PURPOSETo evaluate the results of an intensive polychemotherapy regimen for Burkitt lymphoma (BL) in sub-Saharan African pediatric centers.PATIENTS AND METHODSChildren with advanced-stage BL (stages II bulky, III, and IV) treated with the GFAOP–Lymphomes Malins B (GFALMB) 2009 protocol in 7 centers between April 2009 and September 2015 were prospectively registered. Treatment regimen contained a prephase with cyclophosphamide followed by 2 induction courses (cyclophosphamide, vincristine, prednisone, high-dose methotrexate [HDMTX]), 2 consolidation courses (cytarabine, HDMTX), and a maintenance phase only for stage IV. HDMTX was given at the dose of 3 g/m2.RESULTSFour hundred patients were analyzed: 7% had stage II bulky, 76% stage III, and 17% stage IV disease. Median age was 7.3 years, and sex ratio was 1.9:1 (male:female). A total of 221 patients received the whole protocol treatment and 195 achieved complete remission (CR), 11 of them after a second-line treatment. Treatment abandonment rate was 22%. One hundred twenty-five patients died, of whom 49 deaths were related to treatment toxicity. A total of 275 patients are alive, including 25 despite treatment abandonment, but only 110 are known to be in CR with a follow-up > 1 year, indicating a high rate of loss to follow-up. Twelve-month overall survival (OS) was 60% (95% CI, 54% to 66%) and 63%, 60%, and 31%, respectively, for stage II bulky, III, and IV. Patients with stage III disease who started second induction course within 34 days had OS of 76%, versus 57% (P = .0062) beyond 34 days.CONCLUSIONThe GFA-LMB2009 protocol improved patients’ survival. Early dose intensity of treatment is a strong prognostic factor. Improving supportive care and decreasing loss to follow-up are crucial.

The parents 'educational conditions are one of the factors of health inequalities among children. During May 2009, the parents' instruction level of children admitted at the triage unit of a Pediatric Service in Antananarivo, Madagascar was evaluated and related to the severity of their children' health status and to the mode of reference. All the surviving children (from 2 months to 15 years old) were included in this study. Patients were classified by the IMCI guideline and we analyzed the educational level of their mothers. Each patient was classified as severe illness or without severe illness, according to IMCI algorithm. The quality of referring physician was recorded: public physicians, liberal physicians, nurses, or without referral. Among 296 children, 9 (3%) died before admission, 217 (75.6%) were included. Among them, 123 (56.7%) had a severe illness and 38,2% general signs of danger. The severity (92.3 versus 54.4%; P = 0.003), the number of severe dehydration (15.4 versus 3.9%; P = 0,027) and malnutrition (15.4 versus 4.4%; P = 0.039) were related with a poor parents educational level. The referral agents were mostly liberal physicians (56.7%), public physicians (26.7%) or nurses (1.8%). Mothers with higher educational level preferred to attend liberal physicians (58 versus 41.9%; P = 0.1). The reference delay was shorter if there was a severe illness (6.41 versus 19.6 days; P < 0.000) or no medical referral (51.1 versus 24.4%; P > 0.000). Despite the fact that access to hospital care was respectful of a two-step process (85.3%), the number of patients with severe illness was high among families with low educational level. Theses results suggest to educate in priority the mother with low education, in order to recognize the general signs of danger and facilitate early first health care.

We report a prevalence of 18.2% for M. pneumoniae infection in children in Madagascar. The prevalence of M. pneumoniae infection was higher in the control patients than in asthmatic ones.

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Justification: Tetanus, fatal disease, still exists in Madagascar in spite of the vaccination sessions of mass, and attacks also the children. Objective: To describe the epidemiology, the clinical aspect, the treatments and the evolutions of infantile tetanus. Patients and methods: Retrospective study in the pediatric intensive care unit of the University Hospital of Tamatave, on the cases listed during four years (2013-2016). Results: Twenty-seven cases were recensed, with an average age of 10.8 years old and a sex ratio (M/W) equal to 6. Only forty-one percent were already vaccinated before the one year age. No child of more than 11 years-old profited from vaccine recall. The stain of the wound after the ablation of flea was the most frequent cause (76%). Tetanus was generalized in 80%, including 44.4% with respiratory disorder having required intubation. All the children presented hyperthermia above 38°C at the entry and 63% higher or equal to 40°C. Sedation by diazepam, used at all children, was used with an average amount of 4 mg/kg/day. The beta-lactamine antibiotics were used in 100% of the cases. The antitetanus serum was administered at 3000 IU/day. Nosocomial infections occurred in 61%. The mean hospitalization duration was around 11 days. Mortality was 47%. Discussion and conclusion: The vaccine recalls are still negligent in the old children, making these latter vulnerable. Mortality is especially due to superinfections and denutrition.