[Follow-up of HIV-infected children receiving antiretroviral therapy in a rural area of Togo]. / Suivi des enfants infectés par le VIH/sida sous traitement antirétroviral en milieu rural au Togo.

OBJECTIVE: To evaluate the monitoring of HIV-infected children receiving antiretroviral therapy in rural areas of Togo and the effectiveness of the treatment. METHODS: This retrospective descriptive study, conducted at the Luis Scrosospi Center in Kouvé from 15 November, 2008, through 14 November, 2009, examined the records of children who had been receiving antiretroviral therapy for at least 6 months. RESULTS: We studied the records of 55 children. The sex ratio was 0.9, and the primary opportunistic infections were respiratory infections and malaria. At treatment initiation, their average age was 6 years and 3 months, the average CD4 T cell count 358/mm(3), and the mean weight 12.9 kg. The hemoglobin level was less than 8 g/dL in 31%. All children received a nutritional kit monthly. The antiretroviral therapy for 52 children was a combination of stavudine, lamivudine, and nevirapine. The adherence rate during the first 12 months was 80% (44/55 children). The mean weight gain was 860 g (below -3SD) at 3 months, 1,550 g (between -3SD and -2SD) at 6 months, and 1 270 g (between -2SD and -1SD) at 12 months of treatment. The severe acute malnutrition rate fell from 60% at treatment initiation to 56% at 3 months, 47% at 6 months, and 25% at 12 months. Also after 12 months, the CD4 T cell count had risen in 60% of the children. The main side effects were peripheral neuropathy (29%) and headaches (18%). Eight children died (14%) during the follow-up. CONCLUSION: Monitoring of HIV-infected children on antiretroviral therapy is possible in Togo's rural areas and should be encouraged for it will help to achieve the Millennium Development Goals.

[Knowledge, attitudes and practices of healthcare providers in Togo regarding prevention of mother-to-child transmission of HIV in 2010]. / Connaissances, attitudes et pratiques des prestataires de soins en matière de prévention de la transmission du VIH de la mère à son enfant en 2010 au Togo.

OBJECTIVE: To evaluate the knowledge, attitudes and practices of health care providers (HCP) in Togo regarding prevention of mother-to-child transmission of HIV (PMTCT). METHOD: A cross-sectional study was conducted in 22 antenatal clinics with PMTCT programs from January 18 to February 6, 2010. Clinic selection was based on attendance and local factors. Data were collected through interviews conducted by 23 trained investigators. RESULTS: A total of 97 HCP were interviewed at the 27 selected clinics. Most, i.e., 76%, had received PMTCT training. In terms of knowledge, interview data revealed the following strengths: 83% of HCP identified transmission from mother to child as the main route of HIV transmission in children < 15 years; 87% asserted that HIV-infected pregnant women do not always transmit HIV to their children; 77% knew that the ELISA test was performed after 18 months: and 96% had a clear notion about feeding infants born to HIV-infected mothers. Knowledge assessment revealed the following weaknesses: 30% of HCP had never heard of polymerase chain reaction; 27% said that confidentiality about HIV status was not always necessary; and 22% were unaware that decontamination of equipment using a chlorine solution kills HIV. In addition, interview data revealed the following positive attitudes and practices: 83% of HCP were willing to continue working in a center with a PMTCT program and 87% referred women pregnant for the HIV serology. On the negative side, however, only 27% of HCP summonsed husbands whose wives tested positive for HIV. CONCLUSION: This investigation shows that the knowledge, attitudes and practices of HCP in Togo regarding PMTCT is fairly good. However, it also revealed several weaknesses that should be addressed by further training.

Aplasia cutis congenita associated with Goltz syndrome in a male neonate.

Here we report the association of giant aplasia cutis congenita in a newborn black male with Goltz syndrome. The cutis aplasia defect is extensive and circonscript at the vertex. The cerebral structures are visible through the lesions. In addition, the patient has a low birth weight, syndactyly, adactyly, cutaneous atrophy, and areas of hyperpigmentation on the legs and hypoplastic maxillary. We think that these signs are probably due to mosaic mutations in PORCN. We reviewed 18 cases of Goltz syndrome in 18 male neonates but none has aplasia cutis congenita. Such a combination of severe aplasia cutis congenita was not reported previously in Goltz syndrome.

