Evaluation de l'allaitement maternel exclusif chez les enfants de 0 à six mois dans le district de Tchaoudjo (Togo)

Introduction : le lait maternel seul est l'aliment de prédilection des enfants de moins de six mois. Ce mode d'alimentation n'est pas toujours bien respecté ; d'où cette étude pour évaluer la pratique de l'allaitement maternel exclusif chez les nourrissons de 0 à six mois dans le district de Tchaoudjo. Méthodes : Il s'agissait d'une étude transversale, descriptive et analytique conduite du 02 mai au 29 juillet 2017 auprès des mères de nourrissons de 0 à six mois. La technique par sondage aléatoire simple était utilisée pour choisir les cibles. Résultats : L'étude avait concerné 374 mères. L'âge moyen des mères était 27,5 ans avec des extrêmes de 15 et de 49 ans, le niveau primaire (38,8%) et les ménagères (71,1%) étaient majoritaires, 72,2 % avaient pratiqué l'AME. Les facteurs influençant positivement la pratique de l'AME étaient, l'accouchement dans un centre de santé, l'assistance de l'accouchement par un personnel qualifié, la prise de décision d'allaiter au cours de la grossesse et le soutien du conjoint à l'AME. Conclusion : La pratique de l'AME était de 72,2% chez les nourrissons de 0 à six mois à Tchaoudjo et des facteurs l'influençant ont été identifiés en vue de l'améliorer

Connaissance, attitude et pratique des mères des enfants de moins de cinq ans sur l'anémie au CHR de Tsévié (Togo)

Objectif : déterminer les connaissances, attitudes et pratiques (CAP) des mères d'enfants sur l'anémie. Patients et méthode : l'enquête de type CAP s'était déroulée du 01 février au 31 mars 2013, et portait sur l'interview de 114 mères d'enfants de moins de 5 ans, dans le service de pédiatrie du CHR-Tsévié. Le traitement des données a été fait grâce au logiciel Epi-Info 6.04 et l'analyse par le test de Khi-2 avec un seuil de signification de 5%. Résultats : Vingt mères (17,5%) n'avaient jamais entendu parler d'anémie. Le personnel de santé a été la principale source d'information des mères (66,4%). La pâleur conjonctivale était la principale définition donnée par les mères (59,6%). Le paludisme (60,5%) a été la principale cause citée. La pâleur palmo-plantaire (32,0%) était le signe clinique le plus connu des mères. Le traitement par la transfusion était le moyen thérapeutique le plus cité (65,8%).Le centre de santé était le premier recours en cas d'anémie (84,5%). La bonne alimentation a été le traitement prophylactique le plus connu (52,6%). Il n'existait pas de corrélation entre les connaissances des mères sur l'anémie et leur niveau d'instruction (p=0,5978). Conclusion L'anémie n'est pas bien connue par les mères d'enfants de moins de 5 ans. La réduction de sa fréquence passe par des activités d'information éducation et communication (IEC)

Tuberculosis in children in Togo: epidemiology, diagnosis, treatment, and outcome.

INTRODUCTION: Tuberculosis (TB) remains one of the most lethal communicable diseases in the world, according to the World Health Organization (WHO). New strategies must be implemented to meet targets for 2035. OBJECTIVE: Describe the epidemiological and therapeutic aspects of tuberculosis in children in Togo. MATERIALS AND METHODS: This retrospective, multicenter, descriptive cross-sectional study examined the files of children younger than 15 years who were diagnosed with TB and treatment in the Maritime region from 2008 to 2011. RESULTS: The study included 74 children aged 0-15 years, for an average of 18 cases of childhood tuberculosis annually. Pulmonary tuberculosis (38 cases) was the most common. TB-HIV co-infection was found in 14.9% of cases. Boys accounted for more than half of the patients. The age range of 11-15 years accounted for the highest proportion of cases (41.9%). The most common treatment was a combination of 2RHZE and 4RH (25 children, 33.8%). Laboratory monitoring was satisfactory. In all, 56 (75.7%) children were cured, and 14 (18.2%) lost to follow-up, while 3 (4%) died (all with TB/HIV). CONCLUSION: Active testing for HIV infection is essential in children with TB, because the combination of the two can be lethal.

