[Perinatal asphyxia and acute renal insufficiency in Ouagadougou]. / Asphyxie périnatale et insuffisance rénale aiguë à Ouagadougou.

AIM: This study aimed to analyze acute renal failure in perinatal asphyxia (PNA) of term newborns in a sub-Saharan urban health center. PATIENTS AND METHODS: The study was prospective, conducted from 1st June to 30th November 2013 on term newborns hospitalized at the centre hospitalier universitaire pédiatrique Charles-de-Gaulle for PNA. Renal insufficiency (RI) was defined by a serum creatinine greater than or equal to 90 µmol/L. RESULTS: Eighty-five PNA cases were included, or 19.8% of newborns hospitalized in the study period. The sex ratio was 2.1. Thirty-eight newborns (44.7%) had RI. Their creatinine averaged 153.8±96.6 µmol/L. Twenty-six of 38 (68.4%) had brain damage in Sarnat stage 2 and 12 (31.6%) stage 3. Twelve newborns with RI (31.6%) had seizures. Transfontanellar echography revealed an abnormality in 30 cases (78.9%) of RI. Of the 38 newborns with renal failure, albuminuria was found in 21 cases (65.2%) and leukocyturia in 28 cases (73.7%). Renal function improved in 86.1% of cases. Newborns with initially normal serum creatinine had no RI during hospitalization. Six newborns (7.1%) died. CONCLUSION: This study showed that acute RI is common during PNA most particularly in newborns with severe neurological impairment. In our context, earlier support for women in labor could help prevent PNA and therefore newborn acute RI.

Morbidité et mortalité de l'infection à virus de l'immunodéficience humaine chez l'enfant en milieu hospitalier à Ouagadougou (Burkina Faso)

Introduction : La pandémie de l'infection à virus de l'immuno-déficience humaine demeure une préoccupation majeure dans notre pays, menaçant l'atteinte des objectifs du millénaire pour le développement. Notre étude avait pour objectif d'analyser les aspects épidémiologiques, cliniques et évolutifs des enfants infectés par le virus de l'immunodéficience humaine et sous anti-rétroviraux dans un pays en développement. Patients et méthodes : Il s'est agi d'une étude transversale réalisée du 1er avril au 31 décembre 2010 chez des enfants suivis au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou. Résultats : Nous avons observé 27 enfants dont 26 infectés par le VIH type 1 soit 0,87% des hospitalisations, avec un sex-ratio de 1,25 et un âge moyen de 6,75 ans ; 30% des patients avaient un recul de plus d'un an sous traitement antirétroviral et un seul patient était sous un régime de 2ème ligne. Les principaux motifs d'hospitalisation rapportés étaient : les signes digestifs (67%), la fièvre (55%) et les signes respiratoires (26%). Les pathologies observées étaient surtout d'ordre infectieux (60%), dominées par le sida pédiatrique (33%), le paludisme (15%) et la méningite (11%). Dans 72,5% des cas, l'évolution clinique a été favorable ; 18,5% de décès ont été observés avec 2/3 (75%) de nourrissons. Les principaux facteurs associés au décès étaient les stades cliniques 3 et 4 de la maladie (p < 0,02). Conclusion : La morbidité et la mortalité liées au VIH pédiatrique restent élevées dans les pays à ressources limitées, malgré les traitements antirétroviraux. L'amélioration de cette situation passe par le renforcement des mesures de prévention de la transmission mère enfant du virus de l'immunodéficience humaine

[Living conditions, nutritional status and morbidity in children in prisons and detention centers in Burkina Faso]. / Conditions de vie et morbidité des mineurs détenus dans les maisons d'arrêt et de correction du Burkina Faso.

In Burkina Faso, although children are sometimes separated from adults in prisons, they still live in the same conditions of overcrowding, which can reach 180% of the capacity. The aim of our study was to describe living conditions, nutritional status, and morbidity of children in detention centers of Burkina Faso. The objective of this cross-sectional descriptive study is to describe the social and health conditions of children held in 20 detention centers in Burkina Faso. During the study period, 109 children, with a mean age of 16.3 years, were examined in 20 correction centers. The main reason for incarceration was theft (66% cases, n = 72). Detention exceeded more than one month for 76 children (70%), and 59% (N = 46) had had fewer than one visit per month since their incarceration. Of these 20 facilities, 6 had no separate quarters for children. The main symptoms and diseases encountered in these children were fever in 19% of the cases (N = 16), macroscopic hematuria in 13% (N = 11), urinary tract infection in 12% (N = 10) and diarrhea in 12% (N = 10). These results show that there is a need to take preventive measures to protect these children's health, especially by improving the quality of living conditions in detention center.

