Journal of Tropical Pediatrics - recent issues

In this Issue April 2008

2008-03-29

Rotaviruses and Rotavirus Vaccines

Ebrahim, G. J. — 2008-03-29

Evidence behind the WHO Guidelines: Hospital Care for Children--What are the Useful Clinical Features of Bacterial Meningitis Found in Infants and Children?

Best, J., Hughes, S. — 2008-03-29

Pulmonary Function Correlates with Body Composition in Nigerian Children and Young Adults with Sickle Cell Disease

2008-03-29

Sickle cell disease (SCD) is associated with impaired growth and skeletal maturation. Decreased fat-free mass (FFM) and body fat (BF) have been reported in Nigerian children with SCD relative to healthy age- and gender-matched controls. Pulmonary abnormalities, including reduced forced vital capacity (FVC), forced expiratory volume in one second (FEV₁) and total lung capacity (TLC), have also been described in children with SCD. Since undernutrition is common in sub-Saharan Africa, we were interested in knowing the relationship between pulmonary function and body composition in Nigerian children and young adults with SCD. Body composition was determined using bioelectrical impedance and pulmonary function was assessed by spirometry in Nigerian children and young adults aged 7–35 years (n = 102) as well as healthy age-and gender-matched controls (n = 104). Age-adjusted data revealed 19–26% lower FFM for male (P < 0.001) and female (P < 0.001) subjects with SCD relative to the controls. FVC, FEV₁ and PEF were also significantly reduced in male and female children and young adults with SCD compared to their control counterparts. For both male and female patients and controls, FVC, FEV₁ and PEF correlated positively with FFM (P < 0.001). PEF for the female subjects with SCD diverged progressively with increasing age relative to the controls and the rate of change was significantly lower (P < 0.001). We conclude that pulmonary function is reduced in Nigerian children and young adults with SCD compared to controls and that for both groups, pulmonary function is directly related to body composition. These findings underscore the need for early nutritional intervention for children with SCD.

Malaria Mortality in Venezuela: Focus on Deaths due to Plasmodium vivax in Children

Rodriguez-Morales, A. J., Benitez, J. A., Arria, M. — 2008-03-29

Morbidity and mortality burden of malaria in the childhood represents a public health threat not only in countries with high levels of transmission, but also in those, such as Venezuela and others in Latin America, with moderate to low transmission. Usually its mortality has been attributed just to Plasmodium falciparum malaria, but the changing patterns of increase in Plasmodium vivax malaria morbidity and mortality are now causing concern. We studied malaria mortality by analyzing different epidemiological variables during a 10-year period in Venezuela, finding mortality rates ranging 0.10–0.36 deaths/100 000 population, with almost a third of deaths in children (<10 years old), corresponding 270 deaths to P. falciparum cases and 30 to P. vivax; but along the period with a decrease trend for P. falciparum and an increase trend for P. vivax.

Norovirus and Sapovirus Infections among Children with Acute Gastroenteritis in Ho Chi Minh City during 2005-2006

2008-03-29

A molecular epidemiological study on common diarrheal viruses was conducted in a children's hospital in Ho Chi Minh City between December 2005 and November 2006. Fecal samples were collected from 502 pediatric patients with acute gastroenteritis, and were screened for the presence of norovirus (NoV) and sapovirus (SaV). NoVs GII and SaVs were detected in 6.4% and 1.2% specimens, respectively, while there was no NoV GI found among studied samples. NoVs could be identified through the year, except in April and July, with the peak of detection rate (62.5%) during the rainy season. Conversely, four out of six (66.7%) of the SaV strains were identified during the dry season. Patients aged between 6 and 23 months were found to be more infected by NoVs. The overall mean severity score of norovirus-positive patients was 9.8 ± 3.6, and no significant difference of severity scores among patients belonged to different age groups, gender and place of living. The results of phylogenetic analysis showed the diversity of caliciviruses circulating in the area, and various types of recombination were identified among NoVs and SaVs detected. These results provide important information on calicivirus infections among Vietnamese children.

Factors Associated with Secular Trends in Mortality Attributed to Measles in Gweru, Zimbabwe, in 1967-89

Marufu, T., Siziya, S., Mudambo, K. S. T. — 2008-03-29

A retrospective study conducted in Gweru, Zimbabwe, investigated the trend and its associated factors in measles mortality between 1967 and 1989. Measles and malnutrition surveillance data were analysed in SPSS version 8.0 using the Forward Stepwise Linear Regression method. Measles case fatality rates ranged from zero to 48.2% (median: 4.2, Q₁ = 1.2, Q₃ = 12.9) and they significantly linearly declined [slope = –1.686; 95% confidence interval (CI) –2.327, –1.044; R² = 59%]. Rates of mortality among complicated measles cases (slope = 0.546, 95% CI = 0.133–0.345) and rates of mortality from malnutrition among children aged <5 years (slope = 0.459, 95% CI = 0.031–0.099) independently predicted (R² = 87%) measles case fatality rates. It was concluded that decline in rates of mortality among complicated measles cases, probably due to good management of such cases, and decline in rates of malnutrition among children aged <5 years may have contributed to the decline in measles case fatality rates.

Obesity and Related Behaviors among Adolescent School Boys in Abha City, Southwestern Saudi Arabia

2008-03-29

Using stratified sampling technique 2696 adolescent school boys (aged 11–19 years) in Abha City, Southwestern Saudi Arabia were interviewed and examined for weight and height using standardized techniques. The overall prevalence of obesity and overweight in the present study amounted to 16%. Using logistic regression analysis, lack of exercise practice in the previous week in general [aOR = 1.352, 95% confidence interval (CI) = 1.066–1.941] or in the class (aOR = 1.446, 95% CI = 1.083–1.931) were significantly associated with obesity. The present study showed that obesity among adolescent school boys in Abha City is a public health problem. There is a need for a national program in the country to prevent and control obesity among adolescents. The program should incorporate: dietary management of obesity, promotion of physical activity, health education campaigns and consideration of the possibility of providing facilities for practicing physical activity and exercise in the community.

