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Household accidental child poisonings are frequent pediatric medical emergencies in developing countries.To study the epidemiological, etiological, clinical and therapeutic aspects of acute accidental domestic poisoning in children aged 0 to 15 years admitted to the pediatric emergency department of Gabriel Toure.This was a prospective, descriptive study that ran from January 1, 2014 to December 31, 2014. All patients aged 0 to 15 years admitted to pediatric emergencies for acute intoxication were included.A hundred cases of acute accidental poisoning were collected. Children under five accounted for 94%. The majority of mothers was housewives and had custody of children (83%). Forty-nine percent of the mothers were unschooled. The place of storage of the product was indoor in 96% of cases. The product was taken by the child himself (88%). A gesture at the scene of the accident was reported in 68% of cases, the ingestion of milk (72%) and water (10%) were the first acts used. The hospital was the first resort (72%). The time between taking the product and admission to hospital was 1 to 5 hours in 58% of cases. Vomiting (37 cases), agitation (17 cases) and respiratory distress (16 cases) were the most common symptoms. Domestic products (48%) followed by drugs (33%) ranked first among the families of poisons. Caustic soda (18%) and bleach (17%) were the most commonly found intoxication products. The evolution was good with a cure without sequelae (93%).Accidental acute intoxications to household products are common in Mali. The hospital admission deadline is still long; the actions taken by patients at the accident site often aggravate their states but are largely done by the parents before the use of health care.Les intoxications accidentelles domestiques de l'enfant sont des urgences médicales pédiatriques fréquentes dans les pays en développement. Le but de notre travail était d'étudier les aspects épidémiologiques, étiologiques, cliniques et thérapeutiques des intoxications aiguës accidentelles domestiques chez les enfants âgés de 0 à 15 ans admis aux urgences pédiatriques du CHU Gabriel Touré.Il s'agissait d'une étude descriptive à collecte prospective qui s'est déroulée du 01 janvier 2014 au 31 décembre 2014. Ont été inclus tous les patients âgés de 0 à 15 ans admis aux urgences pédiatriques pour intoxications aiguës accidentelles.Cent cas d'intoxications accidentelles aiguës ont étés colligés. Les enfants âgés de moins de cinq ans représentaient 94%. La majorité des mères était des femmes au foyer et avait la garde des enfants (83%). Quarante-neuf pour cent des mères n'étaient pas scolarisées. Le lieu de stockage du produit était intradomiciliaire dans 96% des cas. Le produit était pris par l'enfant lui-même (88%). Un geste sur le lieu de l'accident était rapporté dans 68% des cas, l'ingestion de lait (72 %) et de l'eau (10%) avaient été les premiers gestes utilisés. L'hôpital était le lieu du premier recours (72%). La durée entre la prise du produit et l'admission à l'hôpital était de 1 à 5 heures dans 58% des cas. Les vomissements (37 cas), l'agitation (17 cas) et la détresse respiratoire (16 cas) étaient les symptômes les plus rencontrés. La soude caustique (18%) et l'eau de javel (17 %) étaient les produits d'intoxication les plus retrouvés. Les produits domestiques (48%) suivis des médicaments (33%) venaient en tête parmi les familles de toxiques. L'évolution était bonne avec une guérison sans séquelle (93%).Les intoxications aiguës accidentelles aux produits domestiques sont courantes au Mali. Le délai d'admission à l'hôpital reste toujours long, les gestes inappropriés apportés aux patients sur le lieu de l'accident aggravent souvent le tableau mais sont largement effectués par les parents avant le recours aux soins de santé.

We report two observations of congenital hypothyroidism diagnosed in 2011 in the university hospital of Gabriel Toure in Bamako. The first occurred in a male infant of 40 days, admitted for respiratory distress and anterior compressive cervical swelling. Although his neonatal period occurred without any medical particularity, family medical history revealed the presence of unexplored goiter in three paternal uncles. Neurological examination was normal with the presence of constipation. A cervical-thoracic scan showed a homogeneous and symmetric hypertrophy of thyroid lobes with a compression of the trachea. The dosage of thyroid hormones confirmed hypothyroidism (FT4 = 1.6 pmol/l, TSH = 60 µUI/ml). After one month of treatment using Levothyroxine, 10 mg/kg, there was a drastic improvement of respiratory distress, a regression of goiter and normalization of thyroid hormones. At six months of life he had no goiter and psychomotor development was normal. The second case occurred in a male infant of 2 years, from an area of endemic goiter. Puffiness of the face without lower limb edema, constipation, and delayed independent walking were the reasons for consultation. On examination, we noted the absence of goiter, large anterior fontanel with facial dysmorphism (lunar facies, hypertelorism, flat nose, macroglossia) and infiltration of the skin more marked in the face with cold extremities. He required support to sit. The thyroid function tests confirmed hypothyroidism (FT4 = 72 nmol/l, FT3 = 0.40 nmol/l, TSH60 µUI/l). Under levothyroxine, there was normalization of thyroid hormones after one month of treatment and disappearance of the skin infiltration. At six months of treatment he had acquired independent walking. Mental prognosis remains to be evaluated. These cases confirm the necessity of routine neonatal diagnosis of hypothyroidism.Nous rapportons deux observations d'hypothyroïdie congénitale diagnostiquées en 2011 au CHU Gabriel Touré de Bamako. Il s'agit d'un nourrisson de 40 jours, de sexe masculin admis dans le service pour une détresse respiratoire et une tuméfaction cervicale antérieure compressive. Son passé néonatal était sans particularités, il aurait trois oncles paternels ayant un goitre non exploré. Une constipation chronique était le seul signe fonctionnel tandis que l'examen neurologique était normal. Une tomodensitométrie cervico-thoracique montrait une hypertrophie homogène et symétrique des lobes thyroïdiens avec compression de la trachée. Le dosage des hormones thyroïdiennes confirmait l'hypothyroïdie (T4L = 1,6 pmol/l, TSH= 60 µUI/ml). Sous lévothyroxine à 10 µg /kg, on notait une disparition de la détresse respiratoire, une régression du goitre et la normalisation du taux des hormones thyroïdiennes à un mois de traitement. A six mois de vie, il n'avait pas de goitre et son développement psychomoteur était normal. Le second est un nourrisson de 2 ans, de sexe masculin, provenant d'une zone d'endémie goitreuse. Une bouffissure du visage sans œdème des membres inférieurs, une constipation, un retard de la marche autonome constituaient les motifs de consultation. A l'examen, on notait l'absence de goitre, une fontanelle antérieure large avec une dysmorphie faciale (facies lunaire, hypertélorisme, nez aplati, macroglossie) et une infiltration de la peau plus marquée au visage avec une froideur des extrémités. Il s'asseyait avec appui. Le dosage des hormones thyroïdiennes a confirmé l'hypothyroïdie (T4L = 72 nmol/l, T3L= 0,40 nmol/l, TSH60 µUI/l). Sous lévothyroxine, on notait la normalisation des hormones thyroïdiennes à un mois de traitement et la disparition de l'infiltration de la peau. A six mois de traitement il avait acquis la marche autonome. Le pronostic mental reste à être évalué. Ces observations confirment la nécessité du diagnostic néonatal de l'hypothyroïdie.

