Mortalité Néonatale dans le Service de Pédiatrie du Centre Hospitalier Universitaire de Kara de 2016 à 2020

Objectif : décrire la mortalité néonatale dans le service de pédiatrie du CHU-Kara Matériel et méthode : il s’agit d’une étude descriptive transversale portant sur les nouveau-nés décédés durant l’hospitalisation du 1er Janvier 2016 au 31 Décembre 2020 au CHU-Kara. Les principaux paramètres étudiés étaient les renseignements généraux, les caractéristiques de la mère, l’histoire et l’évolution de la grossesse, les données liées à l’accouchement, l’état du nouveau-né, la pathologie diagnostiquée et le traitement reçu avant le décès. Résultats : le taux de mortalité néonatale était de 158,4 ‰ dont 87,8% dans la première semaine de vie. Les facteurs maternels associés aux décès néonataux étaient : l’âge maternel compris entre 18-35 ans, le lieu de provenance et le niveau bas d’instruction. Les facteurs obstétricaux et néonataux associés au décès néonatals étaient : le mauvais suivi de la grossesse, le sexe masculin, l’accouchement par voie basse, l’asphyxie périnatale, la primiparité, la prématurité et la détresse respiratoire néonatale. Conclusion : la mortalité néonatale constitue un véritable fléau dans notre société. Le renforcement du suivi des femmes enceintes et de la prise en charge précoce du nouveau-né permettra de réduire cette mortalité. Objective: describe neonatal mortality in the pediatric department of the CHU-Kara. Material and method: It was a cross-sectional descriptive study on newborns who died during hospitalization from January 1st, 2016 to December 31th, 2020. The main parameters studied were general information, mother’s characteristics of the mother, pregnancy’s history, data related to childbirth, conditions/status of the newborn, diagnosed pathology and treatment received before death. Results: the neonatal mortality rate was 158.4 ‰ with 87.8% in the first week of life. Maternal associated factors for neonate’s death were: age between 18-35 years, place of origin and low level of education. The obstetric and neonatal factors associated with neonatal death were: weak pregnancy follow-up, male sex, vaginal delivery, perinatal asphyxia, primiparity, prematurity and neonatal respiratory distress. Conclusion: neonatal mortality is a real scourge in our society. Strengthening the follow-up of pregnant women and early care of the newborn will contribute to reducing this mortality

Assessment of dietary diversity and nutritional support for children living with HIV in the IeDEA pediatric West African cohort: a non-comparative, feasibility study

BACKGROUND: Nutritional care is not optimally integrated into pediatric HIV care in sub-Saharan Africa. We assessed the 6-month effect of a nutritional support provided to children living with HIV, followed in a multicentric cohort in West Africa. METHODS: In 2014-2016, a nutritional intervention was carried out for children living with HIV, aged under 10 years, receiving antiretroviral therapy (ART) or not, in five HIV pediatric cohorts, in Benin, Togo and Côte d'Ivoire. Weight deficiency was assessed using two definitions: wasting (Weight for Height Z-score [WHZ] for children<5 years old or Body-Mass-Index for Age [BAZ] for ≥5 years) and underweight (Weight for Age Z-score [WAZ]) (WHO child growth standards). Combining these indicators, three categories of nutritional support were defined: 1/ children with severe malnutrition (WAZ and/or WHZ/BAZ <-3 Standard Deviations [SD]) were supported with Ready-To-Use Therapeutic Food (RUTF), 2/ those with moderate malnutrition (WAZ and/or WHZ/BAZ = [-3;-2[ SD) were supported with fortified blended flours produced locally in each country, 3/ those non malnourished (WAZ and WHZ/BAZ ≥-2 SD) received nutritional counselling only. Children were followed monthly over 6 months. Dietary Diversity Score (DDS) using a 24h recall was measured at the first and last visit of the intervention. RESULTS: Overall, 326 children were included, 48% were girls. At baseline, 66% were aged 5-10 years, 91% were on ART, and 17% were severely immunodeficient (CD4 <250 cells/mL or CD4%<15). Twenty-nine (9%) were severely malnourished, 63 (19%) moderately malnourished and 234 (72%) non-malnourished. After 6 months, 9/29 (31%) and 31/63 (48%) recovered from severe and moderate malnutrition respectively. The median DDS was 8 (IQR 7-9) in Côte d'Ivoire and Togo, 6 (IQR 6-7) in Benin. Mean DDS was 4.3/9 (sd 1.2) at first visit, with a lower score in Benin, but with no difference between first and last visit (p=0.907), nor by intervention groups (p-value=0.767). CONCLUSIONS: This intervention had a limited effect on nutritional recovery and dietary diversity improvement. Questions remain on determining appropriate nutritional products, in terms of adherence, proper use for families and adequate energy needs coverage for children living with HIV. TRIAL REGISTRATION: PACTR202001816232398 , June 01, 2020, retrospectively registered

