Diarra Yé

Viral etiology of respiratory tract infections in children at the pediatric hospital in Ouagadougou (Burkina Faso).

Background Acute respiratory infections (ARIs) are a major cause of morbidity and mortality in children in Africa. The circulation of viruses classically implicated in ARIs is poorly known in Burkina Faso. The aim of this study was to identify the respiratory viruses present in children admitted to or consulting at the pediatric hospital in Ouagadougou. Methods From July 2010 to July 2011, we tested nasal aspirates of 209 children with upper or lower respiratory infection for main respiratory viruses (respiratory syncytial virus (RSV), metapneumovirus, adenovirus, parainfluenza viruses 1, 2 and 3, influenza A, B and C, rhinovirus/enterovirus), by immunofluorescence locally in Ouagadougou, and by PCR in France. Bacteria have also been investigated in 97 samples. Results 153 children (73.2%) carried at least one virus and 175 viruses were detected. Rhinoviruses/enteroviruses were most frequently detected (rhinovirus n = 88; enterovirus n = 38) and were found to circulate throughout the year. An epidemic of RSV infections (n = 25) was identified in September/October, followed by an epidemic of influenza virus (n = 13), mostly H1N1pdm09. This epidemic occurred during the period of the year in which nighttime temperatures and humidity were at their lowest. Other viruses tested were detected only sporadically. Twenty-two viral co-infections were observed. Bacteria were detected in 29/97 samples with 22 viral/bacterial co-infections. Conclusions This study, the first of its type in Burkina Faso, warrants further investigation to confirm the seasonality of RSV infection and to improve local diagnosis of influenza. The long-term objective is to optimize therapeutic management of infected children.

Morbidité et mortalité néonatales de 2002 à 2006 au Centre hospitalier universitaire pédiatrique Charles de Gaulle de Ouagadougou (Burkina Faso)

INTRODUCTION Neonatal diseases remain a major public health problem in developing countries. The Millennium Goal of reducing child mortality by 2/3 by the year 2015 requires a major reduction in neonatal mortality. Accordingly, in March 2006, Burkina Faso began a policy of subsidizing obstetric care and neonatal emergency care. To be able to assess the effectiveness of the steps undertaken, we examined the characteristics of morbidity and neonatal mortality in the principal pediatric teaching hospital (CHUP-CDG) before implementation of the program. MATERIALS AND METHODS This retrospective study looked at hospital records and the database of newborns hospitalized from 01 January 2002 through 31 December 2006. RESULTS During the study period, of 23 223 children hospitalized, 1226 (5%) were neonates. The number of neonates hospitalized annually has increased from 118 in 2002 to 414 in 2006. Most (70%) were referred by another healthcare facility. Mean age at admission was 9+/-8 days. The socioeconomic level of 60% of the parents was low. The neonatal mortality rate was 15.3%. More than half (58.8%) the deaths occurred on the first day of hospitalization. The leading causes of morbidity were also the biggest killers: the fatality rate for neonatal infections was 16.8%, and that for congenital malformations and acute accidental poisoning 12.9%. CONCLUSION Neonatal morbidity and mortality remain at worrisome levels. Improved monitoring of pregnancies and conditions of delivery, reduction in the cost to families of care and the opening of a neonatal unit equipped with appropriate material at the pediatric hospital center (CHUP-CDG) should help to reduce neonatal mortality.

Missed Opportunities for Early Access to Care of HIV-Infected Infants in Burkina Faso

Objective The World Health Organization (WHO) has recommended a universal antiretroviral therapy (ART) for all HIV-infected children before the age of two since 2010, but this implies an early identification of these infants. We described the Prevention of Mother-to-Child HIV Transmission (PMTCT) cascade, the staffing and the quality of infrastructures in pediatric HIV care facilities, in Ouagadougou, Burkina Faso. Methods We conducted a cross-sectional survey in 2011 in all health care facilities involved in PMTCT and pediatric HIV care in Ouagadougou. We assessed them according to their coverage in pediatric HIV care and WHO standards, through a desk review of medical registers and a semi-structured questionnaire administered to health-care workers (HCW). Results In 2011, there was no offer of care in primary health care facilities for HIV-infected children in Ouagadougou. Six district hospitals and two university hospitals provided pediatric HIV care. Among the 67 592 pregnant women attending antenatal clinics in 2011, 85.9% were tested for HIV. The prevalence of HIV was 1.8% (95% Confidence Interval: 1.7%–1.9%). Among the 1 064 HIV-infected pregnant women attending antenatal clinics, 41.4% received a mother-to-child HIV transmission prevention intervention. Among the HIV-exposed infants, 313 (29.4%) had an early infant HIV test, and 306 (97.8%) of these infants tested received their result within a four-month period. Among the 40 children initially tested HIV-infected, 33 (82.5%) were referred to a health care facility, 3 (9.0%) were false positive, and 27 (90.0%) were initiated on ART. Although health care facilities were adequately supplied with HIV drugs, they were hindered by operational challenges such as shortage of infrastructures, laboratory reagents, and trained HCW. Conclusions The PMTCT cascade revealed bottle necks in PMTCT intervention and HIV early infant diagnosis. The staffing in HIV care and quality of health care infrastructures were also insufficient in 2011 in Ouagadougou.

