[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.

[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.

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.

[Underweight prevention and treatment of the young child in Mono (Benin)]. / Prévention et traitement de l'insuffisance pondérale chez le jeune enfant du Mono (Bénin).

BACKGROUND: This study aimed to assess the prevention and treatment effectiveness of underweight in less than two years old children admitted in 2001 to community nutrition programme of Mono area in Benin. METHODS: A longitudinal retrospective survey took place in 30 villages chosen at random. It concerned a sample of 1799 children. Inside of those children, during the 2001 year, when they were admitted to the programme, 1545 were without underweight, have had more than one month following visit and about them the underweight effectiveness prevention had been analyzed; the others 111 were underweighted, have had more than one month following visit and about them the underweight treatment had been assessed. The 143 other children have been followed for only one month. The prevention effectiveness had been explored by the evolution of the cumulative incidence of underweight according to the number of following visit and the underweight incidence density. The treatment effectiveness has been analysed by calculating the recovery rate and incidence density. RESULTS: During 2001, there have been observed 10% for the underweight cumulative incidence and 51.4% for the cumulative incidence of underweight recovery. The underweight and recovery incidence density were respectively 14 cases for 1000 persons-months of following and 118 cases for 1000 persons-months of following. The children with serious underweight at their last following visit have had the number of following visits lower than those who were with moderate underweight. The recovery was arrived after two to twelve months. There was a significant increase of underweight prevalence with the increase of following visit number inside the children with a normal weight at their admission into the programme. CONCLUSION: During the 2001 following, the underweight prevention and treatment activities of community nutrition workers have been little effectiveness. The low level of instruction of community nutrition workers, their low level of knowledge of essential community nutrition activities, their multiple tasks and the not used appropriate foods for the treatment of underweight are the possible causes of the poor performance observed.

[Management of severe acute malnutrition in an urban nutritional rehabilitation center in Burkina Faso]. / Prise en charge de la malnutrition aiguë sévère dans un centre de réhabilitation et d'éducation nutritionnelle urbain au Burkina Faso.

BACKGROUND: Management of acute severe malnutrition greatly contributes to the reduction of childhood mortality rate. In developing countries, where malnutrition is common, number of acute severe malnutrition cases exceeds inpatient treatment capacity. Recent success of community-based therapeutic care put back on agenda the management of acute severe malnutrition. We analysed key issues of inpatient management of severe malnutrition to suggest appropriate global approach. METHODS: Data of 1322 malnourished children, admitted in an urban nutritional rehabilitation center, in Burkina Faso, from 1999 to 2003 were analyzed. The nutritional status was assessed using anthropometrics indexes. Association between mortality and variables was measured by relative risks. Kaplan-Meier survival curves and Cox model were used. RESULTS: From the 1322 hospitalized children, 8.5% dropped out. Daily weight gain was 10.18 (+/-7.05) g/kg/d. Among hospitalized malnourished children, 16% died. Patients were at high risk of early death, as 80% of deaths occurred during the first week. The risk of dying was highest among the severely malnourished: weight-for-height<-4 standard deviation (SD), RR=2.55 P<0,001; low MUAC-for-age, RR=2.05 P<0.001. Kaplan-Meier survival curves and Cox model showed that the variables most strongly associated with mortality were weight-for-height and MUAC-for-age. Among children discharged from the nutritional rehabilitation centre, 10.9% had weight-for-height<-3 SD. CONCLUSION: The nutrition rehabilitation centre is confronted with extremely ill children with high risk of death. There is need to support those units for appropriate management of acute severe malnutrition. It is also important to implement community-based therapeutic care for management of children still malnourished at discharge from nutritional rehabilitation centre. These programs will contribute to reduce mortality rate and number of severely malnourished children attending inpatient nutrition rehabilitation centers, by prevention and early management.

Lysozyme, lactoferrin, and secretory immunoglobulin A content in breast milk: influence of duration of lactation, nutrition status, prolactin status, and parity of mother.

Milk lactoferrin (LF), lysozyme (LZ), and secretory IgA (sIgA) were measured cross-sectionally in 127 Zaïrean mothers, lactating greater than or equal to 18 mo. The 54 urban mothers were of marginal nutrition status [body mass index (BMI) 22.6 +/- 2.6 kg/m2 and albumin 33.1 +/- 4.5 g/L]. The neighboring rural mothers were of significantly (P less than 0.001) poorer nutrition status (BMI 20.5 +/- 2.2 kg/m2 and albumin 27.7 +/- 5.4 g/L). In both urban and rural mothers, as lactation progressed LF decreased by 33% and 55% whereas sIgA remained unchanged and LZ steadily increased. There was more LZ and sIgA in rural milk, contrasting with the poorer maternal nutrition. As calculated from individual milk yields, the urban infants were fed daily with twice as much LF and sIgA but with similar amounts of LZ as were the rural infants. In the early stage of lactation, the milk of both groups of Zaïrean mothers contains more sIgA than that of a group of west European (Belgian) mothers (n = 20), but the LF and LZ contents were rather similar.

