Hepatitis B Vaccination Coverage of Preschool Children in Libreville, Gabon: Prevalence and Determining Factors.

OBJECTIVE: We aimed to assess hepatitis B vaccination coverage (vaccine coverage) among preschool children in Libreville, Gabon, and determine associated factors. METHODS: A cross-sectional study was done evaluating hepatitis B vaccination records, by cluster random sampling of children aged 4 months to 5 years from 5 medical centres. RESULTS: Of the 500 children (243 males) included, we found a hepatitis B vaccine coverage of 78.6% (95% CI 75% to 82.2%). Factors significantly associated with vaccine coverage included parental confidence in the vaccine (OR=2.2;95% CI 1.4-5.5), the number of children at home lower than the median (aOR=1.6; 95% CI ; 1.3-3.7). and working mothers/fathers. CONCLUSION: Hepatitis B vaccine coverage in Libreville is lower than WHO objectives. Healthcare providers have a crucial role in building up confidence among parents.

HIV-exposed uninfected compared with unexposed infants show the presence of leucocytes, lower lactoferrin levels and antimicrobial-resistant micro-organisms in the stool.

Background: HIV-exposed uninfected (HEU)-infants have been shown to be particularly vulnerable to infections. In this population, disturbance of the gut micro-environment might increase their susceptibility to enteric diseases and even favour the translocation of bacteria in the bloodstream. Methods: The gastro-intestinal micro-environment was explored in 22 HEU infants and 16 HIV-unexposed (HU) infants aged 6-24 weeks. Faecal leucocytes, firmicutes (gram-positive bacteria) and gracilicutes (gram-negative bacteria) were assessed by cytology. Faecal lactoferrin and sIgA were measured by ELISA. The spectrum of micro-organisms in infants' stool was analysed by culturing. Results: HEU infants were 14 times more likely to have leucocytes in their stool than HU infants (p < 0.005). The lactoferrin level was significantly lower in HEU infants than in HU infants (p = 0.02). Potentially pathogenic bacteria such as Escherichia coli were more prevalent in HEU than in HU infants (64% vs 23.5%). Also, E. coli strains resistant to key antibiotics including co-trimoxazole, ß-lactam (cephalosporins included) and tetraclines were observed in some HEU infants. Conclusion: HEU infants are more likely to present an inflamed digestive tract as highlighted by the presence of leucocytes. In addition, there is a real risk of colonisation of HEU infants' microbiota by resistant micro-organisms.

Nutritional status of children with acute lymphoblastic leukemia: a longitudinal study.

To evaluate the nutritional consequences of acute lymphoblastic leukemia and its treatment, 15 children with leukemia were studied. Anthropometric data, fat-free mass by impedance, energy intake, and resting energy expenditure (REE) were determined at diagnosis and on days 22, 36, and 71 of the treatment. Interleukin (IL)-1 beta, IL-6, interferon-gamma, and tumor necrosis factor were also measured. Fifteen healthy control subjects were matched for age and sex. Body weight and height and body composition were comparable at all times of the study, although three children were underweight at diagnosis (weight-for-height < 85% of French standards). Although two different methods were used for dietary recall in the two groups, energy intake expressed as a percentage of normal recommended values for age and sex was lower in patients than in control subjects (104 +/- 19%) on day 1 (47 +/- 32.1%) and day 22 (58 +/- 24%), but was comparable on day 36 (85 +/- 71%) and day 71 (85 +/- 48%). This low energy intake involved both carbohydrates and fats. Energy and carbohydrate intakes improved significantly during the study in patients. The nonprotein respiratory quotient (RQ) in patients was significantly lower than in control subjects (0.84 +/- 0.04) on day 1 (0.79 +/- 0.02) but was comparable on day 71. The REE of the patients on day 1 (5057.8 +/- 1588.4 kJ/24 h) and day 71 (4844.7 +/- 116.1 kJ/24 h) and of the control subjects (4313.8 +/- 823.5 kJ/24 h) was not significantly different. Cytokines remained undetectable on days 1, 36, and 71. The results showed that at the time of diagnosis and during this period of chemotherapy there was no evidence of raised REE. The poor intakes during the first month of chemotherapy were recent as shown by the parents' questionnaire responses and the absence of consequences in body composition. The transient decrease in RQ seemed to be an adaptative mechanism to the poor carbohydrate intake. No indication of undernutrition in the patients as a group was evident during the first 71 d of treatment although further long-term nutritional assessment is needed.

