[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.

[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.

Etude épidemiologique du paludisme dans la periode néonatale au centre hospitalier universitaire (CHU) de Yopougon République de Côte d'Ivoire

But : Le paludisme est une affection rare chez le nouveau-ne; meme en zone d'endemie; de sorte que sa recherche n'est pas systematique a cet age. Notre etude vise a decrire le profil du paludisme pendant la periode neonatale. Patients et methodes : L'etude descriptive retrospective; a porte sur les dossiers des nouveau-nes hospitalises du 01/02/2005 au 31/03/2006; dans le service de Neonatologie du centre hospitalier universitaire (CHU) de Yopougon a Abidjan; Cote d'Ivoire. Les criteres d'inclusion etaient la fievre; isolee ou non et une goutte epaisse/frottis sanguin (GE/FS) positive. Le critere d'exclusion etait la positivite du bilan biologique d'infection. Les parametres etudies prenaient en compte l'epidemiologie; la clinique; la biologie et la therapeutique. Resultats : La prevalence du paludisme neonatal etait de 0;98(6/615) selon notre etude. Hormis la fievre qui etait un critere d'inclusion; la paleur etait le symptome dominant. Quatre de nos patients avaient un antecedent de transfusion sanguine et 3 parmi ceux-ci avaient un paludisme grave postnatal; avec les plus fortes parasitemies et les plus bas taux d'hemoglobine. Les sels de quinine ont ete le traitement le plus utilise. Conclusion : Il importe en zone d'endemie; d'avoir la goutte epaisse facile chez le nouveau-ne et ce; d'autant qu'il existe un antecedent de transfusion sanguine

[Non-tuberculous bacterial pleuropneumopathies in children in Abidjan]. / Les pleuro-pneumopathies bactériennes non tuberculeuses de l'enfant à Abidjan.

We carried out a retrospective study to investigate epidemiological and clinical aspects of patient management in a hospital environment. We studied 90 cases of non-tuberculous bacterial pleuropneumopathies in children, observed over a 5-year period, from January 1 1991 to December 31 1995, at the Pediatric Medical Unit of Yopougon University Hospital. Diagnosis was based on the association of an infectious syndrome with respiratory and digestive disorders, and was confirmed by X ray. Bacteria were isolated from pleural pus and identified in fifty-one cases. Non-tuberculous bacterial pleuropneumopathies accounted for 5.22% of all pneumopathies in children, and the sex ratio for the patients affected was 1.9. Protein and energy malnutrition, anemia, being very young and climatic factors (harmattan and rainy seasons) were identified as major risk factors. The three main bacteria identified were Staphylococcus aureus (21 cases), Streptococcus pneumoniae (19 cases) and Haemophilus influenzae (6 cases). In this series of patients, 20% of the Staphylococcus aureus strains isolated were methicillin-resistant. Patients were generally treated with a combination of penicillin A and M and aminoside, with or without a pleural drain. The outcome was favorable in 77.8% of cases, with no severe sequelae detected by X ray. Six of the children died. Bacterial pneumopathies are still common in Sub-Saharan Africa and the patient being very young is indicative of a poor prognosis.

[Pleuropulmonary staphylococcal infection in newborn infants]. / Staphylococcie pleuro-pulmonaire du nouveau-né.

Pulmonary pleural staphylococcal infection is common in sub-Saharan Africa. It is rare in temperate zones and occurs in different epidemiological conditions. In African regions, very few staphylococcal infections are hospital-acquired, with most cases resulting from infection in everyday life. Pulmonary pleural staphylococcal infection typically affects infants. The frequency of neonatal forms is unknown. We describe here in the epidemiological, clinical and therapeutic characteristics of a case of pulmonary pleural staphylococcal infection in a newborn. The symptoms of our patient were typical, involving predominantly mechanical and hematological problems. The prevention of infection in very young children and early treatment of such infections could reduce the morbidity of this disease.