Suboptimal cotrimoxazole prophylactic concentrations in HIV-infected children according to the WHO guidelines.

AIMS: A clinical study was conduct in HIV-infected children to evaluate the prophylactic doses of cotrimoxazole [sulfamethoxazole (SMX) and trimethoprim (TMP)] advised by the WHO. METHODS: Children received lopinavir-based antiretroviral therapy with cotrimoxazole prophylaxis (200 mg of SMX/40 mg of TMP once daily). A nonlinear mixed effects modelling approach was used to analyse plasma concentrations. Factors that could impact the pharmacokinetic profile were investigated. The model was subsequently used to simulate individual exposure and evaluate different administration schemes. RESULTS: The cohort comprised 136 children [average age: 1.9 years (range: [0.7-4]), average weight: 9.5 kg (range: [6-16.3])]. A dose per kg was justified by the significant influence of implementing an allometrically scaled body size covariate on SMX and TMP pharmacokinetics. SMX and TPM clearance were estimated at 0.49 l h-1 /9.5 kg and 3.06 l h-1 /9.5 kg, respectively. The simulated exposures obtained after administration of oral dosing recommended by the WHO for children from 10 to 15 kg were significantly lower than in adults for SMX and TMP. This could induce a reduction of effectiveness of cotrimoxazole. Simulations show that regimens of 30 mg kg-1 of SMX and 6 mg kg-1 of TMP in the 5-10 kg group and 25 mg kg-1 of SMX and 5 mg kg-1 of TMP in the 10-15 kg group are more suitable doses. CONCLUSIONS: In this context of high prevalence of opportunistic infections, a lower exposure to cotrimoxazole in children than adults was noted. To achieve comparable exposure to adults, a dosing scheme per kg was proposed.

Prevention and care of paediatric HIV infection in Ouagadougou, Burkina Faso: knowledge, attitudes and practices of the caregivers.

BACKGROUND: The paediatric Human Immunodeficiency Virus (HIV) epidemic still progresses because of operational challenges in implementing prevention of mother-to-child HIV transmission (PMCT) programs. We assessed the knowledge, attitudes and practices (KAP) of children's caregivers regarding mother-to-child transmission (MTCT) of HIV, paediatric HIV infection, early infant diagnosis (EID), and paediatric antiretroviral treatment in Ouagadougou, Burkina Faso. METHODS: We undertook a qualitative survey in the four public hospitals managing HIV exposed or infected children, in Ouagadougou in 2011. A sociologist used a semi-structured questionnaire to interview caregivers of children less than 5 years old attending the paediatrics wards on their KAP. Study participants were divided into four groups as follows: those who did not yet know their children's HIV infection status, those who were waiting for their children's HIV test results, those who were waiting for antiretroviral treatment, and those who were already on antiretroviral treatment. RESULTS: A total of 37 caregivers were interviewed. The mean age was 32.5 years, and 29 (78 %) were mothers. Twenty seven (73 %) caregivers had primary or higher level of education, and 15 (40 %) described their occupation as "housewife". Overall, 36 (97 %) of caregivers knew that the main route of HIV transmission for infants was through MTCT and 14 (38 %) specified that it occurred during pregnancy or delivery. Five percent thought that MTCT of HIV occurred during conception. PMTCT interventions could help prevent infant HIV infection according to 32 (87 %) caregivers. Thirty five percent of caregivers stated EID as a prevention strategy. Fifty-four percent of the participants believed that replacement feeding option would prevent MTCT of HIV; 24 (65 %) stated that they would prefer medical practitioners seek caregivers' consent before carrying out any HIV-test for their child, and that caregivers' consent was not compulsory before antiretroviral treatment. All caregivers thought that it was necessary to treat HIV-infected children, although they did not know what interventions could be done. CONCLUSIONS: This study highlighted the low level of caregivers' knowledge on paediatric HIV prevention and care in Ouagadougou. Awareness programs targeting caregivers need to be strengthened in order to improve the uptake of HIV early infant diagnosis and care.

Cyclophosphamide monotherapy in children with Burkitt lymphoma: a study from the French-African Pediatric Oncology Group (GFAOP).