Percutaneous endoscopic gastrostomy in children: influence on gastroesophageal reflux.

OBJECTIVE: Few data exist in the literature about the relationship between percutaneous endoscopic gastrostomy (PEG) and gastroesophageal reflux (GER) in children, and the data that do exist are contradictory. The aim of the present study was to evaluate the effect of PEG on GER. METHODS: Twenty children underwent PEG for enteral nutrition. They were 55 +/- 55 months old and weighed 13 +/- 10 kg. A pH study was performed before and after PEG without treatment when GER status was unknown (n = 10) or under treatment (n = 10) if previous GER was demonstrated. In these cases, the pH study was performed under the same treatment before and after PEG. RESULTS: Six pH studies had abnormal results before PEG. After PEG, the GER of these 6 children significantly improved after the treatment was intensified (n = 50 or spontaneously normalized (n = 1). Results of 13 pH studies that were previously normal remained normal. Only one child with a normal reflux index before PEG had GER after it. For the 20 children, the mean reflux index did not change significantly after PEG (5.5% vs 5.6%). CONCLUSION: Contrary to surgical gastrostomy, PEG does not worsen GER. Therefore, GER is not a contraindication to PEG.

Effect of glucose to fat ratio on energy substrate disposal in children with cystic fibrosis fed enterally.

High fat containing diets lower VCO(2)in patients with impaired pulmonary function fed at a high level of energy intake. We tested the effect of a high fat enteral nutrition on VCO(2)and substrate oxidation in cystic fibrosis patients fed enterally 130% RDA. VCO(2)and substrate oxidation were studied in a group of eight 6-19 year old patients while receiving for 1 month and in a random order isocaloric (1000 kcal/m(2)), isonitrogenous enteral diet with a normal fat and a high fat content (40% and 67% of non-protein energy intake). Substrate oxidation and net balance were estimated using indirect calorimetry at the end of each study period. Overnight high fat enteral infusion resulted in no significant change in VCO(2)and VO(2)but lowered RQ (0.84 +/- 0.01 vs 0.88 +/- 0.01, P= 0.02) and non-protein RQ (0.83 +/- 0.01 vs 0.88 +/- 0.01). In spite of a higher glucose oxidation rate (8.1 +/- 0.5 vs 6.3 +/- 0.5 g. h(-1), P= 0.04), glucose net balance was significantly higher during normal fat formula administration (+2.5 +/- 0.8 v -0.3 7plusmn; 0.7 g/h, P< 0.05). The present study failed to show any benefit of a high fat diet on VCO(2)in non oxygenodependant cystic fibrosis children and adolescents fed slightly above RAD. Normal fat enteral formula led to higher glycogen repletion.

[Cooley's syndrome in a Togolese nursing infant. Clinical and biological considerations]. / La maladie de Cooley chez un nourrisson togolais. Considérations cliniques et biologiques.

Several possible diagnoses are proposed to explain the symptomatology observed in a slightly jaundiced 10 month-old suckling infant suffering from fever and anaemia. Major beta-thalassaemia in its most severe form (Cooley's syndrome) proved to be the correct diagnosis. The importance of family background is stressed for these haemolytic cases.

[Risk factors for the development of diarrhea in children of 6-36 months carrying enteropathogenic microbes (apropos of 130 cases observed in Lomé-Togo)]. / Etude des facteurs de risque diarrhéogène chez l'enfant de 6-36 mois porteur de germes entéropathogènes (à propos de 130 cas observés à Lomé-Togo).

