Audits of Death in HIV-Infected Children and Adolescents Followed up in the Pediatric Department of the Regional Teaching Hospital of Borgou/Alibori from 2005 to 2020

Introduction: Human immunodeficiency virus (HIV) is a major public health problem with high morbidity and mortality among children. The objective of this work was to audit the deaths of children and adolescents with HIV infection followed up in the pediatric department of the Regional Teaching Hospital of Borgou/Alibori (CHUDB/A) the from 2005 to 2020. Patients and Method: This was a retrospective and descriptive study conducted in the pediatric department of CHUD/B-A in Parakou. All children with HIV infection who died from January 1, 2005 to August 31, 2020 were included. Data collection was carried out in three stages: a phase of medical records processing, a phase of community survey and a phase of death audits. The variables studied were sociodemographic, clinical, biological, therapeutic and evolutionary. Results: Over the study period, the data of 464 infected children were recorded, including 92 deaths, representing a case fatality rate of 19.83%. Severe acute malnutrition (69.23%), gastro-intestinal tract infections (43.58%) and serious opportunistic pulmonary infections (24.36% pulmonary tuberculosis and 19.23% pneumocystis) were the main causes of death. The main dysfunctions found were: the delayed diagnosis of HIV infection (79.35%), the absence or delay in consultation when the child’s clinical condition deteriorates (32.61% and 47.83%), delayed initiation of antiretroviral treatment (42.39%) and non-adherence to treatment (38.04%). Non-adherence to treatment was predominant in adolescents (90.49%). Conclusion: Specific interventions for early detection, adequate nutritional care, psychosocial support for adolescents and mothers of children are necessary to reduce mortality due to HIV among children and adolescents.

Evaluation of Antibiotic Prescribing in the Pediatric Department of Gabriel TouréTeaching Hospital, Bamako, Mali

Objectives: The main objective was to evaluate antibiotic prescribing in the Department of Pediatrics at Gabriel Touré teaching hospital. Methods: This was a prospective descriptive study conducted from September 1 to November 31, 2018, in the Department of Pediatrics at Gabriel Touré teaching hospital. All children aged 0 to 15 years hospitalized for any pathology during the study period and having received at least one antibiotic had been included. Results: We collected 445 children’s records out of 1032 admissions during the study period, representing a hospital frequency of 43.1%. The sex ratio was 1.3%. The 2 - 5 age group accounted for 48.1%. Fever was the reason for consultation in 45.6% of cases. Patients’ general condition was altered in 60% of cases. The fathers were blue-collar workers in 65.4% and the mothers housewives in 85%, and had no education in 42.9% and 64.5% respectively. Hepatomegaly was present in 18.2%, splenomegaly in 9.6% and peripheral adenopathy in 3.1%. The site of infection was pulmonary in 37.6% and ENT in 9.2%. Bacterial infection was assumed on admission in 54% of cases, and meningitis in 57.7%. The discharge diagnosis was malaria in 54.6%, severe acute malnutrition in 18.6% and meningitis in 6.7%. The death rate was 3.8%. Neutrophilic leukocytosis was present in 47.3% of patients. CRP was positive in 85% of patients. Blood cultures taken in 27.6% of patients were positive in 5. CSF analysis in 30% of patients showed elevated leukocytes in 6.5%. No cultures were positive. Antibiotic prescription was justified by infectious hypotheses in 43.1% of patients. β-lactam antibiotics were prescribed in 98.6%. Antibiotic therapy was not adapted to national/international recommendations in 68.3% of cases, and was not justified in 16.3% of cases on D5 of hospitalization. Conclusion: Antibiotic use was justified in more than half of patients, but remained inadequate in almost two-thirds of cases, in line with national and international recommendations.

Epidemiological and Clinical Study of Cardiac Diseases in the Pediatric Department of the University Hospital Gabriel Touré(UH GT), Bamako (Mali)

