Caustic oesophageal stricture treated by instrumental dilatation: A review of 6 years of practice at the pediatric university hospital charles de gaulle of Ouagadougou.

Background: Oesophageal stricture is one of the most important and redoubtable complications following caustic ingestions in children. Instrumental dilatation is usually considered the first line of treatment. Aims and Objectives: This study aims to evaluate the outcomes of caustic stenosis treatment when using Lerut dilatators. Materials and Methods: This is a descriptive retrospective study from May 2014 to April 2020. All children under 15 years hospitalised in our department for caustic oesophageal stricture and had a gastrostomy and oesophageal dilatation with insertion of an endless wire were included. Results: A total of 83 patients were included. The sex ratio was 2.2. The mean age was 4 years. The mean time from caustic ingestion to presentation was 90 days. Oesophageal stricture was mostly caused by caustic soda (n = 41) and potash (n = 15). We performed in total 469 dilatations and had only three oesophageal perforations. After a mean follow-up of 17 months, we had 60.2% good results (n = 50) and 7.2% (n = 6) failures. The mortality rate was 13.2% (n = 11). Conclusion: The results of the dilations by Lerut dilatators give encouraging results in our department. It is easy to perform and its complications remain rare. Mortality could be reduced by adequate nutritional support.

Corps étrangers chroniques dans l'œsophage chez l'enfant / Chronic foreign bodies in the oesophagus in children

Les ingestions de corps étrangers sont des accidents fréquents en pédiatrie. La plupart sont sans grande conséquence sauf ceux qui sont enclavés dans l'œsophage. Nous rapportons 2 cas de pile bouton intraœsophagienne chez 2 enfants âgés de: 4ans de sexe masculin et 2 ans de sexe féminin. Le motif de consultation dans les deux cas était la dysphagie aux solides. La fibroscopie broncho-oesophagienne a été effectuée dans les 2 cas avec échec d'extraction conduisant à une extraction chirurgicale par voie de thoracotomie chez le garçon et de cervicotomie chez la fille. Une sténose œsophagienne est survenue à 2 mois dans les suites opératoires chez le garçon. L'évolution a été favorable après dilatation aux bougies de Rehbein modifiées. Chez la fille en postopératoire un œdème laryngé est survenu et a nécessité des séances de nébulisations. L'évolution a été favorable chez les 2 enfants avec un recul de 5 ans et de 2 mois. Conclusion: Les piles boutons sont des corps étrangers particuliers qu'il faut extraire en urgence. L'oesophagoscopie reste le moyen le plus fréquemment employé mais la chirurgie reste le dernier recourt avec des possibilités de complication.

Ingestion of foreign bodies is a common accident in paediatrics. Most of them are of little consequence except for those that are enclosed in the esophagus. We report 2 cases of intraesophageal button stacks in 2 children aged 4 years' male and 2 years female. The reason for consultation in both cases was solid dysphagia. Bronchoesophageal fibroscopy was performed in both cases with failed extraction leading to surgical extraction by thoracotomy in boys and cervicotomy in girls. Esophageal stenosis occurred at 2 months of age in the postoperative period in boys. The development was favourable after expansion at the modified Rehbein candles. In the postoperative girl, laryngeal edema occurred and required nebulization sessions. The evolution was favorable in the 2 children with a follow-up of 5 years and 2 months. Conclusion: Button batteries are special foreign bodies that need to be removed urgently. Esophagoscopy remains the most frequently used method, but surgery remains the last resort with the possibility of complications.

Factors limiting the use of modern contraceptive methods in mothers with children aged 12-23 months at the Yalgado Ouedraogo University Hospital in Ouagadougou, Burkina Faso.

Knowledge of the factors of non-use of modern contraceptive methods should help to reduce the number of infants born after short interpregnancy intervals, which are associated with adverse effects for mothers, children, and families. For this reason, this study aimed to determine the factors associated with this non-use among mothers of infants aged 12 to 23 months. This case-control study included a sample of mothers of children aged 12 to 23 months. The case mothers were users of modern contraceptive methods and the control mothers were non-users. Data were collected from January 1 through March 31, 2018. Six factors were significantly associated with the use of modern contraceptive methods: age younger than 25 years, lack of gainful activity, desire for a family size ≥ 4 children, BMI greater than 25, opposition by husband, and failure to attend the 45-day postnatal consultation. Modifiable socio-economic factors were significantly associated with the non-use of modern contraceptive methods by mothers of children aged 12 to 23 months.

