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Neonatal mortality in Guinea accounts for about 30% of all fatalities in children younger than five years. Countrywide, specialized neonatal intensive care is provided in one single clinic with markedly limited resources. To implement targeted measures, prospective data on patient characteristics and factors of neonatal death are needed. To determine the rates of morbidity and mortality, to describe clinical characteristics of admitted newborns requiring intensive care, to assess the quality of disease management, and to identify factors contributing to neonatal mortality. Half of the 168 admitted newborns underwent postnatal cardiopulmonary resuscitation. Reasons for admission included respiratory distress (49.4%), poor postnatal adaptation (45.8%), prematurity (46.2%), and infections (37.1%). 101 newborns (61.2%) arrived in serious/critical general condition; 90 children (53.9%) showed clinical signs of neurological damage. Quality of care was poor: Only 59.4% of the 64 newborns admitted with hypothermia were externally heated; likewise, 57.1% of 45 jaundiced infants did not receive phototherapy. Death occurred in 56 children (33.3%) due to birth asphyxia (42.9%), prematurity (33.9%), and sepsis (12.5%). Newborns in serious/critical general condition at admission had about a fivefold higher hazard to die than those admitted in good condition (HR 5.21 95%-CI 2.42-11.25, p = <0.0001). Hypothermia at admission was also associated with a higher hazard of death (HR 2.00, 95%-CI 1.10-3.65, p = 0.023). Neonatal mortality was strikingly high. Birth asphyxia, prematurity, and infection accounted for 89.3% of death, aggravated by poor quality of in-hospital care. Children with serious general condition at admission had poor chances of survival. The whole concept of perinatal care in Guinea requires reconsideration.

Background The COVID-19 pandemic has adversely affected access to essential healthcare services. This study aimed to explore healthcare providers’ perceptions and experiences of the response to the COVID-19 pandemic in three referral maternal and neonatal hospitals in Guinea. Methods We conducted a longitudinal qualitative study between June and December 2020 in two maternities and one neonatology referral ward in Conakry and Mamou. Participants were purposively recruited to capture diversity of professional cadres, seniority, and gender. Four rounds of in-depth interviews (46 in-depth interviews with 18 respondents) were conducted in each study site, using a semi-structured interview guide that was iteratively adapted. We used both deductive and inductive approaches and an iterative process for content analysis. Results We identified four themes and related sub-themes presented according to whether they were common or specific to the study sites, namely: 1) coping strategies & care reorganization, which include reducing staffing levels, maintaining essential healthcare services, suspension of staff daily meetings, insertion of a new information system for providers, and co-management with COVID-19 treatment center for caesarean section cases among women who tested positive for COVID-19; 2) healthcare providers’ behavior adaptations during the response, including infection prevention and control measures on the wards and how COVID-19-related information influenced providers’ daily work; 3) difficulties encountered by providers, in particular unavailability of personal protective equipment (PPE), lack of financial motivation, and difficulties reducing crowding in the wards; 4) providers perceptions of healthcare service use, for instance their fear during COVID-19 response and perceived increase in severity of complications received and COVID-19 cases among providers and parents of newborns. Conclusion This study provides insights needed to be considered to improve the preparedness and response of healthcare facilities and care providers to future health emergencies in similar contexts.

