[DOMESTIC ACCIDENTS IN CHILDREN AGED 0 TO 15 YEARS IN THE UNIVERSITY HOSPITAL OF LOMÉ, TOGO]. / Accidents domestiques chez les enfants de 0 à 15 ans dans les CHU de Lomé, Togo.

Introduction: Les accidents domestiques chez les enfants sont des situations d'urgence fréquentes. L'objectif de cette étude était de décrire les caractéristiques des accidents domestiques chez les enfants de 0 à 15 ans. Méthodes: Une étude prospective multicentrique à visée descriptive et analytique, a été menée du 1er janvier au 31 juillet 2022, dans les services de pédiatrie et de chirurgie pédiatrique des CHU Campus et Sylvanus Olympio de Lomé. Les critères d'inclusion étaient les enfants de moins de 15 ans, victimes d'accidents ou de traumatismes non intentionnels survenant à domicile ou dans ses abords immédiats. Résultats: Au total, 329 enfants ont été enrôlés. Le sexe ratio était de 1,6. Les enfants âgés de 30 à 72 mois étaient les plus représentés (34,1%). La supervision des enfants lors de l'accident était assurée principalement par la mère (64,5%). Les accidents survenaient principalement pendant les jeux (73,3%) et dans la cour de la maison (37,2%). Les enfants en étaient responsables dans 70,5 % des cas. Les traumatismes représentaient la principale cause d'accidents (58,4%), suivis des intoxications (24,6%) et des brûlures (13,7%). Le risque de traumatisme diminuait à mesure que l'enfant grandissait. Les filles étaient moins exposées aux traumatismes, intoxications, et présentaient moins d'accidents dans la cour de la maison. Le taux de décès était de 1,5%. Conclusion: Les accidents domestiques des enfants étaient fréquents. La prévention demeure le meilleur traitement. Mots-clés : Accident domestique, Enfant, Traumatismes, Intoxications, Brûlures, Togo.

[Respiratory distress in newborns at the University Hospital of Lomé, Togo]. / Détresse respiratoire du nouveau-né dans les CHU de Lomé, Togo.

Introduction: La détresse respiratoire du nouveau-né est une urgence néonatale source de séquelles neurologiques graves en l'absence de traitement adéquat. L'objectif de cette étude était de décrire les aspects épidémiologiques, diagnostiques et évolutifs de la détresse respiratoire du nouveau-né. Méthodes: Il s'est agi d'une étude rétrospective analytique et descriptive, réalisée dans les services de pédiatrie des CHU de Lomé, incluant les nouveau-nés pris en charge pour une détresse respiratoire sur une période d'un an allant du 1er janvier 2021 au 31 décembre 2021. Les données étaient saisies avec Epi Data 3.1 et analysées avec Epi Info 7.2.1. Résultats: Le nombre total des nouveau-nés hospitalisés pour détresse respiratoire était de 353 cas avec un sex ratio de 1,5. L'âge moyen était de 0,82 ± 3,20 jours ; la tranche d'âge de 0-6 jours représentait 92,4 % des cas. Tous les nouveau-nés avaient un trouble de la fréquence respiratoire. La dyspnée était le principal motif de consultation (100%). Les nouveau-nés avaient été réanimés à la naissance dans 46,7 % des cas. La détresse respiratoire était intense dans 64,9 % des cas. L'hyperleucocytose et la leucopénie étaient constatées chez 14,8 % des cas. L'anémie était de 15,9 % des cas. L'encéphalopathie anoxo-ischémique y était associée dans 49,1% des cas. Le taux de mortalité était de 20,4 %. Conclusion: La détresse respiratoire néonatale était fréquente dans la période néonatale précoce et sa mortalité élevée.

[Gross hematuria in sickle cell disease at Tokoin teaching hospital in Lomé (Togo)]. / Hématurie macroscopique dans la drépanocytose majeure au CHU Sylvanus-Olympio de Lomé (Togo).

The renal complications of sickle cell anemia are well known. Gross hematuria is one of these, although it is associated more often with the sickle cell trait than with the disease. Nonetheless, in Togo, where the frequency of S gene is 16%, hematuria is rarely report in people with this gene. We describe 3 cases of gross hematuria in patients with sickle cell disease: primary hematuria associated with sickle cell disease. We found no promoting factors in our patients. The course was short, and after 4 to 15 years, there have been no recurrences.

