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Resume But Evaluer la baisse de la PIO et la symptomatologie oculaire chez les patients nouvellement diagnostiques de GPAO et traites en monotherapie par le Latanoprost. Patients et methodes Il s’est agi d’une etude multicentrique, transversale et descriptive. Nous avons inclus les adultes nouvellement diagnostiques de GPAO. Tous les patients ont recu une goutte de Latanoprost 0,005 % conserve dans chaque œil tous les soirs pendant 12 semaines. La variation de la PIO et l’apparition des signes et symptomes oculaires etaient evalues pendant et a la fin du traitement. Resultats Au total, nous avons inclus 524 patients avec un taux de participation a 93,3 % a 12 semaines. La moyenne d’âge etait de 52,79 ± 17,33 ans et le sexe-ratio H/F etait de 1,39. La PIO moyenne a l’inclusion etait de 21,68 ± 9,72 mmHg. Apres 2 semaines de traitement, la PIO moyenne etait de 15,49 ± 5,81 mmHg, soit une reduction de 28,55 %. Apres 12 semaines de traitement, la PIO moyenne etait de 13,16 ± 3,54 mmHg, soit une reduction de 39,30 %. Les symptomes enregistres etaient domines par la sensation de grains de sable dont la frequence etait de 4,72 % a S2 et 2,45 % a S12. Les signes etaient majoritairement representes par l’hyperhemie conjonctivale (4,33 % a S2 et 1,84 % a S12). Conclusion Le Latanoprost donne en premiere intention et en monotherapie dans le GPAO chez le melanoderme baisse considerablement la PIO. L’incidence des effets indesirables reste faible ; elle est plus importante en debut de traitement.

Quality of life is defined by the physical, emotional and social well-being of an individual. Primary Open Angle Glaucoma (POAG) is a blinding optic neuropathy, it can change the quality of life by its chronic and irreversible nature. The objective of this study was to evaluate the quality of life in patients with POAG in urban areas.this was a quantitative cross-sectional study with a descriptive aim over 3 months. Patients followed for POAG at CHU-IOTA with an age ≥ 18 years were included and submitted to the GlauQOL-17 questionnaire for data collection.We collected 100 glaucomatous patients, the mean age of patients was 52 years with a standard deviation of 14.02. The extreme ages are 18 and 81 years old. There was a male predominance; (54%) with a sex ratio (M / F) of 1.7. The good visual acuities were majority (higher or equal to 3/10). Among our patients, 35% were at the stage of glaucoma starting at OD and 30% at the stage of moderate glaucoma at OG. Our patients had a poor quality of life score (score50%) in the Anxiety and Driving dimensions. In patients younger than 70 years old, we had a poor anxiety score in all progressive stages of the disease. Scores of self-image dimensions, constraints, and management were greater than 60% in patients over 70 years of age.Alteration of some of the domains studied was proportional to evolution of POAG. This degradation can have physical, psychological and social impacts on his patients.La qualité de vie se définit par le bien-être physique, émotionnel et social d'un individu. Le Glaucome Primitif à Angle Ouvert (GPAO) est une neuropathie optique cécitante, il peut modifier la qualité de vie de par son caractère chronique et irréversible. L'objectif de cette étude était d'évaluer la qualité de vie chez les patients atteints de GPAO en milieu urbain.il s'agissait d'une étude quantitative transversale à visée descriptive sur 3 mois. Les patients suivis pour GPAO au CHU-IOTA avec un âge ≥ 18 ans ont été inclus et soumis au questionnaire GlauQOL-17 pour la collecte des données.Nous avons colligé 100 patients glaucomateux, la moyenne d'âge des patients était de 52 ans avec un écart type de 14,02. Les extrêmes d'âges sont de 18 et 81 ans. Il y avait une prédominance masculine ; (54%) avec un sex-ratio (M/F) de 1.7. Les acuités visuelles bonnes étaient majoritaires (supérieures ou égales à 3/10).Parmi nos patients 35% étaient au stade de glaucome débutant à OD et 30% au stade de glaucome modéré à OG. Nos patients avaient un mauvais score qualité de vie (scoreà 50%) dans les dimensions Anxiété et conduite. Chez les patients de moins de 70 ans nous avons noté un mauvais score d'anxiété dans tous les stades évolutifs de la maladie. Les scores des dimensions image de soi, contraintes, et prise en charge étaient supérieurs à 60% chez les patients de plus de 70 ans.L'altération de certains domaines étudiés était proportionnelle à l'évolution du GPAO. Cette dégradation peut avoir des impacts physiques, psychologiques et sociaux sur ses patients.

