[DOMESTIC ACCIDENTS IN CHILDREN AGED 0 TO 15 YEARS IN THE UNIVERSITY HOSPITAL OF LOMÉ, TOGO]. / Accidents domestiques chez les enfants de 0 à 15 ans dans les CHU de Lomé, Togo.

Introduction: Les accidents domestiques chez les enfants sont des situations d'urgence fréquentes. L'objectif de cette étude était de décrire les caractéristiques des accidents domestiques chez les enfants de 0 à 15 ans. Méthodes: Une étude prospective multicentrique à visée descriptive et analytique, a été menée du 1er janvier au 31 juillet 2022, dans les services de pédiatrie et de chirurgie pédiatrique des CHU Campus et Sylvanus Olympio de Lomé. Les critères d'inclusion étaient les enfants de moins de 15 ans, victimes d'accidents ou de traumatismes non intentionnels survenant à domicile ou dans ses abords immédiats. Résultats: Au total, 329 enfants ont été enrôlés. Le sexe ratio était de 1,6. Les enfants âgés de 30 à 72 mois étaient les plus représentés (34,1%). La supervision des enfants lors de l'accident était assurée principalement par la mère (64,5%). Les accidents survenaient principalement pendant les jeux (73,3%) et dans la cour de la maison (37,2%). Les enfants en étaient responsables dans 70,5 % des cas. Les traumatismes représentaient la principale cause d'accidents (58,4%), suivis des intoxications (24,6%) et des brûlures (13,7%). Le risque de traumatisme diminuait à mesure que l'enfant grandissait. Les filles étaient moins exposées aux traumatismes, intoxications, et présentaient moins d'accidents dans la cour de la maison. Le taux de décès était de 1,5%. Conclusion: Les accidents domestiques des enfants étaient fréquents. La prévention demeure le meilleur traitement. Mots-clés : Accident domestique, Enfant, Traumatismes, Intoxications, Brûlures, Togo.

[Respiratory distress in newborns at the University Hospital of Lomé, Togo]. / Détresse respiratoire du nouveau-né dans les CHU de Lomé, Togo.

Introduction: La détresse respiratoire du nouveau-né est une urgence néonatale source de séquelles neurologiques graves en l'absence de traitement adéquat. L'objectif de cette étude était de décrire les aspects épidémiologiques, diagnostiques et évolutifs de la détresse respiratoire du nouveau-né. Méthodes: Il s'est agi d'une étude rétrospective analytique et descriptive, réalisée dans les services de pédiatrie des CHU de Lomé, incluant les nouveau-nés pris en charge pour une détresse respiratoire sur une période d'un an allant du 1er janvier 2021 au 31 décembre 2021. Les données étaient saisies avec Epi Data 3.1 et analysées avec Epi Info 7.2.1. Résultats: Le nombre total des nouveau-nés hospitalisés pour détresse respiratoire était de 353 cas avec un sex ratio de 1,5. L'âge moyen était de 0,82 ± 3,20 jours ; la tranche d'âge de 0-6 jours représentait 92,4 % des cas. Tous les nouveau-nés avaient un trouble de la fréquence respiratoire. La dyspnée était le principal motif de consultation (100%). Les nouveau-nés avaient été réanimés à la naissance dans 46,7 % des cas. La détresse respiratoire était intense dans 64,9 % des cas. L'hyperleucocytose et la leucopénie étaient constatées chez 14,8 % des cas. L'anémie était de 15,9 % des cas. L'encéphalopathie anoxo-ischémique y était associée dans 49,1% des cas. Le taux de mortalité était de 20,4 %. Conclusion: La détresse respiratoire néonatale était fréquente dans la période néonatale précoce et sa mortalité élevée.

[Knowledge of sickle cell disease and prevention methods in an urban district of Lomé, Togo]. / Connaissances de la drépanocytose et pratiques de prévention dans la population d'un district urbain de Lomé, Togo.

