Background: Bacterial meningitis is one of the most severe infections in infants and children. It is associated with high mortality and neurological sequelae. In order to improve the prognosis of infants and children ...Background: Bacterial meningitis is one of the most severe infections in infants and children. It is associated with high mortality and neurological sequelae. In order to improve the prognosis of infants and children with purulent meningitis, we decided to conduct this study whose main objective was to identify the main pathogens responsible and describe the outcome in infants and children aged 2 months to 15 years admitted for purulent meningitis at the Yaounde Gyneco-Obstetric and Pediatric Hospital (YGOPH). Method: This was a cross-sectional study with retrospective data collection and consecutive sampling. Our study was conducted from 1 January 2009 to 31 December 2013. The patients included in the study were infants and children aged from 2 months to 15 years who were admitted for bacterial meningitis at the YGOPH, confirmed by bacteriological examination of cerebrospinal fluid (CSF) with identification of the pathogen by culture or soluble antigen. The data was analyzed using SPSS Version 18.0 and Excel 2007. The Chi-square test was used to determine the association of various variables. The significance threshold was set as P 0.05. Results: We selected 171 cases of purulent meningitis who represented 1.54% of admitted patients. The sex ratio was 1.2. We noted that 45% of our patients were aged 2 months to 1 year. The main presenting complaints were fever (98.8%), seizures (44.4%) and vomiting (28.7%). Haemophilus influenzae was found in 67 children (39.2%), followed by Streptococcus pneumoniae in 54 children (31.6%) and Neisseria meningitidis in 17 children (9.9%). Acute complications (status epilepticus, coma) were seen in 33% of patients. The statistically significant (P 0.05) factors for poor prognosis were aged from 2 months to 1 year (P = 0.0004), coma (P = 0.32), intracranial hypertension (P = 0.0001), the pathogen (P = 0.0032Pneumococcus), a delay of more than three days between the onset of the disease and the treatment (P = 0.0134) and brain abscess (P = 0.0001). We identified 32 deaths (18.7%) and 17 cases (9.9%) with neurological sequelae before discharge. Conclusion: The incidence of acute bacterial meningitis remains high in our context. The main causes were Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitis. The mortality rate was high with poor prognosis factors such as age less than 12 months, delayed care, pneumococcal meningitis, coma, brain abscess, and intracranial hypertension. Focus should be placed on strengthening the routine immunization on vaccine-preventable diseases of infants and children against Haemophilus influenzae, Pneumococcus and Meningococcus.展开更多
The authors report a case of hepatic glycogen storage diseases type III (Cori-Forbes disease) of a Métis 3-year-old girl born and resident in C?te d'Ivoire. The discovery of this disease was made at the age o...The authors report a case of hepatic glycogen storage diseases type III (Cori-Forbes disease) of a Métis 3-year-old girl born and resident in C?te d'Ivoire. The discovery of this disease was made at the age of 2 years in the diagnosis of abdominal mass in a child subject to frequent hypoglycemia. The management currently consists of a diet enriched with glucose and maltose dextrin. We note in our case, a failure to thrive despite the persistent support.展开更多
Cote d’Ivoire ranks third among African countries with the highest neonatal mortality rate (38‰). Perinatal asphyxia is one of the major causes of neonatal mortality. In its severe form, it imposes an efficient neon...Cote d’Ivoire ranks third among African countries with the highest neonatal mortality rate (38‰). Perinatal asphyxia is one of the major causes of neonatal mortality. In its severe form, it imposes an efficient neonatal resuscitation in the birth room. This can only be done when the proven competence of the staff in charge of the newborn and the availability of the appropriate equipment are met. What is the situation in the birth facilities of these two challenges for the response to the high rate of neonatal mortality in Cote d’Ivoire? Method: It is a cross-sectional study, which took place from March 28 to July 28, 2016, in three health districts of Cote d’Ivoire (Bouaké, Gagnoa, Yopougon). Public health structures offering delivery activities were selected. Based on a fact sheet, the practitioners present have been interviewed and a direct observation of the organization and equipment set up to perform neonatal resuscitation in the birth room has been done. In addition, an observation grid made it possible to evaluate the practical skills of providers in neonatal resuscitation on a newborn mannequin. The data were entered using the Epi-Info 7 software. Based on the data collected, we determined the numbers and frequencies of the responses of the target agents of the survey. Results: The membership structures included 46 first contact health facilities (FCHFs) and 4 reference hospitals (HRs). The heating system, mucus suction, oxygen, timers and self-inflating balloons were available in HR and in six, eight, four, 34 and 10 FCHFs respectively. The 253 midwives surveyed came from Bouaké (86), Gagnoa (62) and Yopougon (105). They had a seniority of at least eight years. Their knowledge for newborns’ care was acquired in initial training (75% of cases). They knew the golden minute in 95.6% of the cases. Inadequacies in the recognition of risk situations, useful equipment and in the execution of neonatal resuscitation steps were noted. Conclusion: The survival of the newborn is still very worrying in Cote d’Ivoire. An analysis of the results of this survey shows that many challenges remain not only at the structural level but also at the level of quality of care.展开更多