In Mali, malaria is a major public health problem. The region of Sikasso is classified according to the geo-climatic facies as a zone with a long seasonal transmission of malaria greater than 6 months.To describe the epidemiological, clinical and therapeutic characteristics of children aged 0- 5 years hospitalized for severe malaria in the pediatric ward of the Sikasso hospital. Variables analyzed were epidemiological, clinical, paraclinical, therapeutic and evolutionary.This is a retrospective, 12-month (January-December 2014) cross-sectional study of all 0-5-year-olds hospitalized for severe malaria at the Sikasso Regional Hospital.The hospital frequency of severe malaria was 55.82%. The age group of 12-35 months was the most concerned (45.3%). The peak frequency was in August (21.2%). Anemic, mixed (anemia and neurological) and neurological forms were the most frequent. Artemether and quinine were the antimalarials used. The use of a blood transfusion was frequent (82.8%). The lethality was 10% and the mixed form (anemia and neurology) was the most lethal ((P10Malaria remains a national concern in Mali. Improving the quality of care and prevention must be a priority to reduce the lethality that remains high.Au Mali, le paludisme constitue un problème majeur de santé publique. La région de Sikasso est classée selon le faciès géo climatique comme étant une zone à transmission saisonnière longue du paludisme supérieure à 6 mois.Décrire les caractéristiques épidémiologiques, et cliniques des enfants âgés de 0 à 5 ans hospitalisés pour paludisme grave au service de pédiatrie de l'hôpital de Sikasso.Il s'agit d'une étude transversale rétrospective sur douze mois (janvier-décembre 2014) de tous les enfants âgés de 0-5 ans hospitalisés pour paludisme grave à l'hôpital régional de Sikasso. Les variables analysées étaient épidémiologiques, cliniques, paracliniques, thérapeutiques et évolutifs.La fréquence hospitalière du paludisme grave a été de 55,82%.La tranche d'âge de 12-35 mois a été la plus concernée (45,3%). Le pic de fréquence des cas a été atteint au mois d'aout (21,2%). Les formesanémique, mixte (anémie et neurologique) etneurologique ont été les plus fréquentes. L'artéméther et la quinine ont été les antipaludiques utilisés. Le recours à une transfusion sanguine a été fréquente (82,8%).La létalité est de10% et la forme mixte (anémie et neurologique) a été la plus létale ((P10Le paludisme reste une préoccupation nationale au Mali. L'amélioration de la qualité de la prise en charge et la prévention doivent êtreune priorité pour diminuer la létalité qui reste élevée.

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.

Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomediastinum, and importantly, pneumopericardium. He had no particular past histories. He abruptly had cough, fever, and eruption on the abdomen. Computed tomography and echocardiography revealed pneumomediastinum and pneumopericardium. Antibiotics, rest, and supportive therapy ameliorated the condition. We must be aware that pneumomediastinum, and importantly pneumopericardium, can be present in a pediatric patient with subcutaneous emphysema. The infant’s symptoms disappeared under strict monitoring of respiratory status, nasal oxygen therapy and antibiotic therapy.

Neonatal mortality remains a public health problem in Mali. The neonatal referral is a systemic factor determining the neonatal prognosis. This work was initiated to determine the frequency of neonatal referrals and to determine their prognosis. Patients and Methods: A cross-sectional study was carried out from November 1, 2019 to January 31, 2020 in the neonatology service of the pediatrics department of the Gabriel Toure University Hospital in Bamako. All newborns referred by another health structure in the country were included in this stud. All newborns referred by another health structure in the country were included in this study. To determine the risk factors related to the neonatal referral, we performed univariate and multivariate analyzes to determine the odds ratios and fitted with a significant p probability if p 0.05 and the 95% confidence interval. Results: The frequency of referrals was 54.3%. Newborns came from basic structures in 19.3% of cases, from tertiary structures in 6.7%. The main reason for transfer was prematurity (40.2%) followed by perinatal anoxia (15.3%), malformations (15.3%), respiratory distress (15.2%) and infection neonatal (9.1%). The ambulance was the primary means of transfer in 71.3%. In 80% of cases the transfer had been made within the first 24 hours of life. On admission, a third of the newborns (31.1%) were less than 1500 g, hypothermic in 43.8% and febrile in 15.1%. The evolution was marked by 40.2% of deaths. The analysis of prognostic factors, allowed us to observe that the more the newborn is premature or of low weight the more risk of death was very high with respectively 18.5 times in the less than 28 weeks of amenorrhea (WA) (ORa = 18.5; CI = 1.9 - 180; p = 0.012) and 6.6 times in those less than 1000g (ORa = 6.6; CI = 1.4 - 29.7; p = 0.015). Likewise, any change in body temperature increased risk of death by 1.9 times compared to normothermia. Conclusion: The establishment of a neonatal referral system is necessary to reduce neonatal mortality in our context.

Introduction: According to Mali’s National Immunization Center, the Haemophilus influenzae b (Hib) vaccine coverage rate was 90% in 2015. Our work aimed to study invasive bacterial infections due to Haemophilus influenzae type b in children aged 0 - 15 years hospitalized in the pediatrics department of the UH-GT. Method: We carried out a retrospective descriptive study from January 2017 to December 2018 (i.e. 2 years) among children aged 0 - 15 years and hospitalized for Haemophilus influenzae type b infection confirmed by culture (blood culture, Cerebro-spinal Fluid, and pleural and skin fluid). Results: Thirty-three cases of Hib infections were collected giving a frequency of 0.2% and the age group 3 months to 3 years was the most affected (72.73%). Children who received no vaccine accounted for 21.21%. The Cerebro-spinal Fluid culture and other samples (pleural and skin) identified the bacterium in 100% of cases, against 72.72% in the blood culture Meningitis was the most frequent pathology (78.79%) and the lethality was high (21.21%). Conclusion: Despite the introduction of the Hib vaccine in the routine immunization program in Mali, Hib infections remain with a high lethality linked to meningitis.

