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Etiologies et pronostic des comas non-traumatiques de l’enfant à l’hôpital universitaire de Lomé ?


B Balaka
L Douti
D Azoumah
B Bakonde
AD Agbere
K Kessie

Abstract

Aim: To determine the incidence, aetiology and outcome of non traumatic coma (NTC) in children aged between 1 month and 16 years.
Methods: All consecutive cases of NTC admitted from january to december 2006 in the University Teaching Hospital of Lomé (Togo) were prospectively studied. Coma was assessed by the classic coma scale and the Blantyre coma scale. All post-neonatal children admitted with acute NTC or turned into comatose patients over a 12-month period were analysed and followed up for 18 months.
Results: Out of 7149 children admitted, 387 (5,4%) cases of NTC, 199 boys and 188 girls, were recruited. 271 children (70%) were under 5 years of age. 280 cases (72,3%) were due to infection, 58 (15%) to toxic metabolic causes, 15 (3.9%) to hypoxic ischaemic insults, 9 (2.3%) to intracranial haemorrhage and 28 (7.2%) were due to miscellaneous causes. Severe malaria due to P. falciparum (44%) and bacterial meningitis (35.3%) were the predominant infectious causes. Of the 387 cases, 27.6% died, 72.3% recovered but 28.16% developed neurological sequelae and 44.2% were discharged well. Infectious coma (74.1% of recovery and 25.3% of lethality) and toxic metabolic coma (74.1% and 25.3%) had the same prognosis. Hypoxic ischaemic insults (83.3% of dead), Hypoxic ischaemic coma (66.6%), renal failure (50%) and coma of child under 5 years of age (41.4%) were causes of high mortality rate.
Conclusion: It is being established that infectious diseases are the commonest overall aetiology and children less than 1 year of age the main victim of NTC in African countries. Fighting infection with the national programmes for malaria and acute respiratory infection can reduce mortality and morbidity due to childhood NTC in our country.

Keywords: Coma; epidemiology; aetiology; prognosis; infection; child

J. Rech. Sci. Univ. Lomé (Togo), 2012, Série D, 14(1) : 33-40

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eISSN: 2413-354X
print ISSN: 1727-8651