Challenges of Hospital Care for sick children in West Africa
What are the most common challenges in West Africa for the treatment of pediatric cases in a humanitarian setting?
Dr. Susan Shepherd: The biggest problem is by far infectious diseases. The biggest difficulty is that children who are sick arrive at the hospital in serious condition, sometimes at the brink of death. Often, they present several problems simultaneously, for example they suffer from dehydration and infectious diarrhea, pneumonia, or malaria.
In this kind of situation, without laboratory exams, it can be difficult to provide proper treatment. Malaria is easily detected, and is treated with specific medicines. But other infections are often treated blindly, with antibiotics. It’s a real challenge to care for children without the means of identifying which microbe is making them sick or which would be the best treatment for each case.
Dr. Mariama Issoufou: In Burkina Faso, we are encountering a similar problem with malnourished children: most arrive at the hospital in an already severe condition.
Burkina Faso is one of the countries most affected by food and nutrition crises. Malnutrition affects nearly 8.5% of children under five years old.
By weakening the child’s immune system’s defense, malnutrition enables the appearance of new pathologies such as, for example, diarrhea or respiratory infections. This is why children arrive at the hospital already very ill.
In these different situations, what solutions have been put in place to improve the hospital care of these children?
Mariama Issoufou: In the conventional system, malnutrition is treated in different ways depending on the severity of the nutritional state, moderate or severe, even though it involves the same physiological process. In Burkina Faso, moderately malnourished children are not treated in 3 of 13 Regions. One of the symptoms of malnutrition is anorexia, which means that children who refuse to eat become more severely ill and need hospitalisation. The pediatric services are overwhelmed.
To avoid having children become severely malnourished and having too many children be hospitalized, ALIMA, in partnership with the country’s health authorities and the partner NGOs SOS Médecins and Keoogo, is studying a new treatment protocol that hopes to treat children early, while in the moderate stage, before their state deteriorates.
In real terms, this means that in the Yako district, ALIMA and its partners are are admitting moderately malnourished children, who have the mid-upper arm circumference between 115 and 125 mm, into the program, treating them with the same therapeutic foods that we use for severely malnourished children. We simply adjust the product quantities to the brachial perimeter measurement and the child’s clinical progress.
Because children are treated early, there are fewer complications, resulting in fewer children hospitalized and fewer deaths.
Susan Shepherd: To improve treatment, and therefore save more children, we must also find diagnostic tools adapted to the circumstances in which we work, meaning tests that can be used by every doctor and nurse after a simple training.
In Chad, since 2016, ALIMA has introduced a test to identify the microbes present in children suffering from diarrhea. This technology, the molecular biology multiplex, allows to test a sample against 22 different microbes. By using this test in N’Djamena, we have discovered that severely malnourished children suffering from diarrhea are often carriers of a little known parasite: cryptosporidium. Thanks to this discovery, we hope to begin a study to find a treatment for this parasite. Without this molecular biology test, it may have been years before we understood the problem.
In the same vein, in Niger, we have introduced a test that enables us to measure electrolytes - among others, sodium and potassium, in blood. We have discovered that many children who suffer from gastroenteritis or malaria had potassium deficiencies, a deficiency that was not corrected by our usual treatments. Thanks to this new technology, we are setting up a new protocol, in which dehydrated children will be systematically tested, so that they may receive a potassium supplement, if needed.
To summarize, if we want to improve the treatment of sick children in West Africa, we need to be able to make the correct diagnosis, with simple tools available to everyone. Then we must adapt treatment to care for children before it’s too late. For that we will need to conduct research, to test new protocols and new treatments.