[Knowledge of sickle cell disease and prevention methods in an urban district of Lomé, Togo]. / Connaissances de la drépanocytose et pratiques de prévention dans la population d'un district urbain de Lomé, Togo.

Despite the important frequency of the gene "S" in Togo, essential information remains insufficient to elaborate a prevention campaign on this affection. In order to assess the knowledge on sickle cell diseases as well as the prevention practices in the Togo population in one of the five districts of the township of Lomé, a cross sectional study was conducted in the third district of the township of Lomé from January 21, 2004 to January 26, 2004 in 210 natives from Togo aged of 15 and over, through a semi-structured questionnaire. The variables studied were: - the socio-demographic features and the knowledge of sickle cell disease characteristics (symptoms, biological diagnosis, treatment and means). Data collected were analysed through software Statically Package for Social Science (SPSS) version 10.0 of Windows using the chi2 test with 5% significance in the comparison of some variables. 117 women and 93 men were interviewed. Sickle cell disease was known in almost all ethnic groups but incompletely: 79.5% of the individuals knew about premarital check up but only 12.4% knew about haemoglobin electrophoresis check up. 74,8% of the people had a good knowledge of the cause of sickle cell disease, 78.6% had a fairly good knowledge of its symptoms, 57.6% knew the factors inducing attacks, 64.3% the prognosis and 69.5% the prevention methods, but a poor knowledge of the complications (62.4%), biological diagnosis (71%) and treatment (97.2%). The prevention practices were poorly adopted: 12% had an haemoglobin electrophoresis check up and 15% of them had their husband to have one as well. Professional status influenced the level of knowledge of the biological diagnosis (p=0.001) and prevention means (p=0.018). The educational level influenced biological diagnosis knowledge (p = 0.000) and prevention means (p = 0.02). On the whole, sickle disease was linked to marital status (p = 0.00). Sickle cell disease remains quite unknown in spite of the gene "S" important frequency in Togo. These results are to be taken into account to implement information, education and communication program to struggle against sickle cell disease.

Management of epilepsy patients in Batamariba district, Togo.

OBJECTIVE: To describe the feasibility of managing epilepsy in a rural setting in a developing country. METHODS: The project comprised four phases. After a study of the perception of epilepsy, we conducted a sensitization campaign in November 2001. The third phase was a survey, to detect epilepsy patients, in which 6249 persons were asked to complete a questionnaire. Persons with epilepsy were then examined, treated, mainly with phenobarbital, and followed up. RESULTS: The prevalence of epilepsy was estimated to be 15.7 per thousand. Ninety-two patients took antiepileptic drugs from 1 February 2002. By November 2005, 92.7% of all treated patients had achieved complete suppression of seizures, and 7.3% had reduced seizure frequency. CONCLUSIONS: Despite the stigma attached to epilepsy in many developing countries, it can be controlled by relatively simple measures. At present, 601 epilepsy patients are being followed up at the Nadoba health centre, where epilepsy is now the second commonest disease.

[Primary results of antiretroviral treatment among HIV/AIDS infected children in Lomé (Togo)]. / Traitement antirétroviral des enfants infectés par le VIH/sida à Lomé (Togo): premiers résultats.

UNLABELLED: Since 2004 in Togo HIV/AIDS infected children have, free of charge, access to antiretroviral drugs according to the national program. The aim of this study was to investigate the clinical, biological and prognosis aspects of anti-retroviral treatment on HIV/AIDS infected children. PATIENTS AND METHOD: We conducted a cross sectional study on 72 HIV/AIDS infected children with anti-retroviral treatment, under the supervision of clinicians within 3 associations specialized in the management of subjects infected by HIV/SIDA at Lomé (Togo). RESULTS: The average age of children was 6 years 9 months. The middle age to HIV screening was 4 years 2 months. The sex ratio was 1.05. The majority of these children (79.2%) were orphans of at least 1 of their parents. All the children were stemmed from families with modest income. The transmission mother to child was the way of HIV contamination found among all the children. To a certain extent, all the children were infected by the HIV 1. Most of the children (66.7%) receiving an antiretroviral treatment for at least 6 months were asymptomatic and had no more immunodeficiency. After 15 months, the children have gained 464 CD4/mm(3). The initial protocols antiretroviral prescribed among children were: zidovudine-lamivudine-abacavir (36.1%), lamivudine-didanosine-nevirapine (30.5%), lamivudine-stavudine-nevirapine (29.2%), zidovudine-lamivudine-didanosine (4.2%). The digestive disorders have been the first side effects (83.4%). The rate of good observance was middle (51%) and lowered with the increased age of children, and the period of the anti-retroviral treatment. CONCLUSIONS: Antiretroviral treatment among HIV/AIDS infected children is giving good results in Togo. But many efforts remain to increase the number of beneficiaries.