Randomized placebo-controlled clinical trial of the effect of a single high dose or daily low doses of vitamin A on the morbidity of hospitalized, malnourished children.

The effect of high-dose vitamin A supplementation on recovery from morbidity and on recovery from nosocomial morbidity of hospitalized children has been poorly studied and results are conflicting. The effect of daily, low doses has never been assessed. We investigated the effect of a single high dose and daily, low doses of vitamin A on diarrhea, acute lower respiratory tract infections (ALRIs), and all-cause fevers in 900 hospitalized preschool-age children in the Democratic Republic of Congo in a randomized, double-blind, placebo-controlled clinical trial. The high-dose treatment group received 200,000 IU vitamin A (100,000 IU if aged <12 mo) orally on the day of admission, the low-dose treatment group received 5000 IU vitamin A/d until discharge. Data on all-cause morbidity were collected daily. Mortality rates were not significantly different among the 3 groups. High-dose vitamin A supplementation had no significant effect on the duration of moderate or severe diarrhea nor on the duration and incidence of ALRIs and all-cause fevers. Children in the high-dose group with no edema had an increased risk of severe nosocomial diarrhea (relative risk: 2.42; 95% CI: 1.15, 5.11). Low-dose vitamin A supplementation significantly reduced the incidence of severe diarrhea in severely malnourished children (relative risk: 0.21; 95% CI: 0.07, 0.62) but showed no significant effect on the duration of moderate or severe diarrhea or on the duration and incidence of ALRIs and all-cause fevers. Supplementation with high doses of vitamin A did not reduce morbidity in this population of malnourished and subclinically vitamin A-deficient children; daily, low doses appeared more beneficial for severely malnourished children.

Sleep problems in healthy preadolescents.

Few data currently exist concerning the sleep problems of preadolescents. A parent report questionnaire concerning sleep habits and problems was developed. The questionnaires were completed by the parents of 1000 unscreened elementary school children attending the third, fourth, and fifth grades. The schools were randomly selected from an urban area. Of the 1000 questionnaires, 972 were completed and could be used for statistical analysis. Among the parents, 24% reported sleeping poorly and 12% regularly relied on sedatives to induce sleep. Sleep difficulties lasting more than 6 months were present in 43% of the children. In 14% (132 of 972), sleep latency was longer than 30 minutes, and more than one complete arousal occurred during the night at least two nights per week. The following variables were seen among the poor sleepers: lower parental educational and professional status, parents who were more likely to be divorced or separated, and more noise or light in the rooms were they slept. They also presented a higher incidence of somnambulism, somniloquia, and night fears (nightmares and night terrors) than the children who slept well. Boys who slept poorly were significantly more likely to have insomniac fathers (P less than .010). Regular use of sedatives was described in 4% (5 of 132) of the children who slept poorly. Among the "poor sleepers," 21% (33 of 132) had failed 1 or more years at school. School achievement difficulties were encountered significantly more often among the poor sleepers than among the children without sleep problems (P = .001). Of the families with children suffering from sleep problems, 28% expressed a desire for counseling.(ABSTRACT TRUNCATED AT 250 WORDS)

Gestational malaria: assessment of its consequences on fetal growth.

In a region of Africa (Nord-Kivu, Zaire) where malaria is endemic, circulating malaria parasites, malaria-associated placental lesions, and a low hemoglobin level (< 10 g/dl) were observed, either singly or in combination, in 73.1% of women (n = 461) delivering at the maternity hospital. These pathologic findings were associated with low birthweight in 18.1% of the newborns, whereas the prevalence of low birthweight was 6.4% among cases without these findings (P < 0.05). Parasitemia was observed in 17.4% of all mothers and was associated with a significant decrease in birthweight. Malaria-associated lesions were found in 52.5% of all placentas and were associated with a decrease in birthweight, head circumference, and ponderal index of the newborns. Such lesions were more frequently observed among primiparae (60.5%) than among multiparae (49.5%; P < 0.05). Lastly, a low hemoglobin level, found in 38.6% of the mothers, was associated with a decrease in birthweight, length, and head circumference. The differences in the physical effects associated with each of the pathologic conditions suggest that parasitemia, placental lesions, and anemia result in acute, subacute, and chronic impairment of fetal growth, respectively. Moreover, their deleterious effects may be cumulative, since the most dramatically affected physical patterns were found when the pathologic findings were associated in the same patient. Frequent antenatal monitoring of maternal hemoglobin and parasitemia, accompanied, when necessary, with curative treatments, may help to reduce the prevalence of intrauterine growth retardation and its procession of perinatal complications.