Diarrhoea, an important cause of infant morbidity and mortality is a priority problem in developing countries. The diarrhoea is most often of infectious origin. This is an evaluation of the parameters susceptible of influencing the carrying of enteropathogenic agents and the apparition of diarrhoea in children 6-36 months of age living in urban and peri-urban areas in the tropics. The study concerns 130 children divided between well nourished and malnourished. To the parameter "nutritional status" most often used in the different studies one finds in the literature, we chose to add a combination of others regrouped under the categories of "type of feeding" and "environmental factors". In our socio-cultural context, these last two parameters are intimately linked to the mother who lives in symbiosis with her child at least until 36 months of age. At the end of the study we were able to put together the results of research on carriage of a large gamut of enteropathogenic agents (parasites, bacteria, viruses) with our chosen parameters. This allowed us observe all the interactions between these two variables, particularly relating to onset of diarrhoea. We were thus able to conclude that the factors characterizing "Food hygiene and environmental hygiene play the most important role whatever the nutritional status of child".

[Routes of care and health of children in Togo]. / Itinéraires de soins et santé des enfants au Togo.

A character of child health in the tropics is that benign diseases elsewhere become serious and even mortal. Thus, in spite of considerable pediatric care in Togo, diarrhoea, malaria, anaemia, malnutrition, and acute respiratory illness remain prevalent and comprise a formidable "gang of 5" for pediatric pathology. The behaviour patterns of families and the population in general confronted by illnesses may in part be responsible for this situation. A survey was conducted over 3 months and based on a questionnaire given to parents bringing their children for consultation at the hospital (CHU) of Lomé. The following proved important aspects concerning the care of sick children: 1) many communities call upon health centers, only when other avenues of health care have failed. The number of emergency cases presenting themselves is therefore increased markedly, as is the number of deaths; 2) malaria and diarrhoea are the main offenders, while less than half the children affected use chloroquine or RVO; 3) self-medication and traditional medicine dominate alternative health care strategies. As a result, access to official health resources is retarded. In conclusion, the efficiency of prophylactic and curative health care would be improved if simple preventive measures were employed at all levels and based upon cultural values adapted to individual populations.

[Bullous toxidermatosis and HIV infection in hospital environment in Lome (Togo)]. / Toxidermies bulleuses et infection à VIH en milieu hospitalier à Lomé (Togo).

A transversal study allowed to analyse the different features of severe bullous toxicodermatosis, and its relations with HIV infection. Since March 1992 to December 1995, 15 patients were hospitalized in Lome Teaching Hospital for severe bullous toxicodermatosis: 16 cases of Lyell's syndrome, 8 cases of Stevens-Johnson's syndrome and 1 case of ectodermosis. The principal drug which induced these diseases were mostly dominated by the sulfanilamide (n = 7). Nine (9) of these subjects were infected by the HIV (four of whose patients had Lyell's syndrome). Its noted five cases of death, all in the patients with HIV infection.

[Use of health facilities by children from 0 to 5 years in Togo. Results of an epidemiological study carried out at a RHC (Atakpamé)]. / Utilisation des structures de soins par les enfants de 0 à 5 ans au Togo. Résultats d'une enquête épidémiologique menée dans un CHR (Atakpamé).

Through a prospective survey coordinated by the CIE of Paris, and carried at a semi-urban regional hospital (Atakpame), the authors studied the use of health structures by inpatient and outpatient consulting children. Questionnaires were filled for the 112 children of the study. Results were as follows: There is a maladjustment between recruitment at the regional hospital and its real mission (emergency cases and special health care). Thus only 13.3% of children were seen for an emergency, and 4.5% admitted for special health case. In the majority of cases (69.4%), the health state of patients was not alarming. Improper channelling of the patients is responsible for this condition. 79.4% of children consult directly at the hospital without prior consultation at the "peripheral" health centers. The regional health center thus finds itself overburdened, whereby long waiting periods before consultation (> 300 mn for certain patients), and delay in the management of referred patients.

