Risk factors for mortality in an African pediatric emergency department: case of Sourô Sanou Hospital, a prospective, cross-sectional study.

BACKGROUND: Childhood mortality rates remain high in sub-Saharan Africa. This study aimed to assess the causes and associated factors of pediatric emergency mortality at the Sourô Sanou University Hospital of Bobo-Dioulasso. METHODOLOGY: This was a cross-sectional study with prospective collection from June to August 2020. We documented and analyzed demographic and clinical characteristics by means or proportions. Logistic regression was performed to identify the factors associated with childhood mortality. RESULTS: From 618 pediatric patients admitted to pediatric emergency unit, 80 (12.9%) were documented as death outcomes. The mean age was 34.10 ± 36.38 months. The male sex represented 51.25%. The main diagnoses were severe malaria (61.25%), acute gastroenteritis (11.25%) and pneumonia (10%); 48.75% of the patients were malnourished and only 55% were fully immunized. The average length of hospitalization was 2.73 ± 3.03 days. Mortality was a strongly significant association with late come to the emergency unit (AOR = 1.11, CI = 1.04-1.18), young maternal age (AOR = 0.95, CI = 0.92-0.99) and incomplete vaccination (AOR = 1.94, CI = 1.13-3.31). CONCLUSION: The in-hospital mortality rate was 12.94%; younger maternal age, delay in consultation, unimmunized or incompletely immunized status and shorter hospital stays were significantly associated with death.

Infant mortality rates remain high in sub-Saharan Africa jeopardizing the achievement of targets for the sustainable development goals. In this article, we identify the causes and factors associated with infant mortality at the Sourô Sanou University Hospital Pediatric Emergency Room in Bobo-Dioulasso. During the study period, the main diagnoses were severe malaria, acute gastroenteritis and pneumonia. Mortality was strongly associated with late arrival at the emergency room, young maternal age and incomplete vaccination. The in-hospital mortality rate was 12.94%, and younger maternal age, delay in consultation, unimmunized or incompletely immunized status and shorter hospital stays were significantly associated with death.

Efavirenz-based simplification after successful early lopinavir-boosted-ritonavir-based therapy in HIV-infected children in Burkina Faso and Côte d'Ivoire: the MONOD ANRS 12206 non-inferiority randomised trial.

BACKGROUND: The 2016 World Health Organization guidelines recommend all children <3 years start antiretroviral therapy (ART) on protease inhibitor-based regimens. But lopinavir/ritonavir (LPV/r) syrup has many challenges in low-income countries, including limited availability, requires refrigeration, interactions with anti-tuberculous drugs, twice-daily dosing, poor palatability in young children, and higher cost than non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs. Successfully initiating LPV/r-based ART in HIV-infected children aged <2 years raises operational challenges that could be simplified by switching to a protease inhibitor-sparing therapy based on efavirenz (EFV), although, to date, EFV is not recommended in children <3 years. METHODS: The MONOD ANRS 12026 study is a phase 3 non-inferiority open-label randomised clinical trial conducted in Abidjan, Côte d'Ivoire, and Ouagadougou, Burkina Faso (ClinicalTrial.gov registry: NCT01127204). HIV-1-infected children who were tuberculosis-free and treated before the age of 2 years with 12-15 months of suppressive twice-daily LPV/r-based ART (HIV-1 RNA viral load (VL) <500 copies/mL, confirmed) were randomised to two arms: once-daily combination of abacavir (ABC) + lamivudine (3TC) + EFV (referred to as EFV) versus continuation of the twice-daily combination zidovudine (ZDV) or ABC + 3TC + LPV/r (referred to as LPV). The primary endpoint was the difference in the proportion of children with virological suppression by 12 months post-randomisation between arms (14% non-inferiority bound, Chi-squared test). RESULTS: Between May 2011 and January 2013, 156 children (median age 13.7 months) were initiated on ART. After 12-15 months on ART, 106 (68%) were randomised to one of the two treatment arms (54 LPV, 52 EFV); 97 (91%) were aged <3 years. At 12 months post-randomisation, 46 children (85.2%) from LPV versus 43 (82.7%) from EFV showed virological suppression (defined as a VL <500 copies/mL; difference, 2.5%; 95% confidence interval (CI), -11.5 to 16.5), whereas seven (13%) in LPV and seven (13.5%) in EFV were classed as having virological failure (secondary outcome, defined as a VL ≥1000 copies/mL; difference, 0.5%; 95% CI, -13.4 to 12.4). No significant differences in adverse events were observed, with two adverse events in LPV (3.7%) versus four (7.7%) in EFV (p = 0.43). On genotyping, 13 out of 14 children with virological failure (six out of seven EFV, seven out of seven LPV) had a drug-resistance mutation: nine (five out of six EFV, four out of seven LPV) had one or more major NNRTI-resistance mutations whereas none had an LPV/r-resistance mutation. CONCLUSIONS: At the VL threshold of 500 copies/mL, we could not conclusively demonstrate the non-inferiority of EFV on viral suppression compared to LPV because of low statistical power. However, non-inferiority was confirmed for a VL threshold of <1000 copies/mL. Resistance analyses highlighted a high frequency of NNRTI-resistance mutations. A switch to an EFV-based regimen as a simplification strategy around the age of 3 years needs to be closely monitored. TRIAL REGISTRATION: ClinicalTrial.gov registry n° NCT01127204 , 19 May 2010.

