[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.

[Anthropometric parameters, frequency and risk factors of intrauterine growth retardation in full-term infants in North Togo]. / Paramètres anthropométriques, fréquence et facteurs de risque du retard de croissance intra-utérin chez le nouveau-né à terme dans la région du Nord-Togo.

OBJECTIVE: To establish fullterm newborn anthropometric parameters to determine the frequency of intrauterine growth retardation and to study mother's and socio-economic risk factors associated with the intrauterine growth retardation in the population in North-Togo. METHODS: Twelve month prospective study in the savana area in North-Togo. One thousand and six alive newborns born after normal single pregnancy, and without severe neonatal diseases were included. RESULTS: The mean birth-weight +/- SD was 2938 +/- 421 g. The incidence of low birth-weight was 11,7%. Among mother's and socio-economic risk factors, teenage mothers, mothers with a weight lower than 50 kg or with body mass index lower than 20 kg/m2 had a significantly high risk of having a child with intrauterine growth retardation (Odds ratio = 2,71; 2,57; 1,57 respectively). Father's job also affected the mother's and newborn's weight. CONCLUSION: The recognition of these easy to identify risk factors should allow specific recommendations for this population.

[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.

Concentrations of riboflavin and related organic acids in children with protein-energy malnutrition.

BACKGROUND: Riboflavin, flavin mononucleotide (FMN), and flavin adenine dinucleotide (FAD) concentrations have been little studied in cases of malnutrition. OBJECTIVE: Our objective was to investigate the effects of malnutrition on riboflavin status and riboflavin's relation with thyroid hormones and concentrations of urinary organic acids. DESIGN: Malnourished children from the savannah in Benin (group S, n = 30) and the coast in Togo (group C, n = 30), as well as 24 control subjects from both regions, were studied. Blood riboflavin, FMN, and FAD were analyzed by HPLC; urinary organic acids were analyzed by gas chromatography-mass spectrometry. RESULTS: Children in group S were more severely malnourished than children in group C. Triiodothyronine concentrations were lower in group S than in group C or the control group (1.12 +/- 0.24 compared with 1.74 +/- 0.18 and 2.92 +/- 0.19 nmol/L, respectively; P < 0.0001). Plasma riboflavin concentrations in group S were higher than those in group C or the control group (66.90 +/- 12.75 compared with 28.09 +/- 9.12 and 20.08 +/- 3.03 nmol/L, respectively; P < 0.001). Plasma FAD concentrations in group S were lower than those in group C or the control group (31.57 +/- 10.19 compared with 59.02 +/- 5.60 and 65.35 +/- 5.23 nmol/L, respectively; P < 0.0001). Dicarboxylic aciduria was higher in group C than in group S or the control subjects. CONCLUSIONS: Children in group S had low triiodothyronine concentrations and low conversion of plasma riboflavin into its cofactors, leading to a plasma FAD deficiency. Plasma FAD was not correlated with urinary dicarboxylic acid concentrations.

[Anemia at delivery in Lome (Togo): prevalence, risk factors and consequences in newborn infants]. / L'anémie à l'accouchement à Lomé (Togo): prévalence, facteurs de risque et répercussions chez le nouveau-né.

A prevalence study was carried out on 125 mothers and their newborns in Lome (Togo): at delivery 48% of the mothers and 30% of the newborns were anaemic according to WHO criteria. Iron deficiency was the major determinant of anaemia in the mothers, as three out of four showed at least one biochemical indicator of iron deficiency. Folate deficiency was detected in 68% of the mothers but did not influence their haematological parameters. Severe iron deficiency in the mothers (serum iron < 7 mumol/l) was associated with a decrease in serum iron in the newborns, thus demonstrating an impaired iron transfer to the fetus. Folate supplementation of the mothers during pregnancy improved their newborn's folate status. A systematic ferro-folic supplementation is needed during pregnancy and would be beneficial to both mothers and newborns. Supplements could be given to women at prenatal care clinics. Attendance in these centers by 98% of pregnant women in Lomé allows us to anticipate a good coverage for such an intervention.

[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.

[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.

[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.

[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.

[Neonatal septicaemia: bacteriological aspects and outcome in the university hospital center of Lome]. / Septicémie néonatale: aspects bactériologiques et évolutifs au centre hospitalier universitaire de Lomé, Togo.