Acute Bacterial Meningitis at the 'Complexe Pediatrique' of Bangui, Central African Republic

2008-03-29

To precis the aetiologies of children meningitis and the susceptibility to antibiotics of bacteria responsible for meningitis in Bangui, we conducted a prospective study between October 2004 and September 2005, at the ‘Complexe Pédiatrique de Bangui’, Central African Republic (CAR). Children from 1 day to 16 years with suspected meningitis and who underwent a lumbar puncture were enrolled. Gram staining, culture on chocolate blood medium, cell count, biochemistry (protein level, glucose ratio), capsular antigen detection were performed for each cerebrospinal fluid. MICs were determined by the E-test method. Four hundred and seventeen patients were enrolled during the study period; 130 were proven acute bacterial meningitis and 37 probable bacterial meningitis. Among proven bacterial meningitis, Streptococcus pneumoniae was the most common organism responsible for meningitis (62 cases, 48%) followed by Haemophilus influenzae (46 cases, 35%) and by Neisseria meningitidis and Salmonella sp. (8 cases, 6% each). Ninety-four percent and 96% of S. pneumoniae strains tested remain susceptible to benzylpenicilline and chloramphenicol, respectively. A beta-lactamase was detected in 92% of H. influenzae strains tested. However, MICs 50% and 90% for amoxicillin were found to be 1 and 4 mg/l, respectively and 33% of these strains were resistant to chloramphenicol. The global mortality rate was 35% (59/167). This mortality rate was 47% for S. pneumoniae, 33% for H. influenzae, 62% for Salmonella sp. and 13% for N. meningitidis. The probabilistic treatment with ampicillin and chloramphenicol usually administered for children meningitis in Bangui must be reconsidered particularly in cases of H. influenzae meningitis. It is of importance to reduce the presentation delays of children with suspected meningitis in Bangui. The H. influenzae b immunization would allow a dramatic reduction of meningitis cases and deaths in Central African children.

Helicobacter Pylori Infection and Gastroesophageal Reflux in Asthmatic Children

2008-03-29

The aim of this article is to investigate the prevalence of Helicobacter pylori (HP) infection, frequency of gastroesophageal reflux (GER), existence of atopy and levels of serum immunoglobulin E (IgE) in children with bronchial asthma. One hundred and thirty seven children who were diagnosed as bronchial asthma and/or wheezy child aged between 1 and 17 years were enrolled into the study. Peripheral venous blood samples were obtained to determine the total IgE and HP IgG antibody levels. GER was evaluated by the scintigraphic method and the presence of atopy was investigated by skin prick test. The study was conducted in 86 (62.8%) boys and 51 (37.2%) girls. HP IgG antibody levels were found negative in 125 (91.2%) and positive in 12 (8.8%) cases. GER was detected in 73 (53.7%) of the children. Forty-one (37.3%) children were accepted as atopic according to skin prick test results. The average total IgE levels of the participants was 168.89 ± 270.76 IU/ml. A significant difference could not be determined related to GER, atopy frequency and serum IgE levels between the cases who had HP antibody positivity or not. The present findings suggest that the rate of HP antibody positivity is low in patients with bronchial asthma and a significant difference could not be determined in GER, and atopy between patients with positive and negative HP antibodies. High atopy frequency found in our patient group raises the question of whether allergic diseases can be protective against fecal–oral infectious diseases.

Epidemiological Survey of Kawasaki Disease in Sichuan Province of China

Li, X.-h., Li, X.-j., Li, H., Xu, M., Zhou, M. — 2008-03-29

Objectives: To investigate the incidence and epidemiological characteristics of Kawasaki Disease (KD) in Sichuan province of China.

Methods: The questionnaire and diagnostic guideline for KD provided by Japan Kawasaki Disease Research Center (JKDRC) were used for the questionnaire investigation in pediatric departments of all hospitals in Sichuan province for data of KD diagnosed in their hospitals from 1 January 1997 to 31 December 2001.

Results: Of the 212 hospitals investigated, 91.5% responded to the questionnaire investigation, with a total of 1811 cases of KD identified. The incidence per 100 000 children <5 years of age was 4.26 in 1997, 5.21 in 1998, 8.57 in 1999, 7.70 in 2000 and 9.81 in 2001, respectively. The average incidence throughout the 5 years was 7.06 per 100 000. The ratio of male to female was 1.62 : 1. The age distribution showed a peak near 1–2 years of age. Cardiac sequelae were seen in 17.0% of the patients. Only 66.2% patients with KD had been treated with intravenous immunoglobulin.

Conclusion: The incidence of KD in Sichuan province was lower than that reported in Japan and Beijing, higher than that in Guangdong, Jiangsu and Shanxi province of China.

Clinical, Laboratory and Radiological Parameters in Children with Dengue Fever and Predictive Factors for Dengue Shock Syndrome

Chacko, B., Subramanian, G. — 2008-03-29

This article is a prospective study of the clinical, laboratory and radiological picture of children satisfying the case definition criteria of dengue by WHO admitted at Sri Ramachandra Medical College and Research Institute, a suburban tertiary referral centre, to determine the predictive factors for dengue shock syndrome (DSS). Data were analyzed by Chi-squared test and Student's t-test for significance after dividing the patients into two groups, those with and those without DSS for the same. Bleeding manifestations, presence of effusion on USG/X-ray, haematocrit >35%, WBC <4000/cumm, Na ≤130 meq/l, bicarbonate level of <18 mmol/l, deranged coagulation profile and serum glutamic pyruvic transaminase (SGPT) ≥40 IU were predictive of DSS.

Coverage of the National Vitamin A Supplementation Program in Ethiopia

Semba, R. D., de Pee, S., Sun, K., Bloem, M. W., Raju, V. K. — 2008-03-29

Periodic vitamin A supplementation is a major intervention to reduce morbidity, mortality, and blindness among children in developing countries. The goal was to characterize the coverage of the Ethiopia national vitamin A program among preschool children and to identify risk factors for not receiving vitamin A. In the Ethiopia Demographic and Health Survey of 2005, among 4762 preschool children, aged 12–59 months, 46.8% received a vitamin A capsule within the last 6 months. There were no significant differences in stunting, underweight, or wasting between children who did or did not receive a vitamin A capsule. In multivariate logistic regression analyses, maternal education of ≥10 years [odds ratio (OR) 1.90, 95% confidence interval (CI) 1.23–2.92], 7–9 years (OR 2.47, 95% CI 1.67–3.65), 4–6 years (OR 1.56, 95% CI 1.18–2.07), and 1–3 years (OR 1.11, 95% CI 0.90–1.37), and paternal education of ≥10 years (OR 1.61, 95% CI 1.14–2.29), 7–9 years (OR 1.24, 95% CI 0.94–1.64), 4–6 years (OR 1.26, 95% CI 1.03–1.56), and 1–3 years (OR 1.29, 95% CI 1.05–1.50) were associated with the child receiving a vitamin A capsule compared with no years of formal parental education. Expanded coverage of the national vitamin A capsule program may help protect children from nutritional blindness and to help reach Millennium goals for reducing under-five child mortality in Ethiopia.