Prevention and care of paediatric HIV infection in Ouagadougou, Burkina Faso: knowledge, attitudes and practices of the caregivers.

BACKGROUND: The paediatric Human Immunodeficiency Virus (HIV) epidemic still progresses because of operational challenges in implementing prevention of mother-to-child HIV transmission (PMCT) programs. We assessed the knowledge, attitudes and practices (KAP) of children's caregivers regarding mother-to-child transmission (MTCT) of HIV, paediatric HIV infection, early infant diagnosis (EID), and paediatric antiretroviral treatment in Ouagadougou, Burkina Faso. METHODS: We undertook a qualitative survey in the four public hospitals managing HIV exposed or infected children, in Ouagadougou in 2011. A sociologist used a semi-structured questionnaire to interview caregivers of children less than 5 years old attending the paediatrics wards on their KAP. Study participants were divided into four groups as follows: those who did not yet know their children's HIV infection status, those who were waiting for their children's HIV test results, those who were waiting for antiretroviral treatment, and those who were already on antiretroviral treatment. RESULTS: A total of 37 caregivers were interviewed. The mean age was 32.5 years, and 29 (78 %) were mothers. Twenty seven (73 %) caregivers had primary or higher level of education, and 15 (40 %) described their occupation as "housewife". Overall, 36 (97 %) of caregivers knew that the main route of HIV transmission for infants was through MTCT and 14 (38 %) specified that it occurred during pregnancy or delivery. Five percent thought that MTCT of HIV occurred during conception. PMTCT interventions could help prevent infant HIV infection according to 32 (87 %) caregivers. Thirty five percent of caregivers stated EID as a prevention strategy. Fifty-four percent of the participants believed that replacement feeding option would prevent MTCT of HIV; 24 (65 %) stated that they would prefer medical practitioners seek caregivers' consent before carrying out any HIV-test for their child, and that caregivers' consent was not compulsory before antiretroviral treatment. All caregivers thought that it was necessary to treat HIV-infected children, although they did not know what interventions could be done. CONCLUSIONS: This study highlighted the low level of caregivers' knowledge on paediatric HIV prevention and care in Ouagadougou. Awareness programs targeting caregivers need to be strengthened in order to improve the uptake of HIV early infant diagnosis and care.

[Prevalence and factors associated with malnutrition in infants aged 6 to 23 months admitted to paediatric emergencies department at the Yalgado Ouédraogo University Hospital in Burkina Faso]. / Prevalence et facteurs associes a la malnutrition des nourrissons ages de 6 a 23 mois admis aux urgences pediatriques du Centre Hospitalier Universitaire Yalgado Ouedraogo, Burkina Faso.