BACKGROUND: The French African Group of Pediatric Oncology was set-up to improve quality of care for children with cancer. Preliminary observations on the efficacy in Burkitt lymphoma (BL) of a cyclophosphamide monotherapy (CPM) have been published. We report the results of a multicentric prospective study combining first-line CPM and a multidrug second-line chemotherapy (SC) for refractory/relapsed patients. PROCEDURE: Patients ≤ 18 years with Burkitt or Burkitt-like lymphoma, were included in six countries (Burkina-Faso, Cameroon, Ivory Coast, Madagascar, Mali, and Senegal). All patients received three weekly CPM courses (1.2 g/m(2) IV with intrathecal methotrexate and hydrocortisone), stage 3/4 patients received three further courses. SC added methotrexate, vincristine, cytarabine, and prednisone. RESULTS: There were 178 patients included (42 stage 1/2, 134 stage 3/4, and 2 unknown). Isolated facial localization was found in 41 patients, diffuse abdominal involvement in 120 patients including 65 with both. Nine early deaths were reported, toxicity occurred in 136/743 courses (83 patients) and was predominantly hematological. After CPM, complete remission (CR) rate was 47% with a 33% EFS. Because of rapid progression 76/108 eligible patients (85 primary refractory and 23 relapses) received SC resulting in 35.7% CR but a 21% toxic death rate. The OS of the whole strategy was 50.5% and correlated to stage. CONCLUSION: A prospective multicentric study on BL was feasible in very low-income countries. CPM can be recommended in stage 1-2 because of optimal cost/benefit ratio. However, more intensive strategies, still adapted to socio-economic conditions, are required for advanced stages 3 and 4.

[Medical audit of neonatal deaths with the "three delay" model in a pediatric hospital in Ouagadougou]. / Audit médical des décès néonatals selon le modèle des trois retards, en milieu hospitalier pédiatrique de Ouagadougou.

OBJECTIVE: To determine the causes of neonatal deaths and their contributing factors. MATERIAL AND METHODS: We used the "three-delay model" to conduct an audit of the neonatal deaths that occurred between January 2006 and December 2010 at the Charles de Gaulle University Pediatric Hospital, in Ouagadougou. RESULTS: The neonatal mortality rate was 12.3%. The main direct causes were infections (70%), cerebral distress (10%), respiratory distress (7%), congenital malformations (5.5%), prematurity (4.5%) and hemorrhagic syndromes (3%). All three delays were found: in decision making in 64.4% of cases, in access to health services in 77%, and in receiving appropriate care in 66.9%; they multiplied the risk of death by a factor of 4, 3 and 5, respectively. CONCLUSION: To reduce deaths of newborn babies, it is necessary to overcome the three delays that contribute to it, pending the improvement of socioeconomic conditions of populations. This combat requires optimizing the implementation of the subsidies for obstetric and neonatal emergency care and strengthening the involvement of all stakeholders, specifically, policy makers, the community and health professionals.

[Urinary tract infections in a pediatric setting: Bacterial ecology and antibiotic susceptibility at the Pediatric Teaching Hospital Charles-de-Gaulle in Ouagadougou (Burkina Faso)]. / Infections du tractus urinaire en milieu pédiatrique : écologie bactérienne et sensibilité aux antibiotiques au Centre hospitalier universitaire pédiatrique Charles-de-Gaulle de Ouagadougou (Burkina Faso).

INTRODUCTION: Urinary tract infection is the second most common bacterial infection in children, after respiratory tract infection. The objective of this work was to study the bacterial ecology and antibiotic susceptibility of germs isolated during childhood urinary tract infections at the Paediatric University Hospital Charles-de-Gaulle in Ouagadougou. PATIENTS AND METHOD: This was a descriptive retrospective study covering the period from July 1st, 2010 to June 30, 2015, including 141 children from 0 to 15 years old hospitalized in the medical paediatrics department for a urinary tract infection. RESULTS: The hospital frequency of urinary tract infection was 0.7%. The mean age of the patients was 43.1 months. Female patients accounted for 57.4%, a sex-ratio of 0.7. Gram-negative bacilli were often involved (67.4%) with Escherichia Coli and Klebsiella in 35.5% and 22% of cases respectively. The main Gram-positive bacteria were staphylococci (15.5%), enterococci (11.3%) and streptococci (5.6%). Enterobacteriaceae isolated were sensitive to netilmicin (80%), chloramphenicol (76.4%), and furan (82.6%). All strains of staphylococcus were susceptible to furan, gentamicin, chloramphenicol and cefixime. In 66.7% of cases, the isolated strains of staphylococcus were resistant to amoxicillin. CONCLUSION: Urinary tract infection is a common problem in pediatrics. Its management must be early and adequate based on knowledge of the bacterial ecology in order to reduce the risk of long-term renal complications.

