Trends in malnutrition among children under 5 in Niger: a retrospective analysis of demographic and nutrition surveys comparing 2008-2014 with 2015-2021.

OBJECTIVES: For decades, Niger, a Sahelian country in Africa, has faced serious food and nutrition crises. Policies and strategies have been implemented by the Government, with the support of its partners, to address this public health problem. The current study was conducted to assess trends in malnutrition among children under 5 years of age. By comparing results from 2008 to 2014 with results from 2015 to 2021, this study aimed to check the efficacy of strategies and policies that were implemented to combat malnutrition. STUDY DESIGN: Retrospective study. METHODS: Data from the annual nutrition survey Standardized Monitoring and Assessment of Relief and Transitions and the Demographic and Health and Multiple Indicator Surveys were used. Meta-analyses were performed on the data as a whole and in each age group by time period. For analysis of age groups, the 95% confidence interval (CI) data were missing, thus an estimate was made from the 'design effect' calculated based on existing CIs. RESULTS: Institutional arrangements had not changed from 2008 to 2014 to 2015-2021, and there were very few changes to existing strategies and policies. The prevalence of Global Acute Malnutrition and Global Chronic Malnutrition (GCM) both remained above critical thresholds for each year in both periods. GCM was above the emergency threshold for both periods, indicating that all regions of the country were affected by malnutrition. The most populated regions (40%) of Maradi and Zinder were the most affected by malnutrition. These two regions also had highest incidence of poverty and the least health service coverage. CONCLUSIONS: Despite the implementation of various policies and strategies, the nutritional status of children under 5 remains an important public health problem.

Persistence of the cholera epidemic in the Tillabery district (Niger): epidemiological analysis of determining factors.

To analyze the determinants of the persistence of the cholera epidemic in Tillabery to obtain a durable solution. Case-control study conducted in three health centers in June 2013 in Tillabery. Cholera cases were confirmed by laboratory testing or epidemiologically linked with a confirmed index case. Controls were individuals with no history of diarrhea, of the same sex, from the same village and with an age difference that did not exceed five years. A logistic regression model was used to analyze the appearance of cholera according to the determining factors. The analysis showed significant association between the occurrence of cholera and variables related to behavior. The adjusted OR confirm higher risks of cholera for persons in households with more than five inhabitants (crude OR = 1.55 95 % CI (1.06 to 2.28) and adjusted OR 95 % CI 2.68 (1.79 to 4.56)), or in contact with a person with diarrhea (crude OR = 1.86 95% CI (1.26 to 2.75) and adjusted OR = 1.61 95% CI (1.5 to 2.68)), and who report not washing their hands after defecation (crude OR = 3.44 95% CI (2.20 to 5.41) and adjusted OR = 2.76 95% CI (1.73 to 3.79)). This study concludes that the Tillabery cholera victims are primarily those with hazardous hygienic practices. Niger must define operational recommendations to limit the continuance of cholera in certain river areas, particularly in the Tillabery.

[Blood transfusion in the Democratic Republic of Congo: efforts and challenges]. / Transfusion sanguine en République démocratique du Congo : efforts réalisés et défis à relever.

The authors trace the history of blood transfusion in the Democratic Republic of Congo, as inherited through the colonial organization of the health system. The current configuration of transfusion system begins with the drafting of the national blood transfusion policy and the establishment of a national technical office within the Ministry of Health to coordinate transfusion activities and of its agents in each province. Despite countless difficulties, several positive points were noted. These involve essentially the drafting of all the necessary documents and standards and the integration of the blood safety system into the country's health system. Initially, the blood transfusion system applied a vertical approach, but with the reform of the country's health system, the performance of blood safety became transversal. In the 12 years from 2001 to 2012, it mobilized 112,882 volunteer blood donors; more than 80% of blood products were checked for safety and covered all blood needs; and 81,806 HIV infections were avoided by routine testing of blood products. During the same period, 7560 people were trained in blood transfusion. The prevalence of viral markers among donors has diminished sharply. Thus, HIV prevalence decreased from 4.7% to 2.1% between 2001 and 2012 that of hepatitis B dropped from 7.1% to 3.5% during the same period, and hepatitis C from 11.8% to 2.3% from 2004 to 2012. Despite this performance, enormous efforts are still required, for the organization of blood safety monitoring, the establishment of a safe supply of reagents and supplies, for sustaining the dynamics of voluntary associations of blood donors, and finally for providing stable funding for these blood safety activities.