Introduction: Children’s heart disease is a major public health problem in developing countries and especially in Mali. The purpose of our work was to determine frequency, different types of heart disease and their short term evolution in the pediatric department. Methods: We performed a retrospective study among children aged 0 to 15 years, hospitalized in the pediatric department from January to December 2015 and whose diagnosis was confirmed using trans-thoracic echocardiography. Results: We included 103 cases of heart disease out of a total of 8613 admissions in the pediatric department, giving an hospital prevalence of 1.2%. Mean age was 4.1 years (from 1 day to 15 years) and children under 5 years were the most affected with 73.80% of cases. Male predominance was noted (sex ratio = 1.2). Respiratory distress was the most common circumstance of discovery (93.20%). Cardiac murmur and tachycardia were the most common cardiac signs with respectively 88.35% and 83.50%. Congenital heart disease accounted for 70.87% and was dominated by ventricular septal defect (VSD) with 30.13%. Acquired heart disease (29.13% of the sample) was dominated by mitral regurgitation (MR) with 56.67%. Mortality rate was 31.9% for congenital heart disease and 11.1% for acquired heart disease. Conclusion: children’s heart disease is responsible for high mortality. Early detection improves the management of this pathology, which remains frequent.

Invasive <i>Haemophilus influenzae</i>Type b (Hib) Infections in Children in the Pediatric Department of the University Hospital Gabriel Touré(UH-GT)

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.

Pulmonary Complications in Children with Sickle Cell Disease Followed at the Pediatric Department of Gabriel Toure University Hospital

Objective: To study the pulmonary complications of major sickle cell syndromes in children aged 6 months to 15 years followed at the Department of Pediatrics of Gabriel Toure University Hospital. Materials and methods: This was a retrospective study from January 1st, 2017 to February 28, 2018 and a prospective study from March 1, 2018 to December 31, 2019, concerning sickle cell disease children followed at the Gabriel Touré University Hospital. All children with sickle cell disease confirmed by hemoglobin electrophoresis, aged 6 months to 15 years with a pulmonary complication and admitted to pediatrics were included. Were not included: 1) Infants and children with sickle cell disease not presenting a pulmonary complication coming only to their routine follow-up. 2) Sickle cell patients over 16 years of age and those whose parents do not consent. 3) Those who have not done electrophoresis. Results: During the study period, we were able to include 45 sickle cell children with a pulmonary complication. The frequency of pulmonary complications was 13.76%, involving homozygotes in 91.11% of cases. The age group 6 - 10 years predominated with 46.66% and the sex ratio was 0.45. Vaso-occlusive crisis was the most frequent reason for consultation with 35.56%. Respiratory distress (80%), fever (66.67%), crepitus rales (64.44%) and chest pain (60%) were the most frequent clinical signs. The main pulmonary complication was acute chest syndrome with 86.67%. Treatment was based on hydration (91.91%), analgesics (91.91%) and antibiotics (73.33%). Lethality was 4.44%. Conclusion: Pulmonary complications of sickle cell disease are serious and constitute the main cause of mortality in our context.

Factors Associated with Non-Adherence to Antiretroviral Therapy among HIV-Infected Adolescents at Pediatric Department of Yopougon University Hospital, Côte d’Ivoire

Context: The consequences of non-adherence to antiretroviral therapy (ART) are harmful in terms of morbidity and mortality among HIV-infected adolescents. There is a little data in this population in West Africa, about non-adherence to ART. Objective: To identify factors associated with non-adherence to ART in adolescents at the Pediatric Ambulatory Treatment Center (PATC) of the pediatric department of Yopougon University Hospital. Materials and Methods: A cross-sectional study was conducted from May to July 2017 among adolescents aged 10 to 19 years old at PATC of pediatrics department of Yopougon University Hospital. We have considered that adolescent was not adherent to ART when he affirm that he have not taking ART at least once in the week before the survey. A logistic regression model was used to identify factors associated with non-adherence to ART. Results: Overall 166 adolescents were included. The median age was 15 years old [IQI = 13 - 17 years]. They had a detectable viral load greater than 1000 copies/ml in 41.8% of cases. The rate of non-adherence to ART was 40.4%. The factors associated with non-adherence to ART were male [OR = 2.5 (CI = 1.1 - 10.0)], having parent widowed [OR = 7.8 (CI = 1.6 - 39.3)] or divorced [RC= 3.7 (IC=1.1 - 13.5)], CD4 inclusion rate ≥ 500 cells/ml [OR = 8.5 (CI = 1.6 - 45.5)] and duration on ART ≥ 10 years [OR = 8.9 (CI = 1.6 - 50)]. Conclusion: A rigorous therapeutic education taking into account associated factors in this study is necessary to reduce the rate of non-adherence among adolescents at PATC.

