Premature Rupture of the Membranes at the Sylvanus Olympio University Hospital of Lomé, Togo: Microbiological Findings and Outcomes

Abstract Introduction: To prevent the risk of infections in cases of premature rupture of the membranes (PROM), a pregnancy complication, gynecologists of the Sylvanus Olympio University Teaching Hospital used clavulanic acid and amoxicillin as empiric antibiotic therapy intravenously. This study aims to identify and assess the susceptibility to antibiotics of bacteria involved in PROM. Methods: A cross-sectional study was conducted from February 25 to June 06, 2014 on 60 pregnant women presenting a PROM and their 65 newborns, recruited in the Gynecology and Obstetrics Service of the Sylvanus Olympio University Teaching Hospital of Lomé, Togo. In mothers, cytological and bacteriological examinations of vaginal and endocervix swabs were carried out and among newborns, cytological and bacteriological examinations were performed on gastric fluid and ear swabs at the Microbiology Service of the university hospital. Results: The frequency of PROM was 6.8% of deliveries during the study period. Pathogens were isolated among 48.3% of mothers and 26.2% of newborns. Vaginal and endocervix swabs allowed isolation of pathogens in 45% and 28.3% of cases, respectively. The most isolated pathogens were Candida albicans (28.6%)(14/53) and enterobacteria (41.5%)(22/53), mainly represented by Escherichia coli (59.1%)(13/22). We also isolated Group B Streptococci (GBS) strains (7.5%)(4/53). Pathogen isolation rate among newborns was 26.2%(17/65). Of these pathogens, Escherichia coli represented 60%(15/25). Pathogens found in 10.7% of newborns were phenotypically identical to those isolated from their mothers. Among newborns, E. coli was the most isolated strain in gastric fluid (66.7%)(4/6) as well as from ear swabs (57.9%)(11/19). Conclusion: Half of PROM cases in this study were associated with presence of pathogen amongst pregnant women; E. coli and Group B Streptococcus known to cause neonatal meningitis were found. Unfortunately, a few isolated strains of E. coli were resistant to clavulanic acid-amoxicillin, a combination used as empiric antibiotic therapy by healthcare practitioners in our settings

Treatment of asymptomatic carriers with artemether-lumefantrine: an opportunity to reduce the burden of malaria?

Background: Increased investment and commitment to malaria prevention and treatment strategies across Africa has produced impressive reductions in the incidence of this disease. Nevertheless, it is clear that further interventions will be necessary to meet the international target of a reversal in the incidence of malaria by 2015. This article discusses the prospective role of an innovative malaria control strategy - the community-based treatment of asymptomatic carriers of Plasmodium falciparum, with artemisinin-based combination therapy (ACT). The potential of this intervention was considered by key scientists in the field at an Advisory Board meeting held in Basel, in April 2009. This article summarizes the discussions that took place among the participants. Presentation of the hypothesis: Asymptomatic carriers do not seek treatment for their infection and, therefore, constitute a reservoir of parasites and thus a real public-health risk. The systematic identification and treatment of individuals with asymptomatic P. falciparum as part of a surveillance intervention strategy should reduce the parasite reservoir, and if this pool is greatly reduced, it will impact disease transmission. Testing the hypothesis: This article considers the populations that could benefit from such a strategy and examines the ethical issues associated with the treatment of apparently healthy individuals, who represent a neglected public health risk. The potential for the treatment of asymptomatic carriers to impair the development of protective immunity, resulting in a \u27rebound\u27 and age escalation of malaria incidence, is also discussed. For policymakers to consider the treatment of asymptomatic carriers with ACT as a new tool in their malaria control programmes, it will be important to demonstrate that such a strategy can produce significant benefits, without having a negative impact on the efficacy of ACT and the health of the target population. Implications of the hypothesis: The treatment of asymptomatic carriers with ACT is an innovative and essential tool for breaking the cycle of infection in some transmission settings. Safe and effective medicines can save the lives of children, but the reprieve is only temporary so long as the mosquitoes can become re-infected from the asymptomatic carriers. With improvements in rapid diagnostic tests that allow easier identification of asymptomatic carriers, the elimination of the pool of parasites is within reach. © 2010 Ogutu et al; licensee BioMed Central Ltd