UNLABELLED: Despite the progress in neonatal intensive care and antibiotics, the neonatal septicaemia remains very frequent and lethal in tropical areas. OBJECTIVE: To study the bacteriology and outcome of the neonatal septicaemia through an analysis of 50 confirmed cases. METHODS: Every child aged of less than 29 days, suspected of infection and with at least one positive blood culture has been included. His perinatal antecedents, clinical features, bacteriological findings, treatments and clinical outcome have been collected. The patients have been divided into 3 groups in regard to the postnatal age at the first positive blood culture: before 48 hours, between 3 and 7 days and after 7 days of life. RESULTS: The neonatal septicaemia occurred in 50% of the cases before 48 hours, 24% from the 2nd to the 7th day and 26% from the 8th to the 28th day of life. Enterobacteriaceae (54%) with E. coli predominant (30%) and S. aureus (28%) were the most frequent germs and particularly during the first week of life: 20/27 and 11/14 respectively. The resistance to the association of ampicillin or amoxicillin and gentamicin was 70% for Enterobacteriaceae and 71% for Staphylococci. The lethality was 36% with an excess of lethality for S. aureus (43%). CONCLUSION: The high rates of frequency and lethality of the neonatal septicaemia in tropical areas require a perinatal care improvement to reduce its morbidity and mortality.

[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.

[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.

[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.

[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.

[Post-hemolytic renal failure in children with glucose-6-phosphate dehydrogenase deficiency at the University Hospital Center in Lome]. / Insuffisance rénale post-hémolytique chez l'enfant déficient en glucose-6-phosphate déshydrogénase au Centre Hospitalier Universitaire de Lomé.

The purpose of the study was to identify predisposing factors for acute hemolysis and post-hemolytic renal failure in children with glucose-6-phosphate dehydrogenase deficiency (G6PD). Any child presenting hemoglobinuria during the study period was prospectively evaluated. Evaluation included detection of the presence of hemolytic agents, laboratory tests to measure hemolysis, G6PD activity, infection and renal failure, and assessment of outcome and management of hemolysis and renal failure. G6PD deficiency was documented in 32.1% of the 230 children admitted with hemoglobinuria. Anuric renal failure occurred during the hemolysis episode in 35.1% of patients with G6PD deficiency (21 boys and 5 girls between 30 months to 13 years old). Acute hemolysis associated with infection occurred before any treatment in 53.8% of cases and after beginning treatment in 46.1%. In 84.6% of cases, occurrence of acute hemolysis involved association of drugs considered as nonhemolytic either with themselves or with other drugs. Anuric renal failure occurred after beginning treatment in all cases and was most severe in patients with of multiple-germ infection (30.7%) and drug association (84.6%). Renal failure was reversible in 80.7% and fatal in 19.2%. Multiple-germ infection and drug association appeared as the main predisposing factors for post hemolytic anuric renal failure in patients with G6PD deficiency. The high frequency of these factors in tropical areas suggests implication of local endemic infections.

[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.

[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.

[Factors related to pathologies in the early neonatal period at the University Hospital Center of Lome (Togo)]. / Facteurs lies aux pathologies en periode neonatale precoce au CHU-Tokoin de Lome (Togo).

PIP: Early neonatal mortality is responsible for almost 75% of overall neonatal mortality in West Africa. In a prospective study of 3174 live births, the authors examined the pathologies diagnosed in newborns aged 0-7 days admitted to the Neonatology Unit of Tokoin Hospital in Lome, explored the factors associated with these pathologies, and studied their hospital evolution. The study was conducted over a 6-month period from early February to the end of July 1996. 250 subjects were included in the study. Infection (36.4%), cerebral disturbance (19.6%), prematurity (16.4%), respiratory difficulties (7.6%), and hemorrhagic disease (4.8%) were the main pathologies observed during the early neonatal period, affecting 84.8% of all subjects. The overall death rate was 52.8%, of which 64.4% died during the first 48 hours of hospitalization. Neonatal and maternal factors associated with these pathologies are discussed. The main factors linked to these pathologies during the early neonatal period are the condition of young primiparous women, the low socioeconomic level of the mothers, poor pregnancy management, and the poor perinatal environment.^ieng