Paediatric tuberculosis at the national teaching hospital CNHU-HKM of Cotonou, Benin: a retrospective study.

UNLABELLED: BACKGROIUND: Tuberculosis (TB) is a public health problem. Knowing its patterns could help address it more efficiently. OBJECTIVE: To determine the hospital incidence, presentation, management, and outcome of TB in our setting. METHODS: We conducted a chart review of children with TB during a five-year period at the University Hospital CNHU-HKM, Cotonou, Benin. RESULTS: Hospital prevalence of TB among hospitalised children was 0.2%. The mean age was six years, with a male:female ratio of 1.4:1. The common clinical features were: cough (78.1%), long standing fever (81.2%), growth retardation (65.6%), pulmonary consolidation (53.1%) and hepatosplenomegaly (34.4%). The skin tuberculin test was positive in only 40.6% of cases. Co-infection with HIV was present in 51.8% of cases. Mycobacterium tuberculosis could be identified in only 21.8% of cases. Twenty-six (81.2%) pulmonary tuberculosis (PTB) cases were diagnosed, eight (25%) of which were associated with extra pulmonary TB. Six (18.7%) presumed isolated extra PTB were also diagnosed. Eight-month treatment regimen was used in most patients, with mortality rate of 9.3%. CONCLUSION: Although TB hospital prevalence seems low in our setting, management needs to be improved according to guidelines.

Tumoral calcinosis due to GALNT3 C.516-2A >T mutation in a black African family.

Familial Tumoral Calcinosis (FTC) is a rare autosomal recessive disorder of the phosphocalcic metabolism caused by mutations in the FGF23 or GALNT3 genes. We have identified a Beninese family in which two brothers present FTC caused by a homozygous A>T transversion at the acceptor splice site in intron 1 of GALNT3 gene. We report on the clinical, biochemical, histopathological and molecular spectrum of the disorder in this family. The particularly severe phenotype, the amelogenesis imperfecta, and the carbapatite deposit observed in these patients, seem to be characteristic of our observations.

[Evaluation of the quality of screening and management of infant malnutrition in Cotonou, Benin]. / Evaluation de la qualité du dépistage et de la prise en charge de la malnutrition infantile à Cotonou, Bénin.

The purpose of this study was to evaluate the quality of screening and management of infant-juvenile malnutrition in medical/social centres in Cotonou, Benin, the nation's capital and largest city. Study was carried out in 19 public and private medical/social centres selected on the basis of their nutritional activity. Data was collected using 5 methods, i.e., retrospective review of the each centre's records, evaluation of physical resources available at each centre, observation of care providers (n=90), questionnaire concerning nutritional activities for the person in charge of each centre (n=19), and questionnaire about care for the mothers of children consulting at the centres (n=43). The overall prevalence of malnourished children identified by screening at the medical/social centres was low (2.2 %) in comparison with the prevalence of malnutrition in Cotonou (20.3 %). Less than half of the centres (47.4 %) used growth charts. None of the centres had a "thinness chart". Many centres (28.6 %) used material intended for cooking demonstrations. Most centres (75 %) conducted effective Information Education and Communication (IEC) sessions and all authorized centres had required essential medications on hand. Observation of care providers showed that 35% could not perform basic anthropometric measurements. Use of growth charts was lowest among physicians and medical assistants. No doctor provided nutritional counselling. Based on responses to the questionnaire the general knowledge of care providers was good despite the lack of supervision and continuous education. Analysis of the responses of the mothers who brought their children to the centres indicated that malnutrition was never the initial reason for seeking medical attention and only 39 % understood that their child was malnourished upon leaving the centre. These findings indicate that the quality of screening and management of infant-juvenile malnutrition in Cotonou is poor. There is a need to develop a program to fight malnutrition which is a major health problem in the city. Special measures will be necessary for the urban setting.

Wolf Hirshhorn syndrome in a case of ring chromosome 4: phenotype and molecular cytogenetic findings.

Ring chromosome 4 associates concomitant loss of the telomeric 4p and 4q regions and leads to variable clinical manifestations depending on the size of the deleted chromosomal material. We report on a patient with ring chromosome 4, showing the Wolf-Hirshhorn Syndrome (WHS) phenotype and minor symptoms of distal 4q deletion syndrome; the severity of the signs of WHS masks the symptomatology of the 4q deletion syndrome. The absence of seizures despite the absence of the specific 4p16.3 region with haploinsufficiency of the LETM1 gene is striking. The double telomeric deletion due to the ring chromosome formation confirmed by FISH has been rarely described in WHS.

