Etiology of Pediatric Bacterial Meningitis Pre- and Post-PCV13 Introduction Among Children Under 5 Years Old in Lomé, Togo.

BACKGROUND: Pediatric bacterial meningitis (PBM) causes severe morbidity and mortality within Togo. Thus, as a member of the World Health Organization coordinated Invasive Bacterial Vaccine Preventable Diseases network, Togo conducts surveillance targeting Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae, at a sentinel hospital within the capital city, Lomé, in the southernmost Maritime region. METHODS: Cerebrospinal fluid was collected from children <5 years with suspected PBM admitted to the Sylvanus Olympio Teaching Hospital. Phenotypic detection of pneumococcus, meningococcus, and H. influenzae was confirmed through microbiological techniques. Samples were shipped to the Regional Reference Laboratory to corroborate results by species-specific polymerase chain reaction. RESULTS: Overall, 3644 suspected PBM cases were reported, and 98 cases (2.7%: 98/3644) were confirmed bacterial meningitis. Pneumococcus was responsible for most infections (67.3%: 66/98), followed by H. influenzae (23.5%: 23/98) and meningococcus (9.2%: 9/98). The number of pneumococcal meningitis cases decreased by 88.1% (52/59) postvaccine introduction with 59 cases from July 2010 to June 2014 and 7 cases from July 2014 to June 2016. However, 5 cases caused by nonvaccine serotypes were observed. Fewer PBM cases caused by vaccine serotypes were observed in infants <1 year compared to children 2-5 years. CONCLUSIONS: Routine surveillance showed that PCV13 vaccination is effective in preventing pneumococcal meningitis among children <5 years of age in the Maritime region. This complements the MenAfriVac vaccination against meningococcal serogroup A to prevent meningitis outbreaks in the northern region of Togo. Continued surveillance is vital for estimating the prevalence of PBM, determining vaccine impact, and anticipating epidemics in Togo

The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger

BACKGROUND: For a health district to function referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own. METHODS: Information was triangulated from three sources in two rural districts in Niger: first, 46 semi-structured interviews with health centre nurses; second, 42 focus group discussions with an average of 12 participants – patients, relatives of patients and others; third, 231 semi-structured interviews with referred patients. RESULTS: Passive patients without 'voice' reinforce authoritarian attitudes of health centre staff. The latter appear reluctant to refer because they see little added value in referral and fear loss of power and prestige. As a result staff communicates poorly and show little eagerness to convince reluctant patients and families to accept referral proposals. CONCLUSIONS: Diminishing referral costs and distance barriers is not enough to correct failing referral systems. There is also a need for investment in district hospitals to make referrals visibly worthwhile and for professional upgrading of the human resources at the first contact level, so as to allow for more effective referral patterns

Monitoring the referral system through benchmarking in rural Niger: an evaluation of the functional relation between health centres and the district hospital

BACKGROUND: The main objective of this study is to establish a benchmark for referral rates in rural Niger so as to allow interpretation of routine referral data to assess the performance of the referral system in Niger. METHODS: Strict and controlled application of existing clinical decision trees in a sample of rural health centres allowed the estimation of the corresponding need for and characteristics of curative referrals in rural Niger. Compliance of referral was monitored as well. Need was matched against actual referral in 11 rural districts. The referral patterns were registered so as to get an idea on the types of pathology referred. RESULTS: The referral rate benchmark was set at 2.5 % of patients consulting at the health centre for curative reasons. Niger's rural districts have a referral rate of less than half this benchmark. Acceptability of referrals is low for the population and is adding to the deficient referral system in Niger. Mortality because of under-referral is highest among young children. CONCLUSION: Referral patterns show that the present programme approach to deliver health care leaves a large amount of unmet need for which only comprehensive first and second line health services can provide a proper answer. On the other hand, the benchmark suggests that well functioning health centres can take care of the vast majority of problems patients present with

Management of sickle cell priapism with etilefrine

Intracavernous injections of etilefrine were effective in seven children with acute sickle cell priapism, and stuttering priapism resolved in five children after one to seven months of oral etilefrine. Compared with our previous reports in adults, etilefrine appears to be more effective in childhood.


