A. Sylla

Anémie chez les enfants sénégalais en bonne santé apparente

[1] Meltzer E, Guranda L, Vassilenko L, et al. Lipoid pneumonia: a preventable complication. Isr Med Assoc J 2006;1:33–5. [2] Baron SE, Haramati LB, Rivera VT. Radiological and clinical findings in acute and chronic exogenous lipoid pneumonia. J Thorac Imaging 2003;18:217–24. [3] Ukkola-Pons E, Weber-Donat G, Teriitehau C, et al. Imagerie de la pneumopathie huileuse. Feuillets Radiologie 2010;50:3–9. d [4] Graef I. Pulmonary changes due to aspirations of lipids an mineral oil. Am J Pathol 1935;11:826–33. l l-

Prematurity: Epidemiology and Etiological Factors in a Maternity Ward in Dakar (Senegal)

Background: Prematurity is the leading cause of neonatal mortality and morbidity in the world. Several etiological factors contribute to its occurrence requiring identification for effective prevention. The objective of this work was to study the epidemiological and etiological factors of prematurity in the maternity ward of the Grand YOFF General Hospital (GYGH) in Dakar. Methods: This was a prospective study including all live and viable newborns conducted during January 1st to August 31st. They were divided into 2 groups: premature infants (22 WA-36 WA+6 days) and term infants (over 37 WA). Statistical comparisons were based on percentages for the chi-square test or Fishers exact small sample test. Results: During the study, 501 newborns were collected including 360 term neonates (71.9%) and 141 premature babies (28.1%). The sex ratio was 1.07. Of the premature babies, 48.2% were hypotrophic. There were 13 cases of premature death (9.22%). The occurrence of prematurity was significantly related to educational level, geographic origin and body mass index (BMI). The number of prenatal consultations (PNC) less than 3 was related to a risk of prematurity (p=0.001). Genitourinary infections (p=0.059), high blood pressure (p=0.047), pre-eclampsia (p=0.009), isolated anaemia (p=0.0001) and isolated bleeding (p=0.015) were found as significant etiological factors. Conclusion: In our study, several etiological factors associated with prematurity were identified. Combating these factors is an effective way to prevent prematurity in our low-income countries.

Evaluation of Malnutrition among Children Aged 2 to 60 Months Hospitalized in the Pediatric Services of Ziguinchor Hospital

Introduction: Malnutrition is a public health problem in the world and especially in developing countries. The prevalence of malnutrition at the national level does not reflect the situation in hospital. It is in this context that we assessed the nutritional status of children under 5 years old hospitalized pediatric services in the municipality of Ziguinchor. Material and methods: This was a prospective study that ran from June 1 to October 30, 2016. Included were children aged 2 to 60 months hospitalized in one of the two services. Children with esdato-ascetic syndrome were not included. Epidemiological, anthropometric data, and associated diagnosis were studied. Results: We included 114 children (70 boys and 44 girls). The average age was 21.9 months. Forty-two point one percent (42.1%) of infants <6 months were breastfed exclusively with breast milk. The weaning of children is done early in 55.3%. The mean age of mothers was 26.6 years. The socioeconomic level was low in 62.3% of cases. The prevalence of malnutrition averaged 35.5% for underweight; 32.9% for wasting and 32.0% for stunting. Acute respiratory infections (ARI) and acute gastroenteritis were the most common associated conditions. Mean hospital stay was 8 days ± 009. About two thirds of the patients (n=72) had a hospital stay of more than 7 days. Malnutrition was significantly associated with multiparity, low socioeconomic status, hospital stay of more than 7 days and infectious diseases. Conclusion: Infections and hospitalization lasting more than a week are factors that promote malnutrition in children under 5 years of age.