Introduction: the objective was to describe the epidemiological and histological aspects of malignant abdominal tumors in children. Methodology: This was a descriptive, cross-sectional study conducted from January 1, 2017 to December 31, 2018. We included all patients aged 0 to 15 years with histologically confirmed abdominal malignancies. Results: We collected 46 files of malignant tumors of the abdomen (35% of pediatric cancers). The majority of patients were under 5 years old (65%). The sex ratio was 1.7. They were generally from disadvantaged socio-economic backgrounds (67%). The average consultation time was 50 days. The main reasons for consultation were abdominal mass (48%), pain (17%) or distension (9%). The mass was large, hard (89%), immobile (71%) and painful (46%). Malnutrition was found in 80% of patients. The mass was retro-peritoneal in 63% of cases and renal in 54%. It was solid in 94% of cases and heterogeneous in 76% of cases. The assay for tumor markers was not performed. Anemia was present in all patients. Fine needle aspiration was performed in 43%, biopsy in 37% and myelogram in 15% of cases. spinal cord involvement was observed in 28% of Burkitt’s cases. The main cancers diagnosed were nephroblastoma (52%), Burkitt’s lymphoma (26%) and neuroblastoma (13%). Stage 1 and stage 2 were frequent in 20% and 22% of cases, respectively; 36% of cases were not staged. The average duration of chemotherapy was 11 weeks. Total resection was performed in 30% of cases. The outcome of the patients was marked by total remission in 65%. Conclusion: Abdominal malignancies are very common in children. The diagnosis of certainty is late in our context.

Introduction: convulsion is a frequent cause of neurological and cognitive sequelae and then of epilepsy. The objective of this work was to describe the socio-demographic, clinical, therapeutic, and evolutionary aspects. Methodology: This was a descriptive retrospective study carried out in the general pediatrics department of CHU-Gabriel Toure. It took place over a period of 02 years from January 2017 to December 2018. We included all children aged 1 to 59 months hospitalized in the ward for convulsion. Results: During the study period, 2653 children aged 2 months to 59 months were hospitalized in the general pediatric ward. We included 288 medical records of children who presented with a seizure on admission. Convulsions represented 11% of pediatric hospitalizations from 1 month to 59 months. The average age was 29 months. Fever was present in 86% of patients. The cerebrospinal fluid (CSF) test was positive in 38 patients. Hypoglycemia was present in 14 patients. Serum calcium was low in 3 patients. The most implicated etiologies were malaria 70%, meningitis 20%, and dehydration 13%. Management consisted of airway clearance, oxygen therapy as needed, and administration of diazepam (54%). Antibiotics were prescribed in 77% of cases and antimalarials in 70%. The average length of hospital stay was 8 days with extremes of 1 and 30 days. The outcome was favorable in 95% of cases. Sequelae were observed in 5% of cases and one case of death was observed. Conclusion: Acute convulsions are one of the most common causes of hospitalization in children under 5 years old. The causes were dominated by infectious diseases (malaria, meningitis). The appropriate course of action was the administration of diazepam rectally.

Background: Very common symptom in children, fever, perhaps a warning sign of more or less severe pathology, rapidly progressive, including an invasive bacterial infection such as acute pyelonephritis (APN). The aim of this work was to study the bacteriological profile and antibiotic sensitivity of APN in children. Methods: A prospective study involving any infant or child aged 3 months to 15 years with an acute fever (≥38°C) in which a urine test strip was performed in the pediatric department of the teaching hospital Gabriel Toure between April 1st and May 15th, 2019 (45 days). Results: 124 children were included out of 244 febrile patients. Infants (3 - 23 months) predominated (52.8%) with a sex ratio of 2. Seventy-five percent of children came directly from home and 30.6% were on antibiotic prior to admission. The urine bag sample was taken in 55.6% and the urine was macroscopically cloudy in 32.3%. Stigmas of urinary tract infection at the urinary strip were present in 56.5%. Confirmation of acute pyelonephritis (APN) by CytoBacteriological Urine Examination (CBUE) was 29% with Escherichia coli (63.9%) or Enterococcus faecalis (30.5%). Sensitivity was excellent for ciprofloxacin and imipenem (100%). The overall resistance was greater for gentamicin, cotrimoxazole, ceftriaxone, cefotaxime and amoxicillin-clavulanic acid (Threshold: 17.9% - 95.6%). APN was associated with bacteremia in 2.8% with hospitalization for 45.2% and mortality of 11.1% (due to severe acute malnutrition, severe dehydration and multifocal infection). Conclusion: The APN, daily activity of pediatrician in Bamako, is observed in one third of febrile children associated with a major life-threatening condition of risk factors, then the likely antibiotherapy could be amikacin in our context.

Introduction: The factors of nephroblastomas’ relapse are a set of elements playing a role in the reappearance of cancer cells in the same place of the kidney or in other regions of the body after a 5-year remission. Objectives: To determine the frequency and the factors of nephroblastomas’ relapse in the pediatric oncology unit and pediatric surgery of the academic hospital Gabriel Toure. Materials and methods: This was a retrospective study carried out from January 1, 2005 to December 31, 2019 in all children treated for nephroblastoma relapses in the pediatric oncology unit and in the pediatric surgery service. Results: In 15 years, we have managed 182 cases of nephroblastoma, of which 128 cases were declared in complete remission after 5 years and 12 cases presented a recurrence. The relapses factors were: capsular break, intraoperative tumor rupture, presence of an associated malformation, surgery without neoadjuvant chemotherapy and tumor surgical stage (p 0.05). Patients’ age at diagnosis, sex, number of neoadjuvant and adjuvant chemotherapy sessions and histological type were not decisive (p > 0.05). Conclusion: Relapses are more and more frequent in cases of nephroblastoma. The correct use of the protocol would avoid these recurrences.

