Growth and Mortality Outcomes for Different Antiretroviral Therapy Initiation Criteria in Children Ages 1-5 Years: A Causal Modeling Analysis.

BACKGROUND: There is limited evidence regarding the optimal timing of initiating antiretroviral therapy (ART) in children. We conducted a causal modeling analysis in children ages 1-5 years from the International Epidemiologic Databases to Evaluate AIDS West/Southern-Africa collaboration to determine growth and mortality differences related to different CD4-based treatment initiation criteria, age groups, and regions. METHODS: ART-naïve children of ages 12-59 months at enrollment with at least one visit before ART initiation and one follow-up visit were included. We estimated 3-year growth and cumulative mortality from the start of follow-up for different CD4 criteria using g-computation. RESULTS: About one quarter of the 5,826 included children was from West Africa (24.6%).The median (first; third quartile) CD4% at the first visit was 16% (11%; 23%), the median weight-for-age z-scores and height-for-age z-scores were -1.5 (-2.7; -0.6) and -2.5 (-3.5; -1.5), respectively. Estimated cumulative mortality was higher overall, and growth was slower, when initiating ART at lower CD4 thresholds. After 3 years of follow-up, the estimated mortality difference between starting ART routinely irrespective of CD4 count and starting ART if either CD4 count <750 cells/mm³ or CD4% <25% was 0.2% (95% CI = -0.2%; 0.3%), and the difference in the mean height-for-age z-scores of those who survived was -0.02 (95% CI = -0.04; 0.01). Younger children ages 1-2 and children in West Africa had worse outcomes. CONCLUSIONS: Our results demonstrate that earlier treatment initiation yields overall better growth and mortality outcomes, although we could not show any differences in outcomes between immediate ART and delaying until CD4 count/% falls below 750/25%.

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.

Neonatal azithromycin administration for prevention of infant mortality.

Background: Biannual mass azithromycin administration reduces all-cause childhood mortality in some sub-Saharan African settings, with the largest effects in children aged 1-5 months. Azithromycin has not been distributed to children <1 month due to risk of infantile hypertrophic pyloric stenosis (IHPS). Methods: This 1:1 placebo-controlled trial, randomized neonates aged 8-27 days to a single oral dose of azithromycin (20 mg/kg) or equivalent volume of placebo in 5 regions of Burkina Faso during 2019 and 2020. The primary outcome was all-cause mortality at 6 months of age. Infants were evaluated at 21 days after treatment and at 3 and 6 months of age for vital status; family and provider surveillance for IHPS continued throughout. Results: Of 21,832 enrolled neonates, 10,898 were allocated to azithromycin and 10,934 to placebo. At 6 months of age, 92 infants had died, 42 (0.44%) in the azithromycin group and 50 (0.52%) in the placebo group (hazard ratio 0.85, 95% confidence interval 0.56 to 1.28, P=0.46). A single IHPS case was detected, which was in the azithromycin arm. Serious adverse events, including death and hospitalization within 28 days of treatment, occurred in 0.27% of infants in the azithromycin group and 0.14% in the placebo group, for an absolute risk difference 0.14 percentage points, 95% confidence interval 0.01 to 0.26. Conclusions: Overall mortality was lower than anticipated when the trial was designed, thus limiting its power. The available data do not support the routine use of azithromycin for prevention of mortality in neonates in sub-Saharan African settings similar to the one in which this trial was conducted. Trial registration: ClinicalTrials.gov NCT03682653.

Development and evaluation of an electronic algorithm using a combination of a two-step malaria RDT and other rapid diagnostic tools for the management of febrile illness in children under 5 attending outpatient facilities in Burkina Faso.

