[Prescription of antimalarial drugs in the pediatric ward of the National Hospital of Lamordé, in Niamey]. / Prescription d'antipaludiques dans le service de pédiatrie de l'Hôpital national de Lamordé, à Niamey.

In Niger, malaria is a major public health problem, due to the high number of deaths that are attributable to it and because of its heavy weight and socioeconomic status. The objective of this study was to contribute to the inventory of medical practices to rationalize the use of medicines and minimize the resistance phenomenon. This is a prospective study, which took place from May 1 to July 31, 2009, in the pediatric ward of the National Hospital of Lamordé. It concerned children aged from 0 to 14 years hospitalized and having received one or more antimalarial drugs during at least 24 h. During the 3 months of the study, 1,248 children had been admitted in the department. Among them, 881 children received antimalarial treatment, i.e., 70.5% with prescriptions. Malaria was confirmed by microscopy in 410 children, i.e., 46.5% of the sick children received antimalarial treatment. Prescription control was deemed noncompliant in 258 patients, i.e., 29.3% of the total. Treatments based on microscopic diagnosis are one of the strategies that will help to streamline the use of antimalarial drugs to improve their effectiveness and efficiency and also to reduce the risk of emergence of resistance.

[Evaluation of integrated management of childhood illness three years after implementation in a health care district in Senegal]. / Evaluation de la Prise en Charge Intégrée des Maladies de l'Enfant dans un district du Sénégal après 3 ans de mise en place.

The strategy of Integrated Management of Childhood Illness (IMCI) has been recommended by both WHO and UNICEF for first-level health facilities to control the main childhood diseases in developing countries. In Senegal, IMCI was adopted in 1996 and had been implemented in several pilot health districts by the year 2000. This study was conducted three years after implementation of IMCI in the Darou Mousty health district. The purpose was to evaluate determinant factors for implementation as well as the required skills of personnel. Evaluation was based on a review of IMCI records at health care facilities in the District and a survey to collect the opinion of healthcare workers involved in the program. All qualified personal, i.e. two doctors, eleven nurses and one midwife at the time of the survey, had received training in the IMCI approach. Although they all stated that this training improved their skills in managing paediatric patients, only 16 % used the approach on a regular basis. The most frequently reported reason for non-use was unwieldiness of IMCI procedures. According to IMCI guidelines, proper procedures were used in only 53 of the 1465 children (3.6%) who consulted during the study period. This low compliance rate was due to the inability of healthcare personnel to apply therapeutic protocols, plan appointments or identify emergency cases. These findings suggest that basic training and in-service courses must place greater emphasis on IMCI procedures and that regular supervision is needed to optimize this strategy in Senegal.

Evaluation de la prise en charge integree des maladies de l'enfant dans un district du Senegal apres 3 ans de mise en place

La strategie de Prise en Charge Integree des Maladies de l'Enfant (PCIME); preconisee au premier niveau du Systeme de sante; par les experts de l'OMS et l'UNICEF pour lutter contre les principales affections infantiles dans les pays en developpement; a ete introduite au Senegal en 1996; et mise en oeuvre en 2000 dans des Districts Sanitaires pilotes comme Darou Mousty; dans la Region de Louga. Trois ans apres sa mise en oeuvre; nous avons evalue dans ce district les determinants de l'application de la strategie et les competences du personnel dans ce domaine. Pour cela nous avons exploite les registres PCIME des structures de sante du District et interroge les agents de sante concernes par la strategie afin de recueillir leur opinion sur le processus. Tout le personnel qualifie; qui comprenait au moment de l'enquete 2 medecins; 11 infirmiers et une sage femme; a ete forme a l'approche PCIME. Bien que tous avouent que cette formation a contribue a renforcer leur competence enmatiere de prise en charge de l'enfant; seuls 16d'entre eux utilisent regulierement cette approche. La lourdeur des procedures de la PCIME est la principale contrainte evoquee. En se referant aux normes de la strategie; sur les 1465 enfants admis en consultation au cours de cette periode; 53 patients (3;6); ont beneficie d'une prise en charge correcte. Ce faible rendement est lie aux difficultes de ces agents a appliquer les protocoles therapeutiques; a planifier les rendez vous ou a identifier les cas a referer en urgence. Ainsi; nous pensons qu'il faut reviser les programmes de formation a la base et en cours d'emploi en accordant plus de place a la prise en charge integree des maladies de l'enfant et assurer une supervision reguliere des activites pour optimiser cette strategie au Senegal

Effect of daily low dose of vitamin A compared with single high dose on morbidity and mortality of hospitalized mainly malnourished children in senegal: a randomized controlled clinical trial.