Despite the important frequency of the gene "S" in Togo, essential information remains insufficient to elaborate a prevention campaign on this affection. In order to assess the knowledge on sickle cell diseases as well as the prevention practices in the Togo population in one of the five districts of the township of Lomé, a cross sectional study was conducted in the third district of the township of Lomé from January 21, 2004 to January 26, 2004 in 210 natives from Togo aged of 15 and over, through a semi-structured questionnaire. The variables studied were: - the socio-demographic features and the knowledge of sickle cell disease characteristics (symptoms, biological diagnosis, treatment and means). Data collected were analysed through software Statically Package for Social Science (SPSS) version 10.0 of Windows using the chi2 test with 5% significance in the comparison of some variables. 117 women and 93 men were interviewed. Sickle cell disease was known in almost all ethnic groups but incompletely: 79.5% of the individuals knew about premarital check up but only 12.4% knew about haemoglobin electrophoresis check up. 74,8% of the people had a good knowledge of the cause of sickle cell disease, 78.6% had a fairly good knowledge of its symptoms, 57.6% knew the factors inducing attacks, 64.3% the prognosis and 69.5% the prevention methods, but a poor knowledge of the complications (62.4%), biological diagnosis (71%) and treatment (97.2%). The prevention practices were poorly adopted: 12% had an haemoglobin electrophoresis check up and 15% of them had their husband to have one as well. Professional status influenced the level of knowledge of the biological diagnosis (p=0.001) and prevention means (p=0.018). The educational level influenced biological diagnosis knowledge (p = 0.000) and prevention means (p = 0.02). On the whole, sickle disease was linked to marital status (p = 0.00). Sickle cell disease remains quite unknown in spite of the gene "S" important frequency in Togo. These results are to be taken into account to implement information, education and communication program to struggle against sickle cell disease.

[Pediatric salmonellosis at the Tokoin's teaching hospital, Lomé (Togo)]. / Les salmonelloses chez l'enfant au CHU Tokoin de Lomé (Togo).

OBJECTIVE: The authors had for aim to describe the epidemiological, clinical, and bacteriological aspects and outcome of pediatric Salmonella enterica, Salmonella septicemia, over the last 10 years. PATIENTS AND METHODS: We analyzed the case history of 132 patients hospitalized for Salmonellasepticemia (positive blood culture) between 1995 and 2004. RESULTS: Salmonellosis accounted for 0.36% of all hospitalizations. The mean age of patients was 5.86 plus or minus 4.06 years, significantly higher in patients with S. ser. Typhi (7.14+/-4.04 years) than in patients with other serotypes (4.95+/-3.8 years). The clinical presentation was severe in many children (with dehydration (34.8%) and emaciation (55.3%)), so HIV was suspected and investigated in 51 patients (38.6%). Eight patients were HIV positive. Three serotypes of S. enterica were predominant: S. ser. Typhi, 55 cases (41.7%), S. ser. Enteritidis, 32 cases (24.2%), and S. ser. Typhimurium, 19 cases (14.4%). The bacterial susceptibility to antibiotics was good for ceftriaxone and ciprofloxacin (100%). But 78.8% of the serotypes were resistant to amoxicillin, 75.4% to chloramphenicol, and 69.4% to cotrimoxazole. The mean duration of hospitalization was 13.7 plus or minus 7.4 days (range 4-34 days). Complications occurred in 15.9% of cases, dominated by digestive bleeding (10.6%), and 6.1% of patients died.

[Priapism in sickle cell anaemia in Senegal: prevalence, attitudes and knowledge]. / Priapisme chez le drépanocytaire sénégalais: prévalence, attitudes et connaissances.

We interviewed 108 sickle cell anaemia patients aged 5 years older on priapism, and 113 healthy subjects in a control group. They were recruited in the out-patient consultation of the two sickle cell anemia care units of the Fann teaching hospital in Dakar. Ten cases of priapism were identified, all in the group of sickle cell patients (the difference is significant, p = 0.004). Prevalence of priapism was 9.3%. Actuarial probability of having priapism was 8.3% by 10 years of age, and 38.9% +/- 5.7 by 20 years of age. Before the interview, only 10.2% of the sickle cell patients and 8% in the control group knew about priapism, and most of them were unaware of its association with sickle cell disease (75% of sickle cell anaemia patients and 80% of control subjects). This lack of information should be improved by an educational program.

[Stuttering priapism in children with sickle cell anemia in Togo]. / Priapisme intermittent chronique chez l'enfant drépanocytaire homozygote au Togo.

AIM: To describe clinical aspects and outcome of stuttering priapism (SP) in children with sickle cell anemia. PATIENTS AND METHODS: We included the 8 children with sickle cell anemia suffering from SP between 1996 and 2004. RESULTS: Age at onset of SP ranged from 5 to 14 years (mean 9.75+/-3.69 years). SP attacks occurred once a day for 6 patients, and 2 and 3 times by week for the others. It happened during deep sleep, especially in the night (all patients) and sometimes in the day (4 patients). The duration of attacks ranged from 10 min to 2 h in 6 patients and 4 to 5 h in 2 patients. Oral étilefrine was administered to all patients until the cessation of attacks, and continued during 1 month. A long remission was obtained in all patients after 7 days to 7 months treatment (follow-up 2 to 7 years) in spite of 1 or many relapses.

