Crise vaso-occlusive drépanocytaire sévère: aspects cliniques, étiologiques et thérapeutiques au CHU Sylvanus Olympio de Lomé / Clinical, aetiological and therapeutic features of severe sickle cell related vaso-occlusive crisis at the Sylvanus Olympio University Hospital, Lomé

Introduction: la crise vaso-occlusive (CVO) est la plus fréquente manifestation de la drépanocytose et la première cause d´hospitalisation des enfants atteints. L´objectif de cette étude est de décrire les aspects cliniques des CVO sévères, de déterminer les étiologies des syndromes infectieux qui les accompagnent et de décrire leur prise en charge. Méthodes: il s'agit d'une étude transversale descriptive portant sur 137 drépanocytaires majeurs hospitalisés pour CVO sévères du 1er janvier 2009 au 31 décembre 2011 dans le service de pédiatrie du CHU Sylvanus Olympio. Résultats: les drépanocytaires homozygotes SS étaient les plus nombreux (n=98; 71,5%), suivis des doubles hétérozygotes SC (n=28; 20,5). Le délai moyen de consultation était de 4,7 ± 4,4 jours. Le traitement avant l´admission comportait des antibiotiques (28,5%). Les CVO étaient surtout ostéo-articulaires (70,8%). Dans 98,5% des cas, une infection bactérienne associée a été confirmée (48,9%) ou présumée (49,6%). Les principales étiologies étaient le syndrome thoracique aigu (26,3%), l´ostéomyélite aiguë (10,9%), l´infection urinaire (6,6%), la septicémie (3,6%). Un germe a été isolé chez 14,6% des patients, Escherichia coli (30%) étaient en tête suivi de Klebsiella pneumoniae (25%), Staphylococcus aureus (15%), Salmonella typhi (10%), Streptococcus pneumoniae (5%), le Streptocoque D (5%), l´Enterobacter (5%) et l´Acinetobacter (5%). Le taux de mortalité était de 2,2%. La durée moyenne d´hospitalisation était de 11,4 ± 8,8 jours. Conclusion: les CVO drépanocytaires sévères sont en majorité associées aux infections bactériennes en milieu tropical. Une antibiothérapie adaptée et précoce constitue le moyen thérapeutique indispensable pour prévenir ou traiter ces patients.

Introduction: vaso-occlusive crisis (VOC) is the most common manifestation of sickle cell disease and the leading cause of hospitalization among affected children. The purpose of this study is to describe the clinical features of severe VOCs, to determine the etiologies of infectious syndromes that accompany them and to describe their management. Methods: we conducted a descriptive cross-sectional study of 137 adult patients with sickle cell disease hospitalised for severe VOC in the Paediatric Department of the Sylvanus Olympio University Hospital from 1 January 2009 to 31 December 2011. Results: the majority of patients (n=98; 71.5%) had homozygous sickle cell (SS), followed by double heterozygous SC disease (n=28; 20.5). The median of consultation time was 4.7 ± 4.4 days. Treatment before admission was based on antibiotics (28.5%). VOCs were mainly osteoarticular (70.8%). In 98.5% of cases, an associated bacterial infection was confirmed (48.9%) or suspected (49.6%). The main etiologies included acute chest syndrome (26.3%), acute osteomyelitis (10.9%), urinary tract infection (6.6%) and septicaemia (3.6%). One germ was isolated from 14.6% of patients: Escherichia coli (30%), followed by Klebsiella pneumoniae (25%), Staphylococcus aureus (15%), Salmonella typhi (10%), Streptococcus pneumoniae (5%), Streptococcus D (5%), Enterobacter (5%) and Acinetobacter (5%). Mortality rate was 2.2%. The average length of stay in hospital was 11.4 ± 8.8 days. Conclusion: severe sickle cell related vaso-occlusive crisis is mainly associated with bacterial infections in tropical environments. Appropriate and early antibiotic therapy is the essential therapeutic means to prevent or treat these patients.

Constipation de l'enfant dans un service de pédiatrie générale à Bamako / Childhood constipation in a general pediatrics Unit in Bamako

