P.M. Faye

Impact of rotavirus vaccine on acute gastroenteritis in children under 5 years in Senegal: Experience of sentinel site of the Albert Royer Children's Hospital in Dakar

BACKGROUND Acute gastroenteritis (AGE) is a leading cause of morbidity and mortality among children <5 years of age in developing countries, with rotavirus being the most common infectious etiology. In November 2014, monovalent rotavirus vaccine was introduced in Senegal. We determined the impact of rotavirus vaccine on hospitalizations for all-cause and rotavirus related AGE in children <60 months of age. METHODS We examined two data sources from the national referral hospital. Using sentinel surveillance data from March 2011 to February 2017, we examined the proportion of AGE hospitalizations among children <60 months of age attributable to rotavirus, stratified by age groups (0-11, 12-23 and 24-59 months). Using pediatric logbook data from March 2010 to February 2017, we examined the proportion of all childhood hospitalizations attributable to AGE, among the same age groups. RESULTS In sentinel surveillance, 673 patients <60 months were hospitalized for AGE, with 30% (203/673) due to rotavirus. In pre-vaccine years, the median proportion of rotavirus-positive hospitalizations was 42%; this proportion declined by 76% to 10% rotavirus positive in 2015-2016 (p < .001) and by 59% to 17% in 2016-2017 (p < .001). From the logbook data, among all children <60 months, a median of 11% of all hospitalizations in the pre-vaccine period were due to AGE, with 2015-2016 seeing a 16% decline (p < .001), to 9% of all hospitalizations, and 2016-2017 seeing a 39% decline (p < .001), to 7% of all hospitalizations. Declines in both rotavirus-associated and all-cause AGE hospitalizations were most marked among infants, with a suggestion of herd effect among older children seen in the surveillance data. CONCLUSION Rotavirus vaccine demonstrated a significant impact on rotavirus-associated hospitalizations and all-cause AGE hospitalizations in the first two seasons after vaccine introduction in Senegal. Our data support the continued use of this vaccine in national immunization program.

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.

Insuffisance cardiaque sur cœur normal révélant une malformation artériole-veineuse complexe du membre inferieur chez un enfant: à propos d'une observation et revue de la littérature

Arteriovenous malformations (AVM) are congenital high-flow vascular defects. They are very rare in children. Diagnosis and treatment are often delayed due to their atypical place of occurrence and to their variable clinical manifestations. We report the case of a child treated at the National Centre Hospitalier Albert Royer Children, Dakar. A boy aged 9 years was referred from a health facility in rural areas for the treatment of heart failure. Admission clinical examination showed impaired general condition, global heart failure syndrome and voluminous right warm inguinocrural mass extended to the right abdominal wall (iliac fossa and right flank), with poorly defined limits. Auscultation of this mass showed a thrill and diffuse murmur. Cardiac ultrasound showed severe pulmonary arterial hypertension (PAH) with extensive impairement of the heart cavities, without cardiac structural involvement. The diagnosis of AVM was confirmed by doppler ultrasound of the mass complemented by angiography scan. They showed multiple arteriovenous fistulas within the mass. The diagnosis of complex stage IV AVM (according to Schöbinger classification) of the root of the right thigh was retained. Clinical treatment of heart failure was based on furosemide, spironolactone and captopril to obtain hemodynamic stabilization before possible surgical procedure. Arteriovenous malformations of the limbs, in particular of the proximal end of the lower limb in children are still largely unknown, hence frequent diagnostic errors and delays. Their evolution is unpredictable requiring early diagnosis and careful monitoring involving multidisciplinary interaction between pediatrics, surgeons and radiologists.

Syndrome hémolytique et urémique de l'enfant au Centre Hospitalier Universitaire (CHU) de Dakar: à propos de quatre observations

Hemolytic-uremic syndrome (HUS) is a common cause of organic acute renal failure (ARF) in children. It is a progressive complication of acute gastroenteritis (AGE), especially caused by Escherichia coli in children. This study aimed to describe the clinical, therapeutic and evolutionary aspects of this affection in four children. We collected four cases of HUS. The average age was 10,5 months (5-15mois), exclusively boys. Clinical examination revealed a hemolytic anemia (pallor and jaundice), oligoanuria and edematous syndrome (2 cases), arterial hypertension (1 patient), AGE associated with severe dehydration and hypovolemic shock (2 patients), consciousness disorders. ARF was found in all patients as well as thrombocytopenia and schizocytes smear. Direct Coombs test was negative. Hyperkalemia was found in 3 patients, of whom 1 with hyperkalemia level of more than 9.2 mmol/L, hyponatremia at 129 mmol/l (1 patient) and hypernatremia at 153 mmol/l (1 patient). HUS was secondary to pneumococcal pneumonia (1 patient) while AGE was secondary to E. coli (1 patient). The treatment was mainly symptomatic and included fluid restriction, transfusion of red cell concentrates, diuretics, peritoneal dialysis and hemodialysis. The evolution was marked by the onset of chronic renal failure (1 patient) after 6 months of follow-up and by recovery (1 case). Three patients died. HUS is the most common cause of organic acute renal failure in newborns. Diagnosis is essentially biological, treatment is mostly symptomatic.

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.

Complication rare d’une méningite néonatale à Streptocoque B : le diabète insipide central

Le diabète insipide central par déficit en hormone antidiurétique est une maladie rare de la période néonatale, souvent secondaire à une affection neurologique sévère [1,2] parfois d’origine génétique [3]. L’efficacité du traitement substitutif par desmopressine en période néonatale a été prouvée [4]. Nous présentons ici le cas d’un nouveau-né ayant développé un diabète insipide central au décours d’une méningite à Streptocoque B. Il s’agissait d’un garçon, second enfant d’une fratrie de deux enfants, né eutrophique à terme après une grossesse et un accouchement sans particularités. Il était admis à 15 j de vie pour un syndrome méningé avec des convulsions tonicocloniques généralisées et une détresse respiratoire sévère. C’était associé à un syndrome infectieux et avait justifié une antibiothérapie empirique en ambulatoire 48 h avant l’hospitalisation. La ponction lombaire (PL) confirmait l’existence d’une méningite suppurée en ramenant un liquide céphalorachidien (LCR) louche avec une pléı̈ocytose à 1820 leucocytes par mm3 avec prédominance de polynucléaires neutrophiles (PNN) altérés (66 %), une hyperalbuminorachie à 1,09 g/L et une hypoglycorachie à 0,16 g/l. L’examen au latex mettait en évidence les antigènes du Streptocoque B mais la culture du LCR était négative (méningite décapitée). L’hémogramme mettait en évidence une leuconeutropénie à 3820 par mm3. L’ionogramme sanguin, en particulier la