Community screening and treatment of asymptomatic carriers of Plasmodium falciparum with artemether-lumefantrine to reduce malaria disease burden: a modelling and simulation analysis

<p>Abstract</p> <p>Background</p> <p>Asymptomatic carriers of <it>Plasmodium falciparum </it>serve as a reservoir of parasites for malaria transmission. Identification and treatment of asymptomatic carriers within a region may reduce the parasite reservoir and influence malaria transmission in that area.</p> <p>Methods</p> <p>Using computer simulation, this analysis explored the impact of community screening campaigns (CSC) followed by systematic treatment of <it>P. falciparum </it>asymptomatic carriers (AC) with artemether-lumefantrine (AL) on disease transmission. The model created by Okell <it>et al </it>(originally designed to explore the impact of the introduction of treatment with artemisinin-based combination therapy on malaria endemicity) was modified to represent CSC and treatment of AC with AL, with the addition of malaria vector seasonality. The age grouping, relative distribution of age in a region, and degree of heterogeneity in disease transmission were maintained. The number and frequency of CSC and their relative timing were explored in terms of their effect on malaria incidence. A sensitivity analysis was conducted to determine the factors with the greatest impact on the model predictions.</p> <p>Results</p> <p>The simulation showed that the intervention that had the largest effect was performed in an area with high endemicity (entomological inoculation rate, EIR > 200); however, the rate of infection returned to its normal level in the subsequent year, unless the intervention was repeated. In areas with low disease burden (EIR < 10), the reduction was sustained for over three years after a single intervention. Three CSC scheduled in close succession (monthly intervals) at the start of the dry season had the greatest impact on the success of the intervention.</p> <p>Conclusions</p> <p>Community screening and treatment of asymptomatic carriers with AL may reduce malaria transmission significantly. The initial level of disease intensity has the greatest impact on the potential magnitude and duration of malaria reduction. When combined with other interventions (e.g. long-lasting insecticide-treated nets, rapid diagnostic tests, prompt diagnosis and treatment, and, where appropriate, indoor residual spraying) the effect of this intervention can be sustained for many years, and it could become a tool to accelerate the reduction in transmission intensity to pre-elimination levels. Repeated interventions at least every other year may help to prolong the effect. The use of an effective diagnostic tool and a highly effective ACT, such as AL, is also vital. The modelling supports the evaluation of this approach in a prospective clinical trial to reduce the pool of infective vectors for malaria transmission in an area with marked seasonality.</p

Profil des thèses d’exercice professionnel de médecine et des mémoires de fin d’études spécialisées en pédiatrie soutenus à l’université de Lomé (Togo)

But : Le but de ce travail était de faire l’inventaire thématique du contenu des thèses et des mémoires de fin d’études spécialisées en pédiatrie, afin d’orienter de façon plus pertinente le choix des sujets de thèses et de mémoires portant sur l’enfant. Matériel et méthodes : Il s’est agi d’une étude rétrospective portant sur 101 thèses et mémoires soutenus au département de pédiatrie du Togo entre 1974 et 2005. Les données recueillies, manuellement, provenaient des registres de thèses et de mémoires. Les titres des thèses et des mémoires ont été relevés, dénombrés puis classés par spécialités, par thèmes, et par pathologies, syndromes ou signes étudiés. Résultats : En 31 ans, 101 thèses et mémoires soit 75 thèses et 26 mémoires ont été soutenus. Les principales spécialités étudiées étaient l’infectiologie (18,8 %) et la santé publique (17,8 %). Les thèmes abordés étaient surtout la pathologie et la thérapeutique (80,2 %). Les principales affections ou symptômes étudiés étaient le paludisme, la drépanocytose et les faibles poids de naissance. Les aspects abordés en rapport avec les principales affections étudiées étaient dominés par les aspects thérapeutiques et évolutifs et les aspects diagnostiques. Les aspects concernant l’évaluation de la prise en charge des principales affections ont été rarement abordés. Conclusion : Le répertoire des sujets de thèses et mémoires soutenus dans le département de pédiatrie au Togo n’est que très imparfaitement congruent avec la réalité épidémiologique des problèmes de santé qui sont à résoudre au Togo et il reflète mal l’ampleur de la morbidité et de la mortalité des affections étudiées, paramètres pourtant pertinents en termes de santé publique infantile