[Knowledge of sickle cell disease and prevention methods in an urban district of Lomé, Togo]. / Connaissances de la drépanocytose et pratiques de prévention dans la population d'un district urbain de Lomé, Togo.

Despite the important frequency of the gene "S" in Togo, essential information remains insufficient to elaborate a prevention campaign on this affection. In order to assess the knowledge on sickle cell diseases as well as the prevention practices in the Togo population in one of the five districts of the township of Lomé, a cross sectional study was conducted in the third district of the township of Lomé from January 21, 2004 to January 26, 2004 in 210 natives from Togo aged of 15 and over, through a semi-structured questionnaire. The variables studied were: - the socio-demographic features and the knowledge of sickle cell disease characteristics (symptoms, biological diagnosis, treatment and means). Data collected were analysed through software Statically Package for Social Science (SPSS) version 10.0 of Windows using the chi2 test with 5% significance in the comparison of some variables. 117 women and 93 men were interviewed. Sickle cell disease was known in almost all ethnic groups but incompletely: 79.5% of the individuals knew about premarital check up but only 12.4% knew about haemoglobin electrophoresis check up. 74,8% of the people had a good knowledge of the cause of sickle cell disease, 78.6% had a fairly good knowledge of its symptoms, 57.6% knew the factors inducing attacks, 64.3% the prognosis and 69.5% the prevention methods, but a poor knowledge of the complications (62.4%), biological diagnosis (71%) and treatment (97.2%). The prevention practices were poorly adopted: 12% had an haemoglobin electrophoresis check up and 15% of them had their husband to have one as well. Professional status influenced the level of knowledge of the biological diagnosis (p=0.001) and prevention means (p=0.018). The educational level influenced biological diagnosis knowledge (p = 0.000) and prevention means (p = 0.02). On the whole, sickle disease was linked to marital status (p = 0.00). Sickle cell disease remains quite unknown in spite of the gene "S" important frequency in Togo. These results are to be taken into account to implement information, education and communication program to struggle against sickle cell disease.

[Pediatric salmonellosis at the Tokoin's teaching hospital, Lomé (Togo)]. / Les salmonelloses chez l'enfant au CHU Tokoin de Lomé (Togo).

OBJECTIVE: The authors had for aim to describe the epidemiological, clinical, and bacteriological aspects and outcome of pediatric Salmonella enterica, Salmonella septicemia, over the last 10 years. PATIENTS AND METHODS: We analyzed the case history of 132 patients hospitalized for Salmonellasepticemia (positive blood culture) between 1995 and 2004. RESULTS: Salmonellosis accounted for 0.36% of all hospitalizations. The mean age of patients was 5.86 plus or minus 4.06 years, significantly higher in patients with S. ser. Typhi (7.14+/-4.04 years) than in patients with other serotypes (4.95+/-3.8 years). The clinical presentation was severe in many children (with dehydration (34.8%) and emaciation (55.3%)), so HIV was suspected and investigated in 51 patients (38.6%). Eight patients were HIV positive. Three serotypes of S. enterica were predominant: S. ser. Typhi, 55 cases (41.7%), S. ser. Enteritidis, 32 cases (24.2%), and S. ser. Typhimurium, 19 cases (14.4%). The bacterial susceptibility to antibiotics was good for ceftriaxone and ciprofloxacin (100%). But 78.8% of the serotypes were resistant to amoxicillin, 75.4% to chloramphenicol, and 69.4% to cotrimoxazole. The mean duration of hospitalization was 13.7 plus or minus 7.4 days (range 4-34 days). Complications occurred in 15.9% of cases, dominated by digestive bleeding (10.6%), and 6.1% of patients died.

[Priapism in sickle cell anaemia in Senegal: prevalence, attitudes and knowledge]. / Priapisme chez le drépanocytaire sénégalais: prévalence, attitudes et connaissances.