Background The AIRE operational project will evaluate the implementation of the routine Pulse Oximeter (PO) use in the integrated management of childhood illness (IMCI) strategy for children under-5 in primary health care centers (PHC) in West Africa. The introduction of PO should promote the accurate identification of hypoxemia (pulse blood oxygen saturation Sp02 < 90%) among all severe IMCI cases (respiratory and non-respiratory) to prompt their effective case management (oxygen, antibiotics and other required treatments) at hospital. We seek to understand how the routine use of PO integrated in IMCI outpatients works (or not), for whom, in what contexts and with what outcomes. Methods The AIRE project is being implemented from 03/2020 to 12/2022 in 202 PHCs in four West African countries (Burkina Faso, Guinea, Mali, Niger) including 16 research PHCs (four per country). The research protocol will assess three complementary components using mixed quantitative and qualitative methods: a) context based on repeated cross-sectional surveys: baseline and aggregated monthly data from all PHCs on infrastructure, staffing, accessibility, equipment, PO use, severe cases and care; b) the process across PHCs by assessing acceptability, fidelity, implementation challenges and realistic evaluation, and c) individual outcomes in the research PHCs: all children under-5 attending IMCI clinics, eligible for PO use will be included with parental consent in a cross-sectional study. Among them, severe IMCI cases will be followed in a prospective cohort to assess their health status at 14 days. We will analyze pathways, patterns of care, and costs of care. Discussion This research will identify challenges to the systematic implementation of PO in IMCI consultations, such as health workers practices, frequent turnover, quality of care, etc. Further research will be needed to fully address key questions such as the best time to introduce PO into the IMCI process, the best SpO2 threshold for deciding on hospital referral, and assessing the cost-effectiveness of PO use. The AIRE research will provide health policy makers in West Africa with sufficient evidence on the context, process and outcomes of using PO integrated into IMCI to promote scale-up in all PHCs. Trial registration Trial registration number: PACTR202206525204526 retrospectively registered on 06/15/2022.

High neonatal mortality remains a major health problem in Guinea (32 deaths /1,000 live births). This represents 15 000 deaths annually, without improvement over the past decade. We evaluated the impact of 2 days of neonatal resuscitation training of health professionals working in the disadvantaged outskirts of Conakry. Non-randomised interventional study with pre-and post-interventional analysis of the very early neonatal mortality with data collection over two 6-month periods, one before and one after intervention. Intervention: Theoretical and practical training given to health professionals working in private obstetric centres within a defined area. After training, all centres were equipped with basic resuscitation devices. We concentrated on the private sector, dominated by informal facilities scarcely equipped and run by often poorly trained paramedical staff. Outcome measures were very early neonatal mortality (6 hours) and the need for referral to higher equipped structures. Theoretical knowledge was assessed by a questionnaire, pre-training, post-training and 6 months later. 27 nurses, midwives and doctors participated, working in 13 health facilities. They performed 589 deliveries during the two periods analysed. The 6-hour neonatal mortality rate decreased (31.8‰ to 5.7‰, p=0.031), need for neonatal transfer dropped from 27.3% to 11.3% (p=0,19), whereas the stillbirth rate remained high and unchanged. There was a sustained improvement in theoretical knowledge (mean of correct answers: 59.3% before, 82.0% after training, (p<0.001) and 85.9% 6 months later). A 2-day training course for health workers in private facilities and provision of basic neonatal resuscitation equipment significantly improved neonatal outcome.

Introduction In sub-Saharan Africa, there is limited evidence on the COVID-19 health-related effect from front-line health provision settings. Therefore, this study aimed to analyse the effect of the COVID-19 pandemic on routine maternal and neonatal health services in three referral hospitals. Materials and methods We conducted an observational study using aggregate monthly maternal and neonatal health services routine data for two years (March 2019–February 2021) in three referral hospitals including two maternities: Hôpital National Ignace Deen (HNID) in Conakry and Hôpital Regional de Mamou (HRM) in Mamou and one neonatology ward: Institut de Nutrition et de Santé de l’Enfant (INSE) in Conakry. We compared indicators of health service utilisation, provision and health outcomes before and during the COVID-19 pandemic periods. An interrupted time-series analysis (ITSA) was performed to assess the relationship between changes in maternal and neonatal health indicators and COVID-19 through cross-correlation. Results During COVID-19, the mean monthly number (MMN) of deliveries decreased significantly in HNID ( p  = 0.039) and slightly increased in HRM. In the two maternities, the change in the MMN of deliveries were significantly associated with COVID-19. The ITSA confirmed the association between the increase in the MMN of deliveries and COVID-19 in HRM (bootstrapped F-value = 1.46, 95%CI [0.036–8.047], p  < 0.01). We observed an increasing trend in obstetric complications in HNID, while the trend declined in HRM. The MMN of maternal deaths increased significantly ( p  = 0.011) in HNID, while it slightly increased in HRM. In INSE, the MMN of neonatal admissions significantly declined ( p  < 0.001) and this decline was associated with COVID-19. The MMN of neonatal deaths significantly decreased ( p  = 0.009) in INSE and this decrease was related to COVID-19. Conclusion The pandemic negatively affected the maternal and neonatal care provision, health service utilisation and health outcomes in two referral hospitals located in Conakry, the COVID-19 most-affected region.