[Predictive factors of all-cause mortality in patients attending the medical emergency unit of Kinshasa University Hospital]. / Facteurs prédictifs de la mortalité des patients admis aux urgences médicales des cliniques universitaires de Kinshasa.

BACKGROUND: The management of medical emergencies is poorly organized in the Democratic Republic of Congo. In addition, the mortality of patients attending the medical emergency unit of Kinshasa University Hospital is relatively high, with death of patients occurring rather early. To date, factors associated with this mortality have been poorly elucidated. This study aimed to identify predictive factors of all-cause mortality in patients admitted to the medical emergency unit of the Kinshasa University Hospital. METHODS: Analytical prospective study of all patients admitted from 15th January to 15th February 2011 in the emergency unit of the internal medicine department of Kinshasa University Hospital (427 patients). Among these patients, 13 were dead at arrival and were excluded from this study. The 414 patients included were followed until discharge from the hospital. Demographic, clinical, biological, diagnostic, therapeutical and evolutive data were collected. Four multivariate logistic regression models were used to identify risk factors associated with mortality. RESULTS: Patients' median age was 40 years (interquartile range, 28-58 years), 54.5% were male, and 15.9% had a life-threatening pathological condition on admission. The overall mortality was 12.3%. According to multivariate analyses, transfer from other health care structures (OR: 3.5; 95% CI: 1.7-7.1), Glasgow Coma Scale score less than 14 on admission (OR: 11.1; 95% CI: 4.7-26.3), high creatinine level (OR: 4.2; 95% CI: 1.8-9.7), presence of cardiovascular (OR: 2.9; 95% CI: 1.5-5.7), renal (OR: 7.4; 95% CI: 3.2-17.3), hematologic and/or respiratory (OR: 6.1; 95% CI: 1.7-21.4) diseases, presence of sepsis and/or meningitis and encephalitis (OR: 5.2; 95% CI: 1.6-17.0) were significantly associated with a high risk of death. However, the Glasgow Coma Scale score less than 14 on admission and renal disease were the only predictive factors of mortality remaining after including demographic, clinical, diagnostic and therapeutical variables in the logistic regression model. CONCLUSION: Our study showed that transfer from another health care structure, low Glasgow Coma Scale score on admission, high creatinine level, cardiovascular, renal, hematologic and/or respiratory diseases, sepsis and/or meningitis and encephalitis were associated with an increased risk of death in Kinshasa University Hospital patients admitted in the medical emergency unit.

[Malaria infection and nutritional status: results from a cohort survey of children from 6-59 months old in the Kivu province, Democratic Republic of the Congo]. / Infection palustre et état nutritionnel: résultats d'une cohorte d'enfants âgés de 6 à 59 mois au Kivu en République démocratique du Congo.