We interviewed 108 sickle cell anaemia patients aged 5 years older on priapism, and 113 healthy subjects in a control group. They were recruited in the out-patient consultation of the two sickle cell anemia care units of the Fann teaching hospital in Dakar. Ten cases of priapism were identified, all in the group of sickle cell patients (the difference is significant, p = 0.004). Prevalence of priapism was 9.3%. Actuarial probability of having priapism was 8.3% by 10 years of age, and 38.9% +/- 5.7 by 20 years of age. Before the interview, only 10.2% of the sickle cell patients and 8% in the control group knew about priapism, and most of them were unaware of its association with sickle cell disease (75% of sickle cell anaemia patients and 80% of control subjects). This lack of information should be improved by an educational program.

[Primary results of antiretroviral treatment among HIV/AIDS infected children in Lomé (Togo)]. / Traitement antirétroviral des enfants infectés par le VIH/sida à Lomé (Togo): premiers résultats.

UNLABELLED: Since 2004 in Togo HIV/AIDS infected children have, free of charge, access to antiretroviral drugs according to the national program. The aim of this study was to investigate the clinical, biological and prognosis aspects of anti-retroviral treatment on HIV/AIDS infected children. PATIENTS AND METHOD: We conducted a cross sectional study on 72 HIV/AIDS infected children with anti-retroviral treatment, under the supervision of clinicians within 3 associations specialized in the management of subjects infected by HIV/SIDA at Lomé (Togo). RESULTS: The average age of children was 6 years 9 months. The middle age to HIV screening was 4 years 2 months. The sex ratio was 1.05. The majority of these children (79.2%) were orphans of at least 1 of their parents. All the children were stemmed from families with modest income. The transmission mother to child was the way of HIV contamination found among all the children. To a certain extent, all the children were infected by the HIV 1. Most of the children (66.7%) receiving an antiretroviral treatment for at least 6 months were asymptomatic and had no more immunodeficiency. After 15 months, the children have gained 464 CD4/mm(3). The initial protocols antiretroviral prescribed among children were: zidovudine-lamivudine-abacavir (36.1%), lamivudine-didanosine-nevirapine (30.5%), lamivudine-stavudine-nevirapine (29.2%), zidovudine-lamivudine-didanosine (4.2%). The digestive disorders have been the first side effects (83.4%). The rate of good observance was middle (51%) and lowered with the increased age of children, and the period of the anti-retroviral treatment. CONCLUSIONS: Antiretroviral treatment among HIV/AIDS infected children is giving good results in Togo. But many efforts remain to increase the number of beneficiaries.

[Emergence of multidrug resistant Salmonella strains in Lome (Togo)]. / Emergence des souches de salmonelles multirésistantes aux antibiotiques à Lomé (Togo).

OBJECTIVE: This study had for aim to compare antibiotic resistance of 332 Salmonella enterica strains identified in human samples in the course of infections, in Lome. DESIGN: The strains were collected over two periods: 1998-2002 (N=168) and 2003-2004 (N=164). The antibiotic susceptibility test was performed by disk diffusion assay. RESULTS: The main serotypes identified were 147 Salmonella Typhi (44.3%), 97 Salmonella Typhimurium (29.2%), and 74 Salmonella Enteritidis (22.3%). The proportions of strains resistant to chloramphenicol, cotrimoxazol, and amoxicillin (first line antibiotics) varied respectively from 33, 46, and 57% in 1998-2002 to 73, 79, and 82% in 2003-2004 (P<0.0001). The percentage of resistance to ciprofloxacin or ceftriaxone was inferior to 10%. CONCLUSION: Fluoroquinolones and third generation cephalosporins have become the first line antibiotics for the treatment of Salmonella in Lome (Togo).

[Stuttering priapism in children with sickle cell anemia in Togo]. / Priapisme intermittent chronique chez l'enfant drépanocytaire homozygote au Togo.

AIM: To describe clinical aspects and outcome of stuttering priapism (SP) in children with sickle cell anemia. PATIENTS AND METHODS: We included the 8 children with sickle cell anemia suffering from SP between 1996 and 2004. RESULTS: Age at onset of SP ranged from 5 to 14 years (mean 9.75+/-3.69 years). SP attacks occurred once a day for 6 patients, and 2 and 3 times by week for the others. It happened during deep sleep, especially in the night (all patients) and sometimes in the day (4 patients). The duration of attacks ranged from 10 min to 2 h in 6 patients and 4 to 5 h in 2 patients. Oral étilefrine was administered to all patients until the cessation of attacks, and continued during 1 month. A long remission was obtained in all patients after 7 days to 7 months treatment (follow-up 2 to 7 years) in spite of 1 or many relapses.

