Family And Community Practices Relating To Infant Feeding In Central Togo:A study preceding implementation of the family and community component of the «Integrated Management of Childhood Illness» strategy (C-IMCI).

The aim of this study was to assess neonate and infant feeding practices in the central region of Togo before implementation of the community component of the «Integrated Management of Childhood Illness» (C-IMCI) strategy. It was a cross-sectional study from 29th March to 8th April 2004 and included a random sample of 983 households, 506 caretakers and 733 under-five children. Using the Epi-info and SPSS softwares, this study assessed mainly breast feeding, the use of breast milk substitutesand weaning practices. It was noted that out of the 733 children, 52% were males and 48% females, 27% less than one year and 21.6% between 12 and 23 months. After delivery, 29.3% of infants were breastfed within one hour, and 75.6% within the first 24 hours. Only 78.4% of the children received colostrum after birth. It was also noted insufficient breast milk flow in 53.1% of the mothers and water was the main substitute for breast milk in 21% of the children. If 57.7% of the children were exclusively breastfed for the first 6 months, only 9.5% of the infants were breastfed up to the 23rd month. Complementary foods were introduced at an average age of 6 months with water, pap, «diuri» (a plant decoction), and at an average age of 11 months with other family foods. Altogether,65% of mothers stopped breastfeeding between 18 and 30 months for varying reasons : 7% because of pregnancy, 6% due to insufficient breast milk flow, 3% professional constraints and 3% death. From this study we recommend that sustained efforts have to be made on the sensitization of mothers during C-IMCI implementation on cultural practices that do not support optimal feeding of the neonate and young infant

Prise en charge de la detresse respiratoire neonatale dans lunite de reanimation pediatrique du CHU-Tokoin Lome (Togo)

