[Nighttime attendance at the Pediatric Emergency Room of the University Hospital Centre in Brazzaville, Congo]. / Consultations de nuit aux urgences pédiatriques du CHU de Brazzaville, Congo.

The University Hospital Center is the only hospital in Brazzaville, Congo with a pediatric emergency room. The purpose of this prospective study carried out from January 1 to December 31, 2006 was to evaluate nighttime emergency room attendance by comparing children (excluding newborns) admitted between 7 p.m. and 7 a.m. (group 1) to those admitted between 8 a.m. and 2 p.m. (group 2). A total of 5796 emergency room admissions were recorded including 2648 children (45.7%) between 7 p.m. and 7 a.m. and 2209 (38.1%) between 8 a.m. and 2 p.m. The delay for admission was comparable for the two groups. The death rate at the time of admission was significantly higher in group 1 than group 2: 84.6 % vs. 15.4 % (p<0.01). The main reasons for seeking emergency room care in group 1 were fever (84.6%), digestive problems (44.2%), cough (35.7%), and convulsions (13.9%). The rate of hospitalization was the same in the two groups: 56.7% in group 1 versus 52.8% in group 2. The most common reasons for hospitalization were acute gastroenteritis (24.7%), bronchopulmonary infection (18.9%), malaria (17.3%), severe septicemia (9.3%) and ORL infection (8.1%). Risk factors for hospitalization included age under 2 years, arrival before midnight, and malnutrition. The death rate within 24 hours after hospitalization was 23% in group 1 and 11.5% in group 2 (p<10-4). The death rate was higher in children admitted before midnight. Nighttime attendance as well as hospitalization and death rates remain high at the pediatric emergency room of the University Hospital Center in Brazzaville. The most frequent reason for attendance was fever. Improving outcomes will require providing better information to parents (reducing admission delay) and upgrading hospital resources in terms of patient assessment and medical intervention (health care personnel and facilities).

[Orphans in Brazzaville orphanages]. / Situation des enfants orphelins dans les orphelinats de Brazzaville.

UNLABELLED: Children are orphaned everywhere, but their situation is particularly acute in developing countries. OBJECTIVES: To assess the epidemiologic situation of orphans in Brazzaville and to identify the social and medical determinants of their placement in institutions. MATERIAL AND METHODS: This exploratory cross-sectional study was conducted from March 3, 2003, through January 30, 2004 (11 months). Direct interviews based on a standardized questionnaire collected information from the orphans old enough to answer questions, their parental substitutes or guardians, and the orphanage directors. The evaluation of the conditions in the orphanages was based on observable, quantifiable indicators. ON THE WHOLE: We identified 12 orphanages and 162 children: 92 boys (56.8%) and 70 girls (43.2%). Their average age was 10.5 years +/- 3.5 (range: 3 months to 15 years). Overall, 38 (23.5%) had lost only their mother, 22 (13.6%) their father, and 102 (63%) both parents. The child was placed at the orphanage by the family in 97 cases (60%), the social services department in 50 cases (30.9%), and by the police or the Red Cross in 15 cases (9.3%). The reasons for placement were: lack of financial support (137 cases, 84.5%), other social reasons (8 cases, 4.9%), abandonment (3 cases, 2%) and unspecified causes (14 case, 8.6%). The principal causes of parents' deaths were: pregnancy and childbirth 73 cases (45%), war, 45 cases (28%), HIV infection, 26 cases (16%), malaria, 6 cases (4%), accidents, 8 cases (5%) and unknown, 4 cases (2.5%). CONCLUSION: Orphanages are one alternative for the survival of children without parents able to care for them. Attention to them, support of their activities, and improvement of the living conditions there are all important.

[Sexual behaviour among adolescents in Brazzaville, Congo]. / La sexualité de l'adolescent à Brazzaville, Congo.