[Epidemiologic aspects of infant-juvenile malnutrition in Cotonou, Benin]. / Aspects épidémiologiques de la malnutrmon infanto-juvénile a Cotonou (Bénin).

The prevalence of malnutrition in Benin has been estimated at 29% and infant-juvenile mortality rate at 156% per hundred. Because there is no specific data on the prevalence of malnutrition in Cotonou, a transverse descriptive study was undertaken to determine the rate and features of malnutrition. Anthropometric measurements were performed in African children who were between 0 and 36 months of age and had been living in Cotonou for at least 6 months. A questionnaire was administered to the mothers of all children including study of risk factors and assessment of food intake for the last 24 hours. A semi-assisted interview was carried out with the mothers of undernourished children to determine awareness of their child's condition. A total of 1085 children were included in the study. The prevalence of malnutrition according to type was 20.6% for stunting (Inadequate height for age or chronic malnutrition), 14.6% for underweight (inadequate weight for age) and 3.6% for wasting (inadequate weight for height or acute malnutrition) including severe cases in 6.4%, 2%, and 9.6% respectively. Our data did not demonstrate a significant correlation between malnutrition and any of the following factors: profession of the father, education of the mother, use of contraception, ongoing pregnancy, number of brothers and sisters, number of siblings, or sleeping under a bed net. Conversely malnutrition was significantly correlated with the following factors: history of malnutrition in siblings, soclo-economic level, inadequate food Intake in the last 24 hours, and regularity of medical surveillance of children (although a significant relationship was not found between malnutrition and activity at health care centers). Findings from the 81 interviews carried out with mothers of undernourished children showed that 35% were unaware of the nutritional status of their child. Only 6.1% of mothers who recognized a development problem attributed it to food intake. Only one third of the mothers of the 75 undernourished children that had been examined in a health care centers had been informed by a health care worker that their child was undernourished and one third of mothers had undertaken no action to Improve the condition of their child.

[Role of severe anemia and hypoglycemia in severe malaria's mortality in children in a pediatric ward in Parakou (Benin)]. / Role de l'anemie severe et de l'hypoglycemie dans la mortalite du paludisme grave de l'enfant en milieu hospitalier a Parakou (Benin).

AIMS: In this study, the objective was to determine the proportion of severe anemia and hypoglycemia in severe malaria in children and to identify factors influencing death. PATIENTS AND METHODS: This is a descriptive and analytic cross-sectional study with prospectively collected data from January to December 2009. It included children from one month to fourteen years of age hospitalized in the Parakou Regional Hospital Center in Benin for severe malaria according to the World Health Organization (WHO) criteria. RESULTS: Among the 1838 cases, 968 cases (52.6%) had either severe anemia or hypoglycemia or both. Among these, 89% were under 5 years. Biologically, the mean parasite density was 40 062/mm3 and the mean hemoglobin rate was 4.94 g/dl. The average blood glucose was 0.45 g/l. The mortality rate was 8.2%. Death occurrence rate was significantly higher in under five children's group hospitalized for severe anemia and/or hypoglycemia compared to those of the same age group with others forms of severe malaria (p=0,000081). CONCLUSION: This work suggests the importance of hypoglycemia and anemia among factors associated with death in children's severe malaria.

BUTS: Dans cette étude, l'objectif était de déterminer la part des anémies sévères et des hypoglycémies dans le paludisme grave de l'enfant et d'identifier les facteurs influençant le décès. PATIENTS ET MÉTHODES: Il s'est agit d'une étude transversale descriptive et analytique menée de Janvier à Décembre 2009. Elle a inclus les enfants de un mois à quatorze ans révolus hospitalisés dans le Service de Pédiatrie du Centre Hospitalier du Borgou à Parakou (Bénin) pour paludisme grave selon la définition de l'Organisation Mondiale de la Santé (OMS). RÉSULTATS: Parmi les 1838 cas, 968 cas (52,6%) avaient présenté soit une anémie sévère, soit une hypoglycémie, soit les deux à la fois. Le taux d'hémoglobine moyen était de 4,94 g/dl avec une glycémie moyenne de 0,45g/l. Le taux de décès était de 8,2%. CONCLUSION: Ce travail a confirmé l'importance de l'hypoglycémie et de l'anémie parmi les facteurs associés au décès au cours du paludisme grave de l'enfant.