[Acute accidental poisoning in children: aspects of their epidemiology, aetiology, and outcome at the Charles de Gaulle Paediatric Hospital in Ouagadougou (Burkina Faso)]. / Les intoxications aiguës accidentelles de l'enfant: aspects épidémiologiques, étiologiques et évolutifs au CHU pédiatrique Charles-de-Gaulle de Ouagadougou (Burkina Faso).

Accidents are a daily concern in the paediatric ward because of their frequency, diversity and severity. Acute accidental poisoning (AAP) accounts for an important portion of these. To help improvement management of AAP, we conducted a retrospective study covering a period of 2 years from January 2005 to December 2006 at Charles de Gaulle Paediatric University Hospital in Ouagadougou. Of 9390 admissions during the study period, 123 children, or 1.3%, were admitted for poisoning. A cumulative average of 11 were admitted monthly, with a peak of 16 patients in April 2005 and 2006, together. AAP was most common among children aged 1 to 4 years. Their mean age was 3 years and ranged from 6 days to 12 years. Boys outnumbered girls, with a sex ratio of 1.2. Mothers of more than half (61%) of the children poisoned worked in the home. Household products accounted for 44.7% of AAPs, followed by drug (22.7%) and food (22%) poisoning. Kerosene and other petroleum products topped the list of household products, with 54.5%. Tranquilizers (46.4%) and dairy products (37%) dominated the drug and food poisoning categories. Immediate outcome was fatal in 3% of cases, and three quarters of these deaths occurred during drug poisoning of children aged 1 to 4 years. The mean hospital stay was 2 days, and ranged from 0 to 9 days. Health officials, the media, and community outreach must all help to increase awareness about the dangers of poisoning and of preventive measures.

[Hemoglobinuria in children hospitalized in Ouagadougou: short term inpatient care and prognosis]. / Hémoglobinurie chez l'enfant à Ouagadougou: prise en charge hospitalière et pronostic à court terme.

INTRODUCTION: The purpose of this study was to analyze the epidemiological, diagnostic, therapeutic and evolutionary features of hemoglobinuria in children hospitalized in the Pediatric University Hospital Charles de Gaulle, Ouagadougou. METHODS: We conducted a cross-sectional descriptive study over the period 01st July-31st December 2014. All children aged 0-15 years hospitalized in the Department of Medical Pediatrics of the Pediatric University Hospital Charles de Gaulle and diagnosed with macroscopic hemoglobinuria during the study period were enrolled. RESULTS: Thirty-eight patients were included in the study. Hospitalization rate for hemoglobinuria was 1.9%. The average age of patients was 80.8 ± 44.1 months (ranging from 21 to 168). The study involved 23 boys (60.5%) and 15 girls (39.5%). The major clinical signs were: fever (86.8%), dark urines like « coca cola ¼ (86.8%), pallor (63.2%), hepatomegaly (50%). Glomerular filtration flow was less than 80 mL/min/1.73m2 in 23 patients (69.7%); 21 patients had Glucose-6-phosphate dehydrogenase (G6PD) deficiency. The main suspected causes of hemoglobinuria were: severe malaria, bacterial and viral infections, G6PD deficiency, biliary haemoglobinuric fever. Treatments included: artemisinin derivatives, antibiotics and antipyretics. One patient underwent dialysis. CONCLUSION: Hemoglobinuria is a symptom mainly causing diagnostic problems in our context. It is a severe disorder which can result in acute renal failure (ARF).