The aim of this study was to determine sociodemographics, clinical and therapeutic aspects in patients with isolated mandibular fractures in the Bamako dentistry teaching hospital (CHU-OS).We carried out restrospective study over a period of four months involving isolated mandibular fracture cases, confirmed by a clinical and radiological examination in 2006. The data were collected from medical records, entered and analyzed using Epiinfo.fr 6.0 software.The lesions involved 42 men and 13 women with a sex ratio of 3.23. The age group of 21-30 was the most affected. The main cause was found to be road traffic accidents with 72.72 % of the total cases. The fractures of the mandible at the level of horizontal branch were the most frequent with 34.54 %. The orthopedic treatment was used in 72.72 % of the cases, with a good and very good results.This study shows the high frequency of isolated fractures of the mandible mainly from road traffic accidents, as well as their occurrence among young adults.L'objectif de cette étude était, de déterminer les aspects sociodémographiques, cliniques et thérapeutiques, des patients présentant des fractures mandibulaires isolées, au Centre Hospitalier Universitaire d'Odonto Stomatologie (CHU OS) de Bamako.Nous avons réalisé une étude rétrospective sur une période de quatre mois, des cas successifs de fractures mandibulaires isolées, confirmés par un examen clinique et radiologique en 2006. Les données ont été recueillies à partir des dossiers médicaux, saisies et analysées avec le logiciel Epiinfo.fr 6.0.Les lésions ont concerné 42 hommes et 13 femmes, avec un sex ratio de 3,23. La classe d'âge la plus atteinte a été celle de 21 – 30 ans. Les accidents de la voie publique ont été la principale cause, avec 72,72% des cas. Les fractures de la mandibule au niveau de la branche horizontale, ont été les plus fréquentes (34,54%). Le traitement orthopédique a été utilisé dans 72,72% des cas, avec de bons à très bons résultats.Cette étude montre la fréquence élevée des fractures de la mandibule isolée lors des accidents de la voie publique, et aussi leur survenue chez l'adulte jeune.

The aim of our study was to determine the reasons of hospitalization of HIV-infected children in our context and to identify factors associated with mortality in the course of hospitalization.Our study took place in the department of pediatrics of the Gabriel Touré Teaching Hospital. It involved all the children hospitalized between March 1st and August 31st, 2010 to whom an infection with HIV was diagnosed before or during the hospitalization.Thirty seven HIV-infected children were hospitalized. The average age at admission was 46,9 months and the sex ratio was 0,76. HIV infection was discovered during the hospitalization for 29 children (78,4%). Fifteen children were orphan of at least a parent. The medical pathological history include sickle cell disease (2 cases) and tuberculosis (1 case). The great majority (91,9%) were at WHO stage 3 or 4. The main AIDS-defining events were severe malnutrition (73%) and pneumonia (45,9%). They were followed by bacterial infections (21,6%) and malaria (13,5%). An anemia was found at 85,7 % of the children.Efforts must be made for early diagnosis and management of pediatric's HIV infection.L'objectif de notre étude était de déterminer les raisons d'hospitalisation des enfants infectés par le VIH dans notre contexte et d'identifier les facteurs associés à la mortalité en cours d'hospitalisation.Elle s'est déroulée dans le service de pédiatrie du CHU Gabriel Touré. Elle a concerné tous les enfants hospitalisés entre le 1Trente sept enfants infectés par le VIH ont été hospitalisés. L'âge moyen à l'admission était de 46,9 mois avec un sexe ratio de 0,76. L'infection au VIH a été découverte pendant l'hospitalisation pour 29 enfants (78,4%). Quinze enfants étaient orphelins d'au moins un parent. Les antécédents pathologiques médicaux retrouvés étaient la drépanocytose (2 cas) et la tuberculose (1 cas). La grande majorité (91,9%) était à un stade 3 ou 4 de l'OMS. Les principales affections classant SIDA retrouvées ont été la dénutrition (73%) et la pneumonie (45,9%) sévères. Elles ont été suivies des infections bactériennes (21,6%) et du paludisme (13,5%). Une anémie a été retrouvée chez 85,7% des enfants.Des efforts doivent être fournis pour le diagnostic et la prise en charge précoces de l'infection à VIH pédiatrique.