Molecular characterisation of Plasmodium reichenowi apical membrane antigen-1 (AMA-1), comparison with P. falciparum AMA-1, and antibody-mediated inhibition of red cell invasion.

Apical membrane antigen 1 is a candidate vaccine component for malaria. It is encoded by a single copy gene and has been characterised in a number of malaria species as either an 83-kDa de novo product (Plasmodium falciparum; Pf AMA-1) or a 66-kDa product (all other species). All members of the AMA-1 family are expressed during merozoite formation in maturing schizonts and are initially routed to the rhoptries. Processed forms may subsequently be associated with the merozoite surface. Because of the unique occurrence of the 83-kDa form in P. falciparum we were interested to determine whether the phylogenetically closely related chimpanzee malaria Plasmodium reichenowi shared characteristics with Pf AMA-1. Here we show that the molecular structure, the localisation and processing are similar to that of Pf AMA-1 and that in vitro growth inhibitory mAbs reactive with Pf AMA-1 also inhibit P. reichenowi growth in an in vitro assay. Polymorphism in the 83-kDa AMA-1 family was analysed through comparison of Pr ama-1 with Pf ama-1 alleles, which showed the most significant evidence for selection maintaining polymorphism in Domains I-III of AMA-1 in P. falciparum. The most substantial divergence between Pr AMA-1 and Pf AMA-1 sequences was in the N-terminal region unique to the 83-kDa form of AMA-1. It was confirmed that the specific Pr ama-1-type allele was not present among P. falciparum parasites in an African population, and an allele coding for lysine at amino acid 187 was uniquely associated with field isolates in this population.

[Malaria of importation in the child: epidemiological, clinical and therapeutic analysis. Apropos of 70 cases observed in a pediatric hospital in Paris]. / Le paludisme d'importation chez l'enfant: analyse épidémiologique, clinique et thérapeutique. A propos de 70 cas observés dans un hôpital pédiatrique parisien.

Seventy children from 7 months to 15 years old have been treated for malaria at Hospital Trousseau (Paris) during years 1987 and 1988. Thirty nine of them were living in France usually. The infection was one chiefly in Africa (68 cases), and by P. falciparum in 78% of children. The digestive symptoms were frequent (40/70); splenomegaly was observed in 40 children and hepatomegaly in 31. Anemia was present in 59 cases and mild thrombopenia for 31 cases. The C. reactive protein raised in 92% of cases. The diagnosis was late in 31 patients. Only one cerebral malaria case was observed. The chemoprophylaxis was unfitted or absent in 74% of children living in Paris. The chloroquino-resistance was clinically present in 17 cases and the mefloquine was more often used during 1988 year.

[Caustic burns of the esophagus in children: experience at the National Hospital and University Center of Cotonou]. / Les brûlures caustiques de l'oesophage chez l'enfant: expérience du CNHU de Cotonou. A propos de 52 cas.

Fifty-two children (mean age = 4.1 years) were admitted from 1992 to 1997 for an caustic burn of the oesophagus. Caustic ingestions were accidental in children less than 10 years old and mainly suicidal in older children. Burns were due to alkaline (82%), acids (14%), ou insecticide (4%). The ingested product was decanted from its original packing in 88% of cases. Thirty-six patients had an exclusive medical treatment, including a naso-gastric tube in 3. Endoscopic treatment included naso-gastric tube (n = 4) and bouginage (n = 5). An oesophagoplasty using a colonic transplant was performed in 8 children (15%), always after a previous feeding gastrostomy to improve the nutritional status. There was no operative mortality. These results conform with the main points of the literature. They underline the difficulties in the management of patients with caustic burns of the oesophagus and allow to determine preventive measures of this disease in children of Benin.

[A study of malaria morbidity in a pediatric hospital service in Benin (West Africa) in 1988 and 1989]. / Une étude de la morbidité palustre dans un Service hospitalier de Pédiatrie au Bénin (Afrique de l'Ouest) en 1988 et 1989.

