirmed TB and 50 (36%) had unlikely TB. Children with TB were more likely to have POCUS-positive results (93%) compared with children with unlikely TB (34%). Common POCUS signs in patients with TB were: lung consolidation (57%), SUNs (55%) and pleural effusion (30%), and focal splenic lesions (28%). In children with confirmed TB, POCUS sensitivity was 85% (95% CI) (67.5% to 94.1%). In those with unlikely TB, specificity was 66% (95% CI 52.2% to 77.6%). Unlike HIV infection and age, SAM was associated with a higher POCUS-positivity. Cohen's kappa coefficient for concordance between field and expert reviewers ranged from 0.6 to 0.9. CONCLUSIONS We found a high prevalence of POCUS signs in children with TB compared with children with unlikely TB. POCUS-positivity was dependent on nutritional status but not on HIV status or age. TB-focused POCUS could potentially play a supportive role in the diagnosis of TB in children. TRIAL REGISTRATION NUMBER NCT05364593.
Collapse
Affiliation(s)
- Laura Moretó-Planas
- Medical Department, Médecins Sans Frontières, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - Merce Rocaspana
- Medical Department, Médecins Sans Frontières, Barcelona, Spain
| | | | - Candida Medina
- Simão Mendes Hospital, Bissau, Guinea-Bissau
- National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau
| | - Miguel Camará
- National Tuberculosis Program, Bissau, Guinea-Bissau
| | | | - Beatriz Alonso
- Medical Department, Médecins Sans Frontières, Barcelona, Spain
| | - Augusto E Llosa
- Medical Department, Médecins Sans Frontières, Barcelona, Spain
| | | | | | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Lisa C Ruby
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Erin Stratta
- Medecins Sans Frontières, New York City, New York, USA
| | - Sabine Bélard
- Institute of Tropical Medicine, University of Tübingen, Tubingen, Germany
- German Center for Infection Research, Tübingen, Germany
| |
Collapse
|
4
|
Hiffler L, Escajadillo K, Rocaspana M, Janet S. Acute respiratory failure in an infant and thiamine deficiency in West Africa: a case report. Oxf Med Case Reports 2020; 2020:omaa041. [PMID: 32617168 PMCID: PMC7315931 DOI: 10.1093/omcr/omaa041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/06/2020] [Accepted: 05/11/2020] [Indexed: 11/12/2022] Open
Abstract
In paediatrics, the overall clinical picture of thiamine deficiency (TD) is not easy to recognize, because it mimics or can be confused with other diseases even in cases of classic beriberi. Unsurprisingly, the likelihood of misdiagnosis of TD is even greater where beriberi has not been described. Critically ill patients have increased thiamine body consumption and dextrose-based IV fluid increases thiamine cellular demand even further. Consequently, severe acute conditions may result in TD, or trigger TD signs in patients with borderline thiamine status, with life-threatening consequences. Here, we describe the case of a young patient admitted to a West African hospital where TD is not well documented and diagnosed with severe pneumonia who responded dramatically to thiamine injection. The lack of rapid diagnostic capacity and the severe outcome of TD justify the use of a therapeutic thiamine challenge in cases with high clinical suspicion. Increased awareness about TD and low threshold for thiamine use should guide clinicians in their practice.
Collapse
Affiliation(s)
- L Hiffler
- Médecins Sans Frontières Spain, Dakar office, Senegal
| | | | | | - S Janet
- Médecins Sans Frontières Spain, Dakar office, Senegal
| |
Collapse
|