[Clinical, aetiological and therapeutic features of severe sickle cell related vaso-occlusive crisis at the Sylvanus Olympio University Hospital, Lomé]. / Crise vaso-occlusive drépanocytaire sévère: aspects cliniques, étiologiques et thérapeutiques au CHU Sylvanus Olympio de Lomé.

Introduction: vaso-occlusive crisis (VOC) is the most common manifestation of sickle cell disease and the leading cause of hospitalization among affected children. The purpose of this study is to describe the clinical features of severe VOCs, to determine the etiologies of infectious syndromes that accompany them and to describe their management. Methods: we conducted a descriptive cross-sectional study of 137 adult patients with sickle cell disease hospitalised for severe VOC in the Paediatric Department of the Sylvanus Olympio University Hospital from 1st January 2009 to 31st December 2011. Results: the majority of patients (n=98; 71.5%) had homozygous sickle cell (SS), followed by double heterozygous SC disease (n=28; 20.5). The median of consultation time was 4.7 ± 4.4 days. Treatment before admission was based on antibiotics (28.5%). VOCs were mainly osteoarticular (70.8%). In 98.5% of cases, an associated bacterial infection was confirmed (48.9%) or suspected (49.6%). The main etiologies included acute chest syndrome (26.3%), acute osteomyelitis (10.9%), urinary tract infection (6.6%) and septicaemia (3.6%). One germ was isolated from 14.6% of patients: Escherichia coli (30%), followed by Klebsiella pneumoniae (25%), Staphylococcus aureus (15%), Salmonella typhi (10%), Streptococcus pneumoniae (5%), Streptococcus D (5%), Enterobacter (5%) and Acinetobacter (5%). Mortality rate was 2.2%. The average length of stay in hospital was 11.4 ± 8.8 days. Conclusion: severe sickle cell-related vaso-occlusive crisis is mainly associated with bacterial infections in tropical environments. Appropriate and early antibiotic therapy is the essential therapeutic means to prevent or treat these patients.

Crise vaso-occlusive drépanocytaire sévère: aspects cliniques, étiologiques et thérapeutiques au CHU Sylvanus Olympio de Lomé / Clinical, aetiological and therapeutic features of severe sickle cell related vaso-occlusive crisis at the Sylvanus Olympio University Hospital, Lomé

Introduction: la crise vaso-occlusive (CVO) est la plus fréquente manifestation de la drépanocytose et la première cause d´hospitalisation des enfants atteints. L´objectif de cette étude est de décrire les aspects cliniques des CVO sévères, de déterminer les étiologies des syndromes infectieux qui les accompagnent et de décrire leur prise en charge. Méthodes: il s'agit d'une étude transversale descriptive portant sur 137 drépanocytaires majeurs hospitalisés pour CVO sévères du 1er janvier 2009 au 31 décembre 2011 dans le service de pédiatrie du CHU Sylvanus Olympio. Résultats: les drépanocytaires homozygotes SS étaient les plus nombreux (n=98; 71,5%), suivis des doubles hétérozygotes SC (n=28; 20,5). Le délai moyen de consultation était de 4,7 ± 4,4 jours. Le traitement avant l´admission comportait des antibiotiques (28,5%). Les CVO étaient surtout ostéo-articulaires (70,8%). Dans 98,5% des cas, une infection bactérienne associée a été confirmée (48,9%) ou présumée (49,6%). Les principales étiologies étaient le syndrome thoracique aigu (26,3%), l´ostéomyélite aiguë (10,9%), l´infection urinaire (6,6%), la septicémie (3,6%). Un germe a été isolé chez 14,6% des patients, Escherichia coli (30%) étaient en tête suivi de Klebsiella pneumoniae (25%), Staphylococcus aureus (15%), Salmonella typhi (10%), Streptococcus pneumoniae (5%), le Streptocoque D (5%), l´Enterobacter (5%) et l´Acinetobacter (5%). Le taux de mortalité était de 2,2%. La durée moyenne d´hospitalisation était de 11,4 ± 8,8 jours. Conclusion: les CVO drépanocytaires sévères sont en majorité associées aux infections bactériennes en milieu tropical. Une antibiothérapie adaptée et précoce constitue le moyen thérapeutique indispensable pour prévenir ou traiter ces patients.