AIM: Estimate sexual activity among Congolese adolescents in Brazzaville and appreciate the influence of sociocultural and economic factors on sexual behaviour. METHODS: Data were collected from 900 adolescents (389 males and 511 females) aged 10-19 years in the seven urban areas of Brazzaville. These subjects were randomly recruited by a two stage sampling. The data were gathered by an anonymous face-to-face questionnaire. Relative risk estimations were calculated for early or first sexual intercourse, multiple sexual partnerness and safe sex. RESULTS: A total of 474 respondents indicated that they were sexually active. Females were more sexually active, 270 compared with 204 males (p<0.05). The mean early age of coital debut was 14.6 years (S.D.=1.7 years). Early intercourse (before 14 years) was found in 73 males and 39 females (p<0.001). Multiple sexual partnerness was found in 81.3% of males, while the frequency of females was 51.1%. Risk factors for pregnancy and multiple sexual partnerness were unemployment mother, non school situation, early puberty and non sexual education. In contrast, regular religious activity was recognized as factor that had significant protection impact on sexual activity. The total use ratio of the condom was estimated at 42.2% in males. More females (41.7%) were using Ogino method of contraception. In addition, 102 females (36.8%) claimed to have already a pregnancy and the mean age was 16.1 years (S.D.=1.2 years). In 64.7% of these cases, teenagers chose the abortion as solution of an unwanted pregnancy. After the birth of a child, it was reported that 82.4% of adolescents gave up with school. CONCLUSION: Our results show the importance of problems associated to sexual activity among Congolese adolescents in Middle Africa. These data should be taken into account when planning the prevention of risk of sexual behaviours among adolescents.

[Retrospective study of 61 cases of multifocal tuberculosis in children in Brazzaville, Congo]. / Etude rétrospective de 61 cas de tuberculose multifocale chez l'enfant à Brazzaville, Congo.

The spread of HIV infection has changed several aspects of tuberculosis notably with regard to disseminated and multifocal forms that have become increasingly common. The purpose of this study was to evaluate epidemiologic, clinical, and prognostic factors associated with multifocal tuberculosis and to assess the impact of HIV infection. The files of children admitted for multifocal tuberculosis to the paediatric department of the Brazzaville University Hospital Centre in Congo were retrospectively reviewed. Patients that were not followed throughout treatment were not included. Multifocal tuberculosis was defined as the presence of at least two extrapulmonary sites. All patients over 18 months old were screened for HIV infection. From January 1995 to December 2005, a total of 61 children with a mean age of 7.2 years (range, 8 months to 15 years) were enrolled according to these inclusion criteria. Multifocal tuberculosis was bifocal (n=15), trifocal (n=44), and quadrifocal (n=2) for a total of 170 sites. To assess the impact of HIV infection, patients over the age of 18 months divided into two groups based on positive versus negative screening tests. The time delay for seeking care was comparable for the 38 HIV-positive children (all infected with HIV-1) and the 20 HIV-negative children. However HIV-positive children exhibited a higher rate of malnutrition, more tuberculosis sites (both quadrifocal patients), and increased mortality (10/38 versus 2/20). These differences were not statistically significant probably due to the small patient population. Multifocal tuberculosis is a major problem for paediatric departments in the Congo. Its unusually high incidence and special severity is linked mainly to HIV infection. Given the high incidence of co-infection, routine screening for HIV is recommended for paediatric patients with multifocal tuberculosis.

[Pulmonary tuberculosis in infants in Brazzaville, Congo. A review of 117 cases]. / Tuberculose pulmonaire du nourrisson à Brazzaville (congo). A propos de 117 cas.

