[Epidemiological features of retroviral infection by HTLV-1 in central Africa]. / Particularités épidémiologiques de l'infection rétrovirale a HTLV-1 en Afrique centrale.

Subsaharian Africa is the most important reservoir of HTLV1 virus but its epidemiology is not well-known. The authors have studied from 1987 to 1990 the situation in 6 countries in Central Africa. The already described routes of transmission are present: through blood transfusions (but it's not such a common practice), heterosexual transmission (but it doesn't seem to be as important as in other continents), and mother to child transmission through breast feeding. Nevertheless, environmental factors--which have to investigated--could play a role for transmission, among them one could think to vectors and parasites.

Proposals for a new therapeutic strategy for simple Plasmodium falciparum malaria attacks in Cameroon.

From simplified in vivo tests, authors set up a cartography of the sensitivity of Plasmodium falciparum to amino-4-quinolines in Cameroon; they also evaluated the clinical and parasitological efficacy of different therapeutic protocols which make use of amino-4-quinolines, quinine, mefloquine and halofantrine. All these drugs are administered orally. They recommend maintaining home medication with chloroquine at the dose of 25 mg/kg over 3 days, conserving quinine for use in the case of a possible failure. The use of most recent antimalarials can be proposed only as a last resort.

[Therapeutic attitudes and malaria in Sanaga Basin (Cameroon)]. / Attitudes thérapeutiques et paludisme dans le bassin de la Sanaga (Cameroun).

In order to evaluate malaria problems such as they are perceived by Sanaga Basin populations in Cameroon, authors appealed to a cluster sample survey on a population sample obtained from a 2 degree population poll in four representative sites. Malaria so defined represents the outstanding endemia by which the most usual therapeutic recourse makes self-medication interfere particularly by amino-4-quinolines. It is convenient to verify the quality of treatment so administered to adapt possibly training objectives of the interested population. In the present context of the chemoresistance extension of plasmodial strains to usual antimalarials, setting up a surveillance system of efficiency is necessary.

Epidemiologie de l'hepatite a virus B (HBV) en Afrique Centrale

Les auteurs rapportent les resultats de quatorze enquetes sero-epidemiologiques sur l'hepatite virale a virus B (HBV) effectues en Afrique Centrale. Les Etats membres de l'OCEAC se situent; d'apres les criteres OMS; dans des niveaux de frequence elevee d'endemicite de l'antigene HBs avec des taux de seroprevalence variant de 7 a 25 pour cent. Ces etudes amenent a penser que le pool des sujets positifs par l'Ag HBs se constitue essentiellement pendant la premiere enfance; ce qui est fortement en faveur de l'introduction de la vaccination specifique dans les Programmes Elargis de Vaccination

Interet d'une surveillance de la chimiosensibilite de plasmodium falciparum aux antimalariques en Afrique Centrale

Les auteurs ont dresse une cartographie de la sensibilite de plasmodium falciparum aux differents antimalariques en Afrique Centrale. Ils sont ainsi a meme de recommander le maintien de l'utilisation a domicile; dans le traitement presomptif de l'acces febrile; de la chloroquine a la dose de 25 mg/kg en 3 jours. Par contre; au niveau des formations sanitaires ou vont aboutir les echecs de ces traitements domiciliaires; il conviendrait; dans le cas des acces palustres simples; de preter un interet accru a l'amodiaquine-base a la dose de 35 mg/kg en 3 jours; en reservant la quinine aux echecs eventuels. L'utilisation des antimalariques les plus recents doit rester l'arme du dernier recours

Evacuation in vivo de la chimiosensibilite de plasmodium falciparum a la chloroquine dans la region de Moundou

En l'absence des donnees anterieures; la sensibilite de plasmodium falciparum a la chloroquine a la dose de 25 mg/kg de poids par os en 3 jours; a ete evaluee in vivo par une enquete effectuee en juin 1990; en en debut de saison des pluies; dans la ville de Moundou au sud du Tchad. 195 enfants ont ete preleves a l'ecole catholique de jeune fille et dans le quartier Djarabe; 28 enfants avec une parasitemie moyenne initiale de 1700 GRP/mm2 ont ete suivie. Aucune resistance de type RII ou RIII n'a ete mise en evidence. La chloroquine doit donc rester le traitement presomptif de l'acces palustre

Interet de l'amodiaquine dans le traitement des acces palustres simples a plasmodium falciparum en zone de chloroquinoresistance

La resistance aux amino-4-quinoleines a ete constatee pour la premiere fois en 1985 au Sud du Cameroun; a Limbe. En 1987-1988; une etude realisee a Yaounde mettait en evidence un taux de 37 pour cent d'echec de l'amodiaquine a la posologie de 25 mg/kg sur trois jours. A celle de 35 mg/kg; toujours sur trois jours; ce taux d'echec a chute a 6 pour cent en 1989 et a 2 pour cent en 1990. En consequence l'amodiaquine; a la posologie de 35 mg/kg repartis sur trois jours; est proposee en traitement de premiere intention dans les formations sanitaires du Cameroun

[Health care accessibility and adequacy of health care system in the Sanaga basin (Central Cameroon)]. / Recours aux soins et adéquation du système de santé dans le bassin de la Sanaga Centre Cameroun.