BACKGROUND: In Sub-Saharan Africa (SSA), febrile illnesses remain a major public health problem in children. However, the persistence of hrp2 antigen and the low sensitivity of pLDH RDT negatively affect antimalarials and antibiotics prescription practices. These limitations lead to poor management of febrile diseases and antimicrobial resistance (AMR). To improve the diagnosis of these febrile diseases and subsequent prescription of antimicrobials, it is hypothesized that the implementation of an algorithm including a two-step malaria RDT PfHRP2/pLDH supported by point-of-care (PoC) tests for bacterial infections could significantly improve the management of febrile diseases and thereby tackling AMR. METHODS: To assess the value of the proposed algorithm, an open-label randomized controlled trial with three arms, enrolling febrile children from 6 to 59 months is proposed. In the control arm, febrile children will be managed according to the Integrated Management of Childhood Illnesses (IMCI), which is part of the standard of care in Burkina Faso. Treatment will be done according to national guidelines. In the RDT decisional algorithm (RDT-DA) arm (intervention), the clinical examination based on IMIC will be supported by a two-step malaria RDT and bacterial infections RDTs. Prescription will be left to the discretion of the healthcare workers based on clinical examination and PoC test results. In the e-algorithm arm (intervention), artificial intelligence integrating multiple layers of clinical information such as clinical examination, signs/symptoms and medical history, and biological information such as biomarkers (CRP and WBC) and pathogen-specific PoC tests, and oximetry will be developed. The e-algorithm will serve to guide the diagnostic and management of febrile infections in children. In the 3 arms, the case report forms will be digitalized. A final follow-up visit (day 7) will be scheduled for all participants. Patients will be asked to come back to the health facilities before the scheduled visit if the symptoms persist or in case of health condition worsening. DISCUSSION: If successful, this study could contribute to improve the management of febrile diseases and reduce inappropriate use of antimicrobials. TRIAL REGISTRATION: The trial is registered at ClinicalTrial.gov, NCT05285657. Enrolment started on 4 March 2022 with long-term outcome being assessed completely by 2023.

[Medical audit of neonatal deaths with the "three delay" model in a pediatric hospital in Ouagadougou]. / Audit médical des décès néonatals selon le modèle des trois retards, en milieu hospitalier pédiatrique de Ouagadougou.

OBJECTIVE: To determine the causes of neonatal deaths and their contributing factors. MATERIAL AND METHODS: We used the "three-delay model" to conduct an audit of the neonatal deaths that occurred between January 2006 and December 2010 at the Charles de Gaulle University Pediatric Hospital, in Ouagadougou. RESULTS: The neonatal mortality rate was 12.3%. The main direct causes were infections (70%), cerebral distress (10%), respiratory distress (7%), congenital malformations (5.5%), prematurity (4.5%) and hemorrhagic syndromes (3%). All three delays were found: in decision making in 64.4% of cases, in access to health services in 77%, and in receiving appropriate care in 66.9%; they multiplied the risk of death by a factor of 4, 3 and 5, respectively. CONCLUSION: To reduce deaths of newborn babies, it is necessary to overcome the three delays that contribute to it, pending the improvement of socioeconomic conditions of populations. This combat requires optimizing the implementation of the subsidies for obstetric and neonatal emergency care and strengthening the involvement of all stakeholders, specifically, policy makers, the community and health professionals.

[Epidemiology, microbiology, and outcomes of septicemia in children treated at the Charles de Gaulle University Pediatric Hospital in Burkina Faso]. / Aspects Épidémiologiques, Microbiologiques et Évolutifs des Bactériémies de L'enfant, au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Burkina, Faso. abdousal2000@yahoo.fr

The aim of this study is to describe the epidemiological and microbiological characteristics and outcome of children with septicemia at the Charles de Gaulle University Pediatric Hospital of Ouagadougou to help improve probabilistic antibiotic therapy in this type of infection. This retrospective descriptive study covered all the children from 0 to 15 years old seen over a period of 7 years in any hospital department with suspected bacteriemia and for whom the bacteriology laboratory performed a blood culture. During the study period, the laboratory received 842 requests for blood cultures and found 154 (18.3%) of them to be positive. Files for 81 of the 154 patients could be found and examined. The distribution according to age showed septicemia was most frequent among those aged 6-15 years (61.7% of the cases). Microbial identification showed the dominant species to be Salmonella enterica (serovars paratyphi and typhi) (58%) followed by Staphylococcus aureus (12.3%). The salmonella isolates had a high rate of resistance to amoxicillin, chloramphenicol and cotrimoxazole. Staphylococci were always sensitive to the antibiotics with which they were tested, although to a lesser extent for penicillin G. All patients routinely received antibiotic treatment, and 81.5% (n=66) were cured (5 children died and 10 left the hospital against medical advice). This study shows that the bacterial epidemiology of septicemia in our setting is dominated by salmonella. Trends in bacterial resistance to antibiotics showed that common antibiotics such as amoxicillin and cotrimoxazole are no longer acceptable as probabilist therapy here. They should be replaced in this type of infection by injectable third generation cephalosporin alone or combined with aminoglycosides.