Seroprevalence of HIV and Other Vertically Transmitted Viral Infections Among Pregnant Women of Amritsar (Punjab, North India)

Jindal, N., Singla, N., Sheevani, , Kaur, R., Aggarwal, A. — 2008-03-29

Investigation of Relationship of Atherosclerotic Risk Factors and Early Atherosclerotic Findings in Obese Children by Doppler Ultrasonography

Dogu, A., Erguven, M., Yilmaz, O., Hayirlioglu, A., Erbahceci, A. — 2008-03-29

Gender Bias in Critically Sick Newborns and Young Infants: An Ethical Dilemma?

Garg, P., Waikar, M. — 2008-03-29

In this Issue February 2008

2008-01-24

Poverty and the Millennium Development Goals

Ebrahim, G. J. — 2008-01-24

Pattern of Malaria-specific T-Cell Responses in a Cohort of Ugandan Children

2008-01-24

Malaria is the leading cause of morbidity and mortality in children in Uganda. The mechanisms whereby malaria parasites are eliminated, or how they may avoid the immune response remain poorly understood. We examined malaria-specific T-cell responses in a well-characterized cohort of African children in an endemic area where malaria transmission occurs throughout the year. In studies of asymptomatic children, we found a low frequency of malaria-specific T-cell responses (15/117), and these appeared to be clustered in older children (≥4 years old). Both CD4– and CD8-mediated T-cell responses were detected against circumsporozoite surface protein (CSP) and merozoite surface protein-1 (MSP-1). The presence of these T cells did not correlate with the frequency of prior episodes of parasitemia and 5 out of the 15 responders had no documented parasitemia within 8–12 months prior to immunologic evaluation. Our data supports focusing on high-risk children in future preventive vaccination efforts to ensure the generation and maintenance of effective anti-malarial cellular immune responses.

Seroprevalence and Risk Factors for Human Papillomavirus in Taiwan

2008-01-24

The aim of the study was to tailor a future Human papillomavirus (HPV) vaccine campaign and to help perform early primary prevention of HPV infection in Taiwan, where the incidence of cervical cancer is high. A cross-sectional survey was conducted of 826 female students, ages 10, 13, 16 and 19–22 years. A self-administered questionnaire was used to collect information on risk factors for HPV infection. Serum samples were tested for antibodies to HPV 16 capsids using a virus-like particle-based enzyme-linked immunosorbence assay. The age-adjusted odds ratio of HPV seropositivity was calculated for each risk factor by multiple logistic regression analysis. HPV 16 antibodies were detected in 13 (1.6%) of 826 participants. The HPV 16 seroprevalence was 0.35% (1/287), 0.85% (2/235), 3.2% (6/185) and 3.4% (4/119), respectively, for age groups of 10, 13, 16 and 19–22 years. In the multiple regression analysis, the history of having sexual activity was the most significant risk predictor for HPV16 seropositivity. The seroprevalence of HPV16 increased dramatically among high school seniors and university students, and was significantly associated with sexual activity. Vaccination against HPV is suggested to be undertaken in early adolescence, before 16 years of age and prior to sexual debut.

Use of Probiotics in HIV-infected Children: A Randomized Double-blind Controlled Study

Trois, L., Cardoso, E. M., Miura, E. — 2008-01-24

HIV/AIDS is an infection characterized by immune cell dysfunction and subsequent immunodeficiency, as well as intestinal disorder. Probiotics are live microbial feed supplements that beneficially affect the host animal by improving intestinal microbial balance and promoting health benefits. The goals of this study were to determine whether the use of probiotics could improve the immune response determined by CD4 cells mm^–3 counts and reduce liquid stool episodes. A randomized double-blind controlled trial with 77 HIV-infected children (2–12 years), divided into two groups: one receiving probiotics (formula containing Bifidobacterium bifidum with Streptococcus thermophilus –2.5 x 10¹⁰ colony forming units) and the other, a standard formula (control group), for 2 months. The CD4 counts (cells mm^–3) were collected at the beginning and end of the study. The quality and number of stools were assessed by a questionnaire (watery to normal stool consistency). There was an increase in the mean CD4 count in the probiotics group (791 cells mm^–3) and a small decrease in the control group (538 cells mm^–3). The change from baseline in mean CD4 cell count was +118 cells mm^–3 vs. –42 cells mm^–3 for children receiving the probiotic formula and control formula, respectively (p = 0.049). A similar reduction in liquid stool consistency in both the groups (p < 0.06), with a slight enhancement in the probiotics group, was observed, but without significant difference (p < 0.522). The incidence of loose-soft stools showed a small decrease in both groups (p < 0.955) and there was an increase in the incidence of normal stool consistency in both the groups (p < 0.01). Our study showed that probiotics have immunostimulatory properties and might be helpful in the treatment of HIV-infected children.

BrainStem Encephalitis Associated with Chandipura in Andhra Pradesh Outbreak

Narasimha Rao, S., Wairagkar, N. S., Murali Mohan, V., Khetan, M., Somarathi, S. — 2008-01-24

Clinical data of 104 hospitalized children during the 2003 epidemic of encephalitis in Andhra Pradesh state was retrospectively analysed to know the clinical profile and risk factors associated with mortality. Fever was the first symptom associated with altered sensorium, seizures, diarrhoea and vomiting. Evolution of illness was very rapid with high fatality (47%). Majority of deaths occurred within the first 24 h of illness due to brainstem involvement. On multiple logistic regression analysis, high-grade fever, absent oculocephalic reflex and Glasgow coma score <7 were found to be significantly contributing to the mortality. Evidence of Chandipura virus was detected in these cases as the etiological agent.