Introduction : La constipation est un symptôme qui correspond à une anomalie des selles ou de leur élimination : elles sont trop volumineuses ou trop dures, trop rares, ou leur élimination est douloureuse, voire incomplète. Objectif : le but de cette étude était de déterminer la fréquence, les facteurs favorisants, les signes et les modalités thérapeutiques de la constipation de l'enfant dans le département de pédiatrie du CHU Gabriel Touré. Patients et Méthode : Il s'agissait d'une étude transversale descriptive à collecte prospective allant du 1 avril 2019 au 31 Janvier 2020. Ont été inclus tous les patients de 0 à 15 ans ayant consulté dans le département de pédiatrie pour constipation et répondant aux critères de Rome IV. Résultat : Nous avions enregistré 75 patients.Lafréquence hospitalière était de 0,23 %. La tranche d'âge d'un mois à deux ans représentait 61,3% des patients, l'âge moyen était de 27,7 +/- 43 mois. Le sexe masculin prédominait avec 58,7%. La constipation était le motif de consultation le plus fréquent avec 62,6%. Une selle par semaine a été retrouvée chez 77,3 % des patients. La douleur à la défécation a été retrouvée chez 65,3 % des patients. La constipation était fonctionnelle chez 69,3% des patients. La maladie de Hirschsprung était la cause de la constipation organique chez 65,2% des patients. Les laxatifs ont été prescrits chez 64 % des patients à la consultation. Conclusion: La constipation est une pathologie fréquente qui touche les enfants à tout âge. Elle est d'origine fonctionnelle dans la majeure partie des cas.

Introduction: Constipation is a symptom that corresponds to an anomaly of the stools or their elimination: they are too bulky or too hard, too rare, or their elimination is painful, even incomplete. Objective: was to determine the frequency, the contributing factors, the signs and the therapeutic methods of constipation in children in the pediatric department of the CHU Gabriel Touré. Patients and Method: This was a descriptive cross-sectional study with prospective collection from April 1, 2019 to January 31, 2020. All patients aged 0 to 15 who consulted in the pediatric department for constipation and responding to the Rome IV criteria. Result: We registered 75 patients. The hospital frequency of 0.23%. The age group from one month to two years represented 61.3% of the patients, the average age was 27.7 +/- 43 months. The male gender predominated with 58.7%. Constipation alone was the most common reason for consultation with 62.6%. One stool per week was found in 77.3% of patients. Pain on defecation was found in 65.3% of patients. Constipation was functional in 69.3% of patients. Hirschsprung disease was the cause of organic constipation in 65.2% of patients. Laxatives were prescribed in 64% of patients at the consultation. Conclusion: Constipation is a frequent pathology that affects children at all ages. It is of functional origin in most case

Dental caries risk assessment in primary school children aged 11 to 12 years: Case of Nyarugenge District, Rwanda

Background Dental caries in children is a public health concern affecting 60-90% of children worldwide. Dental caries perturbs children's eating ability, school performance as well as overall quality of life. This study aimed to determine the prevalence of dental caries and its risk factors among children aged 11 to 12 years in Nyarugenge District in Kigali, Rwanda. Methods The cross-sectional analytical study design involved 400 children from Nyarugenge district. By stratified sampling, we selected Gitega and Butamwa primary schools and used systematic sampling to choose the pupils into the sample. An interview and oral examination were performed. Descriptive statistics and logistic regression were done. Results Dental caries was observed in 25.5% of children. Deep pits and fissures carried a two-fold risk of getting dental caries than children without deep pits and fissures (OR = 2.4, 95% CI = [1.5; 4.0], P-value < 0.001). Dental plaque was identified as a risk factor for getting dental caries (OR=2.2, 95% CI = [1.2; 3.3], P-value: 0.01). Conclusion Dental caries is a public health concern associated with poor oral hygiene, deep pit, and fissures among children aged 11 to 12 years old. Oral hygiene education, application of ART, and regular screening programs are in need.

Tétanos de l'enfant au Centre Hospitalier Universitaire Mère­Enfant de Libreville, Gabon / Child tetanus at the Mother and Child University Hospital Center, Libreville, Gabon

L'objectif de cette étude était de déterminer les aspects épidémiologique, clinique, thérapeutique et évolutif du tétanos de l'enfant au service de réanimation du Centre Hospitalier Universitaire Mère-Enfant de Libreville, au Gabon. Méthodes : Etude rétrospective de type descriptif menée du 1er janvier 2019 au 31 décembre 2022. Les dossiers des enfants âgés de 0 à 16 ans, admis en réanimation pour tétanos, ont constitué la base des données. Les variables étudiées étaient épidémiologiques, cliniques, thérapeutiques et évolutives. Résultats : Parmi les 561 enfants hospitalisés en réanimation durant la période, il y'avait 12 cas de tétanos, soit une prévalence de 2,1%. Le sexe ratio était de 2. Les enfants âgés de 10 ans et plus représentaient la moitié de l'effectif (n=6). La porte d'entrée la plus retrouvée était une plaie du pied soit 50%, suivie d'une plaie céphalique dans 25% des cas. Tous les enfants avaient un état vaccinal incorrect, un trismus et des troubles d'alimentation. Le score pronostique de Dakar était à 2 chez six enfants (50%) et de 3 chez les 6 autres. Les molécules les plus utilisées étaient le Midazolam (92%), le Métronidazole (100%), le sérum et vaccin antitétanique (100%). Cinq patients (42%) ont bénéficié d'une ventilation assistée. La durée moyenne de séjour était de 13,6 jours ±9,9 et la létalité de 42%. Conclusion : le tétanos prédomine chez le grand enfant n'ayant pas de couverture vaccinale. Des mesures de sensibilisation des populations sur la vaccination antitétanique sont indispensables pour baisser la létalité.