BACKGROUND: In vitamin A-deficient populations, children hospitalized with infections and/or malnutrition are at particular risk of developing severe vitamin A (VA) deficiency. High-dose VA supplements are recommended as part of the treatment but results on its effect on recovery from morbidity and on prevention from nosocomial morbidity are conflicting. OBJECTIVE: We aimed to assess the effect of a single high dose and daily low dose of VA on hospitalized malnourished children's morbidity. DESIGN: We carried out a double-blind, randomized trial in 604 and 610 Senegalese hospitalized children. The first mentioned batch received a high-dose VA supplement (200,000 IU) on admission, the second a daily low-dose VA supplement (5000 IU per day) during hospitalization. Children were followed up until discharged. Data on all-cause morbidity were collected daily. RESULTS: Survival analysis showed that the incidence of respiratory disease was significantly lower in the low-dose group than in the high-dose group, hazard ratios (HR): 0.26, 95% CI: 0.07-0.92. The duration of respiratory infection was also significantly lower in the low-dose group than in the high-dose group (HR of cure: 1.41, 95% CI: 1.05-1.89). Duration and incidence of diarrhoea were not significantly different between treatment groups. In children with oedema on admission, mortality was significantly lower in the low-dose group (Adjusted odds ratio: 0.21; 95% CI: 0.05-0.99). CONCLUSIONS: Daily low dose of VA compared with single high dose significantly reduced duration and incidence of respiratory infection but not of diarrhoea in hospitalized children.

[Progressive spinal amyotrophy type I or Werdnig-Hoffman disease. Apropos of 5 cases in Dakar (Senegal)]. / L'amyotrophie spinale progressive de type I ou maladie de Werdnig-Hoffmann. A propos de 5 cas dakarois (Sénégal).

Type I spinal muscular atrophy or Werdnig-Hoffman disease is rarely described in black populations. We report five such cases diagnosed in a paediatric outpatient clinic in Dakar. We conducted a retrospective study relating to patients examined for hypotonia progressing since birth for whom the electromyogram had made it possible to confirm an involvement of the peripheral nerve without nerve conduction anomaly. Mean age of diagnosis was 12.3 +/- 7.6 months. Respiratory distress was noted for 2 patients. A family background of similar symptomatology was found in 1 case and consanguinity in 2 cases. Only 1 case of death occurred whereas the 4 other patients were lost to follow-up. The diagnosis of spinal muscular atrophy must be considered in the presence of any severe hypotonia in infants.

[Echocardiographic aspects in pediatric patients with sickle cell disease]. / Aspects échocardiographiques au cours de la drépanocytose en milieu pédiatrique.

BACKGROUND: Cardiovascular involvement is not well studied in children with sickle cell disease. The aim of this study was to evaluate the echocardiographic parameters of children with sickle cell disease. PATIENTS AND METHODS: We performed a transversal and case-control study including 80 subjects of six months to 16 years of age divided into four groups of 20 children each: heterozygous sickle cell disease, homozygous sickle cell anemia, anemia of other causes than sickle cell, and healthy children. All children had a complete physical examination, biological screening including hemogram and hemoglobin electrophoresis, chest x-ray, electrocardiogram, and Doppler echocardiogram. Data were compared using the chi 2 method and the Student's t-test. RESULTS: The mean age was 8.5 years and the sex-ratio was 1. Echocardiographic abnormalities were observed in seven patients with anemia unrelated to sickle cell, 15 children with heterozygous anemia and all the homozygous patients. The main abnormalities were: left ventricular enlargement (ten homozygous patients, one heterozygous subject, five of the patients with another cause of anemia), increased contractility of the heart (18 homozygous patients, seven heterozygous patients, five in the anemia group) and mild to moderate mitral or tricuspid regurgitation (12 homozygous, five heterozygous and five patients in the anemia group). One homozygous child had a dilated and hypokinetic cardiomyopathy with pulmonary hypertension. The parameters of left ventricular systolic function and left heart chamber dimensions were lower in the control group (P < 0.04). DISCUSSION: This study shows the frequency of heart chamber dilatation with left ventricular hyperkinesis usually described in the literature. The lack of case of chronic cor pulmonale may be due to the young age of our patients. One case of dilated and hypokinetic cardiomyopathy suggests that other causes than anemia should be considered, particularly myocardial ischemia, which could not be demonstrated because of our limited investigative methods. CONCLUSION: These results emphasize the frequency of the heart involvement in sickle cell disease, particularly in the homozygous type, and point out the importance of the cardiologic screening of these patients.