24-Month Clinical, Immuno-Virological Outcomes, and HIV Status Disclosure in Adolescents Living With Perinatally-Acquired HIV in the IeDEA-COHADO Cohort in Togo and Côte d'Ivoire, 2015-2017

Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including HIV serostatus disclosure. We assessed their 24-month outcomes in relation to the disclosure of their own HIV serostatus. Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10-19 years, enrolled in HIV care before the age of 10 years, in Abidjan (Côte d'Ivoire) and Lomé (Togo) in 2015. We measured the HIV serostatus disclosure at baseline and after 24 months and analyzed its association with a favorable combined 24-month outcome using logistic regression. The 24-month combined clinical immuno-virological outcome was defined as unfavorable when either death, loss to follow-up, progression to WHO-AIDS stage, a decrease of CD4 count >10% compared to baseline, or a detectable viral load (VL > 50 copies/mL) occurred at 24 months. Results: Overall, 209 APHIV were included (51.6% = Abidjan, 54.5% = females). At inclusion, the median CD4 cell count was 521/mm (3) [IQR (281-757)]; 29.6% had a VL measurement, of whom, 3.2% were virologically suppressed. APHIV were younger in Lomé {median age: 12 years [interquartile range (IQR): 11-15]} compared to Abidjan [14 years (IQR: 12-15, p = 0.01)]. Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, six (2.9%) died, eight (3.8%) were lost to follow-up, and four (1.9%) were transferred out. Overall, 73.7% did not progress to the WHO-AIDS stage, and 62.7% had a CD4 count above (±10%) of the baseline value (48.6% in Abidjan vs. 69.0% in Lomé, p 2 years compared to those who had not been disclosed to [aOR = 0.21, 95% CI (0.05-0.84), p = 0.03]. Conclusions: The frequency of HIV-disclosure improved over time and differed across countries but remained low among West African APHIV. Overall, the 24-month outcomes were poor. Disclosure before the study was a marker of a poor 24-month outcome in Lomé. Context-specific responses are urgently needed to improve adolescent care and reach the UNAIDS 90% target of virological success

Invagination intestinale aiguë chez l’enfant : a propos de deux cas de revelations trompeuses: Intussusception in children: report of two cases of misleading revelations.

