Evaluation de L’efficacite et de L’acceptabilite de la Prise en Charge Ambulatoire de la Malnutrition Aigue Chez les Enfants Vivants Avec le Vih (Evvih) Au Centre Hospitalier Regional De Ziguinchor (Chrz)/ Senegal

Objectif : La malnutrition aigüe est fréquente chez les enfants infectés par le VIH. L’objectif de notre travail était d’évaluer l’efficacité et l’acceptabilité des protocoles de récupération nutritionnelle ambulatoire basés sur les aliments prêts à l’emploi (ATPE) chez les EVVIH. Matériel et méthodes : Il s’agissait d’une étude prospective, réalisée à la pédiatrie du CHRZ du 7 janvier au 31 Septembre 2018. Ont été inclus les EVVIH, âgés de 6 mois à 19 ans présentant une malnutrition aigüe modérée ou sévère sans complication. Le suivi était bimensuel jusqu’à l’atteinte du poids cible. Un bilan clinico-biologique et anthropométrique, la délivrance des ATPE et la mesure de l’observance aux prescriptions étaient réalisés. Résultats : Douze enfants vivants avec le VIH ont été inclus dont 3 MAS et 9 MAM sur un total de 25 enfants suivis soit une prévalence de 48%. Le sexe ratio (1,4) en faveur des garçons. L’âge médian (9,5 ans). Ils étaient sous ARV dans 92% des cas. La moitié des patients avait un âge > à 10 ans. La toux était le symptôme le plus retrouvé (67%) suivie de la diarrhée (58,3%), des vomissements (8,3%), une otite moyenne chronique (8,3%). La charge virale au début de l'étude a montré (5cas < 50 copies, 3cas < 5000 copies, 4cas > 15 000 copies). Le taux d'hémoglobine était < 10g/dl dans 92% des cas. Un problème d'observance de la prise d'ATPE a été noté dans 58,3%. Onze enfants ont atteint leur poids cible. Nous n’avons pas noté de perdu de vu ni d’hospitalisé. Conclusion : Les ATPE bien que efficaces, pausent souvent un problème d’acceptabilité. On gagnerait à améliorer le gout et la présentation pour permettre une meilleure observance. Objective: Acute malnutrition is common in children with HIV infection. The objective of our work was to evaluate the efficiency and acceptability of ambulatory nutritional recovery protocols (ATPE) based on ready-to-use food) in HIV-positive children (EVVIH). Methods: This was a prospective study, conducted at the pediatrics of the regional hospital center of Ziguinchor (CHRZ) from January 7th to September 31st, 2018. We included all HIV-positive children (EVVIH), aged between 6 months and 19 years with relatively acute or severe malnutrition without complication. The follow-up was done every two months until target weight was reached. A clinic-biological and anthropometric report, the issuing of ATPE and the measurement of compliance with prescriptions were carried out. Results: We chose 12 children living with HIV, including 3 MAS and 9 MAM out of a total of 25 children followed, with a prevalence of 48%. The sex ratio (1.4) was in favor of boys. The medium age was (9.5 years). They were under ARV in 92% of cases. Half of the patients were > 10 years old. Coughing was the most common symptom (67%) followed by diarrhea (58.3%), vomiting (8.3%), medium chronic otitis (8.3%). The viral affection at the beginning of the study showed (5cases <50 copies, 3cases <5000 copies, 4cases> 15,000 copies). The hemoglobin level was <10g / dl in 92% of cases. A problem of respect of ATPE taking was noted in 58.3%. Eleven children reached their target weight. We did not notice any loss ofsight and no child was hospitalized. Conclusion: Although the ATPE are efficient, they often cause a problem of acceptability. It would be better to improve the taste and the presentation to allow a better observance

Evaluation De La Prematurite Superieure Ou Egale A 32 Semaine D’amenorhée A L’hopital Regional De Ziguinchor Au Sud Du Senegal (Afrique De L’ouest)

Introduction: Prematurity is one of the leading causes of neonatal death in Africa. The objective of this work was to assess the preterm birth at the pediatric service of the regional hospital of Ziguinchor. Material and methods: This was a prospective, descriptive and analytical study of the case of hospitalized newborns whose age was between 32 SA to 36SA + 6 days. The study was conducted from May 21, 2013 to May 21, 2014. We included all premature infants at age ≥ 32SA.Those presenting a malformation were not included. We studied maternal socio-demographic, obstetric and neonatal parameters. Results: We have identified 140 newborns out of a total of 342 Preterm births and 2292 maternity births, a prevalence of 40.9% compared to preterm infants and 6.10% in relation to all births. 51.4 percent of mothers came from urban areas, 63.5 percent were between 20 and 34 years of age, not attending school in 45.7 percent, married in 72.9 percent and without work in 94.3 percent. The average gestures represented 3.09 . Arterial hypertension was the most common medical condition (67.7%). The followup was done by a midwife (82.1%) and 23.5% had received at least 4 NPC. Eclampsia and pre-eclampsia (48.9%) and RPM (42.8%) were common obstetric pathologies. The delivery was by caesarian (51.4%), hospital (92.1%), cephalic presentation (80%), with an average weight of 1816.79 g. An RCIU (16.4%), an RPM (61.9%). At birth, a DR (16.4%) was noted due to MMH (43.7%) and transitory tachypnea (50%). Asphyxia was reported in 3.5%. During hospitalization (6.7 days on average), 6.4% had RD caused by infection (77.7%). Other complications were infection (64.4%), hypoglycemia (28.5%), digestive hemorrhage (7.01%). The fatality rate was 7.9% due to infection (63.3%), DR (18%), haemorrhage (9%). The anthropometric measurements at the exit: P 1887.9g, T: 38.3cm, PC: 30.9cm; at 1 month P: 2387.1g, T: 46.6cm, PC: 32.8cm; at 30 months P: 12.1kg, T: 89.5cm, PC: 48.4cm. Conclusion: Moderate preterm birth accounts for almost half of the cases of prematurity in our series. Their optimal management would go through a better obstetric-neonatal collaboration but above all by the installation of kangaroo mother unit