In Mali society, female excision is a cultural practice. Despite the awareness campaigns, it affects nearly 85% of the female population (EDSM IV). This study was initiated to assess the knowledges, attitudes and practices of mothers about female circumcision.We conducted a prospective, cross-sectional study from June 1 to July 31, 2011, in the Department of Pediatrics of the teaching hospital of Gabriel Touré, Bamako, regarding the knowledge, attitudes and practices of mothers related to the female excision.We interviewed 224 mothers. The prevalence of female circumcision was 73%. In 72.7% of cases, the area affected by the mutilation was unknown to the mother. Nearly seventy percent (69.6%) of mothers thought that female circumcision had advantages only and should even be mandatory (74.6%). Female circumcision was associated with tradition, and it would be a religious obligation for 65%, and 21.4% of mothers, respectively. More than half of the girls were circumcised before their first year (76.3%) and 26.3% in the neonatal period. The majority of mothers were against a law banning the practice of female circumcision (54%). Ninety five percent of mothers reported that they would renew the experience of female circumcision.Female circumcision remains a well-established practice. Policies to fight against female circumcision are faced to very deep beliefs.Au Mali, l'excision est une pratique culturelle dans la société. Malgré les campagnes de sensibilisation, elle toucherait 85% de la population féminine (EDSM IV). Ce travail a été initié pour évaluer les connaissances, les attitudes et les pratiques des mères sur l'excision de leurs filles.Nous avons effectué une étude prospective transversale du 1Nous avons interrogé 224 mères. La prévalence de l'excision était de 73%. Dans 72,7% des cas, la zone concernée par la mutilation était méconnue de la mère. Les mères pensaient dans 69,6% des cas que l'excision n'avait que des avantages et qu'elle doit être obligatoire (74,6%). L'excision était associée à la tradition pour 65% des mères. Elle serait une obligation religieuse pour 21,4% des mères. Plus de la moitié des filles était excisée avant leur première année (76,3%) et 26,3% dans la période néonatale. La majorité des mères étaient contre une loi interdisant la pratique de l'excision (54%). Sur 100, 95 mères affirmaient qu'elles renouvelleraient l'expérience de l'excision.L'excision reste une pratique bien ancrée. Les politiques de lutte contre l'excision se heurtent ainsi à des croyances très profondes.

To assess knowledge and practices on iron prescription in the pediatric ward of the Gabriel Touré university hospital of Bamako, Mali.A cross-sectional study was carried out from the 1st to 31st July 2012 in the service. We presented the participants with a questionnaire and analyzed the medical files of children aged 1-60 months old who received an iron prescription. Each prescriber's consent was solicited and obtained prior to the study.Fifty prescribers were interviewed, among them 10 pediatricians (20%), 31 pediatrics' residents (62%), 2 generalist physicians (4%), 7 medical student (14%); and 100 medical records were analyzed. More than half of the prescribers were aware of the need of iron in children, with 42% knowing about iron reserves. 8% of prescribers knew that iron absorbed through food was heme iron or non-heme iron. Thirty percent of patients received iron at a dose of 8 to 10mg/kg. Length of treatment was not indicated in 92% of patients.In our context, sufficient theoretical knowledge and of children's iron need did not exclude bad prescription practices. Future studies should analyze the reasons of behind this discrepancy.Evaluer les connaissances et les pratiques relatives à la prescription du fer dans le service de pédiatrie du Centre Hospitalier Universitaire Gabriel Touré (CHU-GT) de Bamako, Mali.Il s'agissait d'une étude transversale réalisée du 1nous avons enquêté cinquante prestataires dont 10 pédiatres (20%), 31 médecins CES de pédiatrie (62 %), 2 médecins généralistes (4%), 7 étudiants en fin de cycle médical (14%) et analysé 100 dossiers. Trente pour cent des prestataires ont correctement défini le fer. Plus de la moitié des prestataires connaissaient les besoins en fer chez l'enfant. Les réserves en fer étaient connues de 42% des prestataires. Huit pour cent des prestataires savaient que les fers apportés par l'alimentation étaient le fer héminique ou le fer non héminique. Trente pourcent des malades ont reçu le fer à la dose de 8 à 10mg/kg. La durée du traitement n'a pas été précisée chez 92% des malades.Dans notre contexte la bonne connaissance théorique des indications et des règles de prescription du fer chez l'enfant n'excluait pas les mauvaises pratiques de sa prescription. D'autres travaux devraient analyser les raisons de cette discordance.

