Epidemiologie de la drepanocytose

La drépanocytose, est une anémie hémolytique héréditaire. Elle est causée par la présence d'une hémoglobine anormale, l'hémoglobine S, résultat de la substitution, sur la chaîne β, en position 6, de l'acide glutamique par la valine. Seuls les homozygotes sont malades. La première description de la maladie a été faite en 1910 par Herrick, qui a découvert chez un patient des hématies déformées en faucilles. Depuis 1957, on connaît la structure exacte de l'hémoglobine S, première maladie génétique moléculaire connue. Le trait drépanocytaire est très fréquent dans le monde, mais surtout en Afrique Noire Sub-Saharienne, en Amérique du Nord, Centrale et du Sud, au Proche Orient. Mots cles: drépanocytose, epidémiologie, historique Clinics in Mother and Child Health Vol. 1(1) 2004: 6-

Évaluation De L’aptitude De Pseudospondias Microcarpa (A. Rich.) Engl. Var. Microcarpa (Anacardiaceae) Au Marcottage Aérien Et Perspectives De Domestication Dans Le Sud-Est Du Gabon

La Multiplication Végétative Des Espèces Spontanées À Usages Multiples Reste Encore Limitée En Zone Tropicale Humide D’afrique Centrale. Cette Étude Évalue L’aptitude De Pseudospondias Microcarpa Au Marcottage Aérien Dans Les Conditions De Franceville Dans Le Sud-Est Du Gabon. L’objectif À Terme Est Sa Domestication Et Son Intégration Dans Les Systèmes Agroforestiers Traditionnels. Sur 102 Branches Orthotropes, 4 Substrats (Sphaigne Du Chili, Mousse, Inflorescence Mâle Du Palmier À Huile, Sciure De Bois) Ont Été Testés. L’induction Racinaire, Intervenant Au Bout De 30 Jours, S’étend Au-Delà De 120 Jours, Et Ne Dépend Pas Du Type De Substrat. Le Volume Racinaire Par Contre Augmente Avec La Texture Du Substrat Utilisé. Les Taux D’enracinement (78,43 ± 7,98%) Et De Réussite (97,5 ± 3,42%) À 120 Jours Sont Très Prometteurs. Les Taux De Survie En Pépinière (55,56 ± 13,25%) Et En Champ (45,83 ± 19,93%) Restent Assez Variables. Néanmoins, Ces Résultats Indiquent Que Pseudospondias Microcarpa Var. Microcarpa Présente Une Bonne Aptitude Au Marcottage Aérien. Cette Observation Constitue Un Préalable À La Domestication De Cette Espèce. Les Deux Derniers Résultats Suggèrent Cependant De S’appesantir Sur La Recherche Des Conditions Optimales De Sevrage Et De Culture, Afin D’améliorer La Production Des Plants Par Marcottage Aérien De Pseudospondias Microcarpa. L’autre Résultat Majeur Est La Prise En Compte Des Substrats Locaux Dans La Vulgarisation De Cette Technique À Faible Coût. Vegetative propagation of spontaneous multipurpose species is still limited in tropical rainforest areas of Central Africa. This study evaluates the aptitude of Pseudospondias microcarpa for aerial marcottage under the conditions of Franceville in south-eastern Gabon. The ultimate objective is its domestication and its integration into traditional agroforestry systems. A total of 102 orthotropic branches were tested on 4 different substrates: Chilean sphagnum moss, moss, male inflorescence of oil palm, and sawdust. The root induction, occurring after 30 days, extends beyond 120 days and does not depend on the substrate type. Rooting (78.43 ± 7.98%) and success rates (97.5 ± 3.42%) at 120 days were very promising. The nursery (55.56 ± 13.25%) and field (45.83 ± 19.93%) survival rates remain quite variable. However, these results indicate that Pseudospondias microcarpa var. microcarpa has a good ability to aerial marcottage. This observation constitutes a prerequisite for the domestication of this species. The latter two results suggest, however, to further investigates the optimum conditions of weaning and cultivation. This is done in order to improve Pseudospondias microcarpa plant production through aerial marcottage. The other major result has to do with taking into account local substrates in popularizing this low-cost technique

Brief Communication: Disclosure of HIV Illness Status to Children and Adolescents: When, How and by Who?