[Management of malaria in Togolese communities]. / Prise en charge du paludisme dans les communautés du Togo.

The objective of this study was to collect community basis data on prevention and home management of malaria for the future assessment of "Roll Back Malaria", the new world strategy of fighting against malaria. The study was carried out in 3 districts in Togo. Mothers were questioned about the quality of home management of uncomplicated malaria on 951 children aged under 5. Fathers were questioned about the use of mosquito bed nets in 597 households, and 246 women were interviewed about the prevention of malaria during pregnancy. Home management of children under treatment was correct in only 38.1% of cases and the drug observance was followed by only 35.4% of patients. Mosquito nets were used in 30.5% of households and only 16.5% were treated with insecticides. Only 22.7% of children under 5 slept under mosquito nets. 80% women made at least one antenatal visit and 74.4% received regular malaria chemoprophylaxis. Many efforts should be made in Togo to increase the quality of home management of malaria and the use of insecticide-treated bed nets.

[Type 2 diabetes mellitus in children in black Africa: description of first five cases in Togo]. / Le diabète de type 2 de l'enfant en Afrique noire: cinq premiers cas au Togo.

The purpose of this report is to describe epidemiological, clinical and therapeutic features of the first five cases of childhood type 2 diabetes mellitus (T2DM) documented in Togo. The five children were admitted to either the Barruet Clinic (n=4) or Tokoin de Lomé University Hospital Centre (n=1) between 1999 and 2004. All presented one or more of the following risk factors for T2DM: obesity, familial history of T2DM, acanthosis nigricans, polycystic ovary syndrome, dyslipidemia, and high blood pressure. Age at diagnosis was 15 years in two cases and 13, 11 and 12 years in the other three cases (mean, 13.2 + 1.79 years). There were three females and two males. All five patients were obese and had risk factors for obesity (high fat intake, sedentary lifestyle and lack of physical exercise). All had a familial history of T2DM and two had Acanthosis nigricans. All five patients were treated initially with insulin that was gradually discontinued in favor of exercise and diet in four. These are the first reported cases of childhood T2DM in Togo. An education campaign is necessary to inform the population on about the risk factors for T2DM.

[Evolution of severe pediatric malaria in Togo between 2000 and 2002]. / Evolution du paludisme grave de l'enfant au Togo de 2000 à 2002.

The aim of this study was to analyse the clinical and evolutive aspects of severe malaria in hospitalised children in 2000, 2001, and 2002 in Togo. The study included 361 children in the pediatrics department of Lomé-Tokoin University hospital. All them received a 10% dextrose infusion, then an infusion of quinine or intramuscular artemether. Malaria accounted for 4.37% of all hospitalizations. Children aged 1 to 5 years were more affected (69.53%). The most frequent clinical forms were anaemia (55.7%) followed by cerebral manifestations. The frequency of hemoglobinuria increased (17.2%) as well as renal failure (3%) compared to previous years. Thirty-five children died (9.7%). Most of them presented with anaemia, neurological manifestations, or respiratory distress. Neurological sequels were present in 2.2% of patients.

[Gross hematuria in sickle cell disease at Tokoin teaching hospital in Lomé (Togo)]. / Hématurie macroscopique dans la drépanocytose majeure au CHU Sylvanus-Olympio de Lomé (Togo).

The renal complications of sickle cell anemia are well known. Gross hematuria is one of these, although it is associated more often with the sickle cell trait than with the disease. Nonetheless, in Togo, where the frequency of S gene is 16%, hematuria is rarely report in people with this gene. We describe 3 cases of gross hematuria in patients with sickle cell disease: primary hematuria associated with sickle cell disease. We found no promoting factors in our patients. The course was short, and after 4 to 15 years, there have been no recurrences.

[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.

[Ambulatory management of sickle cell disease: evaluation of the first year follow up of patients in the pediatric department of Lomé (Togo)]. / Prise en charge ambulatoire des drépanocytaires: évaluation de la première année de suivi des patients dans le service de pédiatrie de Lomé (Togo).

