Décès d’enfants avant l’arrivée au Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé- Cameroun

David Chelo, Félicitée Nguefack, Anicet Ntoude II, Joseph Kamgno, Patrick Ngu, Paul Olivier Koki Ndombo

Abstract


Résumé
Contexte. Au Cameroun, la mortalité des enfants de moins de 5 ans reste élevée et serait fortement influencée par la qualité des soins. Nombre de parents recourent aux soins inappropriés pour leurs enfants et ne se rendront à l’hôpital qu’à un stade critique. Certains enfants décèdent par conséquent avant leur arrivée à l’hôpital. Le but de l’étude était d’analyser le profil familial de ce groupe d’enfants et de rechercher les causes de décès à l’aide de l’autopsie verbale (AV).
Méthodologie. Cette étude transversale conduite entre octobre 2013 et avril 2014, a porté sur 40 enfants qui sont décédés avant l’arrivée dans un centre pédiatrique à Yaoundé. Les familles étaient contactées par téléphone 5 à 6 semaines après le décès de l’enfant et un seul membre de la famille était interviewé à domicile grâce au questionnaire d’AV. La méthode de lecture par des médecins était adoptée pour l’analyse des données. Les pédiatres ont indépendamment attribué à chaque décès, une cause médicale ainsi qu’une possible cause sous-jacente basées sur les définitions de la classification internationale des maladies de l’OMS. Les informations portaient essentiellement sur les caractéristiques sociodémographiques des familles et les causes de décès.
Résultats. Les répondants étaient généralement jeunes: 50,0% avaient moins de 30 ans et la tranche de 20 à 30 ans prédominait (47,5%). Il s’agissait surtout des géniteurs (87,5%). Les enfants décédés, étaient majoritairement (82,5%) âgés de moins de 5 ans avec 50% < 1 an. 40,0% ‘entre eux étaient malades depuis au moins 3 jours. La méningite (27,5%) et le paludisme (22,5%) représentaient la moitié des causes directes probables de décès. Les principales causes sous jacentes étaient a malnutrition aigue sévère (43,8%), le VIH/SIDA (12,5%) et la drépanocytose (12,5%).
Conclusion. L’autopsie verbale a permis d’attribuer les causes médicales aux décès survenus chez les enfants en cours de transport vers notre site. Une sensibilisation des jeunes parents sur la recherche précoce des soins médicaux dans des structures appropriées permettrait d’éviter les décès en communauté chez les enfants qui convulsent surtout en contexte de fièvre.

Abstract
Introduction. In Cameroon the rate of infanto-juvenile mortality remains high, and is significantly influenced by the quality of the treatment offered. Many parents go in for inappropriate medical treatment for their sick children, thus leading to death of some of them before arrival at the hospital. Our study analysizes the family background of this group of children and also tries to find out the causes of deaths using verbal autopsy (VA).
Methods. It was a cross sectional descriptive study carried out between October 2013 and April 2014 on 40 children who died before arrival, in a pediatric health facility in Yaounde. The families of these children were contacted by telephone 5 to 6 weeks after their death. One family member was interviewed at the residence of the deceased child, and the information obtained recorded on a verbal autopsy questionnaire. The data analysis was done using the physician review approach. The assignment of VA was random and each was certified by 2 pediatricians. They independently assigned to each dead a medical cause and a possible underlying cause following the World Health Organization international diseases classification. The variables analysed were essentially the socio-demographic characteristics of the families and the causes of death.
Results. The majority of the respondents were young; 50.0% being less than 30 years with the 20 to 30 years age group being predominant (47.5%). They were mostly the parents (87.5%). Most of the deceased children were less than 5 years (82.5%); 50.0% of them were less than 1 year of age. Close to half of them (40.0%) had been ill for more than 3 days. Two diseases were responsible for about half of the probable direct causes of death [meningitis (27.5%) and malaria (22.5%)]. The underlying causes were acute severe malnutrition (43.8%), HIV/AIDS (12.5%) and the sickle cell disease (12.5%).
Conclusion. VA permitted the assignment of the medical causes of death in children before arrival at our hospital. Sensitization of young parent on the need to seek medical care early in an appropriate health care facility could reduce the death of children occurring in the community. This is particularly true for children who convulse in febrile context.

