S. Diouf

La méningite purulente en milieu hospitalier pédiatrique à Dakar (Sénégal)

Resume Objectifs. – Etudier la prevalence des germes responsables de la meningite purulente chez l’enfant au Senegal et leur sensibilite aux antibiotiques. Methodes. – A partir d’un travail retrospectif portant sur une periode de 6 ans (du 1 er janvier 1995 au 31 decembre 2000), nous avons etudie les aspects cliniques epidemiologiques et therapeutiques des cas de meningite purulente, hospitalises a l’hopital d’enfants Albert-Royer de Dakar. Ont ete concernes par l’etude, tous les enfants âges de 0 a 15 ans chez qui le diagnostic de meningite purulente a ete confirme par le laboratoire. Resultats. – Il y a eu 1095 meningites purulentes pour 22 162 hospitalisations (soit 4,9 %). L’affection sevit toute l’annee avec une recrudescence de janvier a mai. L’âge moyen des patients etait de 37,8 mois et le pic de frequence se situait entre 1 et 6 mois. La bacteriologie etait positive dans 594 cas (54,2 %). Haemophilus influenzae b, Neisseria meningitidis et Streptococcus pneumoniae sont les principaux germes. L’activite des antibiotiques courants est excellente sur ces germes. L’evolution globale a donne un taux de guerison de 71,9 % et une letalite de 16,3 %. Commentaires. – H. influenzae b, principal agent de meningite purulente dans notre serie, est responsable d’une importante morbidite et d’une mortalite elevee dans des pays comme le Senegal ou la vaccination contre ces germes n’est pas systematique. De ce fait, nous recommandons l’introduction dans les plus brefs delais, du vaccin contre H. influenzae b, dans le programme elargi de vaccination au Senegal.

Prévalence et déterminants de l’anémie chez le jeune enfant en Afrique francophone – Implication de la carence en fer

Anemia and iron deficiency are major public health issues worldwide and particularly in Africa. Reliable information about their prevalence and associated factors is required to allow for effective actions. In this study, we used data from recent (2006-2012) large population health surveys, carried out in 11 French-speaking African countries (Benin, Burkina Faso, Cameroon, Congo Brazzaville, Ivory Coast, Gabon, Guinea, Mali, Niger, Democratic Republic of Congo, and Senegal). Hemoglobin (Hb) was assessed and demographic and health-related parameters were obtained from nation-representative samples of children aged 6-59 months. Anemia (Hb<11g/dL) was found in 72.4% of the children (60.2-87.8%), with no gender difference but a slightly lower incidence in older children (62% at age 4-5 years versus 85% at age 9 months), especially for the more severe forms (2.1% versus 8.7%, respectively). Anemia was only slightly but significantly affected by location (75.5% in rural areas versus 67.3% in towns), income (79.8% in lower quintile of income versus 62.3% in higher quintile), or maternal education (74.1% in children from non-educated mothers versus 62.4% in children whose mothers had secondary education). Nearly 50% of women of child-bearing age had anemia. In the countries that report this information, less than 50% (17-65%) of children consumed iron-rich foods regularly and only 12% (7.4-20.5%) received iron supplementation. Infection and parasitism are known to affect some markers of iron status, because of the inflammatory reaction, thereby making the diagnosis of iron deficiency difficult. In the study countries, acute respiratory diseases and diarrhea affected 6.2 and 15.6% of children aged between 6 and 59 months, respectively; their distribution according to age and location is very different from the one of anemia, which is also the case for the distribution of malaria. It is thus likely that a large part of the anemia observed in young children is due to iron deficiency, although further research is needed to confirm this. This fully justifies the nationwide programs of iron fortification of flour, currently undergoing in most countries of French-speaking Africa. Their formal evaluation is still pending but the initial data suggest some efficacy, although far from optimal. It is thus likely that a more holistic approach, including iron fortification, actions against undernutrition and parasitism in children, and actions in favor of improving young womens iron and nutritional status, together with appropriate communication and education objectives, would be more effective.

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-

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.

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.

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.

SFCP P-102 - Malnutrition et hospitalisation chez les moins de cinq ans

Pour determiner la prevalence hospitaliere de la malnutrition et son impact sur la mortalite des enfants de moins de cinq ans, nous avons etudie l’evolution des parametres anthropometriques. Le poids, la taille et le perimetre brachial etaient evalues chez tous nos patients a l’admission et a la sortie et un hemogramme etait realise. Nous avons trouve des prevalences de 38,2% pour l’emaciation, 31,3% pour le retard de croissance, selon les normes OMS et 73,8% pour l’anemie. A la sortie, la prevalence de la malnutrition aigue a baisse, passant de 38,2% a 29,5%. Une degradation nutritionnelle etait apparue chez les enfants n’ayant pas presente pas une malnutrition a l’admission. La duree moyenne d’hospitalisation (16±3jours) etait significativement plus longue (p=0,0001) en cas de malnutrition initiale. Le taux cumule de deces etait de 11,3%, avec un risque 4 fois plus eleve en cas de malnutrition aigue. L’absence d’allaitement maternel exclusif dans les 6 premiers mois de vie et la mauvaise conduite de l’alimentation etaient les principaux facteurs de risque. En milieu hospitalier pediatrique, la prevalence de la malnutrition reste elevee, avec un impact reel sur la survie des enfants, d’ou la necessite d’ameliorer la prise en charge nutritionnelle.

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.

P329 - Conditions de vie et état de santé des enfants des écoles coraniques au Sénégal

Une etude transversale, descriptive et analytique a ete menee du 08 au 15 aout 2008, avec comme objectifs d’etudier les conditions de vie ainsi que l’etat de sante des enfants des ecoles coraniques.Un choix raisonne des ecoles a ete realise dont 3 dans la banlieue dakaroise et 4 dans le district rural de khombole. L’enquete medicale a interesse 314 enfants qui ont beneficie d’un examen clinique, d’un hemogramme et d»une parasitologie des selles. Les conditions de vie difficiles des enfants etaient caracterisees par la promiscuite, le manque d’hygiene, une alimentation inadequate, la mendicite ainsi que les châtiments corporels. Au moment de l’examen clinique, les talibes avaient signale des plaintes dans 34,7 % des cas, dominees par les douleurs abdominales (34,3 %) et la toux. Les principales pathologies identifiees etaient les dermatoses (55,9 % et, l’anemie (30,6 %) La prevalence de la malnutrition etait elevee, estimee a 19,8 % pour la forme aigue (emaciation) et 18,5 % pour la forme chronique (retard de croissance). Plus de la moitie (66,9 %) des talibes etaient anemies et 48,9 % d’entre eux avaient une parasitose intestinale. Au terme de ce travail, il s’avere necessaire de faire un plaidoyer pour une meilleure prise en charge de ces enfants au plan social mais surtout sanitaire.