BACKGROUND: This study is an evaluation of the first year ambulatory follow up of patients from the sickle-cell care centre of the paediatric ward of the teaching hospital in Lomé-Tokoin. PATIENTS AND METHODS: Togo is situated in the epicentre of the Benin haplotype. A total of 132 patients (109 SS, 22 SC and 1 S beta zero thal) followed up during one year from their admission date (period of 1st January 1996 to 31st December 1997). 132 patients were included in the study. RESULTS: The patients' age varied, for the majority, between 2 months and 15 years, but a few adults (15%) were included in the study. Information was collected from the hospital files and health cards, which unfortunately did not have specific entrees for sickle cell disease. Clinical features revealed that the frequency of tooth decay and chronic persistent splenomegaly was low when compared to the rates in central Africa (Bantu haplotype). Laboratory findings lead to the conclusion that some analysis are relevant such as the dosage of the G6PD activity (24.1% of patients were deficient), parasitologic analysis of faeces (positive in 22.5%), retinal fluoro-angiography (32.2% of ocular lesions), and cardiologic check-up. On the other hand, scanning of biliary tracts and systematic X-rays of the hips seems to be secondary. Some positive results were noticed by the scanning of biliary tracts without any therapeutic decisions in non-symptomatic patients; no case of osteonecrosis was detected by the X-rays. The mean haemoglobin level was 7.4 +/- 1.4 g/dl for the SS and 10.7 +/- 2.4 g/dl for the SC. The mean MCV were 91.3 +/- 10.1 fl and 82.1 +/- 7.7 fl, respectively. Specific vaccinations were not well performed because of their high cost. CONCLUSION: In order to carry on and improve the ambulatory management of patients with sickle cell disease, it is important in low income countries, such as Togo, to target the necessary laboratory tests for an initial and annual check-up. Solidarity networks for patients should be promoted and effective involvement of the health authorities ensured.

[The impact on families of sickle cell disease in Togo]. / L'impact familial de la drépanocytose au Togo.

AIM: In order to master the difficulties due to sickle cell disease, this work aimed at assessing the effects on the families of the presence of a child with sickle cell disease in Togo. POPULATION AND METHODS: From April 1 to November 31, 1998, 103 families with one or many sickle cell patients followed up in the Sickle Cell Care Unit of the pediatric department of the Lome Teaching Hospital were surveyed. Main care takers of patients with sickle cell disease, especially mothers (90.3% of cases), were surveyed. RESULTS: Many parents were disturbed; the most common troubles were: compassion (pity) toward the child, 92.2%; insomnia, 82.5%; frustration, 76.7%; and fear of the death of the child, 73.5%. Less educated parents and those who lived alone (single parents, widows, separated) were more affected. Sickle cell disease caused the separation of seven couples out of 26 (26.9%), while in 11 couples of the 63 who still live together, relationships had deteriorated (17.5%). Most of the parents (83.3%) exaggerated the protection of their child and 65% mentioned financial problems. CONCLUSION: There is no doubt about the unfortunate effects of the presence of children with sickle cell disease in a family in Lome. Many joint actions should be taken toward the sick children and their families in order to reduce their sufferings.

[Home care of vaso-occlusive crisis in sickle cell disease in Togo]. / Traitement à domicile de la crise vaso-occlusive par les drépanocytaires au Togo.

BACKGROUND: Many people with sickle cell disease manage their pain crises at home. This study aims to describe the home management of sickle cell pain by Togolese patients. PATIENTS AND METHODS: From July 1996 to April 1997, parents of children with sickle cell disease, and some adults with sickle cell disease living in rural and urban regions were interviewed about their home treatment habits during pain crises. RESULTS: A total of 165 patients with sickle cell disease (82 from urban and 83 from rural areas) were selected. The techniques most frequently used for pain management included salicylates (61.8%), paracetamol (37%), non-steroidal anti-inflammatory drugs (15.1%), vasodilators and pentoxifylline (5.4%). Only 4.2% of the patients mentioned adequate hydration. None used other antalgics (weak or strong opium derivatives). No difference was noticed between the treatment habits of rural regions and those of urban regions. CONCLUSION: In order to improve the quality of life of patients with sickle cell disease, information and awareness programs must be organized in order to establish a standard home pain management. Emphasis must be put on the use of salicylates and paracetamol at the correct dosage, the intake of abundant fluids, the easy use of analgesic of the second step of the Word Health Organization, and the systematic treatment of malaria which can induce pain crises.

[Sexually transmitted diseases in young children in Lomé (Togo). Role of sexual abuse]. / Les maladies sexuellement transmissibles chez le jeune enfant à Lomé (Togo). Place de l'abus sexuel.

