L'anémie à l'accouchement à Lomé (Togo) : prévalence, facteurs de risque et répercussions chez le nouveau-né

Une étude de prévalence réalisée à Lomé (Togo) a porté sur 125 couples mère-nouveau-né : 48% des mères et 30% des nouveaux-nés sont anémiques d'après les seuils de l'OMS. Trois mères sur quatre ont au moins un indicateur de carence en fer et celle-ci est le déterminant principal de l'anémie. Soixante huit pour cent ont une carence en folates, sans répercussion sur les paramètres hématologiques. Lorsque la carence en fer maternelle est grave (fer sérique <7umol), le fer sérique du nouveau-né est abaissé, ce qui témoigne d'une réduction de l'apport de fer au foetus. Le statut folique des nouveaux-nés est meilleur lorsque les mères ont reçu de l'acide folique pendant leur grossesse. Une supplémentation de ferro-folique systématique est donc nécessaire pendant la grossesse et serait bénéfique à la mère et à l'enfant. Les consultations prénatales devraient servir de cadre à la supplémentation. Leur fréquentation par 98% des femmes enceintes permet d'envisager une bonne couverture pour une telle intervention. (Résumé d'auteur

Acceptability and efficacy of intra-rectal quinine alkaloids as a pre-transfer treatment of non-per os malaria in peripheral health care facilities in Mopti, Mali

<p>Abstract</p> <p>Background</p> <p>The acceptability and efficacy of a new kit with a new formulation of quinine alkaloids designed for the intra-rectal administration in the treatment of non-per os malaria was assessed in the peripheral health care system of Mopti, Mali.</p> <p>Methods</p> <p>A single-arm trial was conducted from August 2003 to January 2004. An initial dose of diluted quinine alkaloids (20 mg/kg Quinimax^®) was administered by the intra-rectal route to children with presumptive non per-os malaria at six peripheral heath care centres. The children were then referred to two referral hospitals where standard inpatient care including intravenous route were routinely provided. A malaria thick smear was done at inclusion and a second malaria thick smear after arrival at the referral facility, where a more complete clinical examination and laboratory testing was done to confirm diagnosis. Confirmed cases of severe malaria or others diseases were treated according to national treatment guidelines. Cases of non per-os malaria received a second dose of intra rectal quinine alkaloids. Primary outcome was acceptability of the intra rectal route by children and their parents as well as the ease to handle the kit by health care workers.</p> <p>Results</p> <p>The study included 134 children with a median age of 33 months and 53.7% were male. Most of the children (67%) and 92% of parents or guardians readily accepted the intra-rectal route; 84% of health care workers found the kit easy to use. At the peripheral health care centres, 32% of children had a coma score ≤ 3 and this was reduced to 10% at the referral hospital, following one dose of intra-rectal quinine alkaloids (IRQA). The mean time to availability of oral route treatment was 1.8 ± 1.1 days. Overall, 73% of cases were confirmed severe malaria and for those the case fatality rate was 7.2%.</p> <p>Conclusion</p> <p>IRQA was well accepted by children, their parents/guardians and by the health workers at peripheral health facilities in Mopti, Mali. There was also a quick recovery from deep coma and a reduced case fatality rate in severe malaria.</p

Clinical and laboratory predictors of death in African children with features of severe malaria: a systematic review and meta-analysis.

The criteria for defining severe malaria have evolved over the last 20 years. We aimed to assess the strength of association of death with features currently characterizing severe malaria through a systematic review and meta-analysis. Electronic databases (Medline, Embase, Cochrane Database of Systematic Reviews, Thomson Reuters Web of Knowledge) were searched to identify publications including African children with severe malaria. PRISMA guidelines were followed. Selection was based on design (epidemiological, clinical and treatment studies), setting (Africa), participants (children &lt; 15 years old with severe malaria), outcome (survival/death rate), and prognostic indicators (clinical and laboratory features). Quality assessment was performed following the criteria of the 2011 Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Odds ratios (ORs) were calculated for each study and prognostic indicator, and, when a test was assessed in at least two studies, pooled estimates of ORs were computed using fixed- or random-effects meta-analysis. A total of 601 articles were identified and screened and 30 publications were retained. Features with the highest pooled ORs were renal failure (5.96, 95% CI 2.93-12.11), coma score (4.83, 95% CI 3.11-7.5), hypoglycemia (4.59, 95% CI 2.68-7.89), shock (4.31, 95% CI 2.15-8.64), and deep breathing (3.8, 95% CI 3.29-4.39). Only half of the criteria had an OR &gt; 2. Features with the lowest pooled ORs were impaired consciousness (0.58, 95% CI 0.25-1.37), severe anemia (0.76, 95% CI 0.5- 1.13), and prostration (1.12, 95% CI 0.45-2.82). The findings of this meta-analysis show that the strength of association between the criteria defining severe malaria and death is quite variable for each clinical and/or laboratory feature (OR ranging from 0.58 to 5.96). This ranking allowed the identification of features weakly associated with death, such as impaired consciousness and prostration, which could assist to improve case definition, and thus optimize antimalarial treatment

Dysgenesie spenique et syndrome d'ivemark

The authors report a Togolese case of splenic dysgenesis associating in a boy aged of 6 years: a splenic hypoplasia, a median and hypertrophic liver, an abdominal aorta and an inferior vena cava all both situated at the right side of the backbone, a dextrocardia by dextroversion, a single auricle and a complete type of endocardial cushion defect. Difficulties of diagnosis and care of that seldom entity are exposed. Les auteurs rapportent l’observation d’un cas de dysgénésie splénique associant chez un garçon de 6 ans : une rate hypoplasique à un foie médian et hypertrophique, une aorte abdominale et une veine caveinférieure situées toutes deux à droite de la colonne vertébrale, une dextrocardie par dextroversion et une oreillette unique avec un canal atrio-ventriculaire complet. Ils exposent les difficultés diagnostiques, et de prise en charge de cette affection rare dans leur service

Management of sickle cell priapism with etilefrine

Intracavernous injections of etilefrine were effective in seven children with acute sickle cell priapism, and stuttering priapism resolved in five children after one to seven months of oral etilefrine. Compared with our previous reports in adults, etilefrine appears to be more effective in childhood.


Reseau de chiari et cariopathie congenitale chez un enfant

The authors report a togolese case of Chiari network revealed at a cross-sectional echocardiography in a nine-year-old boy with cardiac signs of congenital cardiopathy which definite diagnosis has not been made. They describe echocardiographic findings of this rare anomaly named Chiari network. Les auteurs rapportent l’observation d’un réseau de Chiari, découvert à l’échographie bi-dimensionnelle chez un enfant de neuf ans porteur d’une symptomatologie cardiaque en faveur d’une cardiopathie congénitale dont le diagnostic n’a pu être précisé. Ils décrivent les aspects échocardiographiques de cette anomalie rare qu’est le réseau de Chiari

Prématurité au Centre Universitaire de Lomé : resultats à partir de 1672 naissances vivantes

No Abstract Available j. Rech. Sci. Univ. Lomé (Togo) 2002, 6(1) : 179-18

Hémolyse et insuffisance rénale aiguës chez l'enfant déficient en clucose-6-phosphate déhydrogénase au CHU de Lomé

No Abstract Available J. Rech. Sci. Univ. Lomé (Togo) 2002, 6(2) : 191-19

Pathologies en période néonatale précoce au CHU de Lomé, resultats à partir de 3174 naissances vivantes

No Abstract Available j. Rech. Sci. Univ. Lomé (Togo) 2002, 6(1) : 193-19