Pain Reduction of Heel Stick in Neonates: Yakson Compared to Non-nutritive Sucking

Im, H., Kim, E., Park, E., Sung, K., Oh, W. — 2008-01-24

The purpose of this study was to test the effect of Yakson (i.e. a traditional Korean touching method) and non-nutritive sucking (NNS) on reducing the pain that neonates experience when undergoing the heel stick procedure for blood testing. Ninety-nine healthy neonates were recruited and assigned into three groups: Yakson (n = 33), NNS (n = 33), and control group (n = 33). Each intervention was provided to the Yakson and NNS groups from 1 min before heel stick until the completion of the heel stick. For the Yakson group, a researcher caressed the belly of a neonate with one hand while supporting the back with the other hand. For the NNS group, a pacifier packed with sterile gauze was put in the neonate's mouth. The oxygen saturation levels in the Yakson and NNS group neonates were maintained significantly better than in the control group neonates. There was no significant difference between the groups with regard to heart rate and neonatal infant pain, measured using the Neonatal Infant Pain Scale. Findings indicate that Yakson can be used during heel stick to help neonates maintain their oxygen saturation level following the procedure.

Growth of Very Low Birth Weight Infants at 12 Months Corrected Age in Southern Brazil

Oliveira, M. G., Silveira, R. C., Procianoy, R. S. — 2008-01-24

The objective of this article is to describe growth of very low birth weight infants born in southern Brazil. All infants weighing ≤1500 g were followed up until 12 months corrected age (CA). Growth was recorded at 40 weeks, 6 and 12 months CA. Catch up was considered if the measures were ≥–2 SD of World Health Organization growth charts for weight and length; and of National Center for Health Statistics for head circumference. One hundred and ninety three infants born were followed up for the study. At 40 weeks CA, 57.8% patients achieved catch-up in weight and 50.9% in length. At 6 months CA, 82.2% achieved catch-up for weight and length and at 1 year CA, 92% achieved catch-up in weight and 86.9% in length. Catch-up in head circumference was achieved for 93.4%, 85.9% and 85% patients at 40 weeks, 6 months and 12 months CA, respectively. At 12 months CA, no catch-up in weight, length and head circumference was related to higher SNAPPE-II (P = 0.046) and periventricular leukomalacia (PVL) (P = 0.003); longer time to achieve full enteral nutrition at the neonatal intensive care unit (NICU) (P = 0.037), lower maternal education (P = 0.018) and PVL (P = 0,003); higher SNAPPE-II (P = 0,004), PVL (P = 0.005) and longer time to achieve full enteral nutrition at the NICU (P = 0.044), respectively. In conclusion, PVL and higher SNAPPE-II were important factors to catch-up delay. Catch-up growth was high at 12 months CA.

Prevalence of Celiac Disease, Helicobacter pylori and Gastroesophageal Reflux in Patients with Refractory Iron Deficiency Anemia

2008-01-24

Objective:

The aim of this article is to determine the prevalence of celiac disease (CD), Helicobacter pylori (H. pylori) and gastroesophageal reflux (GER) in patients with resistant iron deficiency anemia (IDA).

Patients:

The study included 25 patients <18 years of age with refractory IDA (not responding to iron therapy for 3 months in a dose of 6 mg elemental iron/kg/day).

Methods:

All patients included in the study were subjected to careful history taking and thorough clinical examination. Blood sample was taken for analysis of antibodies for CD including: antigliadin antibody (AGA), antiendomysial antibody (EMA), antireticulin antibody (ARA) and antitissue Transglutaminase (tTg) IgG antibody. Anti-H. pylori IgG antibodies and a ¹³C-urea breath test (UBT) was done to all patients to diagnose H. pylori. Upper gastrointestinal tract endoscopy was done for all patients to evaluate for the presence of some etiologies of intractable anemia as chronic blood loss. These included: CD, H. pylori infection and GER. The upper gastrointestinal tract endoscopy was also done to evaluate the presence of bleeding spots, ulcers or angiomatous malformations. In addition, gastric antral biopsies were taken for diagnosis of H. pylori infection by the following tests: rapid urease test, histopathological examination and culture.

Results:

CD was positive in 11 out of 25 patients (44%), H. pylori infection in 12 out of 25 patients (48%), while GER was diagnosed in 11 out of 25 patients (44%). Patients with CD had age of presentation ≤2 years in two patients (18.2%) while the remaining nine patients (81.8%) had age of presentation >2 years and it was statistically significant (p = 0.05*). Also patients with H. pylori had age of presentation ≤4 years in five patients (41.7%) and the remaining seven patients (81.8%) had age of presentation >4 years and it was statistically significant (p = 0.03*). Logistic regression analysis demonstrated that the risk factors for severity of anemia were age of patients and duration of anemia. On the other hand, other parameters have no significant influence on the severity of anemia. Also risk factors of short stature were age of presentation of anemia, degree of anemia and H. pylori infection. AGA had the highest sensitivity (100%) followed by antiendomysium antibody (81.8%) while the tTG antibody had the highest specificity (85.7%) for diagnosis of CD. UBT and histopathology had the highest sensitivity (100%) for diagnosis of H. pylori while rapid urease test, culture, H. pylori stool antigen and anti-H. pylori IgG antibody had the highest specificity (100%). In conclusion, refractory IDA may be due to clinically unapparent H. pylori gastritis and CD. CD is one of the most common causes of intestinal malabsorption during childhood which leads to impairment of iron absorption. Apart from offering them gluten-free diet rich in iron, early detection and treatment of IDA and prophylactic iron and folic acid supplementation will go a long way to optimize their mental and psychological functions. Eradication of H. pylori infection with concomitant iron therapy should correct the anemia.

Iodine Nutritional Status Among School Children in Selected Areas of Howrah District in West Bengal, India

Chandra, A. K., Debnath, A., Tripathy, S. — 2008-01-24

This article is a study on iodine nutritional status among 1627 school children aged 6–12 years, along with biochemical analysis of iodine of 200 urine samples, 50 drinking water samples and 175 salt samples carried out in certain randomly selected areas of the district Howrah in Gangetic West Bengal. Results indicate that the entire region is clinically goitre endemic having goitre prevalence 38%; however the median urinary iodine level was 25 µg/dl indicating no biochemical iodine deficiency, 70% salt samples had a recommended level of iodine and the region was found to be environmentally iodine sufficient. Consumption of dietary goitrogen and hard drinking water may have the possible role for the persistence of endemic goitre in the region.