[Management of malaria in Togolese communities]. / Prise en charge du paludisme dans les communautés du Togo.

The objective of this study was to collect community basis data on prevention and home management of malaria for the future assessment of "Roll Back Malaria", the new world strategy of fighting against malaria. The study was carried out in 3 districts in Togo. Mothers were questioned about the quality of home management of uncomplicated malaria on 951 children aged under 5. Fathers were questioned about the use of mosquito bed nets in 597 households, and 246 women were interviewed about the prevention of malaria during pregnancy. Home management of children under treatment was correct in only 38.1% of cases and the drug observance was followed by only 35.4% of patients. Mosquito nets were used in 30.5% of households and only 16.5% were treated with insecticides. Only 22.7% of children under 5 slept under mosquito nets. 80% women made at least one antenatal visit and 74.4% received regular malaria chemoprophylaxis. Many efforts should be made in Togo to increase the quality of home management of malaria and the use of insecticide-treated bed nets.

[Evolution of severe pediatric malaria in Togo between 2000 and 2002]. / Evolution du paludisme grave de l'enfant au Togo de 2000 à 2002.

The aim of this study was to analyse the clinical and evolutive aspects of severe malaria in hospitalised children in 2000, 2001, and 2002 in Togo. The study included 361 children in the pediatrics department of Lomé-Tokoin University hospital. All them received a 10% dextrose infusion, then an infusion of quinine or intramuscular artemether. Malaria accounted for 4.37% of all hospitalizations. Children aged 1 to 5 years were more affected (69.53%). The most frequent clinical forms were anaemia (55.7%) followed by cerebral manifestations. The frequency of hemoglobinuria increased (17.2%) as well as renal failure (3%) compared to previous years. Thirty-five children died (9.7%). Most of them presented with anaemia, neurological manifestations, or respiratory distress. Neurological sequels were present in 2.2% of patients.

[Type 2 diabetes mellitus in children in black Africa: description of first five cases in Togo]. / Le diabète de type 2 de l'enfant en Afrique noire: cinq premiers cas au Togo.

The purpose of this report is to describe epidemiological, clinical and therapeutic features of the first five cases of childhood type 2 diabetes mellitus (T2DM) documented in Togo. The five children were admitted to either the Barruet Clinic (n=4) or Tokoin de Lomé University Hospital Centre (n=1) between 1999 and 2004. All presented one or more of the following risk factors for T2DM: obesity, familial history of T2DM, acanthosis nigricans, polycystic ovary syndrome, dyslipidemia, and high blood pressure. Age at diagnosis was 15 years in two cases and 13, 11 and 12 years in the other three cases (mean, 13.2 + 1.79 years). There were three females and two males. All five patients were obese and had risk factors for obesity (high fat intake, sedentary lifestyle and lack of physical exercise). All had a familial history of T2DM and two had Acanthosis nigricans. All five patients were treated initially with insulin that was gradually discontinued in favor of exercise and diet in four. These are the first reported cases of childhood T2DM in Togo. An education campaign is necessary to inform the population on about the risk factors for T2DM.

[Incidence and impact of HIV infection among patients with bacterial pleurisy in Lomé (Togo)]. / Fréquence et impact de l'infection au virus de l'immunodéficience humaine chez les patients souffrant de pleurésies bactériennes à Lomé (Togo).

A prospective study was made in the Tokoin university hospital in Lomé (Togo) to determine the incidence and the impact of HIV among patients with bacterial pleurisy. Two hundred cases of bacterial pleurisy were consecutively included over 17 months. The HIV diagnostic was performed using ELISA (Vironostika HIV Uni-Form II plus O and HIV1 and 2 Bispot Immunocomb II). The 200 cases of pleurisy included 152 (76%) tuberculous pleural effusion and 48 (24%) pleural empyema. Staphylococcus aureus (32%), Streptococcus pneumoniae (14.9%), and Pseudomonas (14.9%) were the main causes of pleural empyema. The HIV incidence was 61% (122/200). The mortality rate ranged from 26.2% in the HIV positive group to 5.1% in HIV negative group (P = 0.0001). The bacterial aspect of pleural empyema was heterogeneous in both groups but Salmonella Enteritidis and Salmonella Typhimurium were identified only among patients with HIV.