Profils épidemiologiques, cliniques et hématologiques de la drépanocytose homozygote SS en phase inter critique chez l’enfant à Ziguinchor, Sénégal

Sickle cell disease poses a public health problem in Senegal. It mainly affects children and adolescents. This study aimed to determine the epidemiological, clinical and hematological profiles of homozygous (SS) sickle cell disease in a cohort of children followed-up at the Peace Hospital in Ziguinchor. We conducted a retrospective study of the medical records from children with sickle cell disease. All patients aged between 2 months and 21 years with sickle cell disease SS during the intercritical period, hospitalized during the study period from 1st January 2015 to 31 August 2017 were included in our study. Compound heterozygous patients (SC, S Beta Thalassemia) were not included. We collected 46 medical records of patients with sickle cell disease SS (20 girls and 26 boys). The average age of children was 8,0 years [11 months-21 years]. Approximately 1/3 of children (39.1%) had an age less than or equal to 5 years. There was an ethnic diversity showing a predominance of the Diola (30.2%) followed by the Mandinga (27.9%) and the Poular (25.6%). The average age of children with first crisis was 35,5 months [7-192 months]. More than 1/3 of children (41.3%) had had first crisis before their second anniversary. In the child, first crisis was dominated by vaso-occlusive crisis (32.6%) followed by hand-foot syndrome (30.4%). Clinical signs during the intercritical period were pallor 95.6%), jaundice (36.9%) and splenomegaly (21.7%). Mean white blood cell count was 12465 leucocytes/mm3 [5340-26900]. Hyperleukocytosis greater than 10 000 leucocytes/mm3was found in 34 patients (73.9%). All patients had anemia with an average hemoglobin of 08,6 g/dl [05,7-11,8]. Hemoglobin S rate ranged between 54.6 and 98.4%. Diagnosis and medical management of sickle cell disease SS are delayed in Ziguinchor. Neonatal screening may lead to improve early management of patients in the region.

Le syndrome néphrotique idiopathique (SNI) de l’enfant à Dakar: à propos de 40 cas

Introduction L’objectif de ce travail était d’analyser les caractéristiques diagnostiques, thérapeutiques et évolutives de l’enfant atteint de néphrose dans un service de pédiatrie de Dakar. Méthodes L’étude était réalisée au service de pédiatrie de l’hôpital Aristide Le Dantec. Il s’agissait d’une étude rétrospective sur une période de 03 ans allant du 1er janvier 2012 au 31 décembre 2014. Ont été inclus tous les patients âgés de 02 ans à 12 ans présentant un tableau de Syndrome néphrotique idiopathique. Résultats Quarante cas de néphrose étaient colligés soit une prévalence de 23% parmi les néphropathies prises en charge dans le service. L’âge moyen était de 7,11± 3,14 ans. Le syndrome néphrotique était pur chez 72,5% (n=29) des patients. Les œdèmes des membres inférieurs étaient présents chez 100% des patients, l’oligurie dans 55% (n=22) et l’HTA dans 5% (n=2) des cas. La protéinurie moyenne était de 145,05 ± 85,54 mg/kg/24heures. La protidémie moyenne était de 46,42 ±7,88 g/L et l’albuminémie moyenne de 17,90 ± 7,15 g/L. Trente-neuf patients avaient reçu une corticothérapie à base de prednisone. La corticosensibilité était retenue chez 77% (n=30) des patients et la corticorésistance chez 13% (n=5) des cas. Le facteur de mauvaise réponse à la corticothérapie était un niveau de protéinurie initiale supérieure à 150 mg/kg/jour (p = 0,024). La biopsie rénale était réalisée chez 18% (n=7) des patients et retrouvait dans 57,2% (n=4) des cas une hyalinose segmentaire et focale. Le cyclophosphamide et l’azathioprine étaient associés aux corticoïdes dans 10% (n=4) des cas chacun. Le taux de rémission globale était de 89,8%. L’évolution vers l’insuffisance rénale chronique était notée chez trois (03) des patients. Conclusion La néphrose représentait près du quart des néphropathies prises en charge dans notre service. Le taux de rémission globale était élevé. Le seul facteur de mauvaise réponse à la corticothérapie était le niveau de protéinurie initiale élevée. En cas d’indication de la biopsie rénale chez nos patients, la HSF était la lésion la plus fréquemment retrouvée.

Mutilation génitale féminine fatale chez une fille de 10 ans

Female genital mutilation (FGM) comprises all procedures involving partial or total removal of the external genitalia and/or any other procedures affecting the female genitalia, for cultural or religious reasons or for nontherapeutic purposes in general. FGM is responsible for a number of short-, medium-, and long-term complications that can engage the vital and functional prognosis, especially in African countries. We report on a case in a 10-year-old girl who underwent genital mutilation, a traditional type of total excision during the neonatal period. She was followed for urethral meatus stenosis, which then was complicated by obstructive chronic kidney failure and urinary sepsis, whose progression was fatal.