Zinc Status and Relation to Thyroid Hormone Profile in Iranian Schoolchildren

Dabbaghmanesh, M. H., Sadegholvaad, A., Zarei, F., Omrani, G. — 2008-01-24

Zinc is an essential element involved in many basic biochemical reactions in thyroid. However, little is known about concentration of this mineral in goitrous Iranian schoolchildren. This study was undertaken to determine the prevalence of zinc deficiency and the current zinc status in goitrous schoolchildren. A cross-sectional study in which 1188 schoolchildren in the age group of 8–13 years were evaluated for goiter prevalence, urinary iodine and zinc status. Zinc measurement was performed by atomic absorption spectrometry apparatus and urinary iodine was measured by digestion method. Goiter was graded according to WHO classification and serum concentration of thyroid hormones and thyroid-stimulating hormone were determined by commercial kits. This study showed an adequate iodine supply. Eleven percent of all cases had low zinc levels and the mean serum zinc concentration was 84.1 ± 20.7 µg/dl with a significant difference between the boys and girls (86.6 ± 22.7 µg/dl vs. 82 ± 18.7 µg/dl, p = 0.017). The mean concentration in goitrous children was 85.1 ± 23 µg/dl and for those without goiters was 82.6 ± 16.7 µg/dl which was not statistically significant. No significant difference was noticed between those with low and normal zinc levels in the prevalence of goiter. In view of normal iodine status, other goitrogenic factors should be evaluated to explain the residual goiter prevalence.

Performance Assessment of the Ugandan National Programme of Immunization in Masindi: Analysis of Routine Data

Vivancos, R., Martinez, R. — 2008-01-24

Vaccine preventable diseases are making a come back in Africa. Investments in national programmes of immunization have yielded noticeable improvements in coverage and disease epidemiology. We reviewed diphtheria-pertussis-tetanus coverage (a multi-dose regime antigen) using data routinely collected at health centre level on immunization coverage and classifying health areas according to coverage of first dose and dropout rates between first and third doses. This analysis classifies health areas in four categories depending on access and quality of immunization services. We argue that this simple analysis can be used by district medical offices paired with a supervision system to improve immunization services.

Validation of a Clinical Score for the Diagnosis of Late Onset Neonatal Septicemia in Babies Weighing 1000-2500 g

Kudawla, M., Dutta, S., Narang, A. — 2008-01-24

There is paucity of data about the predictive values and likelihood ratios of clinical signs of late onset nosocomial sepsis in neonates. A clinical score comprising of seven items had been derived from analysis of individual signs and had been published by this group in the Journal of Tropical Pediatrics in 2003. The current study was done to validate the score in a fresh validation cohort, to evaluate the score at 0 and 24 h after onset of clinical signs of sepsis and to evaluate the sepsis screen in combination with the clinical score. The seven clinical signs in the clinical score included grunting, abdominal distension, increased prefeed aspirates, tachycardia, hyperthermia, chest retractions and lethargy. A total of 220 episodes of sepsis among 208 babies were evaluated. The clinical score was calculated at 0 h and 24 h. A sepsis screen (micro erythrocyte sedimentation rate, C reactive protein, absolute neutrophil count and immature/total neutrophil ratio) and blood culture were performed in all subjects at enrollment. Sepsis screen was considered ‘positive’ if any two parameters were positive. The outcome of interest was ‘definite sepsis’, defined as blood culture positive. The 0-h clinical score had sensitivity, specificity, PPV, NPV, LR⁺ and LR^– of 90, 22.5, 30.3, 85.7, 1.16 and 0.44%, respectively. The 24-h score had higher specificity (60.6%) but lower sensitivity than the 0-h score. Sepsis screen per se had a sensitivity and NPV of 48.3 and 78.3% but when combined with the 0-h clinical score, the sensitivity and NPV rose to 95 and 90.6%, respectively. The ‘clinical score’ in combination with sepsis screen result can be used by clinicians to rule out sepsis.

The Accuracy of Mother's Touch to Detect Fever in Children: A Systematic Review

Teng, C. L., Ng, C. J., Nik-Sherina, H., Zailinawati, A. H., Tong, S. F. — 2008-01-24

Universally, mothers often use touching to detect fever in their children. We perform a systematic review of published diagnostic studies evaluating the ability of mothers to detect fever in their children by touching. We found 10 studies satisfying our inclusion criteria. The meta-analysis revealed a summary sensitivity of 89.2% and summary specificity of 50%—maternal touch is perhaps more useful to exclude fever rather than to ‘rule in’ fever. However, due to significant heterogeneity in the included studies, interpretation of the summary data is difficult.

Resetting the Detection Level of Cord Blood Thyroid Stimulating Hormone (TSH) for the Diagnosis of Congenital Hypothyroidism

Ogunkeye, O. O., Roluga, A. I., Khan, F. A. — 2008-01-24

An appraisal of a 17-year primary thyroid stimulating hormone (TSH) screening programme for the detection of congenital hypothyroidism was carried out to establish the reference interval of cord blood TSH in unaffected infants; the mean cord blood TSH concentration of affected infants and the incidence of congenital hypothyroidism in the Najran province of Saudi Arabia. Our findings show a reference interval of cord blood TSH of 2.0–16.8 mU/l in unaffected infants; a mean cord blood TSH concentration of 399 mU/l in affected infants; a false positive rate for the diagnosis of at-risk infants of 1.02% and a congenital hypothyroidism incidence rate of 34/100 000 (1 : 2931) live births. These findings suggest that there is a need to reset the cord blood TSH concentration for the detection of at-risk infants. We suggest that the detection level of cord blood TSH for the recognition of at-risk infants can be set at 90 mU/l rather than the recommended level of 30 mU/l. This should reduce the false positive rate for detection of infants at risk of congenital hypothyroidism.

New Treatment Strategies for Dengue and Other Flaviviral Diseases by NOVARTIS Foundation Chichester

Ebrahim, G. J. — 2008-01-24

In this Issue December 2007

2007-12-24

Journal of Tropical Pediatrics Online Submission and Review

Simkiss, D. E. — 2007-12-24

Evidence Behind the WHO Guidelines: Hospital Care for Children: What are the Risks of Formula Feeding in Children of HIV-infected Mothers?

Bulteel, N., Henderson, P. — 2007-12-24

Auxologic, Biochemical and Clinical (ABC) Profile of Low Birth Weight Babies A 2-year Prospective Study

Elizabeth, K. E., Krishnan, V., Zachariah, P. — 2007-12-24

Introduction: Low Birth Weight (LBW) is a key determinant of neonatal mortality, morbidity, subsequent growth and development as well as early onset of adulthood diseases. It represents a conflation of two outcomes—preterm- and term ‘light for date’ (LFD) babies. This study looks at key auxologic, biochemical and clinical (ABC) parameters of a cohort of LBW babies, both preterm- and term in comparison to a group of normal-term (control) babies. An attempt was also made to see how these parameters were at the end of a 2 year follow-up period with the currently available interventions.