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Iron deficiency and neurologic disease in children

Iron deficiency is a frequent disorder and a public health problem especially in children and pregnant women. The clinical manifestations are varied, and the most dreaded are neurologic. These neurologic manifestations are often missed as differential diagnosis in current clinical practice. The authors review iron metabolism in the brain and the basic mechanisms underlying neurologic machanisms in iron deficiency states. It is hoped that better understanding of these manifestations will reinforce implementation of preventive mesures of iron deficiency in children and pregnant women, who are the most vulnerable. Clinics in Mother and Child Health Vol. 1(2) 2004: 125-12

Methicillin-resistant Staphylococcus aureus as a cause of invasive infections in Central Africa: a case report and review of the literature

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) colonization and infection are increasingly being reported worldwide and are associated with severe illness. The vast majority of MRSA infections are skin and soft tissue infections, while invasive disease remains rare. In Western countries, the epidemiology of MRSA is well documented, but from Central Africa, reports on MRSA are very limited. Case presentation and review of the literature. The clinical features, epidemiology, and characteristics of MRSA in Central Africa, as well as the treatment options, are discussed. We present a case of severe invasive CA-MRSA infection with pneumonia, pericarditis, and bacteremia in a previously healthy young woman in Gabon. Several virulence factors, like Panton-Valentine leukocidin and type I arginine catabolic mobile element, may play a role in the ability of CA-MRSA to cause severe invasive infections. Based on studies from Gabon and Cameroon (no reports were available from other countries), we find that the prevalence of MRSA is relatively low in this region. Treatment depends primarily on local prevalence and resistance profile of MRSA combined with clinical characteristics. Severe invasive infection with CA-MRSA is a rare disease presentation in Central Africa, where this pathogen is still relatively uncommon. However, cases of MRSA may be complicated by the human immunodeficiency virus (HIV) and tuberculosis epidemics, and also the limited availability of effective antibiotic

Genetic diversity and ecology of coronaviruses hosted by cave-dwelling bats in Gabon

Little research on coronaviruses has been conducted on wild animals in Africa. Here, we screened a wide range of wild animals collected in six provinces and five caves of Gabon between 2009 and 2015. We collected a total of 1867 animal samples (cave-dwelling bats, rodents, non-human primates and other wild animals). We explored the diversity of CoVs and determined the factors driving the infection of CoVs in wild animals. Based on a nested reverse transcription-polymerase chain reaction, only bats, belonging to the Hipposideros gigas (4/156), Hipposideros cf. ruber (13/262) and Miniopterus inflatus (1/249) species, were found infected with CoVs. We identified alphacoronaviruses in H. gigas and H. cf. ruber and betacoronaviruses in H. gigas. All Alphacoronavirus sequences grouped with Human coronavirus 229E (HCoV-229E). Ecological analyses revealed that CoV infection was significantly found in July and October in H. gigas and in October and November in H. cf ruber. The prevalence in the Faucon cave was significantly higher. Our findings suggest that insectivorous bats harbor potentially zoonotic CoVs; highlight a probable seasonality of the infection in cave-dwelling bats from the North-East of Gabon and pointed to an association between the disturbance of the bats' habitat by human activities and CoV infection

A Prospective Comparison of Quick Sequential Organ Failure Assessment, Systemic Inflammatory Response Syndrome Criteria, Universal Vital Assessment, and Modified Early Warning Score to Predict Mortality in Patients with Suspected Infection in Gabon