Introduction: Health care-associated infection is an infection acquired during the care delivered in the hospital or in any other care establishment which was neither present, nor in incubation at the admission of the patient or at the time of delivering the care or which does not manifest itself only after the patient has been discharged or an infection contracted by the professional in the course of his duties. Objectives: To identify mean causative germs and to determine their sensitivity to antibiotics and to identify the risk factors of health care-associated infection. Material and methods: It was about a prospective longitudinal study conducted from November 1, 2017 to April 1, 2018 (6 months) in all children admitted to the pediatric surgery service. Non-consenting parents and outpatient necrosectomy case have not been included in this study. Results: This study included 200 patients, of whom 30 experienced the hospital acquired infections with an infection rate of 15%. The surgical site infection was the most common type, with 16 cases (53.3%), followed by burns in 13 cases (43.3%) and urinary tract infection in 1 case (3.3%). The average age of patients with infection was 56.33 ± 48.66 months with extremes of 1 and 180 months. The sex ratio was 1.30 for infected patients and was 1.83 for uninfected patients. The main bacteria responsible for surgical site infection were: Escherichia coli (4 cases), Acinetobacter baumanii (3 cases), Klebsiella pneumoniae (2 cases), Staphylococcus aureus (2 cases), Enterobacter cloacae (1 case), Pseudomonas aeruginosa (1 case) and Enterobacter faecalis (1 case). Among burn patients, the most frequent germs were: Acinetobacter baumanii (7 cases), Klebsiella pneumoniae (6 cases), Staphylococcus aureus (6 cases), Escherichia coli (4 cases), Pseudomonas aeruginosa (2 cases) and Enterobacter faecalis (2 cases). Escherichia coli was noted only in the case of urinary tract infection. Antibiotics tested were: amoxicillin, amoxicillin associated with clavulanic acid, ceftriaxone, imipenem, gentamicin and ciprofloxacin. Germs were resistant to amoxicillin in 88.9% of cases, sensitive to the amoxicillin-clavulanic acid combination in 85% of cases, sensitive to tobramycin and gentamicin. Recruitment methods and length of hospitalization were the risk factors noted. Conclusion: Massive awareness among all healthcare providers should be conducted on the adoption of standard precautions for the prevention of health care-associated infections and on the rules of antibiotics prescription to reduce the incidence of health care-associated infection and slow the resistance of germs to antibiotics.

The Pica syndrome is an eating disorder characterized by an excessive or abnormal desire to consume a non-nourishing substance which can be relatively harmless, or potentially harmful for the health. It is a rare affection secondary to the accumulation of diverse nature foreign bodies inside the digestive tract and more especially at the stomach level. Gastro-intestinal localization is the most frequent, and can remain long time asymptomatic. Treatment is surgical. We report 3 cases of digestive complication of Pica syndrome. The first one was operated for gastric perforation due to nail (53 nails, a pin and bands of tape recorder cassette ingested), the second one for trichobezoar and the last had a subocclusion by pieces of granite.

Objective: Pediatric jaundice is caused by various conditions. Although some data is available on this issue, data from Mali is insufficient. The present retrospective observational study was an attempt to determine the etiology of pediatric jaundice in the pediatric department of Gabriel Toure teaching hospital in Bamako, Mali. Methods: We reviewed all pediatric patients with jaundice who were hospitalized and treated in this department during January 1 to December 31, 2016 (n = 168). Result: Pediatric jaundice patients accounted for 1.88% of the hospitalized patients, with median age of 6 years and male/female ratio being 1.6. Infectious, cholestatic, and hemolytic jaundice accounted for 75%, 11% and 10%, respectively. Malaria and sickle cell disease accounted for 67% and 9%, respectively. Hepatomegaly and splenomegaly were observed in 49 (29%) and 23 (13.7%) patients, respectively. Of 168, 9 patients died. Conclusion: Infectious jaundice, especially jaundice due to malaria, was the most frequent. However, variety of etiologies was observed, of which the practitioners should be aware. The observation presented here may become fundamental data in health-policy making in this area.

Introduction: In Mali, Intensive nutritional recovery and education units have been established throughout the country and the pediatric unit of Gabriel Toure Teaching Hospital started in May 2010. The objective was to analyze the factors influencing the performance indicators at the Intensive nutritional recovery unit in the Pediatric of Gabriel Toure Teaching Hospital. Material and Methods: Cross-sectional, descriptive and analytical study, it took place over a period of 6 months (June 1 to November 30, 2016). All severe malnourished children under 5 years of age were included. The parents or caregivers of these children as well as the staff of the Intensive nutritional recovery unit were asked about their opinions. Result: During the study period, 4724 children were hospitalized in the service. There were 259 cases of severe acute malnutrition with a frequency of 5.5%. The 12-23 month age group was the most represented with 44.79%. Sex ratio of 0.90. Patients were exclusively breastfed (76.06%) before 6 months of age and 36.68% had not benefited from supplement foods after 6 months. The most common reason for consultation was anorexia with 66.79% of cases. Muscle wasting was the most found sign on physical examination (66.79%). Marasmus was the most represented form of malnutrition (87.65%). The failure of the appetite test was the main complication of management with 42.86% of cases. The combination of milk F75 + F100 + PPN was used for management in 87.26% of cases. Treated successfully are 54.83%. We recorded 18.53% dropout. There was a statistically significant association between the treaties successfully and the father's occupation (OR = 2.7, p = 0.028). The association between death and complications was statistically significant (OR = 21.345, p = 0.001). There was a statistically significant association between treatment discontinuation and financial problems (OR = 3.037, p = 0.005). The death rate was 23.55%. Conclusion: The financial problems of the parents and the association of the complications (serious pathologies) constitute factors which influence considerably on the indicators of performance.

