[Value of fetal pulmonary maturity determination with the Clements test in high risk pregnancies]. / Intérêt de l'évaluation de la maturité pulmonaire foetale par le test de clements dans les grossesses à risque èlevé.

To extract a foetus which presents chronic suffering in high risk pregnancy, the determination of pulmonary maturity leads to take the decision. Among the complementary analysis to determine the pulmonary maturity, we used of Clements test (CT) which realization is easy and the results rapid. The objectives of this paper were to evaluate the pulmonary maturity with CT, to establish correlation between CT and breathing distress syndrome at birth and to determine the validity of CT about new born vitals parameters. During a two years prospection in "Hopital Communautaire" maternity and "Complexe Pédiatrique", we have recruited 390 laboring women with high risk pregnancy who attained six months. We have leaved out the search cases of prematureness membrane rupture or tinted amniotic fluid. The fluid amniotic to be analyzed was taken with syringe and was subjected to different techniques allowing to conclude pulmonary maturity or not. Statistical tests has permitted to establish correlation between CT and new born vitals parameters. The means of laboring women age was 25 years old. In 59.3%, the women have between 1 and 3 children. The caesarians decided in 21.4% of cases were related to generally restricted pelvis with bi-scared uterus. The prematurity confinement had concerned 37.4% of new born. The CT result was positive in 61% of cases. The Apgar score under 7 had been more observed among children who had positive CT. The respiratory distress was significantly more frequent among children born by caesarian. The stillbirths rates of was more exalted with cases of negative CT. The results of this search have permitted to identify new born correlative parameters with pulmonary maturity. This one might be determined by CT, in high risk new born, the vulgarization of this test would improve their management.

Efficacy of BCG vaccination of the newborn: evaluation by a follow-up study of contacts in Bangui.

BACKGROUND: The efficacy of Bacillus of Calmette and Guérin (BCG) vaccination given at birth is still controversial. We therefore conducted a study in Bangui (Central African Republic) to estimate the protection afforded over the first seven years of life by BCG administered at birth. METHODS: One thousand children who had lived in contact with a recently diagnosed case of contagious tuberculosis were followed up for a period of 6 months in order to detect the occurrence of tuberculosis. Diagnosis of tuberculosis was made through a scoring system. Vaccine efficacy (VE) was calculated on the basis of the relative risk of contracting tuberculosis according to vaccination status. RESULTS: The efficacy of BCG was estimated to be 71% (95% confidence interval: 56-81%). This result remained practically the same after changing the definition used for tuberculosis cases (VE = 75% for a threshold with a score of 15 instead of 6, VE = 74% when only confirmed cases were considered). There was no difference between the two groups in the variables measuring intensity of contact with the source of contamination, but there was a difference in age distribution. Vaccine efficacy adjusted for this factor was the same as the crude VE. CONCLUSION: This study, based on a methodology that controls for most of the risks of bias inherent to field efficacy measurement, confirms the protective capacity of neonatal BCG against childhood tuberculosis. Therefore BCG vaccination at birth must remain a public health priority especially in countries with high incidence of the disease.

PIP: The efficacy of Bacillus of Calmette and Guerin (BCG) vaccination given at birth is still controversial, therefore a study was conducted in Bangui, Central African Republic, to estimate the protection afforded over the first 7 years of life by BCG administered at birth. 1000 children who had lived in contact with a recently diagnosed case of contagious tuberculosis (TB) were followed up from May 1989 to February 1991 in order to detect the occurrence of TB. 896 of them were considered as vaccinated. Diagnosis of TB was made through a scoring system endorsed by the World Health Organization. Contact children with a score of or= 6 were considered to have TB. Four groups of children were formed in order to calculate the risk of TB in relation to vaccination status: children with TB who had been vaccinated, children with TB who had not been vaccinated, healthy children who had been vaccinated, and healthy children who had not been vaccinated. Vaccine efficacy (VE) was calculated on the basis of the relative risk of contracting TB according to vaccination status. Of the 1000 contact children, 91 had a score of or= 6. The TB incidence rate was 7.3% in vaccinated children and 25% in nonvaccinated children, which corresponded to a 0.29 relative risk of contracting TB or efficacy of BCG of 71% (95%, confidence interval: 56-81%). This result remained practically the same after changing the definition used for TB cases (VE = 75% for a threshold with a score of 15 instead of 6, VE = 74% when only confirmed cases were considered). There was no difference between the 2 groups in the variables measuring intensity of contact with the source of contamination, but there was a difference in age distribution. BCG vaccination at birth must remain a public health priority, especially in countries with high incidence of the disease in view of the protective capacity of neonatal BCG against childhood TB.

[Morbidity and mortality in the pediatric service of Banqui (Central African Republic) during the year 1990. Implications for public health]. / Morbidité et mortalité dans le service de pédiatrie de Bangui (Centrafrique) au cours de l'année 1990. Implications en matière de santé publique.

Hospitalizations in the department of pediatrics of the Bangui Hospital (Central Africa) during the year 1990 were evaluated in terms of mortality and morbidity. During the study year, 8,052 children were admitted. Overall in-hospital mortality rate was 11.6%. Most deaths occurred shortly after admission (60% within 24 hours), in patients less than one year of age. Analysis of morbid conditions highlighted the growing severity of malaria and anemia in the youngest patients. Since no other facilities for inpatient treatment of children exist in the area, the data presented here can be considered as reflecting local medical problems and, therefore, can be used to guide public health decisions.

Morbidite et mortalite dans le service de pediatrie de Bangui (Centrafrique) au cours de l'annee 1990 : implications en matiere de sante publique

Le bilan d'une annee d'hospitalisations (morbidite-mortalite) dans le Service de Pediatrie de Bangui en Republique Centrafricaine est presente. 8052 enfants ont ete hospitalises dans l'annee 1990 et le taux de mortalite hospitaliere globale est de 11;6 pour cent. Les deces sont precoces et frappent surtout les enfants de moins d'un an. Parmi les pathologies recensees les auteurs insistent particulierement sur l'importance et la gravite croissante du paludisme et des anemies severes dans le jeune age. Le service concerne est la seule structure hospitalisant des enfants dans la region; ainsi les statistiques presentees peuvent constituer un reflet de la pathologie locale et etre utilisees pour l'orientation des decisions en matiere de sante publique