The quick sequential organ failure assessment (qSOFA) score has been proposed for risk stratification of emergency room patients with suspected infection. Its use of simple bedside observations makes qSOFA an attractive option for resource-limited regions. We prospectively assessed the predictive ability of qSOFA compared with systemic inflammatory response syndrome (SIRS), universal vital assessment (UVA), and modified early warning score (MEWS) in a resource-limited setting in Lambaréné, Gabon. In addition, we evaluated different adaptations of qSOFA and UVA in this cohort and an external validation cohort from Malawi. We included 279 cases, including 183 with an ad hoc (suspected) infectious disease diagnosis. Overall mortality was 5%. In patients with an infection, oxygen saturation, mental status, human immunodeficiency virus (HIV) status, and all four risk stratification score results differed significantly between survivors and non-survivors. The UVA score performed best in predicting mortality in patients with suspected infection, with an area under the receiving operator curve (AUROC) of 0.90 (95% confidence interval [CI]: 0.78-1.0, P < 0.0001), outperforming qSOFA (AUROC 0.77; 95% CI: 0.63-0.91, P = 0.0003), MEWS (AUROC 0.72; 95% CI: 0.58-0.87, P = 0.01), and SIRS (AUROC 0.70; 95% CI: 0.52-0.88, P = 0.03). An amalgamated qSOFA score applying the UVA thresholds for blood pressure and respiratory rate improved predictive ability in Gabon (AUROC 0.82; 95% CI: 0.68-0.96) but performed poorly in a different cohort from Malawi (AUROC 0.58; 95% CI: 0.51-0.64). In conclusion, UVA had the best predictive ability, but multicenter studies are needed to validate the qSOFA and UVA scores in various settings and assess their impact on patient outcome

Clinical presentation of severe malaria in children in two district hospitals in Cameroon

Since efforts to eradicate malaria failed in the 1970's, sub-Saharan African countries have learned to live with malaria and children less than 5 years old carry the largest part of this burden with 3000 deaths daily. Knowledge of the various forms of severe malaria at peripheral hospitals is important in order to better direct available resources for case-management. Hence we set out to describe the clinical and paraclinical presentation at two peripheral hospitals in the Centre province, Cameroon. From January 1st to August 31st 2000, at the Djoungolo and the Mfou district hospitals 148 children aged from 6 to 59 months who presented with at least one feature of severe malaria were recruited by consecutive sampling. The incidence of severe malaria was 21.1%. The male/female ratio was 1.06. The most frequent manifestations of severity on admission were fever (96.6%), confusion or drowsiness (70.3%), convulsions (54.7%), prostration (43.2%), abnormal breathing (deep, in-drawing of chest wall, 34.5%) and severe anaemia (14.9%) in these children who arrived at the hospital 4 days on average after the onset of illness. The paraclincal presentation was marked by a high median parasitaemia at 18000 /mm3. Most (79.7%) children were said to have received antimalarial drugs before admission and chloroquine was the most presumed drug of choice (73.4%). We recommend reinforcement of education of parents / caretakers on the management of malaria at home and the equipment of peripheral referral hospitals with transfusion facilities in order to reduce the number of referrals to the central level of patients requiring transfusion. Keywords: severe malaria, children, WHO criteria, clinical, paraclinical, peripheral hospitals, Cameroon Resume: Depuis l'échec des efforts pour l'éradication du paludisme dans les années 70, les pays de l'Afrique subsaharienne se sont accommodés à vivre avec le paludisme et les enfants de moins de 5 ans paient le plus lourd tribut avec 3000 décès par jour. Pour une meilleure orientation des ressources disponibles dans la prise en charge des cas, il est important de connaître les différentes formes du paludisme grave dans les formations sanitaires périphériques. Ainsi, nous avons entrepris de décrire la présentation clinique du paludisme grave dans deux hôpitaux périphériques de la Province du Centre au Cameroun. Du 1er janvier au 31 août 2000, 148 enfants âgés de 6 à 59 mois, présentant au moins un signe de paludisme grave ont été recrutés par échantillonnage systématique dans les hôpitaux de district de Djoungolo et de Mfou. L'incidence du paludisme grave a été de 21.1%, et le sexe ratio de 1.06 en faveur de garçons. La fièvre (96.6%), la confusion ou le somnolence (70.3%), les convulsions (54.7%), la prostration (43.2%), la respiration anormale (profonde, tirage costal, 34.5%) et l'anémie sévère (14.9%). étaient les signes de gravité les plus fréquemment retrouvés chez ces enfants qui arrivaient à l'hôpital 4 jours en moyenne après le début de la maladie. Le profil paraclinique était marqué par une forte parasitémie à 18 000 parasites/mm3. La plupart (79.7%) des enfants avaient reçu des médicaments avant l'admission, la chloroquine était le médicament le plus utilisé à cet effet (73.4%). Ce traitement avant l'admission n'avait pas d'effet sur la parasitémie initiale. Nous recommandons que l'éducation des parents/tuteurs sur la prise en charge du paludisme soit intensifiée et que les responsables des hôpitaux de district au Cameroun s'organisent pour mettre en place le nécessaire pour la transfusion sanguine, ceci pour diminuer le nombre de cas référés au niveau central pour anémie sévère. Mots cles: paludisme grave, critères OMS, enfants, clinique, para clinique, hôpitaux périphériques, Cameroun Clinics in Mother and Child Health Vol. 2(1) 2005: 239-24