[Evolution of severe pediatric malaria in Togo between 2000 and 2002]. / Evolution du paludisme grave de l'enfant au Togo de 2000 à 2002.

The aim of this study was to analyse the clinical and evolutive aspects of severe malaria in hospitalised children in 2000, 2001, and 2002 in Togo. The study included 361 children in the pediatrics department of Lomé-Tokoin University hospital. All them received a 10% dextrose infusion, then an infusion of quinine or intramuscular artemether. Malaria accounted for 4.37% of all hospitalizations. Children aged 1 to 5 years were more affected (69.53%). The most frequent clinical forms were anaemia (55.7%) followed by cerebral manifestations. The frequency of hemoglobinuria increased (17.2%) as well as renal failure (3%) compared to previous years. Thirty-five children died (9.7%). Most of them presented with anaemia, neurological manifestations, or respiratory distress. Neurological sequels were present in 2.2% of patients.

[Anthropometric parameters, frequency and risk factors of intrauterine growth retardation in full-term infants in North Togo]. / Paramètres anthropométriques, fréquence et facteurs de risque du retard de croissance intra-utérin chez le nouveau-né à terme dans la région du Nord-Togo.

OBJECTIVE: To establish fullterm newborn anthropometric parameters to determine the frequency of intrauterine growth retardation and to study mother's and socio-economic risk factors associated with the intrauterine growth retardation in the population in North-Togo. METHODS: Twelve month prospective study in the savana area in North-Togo. One thousand and six alive newborns born after normal single pregnancy, and without severe neonatal diseases were included. RESULTS: The mean birth-weight +/- SD was 2938 +/- 421 g. The incidence of low birth-weight was 11,7%. Among mother's and socio-economic risk factors, teenage mothers, mothers with a weight lower than 50 kg or with body mass index lower than 20 kg/m2 had a significantly high risk of having a child with intrauterine growth retardation (Odds ratio = 2,71; 2,57; 1,57 respectively). Father's job also affected the mother's and newborn's weight. CONCLUSION: The recognition of these easy to identify risk factors should allow specific recommendations for this population.

[Primary nephrotic syndrome in the black African child]. / Le syndrome néphrotique primitif de l'enfant en Afrique noire.

Idiopathic nephrotic syndrome (INS) in black African children differs from that of children in temperate areas. The main differences are the high rate of corticosteroid non-responders and the low rate of minimal change glomerulopathy in black African children, possibly related to a racial factor. The identification of a high corticosensibility in certain African regions (Togo and Ghana) can lead to the identification of an ethnic factor. Further genetic studies should be carried out in order to provide a better approach to INS in Africa.

[Idiopathic thrombopenic purpura in a child in black Africa: a case report in Togo]. / Le purpura thrombopénique idiopathique de l'enfant en Afrique noire: à propos d'un cas au Togo.

UNLABELLED: Idiopathic thrombocytopenic purpurea (ITP) is an autoimmune disease that occurs frequently in Europe and the US, but has rarely been described in Africa. Case report. An 8-year-old girl was admitted for cutaneous and mucosal bleeding. She had a low platelet count (11 x 10(9)/l). ITP was suspected and the diagnosis was confirmed by bone marrow examination. Corticosteroid treatment was effective. DISCUSSION: This is the second case reported in Togo since 1982. The diagnosis of the disease is straightforward, so the lack of cases reported in central Africa suggests that the disease is rare in this region. The rarity of the disease may be due to genetic or environmental factors, or it may simply be that physicians overlook this disease when making their diagnosis. Corticosteroids are now the preferred treatment for ITP because of the risk of transmitting Creutzfeldt-Jacob's disease by intravenous administration of immunoglobulin. Splenectomy is the ultimate treatment for chronic forms. CONCLUSION: Unlike other diseases, the diagnosis and treatment of which require methods unavailable in parts of Africa, ITP treatment, as currently practiced in countries of the northern hemisphere, is within the reach of most African countries. Further studies are required to determine the true frequency of the disease in central Africa.