The authors report on the results of a Survey Carried out in four areas in Center Cameroon. Health gets a major position within the concerns of the population to protect it, they prefer the classical and official system of health Care rather than the primary Health care System. Self-medication is also a preferred solution. In the rural milieu, they often pay a visit to a traditional practitioner. When they have to take a decision, geographical situation and money problem play both a major role.

PIP: A survey was carried out in 4 different locales of the Sanaga River basin of Central Cameroon in mid-1989 to evaluate the felt needs of the population for health care and their reasons for choosing among the health resources available to them. The 4 locales were Edea, an urban industrial complex with 33,000 inhabitants; Mbebe-Kikot, a small village in the tropical forest with 350 inhabitants, Mbandjock, an urban agroindustrial center in the savannah zone with an estimated population of 17,000; and Ntui, a rural agglomeration of around 5000 at the border between the savannah and forest. Mbebe-Kikot had only a health center and the others all had hospitals and a network dispensaries and pharmaceutical depots. Each quarter and village had community health agents trained to provide primary health care. Traditional practitioners were omnipresent in both urban and rural areas. Representative samples of at least 300 persons in 3 of the locales and the entire population of Mbebe-Kikot were interviewed about their illnesses, use of health services, and reasons for their choices. Records of the health facilities serving the survey populations were also examined, but were too incomplete to be of use. The samples included 330 persons in Mbebe-Kikot, 327 in Ntui, and 328 each in Edea and Mbandjock. Nearly 1/3 of respondents reported they had had some sickness in the past month. 70% of all the conditions reported in Ntui and Mbebe-Kikot and 80% in the 2 urban sites led to demands for assistance at a health facility. Malaria was the most common pathology reported, followed by rheumatologic conditions, abdominal pain, cutaneous infections, and bronchopneumopathies. Malaria accounted for 18% of diagnoses with constant rates in all 4 sites. Onchocerciasis is hyperendemic in Mbebe-Kikot, which had a high rate of possibly related diagnoses: 7.3% ocular pathology, 7.0% cutaneous infections, and onchocerciasis in the strict sense 10.3%. 50-60% of those surveyed made a decision about treatment as soon as they became aware of a pathology. The study resulted in 3 major findings. Prevalence rates are high, with acute infections predominating. The demand for care is strong, and almost all individuals seek care. Rates of self-treatment are high, but recourse to community health agents is very rare. The preferred source of care is the official health system, chosen by 50% of the surveyed populations. Rural populations visited traditional practitioners more than did their urban counterparts. Geographical and financial considerations both played major roles in decisions regarding care. The strong preference of the population for the official, curative health system has implications for the government's primary health care program.

Prolonged malaria prophylaxis with chloroquine and proguanil (chloroguanide) in a nonimmune resident population of an endemic area with a high prevalence of chloroquine resistance.

One hundred thirty nonimmune subjects living in Yaoundé, Cameroon, completed an 18-month prospective study on the efficacy and safety of weekly chloroquine and daily proguanil (chloroguanide) (Ch-P) in malaria prevention. A total of 9 of 78 Ch-P-treated subjects and 26 of 52 subjects who received no prophylaxis contracted Plasmodium falciparum infection during this period (P less than 0.00005). These two groups were comparable for demographic parameters and degree of exposure. Clinical manifestations were of similar severities in the two groups, but parasite counts were significantly higher in the subjects who received no prophylaxis (P less than 0.00005). Side effects of prophylaxis were frequent (31%), minor, and related to chloroquine, and they usually resolved within 4 to 6 weeks. Prolonged administration of Ch-P is safe and effectively prevents P. falciparum malaria in an endemic area with a high prevalence of chloroquine resistance.

Reactivation of an old sleeping sickness focus in Mamfe (Cameroon): epidemiological, immunological and parasitological findings.

We report the reactivation of an old sleeping sickness focus in Mamfe (Cameroon). Screening of 9827 people using the Testryp CATT (card agglutination test for trypanosomiasis) gave a total of 137 positive cases (1.4%). The prevalence of CATT positivity was significantly linked to sex, age, place of residence and type of occupation of the people. 26 of these immunological suspects were later confirmed as sleeping sickness patients, giving a morbidity index of 0.26%. Only 44% of 16 sera from these confirmed patients were CATT positive on serum while only 31% of the sera had a positive Indirect Immunofluorescent Antibody Test (IFAT) reaction, supporting the hypothesis of the existence of a new T.b gambiense serodeme in this region. The reasons for the reactivation of this old sleeping sickness focus are discussed.