Dietary Patterns Measured by Principal Component Analysis and its Association with Stunting among Nepalese Schoolchildren in Nepal.

Background There is a gap of knowledge on the link of major dietary patterns with stunting among schoolchildren in Nepal. Objective To identify dietary patterns in rural Nepalese households in two districts and assess their association with stunting among schoolchildren. Method This cross-sectional study gathered data from 708 schoolchildren aged 8-16 years participating in the baseline survey in the Districts of Dolakha and Ramechhap, Nepal. We derived major dietary patterns from a principal component analysis of reported intake from a food frequency questionnaire completed through interviews with the caregivers. Statistical analysis was conducted using mixed logistic regression with random intercepts at the level of schools adjusting for socio-demographic and behavioural indicators. Result The diet of surveyed schoolchildren was mainly comprised of starchy staples and legumes. Five dietary patterns score were derived: mixed food, vegetables and lentils, milk and beverages, salty snacks, and processed food. The vegetables and lentils pattern scores were negatively associated with stunting (aOR 0.84; 95% CI: 0.66-1.08, p=0.17) after adjusting for regional differences, demographic and behavioural risk factors. Conclusion Our results suggest that adherence to dietary patterns high in vegetables and animal protein might be associated with reduced odds of being stunted among schoolchildren. Therefore, the promotion of dietary diversification strategies to improve schoolchildren's food consumption is required in the study area.

[The impact of urbanization on malaria infection rate and parasite density in children in the municipality of Yopougon, Abidjan (Côte d'Ivoire)]. / Impact de l'urbanisation sur l'indice plasmodique et les densités parasitaires chez les enfants de 0 à 5 ans dans la commune de Yopougon, Abidjan (Côte d'Ivoire).

From September 23-30, 2005, we conducted a cross-sectional study in six townships of Yopougon, a municipality of Abidjan. These townships were grouped in three levels of urbanization (village, precarious township, and residential township). The main objective of this survey was to determine the impact of urbanization on the malaria infection (parasite) rate and parasite density, and their consequences on the heterogeneity of malaria transmission in urban Abidjan. Specifically we compared these rates in all three urbanization levels, selecting two townships for each level to take environmental specificities observed from previous data into account. The study included 400 households per township. All children younger than 5 years in these households were included. Thick and thin blood smears were taken for each child on slides, and each slide was examined by microscope after staining. The malaria infection rate was 21.8%, indicating mesoendemic malaria. Its distribution varied significantly between the three urbanization levels. Malaria parasite densities also varied significantly between them. These results confirm the involvement of urbanization in the heterogeneity of malaria transmission in the city of Abidjan.

Quantitative microbial risk assessment related to urban wastewater and lagoon water reuse in Abidjan, Côte d'Ivoire.

We assessed the infection risks related to the use of wastewater in Abidjan, Côte d'Ivoire, by using quantitative microbial risk assessment (QMRA). Giardia lamblia and Escherichia coli were isolated and identified in wastewater samples from the canal and lagoon. The exposure assessment was conducted using a cross-sectional survey by questionnaire with 150 individuals who were in contact with the wastewater during their daily activities of swimming, fishing, washing, and collecting materials for reuse. Risk was characterised using the Monte Carlo simulation with 10,000 iterations. Results showed high contamination of water by G. lamblia and E. coli (12.8 CFU/100 mL to 2.97 × 10(4)CFU/100 mL and from 0 cyst/L to 18.5 cysts/L, respectively). Estimates of yearly average infection risks for E. coli (90.07-99.90%, assuming that 8% of E. coli were E. coli O157:H7) and G. lamblia (9.4-34.78%) were much higher than the acceptable risk (10(-4)). These results suggest the need for wastewater treatment plants, raising awareness in the population in contact with urban wastewater and lagoon water. Our study also showed that QMRA is appropriate to study health risks in settings with limited data and budget resources.