[Pediatric AIDS at the University Hospital Center-Tokoin (Lomé): the role of protein-calorie malnutrition and a formulation trial of a clinical diagnostic score]. / Sida pédiatrique au CHU-Tokoin (Lomé): place de la malnutrition protéino-énergétique et essai d'élaboration d'un score de diagnostic clinique.

Two cross-sectional studies were carried out in the pediatric ward of the Tokoin Teaching Hospital, Lome. One study determined the prevalence of HIV infection in the 49 malnourished patients treated in the ward in February to March and between August and December 1994. The other was carried out between July 1994 and January 1995 and included 57 other hospitalized children fulfilling at least one of the WHO's pediatric AIDS criteria. The aim was to draw up a screening system for pediatric AIDS based on clinical scores that would be more sensitive than and as specific as the WHO criteria. We tested these criteria and the other signs used in the suggested scoring system using the reference test, HIVchek. The seroprevalence of HIV was 28.6% in malnourished children and transmission was probably exclusively from mother to child. It was difficult to distinguish pediatric AIDS from protein energy malnutrition on clinical grounds, although some of the associated morbidities, including anemia, adenopathy and splenomegaly, were highly suggestive of pediatric AIDS. The second study showed that: 1) the sensitivity of the WHO criteria was low; 2) the best positive predictive values were obtained in cases of polyadenopathy and confirmed HIV infection of the mother. Both these criteria were relatively infrequent; 3) there were 6 criteria significantly associated with HIV infection, each being given a point score according to its Yule coefficient: chronic cough (4 points), chronic diarrhea (3 points), chronic fever (2 points), oropharyngeal candidiasis (2 points) and marasmus (1 point). A score of 4 points was the threshold for suspicion of pediatric AIDS. Our scoring system was more sensitive than the WHO criteria and had similar specificity and positive predictive value. We stress the importance of preventive measures against HIV infection, particularly for women of child-bearing age and suggest a new score test and appropriate clinical definitions for infants and older children.

Le lymphome de Burkitt au Togo: aspects epidemiologique; clinique; therapeutique et evolutif

Une etude retrospective portant sur 332 dossiers d'enfants traites pour lymphome de burkitt sur une periode de 10 ans dans le service de pediatrie du CHU de Lome-Tokoin a ete effectuee afin d'analyser les differents aspects epidemiologiques; cliniques; therapeutiques et proposer des solutions pour une meilleure prise en charge des patients. 28 enfants ont ete retenus soit 2;8 cas par an; 0;04 pour cent des hospitalisations en pediatrie et 73;68 pour cent des lymphomes malins non hodgkiniens durant la periode consideree. L'age des patients a varie entre 13 mois et 14 ans avec une moyenne de 7;5 ans; le sexe masculin est predominant (sex-ratio = 1;5); 72 pour cent des patients sont de famille ayant un bas niveau socio-economique et 66;4 pour cent sont originaires du Sud du pays. Le delai moyen avant consultation est de 3 mois; les localisations maxillo-faciales ont ete constatees dans pour 100 cas soit isolement (32;1 pour cent) ou associees aux localisations abdominales (25 pour cent); ganglionnaires (25 pour cent) et medullaires (10;7 pour cent). Le protocole therapeutique utilise est a la base de cyclophosphamide. Les resultats ne sont pas tres satisfaisants puisque la letalite est elevee de l'ordre de 25 pour cent. Le suivi des malades en remission est tres difficile; les patients ne venant pas regulierement aux controles. Les conclusions de cette etude permettent de formuler les recommandations suivantes: - Sensibilisation des parents sur la necessite d'un suivi regulier au long cours; - Approvisionnement regulier des services hospitaliers en drogues antimitotiques; - Creation d'un service d'onco-hematologie avec une unite de radiotherapie