Evaluation of the management of tuberculosis in children in Madagascar. Results of a multicentric study

In Madagascar, tuberculosis remains an important cause of morbidity and letality with a Risk of Annual Tubercular Infection about 1% in 1996 in spite of a vaccination rate of 82.6% and tubercular drugs free of charge. In 1995, the National Tubercular Control Program detected 7,000 cases of pulmonary tuberculosis and expected more than 12,000 cases per year. This study was carried out in order to review the management and the treatment of the child tuberculosis in Madagascar. This retrospective study was conducted in four pediatric units of the General hospital of Befelatanana (A and B), Ambohimiandra Hospital and Regional Hospital Centre of Toliara for a twenty four months period from January 1997 to December 1998. All the less than 15-year-old children medical files were consulted. 214 cases were suspected of tuberculosis. 133 of them were treated upon clinical presumption basis and/or radiological exams (33 bacteriological and/or histopathological exams were only realized). 56% of the cases were vaccinated by BCG vaccine. Respiratory diseases with fever motive 46% of hospitalization. The majority of these children are living in poor conditions and 38% of them had malnutrition. Were found as clinical manifestations: 47% of pulmonary tuberculosis (among them 20% were smear-positive pulmonary tuberculosis), 12% had ganglionar tuberculosis, 10% peritoneal tuberculosis, 8% a tubercular meningitis, 5% a Pott-disease and 2% a miliary-disease. Mortality increases with suffocation. 18% of cases died, especially infants and in tubercular meningitis. The authors conclude that management and treatment of tuberculosis need an early diagnosis. But the diagnosis is difficult in front of non specific clinical manifestations in children and due to lack of means and national agreement which settle up diagnosis and therapy. A scoring system based upon clinical signs in agreement with complementary medical tests is desirable.     

Poliomyelitis in Madagascar (1988-1996): current situation in the World Health eradication program by the year 2000

The number of acute flaccid paralysis (AFP) cases reported to World Health Organization (WHO) decreased from 1988 (48 cases) to 1996 (8 cases), but the real endemic situation of poliomyelitis is unknown. Cases are under or misreported. Very often, notifications are delayed; virological investigations of the etiology could not be performed as well as the environment studies and the immunization ripostes. In 1996, only one AFP case was confirmed by isolation of wild poliovirus. The immunization coverage in children under one by OPV (3 doses) was 73.0% in 1996 from the statistics of the Public Health Services but only 54.7% from randomized studies. The eradication of poliomyelitis by the year 2000 has engaged Madagascar in the disease prevention by improving the immunization coverage within the Expanded Immunization Programme in association with the Organization of National Immunization Days in October and November 1997. Likewise, the Virological Unit of the Pasteur Institute was recognized as the National WHO Reference Centre for Polio.     

Influenza in the pediatric hospital unit at Antananarivo

62 rhinopharingeal samples from malagasy children, aged of 6 days to 14 years old, hospitalized because of acute respiratory infections, with doubtful viral etiology case, during June to August 1992, at the "H?pital des Enfants" in Antananarivo, were examined by two methods: inoculation by embryonned eggs and inoculation by MDCK cells. 24.1% of the samples were positive. The repartition of the cases by age and by sex were studied. The children aged of 1 to 12 months were the most affected with 65.7% of all cases (male: 60%, female: 40%). One subtype was detected: A(H3N2).     

Localisations inhabituelles de la tuberculose : à propos de trois observations

We report three cases of tuberculosis of unusual location in Malagasy patients. The first patient presented with intracardiac tuberculoma during pulmonary tuberculosis. The second patient who had no significant musculoskeletal past medical history presented with tuberculous polymyositis. The remaining one presented with tuberculous epididymitis without involvement of the urinary tract. Diagnosis was histopathological. The outcome was favorable in the two last patients with antituberculous therapy. This report emphasizes the necessary awareness of tuberculosis even in the presence of unusual manifestations in hyper-endemic area of tuberculosis.