Malnutrition: prevalence and risk factors among the children younger than five years in a semi-urban area of Abidjan.

INTRODUCTION: In Côte d'Ivoire, the prevalence of malnutrition among children younger than 5 years exceeded 5% in 2011 and was thus considered serious. This overall prevalence may nonetheless mask differences and specificities between regions and municipalities. This study sought to determine the prevalence and risk factors of malnutrition among children in this age group in a semi-urban area of Abidjan. METHODS: This exhaustive, descriptive, cross-sectional survey took place from May 6 to July 31, 2010. The children's nutritional status was determined according to the WHO criteria. Univariate and multivariate analysis of factors associated with malnutrition (social and demographic characteristics, immunization status, children's eating practices, and household characteristics) were studied. RESULTS: We visited 668 households and recruited 809 children. The prevalence of malnutrition was 22.5%. Multivariate analysis showed that the introduction of porridge after 6 months halved the risk of malnutrition. Risk tripled for children whose father's occupation did not guarantee a regular income. CONCLUSION: Among the factors highlighted by this study, dietary practices seem the most amenable to corrective action. For example, the adoption of outreach programs by the Maternal and Child Protection services could improve nutritional practices in households.

Disease Severity Estimates-Effects of Rater Accuracy and Assessment Methods for Comparing Treatments.

Assessment of disease severity is required for several purposes in plant pathology; most often, the estimates are made visually. It is established that visual estimates can be inaccurate and unreliable. The ramifications of biased or imprecise estimates by raters have not been fully explored using empirical data, partly because of the logistical difficulties involved in different raters assessing the same leaves for which actual disease has been measured in a replicated experiment with multiple treatments. In this study, nearest percent estimates (NPEs) of Septoria leaf blotch (SLB) on leaves of winter wheat from nontreated and fungicide-treated plots were assessed in both 2006 and 2007 by four raters and compared with assumed actual values measured using image analysis. Lin's concordance correlation (LCC, ρc) was used to assess agreement between the two approaches. NPEs were converted to Horsfall-Barratt (HB) midpoints and were compared with actual values. The estimates of SLB severity from fungicide-treated and nontreated plots were analyzed using generalized linear mixed modeling to ascertain effects of rater using both the NPE and HB values. Rater 1 showed good accuracy (ρc = 0.986 to 0.999), while raters 3 and 4 were less accurate (ρc = 0.205 to 0.936). Conversion to the HB scale had little effect on bias but reduced numerically both precision and accuracy for most raters on most assessment dates (precision, r = -0.001 to -0.132; and accuracy, ρc = -0.003 to -0.468). Interrater reliability was also reduced slightly by conversion of estimates to HB midpoint values. Estimates of mean SLB severity were significantly different between image analysis and raters 2, 3, and 4, and there were frequently significant differences among raters (F = 151 to 1,260, P = 0.001 to P < 0.0001). Only on 26 June 2007 did conversion to the HB scale change the means separation ranking of rater estimates. Nonetheless, image analysis and all raters were able to differentiate control and treated-plot treatments (F = 116 to 1,952, P = 0.002 to P < 0.0001, depending on date and rater). Conversion of NPEs to the HB scale tended to reduce F values slightly (2006: NPEs, F = 116 to 276, P = 0.002 to 0.0005; and, for the HB-converted values, F = 101 to 270, P = 0.002 to 0.0005; 2007: NPEs, F = 164 to 1,952, P = 0.001 to P < 0.0001; and, for HB-converted values, F = 126 to 1,633, P = 0.002 to P < 0.0001). The results reaffirm the need for accurate and reliable disease assessment to minimize over- or underestimates compared with actual disease, and the data we present support the view that, where multiple raters are deployed, they should be assigned in a manner to reduce any potential effect of rater differences on the analysis.

