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The authors report a case of a sudden antenatal death, by severe strangulation, unlikely related in a term pregnancy; multiple loops of nuchal umbilical cord (UC) (ten), rarely describe in literature, were observed around the fetal neck. The in utero fetal death (IFD) was suspected by the non-attendance of fetal movements and confirmed by US scan. The tight nuchal cord around the neck (tCAN) diagnostic was made during caesarean delivery, as it was not discovered in pregnancy US scan monitoring nor in the US scan made in emergency. The newborn examination shows severe fetal strangulation by the presence of many spires of a too long UC (1.50 m). Autopsy was not been accepted by the family. Through this reported case the authors wanted to show the difficulties of its diagnosis in less developed Sub-Saharan country were US scan practice is not usual.

Newcastle disease (ND) and infectious bronchitis (IB) are two major viral diseases affecting the respiratory tracts of birds and whose impact on African poultry is still poorly known. In the present study we aimed at assessing NDV and IBV prevalences in Ivory-Coast by molecular screening of > 22,000 avian swabs by nested PCR and by serology testing of close to 2000 avian sera from 2010 through 2012. The NDV and IBV seroprevalences over the study period reached 22% and 72%, respectively. We found 14.7% pooled swabs positive by PCR for NDV and 14.6% for IBV. Both pathogens are therefore endemic in Ivory-Coast. Economic losses associated with NDV and IBV infections still need to be evaluated., Highlights • Surveillance of avian influenza virus is found negative in backyard poultry farm. • Study of Newcastle disease and infectious bronchitis as differential diagnosis diseases • Newcastle disease virus seroprevalence is much lower than infectious bronchitis virus. • First study of infectious bronchitis revealed high prevalence in backyard poultry. • Both pathogens are endemic, cause economic losses and need to be fully evaluated.

Resume Contexte La recommandation de l’OMS et l’UNICEF d’utiliser le solute de rehydratation orale (SRO) et les mesures dietetiques pour traiter la diarrhee aigue ne semble pas etre appliquee par de nombreux personnels de sante en Afrique sub-saharienne d’ou une morbi-mortalite infanto-juveniles elevees. Objectif Decrire les habitudes de prescription du personnel de sante lors de la diarrhee aigue de l’enfant a Abidjan. Patients et methodes Etude transversale realisee dans 52 structures sanitaires publiques non specialisees d’Abidjan du 1 er juin au 31 juillet 2012. Elle a porte sur les habitudes de prescription de 151 personnels de sante consentants prenant en charge des enfants. Resultats Ce sont 100 medecins (pediatre 18, DES en pediatrie 28, generalistes 54) et 51 soignants qui ont ete interviewes. L’âge moyen etait de 39 ans (25–59 ans) ; la moyenne d’annee d’exercice de 8,4 annees (1–35 ans). Les enquetes affirmaient prescrire de facon systematique le SRO (53 %) et les mesures dietetiques (28,5 %). Ils affirmaient conseiller la poursuite du lait maternel 97,4 %, le lait de regime 43 % et le regime alimentaire anti-diarrheique 24,5 %. Les medecins prescrivaient plus le SRO et le regime alimentaire anti-diarrheique par rapport au personnel soignant (32,8 vs 16,9 %, p p Conclusion Les habitudes de prescription du personnel de sante s’eloignent des recommandations de l’OMS et de l’UNICEF. La sensibilisation du personnel sur les directives de prise en charge de la diarrhee aigue s’avere necessaire pour l’amelioration du pronostic de cette affection.

SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons.OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries.DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs.RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages.CONCLUSIONS: Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

Introduction : Exclusive breastfeeding (EBF) has the benefits of reduced rates of infectious morbidity and mortality. However, the EBF rate remains low worldwide including in Cote d'Ivoire despite efforts by health authorities. Objective : The study was carried out to describe the knowledge and practices of mothers concerning infant feeding especially with regards to breastfeeding from birth to six months and to identify factors influencing these practices. Methods : This was a descriptive and cross-sectional study conducted over a one-month period (1st to 31st August 2014)at a hospital in Abobo-Avocatier. Results : A total of 318 mothers and their infants were recruited. The median (range) age of the mothers was 27 (14-40)years. Over half (64.5%) had some form of formal education, 78.9% lived with a partner while 24.5% were unemployed. The HIV status was unknown in 29.6% of cases. The majority of infants (94%), were born at term through vaginal route (91.5%) and the median (range) age was 74 (2-180) days with a M:F ratio of 1.18. More than half of mothers received advice on breastfeeding (57.2%) mainly by a health care provider (83%). The overall breastfeeding, EBF, predominant breastfeeding and mixed feeding rates were 79.9%, 43.3%, 46.84% and 18.9% respectively. Initiation rate of breastfeeding within the first hour was 29%.The maternal age (p=0.007) and low birth weight of the infant (p=0.023) were significantly associated with EBF. Other factors associated with EBF include the mother’s occupation and being married. Conclusion : Despite the high overall rate of breastfeeding in the study, EBF rates and timely initiation of breastfeeding after birth need to be improved. Awareness campaigns need to be strengthened and interventions instituted to scale up optimal breastfeeding practices. Keywords : Infants, breastfeeding, determinants, birth, Cote d’Ivoire, six months.

Introduction: The aim of our study was to describe the morbidity and mortality patterns in HIV-positive pediatric patients followed at the unit in charge of Pediatric HIV, in the pediatrics department of Cocody University Teaching Hospital (CHU-Cocody). Method: This hospital-based retrospective study focused on 218 pediatric patients enrolled at the CHU-Cocody from November 28th 2005 until June 30th 2010. Outcomes of children with anti-retroviral therapy (group A) and children without (Group B) anti-retroviral therapy were described and compared. Antiretroviral Therapy (ART) - eligibility followed national guidelines thus withholding treatment for immune-competent children or those with contraindications to ARTs such as increased transaminases (>10x) or vital distress. Results: The average age of children in group A, was 66.11 months, they were symptomatic in 84.74% of cases, and presented with severe immunodeficiency in 54.74%. The children in group B were younger (mean age=49.14 months), mostly only mildly symptomatic (39.80%) and thus usually without severe immunodeficiency (64.29%). Nearly all children were infected with HIV-1 and receiving cotrimoxazole prophylaxis. There were 764 disease events that occurred during follow-up including 633 in group A and 131 in group B. Anemia (p=0.036) and pneumonia (p=0.011) were more frequent in group A. Hospitalizations were more common in group A children (124/190) than group B children (10/28, p=0.0027). In Group B, the mortality rate was very high (75%) (OR=16, 95% CI [5.79-45.90.], P