The unseen face of humanitarian crisis in eastern Democratic Republic of Congo: was nutritional relief properly targeted?

STUDY OBJECTIVE: Comparison of children's nutritional status in refugee populations with that of local host populations, one year after outbreak refugee crisis in the North Kivu region of Democratic Republic of Congo. DESIGN: Cross sectional surveys. SETTING: Temporary and other settlements, in the town of Goma and surrounding rural areas. SUBJECTS: Anthropometric indicators of nutritional status and presence or absence of oedema were measured among 5121 children aged 6 to 59 months recruited by cluster sampling with probability proportional to size, between June and August 1995. RESULTS: Children in all locations demonstrated a typical pattern of growth deficit relative to international reference. Prevalence of acute malnutrition (wt/ht < -2 Z score) was higher among children in the rural non-refugee populations (3.8 and 5.8%) than among those in the urban non-refugee populations (1.4%) or in the refugee population living in temporary settlements (1.7%). Presence of oedema was scarcely noticed in camps (0.4%) while it was a common observation at least in the most remote rural areas (10.1%). As compared with baseline data collected in 1989, there is evidence that nutritional status was worsening in rural non-refugee populations. CONCLUSIONS: Children living in the main town or in the refugee camps benefited the most from nutritional relief while those in the rural non-refugee areas were ignored. This is a worrying case of inequity in nutritional relief.

Weakness of biochemical markers of nutritional and inflammatory status as prognostic indices for growth retardation and morbidity of young children in central Africa.

OBJECTIVE: To determine to what extent biochemical markers of the nutritional and inflammatory status of young children are related to subsequent growth retardation and morbidity. DESIGN: Population-based follow-up study of a cohort of children from admission to final survey round six months later. SETTING: Health area in Northern Kivu, Zaire. SUBJECTS: 842 children under two years of age of whom about one-third gave informed consent to capillary blood collection. MAIN OUTCOME MEASURES: Concentration of albumin, transferrin, transthyretin, alpha 1-acid glycoprotein, C-reactive protein, and complement component C3 at baseline, and three and six months later. Incremental growth per 1 month, 3 months and 6 months of follow-up. Cumulative incidence of disease per 1 month and 3 months interval. RESULTS: A high proportion of children was with low concentrations of transport proteins and high concentrations of acute-phase reactants. Weight growth and arm circumference growth did not vary significantly with respect to initial concentrations of biomarkers, but subsequent height growth was lower in children with high values of transferrin, alpha 1-acid glycoprotein, and complement component C3 at baseline. Cumulative incidence of malaria, respiratory illness, and diarrhoea was not significantly affected by the concentration of the biomarkers at baseline. CONCLUSIONS: In this part of central Africa performing biochemical measurements should not be encouraged as a means for risk scoring in non-hospitalized children.

The molar ratio of serum retinol-binding protein (RBP) to transthyretin (TTR) is not useful to assess vitamin A status during infection in hospitalised children.

OBJECTIVE: To assess the usefulness of the molar ratio of serum retinol-binding protein (RBP) to transthyretin (TTR) to determine vitamin A (VA) status during infection. DESIGN: We took advantage of previously collected data during a randomised double-blind, placebo-controlled clinical trial to conduct a secondary analysis of the RBP/TTR ratio and its relationship to infection and VA status. In this clinical trial, children were randomly assigned to one of three groups and received either one single oral high dose of VA (200 000 IU) on the day of admission and subsequently a placebo daily until discharge or daily oral low doses of VA (5000 IU) from admission until discharge or a placebo daily from admission until discharge. SETTING: Lwiro pediatric hospital, Province of South Kivu, Democratic Republic of Congo. SUBJECTS: A total of 900 children aged 0-72 months hospitalised consecutively between March 1994 and March 1996. MAIN OUTCOME MEASURES: RBP/TTR molar ratio after 7 days hospitalisation. RESULTS: After 7 days hospitalisation, molar RBP:TTR ratio (mean+/-s.d.) of infected children (C-reactive proteins>10 mg/l) was 0.67+/-0.31 in the high-dose group (n=81), 0.74+/-0.44 in the low dose group (n=71) and 0.73+/-0.39 in the placebo group (n=81). These values did not differ significantly (one-way ANOVA P=0.472). In patients with baseline serum retinol concentrations<0.70 micromol/l, changes in RBP:TTR ratio between admission and day 7 were not statistically different in the three groups (one-way ANOVA P=0.548). CONCLUSIONS: In this population of malnourished hospitalised children, molar RBP:TTR ratio does not appear to be useful to assess VA status during infection. SPONSORSHIP: Our research was partially supported by a grant from the Fonds de la Recherche Scientifique et Médicale (contract 3.4505.94) and the David and Alice Van Buuren Foundation.