Urinary Tract Infection in Pediatric Emergency Department of Mohamed VI Hospital in Marrakech: Epidemiological Profile and Antibiotic Resistance

Background: Urinary tract infection (UTI) is one of the most frequent bacterial infections in pediatrics. The aim of our work was to establish the epidemiological and bacteriological profile of UTIs in children and then to study the sensitivity of the bacterial strains isolated to antibiotics. Materials and methods: This is a retrospective descriptive study over 3 years (2019-2022), including all cytobacteriological examination of urine (CBEU), performed in children aged 3 months to 14 years, admitted and treated for UTI, in the pediatric emergency department of Mohamed VI University Hospital. Results: A total of 239 children were included in our study. The mean age was 26 months. The sex ratio was 1.08. Escherichia coli was the most isolated bacterial strain in 79% of samples. The tested strains showed a high level of sensitivity to susceptibility rate toward amikacin (91%) and ciprofloxacin (100%) and whereas the level of resistance was high to the most current recommended antibiotics, mainly beta-lactams. Management was based, in severe forms of pyelonephritis, dual antibiotic therapy based on Third-generation cephalosporins combined with gentamycin. Favorable outcome was noted in 94% of children. Conclusion: Awareness-raising on the proper use of antibiotics, issuing national recommendations for the treatment of urinary tract infections in order to standardize therapeutic regimens is strongly recommended. Effective control of these infections requires a global prevention strategy that implies close collaboration between epidemiologists, clinicians, bacteriologists, hygienists and the health care team.

Characteristics of Deaths of Children in the Pediatrics Department of Hôpital Spécialisé Mère-Enfant Blanche Gomes (Republic of the Congo) from 2019 to 2021

Introduction: The United Nations Sustainable Development Goals (SDGs) aim to decrease the global maternal mortality ratio to below 70 per 100,000 live births and eliminate preventable deaths of newborns and children under the age of five in all countries by 2030. The pediatric department at Spécialisé Mère-Enfant Blanche Gomes Hospital (HSMEBG) is divided into two sectors, one catering to children aged one month to four years and the other dedicated to children aged five to 17 years. According to department records, over the past three years, there has been an average of 1050 hospitalizations per year, with an average duration of five days. Objectives: This study aims to describe the socio-demographic characteristics of children who died while in the pediatrics department of the HSMEBG and analyze the factors associated with their deaths. Methodology: A retrospective analytical cross-sectional study was conducted, collecting data over a three-year period, covering the years 2019, 2020 and 2021. Data were collected from medical records of deceased children using Excel software version 2016, and statistical calculations and logistic regression were performed using Epi info software version 7.2.5.0. Results: During the three years of operation, the pediatric department at HSMEBG recorded 3060 new admissions, of which 271 resulted in death, representing an overall frequency of 8.8%. December and January had the highest mortality rates, accounting for 15.5% and 12.5%, respectively. Out of the 271 recorded deaths, 143 (52.77%) occurred in children under the age of one, and 230 (84.87%) occurred in children under the age of five. The average age at death was 2.4 years, ranging from one month to 17 years. The sex ratio was 1. More than half of the deaths (51.66%) occurred during the night, and 165 (60.89%) sought medical help more than three days after the onset of symptoms. Weekend deaths accounted for nearly half (45.7%) of the cases. Upon admission, slightly over half of the children (55.72%) had impaired consciousness, 219 (80.81%) presented with respiratory distress, and 194 (71.59%) had a fever. The average time from admission to administering the first medication was 72 minutes. Respiratory infections were the leading cause of death, accounting for 83 (30.26%) cases, followed by severe forms of malaria (anemic and neurological) at 23.25%. Among the 271 recorded deaths, 33 (12.18%) received no treatment before their demise, and 136 (50.18%) died within the first 24 hours of hospitalization. The average duration of hospitalization for patients who spent less than 24 hours was 15 hours, while those who died after the 24th hour had an average hospital stay of five days, ranging from one to 41 days. Children under the age of five who were admitted with impaired consciousness had roughly double the risk of dying compared to those without this condition (p = 0.001). Conclusion: The overall mortality rate in the pediatric department at HSMEBG is 8.8%. Acute respiratory infections are the primary cause of death. Improving this rate necessitates reducing consultation and treatment durations.