Hypothyroïdie congénitale à Dakar: à propos de 28 cas

Child hypothyroidism has been little studied in Senegal. The aim of this study was to evaluate the epidemiological, diagnostic and evolutionary aspects of congenital hypothyroidism. We conducted a descriptive-analytical retrospective study of all children treated for congenital hypothyroidism at the Albert-Royer National Childrens Hospital Center over the period from 2001 to 2014 (14 years). We collected and analyzed socio-demographic, clinical and evolutionary data from patient medical records. A total of 28 patients were included in the study, an average of 2 cases per year. The average age of discovery of hypothyroidism was 54.25 ± 43 months with a female predominance (Sex-ratio 0.47). Only 2 cases of hypothyroidism were diagnosed in the neonatal period. Consanguinity was present in 68% of patients. Clinical signs were dominated by the delay in psychomotor acquisitions (96%), hypothermia (46%), cranio-facial dysmorphia (43%) and goiter (39%). Growth retardation was constant beyond 6 months. The etiologies were dominated by hormonosynthesis disorders (84.21%). During the study period, mean SD of patients had decreased from -3.5 SD to -2.25 SD for a median treatment duration of 28 months. Mental retardation was present in 73% of cases. Growth retardation and mental retardation were more severe as the diagnosis was late. Our results confirm the inadequacy of early management of patients. It is urgent to implement a routine neonatal screening system in order to improve the mental prognosis of this condition.

Méningite tuberculeuse de l’enfant à Dakar

La méningite tuberculeuse, infection des méninges due à Mycobactérium tuberculosis ou bacille de Koch, est responsable d’une morbidité et d’une mortalité élevées dans le monde, en particulier dans les pays en voie de développement. La dernière étude menée au Sénégal par Camara et al. [1] en 2005 avait montré une incidence de 0,74 % chez les patients hospitalisés et une mortalité de 14,3 %. Dans un contexte d’amélioration de la couverture vaccinale par le bacille de Calmette et Guérin (BCG), l’objectif de ce travail était d’étudier les aspects épidémiologiques et thérapeutiques de la méningite tuberculeuse au Centre hospitalier universitaire (CHU) de Dakar par une étude descriptive sur six ans (2009–2014). Parmi les 28 099 patients hospitalisés pendant la période d’étude, 42 présentaient une méningite tuberculeuse soit une incidence de 0,15 %. Dix-neuf dossiers étant inexploitables (45 %), 23 patients ont pu être inclus. L’âge moyen était de 57 mois (extrêmes 4 à 180) et la tranche 0–24 mois était prédominante (35 %). Le sex-ratio était de 2,8. Plus de deux patients sur trois (70 %) avaient reçu le BCG, 4 % n’avaient pas été vaccinés et pour 26 % le statut vaccinal était inconnu. Le délai médian de prise en charge avait été de 2 semaines. Cinquante-sept pour cent des patients étaient malnutris. Un syndrome méningé et de la fièvre avaient été notés chez 96 % des patients, des convulsions chez 78 %. Dix patients (62,5 %) avaient une intradermoréaction à la tuberculine positive à plus de 15 mm. Un patient avait un œdème papillaire au fond d’œil. Le liquide céphalorachidien (LCR) s’était avéré clair à prédominance lymphocytaire dans la majorité des cas (71 %), avec hypoglycorachie et hyperprotéinorachie. Il était trouble chez 5 patients (24 %). La recherche de bacille acido-alcoolo-résistant (BAAR) dans le LCR avait été négative chez 70 % des patients mais positive chez 74 % dans le liquide de tubage gastrique. La radiographie du thorax avait été normale chez 3 patients. Le scanner cérébral avait montré une hydrocéphalie chez 10 patients, un tuberculome et une ischémie cérébrale chez 1 patient. Trois patients étaient décédés avant l’instauration du traitement et 20 (87 %) avaient reçu un traitement antituberculeux. Une dérivation ventriculo-externe avait été effectuée chez les 10 patients qui présentaient une hydrocéphalie. L’évolution avait été favorable sans séquelles chez 3 patients (13 %). Les séquelles notées étaient une hydrocéphalie, une hémiplégie et une surdité. Au total, 9 enfants étaient décédés (39 %). La notion de contage tuberculeux était présente chez 43 % des patients mais 8 % seulement avaient reçu une chimioprophylaxie par isoniazide conformément aux directives du programme national de lutte contre la tuberculose. La méningite tuberculeuse demeure problématique au Sénégal. Son incidence a baissé de 0,74 % en 2005 [1] à 0,15 %, probablement en lien avec l’amélioration de la couverture vaccinale par le BCG et la gratuité des vaccins dans le cadre du programme élargi de vaccination. Les garçons étaient les plus touchés dans notre étude (74 %), alors que Camara et al. avaient observé une prédominance féminine et Herimamy une proportion similaire de filles et de garçons [1,2]. La vaccination est importante pour prévenir la méningite tuberculeuse [3] (la majorité de nos patients étaient vaccinés par le BCG) mais n’est pas suffisante en cas de malnutrition. Le taux de mortalité reste cependant très élevé (près de 40 %). Nos résultats impliquent d’insister sur la prévention primaire et secondaire selon les directives du programme national de lutte contre la tuberculose en dépistant et traitant activement tous les cas de primo-infection.