Cost-efficacy of managing severe malaria in children in two district hospitals in Cameroon

Since efforts to eradicate malaria failed in the 1970's, sub-Saharan African countries have learned to live with malaria, which remains the main cause of morbidity and mortality in children less than 5 years old. There is increasing concern about the cost of health care, because of increasing poverty in the population. Our main aim was to determine the direct cost and efficacy of case-management of severe malaria following the current WHO guidelines in children aged 6 to 59 months. From January 1st to August 31st 2000, 148 children (aged 6 to 59 months, and who presented with at least one feature of severe malaria) were recruited by consecutive sampling, at Djoungolo and Mfou District Hospitals. Treatment according to WHO guidelines was implemented and there was rigorous in-patient monitoring and outpatient follow-up. There were 72 girls and 76 boys; the mean age was 23.1 ± 13.1 months and the commonest clinical forms of severe malaria were: generalised convulsions (54.7%), prostration (43.2%) and severe anaemia (14.9%). Most children (95.9%) were completely cured, 2.0% died and there were no neurological deficits over one month follow-up. We estimate the cost of hospital management of each episode of severe malaria at 26 000 – 36 000 F CFA and the overall direct costs (before and during hospitalisation) at 27 000 – 39 000 F CFA. We conclude that the current WHO guidelines are efficacious, but expensive as compared to the standard of living in Cameroon. Keywords: severe malaria, WHO guidelines, cost-efficacy, children, Cameroon Resume: L'Afrique subsaharienne vit avec le paludisme depuis l'échec des efforts de son éradication dans les années soixante-dix et les enfants en dessous de 5 ans d'âge paient le plus lourd tribut à ce fléau avec 3000 décès par jour. Avec l'appauvrissement continu des populations, on note une préoccupation croissante sur le coût des soins de santé. Notre but est de déterminer le coût direct de prise en charge du paludisme grave selon les recommandations actuelles de l'organisation mondiale de la santé (OMS). Du 1er janvier au 31 août 2000, 148 enfants âgés de 6 à 59 mois, présentant au moins un signe de paludisme grave sont recrutés par échantillonnage systématique dans les hôpitaux de district de Djoungolo et de Mfou. L'incidence du paludisme grave est de 21,1%, et l'age moyen de ces enfants est de 23,1 ± 13,1mois, parmi lesquels 72 filles et 76 garçons. Les formes cliniques du paludisme grave les plus fréquentes ont été les convulsions (54,7%), la prostration (43,2%) et l'anémie sévère (14,9%). Nous avons enregistré 95,9% de guérison complète et 2,0% de décès. Nous n'avons pas observé des séquelles neurologiques pendant un mois de suivie. Le coût de prise en charge hospitalier de chaque épisode de paludisme grave a varié de 26 000 à 36 000 F CFA et le coût direct global (avant et pendant l'hospitalisation) de 27 000 à 39 000 F CFA. Nous concluons que les recommandations actuelles de l'OMS sur la prise en charge du paludisme grave sont efficaces mais chères par rapport au niveau de vie des camerounais. Mots cles: paludisme grave, enfants, traitement, coût, efficacité, Cameroun Clinics in Mother and Child Health Vol. 2(1) 2005: 253-25