Soins traditionnels donnes aux nouveau-nés et nourrissons dans le district sanitaire de Kloto (Togo) : risques et avantages

Purpose: Evaluate the traditional practices of management of neonates and infants, to identify practices to encourage and practices to discourage in the promotion of child health in the health district of Kloto.Population and methods: it was a quantitative and qualitative cross-sectional investigation, conducted from May 28 to June 14, 2008 in the health district of Kloto, and which involved 21 traditional birth attendants, 21 tradipractitioners, 70 pregnant women, 70 lactating women and 70 neonates and infants 0-6 months.Results: more than nine out of ten tradipractitioners received consultation of newborns and infants. They administered care as oral decoction (4.8%), body massage (33.3%) and bath (57.1%). Thirty percent of the neonates had received their first bath since the birth and seventy percent within the first 24 hours of life. They had already received an indefinite nature ophthalmic ointment in 50% of cases. Neonates whose umbilical cord had been treated with ash or Shea butter were in 100% of cases in rural areas. More than eight traditional birth attendants on 10 (83.3%) knew that infants must take the first feeding as soon as its first hour of life. Two-thirds (66.7%) of traditional birth attendants in urban areas and the third party (33.3%) in rural areas felt that the first administration of water and complementary foods to infants should be before 6 months of age. According to 81.7% to 90% of pregnant women the customary time for initiation of infants at the first feeding is the hour after birth. They threw the colostrum in 20% or more of cases. According to 9 out of ten pregnant women first administration of water to the infant was traditionally after 6 months of age of the infant. The traditional time of the introduction of the first baby food is the period of 2 to 6 months of age of the infant, declared by over three quarters of pregnant women. These pregnant women actually introduced the first food to their babies before there one month of age in 100% of cases in urban areas and 75% of cases in rural areas. Introduced food type was porridge or other liquids in almost 100% of cases. According to the majority of lactating women, the customary time for initiation of infants at the first feeding is the hour after his birth. They directly used colostrum in 97.1% of cases. The traditional time of the first administration of water to the baby is before 6 months of age of the infant according to 9 out of 10 mothers. And according to 78.6% of these mothers, the introduction of the first baby food is traditionally from the sixth month of age of the infant. Introduced food type was porridge or other liquids in more than 90% of cases, the pulp or other foods in 1.6%.Conclusion: This study to measure the degree of involvement of the practitioners in the health of children, and we reflect the reality of beneficial or harmful traditional practices.Keywords: Traditional care, newborn and infant, risks and advantages, TogoJ. Rech. Sci. Univ. Lom&#233; (Togo), 2012, S&#233;rie D, 14(2) : 27-3

Evaluation de la prise en charge du paludisme chez les enfants de moins de 5 ans à l’hôpital du District de Haho (Togo).

Devant l’ampleur du paludisme en pays intertropicaux le rôle du personnel soignant dans la réduction de la fréquence des cas de paludisme grave et de son taux de létalité devient évident. Nous avons alors voulu évaluer la qualité de la prise en charge de cette affection chez l’enfant de moins de cinq ans dans un hôpital de district au sud du Togo. Nous avons réalisé une étude prospective transversale du 22 novembre 2007 au 12 janvier 2008. Les résultats obtenus étaient les suivants : la notion d’automédication, qui n’a été recherchée que chez 39,3% des enfants, était confirmée dans tous les cas. L’examen physique à la recherche d’un foyer infectieux n’a été réalisé que dans 9,8% des cas. La quinine a été le principal antipaludique utilisé pour traiter le paludisme grave (94,3%). Elle a été également utilisée dans 93,3% des cas de paludisme simple. La durée du traitement précisée dans 90,2% des cas n’a été incorrecte que dans 3,6% des cas. Il est possible d’améliorer la qualité de la prise en charge du paludisme dans les centres de santé périphériques en formant régulièrement le personnel soignant à la stratégie de Prise en Charge Intégrée des Maladies de l’Enfant. Mots clés : Enfant, paludisme, prise en charge, Togo, Afrique.Malaria is still a deadly in the tropics. The part of the carrying staff in reduction severe malaria cases and it fatality rate is important. With this idea in mind, we investigated the change in ability of malaria carrying among under fives years children in a health district of southern Togo. We conducted a crosssectional study from 22 November 2007 to 12 January 2008.The notion of self treatment was research only in 39.3% cases and it was confirmed in each case. Their first line treatment was quinine in most cases (94.3%). Quinine was also the first treatment in simple malaria cases (93.3%). The treatment duration which was clarified in most cases (90.2%) was mistake in only 3.6% cases. Malaria’s carrying ability can be improved in such peripheral health centre, if health professionals are formed regularly for Integrated Management of Childhood Illness.Key word: Children, malaria, carrying, ability, Togo, Africa