The nephroblastoma is the third pediatric cancer in Mali, this study aimed to describe the prevalence and prognosis of nephroblastoma relapses. Methods: It was a descriptive retrospective study over a 10-year period from January 2005 to March 2015. We collected children aged 0 to 15 years followed for relapse of nephroblastoma in the pediatric oncology unit of university hospital center (UHC) Gabriel Toure. Results: The frequency of relapse of nephroblastoma was 7.4% (19 cases) whose mean age was 42 months with a sex ratio of 1.3. The relapse occurred before the end of the postoperative course in 16% of cases (3 patients). It was local recurrence in 52% of cases (10 patients), pulmonary 16% (3 patients), and hepatic 11% (2 patients). According to the SIOP classification, 47% of patients were diagnosed in stage III (9 patients) and 21% (4 patients) in stage IV. The tumor was high risk in 37%. Palliative chemotherapy was performed in 63% of the patients (12 patients) and the remaining seven were put on a high risk diet. The overall survival at 5 years was 21% or 4 patients. Conclusion: Our results showed all the difficulties in the management of nephroblastoma relapses in our context.

Pneumonia is the most common cause of mortality in child under five years of age. The objective of the study was to assess socio-demographic and clinical characteristics of children under 5 hospitalized for pneumonia. Material and method: We conducted a 6 months prospective study from June 1st, 2016 to December 31st, 2016 in the general pediatric service in the Pediatric Department of Gabriel Toure Teaching Hospital in Bamako, the capital city of Mali. Result: We have selected 63 cases of pneumonia according to our definition criteria, i.e. 2.2% of hospitalizations for children aged 1 to 59 months. The average age was 14 months. Infants under 2 years accounted for 82.53%. The sex ratio was 1.2. Seventy eight percent came from an unfavorable socio-economic background. The majority of mothers were uneducated (71.42%). Breastfeeding was exclusive up to 6 months in 50.79% of patients. Vaccination according to the national program was not up to date in 27% of patients. The average consultation time was 18 days. On admission, 81% of the patients had a fever, 93.64% had a tachypnea and 58.73% had crackling rales at pulmonary auscultation. Hypoxemia was present in 58.73%. Severe anemia was present in 79.36%. Radiologically, opacity was found in 42 patients (66.66%). The blood culture was positive in 8.3%. Beta-lactams were first-line prescribed in all patients. The case fatality rate was 9.52%. The factors associated with mortality were age less than 14 months (p = 0.08), adverse socio-economic conditions (p = 0.0003) and the presence of hypoxemia at the entrance (p = 0.01). Conclusion: Pneumonia remains major cause of morbidity and mortality in our context. Emphasis should be put on preventive measures.

Background :Non-Hodgkin lymphomas are the first childhood cancer in sub-Saharan Africa. Objective: The purpose of this study was to assess non-Hodgkin lymphomas cases in our setting. Methodology: A retrospective and descriptive study carried out in the pediatric oncology unit of the Gabriel Toure Teaching Hospital Bamako over 10 years from 1st January 2005 to 31th December 2015. Results: We exploited 274 (21.6%) cases of Non-Hodgkin Lymphoma out of 1295 cancer cases registered, the age group 6 - 10 years was the most represented (46.4%); the male sex was predominant with a sex-ratio of 1.8; digestive signs were the most common signs of discovery (44.2%) followed by maxillary swelling (42.7%); the majority of patients (52.9%) consulted between 1 and 3 months after the onset of signs; the malnutrition rate was 39.8%, of which 24.1% were severe cases and 15.7% were moderate rate. Abdominal localization was the most common (43.1%) followed by maxillofacial localization (33.9%). Almost all were Burkitt type cytology (92.7%), the majority (73.4%) were in Murphy stage III. Almost all (96%) had received chemotherapy and the modified LMB 01 protocol was widely used (62.4%). The majority of patients (85%) were chemosensitive at day 7 or after the third cyclophosphamide injection but at the end of induction only 31% were in complete remission. Gastrointestinal toxicity was the most common (37.13%) followed by hematologic toxicity 35.09 %; 9.12 % of patients were lost of follow-up and 22.26% died. Tumor progression was the most common cause of death (60.66%) followed by infection (21.31%). Conclusion: In light of these findings, the late diagnosis and the poor management of NHL, as well as the limited ability to primarily treat metabolic complications, explain the high case-fatality rate, hence the important role of early diagnosis and treatment multidisciplinary.

BackgroundIn Mali, the health facility-based prevalence of autism spectrum disorders (ASD) in Mali was 4.5% (105/2,343) and the age of first medical visit for autistic children was around 7 years old in 2018. Parental recognition of developmental abnormalities initiates the early autism detection and diagnosis. We aimed to assess the feasibility of a main study to associate parental concerns with early first medical visits and subsequent ASD diagnostic in Mali.MethodsWe conducted a pilot study from November 2017 to July 2019. We surveyed 57 parents of autistic children aged 3-14 years old.ResultsParents were concerned over verbal communication in 54.1% and reciprocal social interaction in 43.8%. Children with ASD had their first medical visit after 18 months old in 66.7%, ≥ two medical visits in 87.7%, and were identified after 36 months old in 76.8%.ConclusionParental concerns were not significantly associated with early first medical visit and ASD identification. This pilot study will help in the design of larger studies on the same topic in Mali.