[Follow-up of HIV-infected children receiving antiretroviral therapy in a rural area of Togo]. / Suivi des enfants infectés par le VIH/sida sous traitement antirétroviral en milieu rural au Togo.

OBJECTIVE: To evaluate the monitoring of HIV-infected children receiving antiretroviral therapy in rural areas of Togo and the effectiveness of the treatment. METHODS: This retrospective descriptive study, conducted at the Luis Scrosospi Center in Kouvé from 15 November, 2008, through 14 November, 2009, examined the records of children who had been receiving antiretroviral therapy for at least 6 months. RESULTS: We studied the records of 55 children. The sex ratio was 0.9, and the primary opportunistic infections were respiratory infections and malaria. At treatment initiation, their average age was 6 years and 3 months, the average CD4 T cell count 358/mm(3), and the mean weight 12.9 kg. The hemoglobin level was less than 8 g/dL in 31%. All children received a nutritional kit monthly. The antiretroviral therapy for 52 children was a combination of stavudine, lamivudine, and nevirapine. The adherence rate during the first 12 months was 80% (44/55 children). The mean weight gain was 860 g (below -3SD) at 3 months, 1,550 g (between -3SD and -2SD) at 6 months, and 1 270 g (between -2SD and -1SD) at 12 months of treatment. The severe acute malnutrition rate fell from 60% at treatment initiation to 56% at 3 months, 47% at 6 months, and 25% at 12 months. Also after 12 months, the CD4 T cell count had risen in 60% of the children. The main side effects were peripheral neuropathy (29%) and headaches (18%). Eight children died (14%) during the follow-up. CONCLUSION: Monitoring of HIV-infected children on antiretroviral therapy is possible in Togo's rural areas and should be encouraged for it will help to achieve the Millennium Development Goals.

[Evaluation of the glycemia of low-weight newborns within the 24th hour of life at Lomé University Hospital (Togo)]. / Évaluation de la glycémie des nouveau-nés de petits poids avant la 24(e) heure de vie au CHU-Tokoin de Lomé

OBJECTIVE: To assess the glycemia of low-weight newborns (LWNBs) during their first 24h of life as well as their mother's glycemia. PATIENTS AND METHOD: This was a cross-sectional prospective study within a case-control group, conducted at Lomé University Hospital (nationwide main hospital) from January to May 2006. One hundred thirty-nine LWNBs and 150 eutrophic term newborns (ETNBs), 98 mothers of LWNBs (MLWNBs), and 145 mothers of ETNBs (METNBs) were screened and monitored on glycemia dosage. RESULTS: The average glycemia level of the LWNBs (0.34 ± 0.27g/l) was significantly greater than the ETNBs' glycemia level (0.30 ± 0.14 g/l); it was nearly the same for the mean glycemia level of the MLWNBs (0.82 ± 0.2g/l) and the METNBs (0.77 ± 0.1g/l). Neonatal hypoglycemia during the first 24h of life was less frequent (RR=0.8) in the LWNBs (61.15%) than in the ETNBs (80%). The positive correlation between gestational age and glycemia was higher in the ETNBs (r=0.17) than in the LWNBs (r=0.07). This positive correlation between birthweight and glycemia was lower in the LWNBs (r=0.17) compared to the ETNBs (r=0.37); this was not the case within the group of the ETNBs (r=0.02) compared to the group of the LWNBs (r=0.34) concerning the correlation between the glycemia of mothers and newborns. CONCLUSION: The early hypoglycemia was much greater in the ETNBs compared to the LWNBs. Therefore, it is necessary to systematically start breastfeeding all newborns within their first hours of life whatever their gestational age, in order to solve these metabolic disorders.