ObjectivesThe COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes.DesignProspective observational mixed-methods study, combining monthly routine data (March 2019–February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave.SettingSix referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda.Participants22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels.ResultsPercentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and increased at various times in other hospitals. SHP reported unpredictability in the number of referrals due to changing referral networks. All six hospitals registered a slight increase in stillbirths during the study period, the highest increase (by 30%–40%) was observed in Uganda. Four hospitals registered increases in facility maternal mortality ratio; the highest increase was in Guinea (by 158%), which had a relatively mild COVID-19 epidemic. These increases were not due to mortality among women with COVID-19. The main pathways leading to these trends were delayed care utilisation and disruptions in accessing care, including sub-optimal referral linkages and health service closures.ConclusionsMaternal and perinatal survival was negatively affected in referral hospitals in sub-Saharan Africa during COVID-19. Routine data systems in referral hospitals must be fully used as they hold potential in informing adaptations of maternal care services. If combined with information on women’s and care providers’ needs, this can contribute to ensuring continuation of essential care provision during emergency.

Two neonates were presented at the Neonatology Department of the Institute of Child Nutrition and Health in Conakry, Guinea, with tension pneumothoraces as confirmed by chest X-ray. They were initially managed with needle thoracentesis but required continuous thoracic drainage. Due to scarce resources in the public health sector, no prepacked and dedicated pleural drainage systems were available as is the case in many developing countries. Therefore, we fabricated an improvised underwater seal drain out of a plastic infusion bottle and a Heimlich valve out of a vicryl fingerstall. Both devices have shown to be effective. Pneumothorax is a common and potentially life-threatening disease in neonates that often requires prompt treatment. This case series demonstrates how tension pneumothorax in two newborns was successfully managed by improvising different chest drainage systems. The depicted techniques shall serve as an instruction manual to healthcare professionals working in low-resource settings and facing similar challenges.

BackgroundThe Amélioration de l'Identification des détresses Respiratoires de l'Enfant (AIRE) project introduced the routine use of pulse oximetry (PO) into Integrated Management of Childhood Illness (IMCI) consultations within primary health centres (PHCs) in Burkina Faso, Guinea, Mali and Niger. We analysed how severe cases were managed and 14-day mortality by hypoxaemia severity.MethodsAll children aged under 5 years attending IMCI consultations integrating PO use at 16 research PHCs and classified as severe cases (severe IMCI cases or severe hypoxemia: SpO2 <90%) were eligible for referral and enrolled in a 14-day prospective cohort with parental consent. Referral decisions, admissions, access to oxygen therapy and Kaplan-Meier probability of death were compared by hypoxaemia severity. An adjusted mixed-effects Cox regression model with a random effect for PHC estimated adjusted ORs (aORs) and 95% CIs of mortality by day 14.ResultsFrom July 2021 to July 2022, 1998 severe cases were enrolled, including 10.6% aged <2 months; 7.1% had severe hypoxaemia, and 10.5% had moderate hypoxaemia (90%≤oxygen saturation≤93%). By day 14, 625 (31.3%) were referred, 463 (23.2%) hospitalised, and 95 children (4.8%) had died. Referral decisions, hospitalisations and oxygen therapy rates were significantly higher for severe hypoxaemic cases (83.8%, 82.3% and 34.5%, respectively) than for moderate hypoxaemic cases (32.7%, 26.5% and 7.1%, respectively) and cases without hypoxaemia (26.3%, 17.5% and 1.4%, respectively). Similarly, day 14 mortality rates were 26.1%, 7.5% and 2.3%, respectively. The aORs for mortality were severe hypoxaemia (9.34, 95% CI 5.08 to 17.16), moderate hypoxaemia (2.32, 95% CI 1.16 to 4.64), age <2 months (3.68, 95% CI 1.67 to 8.13), severe malaria (2.02, 95% CI 1.03 to 3.97) and living in Niger (4.06, 95% CI 1.41 to 11.67).ConclusionRegardless of severity, hypoxaemia was common among outpatients screened using PO and meeting criteria for severity. Its presence was associated with mortality risk. Incorporating PO within IMCI prompted care management of severely hypoxaemic cases, but hospital referrals and access to oxygen remain sub-optimal and are crucial levers for reducing under-five mortality.Study registration numberPACTR202206525204526 registered retrospectively on 15 June 2022.

