[Computerized temperature monitoring of the vaccine cold chain in a tropical climate, Chad]. / Surveillance informatisée de la chaîne du froid en milieu tropical (Tchad).

Because new EPI liquid vaccines are highly sensitive to freezing and overheating, close monitoring of the cold chain is mandatory. The new Testostore 171-1 electronic thermometer (Testo) provides more reliable monitoring of cold chain temperature than freezer indicators, vaccine vial monitors and color strips that only indicate if vaccines are out-of-date. The Testo thermometer uses a probe placed in refrigeration units to periodically measure and store temperature readings. Temperature curves are displayed via a USB connection on a laptop computer running special software (Comfort software light). Testo temperature data can easily be communicated to all management levels by e-mail. The first experience using the Testo system in Africa involved regional EPI supervision in Mondou, Logone Occidental, Chad. After a preliminary mission in Chad in 2006 showed the feasibility of using this method to manage the national cold chain at all levels, a nurse was appointed as EPI supervisor and given a refresher course in Chad's capital Ndjamena in March 2009. In April-May 2009, the supervisor was sent back to the Logone Occidental Region to monitor, by himself, refrigeration units making up the regional and district cold chain for vaccine storage in five health centers (rural and urban). Temperature curve readings were performed on site in the presence of the medical staff and results were compared to those recorded twice a day on conventional temperature charts using lamellar thermometers installed in refrigerators doors. Testo curves showed that liquid vaccine storage temperatures fell below freezing too frequently and that temperatures readings of door thermometers were often inaccurate. Testo readings also detected power outages in refrigeration units used in urban settings and flame extinctions in kerosene lamp refrigerators due to refrigerator breakdown or windy weather conditions before the rainy season. The main advantage of this monitoring method is to provide reliable data as a basis not only for detection of possible freezing of liquid vaccines but also for discussion of cold chain management and improvement with medical staff.

[The unfinished agenda for child survival: what role for the integrated management of childhood illness?]. / La bataille inachevée pour la survie de l'enfant: quel rôle pour la prise en charge intégrée des maladies de l'enfant?

The endorsement by the United Nations General Assembly of the Millennium Development Goals (MDG) and the growing acknowledgment by the international community that child survival is an unfinished agenda created a new momentum for rapid scaling up of effective child health interventions. In this review, the authors discuss the environment in which child health programs are being implemented and the potential role of the integrated management of childhood illness (IMCI) strategy in country efforts to achieve the MDGs. The discussion is based on the conclusions of a multi-country analytic review of the IMCI strategy conducted jointly by DFID, UNICEF, USAID, and WHO as well as the results of another multi-country evaluation coordinated by the WHO on IMCI costs, effectiveness, and impact. The article concludes on the need to increase child health investments and on the potential importance of IMCI in improving child survival. However, the MDGs may not be reached if IMCI is not implemented in conjunction with other strategies to reduce mortality during the first days of life and to strengthen the health system. The authors also stress the need to increase research on mechanisms to scale up delivery of existing public health interventions.

[Appendicitis and advanced pregnancy. Apropos of 3 cases in the National Hospital of Niamey, Niger]. / Appendicite et grossesse avancée: à propos de 3 cas à l'Hôpital national de Niamey, Niger.

Acute appendicitis during pregnancy is uncommon but a serious situation even in developed countries with imaging and laboratories' poor means. Failure to diagnose this disease during advanced pregnancy exposes foetus and mother to serious complications. In this atypical clinical picture associated with non-significant biologic sign only using sonogram can help to early diagnosis. In our developing countries where obstetrical exam was performed by paramedical or general doctor, in doubt the patient must be transferred in medical centre with a capacity of imaging or laboratory exams. Surgical treatment must be undertaken after surgeon, obstetrician, and other physicians's consultation. Antibiotic and tocolytic treatments are urgent. In this study, all babies were lost by premature labour occurred after surgery.

[Appendicitis in Niger: current prognosis]. / Les appendicites au Niger: pronostic actuel.

Acute appendicitis remains one of the most frequent emergencies in abdominal surgery. Surgery is usually straightforward and prognosis excellent. However, outcome depends essentially on how soon diagnosis is made. In Niger, the 1990s were marked by the development of private medicine and the deterioration of services in state health structures (health centres and hospitals). The goal of this prospective study, carried out over 24 months (March 1997-March 1999) was to analyse existing appendicitis prognosis in our country. The study population was made up of 362 patients and we based our survey on a number of factors found in the medical literature, and in particular on a similar study conducted in the same hospital in 1989 by another group of surgeons. Delays in diagnosis and thus therapy still today tends to transform prognosis for simple acute appendicitis into that of peritonitis. The numerous and varied post-operative complications keep the mortality rate at 4%.

[Apropos of 2 rare severe surgical complications from the use of intramuscular and intrarectal quinine]. / A propos de deux complications chirurgicales rares graves de l'usage de la quinine intra-musculaire et intra-rectale.

Quinine by intramuscular or intrarectal injection has been found to be the best treatment for malaria in Niger, particularly in field health centres where the use of solutions can pose problems. There have been several reports of complications following injections, usually due to technical error or to the toxic side effects of quinine. In our hospital, we treated two such rare complications consisting of a case of coxal osteoarthritis induced by intramuscular injection and a case of anorectal necrotising induced by intrarectal injection. The occurrence of such life-threatening events could be reduced in frequency by teaching health personnel about techniques of quinine administration as well as its dangers.