Malaria is one of the rare public health plagues which has been prevailing over centuries. It is severe around the world poverty line and remains the most widely spread disease in intertropical zones. The Afro-tropical region, which accounts for 8% of the world population, bears the heaviest malaria burden, with 80% to 90% of cases (200 to 280 millions) among which, 90% are due to P. falciparum.To study neuromalarian lesions in 0-15 year old children in the Pediatric Unit at Gabriel Touré, University Hospital.From February 2009 to January 2010 the study covered 92 children, aged 0-15 years old, with neuromalarian lesions hospitalized at the Pediatric unit of the Gabriel Toure University Hospital.2230 patients were received suffering from malaria, among whom 1320 hospitalized for neuromalarian. 92 cases (6.97%) of neuromalarian lesion were identified. There were 57 boys and 35 girls, with 1.63 sex ratio. 0 to 5 years old age group was the most significant, accounting for 67.39% of subjects. Axial hypotony was the most frequent lesion encountered (65.22%). Temporary blindness was reported in six patients (6.52%). Behavior disorders were reported in seven patients (7.61%). Five patients (5.43%) were victim of hemiplegia. Axial hypotonicity was associated with aphasia in thirty-seven patients (40.22%) and peripheral hypertonia in eighteen patients (19.57%). Seven patients (7.61%) became epileptic and six (6.52%) were suffering from dystonia. Recovery effects were 50% in the short term and 73.9% in the medium term.Despite progress made in terms of diagnosis and care, malaria still remain a fearsome pathology and source of neuromalarian lesions among which some lead to permanent disability. Early intervention and proper treatment could reduce the incidence of neuromalarian lesions.le paludisme est l'un des rares fléaux de santé publique qui ait traversé les siècles sans perdre de son activité. Il sévit dans la ceinture de pauvreté du monde et représente la maladie parasitaire la plus répandue dans le monde intertropical. La région afro-tropicale, qui ne compte que 8% de la population supporte le plus lourd fardeau du paludisme avec 80–90% des cas (200 à 280 millions) dont 90% dus à plasmodium falciparum.L'objectif de cette étude était d'étudier les séquelles du neuropaludisme dans le service de pédiatrie.De Février 2009 à Janvier 2010, nous avons réalisé une étude portant sur les séquelles du neuropaludisme dans le service de pédiatrie du CHU Gabriel Touré. L'étude concernait les enfants de 0–15 ans, hospitalisés et ayant gardés des séquelles neurologiques après un neuropaludisme.2230 patients ont été admis pour paludisme dont 1320 hospitalisés pour neuropaludisme. Nous avons recensé 92 cas (6,97%) de séquelles neurologiques .Il y avait 57 garçon contre 35 filles soit un sexe ratio de 1,63. La tranche d'âge de 0 à 5 ans était la plus représentée, soit 67,39%.L'hypotonie axiale était la séquelle la plus fréquemment rencontrée (65,22%).Elle était associée à l'aphasie chez trente sept patients (40,22%) et à l'hypertonie périphérique chez dix huit patients (19,57%). Sept patients (7,61%) sont devenus épileptiques et six (6,52%) ont présenté une dystonie. La récupération des séquelles a été de 50% à court terme et de 73,9% à moyen terme.le paludisme, malgré les progrès réalisés dans sont diagnostic et sa prise en charge demeure toujours une affection redoutable et pourvoyeuse de séquelles neurologiques dont certaines sont responsables de handicap permanent.

Introduction : Les infections respiratoires aiguës (IRA) constituent l'une des principales causes de morbidité et de mortalité infantile au Mali. L'objectif de ce travail était de décrire les aspects épidémiologiques, cliniques et thérapeutiques de la bronchiolite aiguë du nourrisson au service de pédiatrie du CHU Gabriel Touré. Méthodologie: Il s'agit d'une étude rétrospective portant sur 112 nourrissons âgés de 1 à 24 mois hospitalisés dans le service de pédiatrie générale pour bronchiolite aiguë. L'étude s'étalait sur une période d'un an (du 1er janvier au 31 décembre 2012). Résultats: Les nourrissons âgés de 1 à 6 mois étaient majoritaires (69%). L'âge moyen des patients était de 6 mois avec des extrêmes de 1 et 24 mois. Le sexe masculin était prédominant (63%) avec un sex-ratio de 1,73. Le principal motif de consultation était la difficulté respiratoire (87%). Le pic d'hospitalisation était au mois de novembre (33%). Les principaux signes cliniques en plus des sibilants étaient la toux, la rhinorrhée et la détresse respiratoire (97%). La fièvre était présente dans 38% des cas et la cyanose chez 4% des patients. La saturation en oxygène était inférieure à 94% chez 50% des patients. La kinésithérapie respiratoire a été faite chez un tiers des malades. Tous les malades avaient reçu une corticothérapie et une nébulisation avec du salbutamol et sérum physiologique. Une antibiothérapie a été faite chez 85% des patients. La durée moyenne d'hospitalisation était de 6 jours avec des extrêmes de 1 et 30 jours. Le taux de guérison était de 98 %. Conclusion : La bronchiolite est une pathologie bénigne et fréquente chez le nourrisson de 1 à 6 mois qui évolue favorablement dans la majorité des cas.

Les infections sont responsables d'une part importante de la morbidite et de la mortalite chez l'enfant drepanocytaire. Notre objectif etait d’etudier le profil clinique et bacteriologique des infections bacteriennes de l’enfant drepanocytaire dans le service de pediatrie du CHU Gabriel Toure. Materiel et methodes: Nous avons realise une etude retrospective sur 25 dossiers d’hospitalisation d’enfants drepanocytaires febriles ayant beneficie d’une hemoculture sur une periode de 5 ans (2005-2010). Nous avons analyse les caracteristiques cliniques et bacteriologiques des enfants ayant une hemoculture positive. Resultats: Dix des 25 hemocultures realisees etaient positives. La tranche d’âge de 0-5 ans etait la plus touchee (60%). Le suivi etait irregulier pour 7 enfants et 6/10 n'avaient pas recu le vaccin anti pneumococcique. Sur le plan clinique, 5 cas de sepsis, une infection pulmonaire et 4 cas infections osteo articulaires ont ete diagnostiquees. La goutte epaisse etait positive pour 4 patients . Les germes retrouves ont ete : Salmonella enterica serotype Typhi (4 fois), Streptococcus pneumoniae (4 fois), Staphylococcus aureus (1fois), Enterobacter cloacae (1fois) ont ete isoles. Salmonella enterica serotypeTyphia ete isole dans 3 cas d'infections osteo-articulaires et un cas de sepsis, Streptococcus pneumoniae etait en cause dans l'infection pulmonaire et dans un cas de sepsis. L'antibiotherapie probabiliste dans la majorite des cas etait basee sur les cephalosporines de troisieme generation. L’evolution a ete favorable dans 80% des cas. Conclusion : Les complications infectieuses de la drepanocytose peuvent etre graves. La disponibilite de l'hemoculture doit nous permettre de caracteriser le profil bacteriologique dans notre contexte.