Introduction: vaso-occlusive crisis (VOC) is the most common manifestation of sickle cell disease and the leading cause of hospitalization among affected children. The purpose of this study is to describe the clinical features of severe VOCs, to determine the etiologies of infectious syndromes that accompany them and to describe their management. Methods: we conducted a descriptive cross-sectional study of 137 adult patients with sickle cell disease hospitalised for severe VOC in the Paediatric Department of the Sylvanus Olympio University Hospital from 1 January 2009 to 31 December 2011. Results: the majority of patients (n=98; 71.5%) had homozygous sickle cell (SS), followed by double heterozygous SC disease (n=28; 20.5). The median of consultation time was 4.7 ± 4.4 days. Treatment before admission was based on antibiotics (28.5%). VOCs were mainly osteoarticular (70.8%). In 98.5% of cases, an associated bacterial infection was confirmed (48.9%) or suspected (49.6%). The main etiologies included acute chest syndrome (26.3%), acute osteomyelitis (10.9%), urinary tract infection (6.6%) and septicaemia (3.6%). One germ was isolated from 14.6% of patients: Escherichia coli (30%), followed by Klebsiella pneumoniae (25%), Staphylococcus aureus (15%), Salmonella typhi (10%), Streptococcus pneumoniae (5%), Streptococcus D (5%), Enterobacter (5%) and Acinetobacter (5%). Mortality rate was 2.2%. The average length of stay in hospital was 11.4 ± 8.8 days. Conclusion: severe sickle cell related vaso-occlusive crisis is mainly associated with bacterial infections in tropical environments. Appropriate and early antibiotic therapy is the essential therapeutic means to prevent or treat these patients.

[Satisfaction of parents of children hospitalized in pediatrics in Togo]. / Satisfaction des parents d'enfants hospitalisés en pédiatrie au Togo.

In order to evaluate the degree of satisfaction of parents of children treated in the pediatric service of the Sylvanus-Olympio University Hospital of Lomé (Togo), a cross-sectional and analytical study was conducted from August 1 to 31, 2020, among 300 parents. The sociodemographic aspects of the families and those related to their perception of the care provided in the service were evaluated. Overall, the families were satisfied with the reception and the care their child received.

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

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

Maternal and neonatal complications of childbirth among adolescents at the Sylvanus Olympio University Hospital Centre (CHU-SO), Lomé

Objective: To determine maternal and neonatal complications occurring at childbirth among adolescents.Materials and methods: This is a retrospective, descriptive study conducted from 1st July to 31st December 2019 at the maternity ward of the Sylvanus Olympio University Hospital Centre (CHU- SO), Lomé, Togo. The socio- demographic parameters of the mothers, details of prenatal and perinatal events and the clinical profile of the newborns at birth were studied. Results: The records of 332 adolescent mothers were studied. The average age of the mothers was 17.4 ± 1.5 years, with a range of 13-19 years. The pregnancies in two-thirds (66.3%) were supervised in centres without surgical facilities and by midwives in 83.1% of cases. A little over half of the mothers (53.3%) attended at least four antenatal clinic sessions, while 3.6% attended none. The modes of delivery were spontaneous vaginal (62.3%) and Caesarean section (35.2%). Complications of pregnancy were recorded in 12.9% of the mothers. There were statistically significant associations between the referred status of the mothers and haemorrhages, retained placenta and sepsis (p = 0.001, 0.038 and 0.011, respectively). There were no maternal deaths. The newborn babies required resuscitation in 6.3% of cases, while 7.0% were stillborn.There was a statistically significant relationship between the referred status of mothers and the occurrence of perinatal deaths (p =0.0001). Conclusion: Adolescent mothers are at risk of complications during childbirth, and these risks are increased by poor antenatal care and attempted deliveries in centres without surgical facilities.