Challenges of cold chain quality for routine EPI in south-west Burkina-Faso: An assessment using automated temperature recording devices.

BACKGROUND: Abnormal temperatures are a major issue for vaccines within the Expanded Program of Immunization in tropical climates. Prolonged exposure to temperatures outside the standard +2 °C/+8 °C range can impact vaccine potency. METHODS: The current study used automatic temperature recording devices (Testostore 171-1©) to monitor cold chain in remote areas of Western Burkina Faso. A series of 25 randomly selected health centers representing 33% of the existing 176 EPI facilities in Western Burkina Faso were prospectively assessed for eight months in 2015. Automatic measurements were compared to routine temperature loggers and vaccine vial monitors (VVM). RESULTS: The median age for all refrigerators was 9 years with 10/25 (42%) older than 10 years. Adverse temperatures were recorded in 20/24 (83%) refrigerators and ranged from -18.5 °C to +34.2 °C with 12,958/128,905 (10%) abnormal hourly records below +2 °C and 7357/128,905 (5.7%) above +8 °C. Time of day significantly affected the rate of temperature excursions, with higher rates from 00 am to 06 am (p < 0.001) for low temperatures and 10-12 am (p < 0.001) and 13-16 pm (p < 0.001) for high temperatures. Abnormal temperatures lasted from 1 h to 24 h below +2 °C and 13-24 h above +8 °C. Standard manual registers reported only 182/2761 (7%) inadequate temperatures and VVM color change detected only 133/2465 (5%) disruptions. Reliability of the refrigerators ranged from 48% to 98.7% with a median of 70%. Risk factors for excursions were old age of the refrigerators, the months of April and May, hours of high activity during the day, and health staff-associated factors such as inappropriate actions or insufficient knowledge. CONCLUSION: Important cold chain reliability issues reported in the current study in Western Burkina Faso raise concern about vaccine potency. In the absence of systematic renewal of the cold chain infrastructure or improved staff training and monitoring, antibody response assessment is recommended to study levels of effective immunization coverage.

[Evaluation of the Practice of Caesarean Section According to Robson's Classification in a Health District of Ouagadougou, Burkina Faso]. / Évaluation de la pratique de la césarienne selon la classification de Robson dans un district sanitaire de Ouagadougou, Burkina Faso.

The control of the caesarean rate is nowadays an important concern for the obstetric world, the priority being to make every effort to practice a caesarean in all the women who need it only instead of reaching a specific rate. The purpose of the present study was to apply the Robson classification to the evaluation of the practice of caesarean section at the maternity of the Bogodogo District Hospital. It turned to be an analytical cross-sectional study which was carried out from January 1st, 2013 till December 31st, 2015. The information sources used included the computer base of caesarean sections, the delivery records, the operating room records, the delivery hall and the monthly activity reports. The overall hospital frequency of caesarean section was 33.3%. The rate of caesarean section expected during the same period according to the C-Model was 9.7%. Patients in groups 5 (with a scar uterus) and 6 (nulliparous with siege presentation) of the Robson classification had all a caesarean section and contributed to the overall rate of caesarean for 30 and 8.6% respectively. Low-risk women (groups 1, 2, 3 and 4) had a relative contribution of 31.3% to the overall rate of caesarean section. Improvement of the antenatal assessment of the prognosis of childbirth, particularly in the case of uterine scar or siege presentation, improvement of the quality of the supervision of the delivery work and the fight against prematurity will help to control the rate of caesarean section at the Bogodogo District Hospital.