[Factors associated with overweight and obesity in children in Ouagadougou (Burkina Faso)]. / Facteurs associés au surpoids et à l'obésité des élèves de Ouagadougou (Burkina Faso).

INTRODUCTION: The international community is increasing concerned about obesity, which it has become one of the most common noninfectious pandemics worldwide and affects a growing number of children. MATERIAL AND METHODS: We conducted an analytic cross-sectional study from May 25 to June 16, 2010, among a sample of 435 randomly selected students in secondary schools in the city of Ouagadougou to identify the factors contributing to obesity and overweight. RESULTS: The main factors significantly associated with obesity and overweight were family history of obesity (OR = 7.4), higher socioeconomic level (OR = 3.8), snacking on candy (OR = 5, 3), pastry (OR = 3.5), and chocolate (OR = 12.6), frequent consumption of sweets (OR = 2.2), lack of physical activity (OR = 4.4), and conflictual family relationships (OR = 3.9). CONCLUSION: Dealing with these factors in prevention activities should help to reduce the prevalence of overweight and obesity and their morbid consequences later on.

[Urinary tract infections in a pediatric setting: Bacterial ecology and antibiotic susceptibility at the Pediatric Teaching Hospital Charles-de-Gaulle in Ouagadougou (Burkina Faso)]. / Infections du tractus urinaire en milieu pédiatrique : écologie bactérienne et sensibilité aux antibiotiques au Centre hospitalier universitaire pédiatrique Charles-de-Gaulle de Ouagadougou (Burkina Faso).

INTRODUCTION: Urinary tract infection is the second most common bacterial infection in children, after respiratory tract infection. The objective of this work was to study the bacterial ecology and antibiotic susceptibility of germs isolated during childhood urinary tract infections at the Paediatric University Hospital Charles-de-Gaulle in Ouagadougou. PATIENTS AND METHOD: This was a descriptive retrospective study covering the period from July 1st, 2010 to June 30, 2015, including 141 children from 0 to 15 years old hospitalized in the medical paediatrics department for a urinary tract infection. RESULTS: The hospital frequency of urinary tract infection was 0.7%. The mean age of the patients was 43.1 months. Female patients accounted for 57.4%, a sex-ratio of 0.7. Gram-negative bacilli were often involved (67.4%) with Escherichia Coli and Klebsiella in 35.5% and 22% of cases respectively. The main Gram-positive bacteria were staphylococci (15.5%), enterococci (11.3%) and streptococci (5.6%). Enterobacteriaceae isolated were sensitive to netilmicin (80%), chloramphenicol (76.4%), and furan (82.6%). All strains of staphylococcus were susceptible to furan, gentamicin, chloramphenicol and cefixime. In 66.7% of cases, the isolated strains of staphylococcus were resistant to amoxicillin. CONCLUSION: Urinary tract infection is a common problem in pediatrics. Its management must be early and adequate based on knowledge of the bacterial ecology in order to reduce the risk of long-term renal complications.

[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.

[Acute accidental poisoning in children: aspects of their epidemiology, aetiology, and outcome at the Charles de Gaulle Paediatric Hospital in Ouagadougou (Burkina Faso)]. / Les intoxications aiguës accidentelles de l'enfant: aspects épidémiologiques, étiologiques et évolutifs au CHU pédiatrique Charles-de-Gaulle de Ouagadougou (Burkina Faso).