Malaria remains a major health problem in sub- Saharan African countries despite substantial decreases in morbidity and mortality due to sustained control programs. Vaccines candidates were mainly tested in rural endemic setting; however increasing proportion of the population is living in urban area. Evaluation of the qualitative or quantitative immune responses to key targets of anti-Plasmodium immunity requires further investigation in urban area. In a cohort of 144 patients with mild malaria living in Dakar, we analyzed IgG responses against target antigens of P. falciparum: CSP, LSA-3NR2 and GLURP by ELISA. A mean age of 15 yrs (4-65 yrs) was found and patients were separated in 59 adults (15yrs) and 85 children (≤15 yrs). Parasites densities (0,01-15%) did not differ between the two age groups. In contrast, haemoglobin levels appeared lower in children (4.5-16.6 g/dl) (p0.01). For the immune results, the most recognized antigens were GLURP and CSP compared to LSA-3NR2. Levels of IgG against these antigens were significantly different between the two age groups and they were positively correlated (rho = 0.32; p0.001). In addition, levels of IgG anti-GLURP were associated with low parasitemia (≤1%) and absence of anemia (≥11g/dl), particularly in adults (p0.001). In a multiple regression analysis, no significant relationship was found between parasite densities and IgG responses against all the tested antigens. Our study shows the implication of IgG anti-GLURP in humoral immune response against the parasite. The present work contributes to determine IgG levels that can be used as relevant immunologic biomarkers in urban clinical malaria.

Malaria remains a major problem in African countries despite substantial decreases in morbidity and mortality due to sustained control programs. Studies for the evaluation of qualitative or quantitative Ab responses to key targets of anti-plasmodium immunity were mostly done in rural endemic setting compared to urban area. In a cohort of 200 patients with mild malaria and living in Dakar, we analyze total and subclasses IgG responses to a panel of P. falciparum blood stage antigens: MSP1p19, MSP3, EB200, GST-5 and R23. A mean age of 15 yrs (4 to 56 yrs) and parasitemia between 0.1 to 17% were found. Levels of IgG anti-MSP3 were higher in patients with low parasitemia (≤1%) and appear negatively correlated to parasite densities (Rho =. 0.54; p= 0.021). This correlation is more significant in children (≤ 15 yrs). In addition, an increase of IgG responses against MSP1p19 is highly observed in adults having a parasitemia less than 1%. In those patients, we find that IgG1 subclasses were predominant (p0.01). Our study shows an association between Ab responses and parasitemia. This association is dependant to IgG anti-MSP3 in children and IgG anti-MSP1p19 in adults living in urban area.

Si la sous-presence des femmes est un phenomene qui touche tous les domaines de la sphere politique francaise, c’est au Senat qu’elle est la plus flagrante. Certes, la part des femmes elues deputees est proche de celle des femmes elues senatrices puisqu’en 1958, elles representaient 1,6 % des elus a l’Assemblee nationale et 1,9 % au Senat. Trente ans plus tard, 5,9 % des elus a l’Hemicycle en 1993 sont des femmes, contre 5 % aux elections senatoriales de 1992. Pourtant, il existe une differen...

Endemic deep fungal infections are still under recognised diseases in daily medical practice because of their rarity in sub-Saharan area. The African histoplasmosis Histoplasma capsulatum var. duboisii (H. capsulatum duboisii) is the most frequent variety described in Mali through limited studies in adult patients, since the first case described by Catanei and Kervran (1945). Our case report is a disseminated histoplasmosis in a young 6-year-old african child. He was male and rural. The infectious localisations were mucosae, skin, lymphnodes, urinary tract and bones. Evolution has been marred by an episode of worsening of symptoms despite initial clinical improvement with ketoconazole. After healing of mucocutaneous lesions, we noticed a limitation of ampliation of both wrists. The radiographic bone lesions were lysis of the right lower end of the right radius and cubitus and fragmentation of cubital epiphysis of the same arm. Lacunes were present on the fifth right finger in metatarsus and phalanx; lacune and blowing aspect of the second phalanx of the left third finger was noted. The disseminated form of African histoplasmosis may occur in HIV-negative subject. The prognosis depends on early diagnosis and administration of appropriate and well-conducted therapy.