BACKGROUND: Despite a reduction in the magnitude of endemic malaria reported in recent years, malaria and protein-energy malnutrition (PEM) still remain major causes of morbidity and mortality in sub-Saharan Africa among children under five. The relationship between malaria and malnutrition remains a topic of controversy. We aimed to investigate malaria infection according to nutritional status in a community-based survey. METHODS: A cohort of 790 children aged 6 to 59 months and residing in eastern Democratic Republic of the Congo was followed-up from April 2009 to March 2010 with monthly visits. Data on nutritional status, morbidity between visits, use of insecticide-treated nets and malaria parasitemia were collected at each visit. The Z scores height for age, weight for age and weight for height were computed using the reference population defined by the WHO in 2006. Thresholds for Z scores were defined at -3 and -2. A binary logistic model of the generalized estimating equation (GEE) was used to quantify the association between PEM indicators and malaria parasitemia. Odds ratio (OR) and their 95% confidence interval (95% CI) were computed. RESULTS: After adjustment for season, children with severe stunting (height for age Z score<-3) were at lower risk of malaria parasitemia greater or equal to 5000 trophozoits/µL of blood as compared to those in with a better nutritional status (height for age Z score≥-2) (OR=0.48, 95% CI: 0.25-0.91). CONCLUSION: Severely stunted children are at a lower risk of high-level malaria parasitemia.

[Perinatal mortality: extent and causes in Lubumbashi, Democratic Republic of Congo]. / La mortalité périnatale : ampleur et causes à Lubumbashi, République démocratique du Congo.

BACKGROUND: The present study was initiated in order to determine the rate, the causes and the risk factors for perinatal mortality in Lubumbashi, Democratic Republic of Congo. METHODS: Data for this cross-sectional study were collected by interviewing participating women and by analysis of medical files. Women who gave birth in 2010 and were residents of Lubumbashi during the same year were included.Women were included irrespective of the pregnancy outcome and perinatal survival was determined for newborns aged at least seven days.Women were recruited from households selected by cluster sampling for healthcare zones. Perinatal mortality was defined as stillbirths and early neonatal deaths per 1000 births. Risk factors were sought using the odds ratio method adjusted by logistic regression using a 5% threshold. RESULTS: Among 11,536 surveyed women, there were 11,633 births including 177 stillbirths and 133 early neonatal deaths. Perinatal mortality was 27% (95%IC = 23.7­29.6%). The causes of this mortality were respiratory distress (58.2%), neonatal infection (pneumonia and neonatal meningitis, 13.5%), complications of prematurity (9.0%), neonatal tetanus (1.6%), congenital malformations (0.6%). The cause of perinatal death was unknown for 17.1%. Risk factors for perinatal mortality were: unmarried mother; home delivery; complicated delivery; dystocia; caesareansection; multiple pregnancy; low birth weight; prematurity. CONCLUSION: Action should be taken to improve availability, use and quality of Emergency obstetrical and neonatal care. Women should be better informed concerning the danger signs of pregnancy and childbirth.

[Risk factors for perinatal mortality in the city of Lubumbashi, Democratic Republic of Congo]. / Les facteurs de risque de la mortalité périnatale dans la ville de Lubumbashi en République démocratique du Congo.

BACKGROUND: The aim of this study is to establish factors explaining perinatal death rates in the city of Lubumbashi. METHODS: We have carried out a case controlled study in the maternity ward of Jason Sendwe hospital. Perinatal death cases have been compared to those of surviving newborn children among parturient women in the course of 2008. Sociodemographic characteristics, maternal morbidity, children's typical features, have been studied as independent variables. Their effect on perinatal mortality has been assessed using an adjusted odds ratio value at a 5% confidence interval and a logistic regression model. RESULTS: In total, we considered 2279 births (mother and child pairs) for our study. Among these were 415 perinatal mortality cases and 1864 control cases. After adjustment for several parameters, household chores (AOR=1.8; 95% IC=1.2-2.9), multiple pregnancies (AOR=1.9; 95% IC=1.2-2.9), malaria (AOR=1.4; 95% IC=1.1-1.8), primiparity (AOR=1.7; 95% IC=1.3-2.4), stillbirth (AOR=5.2; 95% IC=2.5-11.0) and prematurity (AOR=2.9; 95% IC=1.5-5.5) in previous pregnancies, onset of antepartum ferver (AOR=3.0; 95% IC=1.2-7.3) and antepartum hemorrhage (AOR=6.8; 95% IC=3.1-15.0), lack of fetal motions near delivering time, dystocias (AOR=2.0; 95% IC=1.3-3.0), low birthweight (AOR=15.7; 95% IC=11.2-22.0), very low birthweight (AOR=49.0; 95% IC=28.6-85.1) and foetal macrosomia (AOR=3.5; 95% IC=1.8-7.0) were the main factors explaining perinatal mortality. CONCLUSION: Perinatal mortality in Lubumbashi remains associated with several avoidable factors. Basic and emergency obstetrical-neonatal care (B-EMONC) should be improved. Significant efforts should be made in this direction. Perinatal audits should be established for a good heath care quality follow-up. Obstetrical care should be offered as a continuum in order to facilitate communication between the different caregivers.