Malformations congénitales visibles à la naissance a Lomé, Togo

Introduction : Les malformations congénitales posent des problèmes diagnostiques dans les pays en développement. Elles sont associées à une lourde mortalité néonatale. Les données épidémiologiques sur ce sujet sont rares au Togo. L’objectif du présent travail était de décrire les malformations congénitales visibles à la naissance au Centre Hospitalier Régional de Lomé Commune (CHR – LC).Patients et méthode : Tous les nouveau-nés présentant une ou plusieurs malformations décelables à la naissance dans la maternité du CHR – LC ont été inclus d’avril 2018 à mars 2019. Résultats : La prévalence des malformations congénitales visibles en salle d’accouchement était de 6,9‰. L’âge moyen des mères était de 29,2 ± 9 ans. Le sexe ratio M/F des nouveau-nés malformés était de 1,1. Le poids moyen des nouveau-nés était de 3 050 grammes (2 100 – 4 400). Pour plus de la moitié (12/22, soit 54,5%), l’appareil locomoteur (les membres) était impliqué. Les polydactylies (7/22, soit 31,8%), les pieds bots (3/22, soit 13,6%), les fentes palatines (3/22, soit 13,6%), l’omphalocèle (2/22, soit 9,09%) et le genu recurvatum (2/22, soit 9,09%) étaient les principales anomalies. Cinq syndromes polymalformatifs (22,7%) ont été enregistrés. Conclusion : Les malformations congénitales sont des affections rencontrées en salle d’accouchement au CHR LC. Il n’existe pas pour l’heure de stratégie nationale de dépistage et de prévention. La tenue d’un registre dédié à ces affections dans les maternités, l’archivage des iconographies et la formation des sages-femmes et des échographistes pourraient améliorer le dépistage.&nbsp; &nbsp; English title: Congenital malformations seen at birth in Lome, Togo Introduction: Congenital malformations pose diagnostic problems in developing countries. They are associated with high neonatal mortality. Epidemiological data on this subject are rare in Togo. The objective of the present study was to describe the epidemiology of congenital malformations at birth in the Centre Regional de Lomé Commune (CHR - LC). Patients and method: All newborns presenting one or more malformations detectable at birth in the maternity ward of the CHR - LC were included from April 2018 to March 2019. Results: The prevalence was 6.9‰. The mean age of the mothers was 29.2 ± 9 years. The M/F sex ratio of malformed newborns was 1.1. The mean weight of the newborns was 3,050 grams (2,100 - 4,400). More than half (54.5%) of the malformations involved the locomotor system (limbs) (12/22 malformations). Polydactyly (7/22 or 31.8%), clubfoot (3/22 or 13.6%), cleft palate (3/22 or 13.6%), omphalocele (2/22 or 9.09%) and genu recurvatum (2/22 or 9.09%) were the main anomalies. Five polymalformative syndromes (22.7%) were recorded. Conclusion: Congenital malformations exist at CHR LC. There is currently no national screening and prevention strategy. Keeping a register dedicated to these conditions in maternity wards, archiving iconography, training midwives and antenatal ultrasounds providers could improve this screening