Contribution of Dehydration and Malnutrition to the Mortality of Children 0-59 Month of Age in a Senegalese Pediatric Hospital

In-hospital mortality is an indicator of the quality of care. We analyzed the mortality of under five years children of Pediatric ward of Aristide Le Dantec teaching hospital to update our data, after an previous study conducted ten years earlier. Methods : This was a retrospective study involving children 0-59 months of age, hospitalized from January 1, 2012 to December 31, 2012. For each child, nutritional status was assessed according to 2006 World Health Organization growth standards; clinical and biological data were recorded. The outcome of the disease was specified. Bivariate and multivariable were used to identify risk factors for death. Results : 393 children were included. Overall mortality rate was 10% (39/393). Factors associated with death were severe wasting [OR = 8.27, 95% CI [3.79-18], male gender (OR = 2.98, 95% CI [1.25-7.1]), dehydration (OR = 5.4, 95% CI [2.54-13.43]) in the model using the weight-for- height z score, male gender (OR = 2.5, 95% CI [1.11-5.63]), dehydration (OR = 8.43, 95% CI [3.83-18.5]) in using the height- for- age z score, male gender (OR = 2.7, 95% CI [1.19-6.24]), dehydration (OR = 7.5, 95% CI [3.39-16.76]), severe underweight (OR = 2.4, 95% CI [1.11-5.63]), in the model using the weight-for- age z score, and male gender (OR = 2.5, 95% CI [1.11-5.63]), dehydration (OR = 8.43, 95% CI [3.83-18.5]) in that using MUAC. Dehydration and malnutrition are two independent factors of mortality. Our management protocols of dehydration and malnutrition have to be updated. Screening malnutrition has to be done systematically for each child by anthropometric measurements using WHO growth standards.

Anemia among Apparently Healthy Senegalese Children Aged 9-15 Months

In Senegal, despite its high frequency, there is no real program to fight against anemia among infants. This work was carried out in the Dakar suburb from 1 st September, 2009 to 27 th January, 2010 among apparently healthy children aged 9-15 months at the time of their immunization against yellow fever and measles. They showed no known chronic condition or acute infection at the time of the survey. The objectives were to study the diet, prevalence, type and risk factors of anemia. The questionnaire was about whether the father and the mother were working and about the children’s diet during the first six months of their life. All the children underwent anthropometric measurements (weight and height) and a complete blood count. We considered children as anemic if the hemoglobin rate was below 11g/dl. Of the 245 children, 212 were anemic, which was a prevalence of 86.5%. This anemia, frequently of the microcytic hypochromic type (68. 86%) was significantly (p < 0.0003) observed among the children of housewives compared with those whose mothers were employed. Among anemic children, 60.8% were only taking breast milk with or without cereal porridge as a food supplement. The absence of consumption of protein, vegetables, fruits and dairy products was a risk factor for the occurrence of anemia (p <0.0001). In total, at the time immunization is stopped, almost all Senegalese children, while apparently healthy, still face nutritional anemia. The adverse consequences of anemia on child health require the implementation in developing countries of a specific program of struggle against anemia. The activity of vaccination might be the best opportunity to provide the nutritional education these mothers need.