Understanding couples' attitudes on prenatal HIV testing in the Democratic Republic of Congo.

BACKGROUND: The prevalence of HIV-serodiscordant couples is increasing. In these couples, one member is infected with HIV and the other one is not, so HIV testing for both members of the couple remains one of the significant challenges in the prevention of sexual transmission of HIV within the couple. The aim of this study was to analyze couples' attitudes toward HIV testing after prenatal HIV testing offered to pregnant women and analyze the males' behavior with regard to their own HIV testing. METHODS: One hundred and forty-three pregnant women and their partners were interviewed in the Lubumbashi health district in the Democratic Republic of the Congo. The usual descriptive statistics were applied. RESULTS: Seventy-one percent of the couples declared that they accepted the HIV testing proposed to the woman and approximately 64% of the couples said they had discussed the HIV testing proposed in prenatal healthcare clinics. However, this dialogue seemed to have a poor impact on the HIV testing of the male partner: no male partner was tested in spite of the high proportion of men encouraged to do so. Nearly 30% and 50% of the couples disagreed on systematic condom use and the need for the husband's permission to undergo HIV testing, respectively. Twenty-nine percent of the couples did not wish to have the male sexual partner present at the prenatal consultation. CONCLUSION: The majority of men considered that their wife's HIV testing gives them information about their own HIV status and this makes HIV testing difficult for both members of the couple. Better management of the couple in HIV screening and prevention programs therefore seems necessary.

[Reliability of anthropometric measurements performed by community nutrition workers in a community-based pediatric growth-monitoring program in rural Rwanda]. / Fiabilité des mesures anthropométriques dans le suivi de la croissance à base communautaire des enfants en milieu rural au Rwanda.

BACKGROUND: In Rwanda, the community-based growth-monitoring program is implemented via volunteer community nutrition workers. These volunteers are recruited from within their communities, and receive basic training prior to providing services. Utilizing local volunteers improves access to basic nutrition services, and allows the local health jurisdictions to use qualified health care staff more efficiently. In addition to concerns raised in regards to the accountability of unpaid workers, some question the relevance of the data that is collected. We carried out a nutritional survey in the catchment area of Ruli District Hospital to evaluate the reliability of the community nutrition workers' measurements of anthropometric standards collected within the growth-monitoring framework. METHODS: A nutritional survey was recently organized in the catchment area of the hospital in December 2006. The prevalence rates of malnutrition from the survey were compared with those from the existing community-based growth-monitoring program. Z-test was used to compare the prevalence rate of underweight from the survey with the prevalence rate determined by data collected from community nutrition workers. The concordance of children classified with moderate and severe underweight in each data set was determined by the coefficient Kappa of Cohen. RESULTS: Our findings show that the recent survey reported an overall underweight prevalence rate of 27.2%. Community data calculated a prevalence rate of 28.8% for the same population. The difference is not statistically significant (P=0.294). Of 724 children evaluated, the survey and the community were in agreement in regards to 454 children classified in the category of good nutritional status, 143 children classified in moderate underweight and 11 children classified in the severe underweight category. The Kappa of Cohen coefficient of 0.636 indicates strong concordance between data sets. CONCLUSION: Anthropometric measurements provided by the community are reliable. Information gathered from the community can be used for epidemiologic monitoring of malnutrition. To ensure continued reliability, health centers must provide sufficient and permanent training to community nutrition workers. In addition, continued access to essential materials used for measuring nutritional status and maintenance of these materials will be crucial to the program's ongoing success.