Authors report on a prospective study about malaria morbidity, carried out from April 1988 to March 1989. Malaria diagnosis was based on: 1. An unexplained fever, hours before, during or after entrance. 2. A parasitic density superior to 3,000 trophozoites per mm3 of blood. 3. Efficacy of parenteral malaria therapy. Among 480 hospitalized children, 20% suffered from a malaria attack; 44% of malaria attacks occurred within 6 and 23 months of age. Thus, malaria incidence seems considerable in this urban and lagoon environment. Malaria attacks were observed all year long but with unequal seasonal rates of incidence. As regards malaria morbidity studies, we propose that rates of incidence should be calculated according to several parasitic density thresholds so as to be able to compare various works.

[An update on severe pediatric malaria in Central Africa hospital units]. / Les aspects actuels du paludisme grave de l'enfant en milieu hospitalier pédiatrique centrafricain.

OBJECTIVE: The authors had for aim, to determine the frequency and the main clinical forms of severe malaria and to evaluate its management. PATIENTS AND METHODS: A cross-sectional investigation was made in the "Complexe Pediatrique" of Bangui, the only children hospital of the CAR capital, from 12 January to 12 September 1998. The survey included children 6 months to 15 years of age presenting on admission with a positive thick drop examination, and at least one of the clinical symptoms of severe malaria as defined by the World Organization of Health (WHO). RESULTS: Four hundred and thirty-two children were included. Those from 6 months to 4 years of age accounted for 89.35% of the studied population. The most frequent clinical forms were neurological 31% and anemic 22.2%; the other forms were combined in 42.8%. Managing patients consisted of an etiologic treatment by quinine (91.7%) or sulfadoxine pyrimethamine (3.2%) and symptomatic treatment in the following proportions: rehydration: 49.3%; blood transfusion: 36.3%; preventing seizure: 72.9%; oxygen therapy: 77.5%; use of antipyretics: 96.7%, and correction of hypoglycemia: 9%. The death rate remained high with 62 deaths (14.35%). It was higher in combined forms (48 deaths out of 62). CONCLUSION: Severe malaria and its various clinical forms remain a major problem for our pediatric intensive care unit. Updated technical means and human resources could improve the management of severe pediatric malaria.

[Renal complications associated with human acquired immunodeficiency virus infection in a population of hospital patients at the Hospital and University National Center in Cotonou]. / Complications rénales associées à l'infection par le virus de l'immunodéficience acquise humaine dans une population hospitalisée au CNHU de Cotonou.

We studied 92 HIV-positive patients retrospectively between January 1994 and December 1996 and prospectively from January to July 1997. We determined serum creatinine and 24-hour proteinuria. The median age of the patients was 22 (+/- 4) years and most patients were aged between 25 and 45 years. The sex ratio was 2.17 and most patients were infected with HIV-1 (67.39%). Renal failure occurred in 27.16% of cases, due to changes in blood pressure and infectious diseases. Three patients had a nephrotic syndrome caused by HIV. Thirty-eight cases of lung infection, ten of urinary infection, twelve infections of the digestive system and fifteen cases of skin infection were recorded. The median duration of stay in hospital was 23 (+/- 8) days and the median cost of hospitalization was 147,450 F CFA (+/- 31,057). The treatment given was purely symptomatic and three patients died during the study. One patient suffered chronic renal failure and is now undergoing hemodialysis. Preventive treatment would be of great value.

[Profile of HIV-infected children at the National University Hospital of Cotonou (CNHU)]. / Profil des enfants infectes par le vih suivis au centre National Hospitalier et Universitaire (CNHU) de Cotonou.

OBJECTIVE: To describe the profile of HIV-infected children. METHODS: This was a cross-sectional, descriptive and analytic study involving 317 infected children, monitored from January 1st, 2002 to July 31st, 2010 at CNHU of Cotonou. RESULTS: The average age was 89.1 months with a sex ratio of 0.91. Orphans of at least one parent represented 31.3% of cases. Vertical transmission was predominant (86.1%). Only 9.5% of patients benefited from PMTCT. They were all infected with HIV 1. According to the WHO classification, 52% were at stage 3 or 4 and 56% had advanced to severe immunodeficiency. 61% had suffered from opportunistic infections, and 53% had benefited from antiretroviral therapy. Following the study, 54% of participants had continued follow-up visits, 23% lost contact with the CNHU, 18% died and 5% were referred to another site. Factors associated with outcome were antiretroviral therapy (p < 0.0001), clinical (p < 0.0001) and immunological stage (p = 0.0042) on admission. CONCLUSION: Our findings suggest strengthening the PMTCT program, screening and early management of an HIV infection.