Accidents are a daily concern in the paediatric ward because of their frequency, diversity and severity. Acute accidental poisoning (AAP) accounts for an important portion of these. To help improvement management of AAP, we conducted a retrospective study covering a period of 2 years from January 2005 to December 2006 at Charles de Gaulle Paediatric University Hospital in Ouagadougou. Of 9390 admissions during the study period, 123 children, or 1.3%, were admitted for poisoning. A cumulative average of 11 were admitted monthly, with a peak of 16 patients in April 2005 and 2006, together. AAP was most common among children aged 1 to 4 years. Their mean age was 3 years and ranged from 6 days to 12 years. Boys outnumbered girls, with a sex ratio of 1.2. Mothers of more than half (61%) of the children poisoned worked in the home. Household products accounted for 44.7% of AAPs, followed by drug (22.7%) and food (22%) poisoning. Kerosene and other petroleum products topped the list of household products, with 54.5%. Tranquilizers (46.4%) and dairy products (37%) dominated the drug and food poisoning categories. Immediate outcome was fatal in 3% of cases, and three quarters of these deaths occurred during drug poisoning of children aged 1 to 4 years. The mean hospital stay was 2 days, and ranged from 0 to 9 days. Health officials, the media, and community outreach must all help to increase awareness about the dangers of poisoning and of preventive measures.

[Hemoglobinuria in children hospitalized in Ouagadougou: short term inpatient care and prognosis]. / Hémoglobinurie chez l'enfant à Ouagadougou: prise en charge hospitalière et pronostic à court terme.

INTRODUCTION: The purpose of this study was to analyze the epidemiological, diagnostic, therapeutic and evolutionary features of hemoglobinuria in children hospitalized in the Pediatric University Hospital Charles de Gaulle, Ouagadougou. METHODS: We conducted a cross-sectional descriptive study over the period 01st July-31st December 2014. All children aged 0-15 years hospitalized in the Department of Medical Pediatrics of the Pediatric University Hospital Charles de Gaulle and diagnosed with macroscopic hemoglobinuria during the study period were enrolled. RESULTS: Thirty-eight patients were included in the study. Hospitalization rate for hemoglobinuria was 1.9%. The average age of patients was 80.8 ± 44.1 months (ranging from 21 to 168). The study involved 23 boys (60.5%) and 15 girls (39.5%). The major clinical signs were: fever (86.8%), dark urines like « coca cola ¼ (86.8%), pallor (63.2%), hepatomegaly (50%). Glomerular filtration flow was less than 80 mL/min/1.73m2 in 23 patients (69.7%); 21 patients had Glucose-6-phosphate dehydrogenase (G6PD) deficiency. The main suspected causes of hemoglobinuria were: severe malaria, bacterial and viral infections, G6PD deficiency, biliary haemoglobinuric fever. Treatments included: artemisinin derivatives, antibiotics and antipyretics. One patient underwent dialysis. CONCLUSION: Hemoglobinuria is a symptom mainly causing diagnostic problems in our context. It is a severe disorder which can result in acute renal failure (ARF).

[Pediatric management of sickle cell disease: experience at the Charles de Gaulle University Children's Hospital in Ouagadougou (Burkina Faso)]. / Prise en charge de la drépanocytose en milieu pédiatrique : expérience du centre hospitalier universitaire pédiatrique Charles-de-Gaulle de Ouagadougou (Burkina Faso).

Sickle cell disease is a genetic disease most common in blacks. We retrospectively collected records for patients with sickle cell disease who were seen from January 2002 through September 2006 to assess the care provided for this disease at Charles de Gaulle University Children's Hospital of Ouagadougou. In all, 88 patients were monitored quarterly at outpatient visits for sickle cell disease, in the absence of any crisis. Their age ranged from 6 months to 16 years, with an average age of 7. There were more boys than girls, with a sex ratio of 1.44. The distribution according to sickle cell genotype showed that SC accounted for 62% of cases, while SS forms were more frequent until the age of 5. All children have received the immunizations in the standard Expanded Programme on Immunization (EPI) [diphtheria, tetanus, pertussis, polio, measles and yellow fever]. The immunization rates for non-EPI vaccines including hepatitis B, Haemophilus influenzae B, Salmonella typhi, meningitis, pneumonia and the combined vaccine against measles, mumps and rubella ranged from 94 to 100%. A prophylactic anti-anaemic agent was made with folic acid often associated with iron. In addition, patients receive malaria chemoprophylaxis. Chloroquine was initially provided, and since 2006, children have been receiving sulfadoxine-pyrimethamine. Our encouraging results deserve reinforcement in the short-term - at the local level by neonatal screening, the creation of an immunization unit, and the systematization of antibiotic prophylaxis, and in the medium-term by implementation of a National sickle cell disease programme to help meet the objective of a 40% reduction in mortality among affected children younger than 5 years by 2015, set by the Sickle Cell Disease International Organization.