Le contrôle du taux de césariennes est, de nos jours, une préoccupation importante pour le monde obstétrical, la priorité étant de tout mettre en œuvre pour pratiquer une césarienne chez toutes les femmes qui en ont besoin plutôt que d'atteindre un taux spécifique. La présente étude a pour objectif d'appliquer la classification de Robson à l'évaluation de la pratique de la césarienne à la maternité de l'hôpital de district de Bogodogo. Il s'agit d'une étude transversale descriptive sur une période de trois ans, du 1er janvier 2013 au 31 décembre 2015. La base informatique des dossiers de césarienne, les dossiers d'accouchement, les registres du bloc opératoire, de la salle d'accouchement et les rapports mensuels d'activités étaient les sources d'information utilisées. La fréquence hospitalière globale de césarienne était de 33,3 %. Le taux de césarienne attendu durant la même période selon le C-Model était de 9,7 %. Les patientes des groupes 5 (avec un utérus cicatriciel) et 6 (nullipares avec présentation de siège) de la classification de Robson ont toutes bénéficié d'une césarienne et ont contribué au taux global de césarienne pour respectivement 30 % et 8,6 %. La contribution relative cumulée au taux global de césarienne des groupes 1, 2, 3 et 4 (femmes à bas risque de césarienne) était de 31,3 %. L'amélioration de l'évaluation anténatale du pronostic de l'accouchement, notamment en cas de cicatrice utérine ou de présentation de siège, l'amélioration de la qualité de la surveillance du travail d'accouchement et la lutte contre la prématurité contribueront à maitriser le taux de césarienne à l'hôpital de district de Bogodogo.

Connaissances, attitudes et pratiques des professionnels de santé en soins prénatals focalisés dans le district sanitaire de Ouahigouya

Le but de notre étude était d'étudier les connaissances, attitudes et pratiques des professionnels de santé en soins prénatals focalisés dans le district sanitaire de Ouahigouya. Nous avons mené une étude transversale à visée descriptive avec une collecte prospective des données qui s'est déroulée du 10 mars au 30 mai 2015. L'entretien, l'observation et l'auto-administration ont été les techniques d'enquête utilisées. Les données ont été recueillies à partir d'un questionnaire pour les connaissances, d'une échelle d'appréciation pour les attitudes et les pratiques des prestataires de soins prénatals, d'un guide d'entretien individuel et une liste de vérification des ressources matérielles et des consommables auprès des responsables de la maternité et d'une liste de vérification des éléments de l'organisation du service auprès des infirmiers chefs de poste. Des résultats, il ressort que : 83.9 % des prestataires connaissaient la période de la 1re visite prénatale, 55.9 % celle de la 2e visite prénatale ; 77.4 % et 74,2 % ont pu citer la détection et prise en charge des maladies et la prévention des complications comme composantes des soins prénatals focalisés ; la prévention des carences en vitamine A et en iode et celle des IST-vIH-PTME étaient les moins connues avec des taux de 19,4 et 17,2 %. L'accueil, l'interrogatoire, l'examen gynécologique et les activités de promotion sont réalisés avec beaucoup de difficultés avec des niveaux de performances respectives de 25 %, 35 % 25 % et 5 %

Obstetric hemorrhages at the CHU-Yalgado Ouédraogo of Ouagadougou : etiological, therapeutic, and prognostic aspects.

To evaluate the maternal and perinatal prognosis of obstetric hemorrhages in the maternity department of the Yalgado Ouédraogo University Hospital of Ouagadougou. This descriptive cross-sectional study conducted in the four-month period from April through July 2015 included all women consulting on an emergency basis for vaginal bleeding during pregnancy at or after 28 weeks of gestation, or during labor, delivery, or the postpartum period. Obstetric hemorrhages accounted for 6% of admissions. The women's mean age was 27.7 years; 92.5% lived with a partner, and 43.1% were not employed outside the home. A retroplacental hematoma was the leading cause of antepartum hemorrhage, followed by placenta previa. Soft-tissue laceration was the primary cause of postpartum hemorrhage, accounting for 28.4% of these. Maternal morbidity was dominated by anemia with a fatality rate of 5.6%. With six twin pregnancies, there were 166 births : 60 stillbirths, and 106 live births (63.9%). The various neonatal morbidities encountered were mainly growth restriction (33.1%), prematurity (19.9%), and neonatal distress (19.3%). Obstetric hemorrhage, which affects young women who are often uneducated, unemployed, and of relatively low parity, is a serious public health problem. Both the maternal fatality rate and the perinatal mortality rate remain very high.

Assessment of the Virulence Spectrum and Its Association with Genetic Diversity in Magnaporthe oryzae Populations from Sub-Saharan Africa.