[HIV-1 test acceptance within the prevention of mother-to-child HIV-1 transmission program in Democratic Republic of Congo]. / Acceptation du test de dépistage du VIH dans le cadre du programme de prévention de la transmission du VIH de la mère à l'enfant en République Démocratique du Congo.

BACKGROUND: HIV-1 testing and counselling are essential activities that must be integrated into mother-to-child HIV transmission prevention programs (PMTCT) in order to identify women who can benefit from the treatment, immediately or later and from interventions that can prevent HIV in their infants. The aim of this study was to describe how women's attitudes influence acceptance of HIV-1 testing in the context of antenatal care. METHODS: Four hundred and thirty-nine women attending antenatal care clinics offering HIV-1 testing in the health district of Lubumbashi in Democratic Republic of Congo were included in the study. Data were collected through interviewer-administered questionnaire. Women were asked to give their consent for a home visit and interview of their partners; 143 agreed to participate. Statistical analyses were carried out using Chi-square test and logistic regression. RESULTS: The proportion of pregnant women who declared that they would accept HIV testing was 76.5%. Non-married women (p=0.046), women who had never carried out a former HIV test (p<0.001), who had mentioned that they would wish to share the results of the test with their partner or would wish to be accompanied at least once by their partner at the antenatal clinic (p<0.001), those whose partner agreed to participate in the study (p=0.010) and those who knew at least one mode of HIV transmission (p=0.025) were more likely to accept the HIV testing. CONCLUSION: Improving counselling and a policy of HIV counselling and testing integrating a couple components could help to overcome obstacles to the integration of the women within PMTCT programs and help improve acceptance of HIV testing.

[Improving the management of a community based growth-monitoring program for children in rural Rwanda]. / Amélioration de la gestion d'un programme de suivi de la croissance à base communautaire des enfants en milieu rural au Rwanda.

BACKGROUND: In order to improve the management of a community based nutrition program in the catchment area of Ruli District Hospital in Rwanda, we carried out a nutrition survey to determine the risk factors for childhood malnutrition in the area. Identifying the groups of children at risk of malnutrition and their risk factors allows the community nutrition workers to target the children who require close monitoring, and assists in the development of key messages for educational nutrition training. METHODS: The prevalence of the three forms of malnutrition was estimated by using the Z-scores height for age, weight for age and weight for height with NCHS/OMS/2000 reference. Logistic regression was performed to identify the risk factors for malnutrition. RESULTS: Our findings show that children from 12-35 months of age are at greatest risk of malnutrition. Risk factors for wasting include: low monthly income of the household, concurrent illness of the child and a household that does not practice breeding. Risk factors for underweight include: child being greater than 12 months of age, mother of the child being pregnant and history of malnutrition in the household. Finally, risk factors for stunting include the absence of a mosquito net in the household, an insufficient number of working adults in the household, the child being greater than 12 months of age and a household managed by a man alone or by an orphan. CONCLUSION: Community based growth monitoring must focus its attention on the children from nine to 35 months of age. Children less than nine months of age are generally followed by the health centers through the immunization program, and the older children are generally followed in the child minder schools that need to be promoted in all the cells. Community messages must focus on the identified risk factors of malnutrition, and a positive deviance approach must be introduced in the entire zone.

Increase in maternal mortality associated with change in the reproductive pattern in Spain: 1996-2005.

