Risk Factor for Malnutrition in Children Aged 6 to 59 Months Hospitalized in a Pediatric Ward in the South of the Sahara

Malnutrition is a major public health problem in Mali, along with the country’s political and security instability. We initiated this work with the objective of determining the frequency as well as the risk factors favoring the occurrence of malnutrition in children aged 6 - 59 months hospitalized in the pediatrics department of the Gabriel Touré University Hospital in Bamako, country reference service to identify potential interventions to plan. A cross-sectional study was carried out over a period of 4 months. A bivariate logistic regression analysis allowed us to identify risk factors with degree of significance if p < 0.05. During the study period, 2888 children were hospitalized, including 348 aged 6 to 59 months, or a frequency of 12.04%. One in two children was malnourished, i.e. a frequency of 50%. It more frequently affected infants aged between 6 and 23 months with a frequency of 33.7%, with a hospital frequency of growth retardation which was 23% including 14.7% of severe form. The emaciation was 27% of which 18.7% were severe form. The underweight was 42.2% with 31% in severe form. We found the diet inequality in all malnourished and non-malnourished children. A bivariate analysis showed that children with an out-of-school mother have a 2.4-fold risk of being malnourished (OR = 2.425;CI = 1.9 - 4.2;p < 0.03). Also children from households with no stable income (non-salaried father) have twice the risk of children from a household with stable income (OR = 2.120;IC = 1.1 - 4.1;p < 0.002). Finally, inappropriate nutrients (early introduction of food and early weaning) have been strongly associated with the occurrence of malnutrition. The prevalence of malnutrition reflects the way children eat. Emphasis should be placed on nutritional education and financial stability in households.

Etiology of Pediatric Jaundice: Observation in the Pediatric Ward of the Gabriel Toure University Hospital

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 Touré 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.

Hematological Profile of Newborns Hospitalized for Neonatal Bacterial Infection in the Neonatology of the Pediatric Department of Gabriel Toure Teaching Hospital Bamako, Mali

The blood count is an easily achievable routine exam and will it have specifics in the event of a neonatal bacterial infection? Hence, the present study with the objective of determining the profile of the hemogram of newborns hospitalized for early bacterial neonatal infection. Material and methods: This was a cross-sectional study that took place from June 27 to September 03, 2016 in the neonatology department of teaching hospital Gabriel Toure. Included were all neonates hospitalized for early neonatal bacterial infection (ENBI) and who had a blood count. Results: We included 227 patients, 64.8% of whom were premature. The sex ratio was 1.4. The infants were less than 24 hours old in 93.6% of the cases. The mean hemoglobin level was 16.435 g/dl [8.8 - 22.26]. Erythrocytopenia was found in 18.5% of cases. Anemia was present in 17% of newborns. The average leukocyte was 15.228·103/mm3 [1.4 - 72]. Hyperleukocytosis and leukopenia were found in 12.32% and 6.6% respectively. Neutropenia and lymphopenia were present in 14.5% and 30.8%. There was a correlation between leukocytosis of negative blood cultures (23/27) (p = 0.030). For Neutrophils, neutrophilia was more observed in term neonates and neutropenia in premature infants (p = 0.03). Monocytosis was present in 13.6% of cases. One quarter (25.5%) of newborns had thrombocytopenia. Conclusion: Hematological variations did not allow a specific profile of newborns hospitalized for early neonatal bacterial infection to be identified.

Prevalence and Prognosis of Relapse of Nephroblastoma at the Pediatric Oncology Unit of Bamako

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.