Epidemiology of intussusception among infants in Togo, 2015-2018.

INTRODUCTION: intussusception is the leading cause of bowel obstruction in infants and young children. We describe the epidemiology and diagnostic and treatment characteristics of intussusception among Togolese infants over a 4-year period. METHODS: we implemented active surveillance among infants younger than 1 year of age admitted with intussusception from 2015 to 2018 at Sylvanus Olympio Teaching Hospital and in 2018 at Campus Teaching Hospital. Brighton Collaboration Level 1 case definition criteria were used to confirm the diagnosis of intussusception. RESULTS: during four years, 41 cases of intussusception, with an annual range of 8 to 14 cases (median: 10) were reported; and the highest number of cases (89%) was enrolled at Sylvanus Olympio teaching hospital. Intussusception was uncommon in the first 2 months of life, peaked from 5 to 7 months old (63%), with male predominance (63%), and showed no significant seasonality. One third of cases (34%) were transferred to the sentinel surveillance site from another health facility; and the median delay in seeking care was 4 days (range: 0-11) with ≥ 48-hour delay in 59% of cases. Clinical symptoms, ultrasound and surgery were combined to diagnose intussusception in all the cases (100%). The treatment was exclusively surgical, and intestinal resection was common (28/41, 68%). A high case fatality rate (23%) was observed and the average length of hospital stay was 10 days (range: 1-23). CONCLUSION: active surveillance for intussusception in Togo has highlighted exclusive use of surgical therapy; often associated to an intestinal resection with a very high case fatality rate.

Hutchinson-Gilford Progeria syndrome: Report of the first Togolese case.

The aim of this article is to describe the first case of Hutchinson-Gilford Progeria Syndrome (HGPS) in Togo and review all Africans cases. Our patient was a 12.8-year-old Togolese boy followed in our unit till he was 15-year-old for HGPS. He was the only child of non-consanguineous parents. The phenotypic findings were craniofacial dysmorphy, dwarfism, lipodystrophy, diffusely scattered hyperpigmented foci, pyriform thorax, nail dystrophy, decreased joint mobility, and camptodactyly. He had characteristic facies with prominent forehead, prominent eyes, absent ear lobule, thin nasal skin, convex nasal profile, micrognathia, and crowded teeth. Radiologicals findings were bilateral coxa valga, pyriform thorax, and acro-osteolysis. We sequenced the entire coding region of LMNA gene, and mutation analysis revealed a heterozygous mutation c.1824C>T (p.Gly608Gly). Our patient is therefore the fifth African and the fourth with classical mutation, first of Western Africa, and second of (sub-Saharan) African black race. The recurrence of HGPS is low like the cause is neomutation or germinal mosaicism.

Etiology of Pediatric Bacterial Meningitis Pre- and Post-PCV13 Introduction Among Children Under 5 Years Old in Lomé, Togo.

BACKGROUND: Pediatric bacterial meningitis (PBM) causes severe morbidity and mortality within Togo. Thus, as a member of the World Health Organization coordinated Invasive Bacterial Vaccine Preventable Diseases network, Togo conducts surveillance targeting Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae, at a sentinel hospital within the capital city, Lomé, in the southernmost Maritime region. METHODS: Cerebrospinal fluid was collected from children <5 years with suspected PBM admitted to the Sylvanus Olympio Teaching Hospital. Phenotypic detection of pneumococcus, meningococcus, and H. influenzae was confirmed through microbiological techniques. Samples were shipped to the Regional Reference Laboratory to corroborate results by species-specific polymerase chain reaction. RESULTS: Overall, 3644 suspected PBM cases were reported, and 98 cases (2.7%: 98/3644) were confirmed bacterial meningitis. Pneumococcus was responsible for most infections (67.3%: 66/98), followed by H. influenzae (23.5%: 23/98) and meningococcus (9.2%: 9/98). The number of pneumococcal meningitis cases decreased by 88.1% (52/59) postvaccine introduction with 59 cases from July 2010 to June 2014 and 7 cases from July 2014 to June 2016. However, 5 cases caused by nonvaccine serotypes were observed. Fewer PBM cases caused by vaccine serotypes were observed in infants <1 year compared to children 2-5 years. CONCLUSIONS: Routine surveillance showed that PCV13 vaccination is effective in preventing pneumococcal meningitis among children <5 years of age in the Maritime region. This complements the MenAfriVac vaccination against meningococcal serogroup A to prevent meningitis outbreaks in the northern region of Togo. Continued surveillance is vital for estimating the prevalence of PBM, determining vaccine impact, and anticipating epidemics in Togo.