Vitamin A deficiency and protein-energy malnutrition in a sample of pre-school age children in the Kivu Province in Zaire.

OBJECTIVE: To assess pre-school age children's vitamin A status in a population where protein-energy malnutrition is endemic and serum retinol binding protein and transtyretin concentrations are low. DESIGN: A cross-sectional study. SETTING: Health district of Katana, South-Kivu, Zaire. SUBJECTS: 415 pre-school age children. METHODS: Three methods were used to assess vitamin A status: ophtalmological examination, retinol serum concentration and Relative Dose Response (RDR) test. RESULTS: The only ophthalmological signs of vitamin A deficiency appeared in two cases of night blindness, which represents a prevalence of 0.7%. Deficient serum retinol concentration (< 0.35 mumol/l) was found in 19.7% of the whole study population and in 10.4% of non-infected children in good nutritional status. RDR test carried out on a reduced sample of 79 subjects was abnormal for 7.6% of the children but showed a low sensitivity when compared with serum retinol concentration. CONCLUSION: This survey suggests that in this population of the South-Kivu Province in Zaire, vitamin A deficiency co-exists with protein-energy malnutrition and is a public health problem even with non-malnourished and non-infected children.

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.

Serum and breast milk antibodies to food antigens in African mothers and relation to their diet.

PIP: Results of a series of historical and recent studies of human milk and its protective antibodies against several bacterial and viral diseases and infantile diarrhea are presented. First, 1476 infants from Lahore, Pakistan from 3 socioeconomic groups, were observed and 300 mothers were given instruction on exclusive breast feeding. The prevalence of diarrhea indicated 60-80% protection to consistency of breast feeding, especially in summer when mothers replace breast milk with other liquids. Historically, secretory immunoglobulins (S-IgA) were first isolated from human milk, traced to intestinal antigen exposure, and local production in gut lymph nodes, from which lymphocytes migrate to the breast to secrete antibodies in milk. Specific S-IgA have been shown against Vibrio cholerae and the ETEC E. coli in milk. It is interesting that parental vaccination of a mother will boost milk IgA, but oral exposure stimulates serum antibodies more than milk IgA. Vaccination of mothers will whole cell cholera vaccine booster titers, but not avidities of S-IgA in milk. Avidities of S-IgA were higher in milk secreted for premature infants and in colostrum than in mature milk. Other research demonstrated that breast-fed infants were better able to mount their own antibody response to diphtheria, tetanus, and polio, as measured in their fecal, salivary, and serum antibodies. Breast feeding is advocated to improve infant survival, and thereby to decrease population growth.^ieng

Breast-feeding and the growth and development of the infant.

PIP: Milk production and infant growth were compared in 2 regions of Zaire: the highlands of Central Africa and the city of Bukavu. There were no statistical differences between the 2 groups in breastfeeding patterns or maternal prolactin levels. There were significant differences, however, in anthropometric characteristics and serum albumin levels. Urban women produced almost twice as much milk as women in rural areas. In terms of infant growth, a faltering in weight gain occurs at 3 months of age in rural areas as opposed to 6-7 months in the urban area. In addition, the 1st episode of diarrhea and of intestinal parasitosis occurred earlier in rural children than in their urban counterparts, most likely due to the earlier introduction of supplementary food in rural areas. Height remained well below the reference curve level from birth in the rural sample and from the 3rd month of life in the city. Finally, the serum albumin level remained strikingly low throughout infancy among rural children surveyed. Exclusive breastfeeding for the 1st 5-6 months of life is recommended to combat the exposure the infections and parasitosis conferred by early supplemental feeding.^ieng

[Social inequalities and prevention: vaccination status of adolescents]. / Inégalités sociales et prévention: le statut vaccinal des adolescents.