Little information is available on pulmonary tuberculosis in infants in sub-Saharan Africa. This retrospective study was conducted in infants ranging in age from 1 to 23 months admitted to the Paediatric Departments of the University Hospital Centre in Brazzaville, Congo for pulmonary tuberculosis between January 1, 1999 and July 1, 2004. Tuberculosis was diagnosed on the basis of epidemiological, clinical, radiological, and follow-up data. All children over 12 months old underwent HIV testing. In case of positive test results, children between the ages of 12 and 18 months were retested after the age of 18 months. Of a total of 803 children admitted for tuberculosis during the study period, 117 (14.6%) were under the age of 24 months (53% males). Mean age was 17.5 months. The BCG test was mentioned in 75.2% of cases. Determination of the contagion in 50.4% of cases indicated that transmission was intrafamilial in 69.3% of cases. The mean delay for hospitalization was 2.6 months (range, 21 days to 16 months). Eighty-one patients (69.2%) presented severe malnutrition. Intrathoracic forms accounted for most cases with bronchopneumopathy (72.6%) and mediastinal adenopathy (40.2%). The incidence of bronchopneumonopathy and isolated forms was significantly higher in children over one year old than in children under one year old: 78.3% versus 21.7 % (p<0.01) and 62.8% versus 37.2% (p<0.001) respectively. A total of 35 children (43.8%) over the age of 12 months presented HIV infection. In comparison with HIV-negative children, HIV-positive children were more likely to present malnutrition and presented a statistically higher incidence of mediastinal adenopathy and multifocal forms. All associated extrathoracic lesions (21.4% of cases) occurred in HIV-positive children. Outcome was favourable in all HIV-negative children while 7 HIV-positive children (20%) died during treatment. Pulmonary tuberculosis in infants in Brazzaville is characterized by frequent association with HIV infection and prognosis is more severe in case of HIV co-infection.

[Early neonatal presentation to the pediatric emergency department, Brazzaville (Congo)]. / Consultations et réadmissions avant l'âge d'un mois aux urgences pédiatriques, Brazzaville (Congo).

OBJECTIVES: To identify and analyze factors influencing the readmission of newborns to the paediatric emergency unit of university hospital of Brazzaville after their stay in maternity. MATERIAL AND METHODS: A prospective survey was conducted in newborns discharged from maternity for household, excluding infants delivered by caesarean section. RESULTS: A total of 458 (6.3%) newborns were recruited among 7233 children admitted in the paediatric emergency unit. The visits took place between 8 am-1 pm (51.7%), 14 pm-19 pm (31.7%) and 20 pm-7 am (16.4%). Visit motives were cough, fever, digestive signs, and malformations. Main causes of hospitalization were severe sepsis (21.8%), bronchopulmonary infections (23.0%), isolated fever (12.6%), malformations (5.3%). Low bith weight newborns and newborns with shorter length of stay at maternity (less than 24 h) were most often hospitalized than infants with normal weight (P < 0.01). CONCLUSION: Increased length of hospitalization in maternity, systematic medical examination of newborn in maternity, better information of mothers on breastfeeding, and improved health care should contribute to decrease the rehospitalization rate during the first month of life.

[Risk factors for low birth weight in Brazzaville, Congo]. / Facteurs de risque de petit poids de naissance à Brazzaville, Congo.

OBJECTIVE: To determine prevalence of low birth weight (LBW) in Brazzaville (Congo) and to identify associated risk factors. MATERIAL AND METHOD: A case-control study was performed over a 2-month period. A total of 488 infants with LBW were compiled consecutively from May to June 2005. These subjects were compared to 488 infants with normal birth weight (2500-4000 g). RESULTS: LBW concerned 12.4% of births. The frequency of LBW was higher among teenagers and mothers aged at least 30 years, and among mothers of low socio-economic status. The other principal risk factors of LBW were: primiparity and high parity; previous abortion; body mass index of mother inferior to 18; existent of hypertensive arterial pression, ancient or gravidic. A best control of pregnancy (number of antenatal visits>3 or at least one ultrasound) was linked with a low frequency of LBW. CONCLUSION: Prevalence of LBW in Brazzaville was higher than in developing countries. An appropriate implementation of the National Program of Health during pregnancy and improvement of living conditions could contribute to minimize this phenomenon.

[A nutrition survey among schoolchildren in Brazzaville, Congo]. / Profil alimentaire de l'écolier à Brazzaville, Congo.