INTRODUCTION: Despite the implementation of various nutritional interventions, access to healthy food in sufficient quantity for the population remain challenging in Burkina Faso. The objective of this study was to assess the nutritional status of infants aged 6-23 months and to identify factors associated with malnutrition. PATIENTS AND METHODS: From 1st May to 31th July 2016, we conducted a cross-sectional study at Yalgado Ouedraogo University Hospital paediatric department. Infants aged 6 to 23 months admitted to the paediatric emergency department were enrolled. Factors associated with malnutrition were identified using multivariate logistic regression. RESULTS: A total of 295 infants were included, at an average age of 13 months (standard deviation: 5.1 months). The prevalence of wasting was 15%, 13% was stuntingand 7% was underweight. The majority of mothers (69%) were unaware of exclusive breastfeeding and only 22% knew the importance of colostrum. In multivariate analysis age ≥ 12 months increased the odds of wasting (adjusted odds ratio [aOR]: 2.3, 95% confidence interval: 1.1-4.7), while knowledge of exclusive breastfeeding reduced the risk of wasting (aOR: 0.4, 95% CI 0.2-0.9). In addition, age ≥12 months (aOR: 0.08, 95% CI: 0.03-0.22), female gender (aOR: 0.31, 95% CI: 0.12-0.77) and absence of dietary restrictions (aOR: 0.13, 95% CI: 0.05-0.3) significantly reduced the odds of stunting. CONCLUSION: The prevalence of malnutrition remains high in paediatric department in Burkina Faso. Routine screening and adequate management of malnutrition, coupled with the promotion of optimal nutritional practices in childhood, is needed to improve child healthcare.

INTRODUCTION: Les pratiques d'alimentation constituentle facteur essentiel déterminant l'état nutritionnel des enfants.L'objectif de cette étude était d'évaluer l'état nutritionnel des nourrissons âgés de 6 à 23 mois admis dans le département de pédiatrie du CHU-YO et d'identifier les facteurs associés à la malnutrition. PATIENTS ET MÉTHODE: Nous avons mené une étude transversale chez des nourrissons âgés de 6 à 23 mois admis dans le service des urgences pédiatriques au Centre Hospitalier Universitaire Yalgado Ouédraogo entre le 1er mai et le 31 juillet 2016.Les facteurs associés à la malnutrition ont été identifiés par une régression logistique. RÉSULTATS: Au total 295 nourrissons ont été inclus, à un âge moyen 13 mois(Ecart type :5,1 mois).Les prévalences de la malnutrition étaient de15% pour la malnutrition aiguë, 13% pour la malnutritionchronique et 7% pour l'insuffisance pondérale. En analyse multivariée un âge ≥ 12 mois augmentait le risque de malnutrition aiguë (Rapport de cote ajusté (RCa) : 2,3 ; Intervalle de confiance à 95% : 1,1-4,7) tandis que la connaissance de l'allaitement maternel exclusif réduisait le risque de malnutrition aiguë (RCa : 0,4 ; IC95% 0,2-0,9). De plus, un âge ≥12 mois (RCa : 0,08,IC95% : 0,03-0,22), le sexe féminin (RCa : 0.31 IC95% : 0,12-0,77) et l'absence d'interdits alimentaires (RCa : 0,13 ; IC95% : 0,05-0,3) réduisait le risque d'êtreen malnutrition chronique chez les nourrissons. CONCLUSION: La prévalence de la malnutrition carentielle reste élevée en milieu hospitalier au CHU YO. La promotion des pratiques nutritionnelles optimales du nourrisson sont nécessaires pour améliorer la prise en charge des nourrissons dans le centre.

[Primary congenital lymphedema: Milroy disease: the first case observed in the Department of Pediatrics at the University Hospital Yalgado Ouedraogo, Ouagadougou]. / Le lymphœdème congénital primaire: la maladie de Milroy: à propos du premier cas observé dans le Département de Pédiatrie du Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou.

Congenital lymphedema is the accumulation of lymphatic fluid in the child's interstitial spaces. Milroy disease is a rare, hereditary, autosomal dominant condition showing incomplete penetrance. We report the case of a 7-year old little girl with Milroy disease examined for erysipelas on congenital big right leg. A family history of large congenital member existed. Physical examination showed big oedematous right leg painful to palpation, with skin lichenification and erysipelas. Paraclinical assessment objectified cutaneous lymphedema with vascular involvement suggestive of ectasia of the right saphenous vein. Female karyotype showed no abnormalities, despite the small chromosomal rearrangements. Treatment was based on physiotherapy, bandages, compression stockings and psychotherapy. This first case in Burkina Faso testifies to the rarity of the pathology but especially to the diagnostic difficulties related to the inadequacy of paraclinical investigations.