The prematurity remains in our developing countries a problem of current events. The deficiency in human resources and the low level of the technical equipment exposes premature babies to a high risk of morbidity and mortality in neonatal period. Those who survive need a closer follow-up after their discharge from hospital. Our objective through this study was to appreciate the quality of following-up premature babies in ambulatory. It was a longitudinal study with descriptive aim which took place from January, 2007 till December, 2008 in the paediatric service of the Teaching Hospital of Cocody. Our population was constituted by 100 premature babies selected in a random way. The premature babies had on average 31,7 weeks of gestationel age. The sex ratio was 0,96. The born weight was between 900 and 2550g. The main causes of prematurity were multiple pregnancies (18 %), malaria (15 %), premature break of membranes (12 %) and éclampsia (10 %). Most of premature babies were hospitalized for a problem of breeding ( 47 %.). The average number of consultation was 6,25. Only 25 children were effectively followed during 12 months with a middleweight of 9112g. The follow-up had been interrupted before 3 months of native age in 31 % of cases and before 3 months of real age in 52 % of cases. The mothers had preferred the feeding in 48 % of cases, but the curves of weight development were superposables whatever the type of food supply. The pathology during the follow-up was dominated by digestive disorders, respiratory infections and anaemia. Forty percent of the premature babies was able to have an haemoglobin test and 8 %, a neuroradiological scraeming. A third of the premature babies (30 %) had been hospitalized again for anaemia (10 %) and respiratory infections (10 %). We recorded 3 deaths. CONCLUSION: The follow-up of premature babies getting out of hospital remains difficult in our context of life. The mothers must be sensitived on the consequences of prematurity and the importance of their follow-up. This follow-up has to be the affair of all, as well parents, health workers that government.

Pregnant women HIV infection has main risk the contamination of newborn. MTCT actions permit to reduce that risk.Our survey has been realized in Gabriel Touré teaching hospital gynecology and obstetrics and pediatric departments. It is about an observational prospective and descriptive survey that spreads on a period from January 2005 to December 2008. Has been included in the study all the HIV positive pregnant women followed in our service and their babies that had received ARV prophylaxis and 18 months of life serology.We recorded 211 HIV positive pregnant women on a total of 9291 childbirths (2.27%). We noted 90.52% of HIV-1 vs 7.11% of type 2. The mother treatment consisted in a tri therapy in 77.25 vs 0.47% of bi anti retroviral and 22.28% of mono anti retro viral therapy. Maternal viral load was undetectable at the moment of delivery in 78.20% of cases. We noted vaginal delivery in 84.36% vs 15.64% of caesarean section. Newborns respectively received 67.32%; 4.88% and 22.92% of bi, tri and mono therapy. They formula-fed in 98.98%. The mother to child HIV transmission rate was 1.98%.HIV prevalence in pregnant patients is relatively height. HARRT in HIV positive mothers associated to bi therapy and formula feeding to their infants permit to obtain low vertical HIV transmission rate.

Neonatal morbidity and mortality is a real concern in our context. Several factors including the organization of the reference contribute to it. Our work was aimed at studying the conditions of newborns transfer of the towards the service of pediatrics of teaching hospital Gabriel Touré.Our study proceeded from October 15th, 2006 to January 15th, 2007 in the unit of neonatology of the service of Pediatrics of the CHU of the Hospital Gabriel Touré. It was a cross sectional and descriptive study. All the newborns referred by a health structure were included.We included 760 referred newborns out of 1072 neonatal admissions which means a frequency of reference of 71%. In 91.6% of the cases, the newborn were referred on the very day of their birth. Prematurity (29%), perinatal anoxia (24%), respiratory distress (13.9%) were the main reasons for reference. In no case, the service of pediatrics was contacted in advance by the referring health agent. More than half of the cases (58.6%), the public transport was used. Ambulance car transported 17.4% of the newborns. All the newborns came held in the arms of a member of their family. The referring agent was a physician in 70.3% of cases. Hypothermia was found for all the newborns (759/760) when being received. More half of the newborns (56.4%) had a small weight at birth and the quarter (25.8%) was resuscited. Lethality was 32%. Mother illiteracy, small weight at birth, the outborn birth were factors related to neonatal mortality.In our context, the reduction of neonatal morbidity and mortality has to go through an improvement of the reference system.

Evaluate the efficiency of the treatment of pain by analgesic according to World Health Organization (WHO).We made a descriptive and analytic study in majors sickellers in pain crisis admitted in the service of paediatric of the hospital Gabriel Touré Bamako from January 2005 to January 2006. The efficiency of the treatment by painkiller was evaluated at second hour and at the 24 hour.Our study concerned 70 children with major of sickle cell of both sexes and aged from 6 to 15 years in pain crisis. In 87.1% pain disappeared with painkillers palier I (paracetamol) and 12.9% had necessitated to pass to palier II (buprenorphine) an 64.3% our patients the pain disappeared in a period less than 12 hours with an average of 3 hours against only 35.7% soothed in a period more than 12 hours with average of 64 hours 3 minutes. Pain from the head and limbal region were the most sensible to the treatment.The treatment of pain by palier according to who is efficient in children sickeller.

The accidental intoxications constitute more and more a serious problem among young children in the developing countries because of their frequency and difficulties for taking care of those victims. The objective of our work was to study acute intoxications among children in order to determine the frequency, to identify the products in question and to determine the impact of those accidents in the future life of the victims. The study was carried out in the Paediatric Service of the CHU Gabriel Touré from January 2001 to June 2002. We enrolled 89 children from 0 to 15 years of age. Information on our patients was recorded on investigational questionnaire and completed with data from their entry and hospitalization records. Among 8237 children hospitalized during the study period, 89 of them had acute intoxication i.e. 1.08%. Children less than five years of age were more frequent with 85.4% with a male prevalence of 61.8%. Antimalarial drugs and petroleum were the most accused products. Administration of milk and provoked vomiting were the attitudes and practices of the entourage of the victims when intoxication occurs. The evolution was favourable in 67.2% of the cases with a hospital lethality of 13.7%.