[Spontaneous giant cephalohematoma in a 13-year-old child]. / Volumineux céphalhématome spontané chez un enfant de 13 ans.

Cephalohematoma is usually observed in the neonatal period often as a result of birthing injuries induced during difficult labor (vacuum extraction and forceps delivery). Less common causes include vascular abnormalities, aneurysm, arterial dissection, blood coagulation disturbances, and vascular wall frailty. This report describes a giant cephalhematoma with right ocular protrusion and anemia with no identifiable cause in a 13-year-old boy. Rapid recovery was achieved by surgical drainage and prompt dressing.

[Prognosis of acute intestinal intussusception in infants at the national hospital of Niamey (Niger). Eleven cases treated surgically]. / Pronostic de l'invagination intestinale aiguë du nourrisson à l'hôpital national de Niamey (Niger). A propos de 11 cas traités chirurgicalement.

In order to precise the different prognosised factors of the acute intestinal invagination of the nursling, authors hereby report results of a prospective study lead in the department of general surgery during the period of January 1989 to August 1990. Eleven nursling have been operated during that period. The study of their files showed that the standard clinical triad of the acute intestinal invagination theoretically taught in the schools of health sciences, is never definitive. The diagnostic lateness and indeed therapeutic and the lack of adequate means of pediatric resuscitation constituted the main prognosised factors of this affection. The clinical board of the patients is that of an advanced occlusion or that of a serious peritonis. The surgical operation often consisted in an intestinal resection. The immediate mortality was heavy: 55%. The authors hereby stress the necessity of a training-informing-sensitizing of the health staff in the primary sanitary facilities and the populations.

Traditional uvulectomy in Niger: a public health problem?

Although traditional uvulectomy, a procedure which consists of cutting away a part of the uvula, has been reported in several sub-Saharan African countries, in Maghreb and in Israel, epidemiological and anthropological data on this practice are rare. Severe complications may require hospitalization. The goal of this study was to assess the prevalence of this traditional procedure in Niamey, capital of Niger, the incidence of its severe complications and the beliefs and practices related to it. By the age of 5, 19.6% of the children in our survey had undergone uvulectomy. Severe complications of uvulectomy represented 7.8/1000 cases of hospitalization for children under 15 years of age. Complications were infections (including tetanus), hemorrhage and passage of the cut piece of uvula further down the respiratory tract. The children who had undergone uvulectomy belonged significantly more often to the Hausa ethnic group (66.2%) than to the majority Zarma ethnic group (18.3%) or to the other ethnic groups (15.5%). This can be explained by the fact that, in some Hausa subgroups, uvulectomy is systematically performed on the 7th day after birth, during the naming ceremony, to prevent death due to a 'swelling of the uvula'. In the other Hausa sub-groups and in the other ethnic groups, uvulectomy is solely a curative practice, both for children and adults, for vomiting, diarrhea, anorexia, the child's rejection of the breast, growth retardation and fever. Uvulectomy is performed in Niger by the barbers, whose functions are also to perform specialized surgery. These traditional surgeons claim there is no risk to this practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Randomized clinical trial comparing hospital to ambulatory rehabilitation of malnourished children in Niger.

This study compared hospital to ambulatory nutritional rehabilitation outcomes and costs. Following a hospital stay to resolve initial acute medical conditions, 100 malnourished children (54 per cent male, ages 5 to 28 months) in Niger were randomly assigned to either hospital or ambulatory nutritional rehabilitation. Anthropometric measures were assessed at 15, 30, 60, 90 and 180 days post-randomization. Following randomization, the hospital group received a mean of 12.9 days of hospital rehabilitation and 5.6 days of ambulatory rehabilitation, while the ambulatory group received 2.2 days of hospital rehabilitation and 11.9 days of ambulatory rehabilitation. No significant differences between the two study groups in mortality rates or weight gain were found. The mean cost for hospital rehabilitation was 120 per cent higher (P < 0.001) than ambulatory rehabilitation. This study was the first randomized clinical trial directly comparing hospital to ambulatory nutritional rehabilitation and suggests that ambulatory rehabilitation is more cost-effective.

Are pediatric wards in developing countries only places to die? A study of prior to hospitalization risk factors of death among 0-2 year old hospitalized children in Niamey, capital of Niger.

The 461 0-2-year-old children admitted to the paediatric ward of the National Hospital in Niamey over a 2-month period were closely followed up from admission to discharge or death. The in-hospital mortality rate was 30 per cent, a great proportion of deaths occurring during the first 24 h of hospitalization. Malnutrition was highly prevalent (76 per cent). Children referred from other health facilities (72 per cent) did not experience a higher probability of survival. Using multivariate analysis, three variables remained significantly associated with death: nutritional status, consultation of a traditional practitioner, and a neonate disease. Neonate diseases are the third major cause of death because of a high case fatality rate. For the other causes, the main underlying factor is malnutrition. Most in-hospital deaths are due to events that occurred prior to hospitalization. The role of hospitals' pediatric wards of developing countries is discussed.