Effectiveness of Injectable Iron in the Management of Severe Iron Deficiency in Children in Ouagadougou

Background: Iron deficiency anemia affects 90% of children in Burkina Faso. These studies on the effectiveness of injectable iron are rare in low-income countries with high infant and child mortality related to anemia. Methods: This has been an observational study to assess the effectiveness of injectable iron in children under five years old admitted to the pediatric ward of the Yalgado Ouédraogo University Teaching Hospital (YO-UTH), in 2019, in Ouagadougou, Burkina Faso. Findings: Thirty-five (35) children with severe iron deficiency anemia (average age 2.5 years), 60 %( n=21) of whom had decompensated anemia and required transfusion, were treated with injectable iron polymaltose hydroxide and followed up for one month. On average, 226.9± 45.5mg of iron were injected over an average treatment duration of three days. The mean hemoglobin count increased from 4.7± 0.95g/dl at baseline to 9.7±1g/dl (an increase of 4.9g/dl) one month later (p<0.001). The mean corpuscular volume increased from 66.7±4.7fl to 81.5±3.7fl (p<0.001), and that of the ferritinemia varied from 0.02±0.005μg/ml to 0.83±0.09μg/ml (an increase of 0.81μg/ml, p<0.001) and the mean sideremia increased from 4.8±2.1μmol/l to 40.4±5.5μmol/l. No side effects were noted. Conclusion: By avoiding transfusion in most patients, the use of injectable iron in proven and severe iron deficiency anemias could be a solution in case of blood deficit

Ostéogenèse imparfaite: à propos de quatre cas à Ouagadougou (Burkina Faso)

L'ostéogenèse imparfaite (OI) regroupe un ensemble d'affections constitutionnelles de gravité variable dû à une anomalie de la production du collagène et de la matrice de l'os entraînant une fragilité osseuse. La  présente étude rapporte quatre cas d'ostéogenèse imparfaite suivis aux Centres Hospitaliers Universitaires Charles de Gaulle et Yalgado Ouédraogo. Le but de ce travail était d'analyser les aspects cliniques, thérapeutiques et évolutifs de la maladie. Cette étude souligne la nécessité d'améliorer la prise en charge de cette maladie rare mais non exceptionnelle et handicapante.Key words: Ostéogenèse imparfaite, anomalies osseuses, Burkina-Fas

Evaluation of the Nutritional and Hematological Status of Sickle Cell Children Monitored in the Pediatric Department of the University Hospital Center of Yalgado Ouedraogo

Objective: To assess the nutritional and hematological status of sickle cell children followed in the department of pediatrics of the Yalgado Ouédraogo University Hospital Centre (CHU-YO).Methodology: This was a cross-sectional study conducted from September 1, 2017, to February 28, 2018. All children with major sickle cell syndrome followed in the department of pediatrics at the CHU-YO and following their follow-up appointments were included in the study.Results: We included 230 children aged 11 months to 16 years with an average age of 8.5 years. The sex M/F ratio was 1.09. The SC heterozygotes were the most represented with 56.52%. The average hemoglobin level was 9.39 g/dl. The prevalences of wasting, stunting and underweight were respectively 23.04%, 15.65%, and 13.89%. In univariate analysis, the factors associated with emaciation was hyperleukocytosis (p=0.002).The factors associated with stunting were leukocytosis (p=0.01), severe anemia (p=0.01), SS phenotype (p=0.002), age range of 5-10 years (p=0.007), Secondary (P=0.007) and higher level (p=0.001) of father’s education, secondary (p=0.027) and higher level (p=0.034)of mothers’education , farmer(p=0.003) trader (p=0.042), and informal occupation of father (p = 0.002),and breastfeeding duration after 24 months (p=0.006). For underweight associated factors in univariate analysis were SS phenotype (p=0.003) and severe anemia (p=0.01).Conclusion: The prevalence of different types of malnutrition deficiency of sickle cell children followed at CHU-YO was high. It is important to strengthen the nutritional monitoring of children with sickle cell disease for better management of the disease

Le lymphoedème congénital primaire: la maladie de Milroy: à propos du premier cas observé dans le Département de Pédiatrie du Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou

Le lymphoedème est l'accumulation de liquide lymphatique dans les espaces interstitiels, celui de l’enfant, la maladie de Milroy, est rare, héréditaire, autosomique dominante à pénétrance partielle. Nous rapportons un cas de maladie de Milroy chez une fillette de 7 ans vue, pour érysipèle sur grosse jambe droite congénitale. Des antécédents de gros membre congénital existent dans la famille maternelle. L’examen retrouvait une grosse jambe droite oedématiée et douloureuse à la palpation, avec une lichenification de la peau en regard et un érysipèle cutané. Le bilan paraclinique objectivait un lymphoedème cutané avec atteinte vasculaire à type d’ectasie de la saphène droite. Le caryotype de type féminin, était sans anomalie, n’excluant pas des remaniements chromosomiques de petite taille. Le traitement a constitué en une kinésithérapie, des bandages, le port de bas de compression et une psychothérapie. Ce premier cas décrit au Burkina Faso témoigne de la rareté de la pathologie mais surtout des difficultés diagnostiques liées à l’insuffisance des investigations paracliniques.Mots clés: Lymphoedème primaire, maladie de Milroy, diagnostic, traitement, OuagadougouEnglish Title: Primary congenital lymphedema: Milroy disease: the first case observed in the Department of Pediatrics at the University Hospital Yalgado Ouedraogo, OuagadougouEnglish AbstractCongenital lymphedema is the accumulation of lymphatic fluid in the child’s interstitial spaces. Milroy disease is a rare, hereditary, autosomal dominant condition showing incomplete penetrance. We report the case of a 7-year old little girl with Milroy disease examined for erysipelas on congenital big right leg. A family history of large congenital member existed. Physical examination showed big oedematous right leg painful to palpation, with skin lichenification and erysipelas. Paraclinical assessment objectified cutaneous lymphedema with vascular involvement suggestive of ectasia of the right saphenous vein. Female karyotype showed no abnormalities, despite the small chromosomal rearrangements. Treatment was based on physiotherapy, bandages, compression stockings and psychotherapy. This first case in Burkina Faso testifies to the rarity of the pathology but especially to the diagnostic difficulties related to the inadequacy of paraclinical investigations.Keywords: Primary lymphedema, Milroy disease, diagnosis, treatment, Ouagadougo