Vaccination contre l’hepatite B chez les patients infectes par le VIH au chu Sylvanus Olympio

Objectif : Les objectifs de notre étude étaient de décrire les profils d’immunisation contre le VHB des patients VIH positifs non porteurs d’Ag HBs et d’identifier les patients successibles d’être vaccinés contre l’hépatite B.Matériels et méthodes : Il s’était agi d’une étude transversale, descriptive qui s’était déroulée du 1er octobre 2011 au 31 janvier 2012 chez des patients infectés par le VIH sous traitement antirétroviral depuis au moins six mois. Notre étude s’était déroulée à l’hôpital du jour du service d’infectiologie du CHU Sylvanus Olympio (SO) de Lomé.Résultats : La recherche de l’AgHBs sur les 1222 échantillons collectés a révélé 117 positifs, soit une prévalence globale de 9,6%. La recherche des Ac anti-HBs et anti HBc totaux réalisée chez les 1105 patients négatifs à l’AgHBs a montré que 20,1% des patients n’étaient pas immunisés contre le VHB ; seulement 0,4% des patients avaient été vaccinés.Conclusion : Cette étude confirme la forte prévalence du portage chronique de l’AgHBs chez les personnes vivant avec le VIH et l’insuffisance de la vaccination contre le VHB chez les patients co-infectés.Mots clés : co-infection, VHB, VIH, marqueurs VHB

Participation des hommes aux soins aux enfants avant la mise en oeuvre de la composante familiale et communautaire de la stratégie «prise en charge intégrée des maladies de l'enfant (PCIME) dans cinq districts d'appui de "Plan Togo

Aim : The purpose of this study was to assess the role played by the men in front of child illness before the implementation of the family and community component of the IMCI strategy in Togo.Population and methods: it was a descriptive, cross-sectional study conducted from the 24th to the 29th July, 2006, simultaneously in five health districts of Togo, to 250 households, 211 people in charge of children, and 211 children aged 0-5 years. A survey by dusters was the method used.Results: On 250 head of households surveyed, 87.2% were men, and 44.4% were illiterates. People in charge of the children were the men (41.7%), the women (58.3%). Forty six percent of the children concerned by the study had been sick in the four weeks preceding the survey. The main actions carried out by the people in charge of these sick children were the use of a health center or a health worker (52.6%), and the self-medication (40.2%). The sick children were conducted to health center by their fathers in 44% of the cases. The use of a health center was decided by the men in 58.3% of the cases. The care of children were paid by the men (88.3%), the women (11.7%). The search for money to pay for care, the search for roots and leaves in the bush to prepare herbal teas, and the administration of the medicine to the sick child constituted the main concrete actions carried out by the men. In the case of accident occurred in children, the decision of the therapeutic route came from the father in 71.4% of the cases, and the rugged child care expenses were paid by the father in 93% of the cases. The mosquito net under which slept the child eve was purchased by the father or other parent male in 27% of the cases, and the person to sleep the child under a mosquito net eve was the father in only 0.9% of the cases against 99.1% of the cases by the mother or other female relative.Conclusion: The participation of men in the care of children is a reality in Togo, influenced by many disparities. Despite the cultural diversity that characterizes African societies, it is necessary to sensitize men in knowledge gained today on the impact of paternal engagement on the development of the child, and the need for a redefinition of the paternal role.Keywords: Men participation, care for infants, IMCI, community, TogoJ. Rech. Sci. Univ. Lom&#233; (Togo), 2012, S&#233;rie D, 14(2) : 9-2

Profil des parasitoses intestinales chez l’enfant a l’hopital de Tsevie (Togo)

