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.

[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.

[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.

[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.

[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.

[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.

[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.

[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

[Follow-up of HIV-infected children receiving antiretroviral therapy in a rural area of Togo]. / Suivi des enfants infectés par le VIH/sida sous traitement antirétroviral en milieu rural au Togo.

OBJECTIVE: To evaluate the monitoring of HIV-infected children receiving antiretroviral therapy in rural areas of Togo and the effectiveness of the treatment. METHODS: This retrospective descriptive study, conducted at the Luis Scrosospi Center in Kouvé from 15 November, 2008, through 14 November, 2009, examined the records of children who had been receiving antiretroviral therapy for at least 6 months. RESULTS: We studied the records of 55 children. The sex ratio was 0.9, and the primary opportunistic infections were respiratory infections and malaria. At treatment initiation, their average age was 6 years and 3 months, the average CD4 T cell count 358/mm(3), and the mean weight 12.9 kg. The hemoglobin level was less than 8 g/dL in 31%. All children received a nutritional kit monthly. The antiretroviral therapy for 52 children was a combination of stavudine, lamivudine, and nevirapine. The adherence rate during the first 12 months was 80% (44/55 children). The mean weight gain was 860 g (below -3SD) at 3 months, 1,550 g (between -3SD and -2SD) at 6 months, and 1 270 g (between -2SD and -1SD) at 12 months of treatment. The severe acute malnutrition rate fell from 60% at treatment initiation to 56% at 3 months, 47% at 6 months, and 25% at 12 months. Also after 12 months, the CD4 T cell count had risen in 60% of the children. The main side effects were peripheral neuropathy (29%) and headaches (18%). Eight children died (14%) during the follow-up. CONCLUSION: Monitoring of HIV-infected children on antiretroviral therapy is possible in Togo's rural areas and should be encouraged for it will help to achieve the Millennium Development Goals.