Prevalence of Malnutrition among Hospitalized Pediatric Patients in a Tertiary Hospital in Jordan: Pilot Study

Introduction: Failure to thrive (FTT) occurs when a child’s growth falls below expected standards, typically due to inadequate nutrient intake. Factors include insufficient oral intake, poor nutrient absorption, and increased metabolic demands. Previous studies have shown high malnutrition rates in hospitalized children due to illness-related metabolic demands, decreased appetite, and inadequate intake. Our objective was to assess the growth and nutritional status of children admitted to King Abdullah University Hospital (KAUH) and identify the prevalence of undernutrition and associated factors. Methods: This prospective, cross-sectional cohort study was conducted at KAUH from July to December 2022. We included children aged 2 months to 16 years, excluding those with conditions altering growth parameters. Data were collected through pediatric data sheets, physical examinations, and laboratory tests. Anthropometric measurements were taken, and growth was assessed using CDC growth charts. Nutritional anemia was defined as hemoglobin 16. Results: A total of 111 patients were included (56.8% male, median age 65 months). Most patients had normal height (82%) and weight (86.5%) upon admission. However, 14.4% were stunted, 11.7% were underweight, 14.4% were overweight, and 3.6% were obese. Growth impairment correlated with higher anemia rates (p = 0.042). Nutritional anemia was present in 12% of patients. No significant relation was found between breastfeeding history and growth retardation, but maternal perception of malnutrition correlated well with actual malnutrition. Conclusion: Our study found a malnutrition prevalence of 19.8%, highlighting the need for systematic nutritional screening in hospitalized children. The study’s limitations include its small sample size and specific patient population, suggesting the need for larger, multicenter studies for more generalizable results.

Survey on Blood Transfusion Practices among Medical and Paramedical Staff in the Pediatric Unit of the Mohammed VI University Hospital in Marrakesh, Morocco

Blood transfusion is a complex activity, involving many actors. As a high-risk activity, it necessitates the implementation of specific methods for effective control. The safety of blood transfusion is significantly influenced by the beliefs of healthcare workers and organizational factors, constituting two major considerations. We conducted a cross-sectional, descriptive, and analytical survey to examine the knowledge and practices related to transfusion among the medical and paramedical staff at the Pediatric Department (Mother-Child) of CHU Mohammed VI from September 1, 2022, to December 31, 2022. Among the 135 staff members interviewed, only 41% had received training in blood transfusion. A majority (65.2%) of the staff noted that a mismatch in cross-matching led to transfusion complications. Two-thirds (66.7%) identified chills as the primary clinical sign of potential accidents. Regarding elements to monitor during a reaction, hemolysis (78.5%) and temperature (76.3%) were most commonly mentioned. Surprisingly, more than half (53.3%) of the personnel interviewed did not conduct post-transfusion monitoring. This survey highlighted significant deficiencies in knowledge and practices related to transfusion. To address these issues, we recommend implementing guidelines and providing tailored training for the staff, aiming to rectify these deficiencies and enhance overall practices.

Practice of Glycemic Self-Monitoring in Diabetic Patients Followed at the Endocrinology Department of Donka University Hospital in Guinea

Diabetes is a chronic pathology whose evolution is marked by micro and macroangiopathic complications. Optimal management can prevent the onset of complications and improve patients’ quality of life. Objectives: To determine the frequency of self-monitoring of blood glucose and to describe the errors found during self-monitoring in diabetic patients followed at the Endocrinology Department of Donka University Hospital in Guinea. Materials and methods: Descriptive cross-sectional study carried out between August and September 2020 involving diabetic patients followed up at the Endocrinology and Diabetology Department of the Donka National Hospital, CHU Conakry. Results: A total of 301 patients were enrolled, with an average age of 44.24 ± 21.01 years. 64.12% were female. Type 2 diabetes predominated in 64% of cases. The mean duration of diabetes was 6.14 ± 4.67 years, and 75.08% of patients lived in urban areas. Patients were on insulin in 36.21% of cases, insulin and biguanides (26.25%), hypoglycemic sulfonamide and biguanides (19.27%) and biguanides in 18.27% of cases. The frequency of self-monitoring of blood glucose was 43%, and 38% of patients made errors, notably reusing lancets (60%), not checking the expiration date (55.65%) and not washing their hands (48%). Conclusion: This study shows that self-monitoring of blood glucose is not performed by the majority of patients. Numerous errors were identified during blood glucose testing. Continued therapeutic education on the use of blood glucose meters will help empower patients and improve their quality of life.