 


Keywords


Enfants, décès; autopsie verbale; causes, soins, médicaux

Full Text:

PDF (Français)

References


Références

WHO | Millennium Development Goals (MDGs) [Internet]. WHO. [cité 4 avr 2015]. Disponible sur: http://www.who.int/mediacentre/factsheets/fs290/en/

Murray CJL, Laakso H, Shibuya K, Hill K, Lopez AD. Can we achieve Millennium Development Goal 4? New analysis of country trends and forecasts of under-5 mortality to 2015. The Lancet. 2007;370(9592):1040‑54.

Ekane GEH, Obinchemti TE, Tchente CN, Fokunang LK, Njamen TN, Bechem NN, et al. Attainment of the Fifth Millennium Development Goal: Utopia or Reality Based on Trends in Maternal Mortality in 12 Years in Two Regional Hospitals in Fako Division, Cameroon? A Retrospective Study. Open J Obstet Gynecol. 4 sept 2014;04(13):771.

Shibuya K. Counting the dead is essential for health. Bull World Health Organ. 2006;84(3).

Byass P. Who Needs Cause-of-Death Data? PLoS Med. 20 nov 2007;4(11):e333.

Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet Lond Engl. 28 juin 2003;361(9376):2226‑34.

Ngono G, Kamgho Tezanou BM. Mortalité des enfants, dans Enquête Démographique et de Santé (EDS) et l’Enquête par grappe à Indicateurs Multiples (MICS), Quatrième série des EDS et des MICS-Cameroun , Calverton, Maryland, USA: INS et ORC Macro [Internet]. 2011 [cité 25 juill 2015]. Disponible sur: http://nada.stat.cm/index.php/catalog/34/datafile/F4/V4848

Cameroun - Enquête Démographique et de Santé (EDS) et l’Enquête par grappe à Indicateurs Multiples (MICS), Quatrième série des EDS et des MICS - Aperçu [Internet]. [cité 25 juill 2015]. Disponible sur: http://nada.stat.cm/index.php/catalog/34

World Health Organization. Statistiques Sanitaires Mondiales 2009. World Health Organization; 2009.

Organisation mondiale de la Santé. Statistiques sanitaires mondiales 2014. 2014;

Koffi AK, Libite P, Moluh S, Wounang R, Kalter HD. Social autopsy study identifies determinants of neonatal mortality in Doume, Nguelemendouka and Abong–Mbang health districts, Eastern Region of Cameroon. J Glob Health [Internet]. [cité 23 juill 2015];5(1). Disponible sur: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4459092/

Roy SK, Chowdhury AK, Rahaman MM. Excess mortality among children discharged from hospital after treatment for diarrhoea in rural Bangladesh. Br Med J Clin Res Ed. 15 oct 1983;287(6399):1097‑9.

Chisti MJ, Graham SM, Duke T, Ahmed T, Faruque ASG, Ashraf H, et al. Post-Discharge Mortality in Children with Severe Malnutrition and Pneumonia in Bangladesh. PLoS ONE. 16 sept 2014;9(9):e107663.

Morris SS, Black RE, Tomaskovic L. Predicting the distribution of under-five deaths by cause in countries without adequate vital registration systems. Int J Epidemiol. déc 2003;32(6):1041‑51.

Johnson HL, Liu L, Fischer-Walker C, Black RE. Estimating the distribution of causes of death among children age 1-59 months in high-mortality countries with incomplete death certification. Int J Epidemiol. août 2010;39(4):1103‑14.

World Health Organization. Normes d’autopsie verbale: établissement et attribution de la cause de décès. 2009;

Murray CJ, Lozano R, Flaxman AD, Serina P, Phillips D, Stewart A, et al. Using verbal autopsy to measure causes of death: the comparative performance of existing methods. BMC Med. 9 janv 2014;12(1):5.

Desgrées du Loû A, Pison G, Samb B, Trape J-F. L’évolution des causes de décès d’enfants en Afrique : une étude de cas au Sénégal avec la méthode d’autopsie verbale. Population. 1996;(4-5):845‑82.

Yé M, Diboulo E, Niamba L, Sié A, Coulibaly B, Bagagnan C, et al. An improved method for physician-certified verbal autopsy reduces the rate of discrepancy: experiences in the Nouna Health and Demographic Surveillance Site (NHDSS), Burkina Faso. Popul Health Metr. 2011;9:34.