Apport de l'échographie dans la prédiction de la malignité du nodule froid thyroidien

Objectifs: Analyser les éléments prédictifs échographiques permettant d'évoquer le caractère cytologique bénin ou malin des nodules thyroïdiens froids. Patients et Méthodes: Nous avons étudié 100 nodules froids chez des patients tout venants à la scintigraphie réalisée au technétium 99 m (99mTC) dans le service de biophysique et médecine nucléaire d'Abidjan. Les résultats de l'examen échographique de ces nodules froids ont été soumis au verdict diagnostique de la cytoponction thyroïdienne à l'aiguille fine.Résultats : La prédominance féminine a été de 90%. L'âge moyen était de 44±3 ans avec des extrêmes de 09 et 75 ans. La cytologie a donné 90% de lésions bénignes et 10% de lésions malignes avec la prédominances du carcinome papillaires. Les lésions bénignes étaient composés de:63 % de goitres colloïdes, 23% d'adénomes vésiculaires, 2% de thyroïdites, 2% de kystes thyroïdiens. Concernant la topographie, la taille, le nombre, les dimensions nodulaires et certains éléments propres à l'échographie telle l'échostructure, calcifications parenchymateuses, le seul élément discriminant est l'aspect des contours nodulaires. Autrement dit, lorsqu'un nodule froid thyroïdien présentait des contours irréguliers à l'échographie, il présageait à une malignité cytologique et le contraire à une cytologie bénigne.Conlusion : Le nodule froid comme les autres lésions thyroïdiennes est prédominant chez la femme. L'irrégularité des contours nodulaires semble liée à la malignité nodulaire thyroïdienne

[Self-medication with antibiotics obtained from private pharmacies in Abidjan, Ivory Coast]. / Automédication par les antibiotiques provenant des pharmacies privées de la ville d'Abidjan en Côte d'Ivoire.

UNLABELLED: Self-medication with antibiotics is all the more disturbing in developing countries where this type of medication is easily available, and often without any prescription. OBJECTIVES: The authors wanted to assess and describe self-medication with antibiotics and identify the factors and public perception associated with this type of self-medication. PATIENTS AND METHODS: Eighteen private pharmacies were randomly selected in Abidjan. Data was collected through structured questionnaires and reports. Group meetings were organized for private pharmacy clients and the pharmacy staff. RESULTS: Two hundred and forty-two out of 1,123 purchases of antibiotics were for self-medication (21.5 %). Out of the 1,765 people interviewed, 1,054 (59.7 %) had bought antibiotics for self-medication in the 12 months prior to our study. Pharmacy staff very rarely provided any information to purchasers concerning dose, when to take the medicine, or treatment duration. A logistic regression analysis showed that the probability of self-medication with antibiotics increased with several factors: age, education level, and the possibility of purchasing antibiotics on the marketplace. However, this risk decreased when patients were covered by medical insurance, when the public perceived the risks of self-medication, and when bacterial resistance was clearly defined. CONCLUSIONS: This study was the first in the Ivory Coast to analyze the factors involved in antibiotic self-medication. It stressed the need to establish sustainable interventions to control the antibiotic use.

[Acute peritoneal tuberculosis in HIV-infected patients. Study of 4 cases in Abidjan, Côte-d'Ivoire]. / Péritonite aiguë tuberculeuse au cours de l'infection par le VIh. Etude de 4 cas à Abidjan, Côte-d'Ivoire.

This paper presents 4 cases of histologically verified peritoneal tuberculosis in HIV-infected patients followed in a 18 month-period. The patients were admitted in emergency and were suspected of present acute appendiceal peritonitis. There were 3 females of 18, 22 and 27 years old, and a 41-year-old male. The main symptoms were acute abdominal pain (4 cases), fever superior to 38 degrees C (4 cases) and abdominal defence (4 cases). Laboratory findings were hyperleucocytosis with lymphocytic predominance, anemia and CD4+ rate variable from 250 to 460/mm3. They underwent emergency laparotomy which led to diagnosis of peritoneal tuberculosis by histopathological analysis of peritoneal biopsies. Two patients died from surgery at days 3rd and 10th. The 2 remaining patients were successfully treated by tuberculostatic tritherapy with rifampicin, isoniazid, and pirazinamid. Acute peritoneal tuberculosis in HIV-infected patients is not to be missed in our practice. It must be considered in differential diagnosis of acute abdomens.

[Diabetes in Ivory Coast: special epidemiological features]. / Le diabète sucré diagnostiqué en Côte d'Ivoire: des particularités epidémiologiques.