OBJECTIVE: The purpose of this study was to determine the importance of sexual abuse in young children with sexually transmitted diseases (STD) in Lomé (Togo). METHODS: This transversal study consisted of documenting all cases of STD in young children (up to 11 years of age) diagnosed during 20 months (May 1997 to December 1998) in the dermatovenereology unit of the Lomé teaching hospital. Syphilitic (TPHA-VDRL) and HIV serologies were carried out in all children. These serologies were repeated two weeks and three months later in sexually abused children. RESULTS: During this period, 33 cases of STD were diagnosed. There were 16 cases of anogenital warts (13 females, three males; mean age: 5.6 +/- 2.4 years); 13 cases of gonorrhoea (all were females; mean age: 7.2 +/- 1.8 years); and four cases of genital trichomoniasis (four females; mean age: 6.2 years). In 12 of 13 cases of gonorrhoea, sexual abuse was noted with identification of the alleged contaminators in ten cases. In eight of 16 cases of anogenital warts (all observed in females; mean age: 6.1 +/- 1.9 years), and two of four cases of genital trichomoniasis (mean age: six years) sexual abuse was observed. Syphilitic serology was negative in all children, but one ten-year-old girl had HIV infection with identification of the alleged contaminator. CONCLUSION: The results of this study confirm that sexual abuse in children is not uncommon in black Africa and that the STD, like condylomata acuminata and gonorrhoea, are good indicators of this phenomenon. The classical consequences of such sexual abuses are aggravated in Africa by the high prevalence of HIV infection observed in the majority of countries, mainly in urban areas.

[Acute osteomyelitis in the child with sickle cell disease in a tropical zone: value of oral fluoroquinolones]. / Ostéomyélites aiguës de l'enfant drépanocytaire en zone tropicale: intérêt de l'utilisation des fluoroquinolones par voie orale.

AIM: This study was designed to assess the efficacy and the safety of fluoroquinolones in their compassionate use for acute osteomyelitis in children with sickle cell disease in a tropical country. PATIENTS AND METHODS: This study was non comparative, including twelve children (eight SS, three SC and one SEzerothalassemia) treated for acute osteomyelitis with oral ciprofloxacin or ofloxacin because of the following reasons: financial inability to afford conventional parenteral beta-lactams therapy (nine patients), refusal of hospitalization (two patients), and failure of conventional treatment (one patient). RESULTS: The mean age of patients was 9.5 +/- 2.6 years. The long bones were the predominantly site. Salmonella species were present in 75% of cases, followed by other enterobacteriaceae (16.7%), and Staphylococcus aureus (8.3%). Successful outcome occurred in all cases after three to four-weeks of treatment and 45 days of plaster immobilization. Transient bilateral Achilles tendon tendinitis was noted in a five-year-old patient. CONCLUSION: In economically developing countries, oral fluoroquinolones may be a therapeutic alternative for acute osteomyelitis in patients with sickle cell disease particularly in cases of financial hardship or failure with conventional therapy.

[Elective phagocytosis of polynuclear neutrophils caused by medullary macrophages and autoimmune neutropenia in children]. / Phagocytose èlective de polynucléaires neutrophiles par les macrophages médullaires et neutropénie auto-immune de l'enfant.

UNLABELLED: Autoimmune neutropenia (AIN) is a frequent cause of chronic neutropenia especially in youngest children. Its diagnosis is established by immunological proof of the autoimmune mechanism. The aim of this study is to better describe this autoimmune process and to show the contribution of bone marrow smears to this diagnosis. PATIENTS AND METHODS: Ten children, six girls and four boys, were examined between 1990 and 1995. Eight of them had typical AIN, confirmed by the presence of antibodies against neutrophils. Two other patients were included on the basis of bone marrow pictures. Five non-neutropenic children with normal bone marrow smears were chosen as controls. Bone marrow analysis was always performed by the same cytologist according to a reproducible technique. RESULTS: Six out of ten patients had important features of elective phagocytosis of neutrophils by marrow macrophages (unlike controls) without signs of dysgranulopoiesis or hemophagocytosis. Antibodies against neutrophils were detected in six patients with phagocytosis and in four patients without these cytological features. In two other children presenting the same bone marrow picture and clinical profile, an autoimmune process was probable, even in the absence of antibodies against neutrophils. Some patients had several infections and were given immunoglobulins and/or granulocyte colony-stimulating factor (G-CSF) therapy. The efficacy of Immunoglobulin was not constant, whereas G-CSF was effective at low doses and shortened the duration of infections. CONCLUSION: Prolonged neutropenia in childhood must lead to look for phagocytosis by marrow macrophages in bone marrow smears, as a possible sign of autoimmunity. Growth factors may temporarily be used associated with antibiotics therapy in severe and prolonged infections.