Facteurs de risque de décès au cours du paludisme grave chez l’enfant au Centre hospitalier universitaire pédiatrique Charles de Gaulle de Ouagadougou (Burkina Faso)

To determine the risk factors for death from severe malaria in children in Burkina Faso, we conducted a retrospective case-control study covering a period of 24 months from January 2004 through December 2005, at the Charles de Gaulle Pediatric Hospital in Ouagadougou. Cases (n=72) were defined as all children hospitalized for and dying of confirmed severe malaria. The control subjects (n=72), matched for age, sex and date of hospitalization; were children hospitalized for confirmed severe malaria who were discharged after recovery. Risk factors assessed included: place of residence, socioeconomic level, self-medication, promptness of hospitalization, nutritional status, temperature and parasitemia. Case and control children were compared with pairwise tests. Low socioeconomic level (OR=5.4), late care (OR=15.5), poor nutritional status (OR=7.9) and a parasitemia greater than or equal to 5% (OR=2.8) were associated with a significant increase in the risk of death. In contrast, the malaria deaths were not associated with place of residence (OR=0.5), self-medication (OR=1) or fever of 41 degrees C or higher (OR=1.1). These results show the need for more health education to encourage early care-seeking in the event of fever, community-based interventions, and strengthening of the technical support centers for health facilities, as part of a national poverty reduction program.

Acute accidental poisoning in children: Aspects of their epidemiology, aetiology, and outcome at the Charles de Gaulle Paediatric Hospital in Ouagadougou (Burkina Faso)

Accidents are a daily concern in the paediatric ward because of their frequency, diversity and severity. Acute accidental poisoning (AAP) accounts for an important portion of these. To help improvement management of AAP, we conducted a retrospective study covering a period of 2 years from January 2005 to December 2006 at Charles de Gaulle Paediatric University Hospital in Ouagadougou. Of 9390 admissions during the study period, 123 children, or 1.3%, were admitted for poisoning. A cumulative average of 11 were admitted monthly, with a peak of 16 patients in April 2005 and 2006, together. AAP was most common among children aged 1 to 4 years. Their mean age was 3 years and ranged from 6 days to 12 years. Boys outnumbered girls, with a sex ratio of 1.2. Mothers of more than half (61%) of the children poisoned worked in the home. Household products accounted for 44.7% of AAPs, followed by drug (22.7%) and food (22%) poisoning. Kerosene and other petroleum products topped the list of household products, with 54.5%. Tranquilizers (46.4%) and dairy products (37%) dominated the drug and food poisoning categories. Immediate outcome was fatal in 3% of cases, and three quarters of these deaths occurred during drug poisoning of children aged 1 to 4 years. The mean hospital stay was 2 days, and ranged from 0 to 9 days. Health officials, the media, and community outreach must all help to increase awareness about the dangers of poisoning and of preventive measures.

Reasons for hospitalization in HIV-infected children in West Africa

Current knowledge on morbidity and mortality in HIV‐infected children comes from data collected in specific research programmes, which may offer a different standard of care compared to routine care. We described hospitalization data within a large observational cohort of HIV‐infected children in West Africa (IeDEA West Africa collaboration).

Infections à virus respiratoire syncytial (VRS) au CHU pédiatrique Charles de Gaulle de Ouagadougou, Burkina Faso

Human respiratory syncytial virus (RSV) infections are little known in Burkina Faso. The objective of our work is to study the epidemiological and clinical aspects of RSV infections in infants in the Pediatric Teaching Hospital Charles de Gaulle of Ouagadougou. Between July 1(st) 2010 and June 30(th) 2011, we analyzed by direct immunofluorescence and PCR nasopharyngeal swabs from children from 0 to 36 months old. All in all, 210 patients among whom 74 from the external consultation (35.2%) and 136 hospitalized (64.7%) benefited from a nasopharyngeal aspiration. The motives for consultation were cough (91.7%), rhinitis (79.2%), fever (79.2%) and respiratory distress syndrome (66.7%). The evoked diagnoses were predominantly the acute bronchiolitis in 14 cases (58.3%) followed by the acute pulmonary disease in 7 patients (26.2%) then flue in 1 patient (16.7%). We detected by direct immunofluorescence the antigens of the respiratory viruses in 21 nasopharyngeal aspirations with 10 cases of respiratory syncytial virus (RSV) infections (47.6%). The PCR realized on 208 samples allowed to identify 153 positive samples (73.2%) with 24 RSV, i.e. a global prevalence of 16.1% with a peak of 18 cases (75%). In October, all the patients benefited from an often multiple antibiotic treatment of at least 10 days which was not still necessary. The evolution was favorable for all patients. This study confirms the important place of the viruses which are detected in 70% of the cases. The PCR multiplex, certainly expensive but effective and successful, deserves to be used in our developing countries to avoid the irrational prescription of antibiotic.