Materials and Methods: A cohort of 500 babies was selected at birth from a tertiary care teaching hospital in Kerala, India, key ABC indices were measured including relevant maternal data. The initial biochemical measurements were done using umbilical cord blood. Currently recommended nutritional interventions were provided to all the normal and LBW babies. At the end of 2 years, the measurements were repeated in a subset of babies available for follow-up (n = 147).

Results: From the cohort of 500 babies, two had to be eliminated as biochemical parameters could not be done due to technical reasons from the available umbilical cord blood. They were categorized into three groups: preterm-LBW (11.85%), term-LBW (38.55%) and normal-term controls (49.6%). The maternal characteristics like socio-economic status, maternal weight, height, BMI and hemoglobin levels were comparable in the three subsets. All of them belonged to middle or low-socio-economic status representing the non-affluent. In the initial group (n = 498), all the auxologic measurements and the nutrients measured namely, total protein, albumin, total cholesterol, triglycerides, calcium, magnesium, zinc and iron levels were significantly lower (p < 0.05) among LBW, lowest in preterm followed by term-LBW, compared to term controls. Total iron binding capacity showed inverse correlation with iron level. Protein, albumin, calcium and iron levels were low in many babies, and mean calcium and iron levels were below the normal range in all the three subsets reflecting reduced transfer from the mother. At the end of 2 years, calcium, magnesium, zinc and iron were significantly lower in preterm- and term-LBW (p < 0.05) compared to controls and mean value of serum calcium continued to be below the normal range in all the three subsets. At final follow-up, majority of the LBW babies had varying grades of malnutrition and only 1 (7%) of preterm-LBW subset and 13 (28%) of term-LBW subset had optimum catch up growth resulting in normal nutritional status with the existing interventions. Three (3.5%) of the normal babies were noted to slip down to malnutrition at the end of 2 years.

Conclusions: Preterm- and term-LBW babies are born with significantly lower nutrient reserves at birth compared to term-normal babies, this was lowest among the preterm babies. As this reserve may be further lowered by recurrent infections and inappropriate feeding habits, there is a need for special feeding and nutrient supplements in this group. Calcium and iron levels were suboptimum at birth and calcium levels remained suboptimum even at the end of 2 years in all three subsets including controls in this non-affluent group. Currently available interventions may prevent the occurrence of overt clinical nutrient deficiencies, but do not ensure optimum growth, even among normal birth weight babies as some of these babies were seen to slip into the pool of malnutrition subsequently. Specialized nutritional surveillance and supplements are recommended for LBW babies to promote optimum growth and prevent subclinical nutrient deficiencies. Infant feeding practices should be strengthened and integrated with the existing health care programs to reach all the beneficiaries. Along with the existing special supplementation programs like iron folic acid, vitamin A, iodine etc., calcium supplementation should also be considered. It is also essential to concentrate on the girl child, the adolescent girl, prospective mother and prenatal mother to ensure optimum nutrition and nutrient transfer to future offsprings.

Utility of the WHO Ten Questions Screen for Disability Detection in a Rural Community the North Indian Experience

Singhi, P., Kumar, M., Malhi, P., Kumar, R. — 2007-12-24

The utility of the WHO Ten Questions Screen (TQS) was studied in a rural community of North India. The study was done in three villages, in two phases. In phase 1, the TQS was administered to parents of children aged between 2 and 9 years, during a house-to-house survey. In phase 2, all children screened positive and a random sample of 110 screened negative were clinically evaluated in detail. The total population of the three villages was 5830 with 1763 children aged between 2 and 9 years. Seventy-six children were positive on the TQS, of these, 38 were found to have significant disability, 18 had protein energy malnutrition and 19 were found normal on clinical evaluation. All the 110 screen-negative children were normal. Significantly larger numbers of boys were positive on TQS as compared to girls [Odd Ratio (OR) 1.5]. The sensitivity of the TQS for significant disability was 100%; the positive predictive value was 50% and was higher for boys than for girls. Of the 50% children classified as false positive 23% had mild delays due to malnutrition. The estimated prevalence of disability was 16/1000. The TQS was found to be a sensitive tool for detection of significant disabilities among children 2–9 years of age. The low-positive predictive value would lead to over referrals but a large number of these children would benefit from medical attention.

Prophylaxis of Ophthalmia Neonatorum Comparison of Betadine, Erythromycin and No Prophylaxis

2007-12-24

Ophthalmia neonatorum is a form of bacterial conjunctivitis contracted by newborns during delivery and occurs during the first month of life. Etiologic factors include Neisseria gonorrhoeae, Chlamydia trachomatis, viruses and chemicals. Its prevalence differs in different parts of the world and is dependent mainly upon socioeconomic conditions, level of knowledge about general health, standard of maternal healthcare as well as the type of prophylactic program used. This randomized clinical trial was performed during the years 2004–05 in the Delivery Section of Vali-e-Asr Hospital on 330 neonates who were divided into three equal groups of 110; Group A received betadine eye drops, Group B received Erythromycin eye drops and Group C (control group) received no treatment. Results showed that clinical conjunctivitis occurred in 52 subjects (17%), 58% of whom constituted males. On the whole, 9% of the infected newborns were from group A, 18.4% from group B and 22.4% from group C. It was concluded that 2.5% sterile betadine eye drops had a pronounced effect on ophthalmia neonatorum (p = 0.030).

Helicobacter pylori Colonization Among Children up to 6 Years: Results of a Community-based Study from Northeastern Brazil

2007-12-24

Aim: To determine the prevalence and risk factors associated with Helicobacter pylori infection among children up to 6 years.

Methods: Cross-sectional study carried out in a poor urban community in Fortaleza Northeast Brazil. A standardized questionnaire was applied. Helicobacter pylori status was evaluated by ¹³C-urea breath test (¹³C-UBT) in children up to 48 months and by ELISA in the mothers. Sera were assayed by the Cobas Core anti-H. pylori IgG EIA.

Results: The overall prevalence of H. pylori infection was 40% (88/217), 41% (46/112) boys and 40% (42/105) girls were infected. The prevalence rate of infection by H. pylori increased significantly with age, from 29% (27/93) in the youngest group (3 months to 2 years) to 59% (35/59) in the oldest group (6 years), (p < 0.001). There was no significant difference in the prevalence of infection between gender, height and weight adjusted for age, history of breastfeeding, mother's education, number of people per room, number of people per bed, smoking habit of the mother and children's history of antibiotic intake. A significant difference was found in the prevalence of H. pylori infection and H. pylori status of mother (p = 0.02; odds ratio (OR) 2.98; 95% confidence interval (CI): 1.19–7.46) that remained significant after adjustment for covariates in multivariate analysis (p = 0.012; OR 4.65; 95%CI: 1.39–15.58).

