Background: Pregnancies at extreme ages of reproductive life are considered to be at high risk for mother and neonate. The aim of the study was to determine neonatal risks associated with extreme maternal age.Methods: A retrospective cohort study was conducted at Befelatanana Maternity covering the period from 1 January to 31 December 2018. Data was collected from neonate’s medical files.Results: Of 789 neonates from mothers with extreme age included, 64.7% were from mothers under the age of 18, and 35.3% from mothers aged 40 and over. They were compared to 519 neonates from mothers aged 20-30. Maternal age under 18 was a risk factor for Apgar index below 7 at the 5th minute RR 1.69 (95% CI 1.17, 2.44), preterm birth RR 2.19 (95% CI 1.70, 2.80), low birthweight RR 2.03 (95% CI 1.53, 2.53) and admission to neonatalogy RR 2.64 (95% CI 2.20, 3.16). Also, the neonatal risks of pregnancy after 40 years were fetal death in utero RR 2.97 (95% CI 1.51, 5.85), low birthweight RR 2.47 (95% CI 1.97, 3.10), preterm birth RR 2.85 (95% CI 2.21, 3.68), and admission to Neonatalogy RR 3.06 (95% CI 2.54, 3.68).Conclusions: The extreme age of the mother is therefore a risk of neonatal adverse outcomes. Rigorous prenatal follow-up is needed for these high-risk pregnancies.

Background: Sickle cell disease in children can disrupt life of their mothers who are at the forefront of care. The objectives of this study were to describe the psychosocial experience of these mothers, to identify factors associated to maternal anxiety and depressive disorders.Methods: A cross-sectional study was conducted from December 2017 to February 2018 with mothers of children with sickle cell disease under the age of 15 in Antananarivo and Toamasina. The abbreviated Beck and Hamilton scales were used to assess respectively depression and anxiety.Results: Of 134 mothers surveyed, 61.2% had depression and 35.8% had anxiety. Depression significantly affected mothers with more than one child with sickle cell disease (aOR=4.31, CI- 1.12-16.58) and mothers of children hospitalized at least three times per year for vaso-occlusive crisis (aOR=13.55, CI- 1.56-117.5). Anxiety was associated with blood transfusion more than three times (aOR=9.06, CI- 2.05-40.00). Pity (74.6%) and fear of death (55.2%) were the main feelings reported. Negative occupational repercussions were reported by 48.5% of mothers, marital conflict by 15.6%, financial difficulties by 43.3%.Conclusions: A global approach focused on the child and his family would be optimal for success in the management of pediatric sickle cell disease.

Background: Diagnosing tuberculosis in children remains a challenge especially in low-income countries. The aim of this study was to assess the performance of the scoring system combined to chest x-ray images compared to GeneXpert for diagnosis of pediatric tuberculosis.Methods: A retrospective diagnostic accuracy study was carried out on hospitalized children aged 0 to 14 years old, tuberculosis suspect in the pediatric department of the Tsaralalana mother child university hospital center from August 2018 to June 2020.Results: Fifty-one medical files were retained. The mean age was 4±2 years old with a sex ratio of 1.55. The reason for consultation was dominated by respiratory signs (56.9%). The GeneXpert was positive in 58.9% of cases. The chest X-ray images were pathological in all cases, dominated by images of condensation or infiltration (72.5%). WHO score was positive (≥7) in 72.5% of cases. The clinico-radiological criteria had a sensitivity of 13.3-63.3%, a specificity of 61.9-95.2%, positive predictive values of 1.5-6.9% and negative predictive values of 98.8-99.3%.Conclusion: Clinico-radiological criteria could be useful in individual diagnosis of pediatric tuberculosis.