OBJECTIVE: To identify nutritional characteristics among schoolchildren in Brazzaville, Congo. POPULATION AND METHODS: A 3-day feeding survey was undertaken in 3 primary education schools in the Brazzaville borough. The study was conducted among 1066 schoolchildren (534 boys, 532 girls) ranging from 6 to 14 years. The subjects were divided into 4 age groups: 6-7, 8-9, 10-11 and 12-14 years old. The evolution of the feeding was studied according to age, and the nutritional intakes were compared with recommended dietary allowances. RESULTS AND DISCUSSION: The energy intakes were low, the mean caloric intake was 1984.9+/-448 Kcal. They increased between 6 and 14 years, especially between 13 and 14 years, where mean increase was twice as important as between 6 and 7 years. Energy provided by the evening meal was equivalent to 67.5% of mean caloric intake per day. The quantities of aliments taken increased with age. In addition, there were excesses and insufficiencies common or specific to the Congolese children of 4 age groups. High natrium intakes were observed at age 12 years, insufficient intakes of phosphore and lipids at 10 years. CONCLUSION: On the basis of the observation of the schoolchildren's behavior at Brazzaville, poverty seems to influence the schoolchildren's nutritional status. But, one could propose dietary advices, in order to improve the problems described here.

[Radiological specifities of pulmonary tuberculosis in Congolese children: effect of HIV infection]. / Aspects radiographiques de la tuberculose pulmonaire chez l'enfant Congolais: influence de l'infection a VIH.

The purpose of this retrospective study was to identify special features of radiological lesions associated with pulmonary tuberculosis in HIV-infected children. A retrospective review was carried out on the files of children between the ages of 18 months and 15 years admitted to the University Hospital Centre in Brazzaville, Congo for pulmonary tuberculosis between January 1995 and December 2004. A total of 486 patients were analyzed including 174 (35.8%) HIV-infected patients (group 1) and 312 (64.2%) non-HIV-infected patients (group 2). Radiological findings in the two groups were compared. Parenchymal lesions were observed in a total of 474 patients including 172 (99.0%) in group 1 and 302 (96.8%) in group 2 (p> 0.05). The incidence of bilateral lesions (overall, 260 patients, i.e., 54.9%) was higher (p< 0.01) in HIV-infected patients than in non-HIV-infected patients: 66.1% (n=115) versus 46.5% (n=145) respectively. Most unilateral lesions (overall, 214 patients) involved the right lung but the difference between the two groups was not significant. The distribution of parenchymal lesions in function of radiological aspect was similar (p> 0.05) in two groups. The prevalence of mediastinal adenopathy (46.1% overall, i.e. 244 patients) was higher in HIV-infected children than in non-HIV-infected children: 75.9% (n=132) versus 46.4% (n=92) respectively. Pleural involvement (overall, 67 patients) was always associated with parenchymal lesions, and was found with similar frequency in the two groups. Our findings indicate that the presence of diffuse parenchymal lesions in both lungs is a characteristic radiological finding of pulmonary tuberculosis in HIV-infected children. Another specific feature of HIV/tuberculosis co-infection was high frequency of miliary and mediastinal adenopathy.

[Retrospective study of visceral surgical emergencies in children at the University Hospital Center of Brazzaville (Congo)]. / Etude rétrospective des urgences chirurgicales viscérales de l'enfant au CHU de Brazzaville (Congo).

The purpose of this study was to estimate the Incidence of visceral surgical emergencies In children and to determine the main causes and their prognoses. A retrospective study was carried out among children ranging from 1 month to 15 years who underwent emergency visceral surgery in the pediatric surgery unit of the University Hospital Center in Brazzaville, Congo. A total of 185 of the 206 children (14.1%) admitted for emergency visceral surgery were included In the study. The study population was predominantly male (67%). Most patients (71.3%) were over 5 years of age. The main indications for visceral surgery were acute appendicitis (30.3%), peritonitis (28.1%), strangulated hernia (22.2%), abdominal contusion (7.6%), intussusception (6.4%), other causes of intestinal obstruction (2.7%), and abdominal wounds (2.7%). Peritonitis was due to ruptured appendix in 76.9% of cases. Strangulated hernias were inguinal in 70.7% of cases and wnbilical in 29.3%. Intussusception was idiopathic in all cases and usually observed in infants under 6 months of age (58.3%). Postoperative recovery was uneventful in 79.5% of cases and complicated in 16.2%. EIght deaths (4.3%) were recorded. For the patient that died, the delay between initial symptoms and admission was longer than 3 days in 87.5% of cases and the interval for surgical treatment was longer than 6 hours in all cases. Early diagnosis and prompt surgical treatment are favorable prognostic factors for the outcome of emergency visceral surgery.

