[Epidemiology and outcome of Congolese children who had surgery for heart defects]. / Épidémiologie et devenir des enfants congolais opérés pour cardiopathies congénitales.

AIMS: to determine the principal heart defects for which children underwent surgery and to determine the survival rate. PATIENT AND METHODS: this retrospective cohort study involves Congolese babies treated surgically from September 1989 to September 2010 in France for congenital heart defects (through "Mécénat chirurgie cardiaque" and "Chaîne de l'espoir"). It includes only 110 of the 182 recorded patients during the study period. RESULTS: The sex ratio for the 110 subjects included in the analysis was 1. Their mean age at surgery was 77.4 ± 57.6 months old (range: 8 to 204 months). The main congenital heart defects for which surgery was performed were ventricular septal defect (21.9%), tetralogy of Fallot either isolated (22.8%) or associated with patent foramen ovale (1.8%) or coronary anomalies (1.8%), atrial septal defect associated with other malformations (8.2%), pulmonary atresia with ventricular septal defect (5.5%), aortic stenosis (3.7%), atrioventricular septal defect (0.9%), and Laubry-Pezzi syndrome (0.9%). The median length of follow-up was 42.4 ± 35.6 months (range, 3-240 months). Patients' mean age at the study's end was 121.1 ± 86.3 months (range 20-372 months). The 5-year survival rate was 90% and the 20-year survival, 83.3%. CONCLUSION: Heart surgery for congenital heart defects has improved survival.

[Priapism in children and adolescents with homozygous sickle cell disease in Brazzaville]. / Priapisme chez l'enfant et l'adolescent drépanocytaire homozygote à Brazzaville.

OBJECTIVE: To determine the prevalence of priapism, assess knowledge and appreciate its characteristics in childhood sickle cell disease. METHODOLOGY: A case-control study was conducted at the University Hospital of Brazzaville (Department of Pediatrics, Hematology and Clinical Urology). The cases consisted of 202 sickle cell anemia who are at least 5 years. Witnesses consisted of 112 children with sickle cell disease not of the same age from the same family as the previous. RESULTS: Priapism was found in 68 (34%) affected children, divided into 54 cases (79.4%) of chronic intermittent priapism and 14 cases (20.6%) of acute priapism. In the control group no cases were observed (p=0.001). Priapism was known by six (3%) patients in the group of children with sickle cell disease. In the control group, it was known by 25 (22.3%) children. It was seen in the group of sickle cell disease as any: 113 children (56%), a natural phenomenon that can occur in life: 57 children (28%), a complication of sickle cell disease: 26 children (13%). In the control group, it was considered a natural phenomenon that can occur in life: 60 children (53.6%), a complication of sickle cell disease: 52 children (46.4%). The average age of priapism occurred in the first episode was 10.4±9.5 years. CONCLUSION: The importance of the prevalence of priapism, and insufficient knowledge needed strengthening information, education and communication with children and their parents.

[Tooth decay in school environment at Brazzaville (Congo)]. / La carie dentaire en milieu scolaire a Brazzaville (Congo).

AIM: To determine the frequency of dental caries and habits that can be the cause of this disease in Brazzaville. METHODS: A prospective study was conducted in primary schools between February and May 2010. This study involved a sample of 307 students of both sexes, aged 4-15 years from school in the city of Brazzaville. RESULTS: Prevalence of dental caries was 53.4% and the index of DMFT 2.06. Use of toothbrush was 99.4%. Two children (0.7%) brushed their teeth three times a day. There was a statistical link between regularity of brushing and occurrence of caries. The prevalence of caries was of 53% in children who brushed once a day and 12.8% in those who brushed twice a day. No decay was noted in those who brushed three times a day (p = 0.001). The DMFT was 2.06 in children who used non-fluoridated toothpaste and 1.13 in those who used the fluoridated toothpaste (p = 0.002). CONCLUSION: To ensure students a better oral hygiene and healthier teeth, a module in oral health education in schools is one of the way to fight against this public health problem.

[Prescription of antibiotic drugs for children at the Brazzaville University Hospital Center (Congo)]. / Évaluation de l'antibiothérapie initiale en milieu pédiatrique au CHU de Brazzaville (Congo).

