Coût financier de la prise en charge des hépatites virales chroniques B et C au CHU de Brazzaville (Congo)

Introduction. Les dépenses de santé ont considérablement augmenté dans le monde lors de la dernière décennie. Les hépatites virales chroniques B et C sont des affections chroniques nécessitant un traitement prolongé et qui est encore coûteux, le Congo ne disposant pas encore d'assistance maladie universelle. Le but de cette étude était d'évaluer le coût de la prise en charge des hépatites virales B et C au Congo. Matériels et Méthodes. Il s'agit d'une étude transversale rétrospective et descriptive, réalisée du 1er juin au 31 Décembre 2016 dans le service de Gastro-entérologie et médecine interne du CHU de Brazzaville. Nous avons colligé les dossiers des patients suivis pour hépatite B et C. Les variables d'étude ont été les coûts des examens paracliniques et les coûts des traitements. Résultats. les coûts des examens paracliniques étaient de 296 000 FCFA (451€) pour le coût maximum de l'hépatite B, celui de l'hépatite C était de 596 500 FCFA (910,6 €). Les coûts du traitement de l'hépatite virale C étaient de 1 050 000 FCFA (1603,05 €) pour trois mois. Pour l'hépatite B, ils étaient de 389 987 (595,4€) par semestre. Le coût global de la prise de l'hépatite virale C était de 1 345 313 FCFA (2053,9€) et de 535 569 (817,662 €) pour l'hépatite B. Conclusion. Les coûts de la prise en charge des hépatites B et C sont encore trop élevés au Congo. Une prise en charge globale s'avère nécessaire, similaire à celle de l'infection à VIH

Outcome of HIV-positive children and adolescents treated with second-line antiretroviral agents in Congo.

Antiretroviral agents (ARVs) are the leading therapeutic weapon against HIV/AIDS infection. When first-line treatment fails, a second-line ARV is needed. OBJECTIVE: To determine the prevalence of HIV-infected children treated with second-line ARVs, to assess their adherence and therapeutic response, and to identify factors of good adherence. MATERIAL AND METHODS: A retrospective multicenter study covering the period from January 2015 to July 2016 in all centers providing care to children with HIV included all children treated with a second-line ARV. RESULTS: A total of 71 children were identified, with a male to female ratio of 1.1 and a mean age of 14.2±3.2 years (range: 5 to 19). Mother-to-child transmission was observed for 97.2 %. In all, 64.8 % of the children had lost at least one parent, 29.6 % both of them. Family socioeconomic status was low for 15.5 % and middle for 74.6 %. Nearly half (46.5 %) were aware of their HIV status, and all received psychological support. The therapeutic regimen used for 54.9 % included ABC + DDI + LPV/r, and the treatment lasted for less than 2 years in 22.5 % and between 2 and 4 years in 38 %. Therapeutic adherence was good in 54.9 %, better in boys (p < 0.01) and in those aged 15 years and younger (p < 0.001). The therapeutic response was good in 89 % at 12 months and 86 % at 4 years, better in those aged 15 years and younger (p < 0.001). CONCLUSION: Despite the small proportion of good therapeutic adherence to second-line ARVs, the rate of good clinical and therapeutic response of 86 % in children and adolescents 4 years after being switched to them is an argument that should encourage prescribers to shift patients to second-line treatment as soon as there is an indication. However, challenges remain in improving the management of children and adolescents treated with a second-line ART.

[African histoplamosis. A report of three pediatric cases]. / Trois cas pédiatriques d'histoplasmose africaine à Brazzaville.

Histoplasmosis duboisii (Histoplasma capsulatum var duboisii) is uncommon disease especially in children. It is observed in Africa where the incidence is unknown. The authors report a series of three pediatric cases. The report concerned 2 girls and one boy who were 3, 9 and 4 year-old, respectively. Symptoms evolved for more than two months in each case. At admission, we found fever and poor general condition. Observed lesions were lymphnodes localisation disseminated (cases 1 and 2), subcutaneous (cold abscess) and cutaneous simulating molluscum contagiosum (case 2), osteoarticular (cases 2 and 3), abdominal including peritoneal and hepatosplenic (case 1). In all cases, a mild leukocytosis was found and an accelerated erythrocyte sedimentation rate (ESR) greater than 70mm. The HIV serology was negative. The treatment consisted of itraconazole in 2 cases and ketoconazole in one case. The evolution was insidious, leading to the discharge against medical advice. The death occurred at home in all cases. CONCLUSION: Histoplasmosis duboisii can realize two main clinical presentations (localized or disseminated), affecting the skin, lymph nodes, bones, sometimes the intra-abdominal organs. HIV serology is not always positive in disseminated forms. The evolution is unpredictable and capricious under antifungal treatment. The disease should be well explained to prevent a possible discharge against medical advice, often pejorative.

[Nephrotic syndrome complicated by chylous ascites in a girl of 2 years and 8 months old]. / Syndrome néphrotique compliqué d'ascite chyleuse chez une fillette de 2 ans et 8 mois.