[Carriage of Streptococcus B in the mother and infant pair at birth. Apropos of 106 cases]. / Portage du streptocoque B dans le couple mère-enfant a la naissance. A propos de 106 cas.

Streptococcus of group B found in the upper respiratory tract, the genito-urinary tract and the intestines of humans and animals is responsible for peri- and neonatal infections with serious outcomes: septicemia, meningitis. In Togo, the high frequency of neo-natal infections brought us to question the importance of streptococcus B in the mother-child couple at birth and to undertake a study conducted simultaneously in two maternities in the city of Lomé. During 8 weeks, from 19 March-19 May we studied 100 mother-child couples and 300 placentas. The following laboratory samples were taken: from the mother a vaginal smear during labor at 5 cm dilatation and rectal swabbing, from the new-born, a swabbing of the outer ear canal and an aspiration of gastric liquid, a fragment of the placenta taken under conditions of surgical asepsis. The results obtained prove that streptococcus B play an important role in the mother-child couple in Togo. The authors propose that more systematic research be conducted on children at birth with regard to this issue.

[Neonatal esophago-gastro-duodenoscopy. Apropos of 123 examinations performed on 107 newborn infants]. / L'oesogastroduodénoscopie néonatale. A propos de 123 examens réalisés chez 107 nouveau-nés.

UNLABELLED: Upper gastrointestinal endoscopy is frequently used in the neonatal period. The aim of this study was to assess the frequency of the different lesions occurring as well as to precise indications of upper gastrointestinal endoscopy in neonates. POPULATION AND METHODS: A retrospective study including 107 neonates referred between October 1986 and April 1995 has been achieved in the pediatric gastroenterology unit of the Lille University Hospital. Various factors were analysed: gestational age, sex, reasons for endoscopy and macroscopic lesions observed. Three groups were constituted according to macroscopic findings; group I: normal aspect (n = 22); group II: isolated esophagitis (n = 27); group III: esogastritis or gastroduodenitis or esogastroduodenitis (n = 38). Chi 2 test was performed for statistical analysis. RESULTS: Signs recalling esophagitis (cry during feeding) were more frequent in group II than in group III: 37% vs 13% (P < 0.03). The neonates undergoing endoscopy for life-threatening events were more frequent in group I than in group II or III, respectively: 59% vs 15% (P < 0.01) and 59% vs 8% (P < 10(-4). Upper gastrointestinal endoscopy led to a precise diagnosis in 80% of the neonates. However 95% of those examined for hematemesis presented macroscopic lesions. CONCLUSIONS: Hematemesis and suspicion of esophagitis are good indications for upper gastrointestinal endoscopy in neonatal period. In life-threatening events and suspicion of pyloric stenosis, upper gastrointestinal endoscopy is only complementary of more contributive other examinations.

[Contribution of endosonography to the diagnosis and follow-up of pediatric gastric neurofibroma revealing von Recklinghausen's disease]. / Contribution de l'échoendoscopie au diagnostic et au suivi d'un neurofibrome gastrique pédiatrique révélateur d'une maladie de von Recklinghausen.

BACKGROUND: Gastrointestinal involvement in von Recklinghausen's disease (RD) is rare during childhood; its symptoms are late and its prognosis is poor, related to local recurrence and risk of malignant transformation. CASE REPORT: A 13 year-old boy was admitted for hematemesis revealing gastric ulcer. A second episode of hematemesis led to identify a sessile gastric tumor in this patient having numerous skin café-au-lait spots. Recurrent bleeding required laparotomy that showed diffuse infiltration into the anterior gastric wall: histological examination of the excised piece showed characteristic features of neurofibromatosis. The patient was not compliant to the endosonographic survey so that a symptomatic relapse led to total gastrectomy: histological examination did not show malignant transformation. CONCLUSION: Endoscopy is a major tool for identifying gastrointestinal localization of RD but endosonography is necessary to precise the extent of the tumor.