A collection of 122 isolates of Magnaporthe oryzae, from nine sub-Saharan African countries, was assessed for virulence diversity and genetic relatedness. The virulence spectrum was assessed by pathotype analysis with a panel of 43 rice genotypes consisting of differential lines carrying 24 blast resistance genes (R-genes), contemporary African rice cultivars, and susceptible checks. The virulence spectrum among isolates ranged from 5 to 80%. Five isolates were avirulent to the entire rice panel, while two isolates were virulent to ∼75% of the panel. Overall, cultivar 75-1-127, the Pi9 R-gene donor, was resistant to all isolates (100%), followed by four African rice cultivars (AR105, NERICA 15, 96%; NERICA 4, 91%; and F6-36, 90%). Genetic relatedness of isolates was assessed by single nucleotide polymorphisms derived from genotyping-by-sequencing and by vegetative compatibility tests. Phylogenetic analysis of SNPs of a subset of isolates (n = 78) revealed seven distinct clades that differed in virulence. Principal component analysis showed isolates from East Africa were genetically distinct from those from West Africa. Vegetative compatibility tests of a subset of isolates (n = 65) showed no common groups among countries. This study shows that blast disease could be controlled by pyramiding of Pi9 together with other promising R-genes into rice cultivars that are adapted to East and West African regions.

[Epidemiology of neonatal surgical emergencies in Ouagadougou]. / Épidémiologie des urgences chirurgicales néonatales à Ouagadougou.

OBJECTIVE: The purpose of this study was to determine the rate of neonatal surgery emergencies and to highlight the main causes and difficulties related to better handling of these emergencies. PATIENTS AND METHODS: We conducted a 1-year descriptive prospective study from September 2009 to September 2010 based on 102 cases collected. At admission, we studied the patients' age, the pathologies encountered, the related malformations, the terms for better management, and prognosis. FINDINGS: In 1 year, we registered 102 cases of neonatal surgical emergencies affecting the digestive tract (63.7%), the anterior side of the abdomen (24.5%), trauma (6.7%), and tumors (2%). Males comprised 60.8% of the cases. The sex-ratio was 1.55. The frequency of such cases was 3.94%. The average age of patients was 5 days with the 0- to 5-day-old age group presenting most frequently. The average hospitalization lasted 2.75 days and the admission method was the reference in 75.5%. Congenital pathology accounted for 95.5% of cases with anorectal malformations (ARM) (35; 95%) and omphaloceles (28.1%). Hirschsprung disease was the main cause of bowel obstruction other than ARM (50%). The average time to surgery was about 2.54 days. The overall mortality of neonatal surgical emergencies was 30.3% and postoperative mortality 32.35%. The late consultation, poverty, a shortage of qualified staff, prematurity, low birth weight, congenital disease, and related malformations were the leading factors of a poor prognosis. Acquisition of effective technical means, staff training, measures to combat poverty, and better prenatal care would improve the management of neonatal surgical emergencies. CONCLUSION: Neonatal surgical emergencies include conditions that require immediate and adequate support. The continuous training of healthcare workers at all levels in the detection of neonatal emergencies and equipping healthcare facilities are an absolute necessity to provide better management and reduce the mortality rate.

Child abdominal tumour in tropical context: think about schistosomiasis!

Schistosomiasis presenting as an abdominal mass with chronic pain in a child is not common. This report presents case of child presenting with schistosomiasis presenting as an abdominal mass with chronic pain. Abdominal ultrasonography did not particularly contribute to definitive pre-operative diagnosis. However, pathological examination of surgical specimen confirmed Schistosoma mansoni eggs in the biospy. A decrease in the mass volume was noticed under medical treatment (Biltricide). The aim of this report was to intimate clinicians on possible abdominal schistosomiasis as differential diagnosis of childhood abdominal mass. This is a clarion call for a high index of suspicion of childhood abdominal schistosomiasis in children presenting with abdominal mass in a tropical setting.

[Urachal cyst: contribution of ultrasound (about a case at Sourou Sanou Sobo-Dioulasso university hospital)]. / Kyste de l'ouraque: apport de l'echographie (a propos d'un cas au centre hospitalier universitaire Sourou Sanou Bobo-Dioulasso).

Urachal cyst is difficult to diagnose and is a rare malformation and the authors report a case in a 10-month old boy. The malformation was associated with posterior urethral valve and simple surgical treatment was successful.The authors emphasize the contribution of perineal ultrasound in the diagnosis of associated posterior urethral valves.