The purpose of this study is to determine the prevalence, the characteristics of hypoglycaemia in the newborn admitted to emergency departments of teaching Hospital of Treichville, Abidjan and to evaluate the relevanc...The purpose of this study is to determine the prevalence, the characteristics of hypoglycaemia in the newborn admitted to emergency departments of teaching Hospital of Treichville, Abidjan and to evaluate the relevance of capillary blood glucose in this diagnosis. Patients and Methods: This prospective cross-sectional study was held from 01 February to 25 June 2017 in the Pediatric Emergency Department. It involved 201 newborns under 24 hours of age who consulted in pediatric emergency for any reason. Data were collected from parent direct interviews, analysis of the follow-up record, physical examination of the newborn, results of glucose level in the capillary blood at heel and in venous blood. On dry tube and gray tube (containing sodium fluoride and potassium oxalate), the blood glucose on the latter tube constituting the reference blood glucose, with neonatal hypoglycaemia defined by a venous blood glucose less than or equal to 2.5 mmol/l (0.45 g/l). The statistical tests used were the frequency comparison, the Chi Square, the Fisher Test with a significance threshold p 0.05 or the Odds-ratio with a confidence interval of 95% and a significance threshold of 5%, but also with the correlation coefficient. Results: Newborns of less than 3 hours of life (70.6%) were the most represented with a male predominance (sex ratio = 2.9). The reasons for consultation were dominated by neurological disorders (36.5%), prematurity (31.8%), and fever (22.2%). The average time to complete the blood glucose test was less than one hour after the sampling in 6.5% of the cases. The mean blood glucose was 0.59 g/l (3.28 mmol/l) with extremes ranging from 0.15 to 1.8 g/l (0.83 mmol/l to 10 mmol/l). The prevalence of hypoglycemia by the instantaneous glycemic method was 15.9%. On tube containing sodium fluoride and potassium oxalate, it was 20.4%, while the prevalence of red blood cell hypoglycemia was 38.1%. A good correlation was found between capillary glycemia and gray tube with r = 0.97. Signs associated with hypoglycemia were predominantly male (p 0.05), prematurity (p 0.05). As for cerebral suffering, it had proved to be a protective factor (Fisher: 0.002). The mortality rate was 2.5%. Hypoglycemia was not found. Conclusion: Hypoglycaemia is relatively common in our working setting, particularly in premature infants. However, it should be carefully sought in any newborn admitted to emergency regardless of the reason for admission. The use of capillary blood glucose proves to be a good alternative because it allows a fast management.展开更多
文摘Background: Bacterial meningitis is one of the most severe infections in infants and children. It is associated with high mortality and neurological sequelae. In order to improve the prognosis of infants and children with purulent meningitis, we decided to conduct this study whose main objective was to identify the main pathogens responsible and describe the outcome in infants and children aged 2 months to 15 years admitted for purulent meningitis at the Yaounde Gyneco-Obstetric and Pediatric Hospital (YGOPH). Method: This was a cross-sectional study with retrospective data collection and consecutive sampling. Our study was conducted from 1 January 2009 to 31 December 2013. The patients included in the study were infants and children aged from 2 months to 15 years who were admitted for bacterial meningitis at the YGOPH, confirmed by bacteriological examination of cerebrospinal fluid (CSF) with identification of the pathogen by culture or soluble antigen. The data was analyzed using SPSS Version 18.0 and Excel 2007. The Chi-square test was used to determine the association of various variables. The significance threshold was set as P 0.05. Results: We selected 171 cases of purulent meningitis who represented 1.54% of admitted patients. The sex ratio was 1.2. We noted that 45% of our patients were aged 2 months to 1 year. The main presenting complaints were fever (98.8%), seizures (44.4%) and vomiting (28.7%). Haemophilus influenzae was found in 67 children (39.2%), followed by Streptococcus pneumoniae in 54 children (31.6%) and Neisseria meningitidis in 17 children (9.9%). Acute complications (status epilepticus, coma) were seen in 33% of patients. The statistically significant (P 0.05) factors for poor prognosis were aged from 2 months to 1 year (P = 0.0004), coma (P = 0.32), intracranial hypertension (P = 0.0001), the pathogen (P = 0.0032Pneumococcus), a delay of more than three days between the onset of the disease and the treatment (P = 0.0134) and brain abscess (P = 0.0001). We identified 32 deaths (18.7%) and 17 cases (9.9%) with neurological sequelae before discharge. Conclusion: The incidence of acute bacterial meningitis remains high in our context. The main causes were Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitis. The mortality rate was high with poor prognosis factors such as age less than 12 months, delayed care, pneumococcal meningitis, coma, brain abscess, and intracranial hypertension. Focus should be placed on strengthening the routine immunization on vaccine-preventable diseases of infants and children against Haemophilus influenzae, Pneumococcus and Meningococcus.
