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-

Incidence of Plasmodium falciparum malaria infection in 6-month to 45-year-olds on selected areas of Bioko Island, Equatorial Guinea

BACKGROUND: Extensive malaria control measures have been implemented on Bioko Island, Equatorial Guinea over the past 16 years, reducing parasite prevalence and malaria-related morbidity and mortality, but without achieving elimination. Malaria vaccines offer hope for reducing the burden to zero. Three phase 1/2 studies have been conducted successfully on Bioko Island to evaluate the safety and efficacy of whole Plasmodium falciparum (Pf) sporozoite (SPZ) malaria vaccines. A large, pivotal trial of the safety and efficacy of the radiation-attenuated Sanaria((R)) PfSPZ Vaccine against P. falciparum is planned for 2022. This study assessed the incidence of malaria at the phase 3 study site and characterized the influence of socio-demographic factors on the burden of malaria to guide trial design. METHODS: A cohort of 240 randomly selected individuals aged 6 months to 45 years from selected areas of North Bioko Province, Bioko Island, was followed for 24 weeks after clearance of parasitaemia. Assessment of clinical presentation consistent with malaria and thick blood smears were performed every 2 weeks. Incidence of first and multiple malaria infections per person-time of follow-up was estimated, compared between age groups, and examined for associated socio-demographic risk factors. RESULTS: There were 58 malaria infection episodes observed during the follow up period, including 47 first and 11 repeat infections. The incidence of malaria was 0.25 [95% CI (0.19, 0.32)] and of first malaria was 0.23 [95% CI (0.17, 0.30)] per person per 24 weeks (0.22 in 6-59-month-olds, 0.26 in 5-17-year-olds, 0.20 in 18-45-year-olds). Incidence of first malaria with symptoms was 0.13 [95% CI (0.09, 0.19)] per person per 24 weeks (0.16 in 6-59-month-olds, 0.10 in 5-17-year-olds, 0.11 in 18-45-year-olds). Multivariate assessment showed that study area, gender, malaria positivity at screening, and household socioeconomic status independently predicted the observed incidence of malaria. CONCLUSION: Despite intensive malaria control efforts on Bioko Island, local transmission remains and is spread evenly throughout age groups. These incidence rates indicate moderate malaria transmission which may be sufficient to support future larger trials of PfSPZ Vaccine. The long-term goal is to conduct mass vaccination programmes to halt transmission and eliminate P. falciparum malaria

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

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

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

Outcome of severe malaria in children in two district hospitals in Cameroon

Malaria is a major endemic parasitic disease and remains the main cause of morbidity and mortality in sub-Saharan Africa. Children less than 5 years old carry the largest part of this burden with 3000 deaths daily. Case management of severe malaria is a main problem in Cameroon. The regime proposed by the WHO needed to be tested in African countries to prove its effectiveness and efficacy before adoption. This is thus part of a multi-centre study. Our main aim was to describe the evolution and outcome of severe malaria on management following the current WHO treatment guidelines. From January 1st to August 31st 2000, 148 children aged from 6 to 59 months 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. The incidence of severe malaria was 21.1%. The male/female ratio was 1.06. The commonest clinical forms of severe malaria were: generalised convulsions (54.7%), prostration (43.2%) and severe anaemia (14.9%). The case management of severe malaria was effective, for, the mean fever clearance time was 27.9 ± 21.4 hours, the mean coma recovery time was 36.0 ± 17.0 hours, the parasitaemia reduced by 96.5% 48 hours after onset of treatment and haematocrit increased from 26.4% ± 6.7 initially to 33.7% ± 3.7 on day 28. Most children (95.9%) were completely cured, 2.0% died and there was no neurological deficit over 1 month follow-up. We recommend the generalisation of the protocol throughout the national territory in Cameroon and further training of health personnel to facilitate the utilisation of the protocol. Keywords: severe malaria, children, case management, WHO guidelines, evolution, outcome Clinics in Mother and Child Health Vol. 2(1) 2005: 247-25