[Prevalence of albuminuria in children from 5 to 15 years in the town of Kaya (Burkina Faso)]. / Prevalence de l'albuminurie chez des enfants de 5 a 15 ans de la ville de Kaya (Burkina Faso).

INTRODUCTION: Albuminuria, an important marker of kidney damage, is still insufficiently studied in sub-Saharan Africa. The aim of this study is to describe the epidemiology of albuminuria in the town of Kaya in Burkina Faso. METHODS: We conducted a cross-sectional study in the town of Kaya. Simple random sampling was done. It concerned all households with children 5-15 years old of urban area of the town of Kaya. Selected children or their parents were interviewed. Anthropometric measurements and urinary samples were performed. RESULTS: Two hundred six children (113 girls and 93 boys) participated in the study. Albuminuria was found in 18 children whether 8.7% of cases. The mean systolic and diastolic blood pressures of children with albuminuria (107.2 ± 13.6 and 74.7 ± 11.4 mm Hg) were not significantly different from those of children without albuminuria (110.3 ± 14 and 73.1 ± 11.5 mmHg). Sociodemographic factors were not associated with the occurrence of albuminuria in children. DISCUSSION: The prevalence of albuminuria in the strip involved nearly a tenth of children, which is important. CONCLUSION: The results of this study are a first population database of kidney disease in the country. The study should be completed by the identification of cases of persistent albuminuria in this population.

INTRODUCTION: L'albuminurie, important marqueur d'atteinte rénale, est encore insuffisamment étudiée en Afrique subsaharienne. Par la présente étude, nous voulons connaître l'épidémiologie de l'albuminurie dans la ville de Kaya au Burkina Faso. MÉTHODES: Nous avons mené une étude transversale dans la ville de Kaya. Un échantillonnage aléatoire simple a été effectué à partir d'une base de sondage constituée par l'ensemble des ménages ayant des enfants de 5 à 15 ans du milieu urbain de la ville de Kaya. Les enfants sélectionnés ou leurs parents ont été interviewés. Les mesures anthropométriques et des prélèvements urinaires ont été effectués. RÉSULTATS: Deux cent six enfants (113 filles et 93 garçons) ont participé à l'étude. L'albuminurie a été trouvée chez 18 enfants soit 8,7% des cas. Les moyennes des pressions artérielles systolique et diastolique des enfants avec albuminurie (107,2±13,6 et 74,7±11,4 mm Hg) n'étaient pas significativement différentes de celles des enfants sans albuminurie (110,3±14 et 73,1±11,5 mm Hg). Les facteurs sociodémographiques n'étaient pas associés à la survenue de l'albuminurie chez l'enfant. DISCUSSION: La prévalence de l'albuminurie à la bandelette a concerné près d'un dixième des enfants, ce qui est important. CONCLUSION: Les résultats de cette étude constituent pour le pays une première base de données en population sur la maladie rénale. L'étude doit être complétée par l'identification des cas d'albuminurie persistante dans cette population.

[Infectious Etiologies of the acute diarrheas of the child from 0 to 5 years at the Pediatric University hospital Charles de Gaulle (Ouagadougou, Burkina Faso)]. / Etiologies infectieuses des diarrhees aiguës de l'enfant de 0 a 5 ans au centre Hospitalier Universitaire Pediatrique Charles de Gaulle (Ouagadougou, Burkina Faso).