[Etiological and evolving profile of renal disability of children in hospital in Togo]. / Profil étiologique et évolutif de l'insuffisance rénale de l'enfant en milieu hospitalier au Togo.

OBJECTIVE: To determine the etiological and evolutionary profile of renal failure of chidren in Togo. METHODS: This is a cross-sectional study over the period of 12 months (2016-2017) including children aged 1 to 18 years hospitalized in the pediatric ward of Sylvanus Olympio university teaching hospital of Lome (Togo) for renal failure. RESULTS: Of 2374 patients hospitalized in our unit, 58 (2.4%) had renal failure. The mean age was 8.17±4 years with a sex ratio of 1.32. The average consultation time was 11.9 days. The mean duration of hospitalization was 12.7±7.7 days. Thirty-seven patients (63.8%) were referred from a peripheral center. Thirty-seven children out of 58 (63.1%) were oligoanuric. Renal failure was acute in 94.8% and chronic in 5.2%. Anemia was found in 84.4% of children. The main etiologies found were severe malaria (63.8%), glomerulonephritis (10.3%) and nephrotic syndrome (10.3%). Thirteen children (22.4%) benefited from dialysis sessions. The evolution was favorable in 79.3% of the cases. CONCLUSION: The renal failure of child is relatively common in our daily practice. The low socio-economic level and the lack of adapted equipment make the care difficult.

Immunization coverage and factors associated with incomplete vaccination in children aged 12 to 59 months in health structures in Lomé.

OBJECTIVE: To estimate the immunization coverage among children admitted for consultation or hospitalization in health structures of Lomé. RESULTS: A total of 797 respondent-child couples were included and 31.1% of them had their immunization cards. Complete immunization coverage was 69.3%, 95% confidence interval (65.9-72.5) and per antigen, it ranged from 83.1% for measles to 95.7% for BCG. Factors associated with incomplete immunization were the absence of immunization card (p < 0.001), respondents' sex (p < 0.001), level of education (p < 0.001), marital status (p < 0.001) and the level of the health structure in the organization of the Togolese health system (p < 0.001). Obstacles to immunization were mainly the lack of money to pay for immunization fees (38.4%) and forgetting the immunization appointment (28.1%).

Evidence of the impact of monovalent rotavirus vaccine on childhood acute gastroenteritis hospitalization in Togo.

BACKGROUND: Monovalent rotavirus vaccine (RV1) was introduced in the immunization schedule of Togo in June 2014. We evaluated the impact of rotavirus vaccines on acute gastroenteritis (AGE) and rotavirus-associated hospitalizations in Togolese children. METHODS: Sentinel surveillance for AGE (defined as ≥3 liquid or semi-liquid stools/24 h lasting <7 days) hospitalizations among children <5 years of age was conducted in two sites in the capital city, Lome. ELISA was used for diagnosis of rotavirus infection in children with AGE. Additionally, review of hospitalization registers was performed at five hospitals to assess trends in AGE hospitalizations among children aged <5 years. For the vaccine impact assessment, pre-rotavirus vaccine introduction (July 2010-June 2014) and post-rotavirus vaccine introduction (July 2014-June 2016) periods were compared for annual changes in proportions of hospitalizations associated with AGE and rotavirus. RESULTS: During the pre-vaccine period, sentinel surveillance showed that 1017 patients were enrolled and 57% (range, 53-62%) tested positive for rotavirus, declining to 42% (23% reduction) in the first post-vaccine year and to 26% (53% reduction) in the second post-vaccine year; declines were most marked among infants. The patient register review showed that, compared with pre-vaccine rotavirus seasons, declines in hospitalizations due to all-cause AGE during post-vaccine rotavirus seasons were 48% among <1 year age-group in both first and second years following vaccine introduction. Among 1-4 year olds no reduction was noted in the first year and a 19% decline occurred in the second year. CONCLUSIONS: We report rapid and marked reduction in the number of AGE hospitalizations and the proportion of AGE hospitalizations attributable to rotavirus in the first two years post- RV1 implementation in Togo. It is necessary to monitor long-term vaccine impact on rotavirus disease burden through continued surveillance.