The Management of Neonatal Peritonitis in the Paediatric Surgery Department of the Donka National Hospital

Introduction: Neonatal peritonitis is a rare but serious condition requiring early diagnosis and management. The lack of antenatal diagnosis, the precariousness of neonatal intensive care, and the delay in diagnosis and treatment are the factors of poor prognosis. The objective of this study was to study the epidemiological, diagnostic and therapeutic aspects of neonatal peritonitis in order to improve its management in the pediatric surgery department of the CHU-Donka. Materials and Methods: This is a retrospective descriptive study of the records of patients treated for neonatal peritonitis from January 1, 2017 to December 31, 2022. Results: Results: We compiled 17 records of patients operated on for neonatal peritonitis, representing a frequency of 3.85% and an incidence of 2.83 cases/year. The mean age of our patients was 8.29 days, with extremes of D0 and D25. Males were more dominant, with a frequency of 71% and a sex ratio of 2.4. The average consultation time was 72 h, with extremes of 12 h and 144 h. Abdominal bloating was the main reason for consultation (100%). Fever and vomiting were frequent, at 70.59% and 82.35% respectively. PSA revealed pneumoperitoneum in 12 patients (70.59%). The colon was the most frequent site of perforation at 29.41%. ECUN was the main etiology with 35.29%. Ostomy was the main surgical procedure in 58.82% of cases, followed by suture excision in 29.41%. Postoperative follow-up was simple in 3 patients (17.65%) and complicated in 14 (82.35%). Sepsis was the main cause of death (47.59%). The mortality rate was 76.47%. Conclusion: Mortality from neonatal peritonitis remains high in developing countries. Early diagnosis, early surgical management, and the presence of well-equipped neonatal intensive care units with qualified staff are essential for an improvement in the prognosis of neonatal peritonitis.

Factors Associated with Mortality in Children Aged 1 Month to 15 Years Hospitalized in the Pediatric Ward of the Kalaban-Coro Reference Health Center: Cross-Sectional Study

Introduction: Infant and child mortality is a worldwide concern, but developing countries such as Mali are more affected. The aim of this study was to investigate morbidity and factors associated with mortality in children aged 1 month to 15 years. Methodology: This was a cross-sectional study which took place from January 1 to December 31, 2020 covering children aged 1 month to 15 years hospitalized at the Kalaban-Coro CSRéf. Data were entered into Excel and analyzed using SPSS version 20 software. Results: Five hundred children aged 1 months to 15 years were included. The age range 1 to 5 years (53.6%) and male sex (58.2%) were the most represented. Malaria (72.2%), acute respiratory infections (6.2%) and diarrhea/dehydration (3%) were the main morbidities. Mortality was estimated at 10.6%, and the two main causes of death were malaria (56.6%) and acute respiratory infections (7.54%). Univariate analysis revealed a statistically significant association between the dependent variable (death) and age (p Conclusion: This study confirms the high rate of infant and child morbidity and mortality in our health facilities. Strengthening human resources and intensifying behavior-change communication can help reverse the trend.

Congenital Cervico-Mandibular Cystic Lymphangioma in Pediatric Surgical Setting in Guinea

Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors remain potentially fatal, due to possible compression of the upper aero-digestive tract. The aim of this work is to study the epidemiological, diagnostic and therapeutic characteristics of cervico-mandibular congenital cystic lymphangiomas in the pediatric surgery department of the Donka National Hospital (HND) Conakry. Patients and methods: This is a retrospective and descriptive study of 13 files lasting 7 years from January 2015 to December 31, 2021. The files of children whose age is less than or equal to 15 years operated on cervical tumor with histological evidence of cystic lymphangioma were retained. The data were analyzed using SPSS statistical software 21 and anonymously. Results: The incidence of this study was 1.86 cases per year and a sex ratio of 0.62 in favor of girls. The average age was 8 months 19 days. In the antecedents, we only find poorly monitored pregnancies. The average size of the tumors was 11.85 cm. Cervical ultrasound and standard x-ray of the cervical mass were the only examinations performed. Total surgical excision of the cervical tumor was performed in all patients. The mass was polycystic on exploration. The histological examination of the surgical specimens was in favor of a cystic lymphangioma. The surgical consequences were simple in 11 patients (84.62%) and complicated by parietal suppuration in 2 cases (15.38%). There were no cases of recurrence after one year of follow-up. Conclusion: Cervico-mandibular cystic lymphangiomas are the most frequent locations of congenital lymphangiomas in children. Their severity is linked to the risk of compression of the aero-digestive tracts. Their diagnosis must be confirmed by the histology of the surgical specimen. Despite the therapeutic arsenal, excision of the cystic mass remains the only effective alternative in our socio-economic conditions to avoid recurrences and loss of follow-up of patients.