The practice of excision in girls poses a significant risk to their health. The objective of this study was to determine the immediate acute complications associated with this practice.This was a retrospective descriptive study over a period of 15 months including all girls aged 0-15 years hospitalized for acute complications related to excision within 7 days of the practice in the pediatric department of the University Hospital Gabriel Toure.We collected 17 patient files. The median consultation time was 43 h. The main reason for consultation was post-excision bleeding in 76.4% of the cases. Pallor associated with respiratory distress was found in almost all cases. On admission, four girls (23.5%) were comatose and five girls (29.4%) showed signs of shock. The reasons for hospitalization were hemorrhage associated with post-excisional sepsis (52.9%), complicated shock anemia (23.5%), and severe post-excision anemia (23.5%). The average hemoglobin level was 5.5 g/dL; there was severe anemia in 94.1% of the girls (Hb7g/dl). All the girls received blood transfusions with red blood cell concentrate. The other treatments received were local care (100%), administration of analgesics (100%), antibiotic therapy (82.4%), and oxygen therapy (41.2%). The outcome was unfavorable in two patients (11.8% deaths).This study shows the seriousness of the immediate complications associated with the practice of excision.

To assess the reduction in IOP and ocular symptoms in patients newly diagnosed with POAG and treated with latanoprost as monotherapy.A multicentric, cross-sectional, descriptive study was conducted. We included adults newly diagnosed with POAG. All patients received one drop of preserved latanoprost 0.005% in each eye every night for 12 weeks. Changes in IOP and ophthalmic signs and symptoms were assessed during and at the end of treatment.A total of 524 patients were included, with a participation rate of 93% at 12 weeks. The mean age was 52.79±17.33 years, and the sex ratio M/F was 1.39. At inclusion, the mean IOP was 21.68±9.72mmHg. After 2 weeks of treatment, the mean IOP was 15.49±5.81mmHg, for a reduction of 28.55%. After 12 weeks of treatment, the mean IOP was 13.16±3.54mmHg, for a reduction of 39.30%. The main symptom recorded was a gritty foreign body sensation, the frequency of which was 4.72% at W2 and 2.45% at W12. The main sign was hyperemia (4.33% at W2 and 1.84% at W12).Latanoprost given as first-line monotherapy in POAG in blacks considerably reduces IOP. The incidence of side effects remains low; it is higher at the start of treatment.

Background: In Mali, the national health facility-based prevalence of autism spectrum disorders (ASD) was 4.5% (105/2,343) and the age of first medical visit for autistic children was around 7 years old in 2018. Parental recognition of developmental abnormalities initiates the early autism detection and diagnosis. Our aim was to investigate if parental concerns were associated with early first medical visits and subsequent ASD diagnostic in Mali. Methods: We conducted a pilot study from November 2017 to July 2019. We surveyed parents of 57 out of 60 available autistic children aged 3-14 years old. Results: Parents were concerned over verbal communication in 54.1% and reciprocal social interaction in 43.8%. Children with ASD had their first medical visit after 18 months old in 66.7%, ≥ two medical visits in 87.7%, and were identified after 36 months old in 76.8%. Conclusion: Parental concerns were not significantly associated with early first medical visit and ASD identification. Our results will guide future full scale studies on parental concerns in ASD in Mali.

L’objectif de cette etude est d’evaluer la qualite physico-chimique des ressources en eau alternatives de la ville de Daloa (Cote d’Ivoire). Pour y parvenir, nous avons cartographie les plus consommees afin de mieux observer leur distribution spatiale. Au prealable, la temperature, le pH, la conductivite electrique, les solides dissous totaux (SDT) et la salinite ont ete mesures in situ . Aussi, au niveau de chaque ressource, un echantillonnage a ete effectue dans des bouteilles de 1,5 L pour le dosage des anions majeurs et de 200 mL pour le dosage des cations majeurs et des metaux. Ces differents echantillons ont ete conditionnes dans des glacieres a une temperature de 4 ± 2 °C et convoyes au laboratoire pour analyse. Les resultats obtenus revelent une concentration des ressources identifiees au centre-ville. Les valeurs de pH sont relativement acides, inferieures a 6,5, la limite inferieure des valeurs guides de l’Organisation mondiale de la sante (OMS). Les conductivites electriques oscillent entre 56 et 225 μS/cm. Quant a la turbidite, les valeurs obtenues oscillent entre 0,3 et 8,6 unites de turbidite nephelometrique (UTN). Les valeurs superieures a 5 sont obtenues au niveau des sources des quartiers Labia, Artisanat et Chateau. Du point de vue chimique, les teneurs en anions (NO3 – , SO4 2– et Cl– ) et cations (Al3+ , As3+ , Ca2+ , Cd2+ , Cr3+, 6+ , Cu2+ , Fe2+,3+ , K+ , Mg2+ , Mn2+ , Na+ , Ni2+ , Pb2+ , Sb2+ , Zn2+ ) des differentes sources sont toutes inferieures aux valeurs guides de l’OMS, a l’exception de celles de Gbokora, Labia et CMA ou les teneurs en Al3+ sont respectivement de 0,41, 0,54 et 1,31 mg/L, relativement superieures a la valeur guide de l’OMS de non-depassement fixee a 0,2 mg/L. Dans l’ensemble, il ressort de ces analyses que la qualite des ressources alternatives identifiees est bonne pour tous les usages, mais necessite une neutralisation et une surveillance sanitaire pour garantir l’absence d’eventuelles pollutions anthropiques.