Impact and effectiveness of pentavalent rotavirus vaccine in children <5 years of age in Burkina Faso

BACKGROUND Burkina Faso was one of the first African nations to introduce pentavalent rotavirus vaccine (RV5, RotaTeq) into its national immunization program in October 2013. We describe the impact and effectiveness of rotavirus vaccine on acute gastroenteritis (AGE) hospitalizations among Burkinabe children. METHODS Sentinel hospital-based surveillance for AGE was conducted at four hospitals during December 2013 - February 2017. Demographic, clinical, and vaccination information was collected and stool specimens were tested by EIA. Trends in rotavirus AGE hospitalizations and changes in the proportion of AGE hospitalizations due to rotavirus were examined at two sentinel sites from January 2014 - December 2016. Unconditional logistic regression models using data from all 4 surveillance sites were used to calculate vaccine effectiveness (VE, defined as 1-odds ratio) by comparing the odds of vaccination among rotavirus AGE (cases) and non-rotavirus AGE (controls) patients, controlling for age, season, hospital site and socioeconomic factors. RESULTS The proportion of AGE hospitalizations that tested positive for rotavirus declined significantly among children <5 years of age, from 36% (154/422) in 2014 to 22% (71/323, 40% reduction, p < .01) in 2015 and 20% (61/298, 44% reduction, p < .01) in 2016. Among infants, the percentage of AGE admissions due to rotavirus fell significantly from 38% (94/250) in 2014 to 21% (32/153, 44% reduction, p < .01) in 2015 and 17% (26/149, 54% reduction, p < .01) in 2016. The adjusted VE for full 3-dose series of RV5 against rotavirus hospitalization was 58% (95% [CI], 10%, 81%) in children 6-11 months of age and 19% (-78%, 63%) in children ≥12 months. CONCLUSION Rotavirus hospitalizations declined after introduction of pentavalent rotavirus vaccine in children, particularly among infants. RV5 significantly protected against severe rotavirus gastroenteritis in infants, but effectiveness decreased in older children.

Asphyxie périnatale et insuffisance rénale aiguë à Ouagadougou

AIM This study aimed to analyze acute renal failure in perinatal asphyxia (PNA) of term newborns in a sub-Saharan urban health center. PATIENTS AND METHODS The study was prospective, conducted from 1st June to 30th November 2013 on term newborns hospitalized at the centre hospitalier universitaire pédiatrique Charles-de-Gaulle for PNA. Renal insufficiency (RI) was defined by a serum creatinine greater than or equal to 90 μmol/L. RESULTS Eighty-five PNA cases were included, or 19.8% of newborns hospitalized in the study period. The sex ratio was 2.1. Thirty-eight newborns (44.7%) had RI. Their creatinine averaged 153.8±96.6 μmol/L. Twenty-six of 38 (68.4%) had brain damage in Sarnat stage 2 and 12 (31.6%) stage 3. Twelve newborns with RI (31.6%) had seizures. Transfontanellar echography revealed an abnormality in 30 cases (78.9%) of RI. Of the 38 newborns with renal failure, albuminuria was found in 21 cases (65.2%) and leukocyturia in 28 cases (73.7%). Renal function improved in 86.1% of cases. Newborns with initially normal serum creatinine had no RI during hospitalization. Six newborns (7.1%) died. CONCLUSION This study showed that acute RI is common during PNA most particularly in newborns with severe neurological impairment. In our context, earlier support for women in labor could help prevent PNA and therefore newborn acute RI.

Knowledge, Attitudes and Practices of HIV Positive Breastfeeding Mothers in Prevention of Mother to Child Transmission of HIV in Ouagadougou (Burkina Faso) and Associated Factors

World Health Organization (WHO) places strong emphasis on exclusive breastfeeding of HIV exposed infants during the first 6 months, combined to antiretroviral treatment for mothers and prophylaxis for infants. However, adherence to safe breastfeeding among HIV infected mothers is still a major challenge in Burkina Faso. We conducted a cross sectional study in four hospitals in Ouagadougou, Burkina Faso in order to explore knowledge, attitudes and practices of HIV infected breastfeeding mothers attending selected clinics for Prevention of Mother to Child Transmission of HIV (PMTCT). Two hundred and one HIV infected mothers attended the clinics for their children’s routine medical visit, among them 162 (81%) had chosen breastfeeding. The majority of women (95%) were familiar with PMTCT measures required during pregnancy and childbirth, whereas prevention measures required during breastfeeding period were less mentioned: mothers strict adherence to antiretroviral treatment (48.1%), safe sexual practices (1.85%), cessation of breastfeeding in case of breast infection (6.2%), avoiding traditional enema (36.4%) and stopping breastfeeding at the age of 12 months after 6 months of exclusive breastfeeding along with the introduction of other foods and fluids (43.2%). Moreover, 52.2% of women did not practice exclusive breastfeeding during the first six months. Factors associated with poor breastfeeding practices were: infant feeding option decided solely by the mother, living in well serviced areas and having a low score (≤ 3) of knowledge on how to prevent HIV transmission during breastfeeding. There is a need for urgent interventions in support of safe breastfeeding in HIV exposed infants in Ouagadougou.