[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.

Tuberculosis in children in Togo: epidemiology, diagnosis, treatment, and outcome.

INTRODUCTION: Tuberculosis (TB) remains one of the most lethal communicable diseases in the world, according to the World Health Organization (WHO). New strategies must be implemented to meet targets for 2035. OBJECTIVE: Describe the epidemiological and therapeutic aspects of tuberculosis in children in Togo. MATERIALS AND METHODS: This retrospective, multicenter, descriptive cross-sectional study examined the files of children younger than 15 years who were diagnosed with TB and treatment in the Maritime region from 2008 to 2011. RESULTS: The study included 74 children aged 0-15 years, for an average of 18 cases of childhood tuberculosis annually. Pulmonary tuberculosis (38 cases) was the most common. TB-HIV co-infection was found in 14.9% of cases. Boys accounted for more than half of the patients. The age range of 11-15 years accounted for the highest proportion of cases (41.9%). The most common treatment was a combination of 2RHZE and 4RH (25 children, 33.8%). Laboratory monitoring was satisfactory. In all, 56 (75.7%) children were cured, and 14 (18.2%) lost to follow-up, while 3 (4%) died (all with TB/HIV). CONCLUSION: Active testing for HIV infection is essential in children with TB, because the combination of the two can be lethal.

[Genital bacterial carriage during the last trimester of pregnancy and early-onset neonatal sepsis]. / Portage génital bactérien au dernier trimestre de la grossesse et infection néonatale précoce.

UNLABELLED: Bacterial infections remain a major cause of morbidity and mortality in newborn infants. OBJECTIVE: To determine the bacterial ecology and pathological status of the genital organs during the last trimester of pregnancy and the germs of the following early-onset neonatal sepsis, in order to evaluate the risk of materno-foetal infections and to find out a drug prophylaxis. METHOD: Vaginal and endocervical samples, usually taken during the first trimester of pregnancy were delayed and taken during the last trimester of pregnancy. A macroscopic examination described the aspect of the vagina, the cervix uteri, leukorrhea and of possible inflammatory lesions or ulcerations. A microscopic examination searched for parasites, epithelial cells, clue cells and leukocytes. The appropriate bacteriological cultures were performed after reading the Gram stain and scoring the vaginal flora. The clinical and cytobacteriological aspects were used to identify the bacterial ecology and the pathological genital states. An exploration was carried out in every newborn suspected of infection. RESULTS: Genital samples were collected from 306 pregnant women. Among them, 118 were at 29-32 weeks of gestation, 104 at 33-36, and 84 at 37-40. The most frequent germs were C. albicans (33,5%), Enterbacteriaceae (20.3%) including E. coli (10.9%), S. aureus (15.4%), Gardnerella (13.6%), and Trichomonas (10.6%), in monomicrobian (79.2%) and polymicrobian carriage (20.8%). Lower genital tract pathological states such as vaginitis (29.4%), bacterial vaginosis (21.5%) or endocervicitis (10.4%), asymptomatic bacterial carriage (23.5%) and normal genital flora (15%) were identified. These pregnancies led to 334 live births with 27 cases of early-onset neonatal sepsis to which endocervicitis (25%) and vaginosis (19,7%) were most often linked. CONCLUSION: Genital samples at the last trimester of pregnancy could evaluate the risk of maternofoetal infections and allow to adapt a drug prophylaxis of Enterobacteriaceae, the most frequent germ of neonatal infections, as it has been done for Streptococcus agalactiae. But larger studies are required to evaluate the risk of maternofoetal infections and to state the drug prophylaxis.

[An epidemiological study of health care seeking behavior by children under the age of 5 years at hospital emergency services in Togo]. / Etude épidémiologique du recours aux consultations hospitalières d'urgence chez les enfants de moins de 5 ans au Togo.