UNLABELLED: Antibiotics are a class of drugs commonly prescribed in pediatric practice, often inappropriately. OBJECTIVE: To determine the prevalence of antibiotic prescription in hospitalized children, assess the quality of prescribing, and identify factors related to inappropriate prescriptions. METHODS: This retrospective study was conducted from July through December 2009 (6 months). It included data about 464 children aged from 1 month-16 years who received antibiotic therapy. RESULTS: Antibiotics were prescribed to 61.5% of the children admitted to the hospital. Their mean age was 18.6 ± 20.2 months, and most (78%) were younger than 2 years. The indications for antibiotics were dominated by acute respiratory infections (46%), diarrhea (16%), and severe sepsis (12%). The prescriptions were written by pediatricians in 179 cases (38.6%), and by residents or interns in the other cases. The beta-lactam antibiotics (79%), aminoglycosides (8%) and sulfonamides (7%) were prescribed most often. The initial antibiotic therapy was changed in 82 cases. The indication for antibiotic therapy was correct in 325 cases and the type chosen appropriate in 229, the dosage correct in 437 cases, and the duration correct in 390. The route of administration was intravenous in 243 cases (40.3%), oral in 194 (41.8%), and intramuscular in 37 (7.9%). The qualification of the prescriber was associated with relevance, choice and dosage. The dosage was correct when the drug was administered parenterally in 248 cases (56.8%); in contrast, it was incorrect in 189 cases (43.7%; p>0.05) of oral administration. The route of administration was related to the choice of antibiotic. Thus, it was appropriate when the route was parenteral in 162 cases (70.7%) and in only 67 cases (29.3%) for the oral route (p <0.001). CONCLUSION: Errors in antibiotic prescriptions could be improved by standardized treatment guidelines, compliance with international recommendations, a consistent approach to diagnosis, and better laboratory performance.

[Discharge of children against medical advice at CHU of Brazzaville (Congo)]. / Les sorties contre avis médical en pédiatrie au CHU de Brazzaville (Congo).

In a prospective study conducted from January to December 2010 in the Teaching Hospital of Brazzaville (Congo), we compared the discharge of hospitalized children against medical advice at the parents' request (group 1 - cases) with those admitted during same period with routine discharge (group 2 - controls). Two hundred and seven (7.7%) hospitalized children, 117 boys and 90 girls, were discharged at the parents request. The mean age was 18.0 ± 13.5 months (range: 1 month-5 years). Among these patients, 150 (72.5%) children were from biparental families, and 30.9% of children were the first and/or only child of the household. Among the parents of Congolese nationality, 147 (71%) had a secondary school level education, including 66.7% of mothers and 58% of the fathers 59.9% of children were admitted between 15 and 7 hours, and 75.4% were hospitalized during working days. The duration of hospitalization did not exceed 3 days in 147 cases (71%). The main reasons for hospitalization were digestive disorders (27%), fever (16.4%), convulsions (11.1%) and anaemia (11.1%). Among patients discharged against medical advice, 34.8% left on the first day of hospitalization (72 cases), 36.7% before the start of treatment (76 cases of which 36 during check-up) and 63.3% during treatment (131 cases). The main reasons for discharge request were improvement in the clinical condition improvement (30.9% of cases), lack of money (28% of cases), supposed insufficient medical care (7.7% of cases), unsatisfactory hospitalization conditions (6.3% of cases), care of other children at home (6.3% of cases), traditional and/or religious beliefs (5.8% of cases) and disagreements with nurses (5.3%). Patients discharge against medical advice was correlated strongly with the educational level of parents, age of the child, delay of consultation, time of admission, rank of the child in family and nationality of parents. Discharge against medical advice is associated to the distrust between the patients and nurses. Improvement of hospitalization conditions in our hospitals, improvement of the socioeconomic status of Congolese and establishment of national social security seem to be the main determinants of reduction of discharge against medical advice.

[Orphans in Brazzaville orphanages]. / Situation des enfants orphelins dans les orphelinats de Brazzaville.