Knowledge, attitude and practice of the mothers with anemia of children under five years old in the peadiatric department at Sylvanus Olympio teaching hospital in Lomé.

BACKGROUND: Anemia remains a major cause of morbidity and mortality of children in Togo despite of prevention effort, due to the parents lack of implication. AIM: To determine the knowledges, attitudes and practices of mothers, with anemia ofchildren under five years old Methods : Knowledge Attitudes and Practice survey from the first of february to 31 ofmarch 2012, about an interview of a hundred mothers with children under 5, randomly selected in the consultation, vaccination waiting rooms and in the hospitalisation. RESULTS: Forty mothers had never heard about anemia. Health personnel was the main source of mother's information (29%), mass media represented 8% of mothers information source (radio 5%; television 3%). The decreased of blood in the body is the most given definition from the mothers (44%). Malaria (24%) and malnutrition (19%) were the main causes cited by mothers. Iron deficiency has been mentioned by 3% of the mothers. Palmar - plantar pallor (32%) was the clinical signe the best known by the mothers. Most of the mothers (90%) had never assist to an information education and communication message about anemia prevention. When their children had anemia, 25 mothers (65,8%) took their children to the health center, five mothers (13,2%) had given tomatoes. The use of iron in prophylactic treatment was known by 43% of the mothers. The blend tomatoes and milk was the prophylactic treatment mentioned by 3% of the mothers. Most of the mothers (77%) would advice a mother with a children suffering from anemia to take him to the hospital. The knowledge of anemia by the mothers was correlated to then level of instruction. But the knowledge of prevention did not depend on the instruction level. CONCLUSION: anemia is not well known by the mothers of under five children. It's causes, it's treatment are not well known. Mass media are not very implicated on the subject. The reduction of it's frequency goes by information education and communication activities.

Early Evidence of Impact of Monovalent Rotavirus Vaccine in Togo.

Togo introduced monovalent rotavirus vaccine starting 19 June 2014. We compared all-cause acute gastroenteritis (AGE) hospitalizations and rotavirus-associated hospitalizations during the prevaccine period (July 2008-June 2014) to 1 year after vaccine introduction (July 2014-June 2015). The proportion of children with AGE who tested positive for rotavirus declined from 53% (645/1223) in prevaccine years to 36% (68/187) in the postvaccine year (P< .01). The decline only occurred in children <1 year of age who were eligible for vaccination and was greatest during the rotavirus season months, supporting that it was associated with vaccine implementation.

Surveillance for rotavirus gastroenteritis in children less than 5 years of age in Togo.

