[Materno-fetal transmission of hepatitis B virus in Ivory Coast. Plea for mass vaccination]. / Transmission materno-foetale du virus B de l'hépatite en Côte d'Ivoire. Plaidoyer pour la vaccination de masse.

BACKGROUND: Hepatitis B is a major public health problem in the developing countries of Africa and Asia because the prevalence of HBs antigen carriers is high. In Ivory Coast, the prevalence of HBs antigen carriers is more than 8% (6 to 29%). In these countries, in which hepatitis B is highly endemic, most infections with hepatitis B virus (HBV) occur during early childhood. The chronic carriage of HBV was found to be common in children, who played a key role in maintaining the high level of endemicity in these areas. Vaccines against HBV are effective and their introduction as part of the Expanded Program of Immunization (EPI), as recommended by the WHO, is feasible. OBJECTIVE: The aim of this study was to evaluate the prevalence of HBs antigen in pregnant women and to determine the rate of maternal transmission of HBV to the fetus, to demonstrate the importance of HBs antigen screening during pregnancy and the immunization of babies in the Ivory Coast. PATIENTS AND METHODS: Between August 1995 and February 1996, 395 women in the last three months of pregnancy (age 25 +/- 6.9 years) were screened for HBs antigen. Those testing positive were also screened for HBe antigen. Transmission of HBV in utero was studied with 322 mothers and their offspring. HBs antigen was assayed in the cord blood of the offspring of HBs antigen-positive mothers. If the test for HBs antigen was positive, HBe antigen was also assayed. Second-generation ELISA tests (MONOLISA HBs Ag and MONOLISA HBe Ag from Sanofi Pasteur) were used. Babies from HBs antigen-positive mothers were vaccinated at birth with three doses of GenHevac B.

Le diabete de l'enfant et de l'adolescent a Abidjan

Dans un travail retrospectif du 10 janvier 1978 au 31 decembre 1988 (11 ans); visant a preciser les principaux caracteres du diabete chez l'enfant et l'adolescent; ages de 0 a 20 ans; au Centre Antidiabetique d'Abidjan; les auteurs ont recense 83 cas par le critere d'une glycemie a jeun superieure ou egale a 1;20 g/l (6;60 umol/l). La prevalence estimee par rapport a l'ensemble de la population diabetique est de 1;52 pour cent: 36 sujets de 0 a 15 ans (0;64 pour cent); 47 sujets de 16 a 20 ans (0;88 pour cent). Les malades se repartissent en 45 filles et 38 garcons; 64;63 pour cent des malades sont issus de milieu socio-economique bas. L'heredite en l'absence d'etude HLA semble presente dans 30 pour cent des cas. Les circonstances de decouvertes sont dominees par le syndrome polyuro-polydipsique (83;13 pour cent). Le precoma ou le coma diabetique est inaugural dans 10;84 pour cent des cas. Lors de la prise en charge; la glycemie est comprise entre 2 et 4 g/l (11;1 et 22;2 umol/l) chez 47 sujets (56;62 pour cent); l'acetonurie est relativement rare (8;43 pour cent). Au plan therapeutique et evolutif; l'insulinotherapie est la methode therapeutique dans la majorite des cas. Les resultats sont decevants dans 95 pour cent des cas en raison de la defaillance de l'auto-surveillance. Le pour centage eleve de malades perdus de vue (64;24 pour cent) montre les difficultes de surveillance et de traitement des jeunes diabetiques a Abidjan

Malnutrition proteino-calorifique et infection de l'enfant

L'etude de 103 cas de malnutrition proteino-energetique (MPE) hospitalises repondant aux criteres cliniques et biologiques montre dans 89;2 pour cent (92 cas) une infection dans les 4 semaines precedant la prise en charge. Les infections les plus frequentes sont celles des voies respiratoires (61;5 pour cent) suivies des infections cutaneo-muqueuses. L'etude bacteriologique des diarrhees presentes dans tous les cas ne montre les germes que dans 17 cas. Dans tous les cas; la malnutrition apparait comme un facteur aggravant de la MPC

Chromatographie des acides amines urinaires chez l'enfant malnutri en Cote d'Ivoire

L'etude chromatographique des acides amines urinaires chez l'enfant malnutri a abouti aux constatations suivantes : le tryptophane pourrait etre considere comme un indicateur biologique de la malnutrition proteino-calorifique (M.P.C.); la triade tryptophane-isoleucine-arginine semble caracteriser les MPC et egalement les cas de deces dus a cette affection

[Etiology of splenomegaly in children in the tropics. 178 cases reviewed at the university hospital center of Abidjan-Cocody (Ivory Coast)]. / Etiologie des splénomégalies de l'enfant en milieu tropical. A propos de 178 cas colligés au CHU d'Abidjan-Cocody (Côte d'Ivoire).

Discovery of an enlarged spleen in a child requires steps to identify the etiology. One hundred and seventy-eight patients seen over a four-year period (1985-1988) at the Cocody Teaching Hospital were reviewed. The incidence of splenic enlargement among pediatric inpatients was 1.6%. Males (n = 106) were more often affected than females (n = 72). Slightly over half the children (54.49%) were 0 to 5 years of age. The main clinical presenting features were fever (90%), anemia (72%), a decline in general health (36.50%), enlargement of the liver (33.50%), jaundice (26.50%), and enlarged lymph nodes (7%). Type II of Hackett's classification accounted for most cases (61.80%), followed by Type III (14%). Main etiologies included malaria (53%), salmonella infections (15%), sickle cell anemia (14%), schistosomiasis (9%), AIDS (3%), and thalassemia (2%). Malignancies (leukemia, lymphoma) were relatively infrequent. More than one etiology was found in 13 cases. The distribution of etiologies by age group was determined and a strategy for investigating children with splenic enlargement in tropical countries was developed.