[Pediatric management of sickle cell disease: experience at the Charles de Gaulle University Children's Hospital in Ouagadougou (Burkina Faso)]. / Prise en charge de la drépanocytose en milieu pédiatrique : expérience du centre hospitalier universitaire pédiatrique Charles-de-Gaulle de Ouagadougou (Burkina Faso).

Sickle cell disease is a genetic disease most common in blacks. We retrospectively collected records for patients with sickle cell disease who were seen from January 2002 through September 2006 to assess the care provided for this disease at Charles de Gaulle University Children's Hospital of Ouagadougou. In all, 88 patients were monitored quarterly at outpatient visits for sickle cell disease, in the absence of any crisis. Their age ranged from 6 months to 16 years, with an average age of 7. There were more boys than girls, with a sex ratio of 1.44. The distribution according to sickle cell genotype showed that SC accounted for 62% of cases, while SS forms were more frequent until the age of 5. All children have received the immunizations in the standard Expanded Programme on Immunization (EPI) [diphtheria, tetanus, pertussis, polio, measles and yellow fever]. The immunization rates for non-EPI vaccines including hepatitis B, Haemophilus influenzae B, Salmonella typhi, meningitis, pneumonia and the combined vaccine against measles, mumps and rubella ranged from 94 to 100%. A prophylactic anti-anaemic agent was made with folic acid often associated with iron. In addition, patients receive malaria chemoprophylaxis. Chloroquine was initially provided, and since 2006, children have been receiving sulfadoxine-pyrimethamine. Our encouraging results deserve reinforcement in the short-term - at the local level by neonatal screening, the creation of an immunization unit, and the systematization of antibiotic prophylaxis, and in the medium-term by implementation of a National sickle cell disease programme to help meet the objective of a 40% reduction in mortality among affected children younger than 5 years by 2015, set by the Sickle Cell Disease International Organization.

[Lung disease and HIV infection in children at the Charles de Gaulle university pediatric hospital center in Ouagadougou (Burkina Faso)]. / Pneumopathies et infection VIH chez l'enfant au centre hospitalier universitaire pédiatrique Charles-de-Gaulle de Ouagadougou (Burkina Faso).

To compare the clinical and radiological aspects of lung diseases in HIV-positive and HIV-negative children, we conducted a retrospective case control study covering a 3-year period from January 2003 through December 2005 at Charles de Gaulle University Pediatric Hospital Center in Ouagadougou. HIV-positive patients hospitalised for lung disease were matched to HIV-negative patients controls, hospitalised for the same symptoms, by age and date of hospitalisation. The study included 186 patients (93 HIV-positive and 93 HIV-negative) and collected data on age, sex, clinical signs, radiological signs and short-term course. Of the 93 HIV-positive children suspected to have been contaminated by mother-to-child transmission, 92 had HIV1 and 1 had a double infection of HIV1 and 2. The mean age in both groups was 48 months. Clinically severe lung disease (44%) was more common in HIV-positive children. Radiology showed that interstitial syndrome was significantly more common in HIV-positive children (p=0001) with a sensitivity of 71% and a specificity of 60%. The case-fatality rate was 4.2% among HIV-positive children. This study allows us to remind paediatricians of the importance of lung disease in HIV-infected children. Moreover, the vertical transmission responsible for disease in all our patients shows the need to accelerate the scaling up of the program for prevention of mother-to-child HIV transmission in our country.

[Acute lymphoblastic leukemia among children in Ouagadougou (Burkina Faso): the results of treatment according to the protocol of the Franco-African Pediatric Oncology Group 2005]. / Les leucémies aiguës lymphoblastiques de l'enfant à Ouagadougou (Burkina Faso): résultats de la prise en charge selon le protocole du Groupe Franco-Africain d'Oncologie Pédiatrique 2005.

