[Blinding trachoma: results of a prevalence survey in 8 health districts in CAR]. / Le trachome évolutif: résultats d'une enquête de prévalence dans huit préfectures sanitaires en RCA.

Support of visual disabilities in terms of preventive and curative treatment, is a priority for public health in Central African Republic. The lack of recent and reliable data on ocular pathologies in general including trachoma particularly, has led health authorities, in collaboration with partners to undertake an epidemiological investigation to determine the mapping. This study was designed to assess the importance of endemicity in the most sensitive groups within population, including children of 1 to 9 years old. Eight from sixteen health districts in the country, were selected for this survey as a first step. The data collected will assess the real needs in medical and surgical care to develop an appropriate strategic plan of support for this condition on a large scale. This is a cross-sectional descriptive survey carried out in one month, from November 23 to December 26, 2011 in eight health prefectures of the country. The sampling frame was the population of eight health districts. The exhaustive list of villages and demographic data from the national census conducted in December 2003, adjusted by the rate of annual increase of 2.5%has been used. The administrative headquarters of the places of the visited districts leaders were excluded from the sampling frame. A random survey in clusters at two levels made from formed bases. Twenty villages (clusters) in each health district have been drawn according to the proportional probability to the size of the totals cumulative. 12,800 children of both sexes, aged 1 to 9 years have been identified in this investigation and 11,287 were actually examined, or 88.2 %, sex ratio is significantly 1.11. The proportion by age group of the children sampled is stackable to the general population. 26.9 % of TF and 5.9 % TI have been diagnosed. Six from eight districts surveyed are endemic. Three of them had respectively rates of 32.3 %, 47.1 % and 54.3 %.

[Comparison of the effectiveness of artemether and quinine for treatment of severe malaria in children, Bangui, Central African Republic]. / Comparaison de l'efficacité de l'artémether et de la quinine dans le traitement du paludisme grave chez les enfants à Bangui, République centrafricaine.

The management of severe malaria is a major challenge in the health care services in sub-Saharan Africa. This study aimed to assess the efficacy and safety of artemether and quinine in severe malaria at Complexe pédiatrique of Bangui, Central African Republic. A total of 212 children among 1125 hospital admissions (18.8%), and aged 6 to 59 months were randomly treated with artemether and quinine. Anemia (58.5%) and seizures (33.5%) were the major syndromes observed. On the third day of follow up, a regression of clinical signs and parasite clearance were observed in 98.1% of children treated with artemether and 97.1% of children treated with quinine. The death rate was 2.3% due to anemic and neurological forms. These findings show that the artemether and quinine have similar efficacy. Hence, associated with adequate intensive health care, the use of these antimalarial drugs can significantly reduce mortality from severe malaria in the Central African Republic.

[First documented case of Chryseobacterium meningosepticum meningitis in Central African Republic]. / Premier cas documenté de méningite néonatale à Chryseobacterium meningoseptcum en République Centrafricaine.

Chryseobacterium meningosepdcum is a rare but well-known causative agent of bacterial meningitis and can be the source of epidemic outbreak in neonatal facilities. It has rarely been documented in Africa. The purpose of this report is to describe the first case of C. meningosepticum meningitis in Central African Republic. The case that remained isolated occurred after dystocic delivery with resuscitation in a neonatal unit. Despite intensive care and appropriate antibiotic treatment, the newborn died on day 19. Identification of this rare cause of meningitis underlines the important role of the bacteriologic laboratory in managing bacterial meningitis in Africa. The strain of C. meningosepticum involved in this case was resistant to the main antibiotics used for first-intention treatment of neonatal bacterial meningitis, i.e., third-generation cefalosporins, chioramphenicol, and aminosides. This case also underlines the importance of familiarizing the medical staff with the dangers of nosocomial meningitis and reinforcing hospital hygiene measures.

[A case of tuberculous otitis media associated with meningoencephalitis in the Bangui paediatric institution (Central African Republic)]. / A propos d'un cas d'otite tuberculeuse primitive compliquée de méningoencéphalite au complexe pédiatrique de Bangui (République centrafricaine).

The authors report a case of fatal tuberculous meningoencephalitis following chronic bilateral otitis media in a child. Mycobacterium tuberculosis was identified in the CSF and in the otitis secretions. There were no pulmonary tuberculosis signs, thus the tuberculous otitis was considered as primary. In high tuberculosis endemic areas like Central African Republic it is important to consider tuberculosis, in chronic otitis media resistant to non specific therapy, and to reinforce the immunization programs for children.

[Ocular injuries in children aged 0-15 years: epidemiological and clinical aspects at the Bangui National Teaching Hospital]. / Les traumatismes oculaires chez les enfants âgés de 0 à 15 ans. Aspects épidémiologiques et cliniques au Centre National Hospitalier Universitaire de Bangui.