Le kyste de l'ouraque est de diagnostic difficile et constitue une malformation rare dont les auteurs rapportent un cas chez un garçon de 10 mois. La malformation était associée à une valve de l'urètre postérieur et sa cure chirurgicale très simple a été couronnée de succès.Ils insistent sur l'apport de l'échographie par voie périnéale dans le diagnostic associé des valves de l'urètre postérieur.

First Report of Rice stripe necrosis virus Infecting Rice in Burkina Faso.

Rice stripe necrosis virus (RSNV) was first described in 1977 as a new virus infecting rice in Cote d'Ivoire (3) and was subsequently observed in Liberia, Nigeria, and Sierra Leone (2). RSNV is a soil-borne virus transmitted by the fungus Polymyxa graminis (1) and belongs to the genus Benyvirus (4). During a survey carried out in April of 2013, severe symptoms characterized by seedling death, severe plant malformation, and foliar striping were observed on rice plants in an experimental field of INERA at Banfora located in western Burkina Faso. Disease incidence in the field was estimated to be 80 ± 5%. The symptoms of disease were successfully transmitted to the susceptible rice (Oryza sativa) cultivar IR64 by soil transmission experiments (1). RSNV was detected by ELISA using a polyclonal antiserum (1), kindly provided by Dr. Denis Fargette, IRD, Montpellier, France. Total nucleic acid was extracted with TRIzol reagent (Invitrogen) from IR64 and field infected samples. The presence of the virus was confirmed by RT-PCR using primers 5'-CATCTTGTCGAGATGAG-3' and 5'-GCGTTGTCTTTATCAGTG-3' for specific sequences flanking the RNA2 CP gene. The RT-PCR product was directly sequenced and the sequence was deposited in GenBank (Accession No. LK023710). Sequence analysis showed that the CP gene of the RSNV isolate from Burkina Faso shared the highest nucleotide sequence identity (97.6%) with the known RSNV CP gene sequence from the Colombian isolate (EU099845) available in GenBank, confirming the presence of RSNV in the rice crops in Burkina Faso. To our knowledge, this is the first confirmed report of RSNV in Burkina Faso. Further studies are needed to determine its incidence and spread in the country. Detection of RSNV in Burkina Faso signals the urgent need for adoption of appropriate measures to restrict the spread and impact of this virus within Africa. References: (1) C. Fauquet and J. C. Thouvenel. Proc. Acad. Sci. Ser. D 296:575, 1983. (2) C. Fauquet et al. Develop. Appl. Biol. 2:71, 1988. (3) D. Louvel and J.-M. Bidaux. Agronomie Tropicale 32:257, 1977. (4) I. Lozano and F. Morales. Eur. J. Plant Pathol. 124:673, 2009.

[Acute intestinal obstruction]. / Occlusion intestinale aiguë.

A 12-year-old boy is admitted for emergency surgery for acute abdominal syndrome. The intervention showed strangulation of the terminal ileum by the vermiform appendix. The pathology analysis showed bilharzial appendicitis by Schistosoma haematobium. The patient was treated with praziquantel. The literature is not plentiful on this subject. Because protozoiasis is endemic in this area, it should be looked for in all cases of appendicitis, as it requires medical treatment in addition to the appendectomy.

Determinants of long-lasting insecticidal net use in Burkina Faso after a mass distribution in the Diébougou health district.