INTRODUCTION: acute lymphoblastic leukemia (ALL) is being diagnosed in an increasing number of children in our Department. In the developed countries, the treatment of this hematologic malignancy can cure almost 80% of children. In developing countries, few studies focus on acute leukemias in children. The results of cancer treatments in children are disappointing in most African countries, with a survival rate of 10-15%. This study aimed to investigate the clinical, biological, therapeutic and evolutionary features of ALL in children. METHODS: we conducted a retrospective study of the medical records of children hospitalized for ALL between November 2009 and October 2011 in the pilot Paediatric Oncology Unit at the Charles de Gaulle University Pediatric Hospital Center, Ouagadougou (Burkina Faso). All children treated according to the protocol of the Franco-African Pediatric Oncology Group 2005 (FAPOG) were included in the study. RESULTS: in total, nine children with ALL were hospitalized during the two year study period. The average age of patients was 10.77± 2.82 years. They were predominantly male. The average time of hospitalization was 43.11 days ± 39.54 days. The main symptoms were alteration of general state and fever. Nearly all the patients had tumor syndrome and bone marrow failure. Myelogram showed ALL type 1 in six of the nine patients. Eight patients underwent chemotherapy according the protocol of FAPOG 2005. Children's evolution was favorable in two patients who experienced remission, four patients had treatment failure. Six patients died. CONCLUSION: thanks to information campaigns, which will contribute to encourage early consultations, capacity-building measures for the medical staff allowing early diagnosis of ALL, the construction of a sufficiently equipped pediatric oncology center and a subsidy of anticancer drugs awarded by the state of Burkina Faso, the treatment of children with ALL would allow for better outcomes.

Impact and effectiveness of pentavalent rotavirus vaccine in children <5 years of age in Burkina Faso.

BACKGROUND: Burkina Faso was one of the first African nations to introduce pentavalent rotavirus vaccine (RV5, RotaTeq) into its national immunization program in October 2013. We describe the impact and effectiveness of rotavirus vaccine on acute gastroenteritis (AGE) hospitalizations among Burkinabe children. METHODS: Sentinel hospital-based surveillance for AGE was conducted at four hospitals during December 2013 - February 2017. Demographic, clinical, and vaccination information was collected and stool specimens were tested by EIA. Trends in rotavirus AGE hospitalizations and changes in the proportion of AGE hospitalizations due to rotavirus were examined at two sentinel sites from January 2014 - December 2016. Unconditional logistic regression models using data from all 4 surveillance sites were used to calculate vaccine effectiveness (VE, defined as 1-odds ratio) by comparing the odds of vaccination among rotavirus AGE (cases) and non-rotavirus AGE (controls) patients, controlling for age, season, hospital site and socioeconomic factors. RESULTS: The proportion of AGE hospitalizations that tested positive for rotavirus declined significantly among children <5 years of age, from 36% (154/422) in 2014 to 22% (71/323, 40% reduction, p < .01) in 2015 and 20% (61/298, 44% reduction, p < .01) in 2016. Among infants, the percentage of AGE admissions due to rotavirus fell significantly from 38% (94/250) in 2014 to 21% (32/153, 44% reduction, p < .01) in 2015 and 17% (26/149, 54% reduction, p < .01) in 2016. The adjusted VE for full 3-dose series of RV5 against rotavirus hospitalization was 58% (95% [CI], 10%, 81%) in children 6-11 months of age and 19% (-78%, 63%) in children ≥12 months. CONCLUSION: Rotavirus hospitalizations declined after introduction of pentavalent rotavirus vaccine in children, particularly among infants. RV5 significantly protected against severe rotavirus gastroenteritis in infants, but effectiveness decreased in older children.

[Risk factors for death from severe malaria in children at the Charles de Gaulle pediatric hospital of Ouagadougou (Burkina Faso)]. / Facteurs de risque de décès au cours du paludisme grave chez l'enfant au Centre hospitalier universitaire pédiatrique Charles de Gaulle de Ouagadougou (Burkina Faso).

To determine the risk factors for death from severe malaria in children in Burkina Faso, we conducted a retrospective case-control study covering a period of 24 months from January 2004 through December 2005, at the Charles de Gaulle Pediatric Hospital in Ouagadougou. Cases (n=72) were defined as all children hospitalized for and dying of confirmed severe malaria. The control subjects (n=72), matched for age, sex and date of hospitalization; were children hospitalized for confirmed severe malaria who were discharged after recovery. Risk factors assessed included: place of residence, socioeconomic level, self-medication, promptness of hospitalization, nutritional status, temperature and parasitemia. Case and control children were compared with pairwise tests. Low socioeconomic level (OR=5.4), late care (OR=15.5), poor nutritional status (OR=7.9) and a parasitemia greater than or equal to 5% (OR=2.8) were associated with a significant increase in the risk of death. In contrast, the malaria deaths were not associated with place of residence (OR=0.5), self-medication (OR=1) or fever of 41 degrees C or higher (OR=1.1). These results show the need for more health education to encourage early care-seeking in the event of fever, community-based interventions, and strengthening of the technical support centers for health facilities, as part of a national poverty reduction program.