To identify the infectious agents responsible for acute diarrheas in children from 0 to 5 years, with the aim of improving care, we led a cross-sectional prospective study at the Pediatric University hospital Charles de Gaulle from January 1st - November 30th, 2009. A sample of 103 children's stools hospitalized for acute diarrhea was analyzed. The average age of the patients was of 9.5 months and the most affected age bracket was the one from 0 to 12 months. More than half of the cases of diarrheas (60.2%) had an infectious etiology of which 33% of viral origin, 21.4% bacterial, 9.7% parasitic and in 9.7% of the cases a co-infection. In the viral diarrheas, rotavirus was observed in 17.5% of the cases and serotypes adenoviruses 40, 41 in 15.5% of the cases. The isolated bacteria were essentially represented by enteropathogenic Escherichia coli (21 cases). This bacterium had a strong resistance to amoxicillin, cotrimoxazole (90%) as well as in the amoxicillin+Clavulanic acid (57%). The ascendancy of rotavirus in the etiology of the acute diarrheas of children from 0 to 5 years hints to a need for vaccination against this infectious agent. Aside from the ineffectiveness of group A penicillins and of the cotrimoxazole against most of the isolated bacteria calls to medical prescribers to reconsider antibiotic treatment in the diarrheas of the children.

Afin d'identifier les agents infectieux responsables des diarrhées aigues chez les enfants de 0 à 5 ans, dans le but de mieux les prendre en charge, nous avons mené une étude prospective transversale au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle du 01 janvier au 30 novembre 2009. Un échantillon de 103 selles d'enfants hospitalisés pour diarrhée aigue a été analysé. L'âge moyen des patients était de 9,5 mois et la tranche d'âge la plus touchée était celle de 0 à 12 mois. Plus de la moitié des cas de diarrhées (60,2 %) avaient une étiologie infectieuse dont 33% d'étiologie virale, 21,4 % bactérienne, 9,7% parasitaire et dans 9,7 % des cas il y avait une co-infection. Dans les diarrhées virales, les rotavirus ont été observés dans 17,5 % des cas et les adénovirus serotypes 40, 41 dans 15,5 % des cas. Les bactéries isolées étaient représentées essentiellement par Escherichia coli entéropathogène (21 cas). Cette bactérie avait une forte résistance à l'amoxicilline, au cotrimoxazole (90 %) ainsi qu'à l'amoxicilline+Acide clavulanique (57 %). La prépondérance du rotavirus dans l'étiologie des diarrhées aiguës de l'enfant de 0 à 5 ans commande la promotion de la vaccination contre cet agent infectieux. Par ailleurs l'inefficacité des pénicillines du groupe A et du cotrimoxazole contre la plupart des bactéries isolées interpelle les prescripteurs à la rationalisation de l'antibiothérapie dans les diarrhées des enfants.

[Prevalence of proteinuria in children followed-up for HIV infection at Pediatric University Hospital Charles-de-Gaulle (CHUP-CDG) of Ouagadougou]. / Prévalence de la protéinurie chez les enfants suivis pour infection à VIH au centre hospitalier universitaire pédiatrique Charles-de-Gaulle (CHUP-CDG) de Ouagadougou.

In subjects infected with HIV, proteinuria could represent a marker of HIV associated nephropathy (HIVAN), the most important cause of chronic renal failure in them. To determine the prevalence of proteinuria in children with HIV infection and to improve the screening of renal disease for these children in our country, we conducted a descriptive cross-sectional study over a 3-month period. We included 122 children (0-14 years old) with HIV infection followed at CHUP-CDG. Proteinuria was calculated using the first morning urine sample by dipstick test (significant for a "+" or more). Statistical tests were significant for p < 0.05. The 122 children (121 HIV1 and 1 HIV2) comprised of 64 boys and 58 girls. Eighteen (14.8%) (14 boys and 4 girls) had proteinuria (1 or 2 "+"). The mean age of patients with proteinuria was 10.4 ± 3.3 years. None of the children were hypertensive. All were infected with HIV1. Proteinuria was associated with microscopic hematuria in six cases. The average CD4 count was 21 ± 8% versus 23 ± 10% in 42 patients without proteinuria (p = NS). The mean serum creatinine in patients with proteinuria was 47 ± 29 µmol/l. Three of them had acute renal failure. All patients with proteinuria had antiretroviral treatment (ARV) since 40 ± 24 months versus 36 ± 26 months in 98 patients without proteinuria. No treatment included tenofovir, indinavir, or converting enzyme inhibitor. The prevalence of proteinuria in our sample is lower than that reported by other African writers in untreated subjects. This fact suggests a nephroprotection of ARV in our patients probably treated early and effectively. However, microalbuminuria, a possible early marker of HIVAN, has not been evaluated by our study. Studies of the prevalence of microalbuminuria in children infected with HIVand treated with ARVs in Sub-Saharan African countries should be encouraged. They would help to determine the relevance in these children of research routinely of microalbuminuria and to screen and precociously take care of a possible HIVAN or other chronic glomerulopathy.