[Sickle-cell crisis in the child and teenager in Brazzaville, Congo. A retrospective study of 587 cases]. / Les crises vaso-occlusives drépanocytaires chez l'enfant et l'adolescent a Brazzaville, Congo. Etude rétrospective de 587 cas.

Using files related to children admitted at the Brazzaville teaching hospital (Congo) between May 1995 and May 2002, the authors have studied the part of sickle cell crisis (SCC) in the sickle cell disease, have assessed the epidemiological particularities, the relation between some clinical, biological factors as well as the severity of the disease. On the whole, 587 SCC have been observed in homozygous SS children aged 6 to 17. The distribution was as follows: painful osteo-articular crisis (58.6%), abdominal crisis (23.5%), acute chest syndrome (14%), neurological strokes (3.2%) and priapism (0.7%). The neurological strokes (75%) and the hand-foot syndrome (77.8%) were predominant in male. As regards the interaction age-localization of the crisis, the hand-foot syndrome mainly concerned children under five, long bones and rachis impairment those aged 11 to 15; abdominal and neurological crisis were observed especially before the age of 10, the acute chest syndrome after 10 (68.3%). Malaria (48.9%) and bacterial or viral infections (24.5%) proved to be the triggering factors when these are identified (188 cases). SCC occurred in 67.5% of the cases during the hot and rainy seasons. Moreover the haemoglobin F rate above 10% was correlated with a low prevalence of SCC, in particular the potentially severe crisis, revealing at the same time its protective value. These results show that SCC, by their frequency and/or their severity constitute a major handicap when the vital prognosis is not involved. Rigorous health habits, appropriate vaccination programme, adequate malarial prophylaxis, optimal transfusional strategy and especially the use of hydroxyurea, prove to be urgent preventive measures to put into practice. Their efficient implementation will provide a better quality of life to the sickle cell patient and will decrease the risks of severe crisis.

[Radiological profile in 92 children suffering from Pott's disease]. / Aspects radiologiques du mal de Pott chez i'enfant. A propos de 92 cas.

The aim of this cross-sectional study was to analyse the radiological profile in 92 patients with Pott's disease and to identify severity factors. Among these subjects, aged from 11 months to 15 years old (average: 7.5 years), 37% of children had neurological signs; the HIV test was positive in 11 % of cases. Localisations were mainly dorsal (61%) and thoracic (49%). They were often associated. Almost all patients had lesions on one vertebra (31.5%) or 2 vertebrae (38%). Most of lesions were spondylitis (61%), paravertebra abscess (35%) and compressing vertebra (34%). The severity of vertebra localisations was correlated with late diagnosis and presence of neurological complication, while a high sedimentation rate didn't appear to be a factor of severity. Therefore radiology remains essential in Pott's disease evaluation providing precious information for the diagnosis and prognosis of spine tuberculosis.

[Effects of age on causes of hospitalization in children suffering from sickle cell disease]. / Causes d'hospitalisation des enfants drépanocytaires: influence de l'age (C.H.U. de Brazzaville, Congo).

The objective of this work was to assess the frequency the nature of complications and prognosis of the disease in children suffering from sickle cell disease. This retrospective study was conducted from January 2002 to December 2003 among 251 children suffering from sickle cell disease, hospitalized at the Brazzaville Teaching Hospital, Congo. The main hospitalization causes were dominated by the vaso-occlusive crisis (26.7%), anaemic crisis (20.3%) and infections (36.6%). The vaso-occlusive crisis were observed particularly in the 5 year-old children (p < 0.05); the hand-foot syndrome concerned in particular children under 5 years old. Anaemic crisis were found almost exclusively in patients under 5 (p < 0.05). The infections in children under 5 (35.8%) were almost as frequent as in older children (37.4%). Some non infectious complications were only observed in children above 5: cholithiasis, 4 cases; heart failure, 4 cases; hip osteonecrosis, 1 case. Global mortality was 4.8% and higher in children under five (p > 0.05). In addition, the death causes were dominated by anaemic crisis. In conclusion, this study stresses on the need to implement a primary prevention as well as a secondary prevention adapted to age.