Facteurs associés à la mortalité chez les enfants malnutris aigus sévères du CHU Yalgado Ouédraogo, Ouagadougou

La malnutrition aigüe sévère (MAS) est responsable de 30 % des décès infanto-juvénile dans le monde. Sa prise en charge reste une préoccupation de santé publique dans les pays en développement comme le Burkina Faso. L’objectif de cette étude était de mesurer le taux de mortalité des enfants malnutris sévères hospitalisés au département de pédiatrie du Centre Hospitalier Universitaire Yalgado Ouédraogo et d’identifier ses déterminants. Nous avons mené une étude de cohorte rétrospective des enfants âgés de 6 à 59 mois, hospitalisés pour malnutrition aiguë sévère au CHU-YO entre le 1er janvier 2010 et le 31 décembre 2013. Nous avons utilisé un modèle de risque proportionnel de Cox pour identifier les facteurs associés à la mortalité au cours de l’hospitalisation. Au total 506 enfants ont été inclus dans notre étude à un âge médian de 16 mois [Intervalle interquartile (IIQ) = 10-24], le sex-ratio était de 1,30. Le taux de mortalité était de 12,10 % soit 0,60 décès/100 personnes jour. La présence de MAS avec oedèmes (Hazard Ratio ajusté (HRa) 2,20 [1,25-3,89]) ; une sérologie VIH positive (HRa = 9,21 [4,85-17,49]), ou inconnue(HRa = 6,80 [3,44-13,46]) et le traitement systématique incomplet (HRa : 1,98 [1,11-3,54]) étaient significativement associés à la mortalité des enfants malnutris aigus sévères. Le dépistage et le traitement précoce de l’infection à VIH et la prise en charge suivant les recommandations restent une condition pour l'amélioration du pronostic de la malnutrition aiguë sévère dans notre contexte.Mots-clés : malnutrition, mortalité, traitement, enfant, Ouagadougou

Prevention and care of paediatric HIV infection in Ouagadougou, Burkina Faso: knowledge, attitudes and practices of the caregivers

International audienceAbstractBackgroundThe paediatric Human Immunodeficiency Virus (HIV) epidemic still progresses because of operational challenges in implementing prevention of mother-to-child HIV transmission (PMCT) programs. We assessed the knowledge, attitudes and practices (KAP) of children’s caregivers regarding mother-to-child transmission (MTCT) of HIV, paediatric HIV infection, early infant diagnosis (EID), and paediatric antiretroviral treatment in Ouagadougou, Burkina Faso.MethodsWe undertook a qualitative survey in the four public hospitals managing HIV exposed or infected children, in Ouagadougou in 2011. A sociologist used a semi-structured questionnaire to interview caregivers of children less than 5 years old attending the paediatrics wards on their KAP. Study participants were divided into four groups as follows:those who did not yet know their children’s HIV infection status, those who were waiting for their children’s HIV test results, those who were waiting for antiretroviral treatment, and those who were already on antiretroviral treatment.ResultsA total of 37 caregivers were interviewed. The mean age was 32.5 years, and 29 (78 %) were mothers. Twenty seven (73 %) caregivers had primary or higher level of education, and 15 (40 %) described their occupation as “housewife”. Overall, 36 (97 %) of caregivers knew that the main route of HIV transmission for infants was through MTCT and 14 (38 %) specified that it occurred during pregnancy or delivery. Five percent thought that MTCT of HIV occurred during conception. PMTCT interventions could help prevent infant HIV infection according to 32 (87 %) caregivers. Thirty five percent of caregivers stated EID as a prevention strategy. Fifty-four percent of the participants believed that replacement feeding option would prevent MTCT of HIV; 24 (65 %) stated that they would prefer medical practitioners seek caregivers’ consent before carrying out any HIV-test for their child, and that caregivers’ consent was not compulsory before antiretroviral treatment. All caregivers thought that it was necessary to treat HIV-infected children, although they did not know what interventions could be done.ConclusionsThis study highlighted the low level of caregivers’ knowledge on paediatric HIV prevention and care in Ouagadougou. Awareness programs targeting caregivers need to be strengthened in order to improve the uptake of HIV early infant diagnosis and care