OBJECTIF: Décrire le profil des enfants infectés par le VIH. PATIENTS ET MÉTHODES: Etude transversale, descriptive et analytique portant sur 317 enfants infectés, suivis de Janvier 2002 à Juillet 2010. RÉSULTATS: L'âge moyen des enfants était de 89,1 mois ; le sex ratio de 0,91. Ils étaient orphelins d'au moins un parent dans 31,3% des cas. La transmission était essentiellement verticale (86,1%). Seulement 9,5% avaient bénéficié d'une prophylaxie antirétrovirale pour la PTME. Ils étaient tous infectés par le VIH 1. Selon la classification de l'OMS, 52% étaient à un stade clinique 3 ou 4 et 56% avaient un déficit immunitaire important ou sévère. 61% avaient souffert d'infections opportunistes, et 53% avaient bénéficié du traitement antirétroviral. Quant à leur devenir, 54% avaient continué le suivi, 23% étaient perdus de vue, 18% étaient décédés et 5% transférés sur un autre site de prise en charge. Les facteurs associés au devenir étaient le traitement antirétroviral (p < 0,0001), les stades clinique (p < 0,0001) et immunologique (p = 0,0042) à l'admission. CONCLUSION: Ce profil suggère le renforcement du programme de la PTME, un dépistage et une prise en charge précoces.

[Usefulness of neonatal exams at Cotonou University Hospital, Benin]. / Utilite De L'Examen Systematique Du Nouveau-Ne Au CNHU De Cotonou Au Benin.

AIM: To determine the rate of systematic examination completion, the characteristics of the newborns and the diseases that they bore. METHOD: It was a cross-sectional and descriptive study conducted on newborns that were received for systematic examination from January 1rst 2008 through December 31rst 2009. Consultations were performed by pediatricians. The data that were collected, included in details the rate of implementation of the systematic examination, the neonates demographic characteristics, detected diseases and risk factors. RESULTS: In 2 years, 1325 infants were seen for systematic examination in the neonatal unit of National Teaching Hospital of Cotonou. The global completion rate was estimated to 52%. Newborns were categorized as healthy, at risk of illness or ill in respectively 35.54%, 11% and 53% of cases. The diseases that were found encompassed jaundice (78%), neonatal infections (15%), antenatal growth retardation (12%), prematurity (10%) and birth defects (4.50%). Out of 707 sick newborns, 139 had been hospitalized with a fatal outcome in only one. CONCLUSION: The newborns systematic examination is useful. We do think that it should be generalized if we hope to reduce the neonatal mortality rate in Sub-.Saharan African countries.

[Pleural effusion in children at the National Hospital Center and University of Cotonou: epidemiological, clinical and therapeutic aspects]. / Pleuresie chez l'enfant au Centre National Hospitalier et Universitaire de Cotonou: aspects epidemiologiques, cliniques, paracliniques et therapeutiques.

AIM: To study the epidemiologic, clinic, biologic and therapeutics aspects of pleural effusion at National university healty center (CNHU) of Cotonou. METHOD: From January 2004 to December 2008, we have conduct a retrospective study in the pediatric service of Cotonou's CNHU. 15 children less than 5 years old were included in the study. A chest X ray radiography have been done for all the children at the hospitalization. Epi info and chi square test were used for the statistical study. RESULT: Pleural effusion's incidence is growing in the service and in this statement children old less than 5 years are more concerned. Fever, chest and abdominal complaints were the most clinical sign.The diagnosis of pleural effusion was established in 56.3% and Staphylococcus aureus was found. Antibiotic, pleural puncture and blood transfusion were used as therapeutics method. Mortality rate was 5.6%. In conclusion, pleural effusion management in Cotonou CHNU is suffering by the etiologic diagnosis of the disease.

[Investigation and treatment of vitamin A deficiency in children suffering from malnutrition]. / Enquete et soins de la carence en vitamine A chez les enfants atteints de malnutrition.