Syndrome de QT long découvert en postpartum: à propos d'un cas à Fianarantsoa, Madagascar / Long QT syndrome discovered in postpartum: about a case in Fianarantsoa, Madagascar

Le syndrome de QT long congénital est une canalopathie arythmogène rare mais grave pouvant être responsable d'une mort subite prématurée chez l'enfant et les sujets jeunes. La période du postpartum est particulièrement à risque de survenue d'évènement cardiaque chez la femme. Nous rapportons le cas d'une femme de 29 ans porteuse d'un syndrome de QT long congénitale probable déclenché avec trouble du rythme cardiaque déclenché par le postpartum dont le risque de mort subite à court terme a été imminent en absence de traitement

Assessment of mothers' knowledge and use of oral rehydration therapy for diarrhoea in children under 5 years in Ife, Nigeria

Diarrhoeadisease is the second leading cause of death in children under 5 years old, and is responsible for killing about 300, 000 children annually in Nigeria. Oral rehydration therapy (ORT) is the preferred treatment for fluid and electrolyte losses due to diarrhoea in children with mild to moderate dehydration. This study aimed to assess the knowledge and use of ORT in the management of diarrhoea in children under 5 years at Seventh Day Adventist Hospital (SDAH, Ife).Method: A structured questionnaire was adopted for this study design and data was collected using a self-structured questionnaire both self-administered and interviewer administered.Results: Of 80 participants, 44 (55%) of the respondents had heard of ORT before this study, while 36 (45%) had not. 48 (60%) responded that they use oral rehydration solution while 32 (40%) of mothers said they had not used ORT. There was significant difference in both outcomes. The result revealed that there was significant difference in morbidity and mortality between mothers who use ORT and those who do not. But there was no significant difference between the knowledge of ORT compared with its use.Conclusion:Appropriate knowledge of the therapy will positively influence its use which will drastically prevent morbidity associated with diarrhoea as well as contain the incidence of mortality

Pattern and determinants of outcomes of neurological emergencies admitted into children emergency ward in a tertiary hospital in Port Harcourt, Nigeria

Neurological emergencies are life-threatening central nervous system disorders, significantly contributing to childhood morbidity and mortality. The sequelae may be irreversible and may impact negatively on the quality of life of affected children and their families. This study identified the morbidity pattern and determinants of the outcomes of children with neurological emergencies in the Children Emergency Room (CHER) of the Rivers State University Teaching Hospital (RSUTH). Method: A 4-year retrospective study was carried out in the CHER. Data on demography, diagnosis and outcomes of children with neurological disorders were extracted from the records. Data analysed with SPSS 24 were expressed in percentages and frequency tables. Results: Of the 3040 children admitted in the CHER, 364(12%) aged 0-15 years had neurological emergencies, commoner among males (59.3%) and children aged less than five years (70.9%). Meningitis (40.2%) and febrile convulsion (28.2%) were the topmost diagnoses made. Raised intracranial pressure (17.4%) and head injuries (25.5%) were significantly more prevalent among children aged five years and above. The mortality rate was 61(16.8%) and more among adolescents (30.6%). All the mortalities took place within the first 48hours of admission especially among those with head injuries (46.5%) and perinatal asphyxia (95%), (p < 0.05). Conclusion: Meningitis and febrile convulsion were the commonest neurologic emergencies seen in this study. Mortality rate was high, especially in the first 48 hours of admission and mainly from perinatal asphyxia and head injuries. Education on the prevention and management of neurologic emergencies should be strengthened

Tuberculose chez les enfants de 0-14 ans: résistance primaire de Mycobacterium tuberculosis aux antituberculeux et variants génétiques à Kinshasa / Tuberculosis in children aged 0-14: primary resistance of Mycobacterium tuberculosis to antituberculosis drugs and genetic variants in Kinshasa

