[Tubeculosis in Abidjan: comparison of children and adults]. / La tuberculose à Abidjan: comparaison entre l'enfant et l'adulte.

Tuberculosis (TB) is a global public health problem, especially in developing countries. Although the extent of TB in children is unknown, children are estimated to account for 5 to 20% of all TB cases. The aim of this study was to specify the differences between tuberculosis in children and in adult outpatients managed in Abidjan. This retrospective study analyzed data from 2617 cases of childhood TB and 36,648 cases of adult TB. The sex ratio was 0.93 in children and 1.50 in adults HIV co-infection was present in 24.5% (174/711) of the children with TB and 44% (5106/11,617) of the adults [OR = 0.413 (0.347, 0.492), p<0.001]. Of the 2610 cases of childhood TB for which complete data were available, 77.24% were pulmonary, including 34.63% smear-positive, and 22.76% were extrapulmonary; in adults, there were 2286 cases of smear-negative tuberculosis, 24,000 smear-positive, and 9348 extrapulmonary (26.2%). The most common locations of extrapulmonary TB in children were lymph nodes (30.1%) and the pleura (26.2%). Treatment failure or death was estimated at 1.9% in children compared with 3.9% in adults [OR = 0.465 (0.326, 0.664), p <0.001]. In Abidjan, TB in children is more frequently smear-negative or located in the lymph nodes than among adults, and it affects girls and boys almost equally.

Ambulatory Monitoring of Preterm Infant During Their First Year of Life at the Pediatric Deparment of Cocody Teaching Hospital. / Suivi Ambulatoire Du Premature La Premiere Annee De Vie Au Service De Pediatrie Du CHU Du Cocody.

The prematurity remains in our developing countries a problem of current events. The deficiency in human resources and the low level of the technical equipment exposes premature babies to a high risk of morbidity and mortality in neonatal period. Those who survive need a closer follow-up after their discharge from hospital. Our objective through this study was to appreciate the quality of following-up premature babies in ambulatory. It was a longitudinal study with descriptive aim which took place from January, 2007 till December, 2008 in the paediatric service of the Teaching Hospital of Cocody. Our population was constituted by 100 premature babies selected in a random way. The premature babies had on average 31,7 weeks of gestationel age. The sex ratio was 0,96. The born weight was between 900 and 2550g. The main causes of prematurity were multiple pregnancies (18 %), malaria (15 %), premature break of membranes (12 %) and éclampsia (10 %). Most of premature babies were hospitalized for a problem of breeding ( 47 %.). The average number of consultation was 6,25. Only 25 children were effectively followed during 12 months with a middleweight of 9112g. The follow-up had been interrupted before 3 months of native age in 31 % of cases and before 3 months of real age in 52 % of cases. The mothers had preferred the feeding in 48 % of cases, but the curves of weight development were superposables whatever the type of food supply. The pathology during the follow-up was dominated by digestive disorders, respiratory infections and anaemia. Forty percent of the premature babies was able to have an haemoglobin test and 8 %, a neuroradiological scraeming. A third of the premature babies (30 %) had been hospitalized again for anaemia (10 %) and respiratory infections (10 %). We recorded 3 deaths. CONCLUSION: The follow-up of premature babies getting out of hospital remains difficult in our context of life. The mothers must be sensitived on the consequences of prematurity and the importance of their follow-up. This follow-up has to be the affair of all, as well parents, health workers that government.

[Neonatal mortality and levels of diagnosis at the University Hospital of Yopougon (Abidjan)]. / Mortalite neonatale et niveaux de diagnostic au Centre Hospitalier Universitaire de Yopougon (Abidjan).

INTRODUCTION: The achievement of the 4th millennium development goal needs the reduction of infant mortality, itself dominated by neonatal mortality. Our study aims to establish the influence of the various diagnosis levels on newborn children mortality at hospital environment in Abidjan. PATIENTS AND METHODS: The retrospective study took place in 2006, since january 1st to december 31, in the neonatal unit of the teaching hospital of Yopougon, which represents the top level of the sanitary pyramid in Cote d'Ivoire. All the newborn children who died during their hospitalization, were included. Three levels of diagnosis were identified for the classification of the population of study: the level A (Story of the disease and clinical examination), the level B (laboratory exams for diagnostic assumption), the level C (laboratory exams for diagnostic certainty). RESULTS: The overall mortality was 28.24 %. The majority of deaths (92.4 %) occurred during the early neonatal period with 62.5 % of deaths on the day of birth. The cause of deaths was dominated by infection (52 %) and perinatal asphyxia (36 %). The mortality rate was inversely proportional to the level of diagnostic: 53.68 % at level A, 38.42 % at level B and 7.90 % at level C. CONCLUSION: The availability of sufficient and accessible technical equipments, is necessary in order to improve the level of the newborn children care and to ensure the best diagnosis, the security of a more efficient coverage and consequently the reduction of the neonatal mortality in hospital environment, in developing countries.

[Craniopagus conjoined twins: difficulties of management in Africa]. / Jumeaux conjoints craniopages: difficultés de prise en charge en milieu africain.

Conjoined twins are the rare malformations of monozygotic-twins pregnancies associated with bad fetal prognosis. Craniopagus are even more rarely encountered and their management is complex particularly in our low-medical-equipment countries. From an observation of craniopagus twins, we present several difficulties in the management of the case. Diagnosis was late; because of the onset of labour, delivery was not prepared; the conditions of neonatal and social management were not adapted. Surgical treatment was not considered owing to the absence of appropriate technological conditions and means.

Echographie dans le reflux gastro-oesophagien du nouveau-ne et du nourrisson: experience du CHU de Yopougon (Cote d'Ivoire)

53 enfants dont 23 filles et 30 garcons provenent du service de Pediatrie ont ete explores a l'echographie a la recherche d'un RGO; sur une periode de 3 ans. Cette etude realisee dans le service de Radiologie du CHU de Yopougon d'Abidjan; a pour but d'affirmer la realite du RGO chez nous et de determiner les anomalies de la jonction oesocardio-tuberositaire par la methode echographique. La demande de l'examen echographique a ete motivee par une amnese et un examen clinique orientant vers une pathologie de reflux. L'etude echographique a permis la mise en evidence de 26;4 per cent de reflux pathologue. Des anomalies morphologiques ont ete notees dans 8 cas (57;1 per cent); essentiellement representees par la beance du cardia et la malposition cardiale. Cet examen apparait interessant dans le diagnostic de RGO et merite une meilleure diffusion du fait de ses avantages multiples alliant faible cout; non irradiation; efficacite et sensibilite. Aussi; les auteurs proposent-ils une meilleure vulgarisation de cette methode