[Lung disease and HIV infection in children at the Charles de Gaulle university pediatric hospital center in Ouagadougou (Burkina Faso)]. / Pneumopathies et infection VIH chez l'enfant au centre hospitalier universitaire pédiatrique Charles-de-Gaulle de Ouagadougou (Burkina Faso).

To compare the clinical and radiological aspects of lung diseases in HIV-positive and HIV-negative children, we conducted a retrospective case control study covering a 3-year period from January 2003 through December 2005 at Charles de Gaulle University Pediatric Hospital Center in Ouagadougou. HIV-positive patients hospitalised for lung disease were matched to HIV-negative patients controls, hospitalised for the same symptoms, by age and date of hospitalisation. The study included 186 patients (93 HIV-positive and 93 HIV-negative) and collected data on age, sex, clinical signs, radiological signs and short-term course. Of the 93 HIV-positive children suspected to have been contaminated by mother-to-child transmission, 92 had HIV1 and 1 had a double infection of HIV1 and 2. The mean age in both groups was 48 months. Clinically severe lung disease (44%) was more common in HIV-positive children. Radiology showed that interstitial syndrome was significantly more common in HIV-positive children (p=0001) with a sensitivity of 71% and a specificity of 60%. The case-fatality rate was 4.2% among HIV-positive children. This study allows us to remind paediatricians of the importance of lung disease in HIV-infected children. Moreover, the vertical transmission responsible for disease in all our patients shows the need to accelerate the scaling up of the program for prevention of mother-to-child HIV transmission in our country.

[Acute lymphoblastic leukemia among children in Ouagadougou (Burkina Faso): the results of treatment according to the protocol of the Franco-African Pediatric Oncology Group 2005]. / Les leucémies aiguës lymphoblastiques de l'enfant à Ouagadougou (Burkina Faso): résultats de la prise en charge selon le protocole du Groupe Franco-Africain d'Oncologie Pédiatrique 2005.

INTRODUCTION: acute lymphoblastic leukemia (ALL) is being diagnosed in an increasing number of children in our Department. In the developed countries, the treatment of this hematologic malignancy can cure almost 80% of children. In developing countries, few studies focus on acute leukemias in children. The results of cancer treatments in children are disappointing in most African countries, with a survival rate of 10-15%. This study aimed to investigate the clinical, biological, therapeutic and evolutionary features of ALL in children. METHODS: we conducted a retrospective study of the medical records of children hospitalized for ALL between November 2009 and October 2011 in the pilot Paediatric Oncology Unit at the Charles de Gaulle University Pediatric Hospital Center, Ouagadougou (Burkina Faso). All children treated according to the protocol of the Franco-African Pediatric Oncology Group 2005 (FAPOG) were included in the study. RESULTS: in total, nine children with ALL were hospitalized during the two year study period. The average age of patients was 10.77± 2.82 years. They were predominantly male. The average time of hospitalization was 43.11 days ± 39.54 days. The main symptoms were alteration of general state and fever. Nearly all the patients had tumor syndrome and bone marrow failure. Myelogram showed ALL type 1 in six of the nine patients. Eight patients underwent chemotherapy according the protocol of FAPOG 2005. Children's evolution was favorable in two patients who experienced remission, four patients had treatment failure. Six patients died. CONCLUSION: thanks to information campaigns, which will contribute to encourage early consultations, capacity-building measures for the medical staff allowing early diagnosis of ALL, the construction of a sufficiently equipped pediatric oncology center and a subsidy of anticancer drugs awarded by the state of Burkina Faso, the treatment of children with ALL would allow for better outcomes.

[Risk factors for death from severe malaria in children at the Charles de Gaulle pediatric hospital of Ouagadougou (Burkina Faso)]. / Facteurs de risque de décès au cours du paludisme grave chez l'enfant au Centre hospitalier universitaire pédiatrique Charles de Gaulle de Ouagadougou (Burkina Faso).