Dans les régions endémiques y compris la République Démocratique du Congo, les enfants sont susceptibles d'être exposés à la tuberculose (TB) par un contact dans l'entourage. L'absence de diagnostic peut avoir des conséquences dévastatrices. L'objectif de la présente étude était de déterminer la fréquence de TB, la résistance primaire des souches de Mycobacterium tuberculosis aux antituberculeux ainsi que des variants génétiques. Méthodes. Cette étude transversale et descriptive a été réalisée, entre juin 2011 et décembre 2017, à Kinshasa chez les enfants présumés TB. Les enfants ayant les signes évocateurs de TB figurant dans la tranche d'âge de 0-14 ans étaient inclus. Les échantillons ont été examinés par le Ziehl et mis en culture sur le milieu de Löwenstein-Jensens. Les souches étaient testées aux antituberculeux par la technique des proportions et typées par Spoligotyping. La comparaison des proportions a été faite à l'aide du test de chi-carré de Pearson. Résultats. Quarante-huit souches de Mycobacterium tuberculosis (15,4 %) ont été isolées. Dix souches (20,8%) étaient résistantes à au moins un antituberculeux plus fréquemment à l'INH. Le génotype LAM (66,7 %) et Haarlem (33,3%) était observé. Conclusion. La recherche active de TB infantile confirme qu'elle est relativement fréquente et est résistante à au moins un antituberculeux (surtout à l'INH).

Application de pediatric sequential organ failure assessment (pSOFA) chez les enfants diagnostiqués de Sepsis selon les critères SIRS: Une série des cas de l'hôpital Saint Joseph / Application of pediatric sequential organ failure assessment (pSOFA) in children diagnosed with Sepsis according to SIRS criteria: serial case from Saint Joseph hospital

Le fardeau du sepsis utilisant le Pediatric Sequential Organ Failure Assessment (pSOFA) en Afrique subsaharienne n'est pas connu. L'objectif de la présente étude était de déterminer la fréquence du sepsis appliquant le score pSOFA chez les enfants. Méthodes. C'était une série des cas incluant les enfants âgés entre 1 et 15 ans, préalablement suspectés de sepsis au moyen des critères SIRS, en utilisant le score pSOFA (≥ 2), au service des urgences pédiatriques de l'hôpital Saint Joseph / Kinshasa. Résultats. Nonante deux enfants ont été examinés. Le sexe masculin était prépondérant (53,3 %). Leur âge médian était de 4,5 ans. Les signes cliniques à l'admission étaient marqués par la fièvre (97,8 %) et l'asthénie physique (60,8 %). La mise en évidence du sepsis pSOFA a montré que 39,1% des patients avaient sepsis alors que 60,9 % étaient diagnostiqués à tort (pSOFA < 2). La fréquence de sepsis selon pSOFA était de 7,2 % sur l'ensemble d'admission. Conclusion. Le score pSOFA a permis de diagnostiquer le sepsis seulement chez un enfant sur quatre par rapport au score de SIRS qui a tendance à le surestimer.

Identifying challenges in implementing child rights instruments in Nigeria: A nationwide survey of knowledge, perception, and practice of child rights among doctors and nurses

Context: After thirty years of ratifying the child rights convention and nineteen years of the Child Rights Act, implementing child rights instruments remains challenging in Nigeria. Healthcare providers are well positioned to change the current paradigm. Aim: To examine the knowledge, perception, and practice of child rights and the influence of demographics among Nigerian doctors and nurses. Materials and methods: A descriptive, cross-sectional online survey was done using nonprobability sampling. Pretested multiple-choice questionnaire was disseminated across Nigeria's six geopolitical zones. Performance was measured on the frequency and ratio scales. Mean scores were compared with 50% and 75% thresholds. Results: A total of 821 practitioners were analyzed (doctors, 49.8%; nurses, 50.2%). Female-to-male ratio was 2:1 (doctors, 1.2:1; nurses, 3.6:1). Overall, knowledge score was 45.1%; both groups of health workers had similar scores. Most knowledgeable were holders of fellowship qualification (53.2%, P = 0.000) and pediatric practitioners (50.6%, P = 0.000). Perception score was 58.4% overall, and performances were also similar in both groups; females and southerners performed better (59.2%, P = 0.014 and 59.6%, P = 0.000, respectively). Practice score was 67.0% overall; nurses performed better (68.3% vs. 65.6%, P = 0.005) and postbasic nurses had the best score (70.9%, P = 0.000). Conclusions: Overall, our respondents' knowledge of child rights was poor. Their performances in perception and practice were good but not sufficient. Even though our findings may not apply to all health workers in Nigeria, we believe teaching child rights at various levels of medical and nursing education will be beneficial. Stakeholder engagements involving medical practitioners are crucial

Prévalence de l'infection par l'hépatite virale B et facteurs associés chez les enfants des sujets ivoiriens porteurs de l'AGHBS / Prevalence of hepatitis B infection and factors associated in children of Ivorian HBsAg carrier

