ABSTRACT
According studies run during four years (1992-1995) in the Pediatric Unit of Libreville Hospital, to determine importance and features of sickle-cell disease in children in Gabon, profit and mode of regular follow-up, data of hospitalisation and management of children with sickle-cell disease were found as follow: Sickle-cell disease is third rank of admission motivations (13% of total admissions), and first after 4 years. Mortality is 8.4% of total mortality. Main causes of hospitalisation were acute anemia, painful crisis, and bacterial infections. Half of children had no medical follow-up, third was regularly checked, the remaining very irregularly, 80% of died children had no medical follow-up. A survey with an ambulatory taking-care which concerned 210 kids regularly checked, shows theses outcomes: the social families background was either medium or disavow. More than half of children were detected before one year, mainly by complication. Third had splenomegaly, 70% hepatomegaly and 40% were icteric. Based on 103 children tested for HIV, only 2 were found positive, but 22% were positive for HBs Ag. Growth, puberty and school retardation is a supplementary social handicap. A comparative with other cohorts must headlight genetic and personal environing matters. Unit of management of sickle-cell disease, annexed to a Pediatric Unit, provided that official acknowledgement, seems to be the best solution, as regards cost/efficiency, in the local context.
Subject(s)
Anemia, Sickle Cell/epidemiology , Pediatrics , Africa, Central , Anemia, Sickle Cell/mortality , Anemia, Sickle Cell/therapy , Child , Child, Preschool , Female , Hospitals , Humans , Infant , Infant, Newborn , MaleABSTRACT
BACKGROUND: Clinical manifestations and course of sickle-cell anemia are variable. Knowledge about the factors, possibly geographic, that influence prognosis are still scanty. POPULATION AND METHODS: Data of hospitalization and management of children with sickle-cell disease were studied during two years (1992-1993) in the Pediatric Unit of Libreville Hospital. They concerned 205 admissions of 171 children and 131 outpatients. RESULTS: The main causes of hospitalization were: acute anemia (36 cases before the age of 5 years); painful crisis whose frequency increased with age (23% before 5 years, 35% between 5 and 10, 42% after 10 years); infections, essentially pulmonary occurring early, and bone infections at any age. Eight children died (because a complication of their disease). Among the 131 outpatients, half were detected because pyrexia, anemia and/or more often "hand-foot syndrome". More than 60% had hepatomegaly, one third still had splenomegaly after five years of age and more than one third was icteric. More than half children older than ten years had growth disorders. Mean hemoglobin level was 7 g/dL. 21 of the 83 tested children for HBsAg were positive and only one out of 79 was positive for HIV. CONCLUSIONS: Clinical manifestations and course of sickle-cell anemia in our patients are similar to those reported in Congolese children. Genetic and environmental factors may be responsible for differences with children from other, in particular French, cohorts.
Subject(s)
Anemia, Sickle Cell/epidemiology , Adolescent , Anemia, Sickle Cell/complications , Anemia, Sickle Cell/diagnosis , Child , Child, Preschool , Female , Fever/etiology , Follow-Up Studies , Gabon/epidemiology , Growth Disorders/etiology , Hepatomegaly/etiology , Humans , Infant , Male , Splenomegaly/etiologyABSTRACT
A 27 month epidemiological survey of cryptosporidiosis in stools was conducted in 288 Gabonese children aged between 0 and 2 years (mean 10.2 months). By at least one of two staining techniques, acid-fast and direct immunofluorescence, the rate of infection was determined to be 24%. The rate was 28% in cases of acute diarrhea, in striking contrast with the low prevalence of 14.8% in uninjured gastroenteritus subjects (p < 0.05). The notion of asymptomatic carriers was clearly demonstrated. The maximum of 34.4% was observed for infants aged between 6 and 12 months (p < 0.02). In cases of malnutrition, this rate increased to 31.8%, whereas it was 16.8% in eutrophic children (p < 0.01). For the rainy and dry seasons, it was 31.7% and 19.4%, respectively (p < 0.02). Water is emerging as an important vehicle for the transmission and spread of Cryptosporidium sp. in tropical areas.