BACKGROUND: In Europe, different studies forecast an increase in maternal mortality in the coming years, associated with advanced maternal age and delay in maternity. This study aims to analyse the age-related trend in the maternal mortality ratio among mothers in Spain for the decade 1996-2005, and to describe the causes of death and associated sociodemographic factors for the years with highest mortality. METHODS: An ecological study on trends, for the age-related trend in the maternal mortality ratio; an indirect standardisation and Poisson regression model was used. For the description of the causes of death, a cross-sectional study was used. RESULTS: Prevalence of live births among mothers aged 35 years and over was 15% higher in Spain than in Europe. The maternal mortality rate increased by 20% (standardised mortality ratio of 1.2, 95% CI 0.9 to 1.4) in 2005 with respect to 1996. The age-related risk of maternal mortality was three times higher (relative risk of 2.90, 95% CI 2.01 to 4.06) among mothers aged 35-44 years versus those aged under 35 years. The highest mortality was detected during 2003-2004. The risk of maternal mortality was higher in foreign mothers. CONCLUSION: This study confirms that there was a change in the maternal mortality trend characterised by an increase in deaths, associated with advanced maternal age, as well as an increase in the prevalence of live births among mothers aged 35 years and over. This change in pattern identifies the need to intensify maternal mortality surveillance by collecting the necessary set of variables that allows investigation of the causes and determinant factors underlying deaths.

[The effect of spiruline during nutritional rehabilitation: systematic review]. / Supplémentation en spiruline dans le cadre de la réhabilitation nutritionnelle: revue systématique.

BACKGROUND: To evaluate the impact of spiruline on nutritional rehabilitation. DATA SOURCES: Systematic search in medical and scientific databases (Medline, Cochrane, Embase) and other specific databases (PhD theses, reports...). METHODS: We selected studies in which spiruline was used as supplementation in malnourished patients, irrespective of the form and dose of spiruline and in controlled trials or not. Two persons made the selection separately. Nutritional status was estimated by anthropometric and biological measures. RESULTS: Thirty-one references were identified and seven studies were retained for this review; three randomized controlled and four non-controlled trials. Spiruline had a positive impact on weight in all studies. In non-controlled trials, the other parameters: arm circumference, height, albumin, prealbumin, protein and hemoglobin improved after spiruline supplementation. For these studies, methodology was the main drawback. None of the studies retained for analysis were double-blinded clinical trials and all involved small samples. Four of them did not have a control group for comparison. CONCLUSION: The impact of spiruline was positive for most of the considered variables. However, the studies taken into account in this review are of poor-methodological quality. A randomized, a large-sized double-blind controlled clinical trial with a longer follow-up should be conducted to improve current knowledge on the potential impact of spiruline on nutritional rehabilitation.

[Protein-energy malnutrition and malaria-related morbidity in children under 59 months in the Kivu region of the Democratic Republic of the Congo]. / Malnutrition protéino-énergétique et morbidité liée au paludisme t chez les enfants de 0-59 mois dans la région du Kivu, République Démocratique du Congo.

In the Kivu region located in east of the Democratic Republic of the Congo, malnutrition and malaria is a major cause of morbidity and mortality. The relationship between malaria and malnutrition is unclear and has never been studied in the Kivu region. This report presents an analysis of data from 5695 children aged 0 to 5 years, admitted to the paediatric ward of Lwiro hospital between November 1992 and February 2004. The weight/age (W/A) index and weight/height (W/H) index expressed with standard deviation in relation to the reference median were calculated (Z score). The association between protein-energetic malnutrition and malaria infection and nutritional indicators was measured based on prevalence ratios determined by univariate analysis and adjusted Odds Ratio (OR) derived using a multivariate model. The prevalence of malaria at the time of admission was 35.8 % (n=5695). The W/A and W/H indexes and serum albumin level were correlated with malaria-related morbidity. Logistic regression showed that high malaria OR was associated with both anthropometric nutritional indicators [WHZ > -2: OR (CI 95 %) 1.7 (1.4-2.2)] [WAZ > -2: OR (CI 95 %) 1.3 (1.1-1.6)] and biological nutritional indicators [serum albumin > or = 23 g/L: OR (CI 95 %) 1.6 (1.2-2.1)]. Our findings indicate that malnourished children at admission have a lower risk of malaria infection.