UNLABELLED: Children are orphaned everywhere, but their situation is particularly acute in developing countries. OBJECTIVES: To assess the epidemiologic situation of orphans in Brazzaville and to identify the social and medical determinants of their placement in institutions. MATERIAL AND METHODS: This exploratory cross-sectional study was conducted from March 3, 2003, through January 30, 2004 (11 months). Direct interviews based on a standardized questionnaire collected information from the orphans old enough to answer questions, their parental substitutes or guardians, and the orphanage directors. The evaluation of the conditions in the orphanages was based on observable, quantifiable indicators. ON THE WHOLE: We identified 12 orphanages and 162 children: 92 boys (56.8%) and 70 girls (43.2%). Their average age was 10.5 years +/- 3.5 (range: 3 months to 15 years). Overall, 38 (23.5%) had lost only their mother, 22 (13.6%) their father, and 102 (63%) both parents. The child was placed at the orphanage by the family in 97 cases (60%), the social services department in 50 cases (30.9%), and by the police or the Red Cross in 15 cases (9.3%). The reasons for placement were: lack of financial support (137 cases, 84.5%), other social reasons (8 cases, 4.9%), abandonment (3 cases, 2%) and unspecified causes (14 case, 8.6%). The principal causes of parents' deaths were: pregnancy and childbirth 73 cases (45%), war, 45 cases (28%), HIV infection, 26 cases (16%), malaria, 6 cases (4%), accidents, 8 cases (5%) and unknown, 4 cases (2.5%). CONCLUSION: Orphanages are one alternative for the survival of children without parents able to care for them. Attention to them, support of their activities, and improvement of the living conditions there are all important.

[Rheumatic heart disease in schoolchildren in Brazzaville]. / Les Cardiopathies rhumatismales en milieu scolaire à Brazzaville.

The purpose of this study is to screen for rheumatic heart disease as a basis for treatment of the disease and determination of its prevalence in schoolchildren in Brazzaville, Congo. Surveying was conducted in 4 schools located in suburban districts of Brazzaville from May to June 2005. A cohort of 2250 school children was enrolled by random sampling at 3 levels. Age ranged from 5 to 17 years. The variables recorded were age, sex, socioeconomic status, clinical features, and laboratory findings. Clinical selection was based on cardiac auscultation. Data analysis was performed using the Epi Data 3.1 and Stata 8.2 software packages (differences being considered as significant at p< 0.05). A total of 2232 children underwent testing including 1900 from public schools (boys, 47.5%; girls, 52.5%) and 332 from private schools (boys, 47.3%; girls, 52.7%) (p>0.05). The prevalence of rheumatic heart disease was 3,5 per thousand overall, 3.6 per thousand in children in the low socioeconomic status group, and 3 per thousand in the high socioeconomic status group (p<0.05). The ages of children presenting valvular cardiopathy ranged from 7 and 16-years-old and 75% lived in overcrowded dwellings. One or more previous episodes of strep throat were noted in all cases and had not been treated in 7 out of 8 cases. Valvular disease was significantly correlated with history of strep throat, overcrowded living conditions, and low socioeconomic status (p<0,01). Compliance with prophylactic treatment using benzathyn penicillin was 75% after one month of follow-up and 37.5% after three months.

Les cardiopathies rhumatismales en milieu scolaire a Brazzaville

L'objectif de l'etude est de determiner la prevalence des cardiopathies rhumatismales en milieu scolaire a Brazzaville; Congo; et traiter les cas ainsi depistes. Une enquete de prevalence a ete realisee dans 4 ecoles des quartiers suburbains de Brazzaville. L'etude s'est deroulee aux mois de mai et juin de l'annee 2005. Le sondage etait aleatoire a trois niveaux aupres d'un echantillon de 2250 ecoliers. L'age etait compris entre 5 et 17 ans. Les variables etudiees etaient : l'age; le sexe; le statut socio-economique; les aspects cliniques et para cliniques. La selection clinique etait basee sur l'auscultation cardiaque. Les logiciels Epi Data 3.1 et Stata 8.2; ont permis la saisie et l'analyse des donnees (difference significative pour p0;05). Le nombre d'enquetes etait de 2232. Il y avait 1900 enfants issus des ecoles publiques (47;5de garcons; 52;5de filles); 332 issus de l'ecole privee (47;3de garcons; 52;7de filles) p0; 05. La prevalence clinique des cardiopathies rhumatismales etait de 3;5(3;6chez les ecoliers de classe sociale basse et 3chez ceux de haut statut socio-economique; p0;05). L'age des enfants presentant des cardiopathies valvulaires etait compris entre 7 et 16 ans; 75d'entre eux vivaient dans des habitations surpeuplees. Un ou plusieurs antecedents d'angines etaient retrouves dans tous les cas; non traitees dans 7 cas sur 8. Il y avait une relation entre les antecedents d'angines; la promiscuite; et le statut socio-economique (p0;01). La compliance au traitement prophylactique par la benzathine penicilline etait de 75au 1er mois du suivi; et seulement de 37;5au 3e