BACKGROUND: Rotavirus is the most common cause of severe gastroenteritis and dehydration in young children in both industrialized and developing countries. The anticipated introduction of rotavirus vaccine into Togo's national immunization program highlights the need for baseline data on the burden of this disease. METHODS: We conducted sentinel surveillance for rotavirus gastroenteritis among children <5 years of age in Sylvanus Olympio Teaching Hospital of Lome (Togo) from February 2008 through January 2012, based on the World Health Organization's generic protocol. Rotavirus was detected in stool specimens by enzyme linked immunosorbent assay. The strain characterization by genotyping was performed at Noguchi Memorial Institute for Medical Research in Accra (Ghana) and at Medunsa campus in Pretoria (South Africa). RESULTS: 803 children with acute gastroenteritis were enrolled and of which 390 (48%) were positive for rotavirus. The difference of age among children with rotavirus and nonrotavirus gastroenteritis was significant (P < 0.010) with rotavirus cases younger than nonrotavirus cases. From December to February, significantly (P < 0.002) more cases of rotavirus gastroenteritis were enrolled compared with other months of the year. Vomiting (P = 0.04) was more common in children with rotavirus than nonrotavirus gastroenteritis. The most common G-P combinations were G3P[6] (23%), G1P[8] (12%), G1P[6/8] (8%), G2P[6] (7%), G12P[6] (7%) and G3/12P[6] (6%). CONCLUSIONS: The prevalence of rotavirus is high among children with acute gastroenteritis in Togo. Continued and extended rotavirus surveillance will be important to monitor changes in the epidemiology of rotavirus disease and the impact of vaccination after introduction.

[Home care of childhood malaria: proposals for improving management based on a survey of mothers in Notsé (Togo)]. / Prise en charge à domicile du paludisme chez l'enfant : propositions d'actions à partir des résultats d'une enquête CAP menée auprès des mères d'enfants de moins de 5 ans à Notsé (Togo).

BACKGROUND: Malaria is a common and frequently fatal disease in sub-Saharan Africa and children suffer the consequences of their family's erroneous therapeutic decisions. OBJECTIVE: To assess knowledge, attitudes and practices related to malaria treatment and prevention among mothers of children younger than 5 years old. METHODS: Cross-sectional survey conducted from July to September 2000, in Notsé (Togo) among a sample of 385 mothers of children aged younger than 5 years. Investigators completed environmental evaluation cards and used a questionnaire to interview mothers. RESULTS: Mothers' level of knowledge was qualified as high among 53% of the subjects, intermediate among 30%, and poor among 17%. It was associated with the mothers' level of education. All mothers considered malaria to be a serious disease; 79% said that they were favourable to drug use for malaria prevention in children; 81% preferred mosquito nets as the means of prevention; 94% of them preferred that their child receive modern medical treatment for malaria. Mothers' global practices for malaria prevention and treatment were qualified as good among 5%, intermediate among 23%, and poor among 73%. Practices were associated with educational and level of knowledge and inversely associated with the number of children she had. CONCLUSION: These results suggest that improved communication with the population and promotion of intra- and inter-sector collaborations and literacy in mothers, together with active participation by the population, might be useful measures for reaching the objectives of antimalaria program in Togo.

[Diabetes mellitus in children in Lomé (Togo)]. / Le diabète sucré de l'enfant à Lomé (Togo).

AIM: Describe clinical aspects and outcome of children with diabetes mellitus in Lomé (Togo). METHODS: This work concern eighteen children consecutively admitted between 1997 and 2004 for diabetes mellitus. Diagnosis of type 2 diabetes mellitus (T2DM) were done on the presentation of at least one of T2DM risk factors: obesity, familial history of T2DM, acanthosis nigricans, polycystic ovary syndrome, dislipidemia, high blood pressure. RESULTS: Twelve children presented type 1 diabetes mellitus (T1DM), 5 T2DM and one, corticosteroids induced diabetes. At least one of the first degree parent suffered from diabetes in 4 of the 5 children with T2DM and 4 of the 12 patients with T1DM. Most patients (with T1DM or T2DM) presented polyuria, polydypsia and ketonuria at admission. All patients with T2DM were obese and had lifestyles characterised by high fat intake, sedentary attitudes, and physical inactivity. The corticosteroid induced diabetes cessed when corticosteroid stopped. The other patients were successfully treated with insulin (T1DM) or insulin then exercises and diets (T2DM). CONCLUSION: Clinical presentation of diabetes mellitus is now characterised in Togo by the emergence of T2DM which principal risks factors are obesity and familial history of T2DM.