Malnutrition proteino-energetique et morbidite liee au paludisme chez les enfants de 0-59 mois dans la region du Kivu; Republique Democratique du Congo

Dans la region du Kivu a l'Est de la Republique Democratique du Congo; la malnutrition et le paludisme sont responsables d'une morbidite et mortalite importantes. La relation entre paludisme et malnutrition est controversee et cette association n'a; jusqu'a present; pas ete exploree dans cette region du Kivu. Nous avons analyse les donnees de 5695 enfants ages de zero a cinq ans recueillies a l'admission a l'hopital pediatrique de Lwiro entre novembre 1992 et fevrier 2004. Les indices poids pour age (PPA) et poids pour taille (PPT) exprimes en ecart type par rapport a la mediane de reference ont ete calcules (Z score). L'association entre les indicateurs de la malnutrition proteino- energetique et le paludisme a ete mesuree par les rapports de prevalence en analyse univariee et les OR ajustes derives d'un modele de regression logistique. La prevalence du paludisme a l'admission etait de 35;8(n=5695). Les indices PPT et PPA et l'albumine serique etaient associes a la morbidite liee au paludisme. En regression logistique; des OR eleves de paludisme ont ete observes pour des valeurs elevees des indicateurs anthropometriques [Z score PPT - 2: OR (IC a 95) 1;7 (1;4-2;2)] [Z score PPA - 2: OR (IC a 95) 1;3 (1;1-1;6)] et biologiques [albumine serique = 23g/L : OR (IC a 95) 1;6 (1;2-2;1)] de l'etat nutritionnel. Nos analyses mettent en evidence une association inverse entre la malnutrition et la prevalence de l'infection palustre

Community-acquired bacteremia among hospitalized children in rural central Africa.

OBJECTIVE: To describe the epidemiology of community-acquired bacteremia in children admitted to a rural hospital in central Africa and to identify useful diagnostic signs or symptoms. METHODS: On admission, a blood culture was obtained from all children admitted to Children's Hospital of Lwiro between 1989 and 1990. Clinical and biologic signs of infection and nutritional status were recorded. RESULTS: Among the 779 children included in the study, 15.9% were bacteremic on admission. The rate of bacteremia was the highest among children with jaundice (20/56; 35.7%) and fever (119/487; 24.4%). In contrast, children with severe malnutrition had a lower rate of bacteremia (13.2%) than weight growth retarded or well-nourished children (19.5%) (P = 0.046). Fever was the most useful diagnostic criteria (sensitivity and negative predictive value of 96.0% and 97.8%, respectively) even in severely malnourished children (sensitivity and negative predictive value of 96.4% and 99.1%, respectively). Enterobacteriacea, mostly Salmonella spp, caused 73% of the bacteremia. There was a high rate of resistance to ampicillin and chloramphenicol among the responsible organisms. Only 31 (47.7%) of 65 bacteremic children responded to the combination of ampicillin and gentamicin. The presence of bacteremia on admission did not significantly increase the risk of morality during hospitalization (19.4% compared with 13.5%; P = 0.088). Age less than 12 months and jaundice were independent risk factors for deaths in bacteremic children. CONCLUSIONS: Community-acquired bacteremia caused by multiresistant Enterobacteriacea is an important problem of hospitalized well-nourished and malnourished children in central Africa. Fever on admission is a sensitive diagnostic sign, even in malnourished children.

Ultrasonic evaluation of fetal limb growth: part II.

The length of the ulna, radius, tibia, and fibula was measured in 220 normal fetuses. Computerized curve fitting provided normal values of bone length for age and biparietal diameter. Ratios of the length of the different bones are presented. Possible applications of these measurements include: in utero diagnosis of fetal dwarfism, limb malformations, microcephaly, determination of gestational age, archeological dating of fetuses, and forensic applications.