Déterminants du risque élevé de transmission du VIH de mère à l'enfant dans quatre hôpitaux du Bénin / NA

Introduction : L'objectif actuel est l'élimination de la transmission du VIH de la mère à l'enfant. Ce travail vise à identifier les déterminants des hauts risques d'exposition au VIH chez les nouveau-nés de mère infectée au VIH. Méthodologie : Il s'agissait d'une étude transversale, descriptive et analytique ayant porté sur les enfants à risque élevé d'exposition au VIH, suivis dans les services de pédiatrie de quatre hôpitaux universitaires au sud du Bénin pendant la période de septembre 2018 à septembre 2020. Résultats : Sur 888 nouveau-nés exposés au VIH et admis dans la période, 123 étaient à haut risque, soit une fréquence hospitalière de 13,9%. La majorité des mères (88,6%) vivait en couple. L'allaitement maternel exclusif protégé était le principal mode d'alimentation (77,2%). La plupart des nouveau-nés (73,2%) avait été mis sous ARV dans les 24 premières heures de vie. Le protocole thérapeutique utilisé n'était pas celui recommandé chez 15,5% des enfants et se faisait avec une monoprophylaxie NVP. Les ruptures d'ARV (AZT) avaient été observées périodiquement sur les sites. L'infection au VIH avait été confirmée chez cinq enfants soit 7 % des nouveau-nés classés haut risque dépistés. Les déterminants retrouvés sont le dépistage tardif au troisième trimestre (OR : 4,447 ; IC à 95% : 0,342-57,785), le déni de la maladie par la mère (OR : 9,763 ; IC à 95% : 1,098-86,835), le délai tardif de démarrage des ARV chez la mère (OR : 5,386 ; IC à 95% : 0,333-87,028). Conclusion : Cette étude nous a permis d'identifier les principaux déterminants à haut risque de transmission du VIH de la mère à l'enfant. Dans l'objectif de l'ETME il urge d'en tenir compte afin d'améliorer la prise en charge du couple mère-enfant.

Introduction: The current objective is to eliminate mother to child HIV transmission. This work aims at identifying the determinants of high risks of HIV exposure of newborns to HIV-infected mothers. Methodology: This was a transverse, descriptive and analytical study of infants at high risks of exposure to HIV, followed in the pediatric departments of four university hospitals in southern Benin from September 2018 to September 2020. Results: Out of 888 newborns exposed to HIV and admitted during the period, 123 were at high risk, meaning a hospital attendance of 13.9%. The majority of mothers (88.6%) lived with a partner. Protected exclusive breastfeeding was the main mode of feeding (77.2%). Most of the newborns (73.2%) had been put on anti-retro-viral drugs (ARVs) within the first 24 hours of life. The treatment protocol used was not that recommended for 15.5% of infants and was done with NVP monoprophylaxis. ARV supply shortages (AZT) had been observed periodically at the study sites. HIV infection had been confirmed for five infants, representing 7% of high-risk infants tested. The determinants found are late screening in the third trimester (OR: 4.447; 95% CI: 0.342-57.785), denial of the disease by the mother (OR: 9.763; 95% CI: 1.098-86.835), late start of ARVs treatment for the mother (OR: 5.386; 95% CI: 0.333 - 87.028). Conclusion: This study identified the major determinants of high risk of mother-to-child transmission of HIV. In line with the ETME, these could be considered to improve the care of the mother-child couple

Prevalence of hemoglobin abnormalities in an apparently healthy population in Benin

ABSTRACT Background: Sickle cell disease is the most common monogenic disorder in humans and is a major public health concern in sub-Saharan Africa. In Benin, the prevalence of sickle cell disease is estimated to be 4.8%. Our study aimed to describe the prevalence of hemoglobin abnormalities in an apparently healthy Benin population. Methods: One thousand four hundred and eighty-three men and women, apparently in good health after medical screening, were tested for hemoglobin abnormalities by hemoglobin electrophoresis and the Emmel test. Subjects who were found to have homozygous or double heterozygous hemoglobin abnormalities, were re-sampled and a confirmation hemogram and hemoglobin electrophoresis test by capillary electrophoresis was performed. Results: Our study population was predominantly male (97.7%) with an average age of 21.3 years. 1390 subjects reported that they did not know their hemoglobin electrophoresis status. Hemoglobin electrophoresis profiles found were as follows: 1077 (72.6%) AA (normal), 238 (16.1%) AS, 161 (10.9%) AC, 3 (0.2%) SC, 4 (0.2%) CC and 0 (0%) SS. The 406 subjects with abnormal hemoglobin had balanced somatic growth, with general physical examination results showing no abnormalities. In the seven subjects with major sickle cell syndrome or hemoglobinosis (SC and CC), their values of various hemogram parameters were normal apart from the discreet presence of microcytic anemia. Conclusion: Our study highlights the need for increased routine testing of hemoglobin abnormalities and newborn screening for sickle cell disease in order to enhance early disease detection, prevention and comprehensive care.