Cancellation Causes of Elective Surgical Procedures in a Major Pediatric Surgery Department

Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work was to determine the causes of cancellation of elective surgical operations in a major pediatric surgery department in Senegal. Patients and methods: It was a prospective and descriptive study of 278 patients scheduled during a period of 13 weeks. The study took place between April 3rd, 2017, and January 31st, 2018. Mean age was 2.9 years with extremes of 3 days and 15 years. The age group of 29 days to 30 months was the most represented (62.2%). Sex ratio was 1.41. Causes of cancellation were categorized into administrative and organizational causes, patient-related causes and staff-related causes. Results: Cancellation rate was 29.4%. Patient-related causes were most common (51.2%). Upper Respiratory tract infection (URTI) was commonest reason within this category (57.5%). Organizational causes (28.1%) came second and were mainly represented by the unavailability of the operating room (60.8%) related to breakdowns of anesthesia equipment. Finally, staff-related causes (20.7%) were due for most to the unavailability of the anesthesiologist (12 cases/17). Conclusion: Majority of causes that led to cancellation of elective surgical operations in our Pediatric surgery department are related to intercurrent illnesses affecting the patient, in particular URTI.

Knowledge, Attitudes and Practices of the Health Personnel of the Pediatric and Gynecology-Obstetrics Departments of the BouakéUniversity Hospital Center (CHU) regarding the Intestinal Microbiota and the First 1000 Days of Life

Introduction: The harmonious development of the intestinal microbiota during the first 1000 days of life promotes the child’s immediate and future good health. The objective of the study was to evaluate the knowledge and practices of health personnel on the intestinal microbiota and the first 1000 days of life for the improvement of child health. Methods: Knowledge, attitudes and practices (KAP) type survey conducted among health personnel of the pediatric and gynecology-obstetrics departments of the Bouaké University Hospital from July 1 to 31, 2017. All consenting agents working in the said services and present at the time of the study were included. The parameters studied concerned socio-professional characteristics, knowledge of the intestinal microbiota, and knowledge and practice of the first 1000 days. The data analysis was descriptive and analytical with a significance threshold p ≤ 0.05. Results: Out of 224 active agents, 76 (30 men, 46 women) participated in the survey, i.e. 33.9%. The respondent came from the gynecology-obstetrics (54%) and pediatrics (46%) departments and had professional experience >5 years in 38%. Thirty-eight percent of the respondents had a good knowledge of the intestinal microbiota. Concerning the first 1000 days of life, 64.5% of the respondents had a good knowledge of the first 1000 days overall. They advised exclusive breastfeeding for up to 6 months in 95% of cases. When breastfeeding was not feasible, the main criterion for choosing the infant formula was the composition (57.1%). They proposed a standard infant formula (43%), enriched with prebiotic (29.4%), enriched with probiotic (21.6%), a symbiotic (6%). Good knowledge of the intestinal microbiota was associated with belonging to the paediatric service (p = 0.013), socio-professional category (p = 0.031), year of experience >5 years (p = 0.032) and the first 1000 days of life to year of experience >5 years (p < 0.01). Conclusion: The health personnel interviewed did not have a good knowledge of the intestinal microbiota and the first 1000 days. Capacity building is needed.

Evaluation of the Management of Infant Respiratory Distress at the CNHU-HKM Pediatric Emergency Department

Introduction: Respiratory distress (RD) is a major emergency to which infants are particularly vulnerable. It can lead to neurological sequelae and even death when treatment is not adequate and rapid. Objective: To evaluate the management of RD in infants at the CNHU-HKM in Cotonou. Methods: The study was of a transversal and analytical nature and took place over a period of 06 months, from 1st January to 30th June 2015. Included in the study were all infants hospitalised for DR. The therapeutic modalities were analysed according to the recommendations of the World Health Organization. Results: A total of 96 infants were included. The hospital frequency of DR was 38%. The average age was 12 months. One in 3 infants had SaO2 less than 90% on admission, and in 58.3% of cases, the infant showed at least 3 signs of struggle. The initial assessment was as recommended. The systematic use of oxygenrequires a revision of the criteria for oxygentherapy in the unit. The three main causes were severe pneumonia (31.3%), severe malaria (18.8%) and bronchiolitis (15.6%), and their treatment was correct. However, none of the infants had been able to benefit from ventilatory support. Mortality was high (31.2%) linked to the intensity of DR (p = 0.04) and sepsis (p = 0.006). Conclusion: The procedures for the diagnosis and treatment of RD in infants at the CNHU are fairly consistent with WHO guidelines. Ventilatory support is necessary for some children with severe RD.