[Treatment of cerebral malaria in African children by intravenous quinine: comparison of a loading dose regimen to a regimen without a loading dose]. / Traitement du paludisme cérébral de l'enfant africain par les sels de quinine: comparaison d'un schéma avec dose de charge à un schéma classique sans dose de charge.

OBJECTIVE: To compare in a randomized study the efficacy and the toxicity of the new WHO intravenous quinine treatment of cerebral malaria including a loading dose regimen to a regimen without loading dose. PATIENTS AND METHODS: Seventy-two children eight months to 15 years of age with cerebral malaria were included. Quinine formiate was administered to a group of 35 patients in an initial loading dose of 20 mg salt/kg (equivalent to 17.5 mg/kg of the base) in 10 mL/kg of 5% glucose over four hours, followed eight hours later by a maintenance dose quinine of 10 mg salt/kg (equivalent to 8.7 mg/kg of the base) dissolved in 15 mL/kg of 5% glucose over and every 12 hours. The second group of 37 patients received intravenous quinine 15 mg salt/kg (13.1 mg of base) dissolved in 15 mL/kg of 5% glucose infused over 6 to 8 hours, every 12 hours. In both groups this treatment was continued until the patient could swallow, then quinine tablets were given to complete seven days treatment. The assessment of cardiovascular side effects was made by an ECG at admission, the 4th hour, the 24th hour and at the end of treatment for each patient. RESULTS: Coma mean durations were similar in the two groups: 35.5 +/- 17.8 hours and 28.6 +/- 14.4 hours respectively for the loading dose group and the group without loading dose. The two groups were comparable also for the decrease evolution of parasitemia. Case-fatality rates were also similar: 95% of healing at the 72nd hour and a lethality rate between 5 and 6% in the two groups. But a significant increase of the body temperature was noted between the 51st and the 63rd hour in the group without loading dose. No significant cardiovascular toxicity was noticed in the two groups. The mean cost of the loading dose regimen was less than that of the second regimen. CONCLUSION: The loading dose regimen of quinine is well tolerated and it seemed slightly more effective than the regimen without loading dose. In cases of contra-indications (patients who recently received quinine, mefloquine or halofantrine), regimens without loading dose, which remains effective, should be used.

[Primary nephrotic syndrome in the black African child]. / Le syndrome néphrotique primitif de l'enfant en Afrique noire.

Idiopathic nephrotic syndrome (INS) in black African children differs from that of children in temperate areas. The main differences are the high rate of corticosteroid non-responders and the low rate of minimal change glomerulopathy in black African children, possibly related to a racial factor. The identification of a high corticosensibility in certain African regions (Togo and Ghana) can lead to the identification of an ethnic factor. Further genetic studies should be carried out in order to provide a better approach to INS in Africa.

[Severe malaria in children in Togo]. / Paludisme sévère de l'enfant au Togo.

BACKGROUND: The definition of severe malaria is no longer limited to cerebral malaria, but is as well extended to other clinical forms of the disease. This work analyses epidemiological, clinical and evolutive aspects of severe malaria in Togo. PATIENTS AND METHODS: This study included 549 children, aged from 0 to 15 years, hospitalized in 1994-5 in the pediatric department of the Lome-Tokoin University Teaching Hospital for severe malaria as defined by World Health Organization (WHO) criteria. RESULTS: The hospitalization frequency was 7.44%; the maximum frequency was from 1 to 5 years of age, but 6.56% of patients were more than 10 years old. The most frequent clinical form was that of severe anemia, followed by cerebral complications, as seen in many African countries. The death rate was 18.94% and the proportional mortality was 8.21%; 2.73% of the patients had neurological sequelae (behaviour disturbances in five cases, aphasia in four, hemiplegia in three, mumbling in one, oculomotor paralysis in one, and cerebellar ataxia in one). Hypoglycemia was fairly frequent (11.6%) and was associated with a poor prognosis. CONCLUSION: It is possible to improve severe malaria prognosis in Africa by insisting not only on better equipment in intensive care wards, but also on improved and early management of hypoglycemia.