Introduction: Acute post-infectious glomerulonephritis (APIGN) can be serious due to its complications that still occur in our countries. In this work, we aimed to study the epidemiological, clinical, biological and evolutionary aspects of APIGN. Patients and methods: We conducted a retrospective, descriptive study from January 1st, 2015 to December 31st, 2017 in the pediatric ward of the Gabriel Toure Teaching Hospital in Bamako. All children hospitalized for APIGN were included. Results: In two years, we included 10 children aged 7 years old on average; all from low socioeconomic backgrounds. The sex ratio was 1.5. On average, the children spent 15.8 days before our consultation. Edema was the main reason for consultation. We found a history of infection and high blood pressure in 30% each, and renal failure in 10% of the children. Hematuria and proteinuria were detected in 100% and 90%, respectively. Hypocomplementemia was observed in 66.6%. One third of the children had a positive antistreptolysin O. The average duration of hospital stay was 11.2 days. The evolution was favorable in 90%. Kidney failure was the leading cause of death. Conclusion: Acute post-infectious glomerulonephritis is still a reality in our context. Emphasis should be put on its prevention by improving the hygienic conditions, detection and the management of infections.

to assess epidemiologic and clinical aspects of childhood brain tumors in Mali. a retrospective, descriptive study of children aged 0-15 years with brain tumors, conducted in the pediatrics department of the Gabriel Touré University Hospital Center in Bamako, Mali, from January 31, 2007 to December 3, 2012. In all, 41 cases of brain tumors were recorded during this period (mean: 5.5 years old; range: 1-12 years). Brain tumors were most frequent in the children aged 2-5 years (53.7%) and among boys (53.7%). Late stage at presentation was relatively frequent (34.1%) with a mean time to diagnosis of 10 months. Features of elevated intracranial pressure were the most frequent mode of revelation of primary tumors (26.8%). Supratentorial tumors accounted for 83% of the cases, and gliomas were most frequently (29.3%) identified on computed tomography. Only five patients underwent surgical tumor removal. A broader study including the other hospitals in Bamako could help to assess more accurately the epidemiology of pediatric brain tumors in Mali.

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.

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.

Introduction: Childhood acute lymphoblastic Leukemias (ALL) is relatively rare in sub-Saharan Africa but probably underdiagnosed. The aim of this work was to describe the epidemiological, clinical, and therapeutic aspects of ALL in the pediatric oncology unit of Bamako. Patients and Methods: It was a retrospective, descriptive study on 33 children with ALL, treated at the pediatric oncology unit of Bamako according to a protocol developped by the French African Pediatric Oncology Group (FAPOG). Results: The mean age of patients was 10 years with extremes of 2 and 15 years and a sex ratio (M/F) of 3.7. The majority of patients were over 5 years of age (79%). Clinically, pallor was noted in 72% of cases, fever in 79% and 24% had a hemorrhagic syndrome. Biologically, the tumor lysis was present in all patients, all patients hemoglobin level less than 10 g/dl, 91% had thrombocytopenia and 51% had leukocytosis (>50 Giga/l). Complete remission at the end of induction was 64%, with 27% of early deaths. After a mean follow-up time of two years, we recorded 12% of loss of follow-up and 82% of deaths. The global survival was 6%. Conclusion: Childhood ALL have a very poor prognosis in Mali. Early diagnosis and adapted protocols to high risk patients will help reduce early deaths and improve the survival of patients in remission.

Purpose of the study: To determine the socio-demographic factors influencing the dynamics of HIV prevalence among pregnant women in Burkina Faso. Material and methods : A total of 66,597 pregnant women from the 13 health regions of Burkina Faso were included in this study conducted between 2006 and 2014. Venous blood samples were collected and analyzed for the detection of HIV antibodies according to WHO / UNAIDS strategy II, using the mixed test Vironostika HIV Uniform II Plus O (Bio-Merieux) and the test discriminating ImmunoCombII HIV-1 & 2 BiSpot (Orgenics). Samples with discordant results between the two tests, as well as those positive to HIV-2 or HIV-1 + 2, were retested with HIV BLOT 2.2 (MP Diagnostics). Sociodemographic data collected from the participants were correlated with their HIV status to determine key risk factors influencing HIV infection prevalence in Burkina Faso. Results: Sociodemographic data showed that the study population consisted mainly of married women (91.2%) at their first pregnancy (27.1%) with a large majority of them being housewives (86.2%) who did not attend any form of schooling (69.4%). About 88.4% had stayed longer than a year in the health region where they initially participated in the study and 55.8% were between 20 and 29 years of age. Overall HIV prevalence significantly dropped from 2.7 % in 2006 to 1.3% in 2014. However HIV seroprevalence in this study has varied significantly according to socio-demographic characteristics including marital status, parity, occupation, education, age group and the length of stay in the women's health community (p

Introduction : le taux de mortalite neonatale au Mali est l’un des plus eleves au monde. Le pays ne dispose que d’une seule unite de neonatologie de reference nationale situee a Bamako, la capitale.Objectif : decrire l’evolution de la morbidite et de la mortalite neonatales, du personnel et de la capacite d’accueil de 2008 a 2009 au niveau de l’unite de neonatologie de reference nationale au Mali.Methodes : il s’est agi d’une etude descriptive transversale au niveau de l’unite de neonatologie du Centre Hospitalier Universitaire Gabriel Toure de Bamako. Nous avons compile les donnees concernant le personnel, le nombre d’admissions, le sex ratio, le mode d’admission, les pathologies diagnostiquees, le devenir des patients, la capacite d’accueil et la duree moyenne de sejour sur la periode du 1er janvier 2008 au 31 decembre 2012.Resultats : le personnel medical est passe de un a trois a partir de 2009 et les infirmiers et sages-femmes de 16 a 14 pour un nombre moyen de lits de 44. Le nombre moyen d’hospitalisations par an a ete de 3900 (extremes : 3667-4585) avec 14 % de naissances in born et une duree moyenne de sejour de 3,7 jours. La prematurite, l’anoxie perinatale et l’infection ont represente 80,5 % des causes d’hospitalisation et 79,5 % des deces. Le taux de mortalite a varie de 28,5 % a 36,8 % avec une moyenne annuelle de 33,2 %. Les pathologies les plus letales ont ete le tetanos (60,8 %), la prematurite (42,7 %), l’anoxie perinatale (29,4 %) et l’infection (25,7 %).Conclusion : le taux de mortalite neonatale dans notre contexte reste encore tres eleve. Des efforts doivent etre consentis par les autorites sanitaires pour decentraliser la prise en charge du nouveau-ne malade.

