Each day more than 500 children younger than 15 years die from tuberculosis. Considerable progress has been made to control tuberculosis, but the impact on reducing the burden of childhood tuberculosis lags behind that in adults. A key barrier to decreasing morbidity and mortality associated with childhood tuberculosis is the paucity of accurate and feasible diagnostic tools for this population. WHO estimates that 58% of children younger than 5 years with tuberculosis are never diagnosed or reported.
Severely malnourished patients can present with bilateral pitting oedema, which is a common sign of Kwashiorkor. However, bilateral pitting oedema can also be an expression of other pathologies. In Mali and DRC, the number of children presenting with bilateral pitting oedema at MSF (Médecins Sans Frontiers/Doctors Without Borders) hospitals are up to 30% (Mali) and 49% (DRC) higher than in other countries, however, the reasons underlying this trend are unknown. Through this qualitative study, we aimed to explore the perspectives and lived experiences of health professionals on the diagnosis and management of children with bilateral pitting oedema. Using a participatory approach, we conducted 21 in-depth interviews, and 2 focus groups with health professionals at MSF health facilities who had worked in the settings of Koutiala (Mali) and Rutshuru (DRC) for at least 6 months. The understanding of the bilateral pitting oedema phenomenon is complex. Health workers described clinical obstacles to reducing mortality, including: i) difficulties making the diagnosis due to a lack of specialized staff and insufficient resources, ii) challenges treating complications that may arise due to the complexity of the diseases associated with bilateral pitting oedema, and iii) lack of scientific evidence in the literature explaining the physiopathology of bilateral pitting oedema. Study participants shared several key recommendations for reducing mortality among children presenting with bilateral pitting oedema, including prevention of bilateral pitting oedema at the community level, standardization of the diagnostic process, strengthening of medical training, and better collaboration both within the medical teams and between teams and the children’s families.
La malnutrition aigüe sévère (MAS) contribue annuellement au décès d’un million d’enfants. Les diarrhées et la pneumonie sont les principales morbidités associées à ces décès.
OBJECTIFS
Évaluer les effets des probiotiques sur la diarrhée, la pneumonie et la récupération nutritionnelle des enfants avec MAS non compliquée.
METHODS
Essai randomisé contrôlé en double aveugle contre placebo incluant 400 nourrissons avec MAS non compliquée, assignés aléatoirement aux Aliments Thérapeutiques Prêts à l'Emploi (ATPE) avec (n=200) ou sans (n=200) probiotiques. Ils ont reçu quotidiennement 1 ml d'un mélange de Lacticasebacillus rhamnosus GG et Limosilactobacillus reuteri DSM 17938 (dosage, 109 Unités Formant Colonies ; 50:50) ou un placebo pendant un mois. Ils ont aussi été alimentés simultanément avec les ATPE pendant 6-12 semaines, dépendant de leur moment de guérison. Le résultat primaire était la durée de diarrhée. Les résultats secondaires étaient l'incidence des diarrhées et des pneumonies, la récupération nutritionnelle et le transfert en hospitalisation.
RÉSULTATS
Chez les nourrissons avec diarrhée, le nombre de jours de diarrhées était plus faible dans le groupe probiotique (4.11 ; IC 95% : 3.37, 4.51) comparativement au groupe placebo (6.68 ; IC à 95 % : 6.26, 7.13 ; p < 0.001). Chez les nourrissons de 16 mois et plus, le risque de diarrhée était plus faible dans le groupe probiotique (75.6 % ; IC 95 % : 66.2, 82.9) comparativement au groupe placebo (95.0 % ; IC 95 % : 88.2, 97.9 ; p < 0.001), sans différence significative chez les nourrissons plus jeunes. L’incidence de la pneumonie était similaire dans les deux groupes. La récupération nutritionnelle était plus précoce dans le groupe probiotique comparativement au groupe placebo.
CONCLUSIONS
Cet essai soutient l'utilisation des probiotiques dans le traitement de MAS non compliquée. Leurs effets sur la diarrhée ont un potentiel d’impact positif sur les programmes nutritionnels dans les régions à ressources limitées.
Early psychosocial stimulation for infants in precarious situations can yield both short- and long-term benefits to cognitive and social development. Comprehensive programmes, covering health, nutrition, and psychosocial stimulation prove most effective in preventing cognitive impairment and enhancing treatment for children with severe acute malnutrition (SAM). The StimNut study assesses the effects of early psychosocial stimulation on maternal mental health and mother-child relationship, as well as the acceptability of integrating such an intervention into the existing Médecins Sans Frontières (MSF) nutrition programme in Koutiala, during a 5-week period.
METHODS
Mixed-methods data were collected through standardised pre- and post- intervention questionnaires and included: a ‘Dusukasi’ screening tool for local perinatal depression-like symptoms; observations of mother-child interactions using an adapted PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes) tool; as well as semi-structured interviews with caregivers, MSF psychosocial workers, and healthcare staff.
RESULTS
149 psychosocial stimulation sessions were conducted with 36 families by three supervised MSF psychosocial workers. Perinatal depression symptoms were found in 53% of mothers before the intervention and 28% after the intervention (p=0.001). Positive changes in the mother-child relationship were observed in 83% of families after the 5-week intervention and more frequent and appropriate responses of the caregivers to the child’s emotional state were noted. Positive changes were also perceived by the mothers as the sessions progressed: their sense of parenting skills was strengthened, their children’s health improved, and the other family members became more involved in childcare practices. The intervention also dismantled healthcare staff prejudices towards mothers of children with SAM, fostering a trusting relationship between them.
CONCLUSIONS
This study demonstrates the positive impact of the early psychosocial stimulation of children with SAM on maternal mental health and the quality of mother-child relationship. As MSF pursues further endeavours in this direction, it is important to recognise the transformative potential these interventions hold for promoting the overall wellbeing of families of children with SAM in humanitarian and low-income countries.
Current guidelines for the outpatient treatment of severe acute malnutrition (SAM) recommend the provision of routine medications to all children at admission and prescribed medications as clinically indicated thereafter. The objective of this study was to describe the amount and purpose of medications prescribed during outpatient SAM treatment and explore the effect of routine antibiotics at admission on subsequent medication prescription.
METHODS
Medications prescribed during outpatient treatment were described by medication category, time from admission, and diagnoses among children with SAM in a placebo-controlled, double-blind trial of 7-day amoxicillin use. Total medications were compared by parent trial intervention arm (amoxicillin vs placebo) and differences assessed using Χ^2 and two-sample t-tests.
RESULTS
Of the 2399 children enrolled, 74.6% of children received ≥1 prescribed medication during outpatient treatment. Antipyretics/analgesics (44.1% of children), antimalarials (56.6%) and antibiotics (30.0%) were prescribed most frequently. Children who received placebo in the parent trial received fewer total medications (mean difference: −0.80, 95% CI: −0.96 to –0.65) and oral antibiotics (mean difference: −0.96, 95% CI: −0.99 to –0.92) during treatment compared with children who received routine amoxicillin.
CONCLUSIONS
We found high rates of medication prescription during outpatient treatment for SAM, but fewer total medications and oral antibiotics prescribed to children receiving placebo in the parent trial. Our findings underscore the role of outpatient treatment programmes as an important source of medicine prescription and suggest that provision of antibiotics on a clinically indicated basis for outpatient SAM cases may be a strategy to support prudent antibiotic use in certain settings.