PIP: In Benin, physicians performed the ocular impression test on 18 malnourished children admitted to the university pediatric service in Cotonou to determine the occurrence of vitamin A deficiency. They put a millipore filter paper on the enlarged conjunctiva to lift off cells, which were then transferred to a slide. After the cells had been colored and fixed, laboratory personnel examined the cells under the microscope. Only one malnourished child had normal conjunctival cells. 17 children had vitamin A deficiency. The ocular impression of 7 of them indicated a deficiency of conjunctival cells (a prevalence of 39%). Among healthy children, 12.6% had vitamin A deficiency. 2 children presented at the hospital with an ulceration of the cornea in the right eye, which had developed into blindness. A diet rich in vitamin A in the form of palm oil supplemented with 100,000 units of vitamin A provided treatment of vitamin A deficiency among the malnourished children. Two months after treatment the ocular impression test revealed that the eyes had returned to normal.^ieng

[Accidents linked to traditional treatment of convulsions of infants and children in Benin]. / Les accidents lies au traitement traditionnel des convulsions du nourrisson et de l'enfant au Benin.

PIP: Convulsions represent a frequent pediatric emergency in southern Benin and Nigeria, where they are estimated to occur in 15% of hospitalizations. The principal cause is fever during a malarial attack. The health team provides symptomatic treatment and searches for the etiology so that adequate treatment can be provided. For the family faced with convulsions, the major concern is to bring the child out of the convulsive state at almost any price. The 3 products most commonly used by parents and other caretakers are cod liver oil, honey, and lemon, which are administered orally often in combination in hopes of provoking vomiting or stimulating the child to regain consciousness. Other substances sometimes administered include cow or cat urine, garlic or onion, and rubbing alcohol. Articles such as spoons or sticks or fingers may be used in attempts to loosen the jaws and avoid blockages. Flagellation may be used to revive the child. Scarification or fumigation may be done to combat sorcery or chase away evil spirits. A hand or leg may be plunged into boiling water or fire to revive the child from a postconvulsive coma. Use of these techniques explains the high rate of mortality or morbidity following convulsions, Morbid states induced by traditional treatments of convulsions may include false bronchial route, ocular or cutaneous burns buccal lesions, injuries to the nasal cavities or lips, and edema of the cheeks. A survey of parents indicated that 37% of families interviewed had been present at a convulsive crisis of their children or siblings. Convulsions were considered a natural ailment by only 55% and a sign of sorcery and malediction by 36%. 84% of parents surveyed knew about possible sequelae of traditional treatments and 40% used them. 90% of families knew about possible sequelae of traditional treatments but explained them by the seriousness of the convulsions or sorcery. 69% felt that more adequate treatment should be found. The best preventive measures would be to prevent malaria and fevers which are the main causes of convulsions. Parents should be taught to substitute intrarectal administration of diazepam if needed and that most crises terminate spontaneously within a few minutes. Children with convulsions should be placed in the lateral position to avoid inhalation of secretions, and should be brought to the nearest health center.^ieng

[Prevention of infectious diseases in the drepanocytic child]. / Prevention des maladies infectieuses chez l'enfant drepanocytaire.

PIP: Children with sickle cell anemia are more exposed to infection than healthy children. Indeed, infections are the major cause of morbidity and mortality in children with sickle cell anemia, especially those aged 6 months to 5 years. Phagocytosis is reduced in these children. Polynuclear neutrophils reveal various poorly understood irregularities and are associated with a reduction of phagocytic power: zinc deficiency, reduced post-phagocytic oxidative metabolism, and a prevalence of neutrophils not forming red sheep-like globule carriers of immunoglobulin H. The power of the antibody which renders germs susceptible to phagocytosis in the serum is reduced in sickle cell patients. This may be tied to a disorder in the alternate complementary route with reduction of C3 and properdin. Sequestration of sickle cell-shaped red blood cells, splenic congestion, and short circuits of important functional territories contribute to spleen dysfunction, which occurs early. Common pathogens attacking sickle cell patients are pneumococci, salmonella species, and Haemophilus influenzae. They cause very grave infections (e.g., septicemia and purulent meningitis). Prevention of infections dwells on three perspectives: early screening for sickle cell anemia and for spleen dysfunction, preventive penicillin therapy, and vaccination. In Benin, vaccination is the only means to prevent infections. Essential vaccinations for children with sickle cell anemia include BCG, diphtheria-pertussis-tetanus, polio, and Rouvax. Strongly recommended vaccinations are Pneumovax 23, HEVAC B, TAB, vaccine against H. influenzae, and vaccine against mumps. A vaccine calendar for children with sickle cell anemia guides health workers when they must administer the vaccines and their boosters over a six year period. It is not yet universal in health facilities in Benin. A short- and long-term evaluation of the calendar's efficacy would allow one to appreciate its real impact on reducing morbidity and mortality in children with sickle cell anemia.^ieng