Anemia is a common and life threatening pathology among new born babies from premature. It has the potential to delay the child's growth if appropriate care if not taken. In order to improve care to new born babies with anemia, we carried out a retrospective study on a group of 195 records obtained from the neonatology ward and from 46 outpatients in the CHU of Cocody between January 2001 and December 2003. At the end of the study, we made the following reports: Incidence of early anemia is 17.5% and several risk factors are involved such as absence of anemia and malaria prophylaxis during pregnancy. Anemia whether it is secondary or early is often masked. Palor is observed in small proportions among anemic prematures at birth. Thus, cell blood chemistry is important to confirm the diagnosis. Early anemia is generally normochrome normocytaire and secondary one is hypochronic. Care about anemia cases must rely on clinical data as well as bioiogical and epidemiological data. Early iron supplementation (2 to 3 iron element mg/kg/day) could prevent late and secondary anemia in non-anemic prematures at birth.

Most newborn deaths are associated with birth asphyxia (40%), low birth weigt and prematurity (25%) and infections (20%). In Mali, in the Community Health Centers (CSCOM) exercises a staff composed of the nurse chief of health centers (ICPM) assuring the supervision of the matrons that is charged in pregnancy and the newborn. An investigation KAP (Knowledge, Attitudes and Practises) initiated in order to assess the knowledge and the practices of the community health centers agents on birth asphyxia. The survey was cross-sectional and that took place in September 2004. Have been included in the study the matrons, the nurse chief available at the time of the survey. The multiplicity of the names mentioned among which Ninakili dégou (27,3%) and Niominè (15,2%) are the most frequent and show the necessity of a qualitative investigation to find a name. Prolonged labor more than 12 hours (73,3%) and the stained amniotic liquid (63,3%) are the most recognized signs during labor making fear the birth asphyxia. In our survey the prolonged labor (63,7%), the infection/malaria of mother (60,7%) and the Dystocic delivery (45,5%) were the mostly reported causes of birth asphyxia. The pale or bluish coloration (69,7%), the irregular or lack of breath (69,7%), the lack of cry (63,6%) were known as the main signs of birth asphyxia. We noted some good practices as aspirating with a bulb (69,7%) and clearing upper ways with a finger covered with gauze (30,3% ); doing the mouth to mouth (51,5%); stimulating the newborn (66,7%). The improvement of the neontatal mortality requires the training of the staff and the equipment of the centers in small simple materials of resuscitation.

Our work aimed to propose a manual method of counting CD4 T lymphocytes which is an alternative magnetic immunoseparation followed by a reading with a fluorescence microscope as an alternative to the automated flow cytometry. This alternative technique is easier for use, less expensive and could answer the difficulties encountered for the monitoring CD4 T cells count in developing countries. The specific objectives were: 1) to train the technicians of the peripheral sites in order to make the numeration of the CD4 T lymphocytes more accessible at the peripheral level; 2) to equip the sites with necessary facilities for the T lymphocytes CD4 count; 3) to put in place a system of quality control permitting the reliability of the results. A hundred and fifty patients have been enrolled in three care services for people living with HIV/AIDS in Dakar. This population was constituted of 119 seropositive and 31 seronegative patients acting as control group to have some patients with high rates of T lymphocytes CD4. For the follow-up at peripheral level, the patients were constituted of the active line of the patients living with HIV/AIDS supported in the targeted sites. The measurements allowed studying concordances for different rates of lymphocytes: 0 to 199, 200 to 499 and over 500 cells by mm3. The results showed also a very good correlation (r = 0.97 or r = 0.98 according to the operator) between the two methods for CD4 rates inferior to 500 cells by mm3 among both the negative group and the HIV positive patients. We also discussed the profit of decentralization for the program and the patient, as well as the setting up of an external quality control to validate the alternative technique. According to the results, the Dynabeads is well correlated with the Facscount. It is a technique that can be used as an alternative in the zones with limited resources, low prevalence and for a small number of samples.

With the interruption of larva treatments done by OCP as part of onchocerciasis control in West Africa, Simulium came back in abundance in forest regions and savannah fertile valleys. In addition to the severe discomfort, nuisance by Simulium is in certain cases incompatible with land use. Since ground treatment of larval breading sites using insecticides is not always possible or efficient, it is therefore a necessity to develop other methods among which individual protection against Simulium bites. The general objective of our study was to evaluate different vegetable oil compound repellent formulas against Simulium bites. Activities were carried out in savannah zone (Niakaramandougou) and in forest zone (Soubré) in Côte d'Ivoire. The methodology consisted in catching blackflies on volunteers whose legs were rubbed with a repellent. Gobi raw oil and coconut, palm nut and gobi formulas (lotions and creams) were tested. During each session, which lasted from 07:00 am to 12:00 and from 03:00 pm to 06:00 pm, one person did not apply any repellent and was used as the control person. The results of our experimentations show that for a given zone (savannah, forest), a repellent (coconut, palm nut, gobi) and a compound (shea butter, vaseline), there is no significant difference between protection rates obtained with lotions (maximum: 21 bites/person/day) and those obtained with creams (maximum: 30 bites/person/day). In other respects, the lotion of a given repellent seems to be efficient in savannah as in the forest, in protecting against Simulium bites. It is the same situation with creams. So, repellents can be an efficient solution against Simulium nuisance. However, experimentations should continue to confirm the high repellency of tested formulas, proceed to the identification of principles and evaluate the toxicity and irritant effect of repellents to be applied on the skin.