[Prevalence of infantile diarrhea in districts of Nouakchott (Mauritania) in 2008: analysis of local hygiene]. / Prévalence des diarrhées infantojuvéniles dans deux districts de Nouakchott (Mauritanie) en 2008: analyse de l'influence de l'hygiène du milieu.

In urban areas in Nouakchott, diarrheal diseases present a major public health problem, especially for children and adolescents. In August, 2008, a cross-sectional survey of 300 households in two adjacent districts of the city sought to study correlations between diarrheal disease and environmental health. The results show that 87 children of all ages had about 139 episodes of diarrhea, for an average prevalence of 14.8% that varied by age (23.6% in children younger than 5 years and 9.7% among children aged 5 to 14 years) and area (16.8% in Tevragh-Zeina and 28.3% in Sebkha). The univariate analysis indicates that 52% of the diarrhea risk was due to precarious basic hygiene. Studies of the specific causes of diarrheal diseases to help improve their treatment are necessary to supplement these epidemiological results.

[Socio-economic impact at the household level of the health consequences of toxic waste discharge in Abidjan in 2006]. / Impact socio-économique du déversement de déchets toxiques à Abidjan en 2006 à l'échelle des ménages.

In August 2006, toxic wastes were discharged in the district of Abidjan, causing important health consequences in many households in the area. In order to appreciate the socio-economic impact of the consequences of toxic waste discharge on the households and of the measures taken by the authorities to deal with this catastrophe, and to appreciate the spatial extent of the pollution, we undertook a multidisciplinary transversal investigation at the sites of discharge of oxic waste, from October the 19th to December the 8th, 2006, using a transect sampling methodology. This paper presents the results related to the socio-economic aspects of the survey while the environmental and epidemiological results are presented in two other published papers. The socioeconomics investigation, conducted using a questionnaire, concerned 809 households across the various sites of discharge of toxic waste. More than 62% of households had at least one person who had been affected by toxic waste (affected households). 62.47% of these households were in Cocody district (with 2 sites and 4 points of discharge), 30.14% in Abobo district (with 2 sites and 3 points) and 7.39% in Koumassi district (with 1 site and 1 point). To escape the bad smell and the nuisance, 22.75% of the 501 "affected" households had left their houses. To face the health consequences generated by the toxic waste, 30.54% of the "affected" households engaged expenses. Those were on average of 92 450 FCFA (€141), with a minimum of 1 000 FCFA (€1.5) and a maximum of 1500000 FCFA (€2.287), in spite of the advertisement of the exemption from payment treatment fees made by the government. The decision of destroying cultures and farms near the points of discharge of the toxic products in a radius of 200 meters, taken by the authorities, touched 2.22% of the households. For these households, it did nothing but worsen their state of poverty, since the zone of influence of the toxic waste went well beyond the 200 meters prescribed by the authorities as the limit of the operations of destruction.

[Variability of diarrheal diseases in children under 5 living in an urban setting: observations in Rufisque, Senegal]. / Variabilité des maladies diarrhéiques chez les enfants de moins de 5 ans en milieu urbain: l'exemple de Rufisque au Sénégal.

Rapid urbanization has created numerous health risks in developing countries, but the exact impact on many diseases in function of living conditions is unclear. For insight into this complex relationship, a study on diarrheal diseases was carried out to obtain knowledge about the distribution of health risks in an urban setting. An epidemiological survey with a combined longitudinal and transverse design was conducted in Rufisque, Senegal, from April 2002 to March 2003 in a sample including households with children less than 5-years-old living in four areas presenting different levels of hygiene. Results showed a high overall incidence of diarrhea (6.5 episodes/child/year) but there were major discrepancies between the four study areas in direct relation with level of hygiene. The annual incidence per child was lower in the low-cost housing project (fair hygiene, 3.4 episodes) than in the Castors area (poor hygiene, 6.8 episodes), Diokoul Wague area (very poor hygiene, 7.3 episodes) and Goufe Aldiana area (no hygiene, 8.4 episodes). The study showed only a slight seasonal effect on diarrheal disease in the different areas. However, the differences observed between areas during the cold and hot dry seasons were considerably attenuated in the rainy season. This variability in the incidence rate that underlines the diversity of urban living conditions depends on a variety of risk factors (such as age and number of children) that may interact, although hygiene level remains critical. For issues usually given priority at the national level, multiplying studies aimed at fine analysis of factors underlying disease transmission is useful since this approach can improve understanding of public health policy in city environments characterized by the complex conditions (density and diversity) created by urbanization.