Profil de l'hypertension arterielle de l'enfant en milieu hospitalier pediatrique a Ouagadougou (Burkina Faso)

La frequence de l'hypertension arterielle (HTA) chez l'enfant en milieu hospitalier n'est pas connue au Burkina Faso. Il s'agit d' une etude retrospective de 23 dossiers d'enfants hospitalises pour HTA sur une periode de 9 ans (1er janvier 2002 au 31 decembre 2010) dans notre service afin de decrire les caracteristiques de l'hypertension arterielle de l'enfant ; l'HTA a ete definie selon la classification de la Societe Francaise de Nephrologie Pediatrique. La moyenne annuelle de cas d'HTA etait de 2 a 3 enfants . Le sex-ratio a ete de 1;3 et l'age moyen de 10 ans (extremes = 4 et 14 ans). Les motifs d'admission ont ete domines par les odemes (69;60);; les douleurs abdominales (65;2) et l'asthenie (56;5). L'HTA a ete classee confirmee dans 39;13; maligne dans 30;40 et limite dans 30;40 des cas. L'HTA a ete associee a une anemie dans 82;60 des cas. Les etiologies etaient surtout d'origine renale (87;10); dominees par le syndrome nephrotique impur (34;89). Tous les patients ont recu un traitement diuretique en association avec les inhibiteurs calciques (30;40); les inhibiteurs de l'enzyme de conversion (17;40) et les antihypertenseurs centraux dans (4;30). L'evolution a ete favorable chez 52;20 des patients ; 39;20 des patients ont ete transferes dans le service d'hemodialyse ; un enfant etait decede dans le service .L'HTA confirmee est plus frequente ; la principale etiologie etait le syndrome nephrotique impur

[Tuberculosis in children infected with HIV followed at Charles de Gaulle pediatric university hospital of Ouagadougou (Burkina Faso)]. / Tuberculose Chez Les Enfants Infectes Par Le Vih Suivis Au Chu Pediatrique Charles De Gaulle De Ouagadougou (Burkina Faso).

AIMS: To study the epidemiological aspects, diagnosis and outcome of tuberculosis in children infected with HIV at the University Hospital Pediatric Charles de Gaulle, Ouagadougou. MATERIAL AND METHODS: We conducted a retrospective chart review of children under 15 years followed from 2002 to 2008 for HIV infection. RESULTS: The incidence of tuberculosis was 5.5%. The average patient age was 5 years with a female predominance of 63.6%. Prolonged fever, chronic cough and weight loss were the main reasons for consultation. Pulmonary tuberculosis was the most frequent clinical form with 11 cases. The contribution of the direct smear was low: 13.6%. At the radiological images of miliary (36.4%) were the most frequently encountered followed by non-parenchymal opacities systematized (31.8%). The lethality of co-infection TB-HIV was 18.2%. The prognostic factors were younger age, severe immunosuppression and orphan status or total mother. CONCLUSION: Early detection of HIV infection in children and the capacity of TB diagnosis should improve the management of co-infection in a pediatric setting.

[Failure of first-line antiretroviral therapy in HIV-infected children in Ouagadougou, Burkina Faso]. / Echecs du traitement antirétroviral de première ligne chez les enfants infectés par le VIH à Ouagadougou (Burkina Faso).

Approximately one-fourth of the estimated 10,000 HIV-infected children in Burkina Faso are undergoing antiretroviral (ARV) therapy. At the Charles de Gaulle Pediatric Hospital Center in Ouagadougou, Burkina Faso, Support for ARV therapy began in July 2003 and a total of 250 children were undergoing treatment in late 2007. The purpose of this retrospective case-control study conducted over a period of 54 months from July 2003 to December 2007 was to investigate cases involving failure of first-line ARV therapy in particular with regard to cause. All patients (n = 32) showing poor virological, immunological, and/or clinical response to ARV therapy were considered as failures and thus included in the case group. The control group (n = 160) consisted of patients with good responses to treatment. Cases and controls were compared using the Chi-square test and odds ratio (OR) technique with a confidence interval at 95%. The failure rate was 12.8%. Failure was significantly correlated with low socioeconomic level (OR = 3), orphan status (OR = 4), age over 10 years (OR = 5), male gender (OR = 3), baseline viral load > or = 1,000,000 copies/mL (OR = 9), and poor compliance (OR = 37). Mortality in children who failed to respond to first-line ARV therapy was 25% due to the unavailability of a national second-line ARV therapy program. This study underlines the need for patient education to promote compliance and for creation of reference centers to prescribe ARV therapy to HIV-infected children including second-line ARV and genotyping.