Objectifs : Déterminer la prévalence de l'infection par le virus de l'hépatite B (VHB) chez les enfants (sujets contact) des sujets porteurs chroniques de l'Ag HBs (sujets index) et rechercher les facteurs associés à cette infection chez ces enfants.Patients et méthodes: il s'est agi d'étude rétrospective transversale portant sur les patients positifs pour l'Ag HBs (sujets index), dont la famille (sujets contact: conjoints et enfants) a été soumise à un dépistage systématique de l'infection par le VHB. Résultats: L'âge médian de nos 44 sujets était de 43,1 ± 7,49 ans. Le nombre moyen d'enfants par sujet index était de 2,3 ± 1,1. L'âge médian des 92 enfants était de 9,3 ± 4,55 (de 1 à 15 ans) et 43 (44,8%) étaient vaccinés contre le VHB. La fréquence de l'infection par le VHB était de 24%. Les facteurs indépendants associés à l'infection par le VHB chez les enfants étaient l'ADN du VHB pour les sujets index> 2000 UI/ml (OR = 11,5; p = 0,001), l'existence du VHB chez les deux parents (OR = 7,9; p = 0,03) et l'absence de vaccination contre le VHB chez les enfants (OR = 30,9; p = 0,003). Conclusion: La couverture vaccinale des enfants des sujets index était insuffisante. Outre la transmission verticale, le risque de transmission intrafamiliale était élevé en présence d'au moins un des trois facteurs associés

Objectives: To determine the prevalence of hepatitis B virus (HBV) infection in children (contact subjects) of chronic HBsAg (index subjects) and to investigate the factors associated with this infection in these children. Patients and methods: this was a retrospective cross-sectional study of HBsAg positive patients (index subjects), whose families (contact subjects: spouses and children) were routinely screened for HBV infection. Results: The median age of our 44 subjects was 43.1 ± 7.49 years. The average number of children per index subject was 2.3 ± 1.1. The median age of the 92 children was 9.3± 4.55 (1 to 15 years) and 43 (44.8%) were vaccinated against HBV. The prevalence of HBV infection was 24%. The independent factors associated with HBV infection in children were HBV DNA for index subjects> 2000 IU/ml (OR = 11.5; p = 0.001), the existence of HBV in both parents (OR = 7.9; p = 0.03) and no HBV vaccination in children (OR = 30.9; p = 0.003). Conclusion: Immunization coverage of children of index subjects was insufficient. In addition to vertical transmission, the risk of intrafamilial transmission was high in the presence of at least one of the three associated factors.

Tends of "Zero-dose" children aged 12-23 months in Togo from 2000 to 2017 and predictions for 2030

Guided by the principle of leaving no one behind by improving equitable access and use of new and existing vaccines, the Immunization Agenda 2030 aims, among other things, to halve the incidence of "zero-dose" at the national level. This study aimed at studying the tends of the prevalence of "zerodose" children from 2000 to 2017 and making predictions for 2030. The study consisted of secondary data analyses from the Multiple Indicator Cluster Surveys (MICS) conducted in Togo. The study population consisted of children aged 12-23 months surveyed during MICS2 in 2000, MICS3 in 2006, MICS4 in 2010 and MICS6 in 2017. The dependent variable was the "zero-dose" vaccination status (1=Yes vs 0=No). The explanatory variables were related to the child, mother, household and environment. The study generated the overall annual percentage changes (APC) and by the independent variables. As a result, the prevalence of children with "zero-dose" expected for 2030 was estimated using Excel 2013 and Stata 16.0 software. In total, 636, 864, 916 and 952 children aged 12-23 months were included for MICS2, MICS3, MICS4 and MICS7, respectively. The prevalence of "zerodose" children decreased from 37.15% in 2000 to 31.72% in 2006, then 30.10% in 2010 and 26.86% in 2017, with an overall APC= - 1.89%. The highest relative annual decrease was from 2000 to 2006. If the historical rate of decrease remains unchanged, we predict that percentage of "zero-dose" children aged 12-23 months will be 20.96% in 2030, with a decrease of 22% compared to 2017, against a target of 50%. We suggest that strengthening strategies to increase full immunization coverage of children will contribute to reducing the percentage of zero dose children. A prerequisite will be a better understanding of the predictors of the "zero-dose" phenomenon in children

Estimation of the predictive effect of body mass index-percentile on skeletal maturation in a Nigerian population