Within less than a quarter century diabetes has become a health problem in developing countries. In Africa this metabolic disorder is found in a wide variety of sometimes atypical forms. The purpose of this study was to highlight the special epidemiological features of medically diagnosed diabetes in Ivory Coast. Data from the files of 10320 African patients who presented at a major national outpatient care centre between January 1, 1991 and December 31, 2000 were compiled and analyzed. Findings showed that morbidity gradually increased from 30 to 49 years then stabilized from 50 to 69 years with a higher rate in males between 30 and 49 years. One of the five national ethnic groups appeared to be most affected and two appeared to be relatively unaffected. On the basis of several criteria, 5968 patients were classified as type 1 in 11.8% of cases, type 2 without excess body weight in 48.7% and type 2 with excess body weight in 39.5%. The second of these identified groups was characterized by intermediate-discovered glycaemia and older age at diagnosis. Epidemiological features included age of occurrence and higher morbidity in young male patients, probable higher premature mortality, likely links with socio-cultural environmental factors and existence of two type 2 subgroups. This profile underlines the challenges of screening, management and prevention of diabetes in Ivory Coast.

Comparison of two methods for evaluating the quality of stored drinking water in Abidjan, Côte d'lvoire, and review of other comparisons in the literature.

Membrane filtration, multiple tube fermentation (the standard methods) and Colilert are techniques available for assessing drinking water quality, but there are no published comparisons of Colilert to standard methods in a developing country laboratory. We reviewed the published literature on Colilert and standard methods and conducted a study to compare Colilert with membrane filtration for the detection and enumeration of total coliforms and fecal coliforms (Escherichia coli bacteria) using 35 stored drinking water samples from households in Abidjan, Côte d'lvoire. Our study results are consistent with previous published studies conducted in developed countries. Results from Colilert and membrane filtration correlated for both total coliforms (r2 = 0.81) and E. coli (r2 = 0.93). Colilert is an acceptable method to measure the presence and quantity of coliforms in water samples in a developing country setting.

Les tumeurs malignes de l'oeil et ses annexes. Aspects histo-epidemiologiques de 64 cas observes en 10 ans (1994-2003) dans les CHU d'Abidjan

Il s'agit d'une etude retrospective portant sur 64 cas de tumeurs malignes de l'oeil et ses annexes diagnostiques dans les laboratoires d'anatomie pathologique des centres hospitaliers et universitaires (CHu) de Treichville et de Cocody de 1994 a 2003 (10 ans). AU PLAN EPIDEMIOLOGIQUE : Nous avons observe que les tumeurs malignes de l'oeil et ses annexes etaient rares en Cote d'ivoire avec une frequence annuelle de 6;4 cas. L'age variait de 0 a 74 ans avec une moyenne de 18;6 ans. La predominance masculine est significative. Selon le motif de consultation les patients ont ete recus pour : masse ophtalmique (40;63pour cent); exophtalmie (34;38pour cent); leucocorie (14;66pour cent); hemorragie sous conjonctivale (6;25pour cent) et strabisme (4;69pour cent). AU PLAN HISTOLOGIQUE : Nous avons observe six (05) differents types histologiques:-le retinoblastome 48;44pour cent; -le carcinome epidermoide 31;25pour cent; -les lymphomes malins non Hodgkiniens 12;50pour cent; -le melanome malin 4;69pour cent;-la maladie de Bowen 3;13pour cent. AU NIVEAU DE LA CORRELATION HISTO-EPIDEMIOLOGIQUE : L'age et le siege variaient selon le type histologique. - Le retinoblastome; tumeur intraoculaire ne s'exprimait que chez les enfants de 0 a 15 ans. - Le lymphome de Burkitt ne s'observait que chez l'enfant de 0 a 15 ans avec pour localisation preferentielle l'orbite. - Le carcinome epidermoide; le melanome malin; la maladie de Bowen et les autres lymphomes malins non hodgkiniens s'observaient surtout chez le sujet age et n'avaient pas de localisations preferentielles

Typhoid ileal perforation: surgical experience of 64 cases.

OBJECTIVE: Intestinal complications of typhoid fever are quite common in developing countries. In order to contribute to the improvement of the prognosis of typhoid ileal perforation, the authors report their own surgical experience PATIENTS AND METHODS: between May 95 and July 98, 64 patients, (31 men and 33 women), with an average age of 34 years (ranging from 5 to 63 years) underwent surgery for typhoid ileal perforation. The surgical techniques used were excision-suture (n = 31) and resection-ileostomy (n = 33). All the patients were operated under similar pre-, per- and postoperative care facilities. RESULTS: Postoperative complications were observed in 59 patients (88.1%). The mean hospital stay was 30 days (ranging from 8 to 52 days). The overall postoperative mortality was 34% (22/64), mainly due to digestive fistula in 11 cases (8 cases of anastomotic leak after excision-suture, 3 cases of bowel fistula after conservative resection-ileostomy) and to chronic peristomal ulceration in 9 cases, which led to progressive malnutrition, cachexy and death. CONCLUSION: The mortality and morbidity after surgical treatment of typhoid ileal perforation remains very high in developing countries. However some recommendations could improve the outcome: aggressive resuscitation by intravenous hydratation of 4 to 6 hours, associated with adequate antibiotherapy, the resection of the last 60 centimetres of the ileum, in cases of serious abdominal suppuration, and a large abdominal washout.