[Neonatal morbidity and mortality in 2002-2006 at the Charles de Gaulle pediatric hospital in Ouagadougou (Burkina Faso)]. / Morbidité et mortalité néonatales de 2002 à 2006 au Centre hospitalier universitaire pédiatrique Charles de Gaulle de Ouagadougou (Burkina Faso).

INTRODUCTION: Neonatal diseases remain a major public health problem in developing countries. The Millennium Goal of reducing child mortality by 2/3 by the year 2015 requires a major reduction in neonatal mortality. Accordingly, in March 2006, Burkina Faso began a policy of subsidizing obstetric care and neonatal emergency care. To be able to assess the effectiveness of the steps undertaken, we examined the characteristics of morbidity and neonatal mortality in the principal pediatric teaching hospital (CHUP-CDG) before implementation of the program. MATERIALS AND METHODS: This retrospective study looked at hospital records and the database of newborns hospitalized from 01 January 2002 through 31 December 2006. RESULTS: During the study period, of 23 223 children hospitalized, 1226 (5%) were neonates. The number of neonates hospitalized annually has increased from 118 in 2002 to 414 in 2006. Most (70%) were referred by another healthcare facility. Mean age at admission was 9+/-8 days. The socioeconomic level of 60% of the parents was low. The neonatal mortality rate was 15.3%. More than half (58.8%) the deaths occurred on the first day of hospitalization. The leading causes of morbidity were also the biggest killers: the fatality rate for neonatal infections was 16.8%, and that for congenital malformations and acute accidental poisoning 12.9%. CONCLUSION: Neonatal morbidity and mortality remain at worrisome levels. Improved monitoring of pregnancies and conditions of delivery, reduction in the cost to families of care and the opening of a neonatal unit equipped with appropriate material at the pediatric hospital center (CHUP-CDG) should help to reduce neonatal mortality.

[Major sickle cell syndromes and infections associated with this condition in children in Burkina Faso]. / Syndromes drépanocytaires majeurs et infections associées chez l 'enfant au Burkina Faso.

INTRODUCTION: This study aims to investigate infections in children with major sickle cell syndrome. METHODS: We conducted a monocentric descriptive retrospective hospital study in Ouagadougou, Burkina Faso, over a ten-year period. All children with major sickle cell syndrome (homozygous SS and double heterozygous SC, SDPunjab, Sß thalassemic, SOArab and SE) hospitalized for microbiologically confirmed infections were enrolled in the study. RESULTS: One hundred and thirty-three patients met our inclusion criteria. The SS phenotype accounted for 63.2% of cases and SC 36.8%. The frequency of infections was 21.8%. In 45.9% of cases, these affected children aged 0-5 years. The most frequent signs were osteoarticular pain (42.1%), cough (25.7%), abdominal pain (23.3%), pallor (43.6%). The major diagnoses were bronchopneumonia (31.6%), malaria (16.5%), osteomyelitis (12.8%) and septicemia (10.5%). The isolated pathogenic organisms were Streptococcus pneumoniae (35.5%) and Salmonella spp (33.3%). Third generation cephalosporins were the most commonly prescribed antibiotics. Gros mortality rate was 7.5%. CONCLUSION: Bacterial infections and malaria dominate the clinical picture of infections in children with major sickle cell syndrome at the at the Pediatrics University Hospital Center Charles De-Gaulle. This study highlights the importance of establishing a national program for the management of sickle-cell anemia, which could help prevent or reduce the occurrence of infections in children with sickle cell syndrome.

[Pepper's syndrome: report of two cases at the Charles de Gaulle University Pediatric Hospital Center, Ouagadougou (Burkina Faso)]. / Le syndrome de Pepper: à propos de deux cas observés au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou (Burkina Faso).