To determine the risk factors for death from severe malaria in children in Burkina Faso, we conducted a retrospective case-control study covering a period of 24 months from January 2004 through December 2005, at the Charles de Gaulle Pediatric Hospital in Ouagadougou. Cases (n=72) were defined as all children hospitalized for and dying of confirmed severe malaria. The control subjects (n=72), matched for age, sex and date of hospitalization; were children hospitalized for confirmed severe malaria who were discharged after recovery. Risk factors assessed included: place of residence, socioeconomic level, self-medication, promptness of hospitalization, nutritional status, temperature and parasitemia. Case and control children were compared with pairwise tests. Low socioeconomic level (OR=5.4), late care (OR=15.5), poor nutritional status (OR=7.9) and a parasitemia greater than or equal to 5% (OR=2.8) were associated with a significant increase in the risk of death. In contrast, the malaria deaths were not associated with place of residence (OR=0.5), self-medication (OR=1) or fever of 41 degrees C or higher (OR=1.1). These results show the need for more health education to encourage early care-seeking in the event of fever, community-based interventions, and strengthening of the technical support centers for health facilities, as part of a national poverty reduction program.

[Neonatal morbidity and mortality in 2002-2006 at the Charles de Gaulle pediatric hospital in Ouagadougou (Burkina Faso)]. / Morbidité et mortalité néonatales de 2002 à 2006 au Centre hospitalier universitaire pédiatrique Charles de Gaulle de Ouagadougou (Burkina Faso).

INTRODUCTION: Neonatal diseases remain a major public health problem in developing countries. The Millennium Goal of reducing child mortality by 2/3 by the year 2015 requires a major reduction in neonatal mortality. Accordingly, in March 2006, Burkina Faso began a policy of subsidizing obstetric care and neonatal emergency care. To be able to assess the effectiveness of the steps undertaken, we examined the characteristics of morbidity and neonatal mortality in the principal pediatric teaching hospital (CHUP-CDG) before implementation of the program. MATERIALS AND METHODS: This retrospective study looked at hospital records and the database of newborns hospitalized from 01 January 2002 through 31 December 2006. RESULTS: During the study period, of 23 223 children hospitalized, 1226 (5%) were neonates. The number of neonates hospitalized annually has increased from 118 in 2002 to 414 in 2006. Most (70%) were referred by another healthcare facility. Mean age at admission was 9+/-8 days. The socioeconomic level of 60% of the parents was low. The neonatal mortality rate was 15.3%. More than half (58.8%) the deaths occurred on the first day of hospitalization. The leading causes of morbidity were also the biggest killers: the fatality rate for neonatal infections was 16.8%, and that for congenital malformations and acute accidental poisoning 12.9%. CONCLUSION: Neonatal morbidity and mortality remain at worrisome levels. Improved monitoring of pregnancies and conditions of delivery, reduction in the cost to families of care and the opening of a neonatal unit equipped with appropriate material at the pediatric hospital center (CHUP-CDG) should help to reduce neonatal mortality.

[Major sickle cell syndromes and infections associated with this condition in children in Burkina Faso]. / Syndromes drépanocytaires majeurs et infections associées chez l 'enfant au Burkina Faso.

INTRODUCTION: This study aims to investigate infections in children with major sickle cell syndrome. METHODS: We conducted a monocentric descriptive retrospective hospital study in Ouagadougou, Burkina Faso, over a ten-year period. All children with major sickle cell syndrome (homozygous SS and double heterozygous SC, SDPunjab, Sß thalassemic, SOArab and SE) hospitalized for microbiologically confirmed infections were enrolled in the study. RESULTS: One hundred and thirty-three patients met our inclusion criteria. The SS phenotype accounted for 63.2% of cases and SC 36.8%. The frequency of infections was 21.8%. In 45.9% of cases, these affected children aged 0-5 years. The most frequent signs were osteoarticular pain (42.1%), cough (25.7%), abdominal pain (23.3%), pallor (43.6%). The major diagnoses were bronchopneumonia (31.6%), malaria (16.5%), osteomyelitis (12.8%) and septicemia (10.5%). The isolated pathogenic organisms were Streptococcus pneumoniae (35.5%) and Salmonella spp (33.3%). Third generation cephalosporins were the most commonly prescribed antibiotics. Gros mortality rate was 7.5%. CONCLUSION: Bacterial infections and malaria dominate the clinical picture of infections in children with major sickle cell syndrome at the at the Pediatrics University Hospital Center Charles De-Gaulle. This study highlights the importance of establishing a national program for the management of sickle-cell anemia, which could help prevent or reduce the occurrence of infections in children with sickle cell syndrome.