Anesthésie­Réanimation dans la cure complète des cardiopathies congénitales au Sénégal au CHNU de fann

Le but de ce travail etait d'evaluer la prise en charge peri operatoire des cardiopathies congenitales au service de chirurgie thoracique et cardiovasculaire de Fann. Dans cette etude retrospective; 19 patients ont ete colliges sur un an (juin 2006 a juin2007). La tetralogie de Fallot etait la cardiopathie congenitale la plus frequente suivie des communications inter ventriculaires. Le temps moyen de circulation extracorporelle etait de 114 minutes et celui du clampage aortique de 49;78 minutes. Les complications post operatoires etaient metaboliques (7 cas); hemorragiques (5 cas) et infectieuses (2 cas). La mortalite etait de 10;5. La cure chirurgicale permet le retablissement de la physiologie normale et garantit une guerison complete

[Agricultural activities and malaria transmission in two eco-epidemiological settings in central Côte d'Ivoire]. / Pratiques agricoles et transmission du paludisme dans deux zones éco-épidémiologiques au centre de la Côte d'lvoire.

We comparatively studied the dynamics of malaria transmission in the villages of Zatta (located in close proximity to an irrigated rice perimeter) and Tiémélékro (rural area with traditional agriculture), central Côte d'Ivoire. In the former village, the irrigated rice farming had been interrupted in 2003/2004 due to a farmers' conflict over land. In each village, mosquitoes were collected by human landing catches at night in sentinel houses. Anopheles gambiae was the predominant malaria vector, followed by An. funestus. In Zatta, the return to an irrigated rice farming in January 2005 was paralleled by a significant increase of the entomological inoculation rate (EIR) ranging from 38 infective bites per person per year (ib/ply) in 2003 to 295 ib/ply in 2005. In Tiémélékro high EIRs were found in 2003 (342 ib/ply) and 2005 (572 ib/ply). Our findings confirm that changes in irrigated rice agriculture influence malaria transmission dynamics, and call for control measures that are readily adapted to local eco-epidemiological settings.

Effect of an armed conflict on human resources and health systems in Côte d'Ivoire: prevention of and care for people with HIV/AIDS.

In September 2002, an armed conflict erupted in Côte d'Ivoire which has since divided the country in the government-held south and the remaining territory controlled by the 'Forces Armées des Forces Nouvelles' (FAFN). There is concern that conflict-related population movements, breakdown of health systems and food insecurity could significantly increase the incidence of HIV infections and other sexually-transmitted infections, and hence jeopardize the country's ability to cope with the HIV/AIDS epidemic. Our objective was to assess and quantify the effect this conflict had on human resources and health systems that provide the backbone for prevention, treatment and care associated with HIV/AIDS. We obtained data through a questionnaire survey targeted at key informants in 24 urban settings in central, north and west Côte d'Ivoire and reviewed relevant Ministry of Health (MoH) records. We found significant reductions of health staff in the public and private sector along with a collapse of the health system and other public infrastructures, interruption of condom distribution and lack of antiretrovirals. On the other hand, there was a significant increase of non-governmental organizations (NGOs), some of which claim a partial involvement in the combat with HIV/AIDS. The analysis shows the need that these NGOs, in concert with regional and international organizations and United Nations agencies, carry forward HIV/AIDS prevention and care efforts, which ought to be continued through the post-conflict stage and then expanded to comprehensive preventive care, particularly antiretroviral treatment.