Pepper's syndrome is a neuroblastoma that metastasizes to the liver. It affects infants younger than six months of age. It can regress spontaneously and is associated with a favorable prognosis in 80% of cases. Given its rarity, we here report two cases of Pepper's syndrome observed at the Charles de Gaulle university pediatric hospital center, Ouagadougou (Burkina Faso). Our study involved two female infants in whom the disease manifested as an increase in abdominal volume, hepatomegaly and signs of respiratory distress. Ultrasound enabled diagnosis, which was based on the nodular appearance of the liver in both cases and determination of the primary tumor in one case. Urinary catecholamine test confirmed the diagnosis in one case. Both patients died from complications related to liver compression, chemotherapy (in one of the cases) and lack of treatment (in the other case).

Missed opportunities of inclusion in a cohort of HIV-infected children to initiate antiretroviral treatment before the age of two in West Africa, 2011 to 2013.

INTRODUCTION: The World Health Organization (WHO) 2010 guidelines recommended to treat all HIV-infected children less than two years of age. We described the inclusion process and its correlates of HIV-infected children initiated on early antiretroviral therapy (EART) at less than two years of age in Abidjan, Côte d'Ivoire, and Ouagadougou, Burkina Faso. METHODS: All children with HIV-1 infection confirmed with a DNA PCR test of a blood sample, aged less than two years, living at a distance less than two hours from the centres and whose parents (or mother if she was the only legal guardian or the legal caregiver if parents were not alive) agreed to participate in the MONOD ANRS 12206 project were included in a cohort to receive EART based on lopinavir/r. We used logistic regression to identify correlates of inclusion. RESULTS: Among the 217 children screened and referred to the MONOD centres, 161 (74%) were included and initiated on EART. The main reasons of non-inclusion were fear of father's refusal (48%), mortality (24%), false-positive HIV infection test (16%) and other ineligibility reasons (12%). Having previously disclosed the child's and mother's HIV status to the father (adjusted odds ratio (aOR): 3.20; 95% confidence interval (95% CI): 1.55 to 6.69) and being older than 12 months (aOR: 2.05; 95% CI: 1.02 to 4.12) were correlates of EART initiation. At EART initiation, the median age was 13.5 months, 70% had reached WHO Stage 3/4 and 57% had a severe immune deficiency. CONCLUSIONS: Fear of stigmatization by the father and early competing mortality were the major reasons for missed opportunities of EART initiation. There is an urgent need to involve fathers in the care of their HIV-exposed children and to promote early infant diagnosis to improve their future access to EART and survival.

[Children of HIV-positive mothers: 4 cases of contamination in 14 years of follow-up at the Rouen University Hospital Center]. / Enfants nés de mères VIH-positives: à propos de 4 cas de contamination sur une période de 14 ans de suivi au CHU de Rouen.

UNLABELLED: The prevention of mother-to-child transmission is important in the control of HIV. Despite preventive measures, the objective of a zero transmission rate from mother to child has not yet been reached even in Northern countries. OBSERVATION: A retrospective study covering a 14-year period (January 1988 through December 2001) examined records of 80 children born to HIV-positive mothers at Rouen University Hospital Center. Four children were contaminated. We report several particularities of these four children, contaminated despite the preventive measures taken. CONCLUSION: Prevention of mother-to-child transmission involves not only administration of antiretrovirals during pregnancy, but also better follow-up of pregnancy and delivery and more effective management of risk factors such as drug addiction and poverty. Multidisciplinary follow-up is needed for these children in view of our current lack of knowledge of the long-range side effects of these antiretrovirals.

[Relevance of reactive fillets in detecting urinary infections in African paediatric environment]. / Intérêt des bandelettes réactives dans le déspistage des infections urinaires en milieu pédiatrique africain.