Aim: To determine the predicting effect of BMI-index percentile on the skeletal maturation of Nigerian children. Materials and Methods: A cross-sectional descriptive study. This study was conducted in a tertiary health care facility in North-Central Nigeria. Participants were children between the ages of 5-17 years consisting of 44 males and 30 females who presented in the child dental clinic over a period of eight months were recruited for the study. Skeletal maturation was assessed using the middle phalanx of the third finger (MP3), while the standard WHO growth chart specific for age (2-20 years) and sex was used for grading BMI-percentile. The unpaired t-test was used to compare mean chronological age of the various stages of MP3 according to sex. Multinomial logistic regression was used to determine the predictive effect of age, sex, and BMI percentile on pubertal growth spurt. Results: The BMI- percentile did not show a significant correlation with the pubertal growth spurt (r=0.089, p=0.448). Sex (p=0.004) and chronological age had significant (p<0.001) predictive effect on the skeletal maturation, unlike the BMI-percentile. A onepercentile increase in the BMI- percentile decreases the likelihood of healthy children to be in the peak-pubertal by 1.504 when compared to obese children (p=0.305. Conclusion: This study showed that BMI-percentile is a weak predictor of skeletal maturation. However, obese children had a tendency towards advanced skeletal maturation than healthy participants. It is therefore suggested that orthodontists should consider early implementation of jaw modification treatments among obese children.

Profil évolutif de la limboconjonctivité endémique des tropiques à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé / Gynecological cancer in oncology practice in Lomé

Introduction. La limbo-conjonctivite endémique des tropiques (LCET) est une kérato-conjonctivite allergique récidivante du jeune enfant qui s'améliore après la puberté mais peut persister. Le but de cette étude était de déterminer le profil évolutif de la LCETdans notre pratique. Méthodologie. Étude longitudinale descriptive menée dans l'unité d'ophtalmologie de l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé. Tous les dossiers de LCET reçus de janvier 2011 à décembre 2019 avec un recul d'aumoins deux ans de suivi ont été recensés. Les patients qui ont accepté de participer après apptéléphonique ont été inclus de janvier à mai 2021.Les variables d'étudeétaient: âge, sexe, acuité visuelle (AV), caractéristiques de la LCET selon Diallo, pronostic fonctionnel et anatomique en post puberté (plus de 15 ans). Résultats. Au total,30 patients (60 yeux) ont été étudiés. Le sex-ratio était de 2. La moyenne d'âge était de 15 ans ± 9 ans. Initialement, le prurit était le maitre symptôme (96,7%). Après un recul moyen de cinq ans, l'AV était utile chez tous les patients (100%) et la LCET stade 2 plus représentée (60%). Le nombre moyen de récidives était de trois. Les patients post pubertaires on eu une amélioration anatomique dans 56.7% des caset une aggravation dans 10%des casConclusion. Notre travail confirme l'amélioration post pubertaire globale de la LCET, nonobstant quelques formes graves depronosticpéjoratif pour la fonction visuelle.

Introduction. Tropical endemiclimbo-conjunctivitis (TELC) is a recurrent allergic kerato-conjunctivitis in young children which improves after puberty but may persist. The aim of this study was to determine the evolutionof TELCin our setting. Methodology. This was a longitudinal descriptive study conducted in the ophthalmology unit of the Yaoundé Gyneco-Obstetric and Pediatric Hospital. All TELC files received from January 2011 to December 2019 with a follow-up of at least two years of follow-up were identified. Patients who agreed to participate after a phone call were included from January to May 2021. The variables of interest were: age, sex, visual acuity (VA), TELC classification according to Diallo, functional and anatomical prognosis in post puberty (more than 15 years).A totalof30 patients (60 eyes) were recruited. The sex ratio was 2. The average age was 15 ± 9 years. Initially, pruritus was the main symptom (96.7%). After an average follow-up of five years, VA was usefulin all patients (100%) and TELCstage 2 was the most frequent stage (60%). The mean number of recurrences was three. Postpubertal patients had anatomical improvement in 56.7% of cases and worsening in 10%of cases. Conclusion. Our study confirms the overall postpubertal improvement ofTELC, except some serious forms with poor prognosis ofvisual function

Aspects épidémiologiques des enfants diabétiques perdus de vue à Abidjan / Epidemiological aspects of children with diabetes lost to follow-up at Abidjan

Introduction. Ces vingt dernières années, on assiste à une augmentation spectaculaire du nombre de cas de diabète de type 1 avec une mortalité plus élevée en Afrique Noire en lien avec les difficultés d'accès aux soins, à la rupture de suivi engendrant un nombre élevé de perdus de vue. L'objectif du travail est de déterminer le profil épidémiologique des enfants diabétiques perdus de vue dans notre pratique. Patients et méthodes. C'est une étude transversale à visée descriptive et analytique qui a concerné les enfants diabétiques perdus de vue de 2002 à 2019 dans le service de diabétologie du CHU de Yopougon. Résultats. Durant l'étude 195 enfants ont été suivi dans le service, 90 ont été considérés comme perdus de vue soit une fréquence de 46,15 %. L'âge moyen des perdus de vue était de 14,6 ± 5,3 avec des extrêmes allant de 2 à 20 ans. Ils sont majoritairement de sexe F dans 50,6 %. Dans 37 % on retrouve un niveau socio-économique faible calculé selon l'indice IPSE avec une association statistiquement significative entre les classes socio-économiques moyenneinferieure et moyenne (p respectivement < 0,01 et 0,001). La plupart des perdus (84,5 %) n'ont pas d'assurance maladie. Le lieu de résidence était urbain (Abidjan) dans 73 %. Ils ont issus d'une famille biparentale dans 79 ,8 % des cas. Une association statistiquement significative a été retrouvée entre la non-scolarisation et la perte de vue (P < 0,05).Conclusion. Le manque de suivi chez les enfants diabétiques a des conséquences drastiques sur le pronostic de la maladie au long cours, marqué par une mortalité de 11 % qui touche essentiellement les populations à revenu faible