Malaria transmission dynamics in central Côte d'Ivoire: the influence of changing patterns of irrigated rice agriculture.

The dynamics of malaria transmission was studied comparatively in the villages of Zatta and Tiemelekro, central Cote d'Ivoire, from February 2002 to August 2003. Prominent agroecosystems in these villages are irrigated rice growing and vegetable farming, respectively. Mosquitoes (Diptera: Culicidae) were collected on human bait at night and by pyrethrum knock-down spray sheet collections at four randomly selected sentinel sites in each village. In 2002, for a total of 96 man-nights per village, 7716 mosquitoes were collected in Zatta and 3308 in Tiemelekro. In 2003, with half the sampling effort, 859 and 2056 mosquitoes were collected in Zatta and Tiemelekro, respectively. Anopheles gambiae Giles s.l. was the predominant mosquito and the key malaria vector throughout, followed by An. funestus Giles. Anthropophily among adult female Anopheles exceeded 95% in both villages. Comparison between years revealed that the biting rate of An. gambiae s.l. in Zatta decreased several-fold from 49.3 bites per person per night (b/p/n) in 2002 to 7.9 b/p/n in 2003 (likelihood ratio test (LRT) = 1072.66; P < 0.001). Although the biting rate remained fairly constant in Tiemelekro, the difference between years was significant (16.1 vs. 18.2 b/p/n; LRT = 148.06; P < 0.001). These observations were paralleled by a marked decrease in the infective rate of An. gambiae s.l. in Zatta (4.6-1.2%), and an increase in Tiemelekro (3.1-7.6%). Meanwhile, the entomological inoculation rate of An. gambiae s.l. decreased 21-fold in Zatta, from 789 to 38 infective bites per person per year (ib/p/y), whereas it remained high in Tiemelekro (233 vs. 342 ib/p/y). The interruption of irrigated rice growing in Zatta in 2003, consequential to a farmers' conflict over land, might be the underlying cause for the significant reduction in malaria transmission, whereas more stable conditions occurred in Tiemelekro.

[Diarrhea in urban agricultural workers in Nouakchott in Mauritania]. / La diarrhée chez les agriculteurs urbains de Nouakchott en Mauritanie.

Nearly 200 million people in the developing world are dependent or urban gardening for food and income. This practice has been accelerated by the droughts of recent decades which have forced more and more migrants into urban areas. Numerous potential health hazards have been attributed to urban gardening but the exact risks in Sahelian areas remain unclear. The purpose of this cross-sectional study was to evaluate the incidence of diarrhea at the Tel Zatar gardening site in urban Nouakchott, Mauritania. In addition, a case-control study was carried out to identify risk factors for diarrhea in function of gardeners' activity and living conditions. Statistical analysis was performed using univariate and logistical regression methods. The annual incidence of diarrhea ranged from 6.9 (IC95 p. 100 = 5.0-8.8) to 8.5 (IC95 p. 100 = 6.2-10.8) episodes per gardener and year. Multivariate analysis identified four significant risk factors. Two of these factors were unrelated to gardening, i.e., not having spent more than USD 3.50 the previous day (odds ratio (OR = 2.8, IC95 p. 100 = 1.01-7.81) and poor food hygiene (cooking outside (OR = 4.69, IC95 p. 100 = 1.06-20.83). The other two factors were regular consumption of raw vegetables (OR = 25.5, IC95 p. 100 = 2.0-32.0) and use of untreated well water (OR = 3.85, IC95 p. 100 = 1.08-14.29). Unprotected well water was the cause of 59.2 p. 100 of diarrheal episodes reported by gardeners at Tel Zatar. The results of this study confirm that vegetable production in urban gardens such as Tel Zatar is associated with health risks. Public health measures should address not only the garden sites but also domestic hygiene.