Thanks to larviciding and distribution of ivermectine, transmission of onchocerciasis was virtually halted in all countries covered by the WHO Onchocerciasis Control Program (OCP). However as a result of this success vector control has been stopped in most areas covered by the program and a recrudescence of files is an increasing problem. In some rural communities fly biting hinders normal agricultural activity. Since local farmers cannot afford ground larviciding, many rely on topical repellents. For this reason, development of an inexpensive method of individual protection is a major priority. The purpose of this study carried out in the savannah area of the Côte d'Ivoire was to assess the repellent properties of cocoa oil, which is frequently used in some rural areas of the Côte d'Ivoire to prevent fly biting. Results showed that cocoa oil provides excellent protection against Simulium damnosum s.l.

In Ivory Coast, treatments against black flies larva are interrupted since December 1998 and these flies are back everywhere in abundance. They are now a severe source of discomfort, so it is therefore very important to propose to rural populations a personal protection method against their bites. This article is about the individual attraction of fly boys on the efficiency of lotions and creams of the different repellents (coconut, palm nut, gobi). Our works were carried out in savanna zone (Niakaramandougou) and in forest zone (Soubré) in Ivory Coast. The methodology consisted in capturing black flies on volunteers whose legs were rubbed with repellent. Coconut, palm nut and gobi formulas (lotions and creams) were tested on Simulium damnosum s.l. During each session, which lasted from 07:00 am to 12:00 and from 03:00 pm to 06:00 pm, one person without repellent was used as a control person. The results show that the least efficient repellent (gobi) ensures nonetheless a reduction of 90% of the number of bites that an individual would have received if he was not protected by the repellent. Experimentations allows to say that for a given repellent and formulas (lotion and cream), there is no significant difference between the number of Simulium damnosum s. l. bites received by fly boys.

Early delivery is not rare, it is an important cause of perinatal mortality. In this study its rate, was 4.95%. The early and late ages of procreation were particularly interested (7.95%) and 3.90%. The first and last parities were more exposed (7.75%-5.31%). The woman occupation was as an important risk-factor. The incidences increased in the poor and rich women groups (7.34%-3.84%) the early labor risk was reduced when the women had efficient prenatal care; when the women had delivered early, the early labor risk increased. So when the women had delivered a stillborn. The early labor risk factor was more important. Finally the authors founded 83.33% of maternal causes could be controlled by efficient prenatal care. Even this rate was so important in the foetal group causes.An important cause of perinatal mortality, premature delivery involves the expulsion of the fetus during weeks 28-37 of gestation. Such deliveries are seen rather often, but its frequency varies by country and in the same country from one time period to the next. Results are presented from a study on the frequency and epidemiology of premature deliveries at Ignace Deen Hospital in Conakry between May 1994 and June 1995. This prospective study was conducted using hospital documents. Of 2057 births, 102 were premature, for a frequency of 4.95%. Adolescents, women aged 35 years and older, primiparous women, and grand multiparas ran the greatest risks of bearing a premature child. The risk of premature delivery was 3.8 times greater in the group of housewives than in the group of salaried women, and 2.45 times more than among students. The highest incidences of premature delivery were among poor and wealthy women, at the respective levels of 7.54% and 3.84%. The absence of prenatal care was an important risk factor, with the risk of premature delivery decreasing as the degree of prenatal follow-up increased. Having already had a premature birth and a stillbirth multiplied by 7.86 and 12.58, respectively, the risk of premature delivery. 83.33% of maternal factors involved in premature delivery could have been controlled using effective prenatal care.

The introduction of a program for the treatment of plantar ulcers (PU) in field conditions in Senegal was studied. The program was complementary to the Health Education and Protective Footwear to Prevent Disability (POD) initiatives within the Senegalese anti-leprosy program. The wound care given in health centers was coded and simplified. Access to hospitals was made easier for those patients requiring surgery. More than 30% of patients with PU were treated each year, with a mean of 62% cured. An increasing number of leprosy patients have been admitted to regional hospitals for surgery. Never before have patients with signs of leprosy had access to general hospitals. This study emphasizes the need for regular supervision of the individuals treating wounds.

MDT for leprosy recommended by WHO in 1981 has been introduced and implemented in 8 Member States of OCCGE (an organization for leprosy control in francophone West Africa). This implementation from 1983 to 1993 can be divided in two phases: 1983-1987: introduction phase by pilot projects; 1988-1993: extension phase by national leprosy control programmes. During the ten years, MDT coverage rose to 68%, leprosy prevalence rate widely decreased (40.71 to 6.56 per 10,000), while annual detection rate weakly varied (1.89 to 1.26 per 10,000). Factors influencing this evolution of leprosy are brought out and recommendations are made about strategies to be developed for leprosy control up to year 2000.

In order to examine the factors determining irregularity among patients undergoing multidrug therapy in Bamako district, we conducted a non-experimental study based, in the first instance, on medical records and later on a questionnaire. One thousand one hundred and seventy-five (1,175) treatment cards were reviewed in this way. The results of our study show that 3.1% of the patients fail to attend treatment sessions regularly and that multibacillary patients have more irregular attendance than paucibacillary patients. We have not observed any statistically meaningful difference between old and new patients as far as irregularity in attending multidrug therapy sessions is concerned. The second part of our research based on a questionnaire targeting a group of cases (36 patients who did not attend regularly) and a random control group (50 patients who attended treatment regularly but had missed at least one treatment) has shown that it is only for Item VI ("Have you ever missed your appointment because you perhaps considered yourself cured?") that a statistically meaningful difference emerges between cases and controls regarding the rates of affirmative responses (p0.05).