It is quite obvious that African paediatricians are facing numerous challenges. However, their daily fight against frequent pathologies such as malaria, diarrhoeal diseases and respiratory infections should not prevent them from taking into consideration the existence of other pathologies, particularly urinary infections. The clinical picture of urinary infections which is often polymorphic would require a systematic test among infants. Reactive fillets may therefore be relevant in detecting such urinary infections. This survey shows that the best intrinsic values of the fillets used (multistix 8 SG) are reached with leucocytes (sensibility: 95%) and with the combination of leucocytes and nitrites (specificity: 77.1%). The best predictable validities were obtained with the combination of leucocytes and nitrites (positive predictable value: 68.1%) as well as with the combination of leucocytes or nitrites (negative predictable value: 86%). In the daily practice, reactive fillets may turn out to be helpful to the clinician. The negativity of both tests speaks for the isolation and exclusion of urinary infections. On the other hand, the positivity of both tests highlights a strong urinary infection which is subject to a careful and rigorous use of fillets.

Viral etiology of respiratory tract infections in children at the pediatric hospital in Ouagadougou (Burkina Faso).

BACKGROUND: Acute respiratory infections (ARIs) are a major cause of morbidity and mortality in children in Africa. The circulation of viruses classically implicated in ARIs is poorly known in Burkina Faso. The aim of this study was to identify the respiratory viruses present in children admitted to or consulting at the pediatric hospital in Ouagadougou. METHODS: From July 2010 to July 2011, we tested nasal aspirates of 209 children with upper or lower respiratory infection for main respiratory viruses (respiratory syncytial virus (RSV), metapneumovirus, adenovirus, parainfluenza viruses 1, 2 and 3, influenza A, B and C, rhinovirus/enterovirus), by immunofluorescence locally in Ouagadougou, and by PCR in France. Bacteria have also been investigated in 97 samples. RESULTS: 153 children (73.2%) carried at least one virus and 175 viruses were detected. Rhinoviruses/enteroviruses were most frequently detected (rhinovirus n = 88; enterovirus n = 38) and were found to circulate throughout the year. An epidemic of RSV infections (n = 25) was identified in September/October, followed by an epidemic of influenza virus (n = 13), mostly H1N1pdm09. This epidemic occurred during the period of the year in which nighttime temperatures and humidity were at their lowest. Other viruses tested were detected only sporadically. Twenty-two viral co-infections were observed. Bacteria were detected in 29/97 samples with 22 viral/bacterial co-infections. CONCLUSIONS: This study, the first of its type in Burkina Faso, warrants further investigation to confirm the seasonality of RSV infection and to improve local diagnosis of influenza. The long-term objective is to optimize therapeutic management of infected children.

Missed opportunities for early access to care of HIV-infected infants in Burkina Faso.

OBJECTIVE: The World Health Organization (WHO) has recommended a universal antiretroviral therapy (ART) for all HIV-infected children before the age of two since 2010, but this implies an early identification of these infants. We described the Prevention of Mother-to-Child HIV Transmission (PMTCT) cascade, the staffing and the quality of infrastructures in pediatric HIV care facilities, in Ouagadougou, Burkina Faso. METHODS: We conducted a cross-sectional survey in 2011 in all health care facilities involved in PMTCT and pediatric HIV care in Ouagadougou. We assessed them according to their coverage in pediatric HIV care and WHO standards, through a desk review of medical registers and a semi-structured questionnaire administered to health-care workers (HCW). RESULTS: In 2011, there was no offer of care in primary health care facilities for HIV-infected children in Ouagadougou. Six district hospitals and two university hospitals provided pediatric HIV care. Among the 67 592 pregnant women attending antenatal clinics in 2011, 85.9% were tested for HIV. The prevalence of HIV was 1.8% (95% Confidence Interval: 1.7%-1.9%). Among the 1 064 HIV-infected pregnant women attending antenatal clinics, 41.4% received a mother-to-child HIV transmission prevention intervention. Among the HIV-exposed infants, 313 (29.4%) had an early infant HIV test, and 306 (97.8%) of these infants tested received their result within a four-month period. Among the 40 children initially tested HIV-infected, 33 (82.5%) were referred to a health care facility, 3 (9.0%) were false positive, and 27 (90.0%) were initiated on ART. Although health care facilities were adequately supplied with HIV drugs, they were hindered by operational challenges such as shortage of infrastructures, laboratory reagents, and trained HCW. CONCLUSIONS: The PMTCT cascade revealed bottle necks in PMTCT intervention and HIV early infant diagnosis. The staffing in HIV care and quality of health care infrastructures were also insufficient in 2011 in Ouagadougou.