The functioning and efficacy of pediatric emergency services are currently being questioned in many Northern countries, as well as in the South, for example in North Africa. Reference is often made to unjustified medical emergencies in the face of an influx of patients with benign problems who come from socially disadvantaged families. In the university and regional hospitals in three regions in Togo, we compared three categories of under-5 patients: children sent to "day-time" emergency services after triage done by health personnel; those sent to the "ordinary consultation"; and children brought after hours by their family (without referral by a health professional in 92% of cases) and seen in the "after-hours" emergency service. Serious tropical pathology (cerebral malaria, malaria, sickle cell disease) is mainly seen in emergency consultations, in which high hospitalization rates are noted (83% during the day, 67% at night) and a lethality of 3.4%. One cannot therefore use terms such as "false emergencies", "felt" and "medically unjustified" and the pediatric supervisor for the research considered that recourse to after-hours emergency services was justified in 75% of cases. Families using night services have higher educational levels than those sent to day emergency services, the mother's educational level being the main factor associated with certain characteristics of health seeking behavior (duration of symptoms prior to arrival at hospital, recourse to modern medical drugs). There is often a long delay before recourse to hospital: only 45% of children seen after hours and half of those who died came the 1st or 2nd day of the illness. Self-medication at home is usual but recourse to tradi-practitioners appears rare (4%). Several solutions can be envisaged and should be linked: strengthening of the first level of care, technical improvements in emergency services, training of tradi-practitioners in the recognition and referral of emergency cases, improvement of reception practices at the hospital level, prophylactic and preventive measures for tropical diseases.

[Bilateral choanal atresia in the newborn. Recommended management apropos of 1 case observed in Lomé, Togo]. / Atrésie choanale bilatérale du nouveau-né. Conduite préconisée à propos d'un cas observé à Lomé, Togo.

The bilateral choanal atresia is a neonatal emergency. Its diagnosis is easily evoked when faced with a respiratory distress and cyanosis. It is quickly confirmed by a nasal optic endoscopy or when a nasopharyngeal aspiration catheter is held up by an obstacle. Putting a pharyngeal Mayo's cannula is an urgent gesture. The treatment uses transnasal perforation of the septum followed for two months with frequent aspirations.

[Infectious profile of the newborn in a pediatric unit in a regional hospital center in Togo]. / Profil infectieux du nouveau-né dans un service de pédiatrie d'un chr au Togo.

In one year 106 suspect cases of neo-natal infection were admitted to the pediatric ward of CHR in Kara. The principal elements of diagnosis (slow labor, premature membrane rupture, troubled or fetid amniotic fluid, other obstetrical maneuvers or neo-natal reanimation) were related to insufficient follow-up during pregnancy. Given the lack of means for microbiologic investigation we were unable to identify any etiologic agent apart for Plasmodium. However, therapeutic response indicated infections of bacterial origin. The high rates of infectious morbidity (87%) and lethality (36%) could be reduced by the continued training of traditional birth attendants and the application of a maternal child health policy as part of an integrated primary health care program.

[Risk factors associated with prematurity at the University Hospital of Lome, Togo]. / Facteurs de risque associés à la prématurité au CHU de Lomé, Togo.

OBJECTIVE: To determine the premature birth rate and the risk factors of preterm delivery linked to local conditions of life. METHOD: It is a prospective study including all births before 37 amenorrhoea weeks. All social, medical and behavioural factors linked to preterm deliveries have been analysed for and compared with those of the medical literature. RESULTS: Out of 1672 alive births, we identified 186 (11.1%) cases of prematurity and 30.1% of lethality. The main risk factors of preterm delivery were history of adverse pregnancy outcome (17.2%), history of induced abortion (11.3%), maternal age under 20 (26.3%), under 20 year old primipara (38.7%), inadequate antenatal care (66.6%), low level of education (38.7%) and mother suffering of overwork (29%). Other associated factors such as premature membrane rupture, malaria, urinary infections, gravidic toxaemia, genital infections and above all "unmarried-under 20 year old-primipara with low level of education and low socio-economical status", were significantly linked to preterm delivery. CONCLUSION: The risk factors thus identified correspond with the well-known factors. But many factors significantly linked to preterm delivery were local features whose importance could be reduced through better means of perinatal care and prevention.