[Primary results of antiretroviral treatment among HIV/AIDS infected children in Lomé (Togo)]. / Traitement antirétroviral des enfants infectés par le VIH/sida à Lomé (Togo): premiers résultats.

UNLABELLED: Since 2004 in Togo HIV/AIDS infected children have, free of charge, access to antiretroviral drugs according to the national program. The aim of this study was to investigate the clinical, biological and prognosis aspects of anti-retroviral treatment on HIV/AIDS infected children. PATIENTS AND METHOD: We conducted a cross sectional study on 72 HIV/AIDS infected children with anti-retroviral treatment, under the supervision of clinicians within 3 associations specialized in the management of subjects infected by HIV/SIDA at Lomé (Togo). RESULTS: The average age of children was 6 years 9 months. The middle age to HIV screening was 4 years 2 months. The sex ratio was 1.05. The majority of these children (79.2%) were orphans of at least 1 of their parents. All the children were stemmed from families with modest income. The transmission mother to child was the way of HIV contamination found among all the children. To a certain extent, all the children were infected by the HIV 1. Most of the children (66.7%) receiving an antiretroviral treatment for at least 6 months were asymptomatic and had no more immunodeficiency. After 15 months, the children have gained 464 CD4/mm(3). The initial protocols antiretroviral prescribed among children were: zidovudine-lamivudine-abacavir (36.1%), lamivudine-didanosine-nevirapine (30.5%), lamivudine-stavudine-nevirapine (29.2%), zidovudine-lamivudine-didanosine (4.2%). The digestive disorders have been the first side effects (83.4%). The rate of good observance was middle (51%) and lowered with the increased age of children, and the period of the anti-retroviral treatment. CONCLUSIONS: Antiretroviral treatment among HIV/AIDS infected children is giving good results in Togo. But many efforts remain to increase the number of beneficiaries.

[Genital bacterial carriage during the last trimester of pregnancy and early-onset neonatal sepsis]. / Portage génital bactérien au dernier trimestre de la grossesse et infection néonatale précoce.

UNLABELLED: Bacterial infections remain a major cause of morbidity and mortality in newborn infants. OBJECTIVE: To determine the bacterial ecology and pathological status of the genital organs during the last trimester of pregnancy and the germs of the following early-onset neonatal sepsis, in order to evaluate the risk of materno-foetal infections and to find out a drug prophylaxis. METHOD: Vaginal and endocervical samples, usually taken during the first trimester of pregnancy were delayed and taken during the last trimester of pregnancy. A macroscopic examination described the aspect of the vagina, the cervix uteri, leukorrhea and of possible inflammatory lesions or ulcerations. A microscopic examination searched for parasites, epithelial cells, clue cells and leukocytes. The appropriate bacteriological cultures were performed after reading the Gram stain and scoring the vaginal flora. The clinical and cytobacteriological aspects were used to identify the bacterial ecology and the pathological genital states. An exploration was carried out in every newborn suspected of infection. RESULTS: Genital samples were collected from 306 pregnant women. Among them, 118 were at 29-32 weeks of gestation, 104 at 33-36, and 84 at 37-40. The most frequent germs were C. albicans (33,5%), Enterbacteriaceae (20.3%) including E. coli (10.9%), S. aureus (15.4%), Gardnerella (13.6%), and Trichomonas (10.6%), in monomicrobian (79.2%) and polymicrobian carriage (20.8%). Lower genital tract pathological states such as vaginitis (29.4%), bacterial vaginosis (21.5%) or endocervicitis (10.4%), asymptomatic bacterial carriage (23.5%) and normal genital flora (15%) were identified. These pregnancies led to 334 live births with 27 cases of early-onset neonatal sepsis to which endocervicitis (25%) and vaginosis (19,7%) were most often linked. CONCLUSION: Genital samples at the last trimester of pregnancy could evaluate the risk of maternofoetal infections and allow to adapt a drug prophylaxis of Enterobacteriaceae, the most frequent germ of neonatal infections, as it has been done for Streptococcus agalactiae. But larger studies are required to evaluate the risk of maternofoetal infections and to state the drug prophylaxis.