2423 medical school files of adolescents aged 14 to 18 years were analysed according to five socio-economic categories in order to assess existing disparities in vaccine coverage. The poliomyelitis, tetanus and mumps vaccination coverage decreased progressively with decreasing social class. Depending on the type of vaccination, the risk of not being vaccinated was 1.5 to 4 times higher in children in the lowest socio-economic class than in those in the highest class. Disparities in vaccine coverage observed among very young children continued during childhood. Almost one quarter of adolescents in the lowest socio-economic category were not correctly vaccinated against tetanus and more than one third had not received the fourth dose of oral poliomyelitis vaccine which is recommended at the age of 6. Rubella vaccination in girls was the only type of vaccination which did not show any social gradient. Vaccination at school, such as that currently carried out for rubella, would be an effective strategy for reducing the social disparities in vaccine coverage. School health services should be able to play a more active role in preventing social inequalities in vaccination.

[Effect of a participation in a community-based nutrition program on children's outcomes]. / Effet de la participation à un programme de nutrition communautaire sur l'état nutritionnel des enfants.

BACKGROUND: This study aimed to assess the effectiveness of a protein-energetic malnutrition prevention and treatment community program on the nutritional status of 18 to 36-month-old children in the poor communities of the Mono Region in Benin. METHODS: Two cross sectional anthropometric surveys were conducted. The first survey took place in 1998, before the implementation of the program; the second survey was conducted three years later. At each survey, cluster samples proportional to the population size was done; the sizes of the samples were 617 in 1998 and 648 in 2001. The nutritional status of 18 to 36 month-old-children was assessed by z-score of the indexes height-for-age, weight-for-age and weight-for-height and the cut-off point of -2 standard deviation was used to identify children who had stunting, wasting or underweight; children with serious stunting, wasting or underweight were identified with the cut-off point of -3 standard deviation. RESULTS: From 1998 to 2001, there was a significant reduction in the prevalence of growth retardation (-13.1%) and underweight (-13.0%). The reductions observed for the three types of protein-energetic malnutrition were more pronounced in the 30 to 36 months age group than in the others age groups. CONCLUSION: Substantial improvement was observed during the three years activities. This improvement cannot be attributed to the program unconditionally, because there was no difference between the nutritional status of participant and non participant children.

[Referral and delivery outcomes in Kivu, Democratic Republic of Congo]. / Référence et issues à l'accouchement au Kivu, République Démocratique du Congo.

BACKGROUND: The process of referral between the first and the second level of the health system in the Democratic Republic of Congo is poorly understood. This report intends to study the association between the referral and the hospital perinatal outcomes. METHODS: Delivery outcomes in a retrospective cohort of 1162 women admitted between June 95 and May 96, in two referral hospitals in Kivu were analyzed according to the referral status and the women's characteristics. RESULTS: Forty-three percent (n=492)of women admitted, corresponding to 2.3% of expected pregnant women, were referred. Referred women had higher risks of obstetrical complications (OR=2.0; CI95%: 1.3-3.1) and intervention (OR=1.5; CI95%: 1.0-2.3) and similar risks of low birth weight and perinatal mortality. Women with complications during the antenatal period had a double risk of intervention and perinatal mortality. The risk of obstetrical intervention was lower when women had attended 2 visits (OR=0.5; CI95%: 0.3-0.8); the risk of low birth weight was lowest only for mothers who had attended one visit (OR=0.5; CI95%: 0.3-0.9). Distance > or =90 minutes walking from home to hospital raised the risk of obstetrical complication (OR=1.7; CI95%: 1.1-2.5), the risk of obstetrical intervention (OR=1.5; CI95%: 1.0-2.1), and the risk of perinatal mortality (OR=1.6; CI95%: 1.0-2.7). Late admission raised the risk of perinatal mortality (OR=1.8; CI95%: 1.2-2.9) and lowered the risk of obstetrical complication (OR=0.7; CI95%: 0.5-1.0). Part payment of care was associated with higher risks of low birth weight (OR=1.9; CI95%: 1.3-2.9), perinatal mortality (OR=2.2; CI95%: 1.4-3.5) and obstetrical intervention (OR=2.4; CI95%: 1.7-3.4). CONCLUSION: These results suggest a deficit of referred cases considering that 15% of pregnant women in the area covered by the referral hospitals should have been referred. They confirm the negative influence of economic and geographic constraints on the delivery outcomes. They point out the relevance of making reorganization of the referral system a priority.