[Bourneville's tuberous sclerosis and childhood epilepsy Apropos of 4 cases in Togo]. / Sclérose tubéreuse de Bourneville et épilepsie de l'enfant. A propos de quatre observations togolaises.

The authors report four cases of childhood epilepsy symptomatic of tuberous sclerosis. Epilepsy appeared in the forefront of the epileptic scene: in two cases, the features of epilepsy were haut mal and in two cases, WEST'S syndrome. Epileptic seizures began precociously for all children. Mental retardation was identified in three cases with one case of autistic behaviour. Diagnosis was possible given skin lesions, family investigations, and X-ray of the skull. Brain scanners were not carried out on any of the children. Whilst recognizing the scarcity of BOURNEVILLE'S tuberous sclerosis, the authors point out the need for interdisciplinary collaboration in the diagnosis of rare but not exceptional hereditary affections.

[Comparative study of neonatal bacterial meningitis in Lomé, Bobo-Dioulasso, Casablanca and Lyon]. / Analyse comparative des méningites bactériennes néonatales à Lomé, Bobo-Dioulasso, Casablanca et Lyon.

UNLABELLED: Bacterial meningitis in new-borns remains a serious event because of its high mortality and morbidity rates in Africa. OBJECTIVE: To identify the clinical and bacteriological epidemiology and the outcome of neonatal bacterial meningitis in three African cities. METHOD: We have analysed and compared three hospital studies done in humid tropical, Sahelian, and desert Africa with a European study. RESULTS: Compared with the European study this African study is characterized by a high mean frequency of neonatal meningitis (6 cases per year against 1.4), more important risk factors linked to pregnancy and childbirth (50% against 33%), high rates of death (61 to 68% against 5%) and sequelae (25 to 40% against 30%), rarity of Streptococcus agalactiae (7 to 15% against 38%) and absence of Listeria. Enterobacteriaceae were predominant both in African (50 to 68%) and European (43%) studies. E. coli appeared as the most frequent germ in both European and African studies and Salmonella as more frequent in Sub-Saharan Africa than in occidental countries. CONCLUSION: The epidemiological, bacteriological and evolutional aspects of the neonatal meningitis were identical in the three African cities. The African studies were different from the European only by their high incidence, the rarity of S. agalactiae and Listeria and the difficulties of bacterial diagnosis and management, all might explain the high rates of death and sequelae. An epidemiological survey and adequate antimicrobial therapy according to antibiotic susceptibility may improve the outcome.

[Neonatal mortality in the Tantigou pediatric hospital, Dapaong (north Togo) in 1984-1985 and 1994-1995]. / Mortalité néonatale à l'hôpital d'enfants de Tantigou, Dapaong (nord-Togo) en 1984-1985 & 1994-1995.

370 deaths out of 1141 hospitalized cases of newborns aged 0-28 days were retrospectively analyzed in the Tantigou pediatric hospital of Dapaong, situated 645 km from Lome in northern Togo, in 1984-1985 and 1994-1995. A decreasing trend in neonatal mortality was noted: 42.5% and 27.6% respectively. Major causes of death were prematurity or low birth weight, sepsis, hypoxia conditions. The attendance of pregnant women at health information centres seems to be improving, but the neonatal mortality rate remaining high, the implementation of primary health care/Bamako Initiative resulting especially aiming at better prenatal care for pregnant women must be sustained.

[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.

[Congenital malarial disease due to Plasmodium falciparum in high-infection-risk newborn]. / Paludisme congénital-maladie à Plasmodium falciparum chez le nouveau-né à risque infectieux.