[Comparative study of neonatal bacterial meningitis in Lomé, Bobo-Dioulasso, Casablanca and Lyon]. / Analyse comparative des méningites bactériennes néonatales à Lomé, Bobo-Dioulasso, Casablanca et Lyon.

UNLABELLED: Bacterial meningitis in new-borns remains a serious event because of its high mortality and morbidity rates in Africa. OBJECTIVE: To identify the clinical and bacteriological epidemiology and the outcome of neonatal bacterial meningitis in three African cities. METHOD: We have analysed and compared three hospital studies done in humid tropical, Sahelian, and desert Africa with a European study. RESULTS: Compared with the European study this African study is characterized by a high mean frequency of neonatal meningitis (6 cases per year against 1.4), more important risk factors linked to pregnancy and childbirth (50% against 33%), high rates of death (61 to 68% against 5%) and sequelae (25 to 40% against 30%), rarity of Streptococcus agalactiae (7 to 15% against 38%) and absence of Listeria. Enterobacteriaceae were predominant both in African (50 to 68%) and European (43%) studies. E. coli appeared as the most frequent germ in both European and African studies and Salmonella as more frequent in Sub-Saharan Africa than in occidental countries. CONCLUSION: The epidemiological, bacteriological and evolutional aspects of the neonatal meningitis were identical in the three African cities. The African studies were different from the European only by their high incidence, the rarity of S. agalactiae and Listeria and the difficulties of bacterial diagnosis and management, all might explain the high rates of death and sequelae. An epidemiological survey and adequate antimicrobial therapy according to antibiotic susceptibility may improve the outcome.

[Bacterial flora in the genital tract the last trimester of pregnancy]. / Flores bactériennes génitales au dernier trimestre de la grossesse.

UNLABELLED: Very widespread in our clinical setting, early-onset sepsis is due to organisms that commonly colonize or infect the maternal genital tract; identifying such organisms would help improve prevention and treatment. OBJECTIVE: To determine the bacterial ecology and the pathological status of the genital organs during the last trimester of pregnancy, in order to evaluate the risk of materno-fetal infections and to improve the present prophylactic measures based on monitoring bacterial carriage during the first trimester. METHOD: Vaginal and endocervical samples, usually taken during the first trimester of pregnancy were delayed and taken during the last trimester of pregnancy, in patients with no signs of sepsis and not taking antibiotics. A macroscopic examination described the aspect of the vagina, the cervix uteri, leukorrhea and possible inflammatory lesions or ulcerations. A microscopic examination searched for parasites, epithelial cells, Clue cells and leukocytes. The appropriate bacteriological cultures were performed after reading the Gram stain and scoring the vaginal flora. The clinical and cytobacteriological aspects were used to identify the bacterial ecology and the pathological genital states. RESULTS: Genital samples were collected from 306 pregnant women. Among them 118 were at 29-32 weeks of gestation, 104 at 33-36 and 84 at 37-40. The most frequent germs were C. albicans (33.3%), Enterobacteriaceae (20.3%) including E. coli (10.9%), S. aureus (15.4%), Gardnerella (13.6%), and Trichomonas (10.6%), in monomicrobian (79.2%) or polymicrobian carriage (20.8%). Lower genital tract pathological states such as vaginitis (29.4%), bacterial vaginosis (21.5%) or cervicitis (10.4%) and asymptomatic bacterial carriage (23.5%) and normal genital flora (15%) were identified. CONCLUSION: This is the first report of genital bacterial carriage in African women during the last trimester of pregnancy. Larger studies are required to evaluate the risk of maternofetal infections and to improve current prophylaxis measures.