Introduction : L’Invagination Intestinale Aiguë (IIA) est une pathologie du nourrisson et du petit enfant. Elle est majoritairement idiopathique. Son diagnostic n'est pas toujours aisé. Le but de ce travail était de rapporter deux présentations trompeuses de l’IIA chez l’enfant.Observations : Le premier enfant est un&nbsp; nourrisson de 5 mois, hospitalisé pour changement de comportement avec refus de s’alimenter. L’examen neurologique a montré une hypotonie globale, sans altération de la conscience, de signes méningés, ni d’hypertension intracrânienne. L’examen cardiorespiratoire et abdominal était normal, en dehors de vomissements alimentaires au début. Les explorations à visée neurologique ont été peu contributives : examen cytobactériologique LCR, EEG et IRM normaux. Devant le caractère devenu bilieux des vomissements, une échographie abdominale a été prescrite, montrant une IIA iléo-caecale. Une désinvagination hydrostatique a été alors réalisée avec succès. Le second enfant, âgé de 6 ans, a été hospitalisé pour éruptions cutanées d’allure purpurique des membres inférieurs et arthralgies évoluant par poussées. Il a été traité par des antalgiques, puis libéré. Mais, 24 heures plus tard, il avait été réadmis pour douleurs abdominales périombilicales, paroxystiques, sans fièvre, avec occlusion intestinale. Le diagnostic de purpura rhumatoïde compliquée de IIA iléo-iléale a été posé à l’échographie. La guérison a été obtenue sous corticoïdes et une surveillance rénale du purpura rhumatoïde a été instituée.Conclusion : Les symptômes précoces de l'IIA pourraient échapper aux médecins. Une grande vigilance du clinicien est nécessaire face aux présentations non typiques, qui ne doivent pas être responsables d’un retard de prise en charge. Introduction: Acute intestinal intussusception (IIA) is a pathology of infants and small children. In most cases, it is idiopathic. Its diagnosis is not always easy. The aim of this work was to report two misleading presentations of IIA in children.Observations: The first child was a 5-month-old infant, hospitalized for behavioral changes with feeding refusal. Neurological examination showed global hypotonia, without alteration of consciousness, meningeal signs, or intracranial hypertension. Cardiorespiratory and abdominal examination was normal, apart from initial vomiting of food. Neurological explorations were normal CSF cytobacteriological examination, EEG and MRI. In view of the bilious character of the vomiting, an abdominal ultrasound was prescribed, showing an ileo-caecal IIA. A hydrostatic reduction of intussusception was then successfully performed. The second child, 6 years old, was hospitalized for purpuric skin rashes on the lower limbs with arthralgias evolving in flares. He was treated with analgesics and then discharged. But 24 hours later, he was readmitted for paroxysmal periumbilical abdominal pain without fever, with intestinal obstruction. The diagnosis of rheumatoid purpura complicated with ileo-ileal IIA was made on ultrasound. Recovery was obtained under corticosteroids and renal monitoring of the rheumatoid purpura was instituted.Conclusion: The early symptoms of IIA may be missed by physicians. Great vigilance on the part of the clinician is necessary in the face of non-typical presentations, which should not be responsible for a delay in management

High rates of virological failure and drug resistance in perinatally HIV-1-infected children and adolescents receiving lifelong antiretroviral therapy in routine clinics in Togo.

International audienceIntroduction: Antiretroviral treatment (ART) has been scaled up over the last decade but compared to adults, children living with HIV are less likely to receive ART. Moreover, children and adolescents are more vulnerable than adults to virological failure (VF) and emergence of drug resistance. In this study we determined virological outcome in perinatally HIV-1-infected children and adolescents receiving ART in Togo.Methods: HIV viral load (VL) testing was consecutively proposed to all children and adolescents who were on ART for at least 12 months when attending HIV healthcare services for their routine follow-up visit (June to September 2014). Plasma HIV-1 VL was measured using the m2000 RealTime HIV-1 assay (Abbott Molecular, Des Plaines, IL, USA). Genotypic drug resistance was done for all samples with VL>1000 copies/ml.Results and discussion: Among 283 perinatally HIV-1-infected children and adolescents included, 167 (59%) were adolescents and 116 (41%) were children. The median duration on ART was 48 months (interquartile range: 28 to 68 months). For 228 (80.6%), the current ART combination consisted of two nucleoside reverse transcriptase inhibitors (NRTIs) (zidovudine and lamivudine) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) (nevirapine or efavirenz). Only 28 (9.9%) were on a protease inhibitor (PI)-based regimen. VL was below the detection limit (i.e. 40 copies/ml) for 102 (36%), between 40 and 1000 copies/ml for 35 (12.4%) and above 1000 copies/ml for 146 (51.6%). Genotypic drug-resistance testing was successful for 125/146 (85.6%); 110/125 (88.0%) were resistant to both NRTIs and NNRTIs, 1/125 (0.8%) to NRTIs only, 4/125 (3.2%) to NNRTIs only and three harboured viruses resistant to reverse transcriptase and PIs. Overall, 86% (108/125) of children and adolescents experiencing VF and successfully genotyped, corresponding thus to at least 38% of the study population, had either no effective ART or had only a single effective drug in their current ART regimen.Conclusions: Our study provided important information on virological outcome on lifelong ART in perinatally HIV-1-infected children and adolescents who were still on ART and continued to attend antiretroviral (ARV) clinics for follow-up visits. Actual conditions for scaling up and monitoring lifelong ART in children in resource-limited countries can have dramatic long-term outcomes and illustrate that paediatric ART receives inadequate attention