[The consumption of cassava is not responsible for the etiology of endemic goiter in rural areas in Senegal]. / La consommation de manioc n'intervient pas dans la genèse du goitre endémique en zone rurale sénégalaise.

An epidemiological study of iodine deficiency disorders (IDD) was carried out in West Senegal and Casamance. Five hundred and eighty five households were selected in 3 areas with a high prevalence of goiter. We assessed the relative impact of iodine deficiency (estimated by mean iodine excretion in the urine of family members) and cassava consumption (mean frequency of consumption by the household). Cassava consumption, even if on a regular basis, neither caused nor increased goiter formation in this area of West Africa. This was probably due to the local method of cassava root preparation, which reduces the amount of cyanogenic compounds consumed. Iodine deficiency was principally responsible for goiter formation. Therefore, the commercial availability of iodine-supplemented salt should lead to the eradication of IDD from Senegal in the near future.

[Nutritional state of women and children in the rural community of Mpal (District of Saint Louis, Senegal)]. / Etat nutritionnel des femmes et des enfants dans la communauté rurale de Mpal (District de Saint-Louis, Sénégal).

This cross sectional survey carried in april 1995 aimed to assess the nutritional status of the women old enough to procreate++ and the children less than 5 years old in the community of Mpal (District of St Louis). The method of sampling used was the method of stratified poll. The assessment of the nutritional status is carried among the women by measuring the brachial circumference and the corporal mass index. Among the children, the indicators used were the ratios: weight-age, weight-height and the brachial circumference. The results showed a rate of malnutrition very high in comparison to the national averages as well in ythe women old enough to procreate (31% versus 17.4%) as in the children (11% of acute malnutrition versus 8.7% and 24.4% of chronic malnutrition versus 21.7%). The young mothers and the children more than 3 years old were the more frequently reached. It urges to set up in this locality a programme of struggling against malnutrition based on the integration of the economics activities of the communitary groups to their health activities.

Contribution a l'etude des problemes medico-sociaux des jeunes adolescents a Guediawaye (Zone suburbaine de Dakar; Senegal)

Une enquete dans le district de Guediawaye; aupres d'adolescents ages de 12 a 16 ans; recrutes selon une methode d'echantillonnage aleatoire stratifie dans 4 milieux differents a ete menee afin d'evaluer leurs principaux problemes medico-sociaux. Elle a abouti aux constatations suivantes: la majorite vit dans des conditions socio-economiques difficiles marquees par la promiscuite; un revenu familial faible; et un bas niveau d'instruction des parents; 39;2 pour cent ont ete places sous la tutelle d'un parent autre que les parents geniteurs; 98;8 pour cent ne trouvent pas de structures de loisirs dans leur environnement; l'usage du tabac et de la drogue est respectivement de 14 pour cent et 1 pour cent; 79;4 pour cent des eleves ont difficilement acces aux fournitures scolaires; alors que les adolescents en apprentissage d'un metier ont des contraintes liees a de longues heures de travail (95 pour cent); les affections morbides sont assez variees; dominees par les douleurs abdominales (37;8 pour cent) loin devant les traumatismes (6 pour cent); le recours therapeutique le plus frequent est le traitement traditionnel ou empirique. Les auteurs preconisent la mise en place de centres medico-sociaux faisant intervenir toutes les personnes et ressources impliquees dans la prise en charge des adolescents

[Medico-social problems of young adolescents in Guediawaye (suburban area of Dakar-Senegal)]. / Contribution à l'étude des problèmes médico-sociaux des jeunes adolescentes à Guédiawaye (Zone suburbaine de Dakar-Sénégal).

A survey in the district of Guediawaye, towards teenagers from 12 to 16 years old, recruited according to a stratified risky method of sampling in 4 different areas has been carried out in order to evaluate their main medico-social problems. It ended up to the following findings: the majority live in hard socio-economic conditions stamping by promiscuity, a weak family income and a low level of education of the parents. 39.2% have been placed under the guardianship of a relative other than the parents. 98.8% do not find spare time structures in their environment. The usage of tobacco and drug is respectively 14% and 1%; 79.4% of students have hardly access to the school stationery, while the teenagers in job apprenticeship have constraints linked to long hours of work (95%). The morbid affections are too varied, dominated by stomach aches (37.8%) far before traumatics (6%); the most frequent therapeutic is resort traditional or empiric treatment. The authors advocate the setting up of a medico-social center making interfere all persons, implied resources in the undertake of the teenagers.