[Factors contributing to smoking among students in Ouagadougou (Burkina Faso)]. / Facteurs favorisant le tabagisme des élèves à Ouagadougou (Burkina Faso).

INTRODUCTION: Smoking is of great concern to the international community because of the sharp increase in tobacco consumption among adolescents. MATERIAL AND METHODS: We conducted a transverse descriptive study on 23 to 27 May 2006, on a sample of 500 smoking students randomly selected from secondary schools in the city of Ouagadougou, to identify their motivation with the aim of prevention. RESULTS: The main factors encouraging smoking among students were: *Economic conditions: 64% came from a favourable economic environment with daily pocket money (100%) and a means of travel (74.8%). *Difficulties with their studies: 57.2% of smoking students had repeated at least one class and half had a class average lower than 10/20. *A smoking environment: 72% of smokers lived away from their parents, 46% of students had smoked in imitation of their colleagues. School was the preferred place for the consumption of cigarettes (67.9%). *The influence of the media: 80.8% were drawn into smoking by the influence of advertising. CONCLUSION: Prevention programmes must take all these factors into account.

Analyse situationnelle de l'unite de consultation de pediatrie medicale du CHU de Yopougon

Dans l'organisation des soins aux enfants; les structures sanitaires de 2eme niveau de reference doivent fournir des prestations de qualite. Le constat de la degradation progressive du plateau technique et de l'insatisfaction de certains utilisateurs de services du CHU de Yopougon nous ont incites a entreprendre l'Analyse Situationnelle de l'unite de consultation de Pediatrie Medicale afin de decrire le niveau de ses activites; sa capacite fonctionnelle et la qualite des prestations fournies.Le niveau des activites de l'unite est en baisse progressive. Cette reduction est de moins 40pour cent pour les consultations et de moins 45pour cent pour les vaccinations;Le materiel et l'equipement necessaires pour des prestations de qualite font defaut;Les ruptures de stocks de vaccins sont frequentes et il n'existe de visite de supervisionPour la qualite des services; malgre le temps d'attente trop long du au debut tardif des consultations; toutes les meres ont ete satisfaites de leur visite.Une rehabilitation du plateau technique et une redynamisation des activites du service sont donc necessaires pour l'amelioration des prestations fournies aux enfants

[Pleuropulmonary staphylococcal infection in infants, in a hospital environment in Ouagadougou (Burkina Faso)]. / La staphylococcie pleuro-pulmonaire du nourisson en milieu hospitalier à Ouagadougou (Burkina Faso).

We observed 36 cases of pleuropulmonary staphylococcal infection (PPS) in infants aged 0 to 30 months, during a prospective study carried out between April 1st 1995 and March 31 1996 at the Pediatrics Department of Ouagadougou University Hospital. PPS accounted for 0.5% of all hospital admissions and 11.6% of all acute basal respiratory infections in children aged less than 30 months. Slightly more boys than girls were affected, with a sex ratio of 1.2. We identified the classic triad of symptoms: cough-fever-polypnea, associated with abdominal ballooning and a change in general condition. On X rays, the typical images showing parenchymatous bubbles were the second most frequent observation (27.8%) after parenchymatous opacities (69.5%). The most frequently used antibiotics were oxacillin (Bristopen), gentamycin (Gentallin) and cefuroxime-axetil (Zinnat). The prognosis of PPS is poor, with a high mortality rate (27.8%) and a risk of pleural recurrence. Being very young, late hospitalization, malnutrition and leukopenia were identified as factors indicating a poor prognosis. Recygling of health care personnel for the management of acute respiratory infections, a decrease in malnutrition and an improvement in vaccination cover are essential if the mortality and morbidity of acute respiratory infections, and PPS in particular, are to be reduced.