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.

[Prevention of HIV mother to child transmission in Cotonou: child follow-up]. / Suivi de l'enfant de mère infectée par le VIH dans le cadre de la prévention de la transmission mère-enfant à Cotonou (Bénin).

UNLABELLED: The aim of this survey was to analyse the constraints of implementing on a larger scale the protocol of prevention of HIV/AIDS from mother to child by Nevirapine intake. This survey takes stock of the components of the children medical care follow-up. PATIENTS AND METHODOLOGY: Here is a straight line survey on 231 newborns from 222 screened mothers during pregnancy in 36 Health Centres in Cotonou and suburbia. Nevirapine has been administered in a single dose of 200 mg to mothers during labour and a dosage of 7 mg to the infant at birth. These infants have been steadily followed-up from 13 June 2000 to 30 April 2002. Exclusively feeding either on artificial milk or breastfeeding and a premature weaning at four months of age have been recommended. PCR screening has been conducted at one and six months of age or one month after the effective weaning. Cotrimoxazole has been systematically administered at six weeks. RESULTS: HIV/AIDS sero prevalence was globally evaluated at 4% in the screened pregnant women. One hundred and ninety seven mothers and children have effectively benefited from nevirapine intakes and this protocol has been adequately observed in 51% cases. The medical check-up rate was 18.5%. The average age of children under medical care was 10.8 months at the end of the study. The mother to child transmission rate was globally estimated at 20.4% and 7% in an optimal situation (the protocol was observed and the rate of CD4 above 500). In case of breastfeeding exclusively followed by a premature weaning in most cases, the average age of effective weaning was 8.3 months. Twenty-three children died during medical care follow-up basically from dehydration brought about by diarrhea and vomiting during weaning period. CONCLUSION: The survey confirms the potency of nevirapine in preventing HIV transmission from mother to child in non immunosuppressed women and lays emphasis on real problems for which appropriate solutions should be found before the implementation on a larger scale of this protocol.

[Rotavirus gastroenteritis in a pediatric service at the National University Hospital Center of Cotonou (Benin)]. / Gastro-entérites à rotavirus en pédiatrie hospitalière au Centre National Hospitalier et Universitaire de Cotonou (Bénin).

The authors are reporting results from rotavirus research in diarrhoeal stools among 220 children under 5 years of age in Cotonou C.N.H.U. (Bénin). Among them, 64 (29%) are rotavirus carriers.

The burden and outcomes of childhood tuberculosis in Cotonou, Benin.

SETTING: The National Tuberculosis Programme (NTP) and the paediatric ward of the General Hospital (GH), Cotonou, Benin. OBJECTIVE: To describe the burden of tuberculosis (TB), characteristics and outcomes among children treated in Cotonou from 2009 to 2011. DESIGN: Cross-sectional cohort study consisting of a retrospective record review of all children with TB aged <15 years. RESULTS: From 2009 to 2011, 182 children with TB were diagnosed and treated (4.5% of total cases), 153 (84%) by the NTP and 29 (16%) by the GH; the latter were not notified to the NTP. The incidence rate of notified TB cases was between 8 and 13 per 100 000 population, and was higher in children aged >5 years. Of 167 children tested, 29% were HIV-positive. Treatment success was 72% overall, with success rates of 86%, 62% and 74%, respectively, among sputum smear-positive, sputum smear-negative and extra-pulmonary patients. Treatment success rates were lower in children with sputum smear-negative TB (62%) and those with HIV infection (58%). CONCLUSION: The number of children being treated for TB is low, and younger children in particular are underdiagnosed. There is a need to improve the diagnosis of childhood TB, especially among younger children, and to improve treatment outcomes among HIV-TB infected children, with better follow-up and monitoring.

[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.

[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