Epidemioclinical Profile of Premature Infants at the Neonatology Unit of the Mali Hospital 2012-2015

Introduction: A newborn is preterm when it is born before 37 weeks of amenorrhoea. Preterm births account for 11.1% of live births worldwide, 60% of which are in South Asia and sub-Saharan Africa. Preterm birth is the leading cause of neonatal mortality and the second leading cause of mortality in children under 5 years of age. The aim of this study was to investigate prematurity in the neonatology unit of the Mali Hospital. Materials and Methods: This was a cross-sectional, descriptive study from January 2012 to December 2015 of premature newborns from 28 to 36 weeks of amenorrhea in the neonatology unit of Mali Hospital. Results: From January 2012 to December 2015, we recorded 1692 inpatient newborns, including 614 preterm newborns, a frequency of 36.29%. The sex ratio was 1.43 in favor of boys. The average age of the mothers was 23.9 years with a minimum of 15 and a maximum of 47 years. The majority were housewives (92.7%). The pregnancy was poorly monitored in 51.8% of the mothers. The average gestational age was 32.9 days with extremes of 25 and 36 days. The most frequent mode of delivery was vaginal delivery (93.2%), with late prematurity in 51.5%, moderate prematurity (24.4%), extreme prematurity (18.7%) and very premature (5.4%). The mean birth weight was 1464 g with a standard deviation of 485 g and 2751 g. Prematurity was associated with neonatal infection in 49.4% of newborns, perinatal anoxia (13.9%) and hypotrophy (2.6%). The most frequent maternal risk factors were fever (83.4%), twinship (38.9%) and high blood pressure (8.6%). The average length of hospitalization was 9.75 days with extremes of 0 and 68 days. We recorded a cure rate of 57.7%, a death rate of 35.7% and a dropout rate of 6.7%. Conclusion: Prematurity is frequent in the neonatology unit of the Mali Hospital. We observed a high frequency among women of extreme age and low socio-economic and educational level. In our study we also noted a high mortality rate proportional to gestational age.

Study of Tuberculosis in Children Aged 1 Month to 15 Years in the Pediatric Ward of the Hospital of Mali 2015-2021

Introduction: In 2020, an estimated 9.9 million people are living with tuberculosis worldwide, including 1.1 million children. Tuberculosis is the 2nd leading cause of death from infectious disease after COVID-19 and the 13th leading cause of death worldwide. Objective: To collect cases of tuberculosis in children aged 1 month to 15 years in order to study the epidemio-clinical aspects in the pediatric department of the Mali Hospital during the period 2015-2021. Materials and Methods: This was a descriptive, retrospective study from January 1, 2015, to December 31, 2020, and a prospective study from January 1 to December 31, 2021, among children aged 1 month to 15 years admitted for suspected tuberculosis in the pediatric ward of the Mali Hospital. Results: From January 2015 to December 2021, we collected 69 cases of tuberculosis among 9438 hospitalized children, i.e. a frequency of 0.73%. The average age was 6.16 years with extremes of 3 months and 15 years. The sex ratio was 1.1% in favor of boys. The majority of children were vaccinated against tuberculosis (88.4%). The most frequent symptoms were fever (76.8%) and weight loss (73.9%). The pulmonary form was the most frequent (54.9%). Bacteriological confirmation was done in 43.5% of our children. It was Mycobacterium tuberculosis in all confirmed cases. More than half of our children (65.2%) were treated with first-line anti-tuberculosis drugs for 6 months. We observed a cure in 42.0% of our patients and a case fatality rate of 39.1%. Conclusion: Tuberculosis in children is frequent in Mali Hospital despite good BCG vaccination coverage. Its mortality remains high and is maintained by malnutrition, HIV, and the emergence of resistant strains of bacilli.

Epidemiological Profile of Newborns Who Died during Their Hospitalization in the Neonatology Unit, Mali Hospital

Introduction: Neonatal mortality is a serious problem, particularly in developing countries. Objective: To study the epidemiological and clinical profiles of newborns who died during their hospitalization in the neonatology unit of the hospital in Mali. Methodology: This was a prospective study over a 12-month period (January 1 to December 31, 2020) including all newborns aged 0 - 28 days who died during their hospitalization. Results: A total of 424 neonates were hospitalized in neonatology, 54 died, or 12.73%. Newborns aged 0 - 7 days at admission were the most represented at 79.63% and 94.4% were full-term babies. The male gender was dominant with a ratio of 1.17. The following characteristics were frequently observed in the mothers: not educated (46.3%), poor 75.9%, living in urban areas (68%), housewives 75.4%, and having had less than 4 antenatal care visits (53.7%). For babies, respiratory distress and hyperthermia were the most common reasons for hospitalization (37% and 22.2%, respectively), with 40% being resuscitated at birth. Infection and perinatal anoxia were the most frequent diagnoses, respectively 96.3% and 37%. The death occurred within the first three days of hospitalization in 60% of cases. Conclusion: In order to reduce the mortality rate in our facilities, monitoring of pregnancy and delivery, and correct management of newborns both at birth and in the pediatric wards are important.

Pneumothorax in Children: A Study of 47 Pediatric Cases at Mali Hospital 2017-2020

Objectives: Pediatric pneumothorax, whether primary or secondary (infection, trauma, or iatrogenic), is sometimes life-threatening. We tried to determine the clinical characteristics of pediatric pneumothorax in Mali. Materials and Methods: We collected all pediatric patients (0 - 15 years) admitted for pneumothorax in the pediatric department of the Mali Hospital from January 2017 to December 2020. Results: During this period, a total of 5569 children aged 0 - 15 years were hospitalized, of whom 47 had pneumothorax or 0.84%. Children under 5 years of age were the most affected (80%). Dyspnea was the most common reason for hospitalization (95.7%). The causes of pneumothorax were (in order): infectious causes dominated by bullous dystrophies (70.2%), traumatic (25.5%), and iatrogenic (4.2%). Pneumothorax was compressive in 42.6%. The frequency of anemia was 79.3%. Surgical drainage was performed in 87.2% and almost all (97.6%) were treated with amoxicillin/clavulanic acid. The mean duration of hospitalization was 10.06 days (range: 0 - 35 days): 74.5% were cured while 25.5% died. Conclusions: We reconfirmed that pneumothorax is a pediatric emergency. Children under 5 years of age are the most affected. The main etiologies are infectious bronchopneumonia. The prevention and treatment of respiratory infections, the implementation of good bacteriological diagnostic tools, and the use of surgical video-thoracoscopy will reduce its mortality rate.