BACKGROUND: In 2009, a mass distribution of long-lasting insecticidal nets (LLINs) was conducted in an experimental site of the Diébougou health district. Carried out 1year after the distribution, this study aimed to determine the presence of LLINs in households, to determine the LLIN use rate, and thirdly, to identify key factors associated with LLIN use in households. METHODS: We conducted a cross-sectional descriptive and analytical study, which covered the entire Diébougou health district. The study population consisted of households in the district. The statistical unit was the household head, or if absent his designated representative. For the selection of households to be studied, we considered the health centers and their geographic accessibility. We thus defined three zones: an area within 5 km of health centers, the area between 5 and 10 km away, and the area beyond 10 km. In each area, we randomly selected 20 households, totaling 60 households in the area of each health center, giving a sample of 840 households to be surveyed. We selected 60 households per health center in accordance with the time and financial resources allocated to data collection. The data were analyzed using the Epi Info 3.5.1 software package. The Chi square test was used to investigate the association between the dependent and independent variables with statistical significance set at P<0.05. When an association was demonstrated, the relative risk (RR) was calculated with the 95% confidence interval. RESULTS: A total of 822 households (97.8%) were surveyed, households inhabited by 6379 people including 1175 (11.4%) children under 5 years of age and 158 (2.5%) pregnant women. The overall use of LLINs was 76.5%. This rate was 81.7% in children under 5 years and 57.6% among pregnant women. Factors influencing the use of LLINs were the implementation of a communication plan by health actors (RR=2.42 [2.03-2.83]), the social position of the household head (RR=1.62 [1.43-1.83]), the marital status of the household head (RR=1.41 [1.33-1.49]), the number of persons per room (RR=1.39 [1.08-1.78]), the religion of household head (RR=1.21 [1.15-1.27]), the level of education of the household head (RR=1.15 [1.06-1.24]), and the number of IECs (information, education, communication) sessions followed by the household (RR=1.14 [1.08-1.20]). CONCLUSION: The results of this study provide guidance on measures to ensure the success of the mass distribution of LLINs to the entire country.

Femur malunion treated with open osteotomy and intramedullary nailing in developing countries.

INTRODUCTION: In developing countries, malunion, after diaphyseal femur fractures initially untreated by internal fixation, is not rare. Their difficult management contrasts with the deficiency of the technical operating room facilities. PATIENTS AND METHODS: Our prospective study, conducted over a 1-year period, reports 16 open osteotomies fixed using Küntscher intramedullary nailing in patients who presented malunion of the femoral diaphysis. Twelve males and four females (mean age, 34.5 years; range, 18-67 years) were managed with a mean time to surgery of 8 months (range, 4-14 months). All had initially consulted a bonesetter. The mean length inequality was 3 cm (range, 2-6 cm); the mean knee flexion limitation was 90° (range, 10°-120°). Locking of the rotation was obtained by the obliquity of the osteotomy line. No bone filling was added but reaming and decortications were systematic. The patients were clinically and radiographically assessed at D21, D45, D90, and D120, based on the evaluation of the length inequality, mobility, and bone union. Rotational malunion or deformity were not analyzed. RESULTS: Fifteen patients had achieved union in 90 days. In one case, secondary incurvation of the nail led to changing the nail, allowing union with no axis deformity at D120. The mean postoperative knee flexion was 120° (range, 45°-130°). The mean gain in length was 2 cm (range, 1.5-4 cm). DISCUSSION: This open technique using non-interlocking material allowed us to obtain bone union while improving joint mobility and length inequality. LEVEL OF EVIDENCE: Level IV. Retrospective study.

[Morgagni hernia: Concerning 2 pediatric cases in Sub-Saharan Africa]. / Hernie de morgagni: a propos de deux cas pediatriques en Afrique Sub Saharienne.

Morgagni hernias are uncommon diaphragmatic hernias that are generally asymptomatic, and so far, very limited data is available about them. We report two cases of repaired successfully Morgagni hernias using a transabdominal approach. The aim of this study is to illustrate the diagnostic difficulties and the excellent post operational prognostic observed following the transabdominal procedure. Both patients were female, one 8 months old and the other 3 months old. The presenting symptom was recurrent chest infection. Chest x-rays were carried out on both patients, which showed a pre-cardiac gas mass. A transabdominal surgical approach enabled surgeons to sow the defect with non resorbable suture material in one patient, and a prolene plate in the other. The patients fully recovered and no postoperative difficulties were reported.

La hernie de Morgagni ou hernie diaphragmatique congénitale antérieure est une entité peu décrite dans la littérature et est le plus souvent asymptomatique. Le but de cette étude est d'illustrer les difficultés diagnostiques et l'excellent pronostic après traitement chirurgical après abord trans abdominal sus ombilical de cette forme rare de hernie des coupoles diaphragmatiques. Nous rapportons deux cas simulant une pneumopathie chronique chez deux nourrissons de sexe féminin âgés respectivement de 8 mois et 3 mois. Les radiographies pulmonaires de face et de profil ont permis de poser le diagnostic par la mise en évidence d'une clarté gazeuse pré cardiaque. La laparotomie transversale sus ombilicale a permis la fermeture du défect par suture avec du fil non résorbable chez une patiente et une obturation à l'aide d'une plaque de prolène chez la deuxième patiente. Les suites opératoires ont été simples.

