Prevalence of rheumatic valvular heart disease in Rwandan school children: echocardiographic evaluation using the World Heart Federation criteria.

BACKGROUND: Rheumatic fever (RF) and rheumatic valvular heart disease (RHD) remain important medical, surgical and public health concerns in many parts of the world, especially in sub-Saharan Africa. However, there are no published data from Rwanda. We performed a RHD prevalence study in a randomly selected sample of Rwandan school children using the 2012 World Heart Federation (WHF) criteria. METHODS: Echocardiographic assessment of 2 501 Rwandan school children from 10 schools in the Gasabo district near Kigali was carried out. Resulting data were evaluated by four experienced echocardiographers. Statistical analyses were carried out by statisticians. RESULTS: RHD prevalence was 6.8/1 000 children examined (95% CI: 4.2/1 000-10.9/1 000). Seventeen met WHF criteria for RHD, 13 fulfilled criteria for 'borderline' RHD and four were 'definite' RHD. None of these 17 had been previously identified. CONCLUSION: These data indicate a significant burden of RHD in Rwanda and support a need for defined public health RF control programmes in children there.

[Prolonged seizures in children in sub-Saharan Africa Clinical aspects and management]. / Convulsions prolongées chez l'enfant en Afrique subsaharienne Aspects cliniques et prise en charge.

BACKGROUND: There is a paucity of epidemiologic studies of prolonged seizures (persisting for more than 5 minutes) in the Democratic Republic of Congo (DRC) and in Rwanda. OBJECTIVE: We sought to analyze the clinical presentation, causes, pharmacologic management, and shortterm course of these seizures. METHODS: We enrolled 436 children, aged five months to ten years, who presented with prolonged seizures at the pediatric emergency departments of nine hospitals. Findings: Overall, 57.8% of the children were younger than three years; 7% had pre-existing psychomotor delay. Although 21% had had previous seizures, only 13% were receiving antiepileptic therapy. On presentation, 63.5% of the patients had fever and 26% were in status epilepticus. The seizures were focal in 21% of the cases. Malaria was the most common cause, involving 63% of the cases. The recurrence rate was 38%, and the mortality rate 4%. CONCLUSION: Prolonged seizures in DRC and Rwanda are frequently associated with fever, most commonly caused by malaria. The immediate use of long-acting antiepileptic drug could improve their outcomes.

Aspects epidemiologiques et anatomopathologiques des cancers dans les centres hospitaliers universitaires (CHU) du Rwanda

Il s'agit d'une etude retrospective realisee dans le but de mesurer la frequence des cancers de toute origine dans les Centres Hospitaliers Universitaires (CHU) du Rwanda durant la periode de 2000 a 2004. Deux milles cinq cents dix sept (2517) patients ont ete retenus pour notre etude et 942 cas de cancers ont ete histologiquement confirmes dans le service d'anatomopathologie. Les tumeurs representent 38;5 des tissus examines dans le laboratoire d'anatomopathologie; dont 20;85 sont des tumeurs malignes. Seuls 30;1 des suspicions de cancers dans les CHU ont ete confirmees par l'histologie. Parmi les cancers diagnostiques; 54;4 surviennent chez des sujets de sexe feminin. L'age moyen est de 44;8 ans. Chez l'homme les cancers les plus frequents sont : les cancers de l'estomac (16;4); le sarcome de Kaposi (11;5); du foie (10;1) et les lymphomes malins non Hodgkiniens (9;1). Chez la femme; les cancers du col uterin constituent la localisation la plus frequente (27;3); precedant les cancers du sein (10;5) et de l'estomac (8;8). Les enfants de moins de 15 ans ont presente 7;7 des cancers diagnostiques et les cancers de l'enfance les plus frequents sont les lymphomes malins non hodgkiniens (33;15) et le nephroblastome (9;84). La frequence des tumeurs malignes observees au laboratoire d'anatomopathologie n'est certainement pas representative de toute la realite cancereuse et la mise en place d'un registre des cancers au Rwanda est necessaire pour la surveillance epidemiologique de cette affection

A randomised trial to assess the efficacy and safety of chlorproguanil/dapsone + artesunate for the treatment of uncomplicated Plasmodium falciparum malaria.

We tested the efficacy and safety of chlorproguanil/dapsone co-administered with artesunate (CD+A) for the treatment of uncomplicated Plasmodium falciparum malaria in children compared with amodiaquine+sulfadoxine/pyrimethamine (AQ+SP) at two different sites in Rwanda. The trial was open label and 800 patients were randomly assigned to AQ+SP (n=400) or CD+A (n=400). Patients were hospitalised for 3 days and then followed-up weekly until Day 28 after treatment. Clinical and parasitological outcomes were recorded. Results showed that neither treatment was adequately efficacious. At one site, the adequate clinical and parasitological response (ACPR), PCR-adjusted, was 73.3% in the CD+A arm and 87.8% in the AQ+SP arm (P<0.001), and at the second site the ACPR, PCR-adjusted, was 70.5% in the CD+A arm and 38.1% in the AQ+SP arm (P<0.001). The combination CD+A is considered an alternative to, or replacement for, SP in Africa because CD has been shown to be effective in patients for whom SP treatment has failed and, with its short half-life, it is expected to exert less selection pressure for resistant parasites than SP. However, the results of this trial indicate that in an area of high SP resistance, CD+A may not be the best choice.