Is drinking water in Abidjan, Côte d'Ivoire, safe for infant formula?

OBJECTIVE: To survey knowledge, attitudes, and practices regarding water use and infant feeding in the Koumassi District of Abidjan, Côte d'Ivoire, and to evaluate the microbiologic quality of source and stored drinking water. DESIGN: Random-cluster household survey. METHODS: We randomly selected 20 clusters, each comprising six households with at least 1 child aged < or =3 years. In each household, we administered a questionnaire and collected source and stored drinking water samples and tested these for chlorine levels and for total coliform and fecal bacteria count ( Escherichia coli ). RESULTS: Municipal water was used for drinking in 112 (93%) of 120 households, and in 99 (83%), it was stored for later use. By 1 month of age, 97 (90%) of 108 infants given drinking water were given stored water for drinking. In 8 (66%) of 12 households where children were receiving artificial feeding, formula was prepared from municipal water without additional treatment. Stored water had lower levels of free chlorine than source water (median of 0.05 versus 0.2 mg/dl; p <.001), and E. coli was detected in 36 (41%) of 87 stored water samples and 1 (1%) of 108 source water samples ( p <.001). CONCLUSIONS: In the Koumassi District of Abidjan, where municipal water is widely available and of good quality, drinking water is stored in most households, is often contaminated with E. coli, and is given to children at a young age. If replacement feeding is to be more widely used to prevent postnatal transmission of HIV-1, communities using stored water need interventions to make stored water safer.

[Salubrity of ice sold in blocks: from production to sales]. / Etude de la salubrité de la glace alimentaire en bloc: de la production à la vente sur les marchés.

We conducted a study in order to determine the salubrity of ice produced in blocks, tracing them from 10 factories in Abidjan to 10 different market places where they are sold in town. On the basis of physico-chemical and microbiological analyses, the water was shown to be potable. However, the results of the analysed samples taken from the ice indicated a deterioration of the physico-chemical and microbiological qualities. The data revealed that consumers may be exposed to water-borne diseases such as cholera, salmonelloses, shigelloses, gastro-enteritis. Ice producers and vendors must be provided with special training in sanitation so as to prevent the transmission of pathogenic bacteria in ice.

[Potability of drinking water sold in bags to public primary school children in Abidjan]. / Etude de la potabilité des eaux de boisson en sachet vendues aux abords des écoles primaires publiques d'Abidjan.

This study was carried out in order to determine the potability of drinking water sold in bags near 26 primary schools in Abidjan. Samples of this water revealed its poor microbiological and chemical quality. This exposes consumers to health risks. Consumers should be informed of the danger involved while vendors should be educated and their activities monitored by the Municipal Health services.

Structural analysis of 21-hydroxypregn-4-ene-3,20-dione (deoxycorticosterone) derivative compounds. Part II: Proton NMR spectra.

Complete analysis of the proton nuclear magnetic resonance spectrum of desoxycorticosterone (DOC) has been made using selective double irradiation, two-dimensional experiments, relaxation rate, and nuclear Overhauser effect measurements in order to specify the structure and conformation of products encountered during the preparation of the specific antigen DOC-bovine serum albumin (BSA). It has been shown that DOC has the normal P conformation with ring A half-chair, and ring B chair. This confirms results previously obtained by circular dichroism measurements.

Structural analysis of 21-hydroxypregn-4-ene-3,20-dione (deoxycorticosterone) derivative compounds. Part I: Synthesis and circular dichroism identification.

Deoxycorticosterone (DOC) derivative compounds (DOC, DOC 21-acetate, and 7-mercaptopropionic DOC) have been prepared and purified by high pressure liquid chromatography. Synthesis products have been identified, and three chromophores have been displayed by their n----II and II----II dichroic transitions. A normal half-chair conformation is favored in ring A.