PURPOSE: Ocular injuries in children are frequent and are an ophthalmological emergency. If not managed sufficiently early, these lesions may cause definitive partial loss of vision or blindness. In this survey, the authors analyze different epidemiological and clinical aspects of ocular injuries at the Bangui National Teaching Hospital in the Central African Republic to increase the awareness of children's parents, guardians, and care-takers. PATIENTS AND METHODS: A prospective study was conducted on 194 cases in the ophthalmology department over a period of 3 years, and included children aged 0-15 years. A total of 197 eyes were examined by the same practitioner, comprising 191 unilateral ocular injuries and three bilateral injuries. RESULTS: Of the children examined, 59% were males and 41% were females, with a sex ratio of 1.3. The age group with the highest exposure (39.3%) was between 5 and 10 years. Punishments (25.9%), accidents during games (19.3%) and fights (18.8%) were the main sources of these ocular injuries. Consultation most often occurred long after the incident. Only 2.0% were seen before the 6th hour and 43.7% between 48 hours and 1 week. The clinical picture was dominated by bruises posing a therapeutic problem: 25 hyphemas (12.7%), 19 conjunctival injuries (9.6%), 19 lens dislocations with or without vitreous loss (9.6%), 18 trauma-induced cataracts (9.4%), and 15 eye lid injuries with or without lachrymal duct ruptures (7.6%). The most serious injuries were cornea injuries with or without hernia of the iris (19.8%) and nine globe dislocations (4.5%). CONCLUSION: The frequency and gravity of the lesions identified, the severity of the injuries and the delay in treating these injuries show that the public authorities, parents and child care-takers need more information in order to reduce the frequency of these accidents.

[Tuberculosis and HIV co-infection among children hospitalized in Bangui (Central African Republic)]. / Co-infection tuberculose et virus de l'immunodéficience humaine chez les enfants hospitalisés à Bangui (République Centrafricaine).

INTRODUCTION: Tuberculosis associated with HIV-infection in children makes the diagnosis of tuberculosis more complicated since it is already difficult to establish because clinically based in low-income countries, and worsens its outcome under treatment. We report our experience from the paediatric clinics of Bangui, Central African Republic. PATIENTS AND METHODS: Our retrospective study analyzed 18-month -to 15-year-old children treated for tuberculosis from April 1998 to June 2000. Diagnosis and outcome data were abstracted from patient medical reports and we compared seropositive and seronegative patients. RESULTS: Globally, 284 cases have been analyzed. HIV-infection rate was 25.7% (95% CI: 20.7-31.2%). Pulmonary tuberculosis and mixed forms rates were 94.4% (N = 268). Extrapulmonary tuberculosis was essentially lymphadenopathies which have been restricted only to seronegative patients. Tuberculosis microbiological findings were significantly lower in seropositive patients compared with seronegative ones, for microscopy (8.2 vs 24.6%) and for culture (35.6 vs 58.5%) (P-value < 0.05). On 28 seropositive and 72 seronegative children for which outcomes were registered, mortality rate was higher in seropositive than in seronegative patients (57.1 vs 19.4% respectively, P-value < 0.05). CONCLUSION: The authors suggest that diagnosis of tuberculosis should be strengthened by blood or lymph node puncture culture particularly for HIV-infected children and that the treatment outcomes could be improved by diagnosis and treatment of other opportunistic infections.

[An update on severe pediatric malaria in Central Africa hospital units]. / Les aspects actuels du paludisme grave de l'enfant en milieu hospitalier pédiatrique centrafricain.

OBJECTIVE: The authors had for aim, to determine the frequency and the main clinical forms of severe malaria and to evaluate its management. PATIENTS AND METHODS: A cross-sectional investigation was made in the "Complexe Pediatrique" of Bangui, the only children hospital of the CAR capital, from 12 January to 12 September 1998. The survey included children 6 months to 15 years of age presenting on admission with a positive thick drop examination, and at least one of the clinical symptoms of severe malaria as defined by the World Organization of Health (WHO). RESULTS: Four hundred and thirty-two children were included. Those from 6 months to 4 years of age accounted for 89.35% of the studied population. The most frequent clinical forms were neurological 31% and anemic 22.2%; the other forms were combined in 42.8%. Managing patients consisted of an etiologic treatment by quinine (91.7%) or sulfadoxine pyrimethamine (3.2%) and symptomatic treatment in the following proportions: rehydration: 49.3%; blood transfusion: 36.3%; preventing seizure: 72.9%; oxygen therapy: 77.5%; use of antipyretics: 96.7%, and correction of hypoglycemia: 9%. The death rate remained high with 62 deaths (14.35%). It was higher in combined forms (48 deaths out of 62). CONCLUSION: Severe malaria and its various clinical forms remain a major problem for our pediatric intensive care unit. Updated technical means and human resources could improve the management of severe pediatric malaria.

Surveillance of drug-resistant childhood tuberculosis in Bangui, Central African Republic.

SETTING: Bangui, the capital of the Central African Republic, where overall drug resistance and multidrug resistance among adult new tuberculosis (TB) cases were respectively 16.4% and 1.1% in 1998. OBJECTIVE: To determine the prevalence of drug resistance among children with tuberculosis and to compare the epidemiological and clinical features of TB in children with drug-resistant and drug-susceptible TB. METHODS: All strains of Mycobacterium tuberculosis obtained from children aged 0-15 years at Bangui Paediatric Hospital were prospectively collected from April 1998 to June 2000, and susceptibility testing was performed for each specimen. The children's epidemiological and clinical data were recorded. RESULTS: Susceptibility results were available for 165/190 children with M. tuberculosis. Overall drug resistance and multidrug resistance were 15.2% and 0.6%, respectively. Isoniazid and streptomycin were the only drugs associated with TB monoresistance. No significant difference was found in the epidemiological or clinical data of children infected with a resistant strain and those infected with a susceptible strain. CONCLUSION: The prevalence of drug resistance in childhood is similar to that observed in adult new TB cases in the same period. Surveillance will continue to be performed in Bangui periodically to assess the trend of true drug resistance among new TB cases.