UNLABELLED: The aim of this work was to differentiate in an endemic area congenital malaria diseases (CMD) from congenital malaria infestations (CMI) or other maternal-fetal infections. METHODS: Four hundred and seventy-five newborn (0-7 d) suspected of infection were prospectively studied. CMD was diagnosed when clinical manifestations were associated with positive thick and thin blood films in a mother and her newborn. The diagnosis of CMI was retained when despite positive parasitemia, no clinical manifestations were observed. RESULTS: Forty newborns (1.7% of the cases of maternal malaria) were diagnosed as CMD and ninety-one (19% of live births) were considered as CMI. The main clinical manifestations were related to cerebral (100%), respiratory (95%) and hemodynamic (90%) systems. Hematologic signs were present in 95% of cases. The level of parasitemia varied from 700 to 3,000 parasites/mL in CMD and from 360 to 870 parasites/mL in CMI. Death occurred in ten cases (25%) of CMD. CONCLUSION: In this malaria-endemic area, neither clinical manifestions nor parasitemia allow one to distinguish CMD from CMI associated with bacterial materno-fetal infections. Studying placental or systemic immunity and antimalaria IgM in the newborn could be of interest to clarify this problem.

[Upper arm circumference reference values for children aged 1 to 36 months in Lome (Togo)]. / Croissance du périmètre brachial chez l'enfant de un à 36 mois à Lomé (Togo).

BACKGROUND: Mid-upper-arm circumference (MUAC) is widely used as a nutritional status index for children. The aim of our study was to construct MUAC-for-age curves for well-fed 1-36-month-old children of a developing country and to compare them with the WHO reference charts based on samples of American children. POPULATION AND METHODS: Five thousand thirty-eight boys and 4,972 girls aged 1-36 months were recruited cross-sectionally from 1994 to 1997. Their MUAC were measured as recommended by the WHO. To develop the curves, estimations were first obtained for the mean and standard deviation (SD) of MUAC for each month of age using a 7-month segmental regression equation; the Count model and 2nd degree polynomial in age were then used to describe the mean and SD respectively. RESULTS: These curves showed important differences for age and sex and were lower than the reference curves, particularly for the older children. The mean curve was -0.44 to -0.75 SD for boys and 0 to -0.8 SD for girls, far from the WHO's reference. CONCLUSIONS: The authors proposed to take into account the WHO's nutritional recommendations and developing country features in the construction of the reference charts.

[Bacterial flora in the genital tract the last trimester of pregnancy]. / Flores bactériennes génitales au dernier trimestre de la grossesse.

UNLABELLED: Very widespread in our clinical setting, early-onset sepsis is due to organisms that commonly colonize or infect the maternal genital tract; identifying such organisms would help improve prevention and treatment. OBJECTIVE: To determine the bacterial ecology and the pathological status of the genital organs during the last trimester of pregnancy, in order to evaluate the risk of materno-fetal infections and to improve the present prophylactic measures based on monitoring bacterial carriage during the first trimester. METHOD: Vaginal and endocervical samples, usually taken during the first trimester of pregnancy were delayed and taken during the last trimester of pregnancy, in patients with no signs of sepsis and not taking antibiotics. A macroscopic examination described the aspect of the vagina, the cervix uteri, leukorrhea and possible inflammatory lesions or ulcerations. A microscopic examination searched for parasites, epithelial cells, Clue cells and leukocytes. The appropriate bacteriological cultures were performed after reading the Gram stain and scoring the vaginal flora. The clinical and cytobacteriological aspects were used to identify the bacterial ecology and the pathological genital states. RESULTS: Genital samples were collected from 306 pregnant women. Among them 118 were at 29-32 weeks of gestation, 104 at 33-36 and 84 at 37-40. The most frequent germs were C. albicans (33.3%), Enterobacteriaceae (20.3%) including E. coli (10.9%), S. aureus (15.4%), Gardnerella (13.6%), and Trichomonas (10.6%), in monomicrobian (79.2%) or polymicrobian carriage (20.8%). Lower genital tract pathological states such as vaginitis (29.4%), bacterial vaginosis (21.5%) or cervicitis (10.4%) and asymptomatic bacterial carriage (23.5%) and normal genital flora (15%) were identified. CONCLUSION: This is the first report of genital bacterial carriage in African women during the last trimester of pregnancy. Larger studies are required to evaluate the risk of maternofetal infections and to improve current prophylaxis measures.