Objectif : L’objectif de cette étude était de décrire le profil des parasitoses intestinales chez l’enfant à l’hôpital de Tsévié (Togo).Matériels et méthodes Il s’agissait d’une étude descriptive analytique des dossiers des enfants hospitalisés dans le service de pédiatrie de l’hôpital de Tsévié et ayant bénéficié d’un examen parasitologique direct des selles du 1er janvier 2005 au 31 décembre 2009.Résultats : Sur 5 171 enfants hospitalisés, 628 (12,14%) avaient bénéficié d’un examen des selles. Un peu plus du tiers 196/628 (31,21 %) des enfants étaient porteurs de parasites intestinaux. L’âge moyen des enfants porteurs de parasites intestinaux était de 60,57 mois (6-168 mois). Leur poids moyen était de 16,61 kg. Les parasites les plus fréquents étaient : Entamoeba histolytica (41,27%), Trichomonas intestinalis (38,53%) et l’ankylostome (5,96%). Parmi les enfants ayant bénéficié des examens parasitologiques des selles 111 (56,63%) avaient un poids normal pour l’âge, 37 (18,88%) un poids insuffisant. Dans plus de la 1/2 des cas (58%), les enfants souffrant de parasitoses intestinales n’ont pas présenté de symptômes. Les parasitoses intestinales étaient rares avant 6 mois d’âge. Le paludisme (52%) et l’anémie (28%) sont les pathologies les plus fréquemment associées aux parasitoses intestinales. Vingt cas (11,22%) de polyparasitismes ont été notés. Les enfants parasités ont été traités par des antihelminthiases (pour les nématodes), et par des imidazolés (pour les protozoaires).Conclusion : Cette étude montre une prévalence élevée des parasites intestinaux chez lesenfants en milieu pédiatrique à Tsévié Seul le respect des règles générales d’hygiène et un bon approvisionnement en eau potable peuvent contribuer à faire baisser cette prévalence.Mots clés : Parasites intestinaux, enfant, Togo.ABSTRACTIntestinal parasites prevalence in childhood in Tsevie hospital.Aim: Describe prevalence intestinal parasites in childhood at Tsevie’s hospital.Material and methods: It was descriptive analytic of hospitalized children medical reports who benefited spelling of faeces exam from 1st january 2005 to 31st december 2009.Results: Among 5 171 hospitalized children, 628 (12.14%) benefited faeces exam along these 5 years. A more than the third party 196/628 of the children whose gave spelling of faeces had intestinal parasites (31.21%). their mean age was 60.57 months (6-168 months). The mean weight was 16.61 kg. Parasites the most frequent were: Entamoeba histolytica (41.27%), Trichomonas intestinalis (38.53%) and Ankylostomia (5.96). 111 (56.63%) children had a normal weight, 37 (18.88%) an inadequate weight. In more than the half of cases (58%), children suffering of intestinal parasites had not clinic signs. Intestinal parasites were rare before 6 months. Malaria (52%) and anemia (28%) were pathologic the most frequently associated to intestinal parasites. 22 (11.22%) cases of poly parasites were noted. Parasitic children were treated by anthelmintic treatment and imidazole treatment.Conclusion: This study showed high prevalence of intestinal parasites in children at Tsevie’s hospital. Alone respect of general rules of hygiene and the use of drinking water could contribute to put down this high prevalence.Keywords : Intestinal parasites, childhood, Togo

Erythropoïétine recombinante, traitement de l’anémie grave d’un nourrisson

L’érythropoïétine recombinante (EPOr) est utilisée en néonatalogie afin de prévenir l’anémie et de limiter le nombre de transfusions, qui sont essentiellement administrées dans les 3 ou 4 premières semaines de vie chez les nouveau-nés prématurés de moins de 1500 g ou de moins de 36 semaines d’aménorrhée (SA). Un nourrisson de 25 mois présentant un paludisme grave forme anémique décompensé avec un taux d’hémoglobine de 1,9 g/dl dont les parents sont des Témoins de Jéhovah a été traité par de l’EPOr en lieu et place d’une transfusion sanguine. En effet, les parents étaient contre la transfusion sanguine en raison de leur foi. L’utilisation de l’EPOr n’est pas habituelle à cet âge mais il est nécessaire qu’on s’en approprie pour les situations où nous ne disposerons pas de sang, tout en tenant compte du coût. C’est le lieu aussi de sensibiliser les Témoins de Jéhovah à être plus réalistes surtout devant des cas comme celui de ce nourrisson.Mots clés : Anémie, Erythropoïétine, transfusion, Témoins de Jéhovah.Recombinant erythropoietin (EPOr) is used in neonatology to prevent anaemia and to limit the number of transfusions which are essentially administered in the first 3 or 4 weeks of the life in preterm infants with birth weights below 1500 g. or below 36 SA. An infant of 25 months presented an acute malaria and anaemia, the haemoglobin rate was 1,9 g/dl, whose parents were Témoins de Jéhovah, was treated by EPOr instead of blood transfusion. In fact, the parents were against blood transfusion because of their faith. The EPOr’s use is not usual at this age but it is necessary we appropriate for the situations for which we didn’t have blood. It’s the moment to sensitize Témoins de Jéhovah to preserve children life in the situations like of this infant.Keys words: Anaemia, Erythropoietin, transfusion, Témoins de Jéhovah