Conclusions: This study shows that children living in low socioeconomic status and poor hygienic conditions are infected very early in childhood. It identifies age and H. pylori positive mother as independent risk factors for infection.

Reasons for Delay in Initiation of Antiretroviral Therapy in a Population of HIV-Infected South African Children

Feucht, U. D., Kinzer, M., Kruger, M. — 2007-12-24

The aim of this study was to determine the reasons for delay of antiretroviral therapy (ART) in eligible HIV-infected children after the implementation of the South African National ART programme in April 2004, and to describe implemented interventions to improve ART access. This descriptive, retrospective audit included all HIV-infected children attending an ART clinic from April to December 2004, summarizing the following: (i) demographic data; (ii) HIV disease stage; (iii) CD4+ counts/percentages; (iv) ART eligibility and (v) reasons for ART delay. There were 276 study participants with a mean age of 4 years 4 months (range: 1 month–13 years). According to the South African national guidelines, 243 children were eligible for ART, but only 96 children were initiated on treatment during the study period, which was 39.5% of the eligible group and 34.8% of the total group. Important reasons for treatment delay were: (i) co-infection with tuberculosis (26.4%); (ii) lack of human resources (20.3%); (iii) socio-economic obstacles (17.3%) and (iv) incorrect disease stage classification (13.7%). Paediatric ART clinics need to co-operate closely with existing tuberculosis clinics for the effective management of tuberculosis co-infection; address socio-economic factors of HIV-affected families, especially the legal guardianship in orphans and improve their own staff capacity and the education of medical staff in HIV/AIDS management.

Is Urine Interleukin-8 Level a Reliable Laboratory Test for Diagnosing Late Onset Sepsis in Premature Infants?

2007-12-24

The present study is aimed to determine serum and urine interleukin-8 (IL-8) levels in premature infants with late onset sepsis (LOS) and to evaluate if urine IL-8 is a useful test for LOS diagnosis. Fifty-six premature infants admitted to the NICU over 1 year had serum and urine IL-8 determined by ELISA. They were divided into three groups: I definite sepsis, II probable sepsis and III non-infected. Results were expressed as mean or median. Differences between groups were assessed by ANOVA, Kruskal-Wallis ANOVA and Dunn's Method. Sensitivity, specificity and positive and negative predictive values were calculated and a receiver operator characteristic curve was constructed to determine serum and urine IL-8 accuracy. There were no differences between groups for birth weight, and gestational and post-natal age. Median serum and urine IL-8 levels were significantly higher in GI and GII: 929 x 906 x 625 pg/ml; P = 0.024, and 249 x 189 x 42 pg/mgCr; P < 0.001. Optimal cut-off point was 625 pg/ml for serum IL-8 with 69% sensitivity and 75 pg/mgCr for urine IL-8 with 92% sensitivity. IL-8 can be determined in urine from premature infants with LOS and is an accurate and feasible diagnosis method.

Bacterial Contamination and Over-Dilution of Commercial Infant Formula Prepared by HIV-Infected Mothers in a Prevention of Mother-to-Child Transmission (PMTCT) Programme, South Africa

Andresen, E., Rollins, N. C., Sturm, A. W., Conana, N., Greiner, T. — 2007-12-24

To examine the safety of formula feeds used by mothers participating in a Prevention of Mother-to-Child Transmission (PMTCT) programme, contents of 94 feeding bottles collected at a PMTCT-clinic were analysed. An additional 17 samples were taken from already prepared feeds during home visits, as well as 21 samples from bottles prepared under observation. Living conditions and educational levels were overall good and mothers had been counselled on safe formula preparation. Samples were analysed for faecal bacteria, using Escherichia coli and Enterococcus sp. as indicators. Protein concentration was used as an indicator of concentration of the formula. Out of 94, 63 (67%) of samples obtained at the clinic and 13/16 (81%) of available home samples were contaminated with faecal bacteria, compared to 8/21 (38%) of those prepared under observation. Out of 94, 58 (62%) of the clinic samples containing E. coli and 23/94 (24%) of those containing Enterococcus sp. were contaminated with more than the US government recommended limit of 10 CFU/ml. Out of 94, 26 (28%) of samples obtained at the clinic, 8/17 (47%) of home samples and 3/21 (14%) of those prepared under observation were over-diluted, compared to standards. Many mothers did not follow recommended practices in preparing and feeding the bottles.

Preferences and Practices: Use of Neonatal Resuscitation Devices in Low-Resource Settings

Coffey, P. S., Kelly, K., Tsu, V. — 2007-12-24

Background: Birth asphyxia, when a baby does not breathe at birth, is estimated to account for 23% of the approximately four million neonatal deaths that occur annually. Correct use of neonatal resuscitators is critical to lower neonatal mortality rates due to birth asphyxia.

Methods: In order to understand the context of use of resuscitators including use scenarios, training, device readiness and design features and preferences, PATH conducted an anonymous web-based survey among neonatal health experts. Twenty-eight percent (22/80) of experts completed the survey.

Results: In general, the bag and mask devices were used by more practitioners and in more places than the tube and mask design; the tube and mask device was not well known. Features of the bag and mask device that mattered most were ease of use, mask size and device function.

Features of the tube and mask device that mattered most were ease of use and availability. Device readiness at delivery and use of devices after long periods of inactivity were also concerns.

Conclusions: There was a clear preference for the bag and mask device over the tube and mask device due to its ease of use. Programmatic implications include the need to improve health workers’ confidence in the ability of the device to be cleaned and to remain in safe working order over time. These issues should be reviewed during periodic refresher training courses.

Predictor of Low Birth Weight Babies by Anthropometry

Taksande, A., Vilhekar, K.Y., Chaturvedi, P., Gupta, S., Deshmukh, P. — 2007-12-24

Objective: The present study was undertaken to find out the best simple anthropometric parameter for identifying low birth weight (LBW) babies.

Study design: Hospital-based cross-sectional study.

Participants: Newborn babies born in KHS hospital, Sevagram.