[Choanal atresia: an abnormality not to be overlooked. Study of three cases in the University Hospital Center of Lome, Togo]. / Atrésie choanale: une malformation à ne pas méconnaitre. Etude de trois cas au Centre Hospitalier Universitaire de Lome, Togo.

Choanal atresia is an uncommon congenital malformation which the midwife or obstetrician must recognize at birth. In this report the authors describe three cases observed at the University Hospital Center of Lome, Togo, in which diagnosis was made late, i.e. at the ages of 7 days, 13 days and 8 months. Atresia identified by rhinoscopy was bilateral in one case and unilateral in two cases. All three cases were treated by transnasal divulsion, using a rubber catheter in 2 cases and a curette in one case, followed by calibration with a Portex catheter that was removed after two months. At 6 months after treatment, all three children presented normal nasal ventilation. Since it can be easily diagnosed and treated, choanal atresia is curable and better training is needed to ensure detection at birth.

[Gastrointestinal and urinary parasitic infection in children at a regional hospital center in Togo: some epidemiological aspects]. / Parasitisme digestif et urinaire chez l'enfant dans un Centre Hospitalier Régional du Togo: quelques aspects épidemiologiques.

To determine the impact of parasitic infection of the digestive and urinary tract in children living in a rural area of Togo, a retrospective study was conducted in a Pediatric Department of Kara, Togo. Results revealed that 35% of the 1610 children between the ages of 0 and 16 years had positive tests for parasites in stools or urine and that 117 had more than one parasite. Trichomonas intestinalis, Entamoeba histolytica, Schistosoma mansoni and Necator americanus accounted for 86.5% of the parasitic infections observed. Parasitic infection was observed during the neonatal period and its incidence increased in males up to the age of 12 years and during the rainy months of the year. Study of associated diseases indicated that 56% of children with parasites also had malaria and that 47% were anemic. Parasitic infection of the digestive and/or urinary tract was noted in 31.8% of children under the age of 5 years with malnutrition.

[Foreign bodies of the esophagus: etiologic and therapeutic aspects. Experience at the CHU of Lomé (Togo)]. / Corps étrangers oesophagiens: aperçu étiologique et thérapeutique. Expérience du CHU de Lomé (Togo).

AIM: To give details of the management of esophageal foreign bodies (EFB) at our hospital. DESIGN: Retrospective case review. SETTING: ENT ward of Tokoin Teaching Hospital, Lome, Togo. PATIENTS: All 105 patients admitted to the hospital for ingestion of foreign bodies between January 1990 and December 1993. The outcome for each patient was determined by examining hospital records of demographic information, identification of the foreign body and the removal procedure used. RESULTS: EFBs accounted for 6.5% of all hospital admissions. The objects ingested included coins (59.0% of cases), particularly in 2 to 5 year-old children, fish bones (12.4%), meatballs, meat bones and dentures, particularly in adults. The foreign objects were mostly removed by esophagoscopy, but sharp objects required esophagotomy (2.9%). One patient died (0.9% of cases) due to mediastinitis caused by perforation of the esophagus by a chicken bone. CONCLUSION: Community health education programs, increasing awareness of household accidents might reduce the number of emergency hospital admissions for ingestion of foreign bodies.

[Prevalence of skin manifestations in AIDS patients in the Lome-Tokoin University Hospital (Togo)]. / Prévalence des manifestations dermatologiques au cours du SIDA au centre hospitalo-universitaire de Lomé-Tokoin (Togo).

