Child mortality infected with HIV1 followed in 40 pediatric care sites in Togo.

INTRODUCTION: The infection in pediatric HIV is the reason a lot of problems in Africa The objective of our study were to identify factors associated with mortality during follow-up of children receiving antiretroviral therapy in Togo. METHODS: It was a cross-sectional study of 870 children aged files from 7 weeks to 15 years infected with HIV on antiretroviral treatment, covering the period 1 January 2001 to 31 December 2010 taking in 40 sites medical management in Togo. Data processing was done with the software Epi-Info 6.04d and duplicates were treated by the Software ESOPE. RESULTS: All patients were infected with HIV-1. In total forty six (46) deaths is 5.29% of the overall cohort were reported in our series. The lethality of the overall cohort followed for 60 months was 5.29%. The survival rate of the overall effective monitoring in our study was 89.2%. Fifty-eight percent (58%) of deaths had affected children in a state of severe malnutrition and forty two percent (42%) in a state of moderate malnutrition. Sixty two percent (62%) of children under HAART treatment died benefited monitoring a psychologist. CONCLUSION: The diagnostic inadequacies of pediatric HIV strike the prognosis of infected children. Efforts still needs to be done to improve the load take pediatric HIV in Togo.

Global HIV prevention, care and treatment services for children: a cross-sectional survey from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium.

OBJECTIVES: To assess access children with HIV have to comprehensive HIV care services, to longitudinally evaluate the implementation and scale-up of services, and to use site services and clinical cohort data to explore whether access to these services influences retention in care. METHODS: A cross-sectional standardised survey was completed in 2014-2015 by sites providing paediatric HIV care across regions of the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We developed a comprehensiveness score based on the WHO's nine categories of essential services to categorise sites as 'low' (0-5), 'medium', (6-7) or 'high' (8-9). When available, comprehensiveness scores were compared with scores from a 2009 survey. We used patient-level data with site services to investigate the relationship between the comprehensiveness of services and retention. RESULTS: Survey data from 174 IeDEA sites in 32 countries were analysed. Of the WHO essential services, sites were most likely to offer antiretroviral therapy (ART) provision and counselling (n=173; 99%), co-trimoxazole prophylaxis (168; 97%), prevention of perinatal transmission services (167; 96%), outreach for patient engagement and follow-up (166; 95%), CD4 cell count testing (126; 88%), tuberculosis screening (151; 87%) and select immunisation services (126; 72%). Sites were less likely to offer nutrition/food support (97; 56%), viral load testing (99; 69%) and HIV counselling and testing (69; 40%). 10% of sites rated 'low', 59% 'medium' and 31% 'high' in the comprehensiveness score. The mean comprehensiveness of services score increased significantly from 5.6 in 2009 to 7.3 in 2014 (p<0.001; n=30). Patient-level analysis of lost to follow-up after ART initiation estimated the hazard was highest in sites rated 'low' and lowest in sites rated 'high'. CONCLUSION: This global assessment suggests the potential care impact of scaling-up and sustaining comprehensive paediatric HIV services. Meeting recommendations for comprehensive HIV services should remain a global priority.

Predictors of early-onset neonatal sepsis in premature newborns: Case-control study.

INTRODUCTION: Early-onset neonatal sepsis (EOS) is difficult to diagnose clinically because the semiology of premature newborns is poor during the first days of life. This study aimed to identify predictive factors of EOS in neonates less than 37 weeks' gestational age in neonatal care at Louis Mourier Hospital, France. METHOD: This was a case-control study of all newborns less than 37 weeks of gestational age diagnosed and managed for EOS from January 1 to December 31, 2019. The main parameters studied were demographic characteristics, risk factors, laboratory, and bacteriological characteristics. At the benchmarking level, the statistical tests used were the McNemar test for qualitative variables and the paired Student's t-test for quantitative variables. RESULTS: A total of 50 mother-child pairs were included in this study (25 cases and 25 matched controls). The results showed a statistically significant relationship between the birth of a child with EOS and between a premature rupture of membranes of > 18 h (68% of cases vs. 36% of controls; p = 0.042); a positive culture of the placenta (p = 0.0002); C-reactive protein levels of > 6 mg/L (88% of cases vs. 20% of controls; p = 0.001); a procalcitonin level of > 0.6 ng/mL (72% of cases vs. 16% of controls; p = 0.001). Gram-negative bacteria including Escherichia coli (44.5%) and Haemophilus influenzae (14.8%) were the most common pathogens found. CONCLUSION: The search for risk factors must be systematic and the clinic must remain at the center of the diagnostic approach.