High rates of virological failure and drug resistance in perinatally HIV-1-infected children and adolescents receiving lifelong antiretroviral therapy in routine clinics in Togo

Introduction: Antiretroviral treatment (ART) has been scaled up over the last decade but compared to adults, children living with HIV are less likely to receive ART. Moreover, children and adolescents are more vulnerable than adults to virological failure (VF) and emergence of drug resistance. In this study we determined virological outcome in perinatally HIV-1-infected children and adolescents receiving ART in Togo. Methods: HIV viral load (VL) testing was consecutively proposed to all children and adolescents who were on ART for at least 12 months when attending HIV healthcare services for their routine follow-up visit (June to September 2014). Plasma HIV-1 VL was measured using the m2000 RealTime HIV-1 assay (Abbott Molecular, Des Plaines, IL, USA). Genotypic drug resistance was done for all samples with VL>1000 copies/ml. Results and discussion: Among 283 perinatally HIV-1-infected children and adolescents included, 167 (59%) were adolescents and 116 (41%) were children. The median duration on ART was 48 months (interquartile range: 28 to 68 months). For 228 (80.6%), the current ART combination consisted of two nucleoside reverse transcriptase inhibitors (NRTIs) (zidovudine and lamivudine) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) (nevirapine or efavirenz). Only 28 (9.9%) were on a protease inhibitor (PI)-based regimen. VL was below the detection limit (i.e. 40 copies/ml) for 102 (36%), between 40 and 1000 copies/ml for 35 (12.4%) and above 1000 copies/ml for 146 (51.6%). Genotypic drug-resistance testing was successful for 125/146 (85.6%); 110/125 (88.0%) were resistant to both NRTIs and NNRTIs, 1/125 (0.8%) to NRTIs only, 4/125 (3.2%) to NNRTIs only and three harboured viruses resistant to reverse transcriptase and PIs. Overall, 86% (108/125) of children and adolescents experiencing VF and successfully genotyped, corresponding thus to at least 38% of the study population, had either no effective ART or had only a single effective drug in their current ART regimen. Conclusions: Our study provided important information on virological outcome on lifelong ART in perinatally HIV-1-infected children and adolescents who were still on ART and continued to attend antiretroviral (ARV) clinics for follow-up visits. Actual conditions for scaling up and monitoring lifelong ART in children in resource-limited countries can have dramatic long-term outcomes and illustrate that paediatric ART receives inadequate attention