Lozano R, Lopez AD, Atkinson C, Naghavi M, Flaxman AD, Murray CJ. Performance of physician-certified verbal autopsies: multisite validation study using clinical diagnostic gold standards. Popul Health Metr. 4 août 2011;9:32.

Aggarwal AK, Kumar P, Pandit S, Kumar R. Accuracy of WHO Verbal Autopsy Tool in Determining Major Causes of Neonatal Deaths in India. PLoS ONE. 25 janv 2013;8(1):e54865.

Arudo J, Gimnig JE, Kuile FOT, Kachur SP, Slutsker L, Kolczak MS, et al. Comparison of Government Statistics and Demographic Surveillance to Monitor Mortality in Children Less Than Five Years Old in Rural Western Kenya. Am J Trop Med Hyg. 4 janv 2003;68(4 suppl):30‑7.

Anker M, Black RE, Coldham C, Kalter H, Quigley MA, Ross D, et al. A standard verbal autopsy method for investigating causes of death in infants and children. World Health Organization Geneva; 1999.

Senga P, Mayanda HF, Etokabeka-Mkanta F. Mortalité hors hôpital des enfants à Brazzaville. Médecine Afr Noire. 1993;40(2):119‑21.

Wolf BH, Ikeogu MO. Deaths at home and in hospital in Zimbabwe. Arch Dis Child. mai 1992;67(5):600‑2.

Rasmussen F, Smedby B. Physician visits and prescribed drugs among young children and their mothers. Scand J Prim Health Care. nov 1987;5(4):225‑31.

Pattison CJ, Drinkwater CK, Downham MAPS. Mothers’ appreciation of their children’s symptoms. J R Coll Gen Pract. mars 1982;32(236):149‑62.

WRIGHT PW, AVERY WG, Ardill W, McLarty J. Initial clinical assessment of the comatose patient: cerebral malaria vs. meningitis. Pediatr Infect Dis J. 1993;12(1):37‑41.

Berkley JA, Mwangi I, Mellington F, Mwarumba S, Marsh K. Cerebral malaria versus bacterial meningitis in children with impaired consciousness. QJM. 1 mars 1999;92(3):151‑7.

Laman M, Manning L, Hwaiwhange I, Vince J, Aipit S, Mare T, et al. Lumbar Puncture in Children from an Area of Malaria Endemicity Who Present with a Febrile Seizure. Clin Infect Dis. 9 janv 2010;51(5):534‑40.

Riordan F a. I, Cant AJ. When to do a lumbar puncture. Arch Dis Child. 9 janv 2002;87(3):235‑7.

Pb M, Sv G, Jc V. Unsuspected bacterial infections in febrile convulsions. Med J Aust. févr 1990;152(4):183‑6.

Wolf BHM, Ikeogu MO, Vos ET. Effect of nutritional and HIV status on bacteraemia in Zimbabwean children who died at home. Eur J Pediatr. 1995;154(4):299‑303.

Liu L, Li Q, Lee RA, Friberg IK, Perin J, Walker N, et al. Trends in causes of death among children under 5 in Bangladesh, 1993-2004: an exercise applying a standardized computer algorithm to assign causes of death using verbal autopsy data. Popul Health Metr. 5 août 2011;9(1):43.

Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. The Lancet. 31 janv 2015;385(9966):430‑40.

Mwanyangala MA, Urassa HM, Rutashobya JC, Mahutanga CC, Lutambi AM, Maliti DV, et al. Verbal autopsy completion rate and factors associated with undetermined cause of death in a rural resource-poor setting of Tanzania. Popul Health Metr. 2011;9:41.

Bhandari N, Mazumder S, Taneja S, Sommerfelt H, Strand TA, on behalf of the IMNCI Evaluation Study Group. Effect of implementation of Integrated Management of Neonatal and Childhood Illness (IMNCI) programme on neonatal and infant mortality: cluster randomised controlled trial. BMJ. 21 mars 2012;344(mar21 1):e1634‑e1634.

Johnson AD, Thomson DR, Atwood S, Alley I, Beckerman JL, Koné I, et al. Assessing early access to care and child survival during a health system strengthening intervention in Mali: a repeated cross sectional survey. PloS One. 2013;8(12):e81304.

Sinclair-Smith C, Dinsdale F, Emery J. Evidence of duration and type of illness in children found unexpectedly dead. Arch Dis Child. 6 janv 1976;51(6):424‑9.


Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

********************************************************************************************