[Place on information in health services use by mothers in Guediawaye]. / Place de l'information dans l'utilisation des services de santé par les mères à Guédiawaye.

The authors report the results of a survey in a suburban healthcare structure. The purpose was to evaluate the knowledge of mothers about the healthcare delivered through a childhood and maternal healthcare program in Senegal. 244 women were selected at random. The consultant mothers came more for their children than for themselves (79% of consultations were for their children, 49% for themselves). 60% to 80% of women are unaware of basic notions currently teached through the "Information-Education-Communication (I.E.C)" program. All that requires to elaborate with these women healthcare strategies, which are in adequacy with their needs in these peripheral healthcare structures, and which are supported by an adequate and regularly evaluated I.E.C.

Le paludisme chez l'enfant

Le paludisme est la premiere cause de mortalite infantile en Afrique; d'ou sa gravite. Il reste alors un defi; car les proges therapeutiques sont remis en cause par l'apparition de resistance aux medicaments antipaludeens

[Nutritional regulation of serum osteocalcin: study in kwashiorkor]. / Régulation nutritionnelle de l'ostéocalcine sérique: étude dans le kwashiorkor.

The serum levels of osteocalcin (bone gla protein) in two groups of Senegalese children, healthy controls and severely malnourished (kwashiorkor) children during nutritional rehabilitation, were measured. The serum osteocalcin of all kwashiorkor children was dramatically decreased on admission to hospital, but increased fourfold during rehabilitation. Serum osteocalcin was low in the control group. In both groups these low levels seemed to be independent of those of 1,25-dihydroxyvitamine D3 which were in the normal range. The results suggest that serum osteocalcin levels might be related to protein-energy status.

[Nutrition and growth]. / Nutrition et croissance

PIP: This article reports on the research and training activities on the Social Pediatric Center at Khombole (SPCK), the rural branch of the Social Pediatric Center of the University of Cheikh Anta Diop in Dakar, Senegal. One of the major goals of the SPCK is fighting the war against infant-child mortality caused in large part by malnutrition. The SPCK's 2 major goals are to: 1) survey the growth rate of infants and children 0-14 under the supervision of 2 pediatricians in 8 villages by charting, measuring and examining them; and 2) provide nutritional education, in special sessions, to mothers of the community. The goals of the sessions are to teach mothers: 1) to differentiate between the different food groups; 2) to learn about an infant's growth and developmental stages; and 3) to learn how to properly feed infants 0-3 years with local resources. To measure the effects of the activities a survey took place from 1974-1979 on 8675 children 0-4 years; only 1% were found seriously malnourished and 32% mildly malnourished. In spite of the fact that malnutrition is closely related to underdevelopment, these 2 interventions helped alleviate the problem in this community.^ieng

[The war against malnutrition in rural areas]. / La lutte contre la malnutrition en milieu rural

PIP: This article analyzes the interaction between nutritional factors and growth rates in Senegal from data collected at the pediatric unit at the CHU Hospital in Dakar. In Senegal, as in most of Sub-Saharan Africa (SSA) children grow rapidly between 6-36 months because of good nutrition. The problems cited during the survey that have led to malnutrition among infants and children are: 1) the lack of education of mothers; 2) demographic factors (many pregnancies and polygamy); 3) maldistribution of f ood especially when children eat from the same bowl as adults; 4) the lack of diversification in food given to infants after 5 months; 5) special foods considered taboos (eggs, dried fish, some vegetables) limits children's consumption of a balanced diet; 6) abusive malnutritional publicity campaigns that encourage mothers to purchase imported milk and food products; 7) high poverty level of most malnourished children due to the parents unemployment, and 8) the lack of immunization and medical surveillance. These factors explain what happens to most SSA children after beginning the 16 month when the lack of adequate and diversified nutrition causes retardation in their growth rates. The prevalence of marasmus is responsible for 50% of all deaths in Dakar due to malnutrition. The intervention of special foods such as "Ladylac" "Ferelin" and the "rouye-complet" form Dakar's Institute of Food Technology have had positive results in producing nutritional rehabilitation. However, the price remains a problem because the majority of the people are so poor. Recommendations to win the war against child malnutrition includes: 1) nutritional and health programs aimed at the literacy levels of Senegalese families; 2) controls on polygamy; 3) a policy on family planning; 4) increasing family revenues and the availability of local infant products; 5) improvement in the health system and inclusion of nutritional education in the training of health workers.^ieng