[Pepper's syndrome: report of two cases at the Charles de Gaulle University Pediatric Hospital Center, Ouagadougou (Burkina Faso)]. / Le syndrome de Pepper: à propos de deux cas observés au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou (Burkina Faso).

Pepper's syndrome is a neuroblastoma that metastasizes to the liver. It affects infants younger than six months of age. It can regress spontaneously and is associated with a favorable prognosis in 80% of cases. Given its rarity, we here report two cases of Pepper's syndrome observed at the Charles de Gaulle university pediatric hospital center, Ouagadougou (Burkina Faso). Our study involved two female infants in whom the disease manifested as an increase in abdominal volume, hepatomegaly and signs of respiratory distress. Ultrasound enabled diagnosis, which was based on the nodular appearance of the liver in both cases and determination of the primary tumor in one case. Urinary catecholamine test confirmed the diagnosis in one case. Both patients died from complications related to liver compression, chemotherapy (in one of the cases) and lack of treatment (in the other case).

Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.

Background: There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents. Methods: A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in Europe, Southern Africa and West Africa, were included. We compared mortality and growth outcomes for different ART initiation criteria, aligned with previous and recent World Health Organization criteria, for 5 years of follow-up, adjusting for all measured baseline and time-dependent confounders using the g-formula. Results: Median (1st;3rd percentile) CD4 count at baseline was 676 cells/mm 3 (394; 1037) (children aged ≥ 1 and < 5 years), 373 (172; 630) (≥ 5 and < 10 years) and 238 (88; 425) (≥ 10 and < 16 years). There was a general trend towards lower mortality and better growth with earlier treatment initiation. In children < 10 years old at enrolment, by 5 years of follow-up there was lower mortality and a higher mean height-for-age z-score with immediate ART initiation versus delaying until CD4 count < 350 cells/mm 3 (or CD4% < 15% or weight-for-age z-score < -2) with absolute differences in mortality and height-for-age z-score of 0.3% (95% confidence interval: 0.1%; 0.6%) and -0.08 (-0.09; -0.06) (≥ 1 and < 5 years), and 0.3% (0.04%; 0.5%) and -0.07 (-0.08; -0.05) (≥ 5 and < 10 years). In those aged > 10 years at enrolment we did not find any difference in mortality or growth with immediate ART initiation, with estimated differences of -0.1% (-0.2%; 0.6%) and -0.03 (-0.05; 0.00), respectively. Growth differences in children aged < 10 years persisted for treatment thresholds using higher CD4 values. Regular follow-up led to better height and mortality outcomes. Conclusions: Immediate ART is associated with lower mortality and better growth for up to 5 years in children < 10 years old. Our results on adolescents were inconclusive.

Predictors of mortality of low birth weight newborns during the neonatal period: A cohort study in two health districts of Burkina Faso.

OBJECTIVE: To determine the neonatal mortality rate among low birth weight infants, and identify the predictors of mortality during the neonatal period in two health districts in Burkina Faso. METHODS: A prospective cohort study of live born babies delivered in health centers that weighed less than 2500 g. Their survival status at the end of the neonatal period was measured and analyzed using multivariate analysis in a Cox proportional hazards model. RESULTS: The study included 341 newborns (146 newborns from Kaya health district and 195 from Dori health district). The mean weight was 2158.2±287.1g. Neonatal mortality was 53 per 1000 live births (18 deaths and 323 survivors), while the incidence density was 1.93 per 1000 persons/days (95% CI, 1.2-3.1). After adjustment, the factors significantly associated with neonatal death included preterm infants (HR 8.0; 95% CI, 2.4-26.5), the mother's history of infant death (HR 14.3; 95% CI, 4.1-49.7), young maternal age (HR 0.9; 95% CI, 0.8-0.9), immunization status (HR 5,1; 95% CI, 1.8-14.2), and infant birth weight (HR 0.8; 95% CI, 0.7-0.9). CONCLUSION: Neonatal mortality among low birth weight infants in the study population was 53 per 1000 live births. This is higher than the 28 per 1000 live births reported by the 2010 Demographic Health Survey for the general population. Therefore, it is necessary to follow infants with low birth weight after they leave health centers.