We report on a case of nephrotic syndrome with focal and segmental hyalinosis complicated by chylous ascites in a girl of 2 years and 8 months old. This pure nephrotic syndrome in its early stage was initially treated with intensive steroid treatment at 2mg/kg/day orally for 2 months, followed by a bolus of methylprednisolone. The persistence of proteinuria meant corticosteroid resistance. Renal biopsy then revealed focal and segmental hyalinosis. A recurrence of the edema-ascites syndrome was associated with macroscopic hematuria. Blood pressure and serum creatinine remained normal. Protidemia decreased to 28g/L, with severe hypoalbuminemia at 7g/L. The ascites puncture brought 1 L of aseptic and milky fluid, containing 0.22g/L of proteins, 20 IU/L of amylase, and 331g/L of total lipids. The treatment protocol included a hyperprotein diet, prednisone at 0.5mg/kg/day, cyclophosphamide at 2.5mg/kg/day for 1 month, then once every 2 days for 3 months, and repeated ascites punctures. After 12 ascites punctures performed every 15 days, a polyuric episode occurred and the ascites disappeared. Proteinuria persisted at a nephrotic rate up to the 14th month, without impairment in kidney filtration function, and completely disappeared at the 20th month. After 5 years of follow-up, proteinuria remains undetectable and the physical exam is normal. The occurrence of chylous ascites during the nephrotic syndrome is a rare event. The formation of bowel lymphangiectasia, caused by a slowdown in venous return due to the pressure exerted by ascites, is probably the predominant mechanism.

[Study of 11 new cases of Kawasaki disease Congolese]. / Étude de onze nouveaux cas congolais de maladie de Kawasaki.

Kawasaki's disease (KD) is a rarely described entity in Africa. The purpose of this work is to describe the clinical, biological and evolutionary aspects of KD in the Congolese child. This is a retrospective study of 11 cases of KD collected from 2003 to 2014 at the University Hospital of Brazzaville. The diagnosis was based on the criteria proposed by the Mucocutaneous Lymph Node Syndrome Research Commitee and validated by the Center for Disease Control grouping the major criteria originally described by Kawasaki and updated by the American Heart Association. The sex-ratioM/F was 2.7 and the mean age of 16.5 ± 5.9 months (range 9 to 43 months). The average intake time was 12.8 ± 5.9 days (range 6 and 30). In nine cases there was a complete form. The symptoms began with an invasion of the upper airway in 8 cases. Achieving oropharyngeal was in the form of oral enanthema with strawberry tongue and / or angular cheilitis; it was associated with perineal erythema in 7 cases. Reaching the end realized swelling and/or redness and / or peeling finger gloves or flap toes. The latter occurred at an average of 11 ± 3.5 days (range 8 to 16) after the start of the fever. The treatment with acetylsalicylic acid administered to all children, began within varying between 4 and 15 days of admission. The defervescence was obtained after 5.3 ± 2.6 days (range 4 to 11). The average hospital stay was 16.6 ± 9.7 days (range: 11 to 25 days). The evolution after discharge was considered favorable in all cases. However, no control echocardiography was performed. KD remains an ubiquitous condition but with a variable incidence from one continent to another. The arrival of the twodimensional ultrasound should enable the systematic investigation of coronary abnormalities to catch up unnoticed past cases but also to prevent complications related there.

[Prescription of antibiotic drugs for children at the Brazzaville University Hospital Center (Congo)]. / Évaluation de l'antibiothérapie initiale en milieu pédiatrique au CHU de Brazzaville (Congo).

UNLABELLED: Antibiotics are a class of drugs commonly prescribed in pediatric practice, often inappropriately. OBJECTIVE: To determine the prevalence of antibiotic prescription in hospitalized children, assess the quality of prescribing, and identify factors related to inappropriate prescriptions. METHODS: This retrospective study was conducted from July through December 2009 (6 months). It included data about 464 children aged from 1 month-16 years who received antibiotic therapy. RESULTS: Antibiotics were prescribed to 61.5% of the children admitted to the hospital. Their mean age was 18.6 ± 20.2 months, and most (78%) were younger than 2 years. The indications for antibiotics were dominated by acute respiratory infections (46%), diarrhea (16%), and severe sepsis (12%). The prescriptions were written by pediatricians in 179 cases (38.6%), and by residents or interns in the other cases. The beta-lactam antibiotics (79%), aminoglycosides (8%) and sulfonamides (7%) were prescribed most often. The initial antibiotic therapy was changed in 82 cases. The indication for antibiotic therapy was correct in 325 cases and the type chosen appropriate in 229, the dosage correct in 437 cases, and the duration correct in 390. The route of administration was intravenous in 243 cases (40.3%), oral in 194 (41.8%), and intramuscular in 37 (7.9%). The qualification of the prescriber was associated with relevance, choice and dosage. The dosage was correct when the drug was administered parenterally in 248 cases (56.8%); in contrast, it was incorrect in 189 cases (43.7%; p>0.05) of oral administration. The route of administration was related to the choice of antibiotic. Thus, it was appropriate when the route was parenteral in 162 cases (70.7%) and in only 67 cases (29.3%) for the oral route (p <0.001). CONCLUSION: Errors in antibiotic prescriptions could be improved by standardized treatment guidelines, compliance with international recommendations, a consistent approach to diagnosis, and better laboratory performance.