Introduction: La détresse respiratoire néonatale (DRNN) est une affection fréquente très meurtrière dont la prise en charge doit être bien codifiée. Au Togo, l’insuffisance du plateau technique et des difficultés d’organisation des soins rendent difficile la prise en charge. Très peu d’études ont été consacrées à la DRNN en Afrique Sub-saharienne. Le but de la présente étude est d’évaluer la prise en charge de la DRNN dans l’Unité de Réanimation Pédiatrique du CHU-Tokoin de Lomé.Patients et méthode d’étude: Il s’agissait d’une étude rétrospective ayant porté sur l’analyse de 219 dossiers des nouveau-nés à terme, hospitalisés du 1er janvier au 31 décembre 2007 pour DRNN ou l’ayant développé au cours de l’hospitalisation.Résultats: La fréquence de la DRNN était de 26,7% ; une prédominance masculine a été observée avec une sex-ratio de 1,67. L’âge des nouveau-nés était compris entre J0 et J7 dans 94,5% des cas; 51,5 des nouveau-nés étaient nés de mères primigestes. Les nouveau-nés par césarienne représentaient 23,7% ; 52% des nouveau-nés étaient réanimés en salle de naissance ; les nouveau-nés ayant eu un score d’APGAR ≥8 ont été réanimé à tort dans 14,9%, à la 1ère, 36,3% à la 5ème et 48,6% à la 10ème minute. Les principaux motifs d’hospitalisation étaient la détresse respiratoire (42,1%) et la réanimation en salle de naissance (19,1%) ; la tachypnée était le trouble du rythme respiratoire le plus fréquent (60,7%) ; le tirage intercostal (99,1%) et le battement des ailes du nez (95%) étaient des signes de lutte respiratoire les plus observés. Le score de Silverman était compris entre 5 et 7 dans 60,7% ; les signes de gravité les plus retrouvés étaient un score de Silverman ≥ 5(25,8%), la prostration (24,1%) et la cyanose (20%). Un bilan paraclinique été très peu demandé. Les principales étiologies étaient l’infection (47 ,9%), la souffrance néonatale (25,2%) et les troubles métaboliques (8,9%). Le traitement était essentiellement constitué d’oxygénothérapie, d’une bi-antibiothérapie parentérale (céphalosporine de 3ème génération + aminoside) de courte durée (durée moyenne ± 3,65 jours). Une surcharge hydrique a été observée dans 55,3% des cas. L’évolution a été favorable dans 42,5% des cas ; la létalité a été très élevée (45,2%). Les principales causes de décès étaient l’infection (47,5%) la souffrance (21,2%) et les troubles métaboliques (17,2%).Conclusion: Cette étude a révélé des insuffisances dans la prise en en charge des nouveau-nés en détresse respiratoire hospitalisés. L’amélioration de la qualité de la prise en charge de ces détresses respiratoires s’impose et cela doit passer par le renforcement du plateau technique de l’unité, des soins adaptés et un bon suivi du nouveau-né hospitalisé pour détresse respiratoire. Leur prévention passe par une bonne prise en charge de la grossesse et de l’accouchement et une bonne réanimation en salle de naissance si elle est indiquée.Mots clés: Détresse respiratoire, nouveau-né à terme, prise en charge, TogoEnglish AbstractBackground: Neonatal Respiratory Distress (NNRD) is a frequent affection which is very lethal and which management must be well codified. In Togo, inadequate technical equipment and organizational difficulties make the management difficult. Very few studies have been devoted to NNRD in Sub-Saharan Africa.Objective: Evaluate the management of NNRD in the Paediatric Intensive Care Unit of Tokoin Teaching Hospital of Lome.Method: It was a retrospective study on the analysis of 219 cases of infants born at term, hospitalized from January 1st to December 31st, 2007 for NNRD or having developed it during hospitalization.Results: The frequency of the NNRD was 26.7%; a male predominance was observed with a sex ratio of  1.67. The age of the newborns ranged between D0 and D7 in 94.5% of cases; 51.5% of the newborns were born to primigravidae. infants born by caesarean section accounted for 23.7%; 52% of infants were reanimated in the delivery room; newborns who had an APGAR score ≥ 8 were reanimated in 14.9% at the 1st, 36.3% at the 5th and 48.6% at the 10th minute. The main reasons for hospitalization were respiratory distress (42.1%) and reanimation in the delivery room (19.1%), tachypnea was the most common respiratory rythm trouble (60.7%); the intercostal pull (99.1%) and the flaring of the nose (95%) were the most observed signs of respiratory struggle. Silverman's score was between 5 and 7 in 60.7%; the most found signs of severity were Silverman’s score ≥ 5 (25.8%), prostration (24.1%) and cyanosis (20%). A paraclinical checkup was rarely asked. The main etiologies were infection (47. 9%), neonatal suffering (25.2%) and metabolic disorders (8.9%). The treatment consisted essentially of oxygen, bi-parenteral antibiotics (3rd generation cephalosporin + aminoside) of short duration (average duration ± 3.65 days). Fluid overload was observed in 55.3% of cases. The evolution was favorable in 42.5% of cases; lethality was very high (45.2%). The main causes of death were infection (47.5%) suffering (21.2%) and metabolic disorders (17.2%).Conclusion: This study has revealed insufficiencies in the management of hospitalized newborns with respiratory distress. Improving the quality of the management of these respiratory distresses is a must and can only be achieved by the improvement of the technical equipment of the unit, appropriate cares and proper monitoring of hospitalized newborns for respiratory distress. Their prevention requires good management of pregnancy and childbirth and a good reanimation in the delivery room when indicated.Keywords: Respiratory distress, newborn at term, management, Tog

Environnement sanitaire de l’enfant dans la region centrale du Togo

Objective: To Determine the sanitary and socio-educational environment of the child less than five years in the central region of Togo.Method: A descriptive survey led simultaneously in the five districts of this region on a sample of 983 households in care of 733 children less than five years has been carried from March 29 to April 08, 2004.We had to study the socio-demographic aspects mainly including the living conditions, drainage work and the practices in relation with child's physical, mental and social development.Results: The investigated householders were farmers (56.7%), illiterate (53.6%) and aged from 30 to 49 years (47.6%). With two or three persons by room and seven by household the domestic environment was marked by promiscuity. Out of the 733 children, 52% of boys, 48% of girls, 27% were aged less than one year and 21.6% from 12 to 23 months. Non drinking water was used by 67.4% of households, nature was taken for lavatory (68.1%) and household refuse and waste water were put in domestic dumping grounds(49.8%). Only 2.7% of the children were sent to school. The early-learning games (36.5%) and games of skill (26.9%) were the most used traditional means for children’s education. Drubbing was the mostcurrent punishment of children (51.2%) and laziness and unruliness were the most frequent motives for it (47.2%).Conclusion- This living environment of the child in the central region of Togo, marked by a weak domestic income, promiscuity, lack of drinking water, faecal peril, pollution and insufficiencies of sanitary education, appeared not very propitious to child's physical, mental and social development, but favourable to various pathologic outbreaks mostly targets of the strategy of PCIMN

Efficacite de la strategie pcime (prise en charge integree des maladies de l’enfant) dans le diagnostic et le traitement de la toux et/ou des difficultes respiratoires chez les enfants de moins de 5ans vus en unites de soins peripheriques a Lome (Togo).

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