Introduction. Over the past twenty years, there has been a spectacular increase in the number of cases of type 1 diabetes with a higher mortality rate in Black Africa due to difficulties in accessing care but also a lack of follow-up resulting in a high number of people being lost to follow-up. Our work aims to determine the epidemiological profile of diabetic children lost to follow-up. Patients and methods. This was a cross-sectional study with descriptive and analytical aims which concerned diabetic children lost to follow-up from 2002 to 2019 in the diabetes department of the University Hospital of Yopougon. Results. During the study period, 195 children were followed up in the department, 90 were considered as lost to follow-up, i.e. a frequency of 46.15%. The average age of the lost to follow-up was 14.6 ± 5.3 years with extremes ranging from 2 to 20 years. The majority of them were male (50.6%). Thirty-seven percent had a low socioeconomic level calculated according to the IPSE index, with a statistically significant association between the lowermiddle and middle socioeconomic classes (p < 0.01 and 0.001 respectively). Most of the lost (84.5%) did not have health insurance. The place of residence was urban (Abidjan) in 73%. They came from a two-parent family in 79.8% of cases. A statistically significant association was found between non-education and loss of sight (P < 0.05). Conclusion. The lack of follow-up in diabetic children has drastic consequences on the prognosis of the disease in the long term marked by a mortality of 11% which affects mainly low-income populations.

Recovering from COVID lockdowns: Routine public sector PHC services in South Africa, 2019 - 2021

Background. In a previous article on the impact of COVID-19, the authors compared access to routine health services between 2019 and 2020. While differential by province, a number of services provided, as reflected in the District Health Information System (DHIS), were significantly affected by the pandemic. In this article we explore the extent to which the third and fourth waves affected routine services. Objectives. To assess the extent to which waves 3 and 4 of the COVID-19 pandemic affected routine health services in South Africa, and whether there was any recovery in 2021.Methods. Data routinely collected via the DHIS in 2019, 2020 and 2021 were analysed to assess the impact of the COVID-19 pandemic and extent of recovery. Results. While there was recovery in some indicators, such as number of children immunised and HIV tests, in many other areas, including primary healthcare visits, the 2019 numbers have yet to be reached ­ suggesting a slow recovery and continuing impact of the pandemic. Conclusions. TheCOVID-19 pandemic continued to affect routine health services in 2021 in a number of areas. There are signs of recovery to 2019 levels in some of the health indicators. However, the impact indicators of maternal and neonatal mortality continued to worsen in 2021, and if interventions are not urgently implemented, the country is unlikely to meet the Sustainable Development Goals targets

Association of intestinal helminthic infection and nutritional status of primary school children in Gombe State, Nigeria

Background: Intestinal helminthic infections are among the commonest infections worldwide. It often affects the poorest communities and has similar geographic distribution with malnutrition. Intestinal helminthic infection contributes to undernutrition through subtle reduction in digestion and absorption of food, chronic inflammation and loss of nutrients. The objective of this study is to determine the prevalence of intestinal helminthic infection and its relationship with nutritional status of primary school children in Gombe, Gombe State, Nigeria. Methodology: This was a cross sectional study of 350 pupils selected through multistage random sampling technique from 24 primary schools in Gombe, Gombe State, Nigeria from July 2018 to January 2019. Demographic information including age, gender, height, and weight were collected from each participant with a designed collection form. The data were analysed using SPSS version 24.0, and presented as frequency distribution and mean ± SD. The Chisquare test (with Odds ratio and 95% confidence interval) was used to test for association between prevalence of helminthiasis and factors such as gender, age group and school type. A p value of less than 0.05 was considered statistically significant at 95% confidence interval. Results: The prevalence of intestinal helminthic infection was 23.7% (83/350). Eighty (96.4%) of the 83 infected pupils were in public schools while only 3 (3.6%) were in private schools (p<0.001). The prevalence of helminthiasis was significantly higher in underweight pupils (34%, OR=2.113, p=0.0065)) and significantly lower (5.4%, OR=0.1637, p=0.0037) in overweight pupils while the prevalence was not significantly associated with normal weight (p=0.5482) or obesity (p=1.000). Conclusions: Intestinal helminthic infection is a public health problem in children with adverse significant relationship with nutritional status. Provision of toilet facilities in schools and periodic de-worming of pupils aimed at reducing loss of nutrients from intestinal helminthiasis are recommended.

