[Cerebral cysticercosis in Madagascar. Proposal of a diagnostic algorithm]. / La cysticercose cérébrale à Madagascar: proposition d'un algorithme de diagnostic.

Neurocysticercosis is endemic in Madagascar. It is caused by fecal-oral contact and is common in developing countries where hygiene and sanitation are poor. Cerebral involvement is more frequent than spinal involvement. Definitive diagnosis remains difficult and no consensus has been established on optimal workup. The aim of this report describing two cases of cerebral cysticercosis in Madagascar was to assess the utility of various clinical and laboratory findings and to propose a diagnostic algorithm that is compatible with locally available facilities.

[Psychiatric disorders in Madagascar: clinical study of 376 cases registered in Mahajanga]. / Les troubles psychiatriques à Madagascar: étude clinique de 376 cas répertoriés à Mahajanga.

Epidemiological and clinical data on psychiatric disorders from Madagascar are rare, particularly those issued from the coastal provinces. This retrospective study of cases, registered in the hospital of Mahajanga, from January 1st 1998 to December 31st 2000, gives a general scope on their frequency, their distribution and their features in this North Western littoral of the island. Concurrent resorts (traditional and religious healers) may reduce hospitalisation rate, by filtering minor and brief mental disorders at their level, but they delay the accurate management of severe or complicated cases, and enhance their frequency. The features of depression, the first cause of referrals (136/376), are characterized by the predominance of somatic complaints (89/136) over psychic symptoms (47/136), by that of persecutory ideas on self culpabilization and loss of self esteem, which accounts for the rarity of suicide (only 4/136 cases). Patients are sensitive to lower dose of antidepressant drugs, compared with patients from occidental countries. Psychosis, the second cause of medical resort (95/376), are essentially represented by schizophrenia (57/95), which involves males more than females (sex ratio 2), and displays more hebephrenic symptoms (31/57) than paranoid's (24/57). In spite of serious economical constraints, family dismissal is rare. Implementation of an accurate drug policy (long acting neuroleptics supply), along with this family support, may enhance patients' reintegration. Addictive (drugs, alcohol) and anxiety disorders seem to be underrepresented. In conclusion, the same pathologies reported in western literatures are encountered, but their features are sometimes modified by cultural particularities. A recent general population survey has brought complementary data, but this clinical study needs reproduction in other provinces, to be representative of the whole island.

[Sociocultural aspects of epilepsy in Madagascar. K.A.P. survey carried out in Antananarivo]. / Aspects socioculturels de l'épilepsie chez le Malgache. Enquête C.A.P. faite à Antananarivo.

A general population survey on knowledge, attitudes and practices (K.A.P.) concerning epilepsy was conducted from 1st July to 31st December 1997 in Antananarivo, a region representative of ecological and cultural patterns of the Malagasy "Highlands". The sample, randomly selected according to the two-step cluster method, recruited 1392 men and women aged 18 years and older who were interviewed with a 16-item questionnaire. Knowledge and practices have significantly evolved since 1983, when a similar study was conducted. More natural explanations are given for the condition and health-care seeking is more common. However, popular attitudes towards the epileptic patient remain contradictory: the majority of those interviewed claimed to be tolerant; work and marriage could be envisaged for the epileptic patient, but not total freedom of movement nor regular school attendance. A more active popularisation of the disease thus appears to be necessary. Since some 60% of people had a radio, broadcasting and church involvement would be the most effective means towards this end. Traditional practicer do not seem to have an overwhelming influence; rather, healthcare seeking behaviour was determined by the availability of service, the efficacy of the intervention and cost. To be representative of Madagascar as a whole, our data should be compared to those of other surveys in more culturally enclosed and disadvantaged areas.