[Long-term follow-up of children with esophageal caustic stenosis]. / Evolution à long terme des sténoses caustiques de l'oesophage de l'enfant.

BACKGROUND: Long term follow-up of children with esophageal caustic stenosis is not well known. The aim of the present study was to describe functional, organic and psychological, as well as social consequences. PATIENTS AND METHODS: Thirty-four children with a mean age of 3 years and 7 months +/- 3 years and 2 months (ranges: 1 month-14 years and 3 months) were included in a longitudinal study. Various parameters have been studied: treatment, functional symptoms, nutritional status (weight/height, body composition) and psychological and social consequences. chi 2 and Mann-Whitney tests were used for statistical analysis. RESULTS: Twenty-one patients have been treated by mechanical dilatations whereas surgery was performed in 12 children; the mean number of dilatations per child was higher in patients treated by dilatations (21 +/- 17 vs 14 +/- 16; P < 0.05). The frequency of dysphagia was not different in patients with colon interposition or not (69% vs 53%; P = 0.1). Nutritional status was not affected by the presence of esophageal caustic stenosis. Psychological and social consequences were characterized by scholastic difficulties, anxiety and severe depression. One case of suicide was observed. CONCLUSION: Children with caustic stenosis should be followed for a long period of time. A multidisciplinary approach is necessary, taking into account medical, social and psychological consequences.

[Nasal transepithelial difference of potential in mucoviscidosis. Clinical application of the measurement]. / Différence de potentiel transépithélial nasal dans la mucoviscidose. Application clinique de sa mesure.

OBJECTIVES: To demonstrate the value of nasal transepithelial potential difference measurements in the diagnosis and assessment of therapeutic effect in cystic fibrosis. METHOD: Nasal transepithelial potential difference was measured in 50 patients with cystic fibrosis (mean age 10 years) and 21 controls (mean age 8 years). RESULTS: There was a very significant increase in nasal transepithelial potential in cystic fibrosis patients (-28 +/- 8 mv) compared with controls (-8 +/- 3 mv) (p < 0.0001). The sensitivity and specificity of this test for the diagnosis of cystic fibrosis were 92% and 95% respectively. Nasal transepithelial potential difference was positively correlated with age (r = 0.43; p < 0.002) in cystic fibrosis patients but no correlation was found in controls. There was no significant difference in potential differences as a function of sex or Delta F508 genotype (homozygous vs heterozygous; Delta F508 vs non-Delta F508). CONCLUSION: These findings demonstrated the value of transepithelial potential difference in the diagnosis of cystic fibrosis and emphasized its capacity to assess the effect of new therapeutic protocols aimed at modifying C1- and Na+ ion transport. It could be particularly helpful for the interpretation of doubtful sweat tests.

[Human African trypanosomiasis: report of three cases]. / Trypanosomose humaine africaine révélée par une fièvre prolongée : à propos de trois cas pédiatriques.

Prolonged fever is an important cause of morbidity in pediatric practice, especially in tropical areas. It is above all a problem of etiological diagnosis given the vast number of etiologies. In sub-Saharan Africa, practitioners more often focus on bacterial infections and malaria at the expense of other infectious diseases such as human African trypanosomiasis (HAT), most often leading to overuse of antibiotics and antimalarials. A dramatic resurgence of HAT, also called sleeping sickness, has been reported during the last few decades in large areas of Central Africa. Furthermore, with the development of air transport, cases of children infected during a trip to Africa can be exported outside endemic areas, making diagnosis even more difficult. This parasitic infection causes a protracted, often initially unrecognized, illness with episodes of fever, headache, and malaise, accompanied by progressive lymphadenopathy, before the development of a progressive meningoencephalitis. These three case reports aim to remind practitioners of clinical and biological signs suggestive of HAT diagnosis in children living in endemic areas or having stayed there during the months prior to visiting the doctor. The prognosis is largely dependent on the precocity of diagnosis and therapeutic support.