Les avulsions dentaires au cours du traitement orthodontique à Conakry / NA

En orthodontie, l'extraction des dents saines tient une place importante parmi les moyens thérapeutiques, pour le rétablissement d'une denture fonctionnelle et esthétique. Objectifs : les objectifs étaient de déterminer la fréquence des avulsions au cours du traitement orthodontique, répertorier les types d'anomalies orthodontiques qui nécessitent des extractions dentaires et identifier les dents les plus couramment extraites. Méthodes. il s'agit d'une étude prospective de type descriptif, effectuée au service d'odontostomatologie et de chirurgie maxillofaciale de l'hôpital national Donka, CHU de Conakry sur la période d'août 2019 à avril 2020. Résultats : trois cent patients ont été examinés, 31 présentaient des anomalies orthodontiques dont les traitements nécessitaient des extractions dentaires pilotées, soit une fréquence de 10,33%. L'âge moyen était de 11 ans. Le sex-ratio était de 1,21 en faveur du sexe masculin. L'encombrement antérosupérieur était l'anomalie la plus fréquente (58,06%), les incisives temporaires étaient les dents les plus intéressées par les extractions avec 41,18%. Conclusion. La maitrise des indications, du moment et des séquences d'extractions à but orthodontique constitue l'élément clé dans la prise en charge des anomalies orthodontiques en omni pratique.

Factors associated with smoking and transitioning to nyaope injection amongst women in the City of Tshwane Municipality: A self-report by women

Background: Substance use disorder has emerged as a key health and social challenge in South Africa (SA). It is projected that about 15% of South African youth, especially young women are prone to engage in drug use and the prospects of coming into contact with nyaope, a highly addictive drug, are higher. Nyaope is mainly smoked, but the prevalence of injecting it is increasing in most regions. Aim: This study aimed to explore and describe the perception of women, who use nyaope, about the factors contributing to nyaope smoking and transitioning to injecting nyaope amongst women in the City of Tshwane Municipality (CoT), Gauteng. Setting: The research was conducted within Community Oriented Substance Use Programme sites across the CoT Municipality. Methods: Qualitative research methods were utilised to explore and describe the perceptions of the participants on factors contributing to the use of nyaope amongst women residing in the CoT. Data were collected through face-to-face interviews and thematically analysed. Results: Intimate partner influence (IPI), peer pressure, being misled by friends, weight loss, lack of effective coping mechanisms and counteracting other drugs contributed to women smoking nyaope. Additionally, a need for an intense high, IPI, influence by the social network, curiosity and cost-effectiveness contributed to women transitioning from smoking to injecting nyaope. Conclusion: The study has established factors contributing to smoking and transition to injecting nyaope as viewed by women residing in the CoT.

Early detection of acute renal lesions by serum cystatin C in children at hospital and university Centre of Brazzaville

Acute Kidney Injury (AKI) is considered one of the main public health problems. The effective management of these alterations is based on the early detection of renal lesions. The objective of this study was to evaluate the contribution of the Cystatin C (CysC) assay in the early diagnosis of acute kidney injury (AKI) in children hospitalized in pediatric intensive care units in Brazzaville. MATERIALS AND METHODS Sixty children at high risk of developing AKI were included. Consent form signed was obtained from parents, socio-demographic data, weight and height of children recorded. Creatinine (Cr), CysC and urea were assayed in serum 24 hours after admission. Glomerular filtration clearance was estimated using serum creatinine and CysC. Glomerular filtration rate (GFR) was calculated from CysC and Cr. The diagnostic accuracy was determined by comparing the results of CysC to those of Cr (considered as a reference biomarker). RESULTS The median age was 5 years (with extremes ranging from 1 month to 17 years). Cr, CysC, urea, and GFR/Cr (mean ± standard deviation [range]) were 0.94±1.17 (0.2­ 1.4 mg/dl), 0.14 ± 0.062 (0.053-0.095 mg/l), 46.65±47.75 (15.0­45.0 mg/dl), 81.85±31.90 (≥190 ml/min per 1.73 m2 , respectively. The level of CysC in patients with ARL was significantly higher than that of children with normal renal function (p<0.001). Our results show that the performance of serum CysC in detecting AKI early was superior to that of serum Cr in children hospitalized in pediatric intensive care units in Brazzaville