A prospective study was conducted for 13 months to determine the prevalence of skin disease in AIDS patients in the Lome teaching hospital. 99 of the 120 AIDS patients (75 males, 49 females) examined during this period had skin diseases (82.5% of the cases). This prevalence was 59.99% during 1 to 3 months of AIDS evolution, 81.77% during 4 to 6 months, and 100% after 6 months. The principal skin diseases were: pruritic papular eruption (33.33%), oral candidiasis (25%), herpes zoster (16.16%), hair dystrophies (13.13%), xeroderma (14.60%), furuncle (10%), seborrheic dermatitis (6.66%), Kaposi's sarcoma (5%) and recurrent folliculitis (4.16%). Thus, the skin diseases were common in AIDS patients in Lome, Togo, and tended to be more frequent as immunodeficiency progressed. Dermatological examination remains important in the detection of HIV infection and AIDS.

[The use of Doppler echocardiography in the diagnosis of congenital heart disease in the Pediatric Department of CHU-Tokoin, at Lomé (Togo)]. / Apport de l'échocardiographie-Doppler dans le diagnostic des cardiopathies congénitales dans le service de pédiatrie du CHU-Tokoin, à Lomé (Togo).

Currently, echography coupled with Doppler is a primary technique in the diagnosis of congenital heart disease. Since September 1993, the pediatric ward of the Tokoin teaching hospital of Lome has been equipped with this technology. During the following 23 months, there were 299 examinations with Doppler-echocardiography among the consultations of 15,082 children. Eighty-two cases of congenital heart defects were detected in 73 children, aged between 3 days and 13 years, of whom 79.4% were between 7 days and 30 months old. In all cases, either pulsed or continuous Doppler-echocardiography was performed at the request of doctors treating symptoms suggestive of cardiac disease, such as heart murmur (67%) and cyanopathy (22%). The noncyanotic cardiopathies found were ventricular septal defects (24%), patent ductus arteriosus (21%), interatrial septal defects (18%) and atrioventricular canal defects (9%). The most frequent cyanotic cardiopathy detected was Fallot's tetralogy (19.5%). Thus, early diagnosis and management of congenital heart disease is facilitated by systematic examination of newborns and sustained collaboration between pediatricians, obstetricians and cardiologists.

[Pediatric AIDS at the University Hospital Center-Tokoin (Lomé): the role of protein-calorie malnutrition and a formulation trial of a clinical diagnostic score]. / Sida pédiatrique au CHU-Tokoin (Lomé): place de la malnutrition protéino-énergétique et essai d'élaboration d'un score de diagnostic clinique.

Two cross-sectional studies were carried out in the pediatric ward of the Tokoin Teaching Hospital, Lome. One study determined the prevalence of HIV infection in the 49 malnourished patients treated in the ward in February to March and between August and December 1994. The other was carried out between July 1994 and January 1995 and included 57 other hospitalized children fulfilling at least one of the WHO's pediatric AIDS criteria. The aim was to draw up a screening system for pediatric AIDS based on clinical scores that would be more sensitive than and as specific as the WHO criteria. We tested these criteria and the other signs used in the suggested scoring system using the reference test, HIVchek. The seroprevalence of HIV was 28.6% in malnourished children and transmission was probably exclusively from mother to child. It was difficult to distinguish pediatric AIDS from protein energy malnutrition on clinical grounds, although some of the associated morbidities, including anemia, adenopathy and splenomegaly, were highly suggestive of pediatric AIDS. The second study showed that: 1) the sensitivity of the WHO criteria was low; 2) the best positive predictive values were obtained in cases of polyadenopathy and confirmed HIV infection of the mother. Both these criteria were relatively infrequent; 3) there were 6 criteria significantly associated with HIV infection, each being given a point score according to its Yule coefficient: chronic cough (4 points), chronic diarrhea (3 points), chronic fever (2 points), oropharyngeal candidiasis (2 points) and marasmus (1 point). A score of 4 points was the threshold for suspicion of pediatric AIDS. Our scoring system was more sensitive than the WHO criteria and had similar specificity and positive predictive value. We stress the importance of preventive measures against HIV infection, particularly for women of child-bearing age and suggest a new score test and appropriate clinical definitions for infants and older children.