[Body composition in Negro African children suffering from sickle cell disease. A mixed cross-sectional longitudinal study in Brazzaville, Congo]. / Composition corporelle d'enfants drépanocytaires homozygotes congolais. Etude longitudinale a Braz- zaville, Congo.

This study evaluates the changes of body composition in homozygous children suffering from sickle cell disease and appreciates the interaction between some factors of severity of the disease. A mixed cross-sectional longitudinal study with control cases cohort was conducted in Brazzaville (Congo) among 91 children with sickle cell disease (45 boys and 46 girls) and 95 healthy children (48 boys and 47 girls), aged of 8-17 years old. Each group was initially divided into three subgroups of age: 8, 11, 14. These children were subsequently followed for 3 years. Each year, at the same period, body mass, percentage of body fat, lean body mass and body mass index were evaluated in the two groups and then compared. The effects of frequency of painful episodes, the number of severe anaemia crisis and haemoglobin F on different variables were also appreciated. The children with sickle cell disease had stunting, lower values of body mass (p < 0.001), percentage of fat (p < 0.01), lean body mass (p < 0.01), and body mass index (p <0.001) between 8 and 17 years of age. In addition, we observed a non linear association between body mass index and fat percentage, but this interaction was stronger in girls. Finally the yearly frequency of painful episodes, the number of severe anaemia crisis and haemoglobin F had most of the time an influence on body composition. Children with sickle cell disease had a decreased body composition influenced by the complications associated with the disease . These limitations are modulated by haemoglobin F but the body composition is affected by painful episodes and severe anaemic crisis. Therefore more care and attention are recommended for the children suffering from sickle cell disease in order to control this severe disease.

Cerebral malaria in African children: socioeconomic risk factors in Brazzaville, Congo.

Current epidemiologic and clinical research on cerebral malaria is directed towards prognostic criteria and neurologic sequelae. However, the assessment of risk factors related to the environment and the socioeconomic standard of the family is of practical as well as theoretical interest. A prospective survey was carried out in March 1990 in Brazzaville, Congo by interviewing subjects in two groups: 1) 600 households representative of the Brazzaville population and 2) 84 households with a child who had been hospitalized for cerebral malaria between January 1, 1988 and June 30, 1989 (i.e., 9-27 months prior to the interview). The mothers' knowledge and attitudes with regard to the prevention and treatment of malaria in children were assessed, as was the socioeconomic standards of the households. The group in which at least one child had been hospitalized for cerebral malaria had a lower socioeconomic standard than the control group. Other differences in this group included a greater number of offspring and a higher average number of decreased children, less chemoprophylaxis, antimalarials available less often in the household, less early treatment of fever at home, and drugs bought more often at the market. There was no significant difference between the groups with regard to using the correct dosage of chloroquine, ownership of a mosquito net, or the use of insecticides or repellents.

PIP: The aim was to compare a cerebral malaria group (B) with a control group (A) representative of the entire population of Brazzaville. Group A was composed of mothers with at least 1 child younger than 10 years old living in the urban district of Brazzaville. 30 clusters of 20 households totalling 600 were selected from the 1984 population census. Group B was composed of Brazzaville children who had been admitted to the University Hospital for cerebral malaria between January 1, 1988, and June 30, 1989. Of the 170 children for whom precise hospital records were available 145 were discharged from the hospital. In the 1st quarter of 1990 a family-based survey was carried out on 84 households to study postcerebral malaria mortality analyzing: 1) the preventive and therapeutic measures taken by mothers, and 2) the socioeconomic standards of the families in 68 and 84 households, respectively. The socioeconomic standard of group B was lower than that of group A. Those with less than a primary school education constituted: 502 (84%) in 600 controls vs. 61 (73%) in 84 cases (p = 0.02 odds ratio [OR] = 1.9). For 461 controls (77%) vs. 47 cases (56%), mothers had a good comprehension of French (p = 0.0007, OR = 2.3). The other differences were that Group B had a greater number of children, a higher average number of deceased children, less use of chemoprophylaxis, antimalarials available less often in the household, less early treatment of fever at home, and the purchase of drugs more often at the market. However, significant differences were not found with respect to owning a mosquito net or the use of insecticides and repellents.