Malformations congénitales visibles à la naissance a Lomé, Togo

Introduction : Les malformations congénitales posent des problèmes diagnostiques dans les pays en développement. Elles sont associées à une lourde mortalité néonatale. Les données épidémiologiques sur ce sujet sont rares au Togo. L’objectif du présent travail était de décrire les malformations congénitales visibles à la naissance au Centre Hospitalier Régional de Lomé Commune (CHR – LC).Patients et méthode : Tous les nouveau-nés présentant une ou plusieurs malformations décelables à la naissance dans la maternité du CHR – LC ont été inclus d’avril 2018 à mars 2019. Résultats : La prévalence des malformations congénitales visibles en salle d’accouchement était de 6,9‰. L’âge moyen des mères était de 29,2 ± 9 ans. Le sexe ratio M/F des nouveau-nés malformés était de 1,1. Le poids moyen des nouveau-nés était de 3 050 grammes (2 100 – 4 400). Pour plus de la moitié (12/22, soit 54,5%), l’appareil locomoteur (les membres) était impliqué. Les polydactylies (7/22, soit 31,8%), les pieds bots (3/22, soit 13,6%), les fentes palatines (3/22, soit 13,6%), l’omphalocèle (2/22, soit 9,09%) et le genu recurvatum (2/22, soit 9,09%) étaient les principales anomalies. Cinq syndromes polymalformatifs (22,7%) ont été enregistrés. Conclusion : Les malformations congénitales sont des affections rencontrées en salle d’accouchement au CHR LC. Il n’existe pas pour l’heure de stratégie nationale de dépistage et de prévention. La tenue d’un registre dédié à ces affections dans les maternités, l’archivage des iconographies et la formation des sages-femmes et des échographistes pourraient améliorer le dépistage.&nbsp; &nbsp; English title: Congenital malformations seen at birth in Lome, Togo Introduction: Congenital malformations pose diagnostic problems in developing countries. They are associated with high neonatal mortality. Epidemiological data on this subject are rare in Togo. The objective of the present study was to describe the epidemiology of congenital malformations at birth in the Centre Regional de Lomé Commune (CHR - LC). Patients and method: All newborns presenting one or more malformations detectable at birth in the maternity ward of the CHR - LC were included from April 2018 to March 2019. Results: The prevalence was 6.9‰. The mean age of the mothers was 29.2 ± 9 years. The M/F sex ratio of malformed newborns was 1.1. The mean weight of the newborns was 3,050 grams (2,100 - 4,400). More than half (54.5%) of the malformations involved the locomotor system (limbs) (12/22 malformations). Polydactyly (7/22 or 31.8%), clubfoot (3/22 or 13.6%), cleft palate (3/22 or 13.6%), omphalocele (2/22 or 9.09%) and genu recurvatum (2/22 or 9.09%) were the main anomalies. Five polymalformative syndromes (22.7%) were recorded. Conclusion: Congenital malformations exist at CHR LC. There is currently no national screening and prevention strategy. Keeping a register dedicated to these conditions in maternity wards, archiving iconography, training midwives and antenatal ultrasounds providers could improve this screening

Global HIV prevention, care and treatment services for children: a cross-sectional survey from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium

Objectives To assess access children with HIV have to comprehensive HIV care services, to longitudinally evaluate the implementation and scale-up of services, and to use site services and clinical cohort data to explore whether access to these services influences retention in care.Methods A cross-sectional standardised survey was completed in 2014–2015 by sites providing paediatric HIV care across regions of the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We developed a comprehensiveness score based on the WHO’s nine categories of essential services to categorise sites as ‘low’ (0–5), ‘medium’, (6–7) or ‘high’ (8–9). When available, comprehensiveness scores were compared with scores from a 2009 survey. We used patient-level data with site services to investigate the relationship between the comprehensiveness of services and retention.Results Survey data from 174 IeDEA sites in 32 countries were analysed. Of the WHO essential services, sites were most likely to offer antiretroviral therapy (ART) provision and counselling (n=173; 99%), co-trimoxazole prophylaxis (168; 97%), prevention of perinatal transmission services (167; 96%), outreach for patient engagement and follow-up (166; 95%), CD4 cell count testing (126; 88%), tuberculosis screening (151; 87%) and select immunisation services (126; 72%). Sites were less likely to offer nutrition/food support (97; 56%), viral load testing (99; 69%) and HIV counselling and testing (69; 40%). 10% of sites rated ‘low’, 59% ‘medium’ and 31% ‘high’ in the comprehensiveness score. The mean comprehensiveness of services score increased significantly from 5.6 in 2009 to 7.3 in 2014 (p&lt;0.001; n=30). Patient-level analysis of lost to follow-up after ART initiation estimated the hazard was highest in sites rated ‘low’ and lowest in sites rated ‘high’.Conclusion This global assessment suggests the potential care impact of scaling-up and sustaining comprehensive paediatric HIV services. Meeting recommendations for comprehensive HIV services should remain a global priority

ART initiation according to ART eligibility at baseline and during follow-up among the 135,479 HIV-infected children in the IeDEA Global Cohort Consortium, 2004–2015.

<p>ART initiation according to ART eligibility at baseline and during follow-up among the 135,479 HIV-infected children in the IeDEA Global Cohort Consortium, 2004–2015.</p