Results: In the present study, out of 868 newborn babies studied, 52.2% were male. Total 12.6% of them were birth weight < 2000 g and 44.6% were birth weight < 2500 g. Birth weight was significantly correlated (p < 0.001) with thigh circumference (TC), mid-arm circumference (MAC), calf circumference (CFC) and head circumference (HC). All anthropometric indicators had a statistically significant sensitivity, specificity and predictive value (p < 0.001) for identifying ≤2500 g birth weight babies. Receiver operating curve (ROC) analysis was done to identify the optimal cut-off points of these anthropometric measures separately for LBW babies and <2000 g birth weight babies.

Conclusion: HC and TC appears to be better indicators for picking up LBW babies and MAC and CFC appears to be better in picking up very LBW babies.

Is Presence of Hypertension in Obese Children Correlate with the Criteria of Metabolic Syndrome?

Mir, S., Tabel, Y., Darcan, S. — 2007-12-24

In this article, we will describe the presence of metabolic syndrome and its components in a group of hypertensive and obese adolescents. The study presented here was conducted on 20 patients (10 boys) presented with complaints of obesity and hypertension who were diagnosed as metabolic syndrome. In 20 patients who were all obese and hypertensive, existence of a third metabolic syndrome component such as glucose intolerance or dyslipidaemia, was 47% and 35% respectively, whereas existence of both was 55%. Only three of the patients carry all of the five criteria of metabolic syndrome. Mean body mass index and mean blood pressure (P = 0.021), uric acid (P = 0.046) and fasting blood glucose levels (P = 0.023) were found statistically significant. Mean blood pressure levels were related with increase at LDL-cholesterol (P = 0.029) and increase in fasting blood glucose levels (P = 0.04). Prevention of complications by effective measures in the metabolic syndrome patients is also mentioned. We believe that obese and hypertensive children should be screened for the other components of metabolic syndrome.

Significant Findings on Cranial CT Scan After a First Unprovoked Seizure in Children from North India

Mathur, S., Southern, K., Sharma, M. — 2007-12-24

Neuroimaging after a first unprovoked seizure may show significant abnormalities. In our study, 32% of all children with a first apparent unprovoked seizure had an abnormal CT scan result. Most of these were ring-enhancing lesions of cysticercal or tubercular origin.

Successful Treatment with Linezolid of Meningitis Complicated with Subdural Empyema in a 6-Month-Old Boy

Dinleyici, E. C., Yarar, C., Dinleyici, M., Yakut, A. — 2007-12-24

Recent findings have focused on the possible role of linezolid as a suitable candidate for the treatment of central nervous system infections. The linezolid treatment for meningitis was sporadically reported in adults but there was no report in children. Here, we present a 6-month-old boy with meningitis and subdural empyema which was unresponsive to more conventional agents but successfully treated with linezolid therapy. A previously healthy 6-month-old boy was referred to our clinic for deteriorating general condition with fever, vomiting and seizures. He had fever and tense-bulging anterior fontanelle. Based on his first cerebrospinal fluid (CSF) results, empirical antibiotic therapy for bacterial meningitis consisting of vancomycin and ceftriaxone was started. However, CSF culture yielded no micro-organisms but blood culture showed coagulase-negative Staphylococci. On the 7th day, he still had high fever and the erythrocyte sedimentation rate (ESR) and serum CRP levels had risen by 105 mm/h and 36.2 mg/dl, respectively. On 10th day, computerized cranial tomography showed bilateral frontoparietal subdural empyema. Purulent material was evacuated by burr hole, and gram stains of the material showed polymorphonuclear leukocytes and no microorganisms. Clinical and CSF findings of our case were, unresponsiveness to vancomycin, ceftriaxone and consecutive meropenem treatment while we still observed subdural empyema during these treatments. For this reason we started linezolid 10 mg/kg twice daily. Clinical signs improved dramatically, with both completely normal neurological findings and normalization of CSF and radiological findings. To the of our best knowledge, linezolid treatment of meningitis in children has not been reported previously. Clinical and CSF findings of our case were improved completely with linezolid treatment. Also, control cranial computerized tomography showed the total recovery of subdural empyema. Here we present the youngest case with meningitis which was successfully treated with linezolid treatment.

Molecular Analysis in Two Siblings African Patients with Severe Form of Hunter Syndrome: Identification of a Novel (p.Y54X) Nonsense Mutation

2007-12-24

Hunter syndrome (or Mucopolysaccharidosis type II, MPS II) is an X-linked recessive disorder due to the deficiency of the iduronate-2-sulfatase (IDS) enzyme, resulting in the accumulation of heparan and dermatan sulfates in the lysosomes. The heterogeneity of clinical phenotypes, ranging from mild-to-severe forms, is a result of different mutations in the IDS gene. We report here, a novel nonsense mutation (p.Y54X) in two siblings MPS II African patients affected with a severe form of the disease. We postulated that the p.Y54X mutation which causes a loss of the IDS region highly conserved among sulfatase enzymes, could be predicted as a severe disease-causing mutation for Hunter syndrome.

Is Exclusive Artificial Feeding Feasible at 6 Months Post Partum in Cameroon Urban Areas for HIV-Exposed Infants?

Njom Nlend, A., Penda, I., Same Ekobo, C., Tene, G., Tsague, L. — 2007-12-24

The aim of the study was to evaluate the feasibility of infant feeding options of HIV positive mothers in urban areas (especially compliance to artificial feeding choices), before the implementation of the infant feeding interventions and procurement of breastmilksubstitutes. We conducted a survey among seropositive women diagnosed during pregnancy and counselled for infant feeding options. At 6 months post delivery an interview was done. 47 mothers were included. Bromocriptine was prescribed to all the mothers who opted for artificial feeding from birth.

Findings: After counselling 85% of women opted for exclusive artificial feeding of whom 83% mothers practised this option since birth. For those who opted for replacement feeding The main given reason for infant feeding choice was related to medical or nurses advices. Overall 36% [CI 95%, 22–50] of the mothers who opted for artificial milk faced difficulties to afford supplies during the 6 months, leading into an early introduction of paps. Clinical mastitis were mentioned by all those mothers who breastfed. Infant feeding choices were related to the level of education (X2 = 24.10, P = 0.002).

Conclusion: Artificial feeding under recovery of cost seems feasible in urban areas in Cameroon and can be facilitate by the administration of antilacteal drugs. More adequate support must be provided for the mother who breastfeed in order to prevent and to treat mastitis. Additional training for counselling in HIV and infant feeding options is recommended for health workers.