Hirschsprung's disease: management problem in a developing country.

BACKGROUND: The management of Hirschsprung's disease remains a problem in developing countries. Our aim is to identify the main epidemiological, clinical, and therapeutic characteristics of Hirschsprung's disease at the University Child Hospital Charles De Gaulle of Ouagadougou (CHUP-CDG). PATIENTS AND METHOD: It is a retrospective study carried out in the period from January 2001 to December 2007 in the Surgery Unit at CHUP-CDG, which is a reference centre for Paediatric Surgery in Burkina Faso. RESULTS: There were 52 patients (M: F=3.3:1). The annual incidence was seven cases. Age at presentation and diagnosis ranged from two days 10 years (median 20 months). Twenty five patients were from poor socio-economic conditions. Presentations were mainly intestinal obstruction, chronic constipation and enterocolitis. There were two cases of associated trisomy 21. Average age at operative intervention was 3.17 months. The rectosigmoidal form was the most frequently encountered. Over two-thirds (67.31%), with no complications at presentation, had benefited from nursing before their final treatment. A temporary colostomy was requested in case of complication. Swenson's technique was practiced for all the patients who underwent surgery operation. The assessment of functional results in eight patients after an average decrease of 3.5 years gave excellent results. Post-surgery complications were mainly enterocolitis in 12% of patients. Mortality rate was 16%. CONCLUSION: Management of Hirschsprung's disease is a problem in Burkina Faso. It is characterised by its late presentation and difficult diagnosis due to inaccessibility and the non-availability of some investigation services (barium enema, histochemistry, and histology), resulting in high morbidity and mortality rates. Effective technical capacities, adequate staff training, and public education will be necessary to improve care quality.

[Strangulated umbilical hernia in children (Burkina Faso): differences with developed countries]. / Hernies ombilicales étranglées chez l'enfant au Burkina Faso: différences avec les pays développés.

Umbilical hernias occur frequently in children but complications are rarely reported. This study assesses the incidence of complicated umbilical hernias in our patients, evaluates data for risk factors, and shows dissimilarities with those encountered in developed countries. This study reports all children operated for complications due to strangulated umbilical hernia over a period of 3 years. On the whole, 162 children had umbilical hernias treated during this period. Thirty (18.5%) of these had complicated hernias. The average age of the complicated group was 3(1/2) years. Twenty-nine cases had a painful irreducible umbilical mass. Twenty-four children had bowel obstruction, while stercoral fistula occurred in one child. The average diameter of the hernia ranged between 1 and 1.5 cm. Five patients had ischemic intestine that required resection. One patient died. When active observation and follow-up after 1 year is difficult or not feasible when the wall defect diameter is 1.5 cm or less, and in suspicion of incarceration (unexplained abdominal pain, and irreducibility), umbilical hernia should be operated.

[Laryngo-tracheo-bronchial foreign bodies in children at the University Hospital Center of Ouagadougou (analysis of 96 cases)]. / Les corps étrangers laryngo-trachéo-bronchiques chez l'enfant au CHU de Ouagadougou (une analyse de 96 observations).

Over a 10-year period, a series 96 patients were treated for laryngotracheal and bronchial foreign bodies in the ENT department of the Ouagadougou University Hospital Center (Burkina Faso). The purpose of this study was to analyze the epidemioclinical features and therapeutic pitfalls encountered in that series and to propose measures to improve management. The age of patients ranged from 10 months to 14 years. The male-female ratio was 1.7. Anamnesis documented foreign body aspiration was obtained in 77% of cases. The foreign body was organic in 78 cases (81.2%) including vegetal material in 56 cases. Management was delayed due to late diagnosis since only 59.3% of the patients were admitted to the hospital within the 48 first hours. Endoscopic removal was performed in all cases but such procedures remain challenging in developing countries due to a lack of proper anesthetic facilities, skilled personnel and adequate equipment. Tracheostomy was performed in 10.4% of cases mainly in patients with foreign bodies located in larynx. One patient died during extraction. In addition to providing more information and education on prevention of laryngotracheal and bronchial foreign bodies, better management requires better training of medical personnel and improvement of technical facilities.