Frequency of Group A Beta-Hemolytic Streptococcal Angina in Children in the Department of Pediatrics of Donka National Hospital

Background: Angina is a common paediatric condition. It has certain peculiarities in children, particularly with regard to the frequency of bacterial germs and the use of diagnostic tests. The aim of this study was to determine the place of the rapid diagnostic test in the management of group A beta-hemolytic streptococcal angina in children in the paediatric ward at Donka National Hospital. Methods: This was a prospective descriptive study lasting 6 months from 1st February to 31st July 2019 concerning children aged between 3 and 15 years old who were diagnosed with angina. Epidemiological, clinical, para-clinical and therapeutic variables were studied. Results: Out of 1494 registered children, we collected 116 cases of angina (7.76%). Out of 52 patients who benefited from the rapid diagnostic test, we recorded 13 cases of angina due to group A beta-hemolytic strptococcus. The male sex was the most dominant with 31 cases (59.69%) and a G/F sex ratio of 1.47. The age group most affected was between 3 and 5 years old (50%). The average age of our patients was 4.8 years with extremes of 3 and 14 years. Clinical manifestations were dominated by fever and dysphagia (100%) followed by odynophagia (11.79%). We recorded 13 cases of streptococcal angina (25%). Conclusion: The factors that influence it are multiple, dominated by community life, passive smoking and allergies. The use of RDTs in these young children would help in the diagnosis of acute group A beta hemolytic streptococcal angina and rational antibiotic prescription.

The Scrotoschisis about a Case in the Pediatric Surgery Department of the Donka National Hospital

Introduction: Scrotoschisis is a very rare congenital defect of the scrotum characterized by the exteriorization of one or two testes. We report a case of right scrotoschisis in a newborn as well as a review of the literature for an approach of probable etiology. Patient and Observation: A newborn baby of 8 hours of life, weighing 3200 g was referred to our department for a right scrotal defect with exteriorization of the testis associated with fluid swelling of the left bursa. The 18-year-old mother, primiparous and primigeste followed all the prenatal consultations with eutocic delivery. After clinical investigation the diagnosis of right scrotosisis and left hydrocele was retained. Surgical treatment was carried out by primary closure after orchidopexy and exploration of the contralateral bursa, the content of which was calcified meconium bathed in a yellowish liquid. The post-operative consequences were simple. Conclusion: Scrotoschisis is an extremely rare birth defect whose etiology is poorly understood. However, it could be the cause of meconium peritonitis secondary to a scarred fatal intestinal perforation.

Upper Extremities Injuries in Children Attending Pediatric Emergency Department-SFH, Riyadh-Saudi

Trauma is a physical injury caused by violence or other forces;in serious trauma, the patient will be at risk of death or loss of function. Trauma is a leading cause of morbidity and mortality among all age groups. Objective: To study the pattern and outcome of upper limbs trauma in children attending the pediatric emergency department. Methodology: This was a retrospective cross-sectional study conducted in the Department of Pediatrics at Security Forces Hospital-Al-Riyadh. Result: Total number of patients seen during the study period was 343 patients, their age range between 6 months and 13 years old with a mean age of 5.473 (±3.8572);also, results showed boys were 187 (54.5%) patients and girls were 156 (45.5%) patients. Based on the site of trauma in the upper limbs, lacerations were in 114 (33.2%), Hand and/or wrist fracture in 67 (19.5%), Nursemaid Elbow in 43 (12.5%), both Radius and Ulnar bones fracture in 33 (9.6%), Radius bone fracture in 29 (8.5%), supracondylar fracture in 22 (6.4%), Clavicle bone fracture in 20 (5.8%), Humorous bone fracture in 7 (2%), Condylar bone fracture 6 (1.7%), and there was 1 (0.3%) patient with Scapulae and Ulna fracture.