International audience; This study aims in filling the gap in understanding the relationship between trend and extreme in diurnal and nocturnal temperatures (Tx and Tn) over the Gulf of Guinea area and the Sahel. Time-evolution and trend of Tx and Tn anomalies, extreme temperatures and heat waves are examined using regional and station-based indices over the 1900-2012 and 1950-2012 periods respectively. In investigating extreme temperature anomalies and heat waves, a percentile method is used. At the regional and local scales, rising trends in Tx and Tn anomalies, which appear more pronounced over the past 60 years, are identified over the two regions. The trends are characterized by an intensification of: i) nocturnal/Tn warming over the second half of the 20th century; and ii) diur-nal/Tx warming over the post-1980s. This is the same scheme with extreme warm days and warm nights. Finally annual number of diurnal and nocturnal heat waves has increase over the Gulf of Guinea coastal regions over the second half of the 20th century, and even more substantially over the post-1980s period. Although this trend in extreme warm days and nights is always overestimated in the simulations, from the Coupled Model Intercompar-ison Project Phase 5 (CMIP5), those models display rising trends whatever the scenario, which are likely to be more and more pronounced over the two regions in the next 50 years.

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.

Numerical simulation of complex phenomena involving large or multiples scales requires the use of methods that are highly precise and fast. Classical numerical methods consist in replacing a given problem, thanks to discretization, with a chain of algebraic equations to be solved.

Les femmes enceintes constituent l’un des groupes vulnerables de la population. Objectif Notre travail avait pour but d’evaluer les connaissances generales sur le VIH/SIDA et la transmission verticale des gestantes. Materiel et Methodes Notre etude qui s’est deroulee dans le Centre de Reference de la Commune IV a porte sur 322 femmes enceintes recues en consultation prenatale recensees durant 3 mois du 1er juin au 31 aout 2007. Resultats Tres peu des gestantes interrogees avaient fait la demarche de depistage du VIH (24 %), generalement au cours de CPN (15,21 %). Une faible proportion (14,3 %) des sujets de notre etude connaissait la serologie du pere. La majorite des femmes (93 %) etait informees de la possibilite de la transmission mere enfant du VIH. La transmission pendant la grossesse est la periode la plus citee (83,85 %) puis l’allaitement maternel (12,42 %) ; l’accouchement n’a jamais ete evoque comme periode de TME. Les moyens evoques pour reduire la TME du VIH ont ete la prise de medicaments pendant la grossesse (20,8 %) ou l’accouchement (1,5 %), le depistage precoce (12,42 %) et l’allaitement artificiel (6,21 %). Conclusion Les connaissances des gestantes sur le VIH et la transmission verticale du VIH sont satisfaisantes.

La mortalite neonatale en general et celle des prematures en particulier reste preoccupante dans notre contexte. But Notre travail avait pour objectif d’etudier les facteurs associes a la mortalite des prematures dans notre contexte. Materiel et Methodes Il s’agit d’une etude transversale, descriptive qui s’est deroulee du 15 octobre 2006 au 15 janvier 2007 dans l’unite de neonatologie du CHU Gabriel Toure. Ont ete inclus tous les nouveau-nes referes prematures hospitalises. Resultats Nous avons inclus 327 prematures. Les naissances out born ont representees 85,9 %. Le transfert a ete fait par taxi dans 50,2 % des cas. Une hypothermie a ete retrouvee chez 60,5 % a l’admission. Le taux de mortalite a ete de 33,3 %. Les facteurs associes a la mortalite ont ete le poids de naissance p p p p = 0,002), le transport a pied ( p = 0,004). Conclusion La reduction de la mortalite des prematures passe par une amelioration du systeme de transfert et des conditions de prise en charge dans notre contexte.

International audience; Ce chapitre vise ainsi à illustrer ces enjeux sociaux, religieux, politiques, voire économiques que suscite le Maouloud au Mali. En partant d’une analyse micro-sociale autour de la ville de Djenné, on cherchera à questionner dans un premier temps la dimension traditionnelle que les habitants assignent à leur Maouloud. Nous verrons que si cette tradition relève sans conteste d’une histoire longue, elle est aussi réactualisée et réinventée par une mémoire urbaine très contemporaine. On s’attachera ensuite à restituer ce qu’on peut appeler le « réveil » du Maouloud à Djenné, réveil qui se structure en trois phases chronologiques pour constituer au final le Maouloud de Djenné : un emprunt vers 1900 ; une modernisation dans les années 1960-70 ; une politique de conservation à partir du milieu des années 2000. Enfin, on analysera les dynamiques sociales et politiques dans lesquelles le Maouloud de Djenné est pris entre : une réislamisation nationale qui se déploie sous les traits d’un réformisme salafî auquel répond depuis quelques années un réformisme soufi ; une nouvelle historicité malienne, où les « villes d’islam », leur culte des saints et leur Maouloud se voient mobilisés par l’État comme un patrimoine porteur d’une certaine identité nationale