文摘The authors report a case of hepatic glycogen storage diseases type III (Cori-Forbes disease) of a Métis 3-year-old girl born and resident in C?te d'Ivoire. The discovery of this disease was made at the age of 2 years in the diagnosis of abdominal mass in a child subject to frequent hypoglycemia. The management currently consists of a diet enriched with glucose and maltose dextrin. We note in our case, a failure to thrive despite the persistent support.
文摘Cote d’Ivoire ranks third among African countries with the highest neonatal mortality rate (38‰). Perinatal asphyxia is one of the major causes of neonatal mortality. In its severe form, it imposes an efficient neonatal resuscitation in the birth room. This can only be done when the proven competence of the staff in charge of the newborn and the availability of the appropriate equipment are met. What is the situation in the birth facilities of these two challenges for the response to the high rate of neonatal mortality in Cote d’Ivoire? Method: It is a cross-sectional study, which took place from March 28 to July 28, 2016, in three health districts of Cote d’Ivoire (Bouaké, Gagnoa, Yopougon). Public health structures offering delivery activities were selected. Based on a fact sheet, the practitioners present have been interviewed and a direct observation of the organization and equipment set up to perform neonatal resuscitation in the birth room has been done. In addition, an observation grid made it possible to evaluate the practical skills of providers in neonatal resuscitation on a newborn mannequin. The data were entered using the Epi-Info 7 software. Based on the data collected, we determined the numbers and frequencies of the responses of the target agents of the survey. Results: The membership structures included 46 first contact health facilities (FCHFs) and 4 reference hospitals (HRs). The heating system, mucus suction, oxygen, timers and self-inflating balloons were available in HR and in six, eight, four, 34 and 10 FCHFs respectively. The 253 midwives surveyed came from Bouaké (86), Gagnoa (62) and Yopougon (105). They had a seniority of at least eight years. Their knowledge for newborns’ care was acquired in initial training (75% of cases). They knew the golden minute in 95.6% of the cases. Inadequacies in the recognition of risk situations, useful equipment and in the execution of neonatal resuscitation steps were noted. Conclusion: The survival of the newborn is still very worrying in Cote d’Ivoire. An analysis of the results of this survey shows that many challenges remain not only at the structural level but also at the level of quality of care.
文摘The purpose of this study is to determine the prevalence, the characteristics of hypoglycaemia in the newborn admitted to emergency departments of teaching Hospital of Treichville, Abidjan and to evaluate the relevance of capillary blood glucose in this diagnosis. Patients and Methods: This prospective cross-sectional study was held from 01 February to 25 June 2017 in the Pediatric Emergency Department. It involved 201 newborns under 24 hours of age who consulted in pediatric emergency for any reason. Data were collected from parent direct interviews, analysis of the follow-up record, physical examination of the newborn, results of glucose level in the capillary blood at heel and in venous blood. On dry tube and gray tube (containing sodium fluoride and potassium oxalate), the blood glucose on the latter tube constituting the reference blood glucose, with neonatal hypoglycaemia defined by a venous blood glucose less than or equal to 2.5 mmol/l (0.45 g/l). The statistical tests used were the frequency comparison, the Chi Square, the Fisher Test with a significance threshold p 0.05 or the Odds-ratio with a confidence interval of 95% and a significance threshold of 5%, but also with the correlation coefficient. Results: Newborns of less than 3 hours of life (70.6%) were the most represented with a male predominance (sex ratio = 2.9). The reasons for consultation were dominated by neurological disorders (36.5%), prematurity (31.8%), and fever (22.2%). The average time to complete the blood glucose test was less than one hour after the sampling in 6.5% of the cases. The mean blood glucose was 0.59 g/l (3.28 mmol/l) with extremes ranging from 0.15 to 1.8 g/l (0.83 mmol/l to 10 mmol/l). The prevalence of hypoglycemia by the instantaneous glycemic method was 15.9%. On tube containing sodium fluoride and potassium oxalate, it was 20.4%, while the prevalence of red blood cell hypoglycemia was 38.1%. A good correlation was found between capillary glycemia and gray tube with r = 0.97. Signs associated with hypoglycemia were predominantly male (p 0.05), prematurity (p 0.05). As for cerebral suffering, it had proved to be a protective factor (Fisher: 0.002). The mortality rate was 2.5%. Hypoglycemia was not found. Conclusion: Hypoglycaemia is relatively common in our working setting, particularly in premature infants. However, it should be carefully sought in any newborn admitted to emergency regardless of the reason for admission. The use of capillary blood glucose proves to be a good alternative because it allows a fast management.