Malaria and urbanization in central Africa: the example of Brazzaville. Part V: Pernicious attacks and mortality.

The current incidence of pernicious attacks and of mortality due to malaria were studied in Brazzaville. The results of this study, which concerned all the medical units of the town, were analysed in terms of previous studies on the epidemiology of malaria transmission in the various districts of the town. It was estimated that the annual incidence of pernicious attacks in children in Brazzaville is 1.15 per thousand between 0 and 4 years, 0.25 per thousand between 5 and 9 years and 0.05 per thousand between 10 and 14 years. The annual mortality due to malaria was estimated at 0.43 per thousand between 0 and 4 years and 0.08 per thousand between 5 and 9 years. These values are about 30 times lower than those expected from the results of previous studies of the mortality due to malaria in intertropical Africa. Whereas considerable differences in intensity of malaria transmission exist in the different districts of Brazzaville, the incidence of pernicious attacks and the resulting mortality are remarkably unvarying whatever the level of transmission. In particular, similar results were observed for the sector Mfilou-Ngamaba-Ngangouoni, where malaria is holoendemic with over 100 infective bites per person per year and a parasite rate of 80.95% in schoolchildren, and the central sector of Poto-Poto-Ouenze-Moungali, where malaria is hypoendemic with less than one infective bite per person every three years and a parasite rate of less than 4% in schoolchildren. These results are discussed in terms of previous observations in urban and surrounding rural areas.(ABSTRACT TRUNCATED AT 250 WORDS)

[Early diagnosis of leukaemia in the trisomic child. Congolese experience based on two cases]. / Diagnostic précoce de la leucémie chez l'enfant trisomique. Expérience congolaise de deux cas.

We are reporting here two cases of acute leukemia in Congolese children with Down syndrome. They were aged 27 and 30 months. The two cases were revealed by anemia, hyperthermia with enlargement of the liver and the spleen. Clinical course was unfavorable. Therefore, the early diagnosis of leukemia remains very important in patient with Down syndrome presenting hyperthermia with hepatosplenomegaly.

[Kawasaki syndrome: apropos of 2 cases observed in Brazzaville]. / Le syndrome de Kawasaki: à propos de deux cas observés à Brazzaville.

The authors report for first time in Congo two cases of Kawasaki syndrome. One case from a five years boy carried out a typical form of an adeno-mucocutaneous syndrome; the other from a six month little girl was an incomplete form. In both cases, the immediate development has been excellent. The scarceness of this syndrome among the blacks and the diagnostic difficulties have been the background of the interest of this work.

[Severe malaria associated with acute renal insufficiency: apropos of a case]. / Paludisme grave associé à une insuffisance rénale aiguë: à propos d'une observation.

Renal insufficiency as a complication of severe malaria is a rare pathology. A case was observed in young girl aged 10.5 years following Plasmodium malaria fever. Clinical features included severe anemia, oligo-anuria, and creatinemia of 80 mg/l. The haemoglobin electrophoresis was standard. Under furosemide, the resumption of diuresis was effective nine days later. Renal functions of the child affected by severe Plasmodium malarial fever must always be checked.

[Early isosexual precocious pseudopuberty revealing a juvenile granulosa cell tumor in a 3-year-old Congolese girl]. / Pseudo-puberté précoce isosexuelle révélatrice d'une tumeur de la granulosa juvénile chez une fillette congolaise de 3 ans.

We describe a juvenile granulosa cell tumor expressed by an early pseudopuberty occurring in a 3-year-old black child. Clinically, an endocrine syndrome was associated with a pelvic mass and ascites. Hyperoestrogenia and serum alphafetoprotein level were biologically detected. Histological examination showed typical microscopic features of a granulosa cell tumor. The patient is well four years after surgery. Growth and mental development are normal.