La COVID-19 est due au virus SRAS-CoV-2 génétiquement semblable au virus du syndrome respiratoire aigu sévère (SRAS). En pédiatrie, les formes cliniques ont un caractère bénin. En Guinée, suite à la pandémie du COVID-19 dont l´épicentre était Conakry, des cas pédiatriques ont été observés au CTEPI de Donka. L´objectif de cette étude était de déterminer leur profil épidémiologique. Etude transversale de type descriptif de 04 mois chez les enfants de 0 à 16 ans admis au CTEPI Donka. Sur 7308 patients provenant principalement des 5 communes de Conakry hospitalisés au CTEPI, 189 étaient âgés de 0 à 16 ans, soit 2, 59%. La tranche de 0-4 ans était plus représentée (38,62%) avec un sex-ratio (F/M) de 1,52; 62,96% étaient des élèves, 70% des enfants résidaient à Conakry, 28,57% des mères étaient des marchandes et personnes contactes dans 39,68%; 37,57% des pères étaient des fonctionnaires, 2,65% des enfants avaient des antécédents de drépanocytose et 1,59% de rhinite allergique. Les cas asymptomatiques représentaient 52,38% et les cas confirmés 74, 6%; les symptômes étaient: fièvre, rhinorrhée, céphalées, toux, douleurs abdominales, éternuement, diarrhée, asthénie physique. La proportion des cas pédiatriques infectés au COVID-19 au CTEPI de Donka est faible. Les enfants de 5 ans et plus sont plus concernés et près de 50% était asymptomatique. Les symptômes dominants sont: fièvre, céphalées, rhinorrhée, toux, douleurs abdominales, éternuement, diarrhée, asthénie physique.

Valvular Heart Disease (VHD) is a known late complication of radiotherapy for childhood cancer (CC), and identifying high-risk survivors correctly remains a challenge. This paper focuses on the distribution of the radiation dose absorbed by heart tissues. We propose that a dosiomics signature could provide insight into the spatial characteristics of the heart dose associated with a VHD, beyond the already-established risk induced by high doses. We analyzed data from the 7670 survivors of the French Childhood Cancer Survivors’ Study (FCCSS), 3902 of whom were treated with radiotherapy. In all, 63 (1.6%) survivors that had been treated with radiotherapy experienced a VHD, and 57 of them had heterogeneous heart doses. From the heart–dose distribution of each survivor, we extracted 93 first-order and spatial dosiomics features. We trained random forest algorithms adapted for imbalanced classification and evaluated their predictive performance compared to the performance of standard mean heart dose (MHD)-based models. Sensitivity analyses were also conducted for sub-populations of survivors with spatially heterogeneous heart doses. Our results suggest that MHD and dosiomics-based models performed equally well globally in our cohort and that, when considering the sub-population having received a spatially heterogeneous dose distribution, the predictive capability of the models is significantly improved by the use of the dosiomics features. If these findings are further validated, the dosiomics signature may be incorporated into machine learning algorithms for radiation-induced VHD risk assessment and, in turn, into the personalized refinement of follow-up guidelines.