Immunosuppression and GB virus C-RNA detection among HIV-infected patients in Cambodia.

In this survey, 213 patients in an antiretroviral treatment programme in Phnom Penh, Cambodia, were tested for GB virus C (GBV-C) RNA before treatment initiation. Most had advanced HIV infection, only 34 having CD4 cell counts > 200 cells/microl. GBV-C-RNA was detected in 35 patients. The proportion with positive GBV-C-RNA decreased dramatically with CD4 cell counts < 100 cells/microl. In multivariate analysis, low CD4 cell counts, tuberculosis, anaemia, and traditional medicine were independently and negatively associated with GBV-C-RNA detection.

[Malaria at the medical center of the mission of French cooperation in Bissao]. / Le paludisme au centre médical de la mission française de cooperation a Bissao.

Malaria is the leading cause of disease in Guinea-Bissau. The consequences of the disease are further compounded by extremely low living conditions in one of the poorest nations of Africa. The Medical Dispensary and Social Center ran by the mission of the French Cooperation and Cultural Action in Bissau has set up a program to screen, treat, and monitor malaria. Screening and monitoring are greatly facilitated by systematic use of the Quantitative Buffy Coat test for plasmodium that has developed by Becton-Dickinson Laboratories. The purpose of this retrospective report is to describe routine clinical and parasitological data collected at the Dispensary between September 1995 and June 1997. This study confirms the endemic nature of malaria which accounted for 15% of consultations during the study period. Chloroquine or a combination of sulfadoxine and pyrimethamine was effective in 85% of cases. The efficacy of these low-cost drugs is important within the local context. The program implemented at the Medical Dispensary and Social Center of Bissau should provide a useful tool for national health authorities to monitor changes in the endemic level of the disease and effectiveness of treatment.

[Leptospirosis in Mayotte]. / La leptospirose à Mayotte.

We have got 42 leptospirosis cases from 1984 to 1989, in a retrospective study. The annual incidence is now, in a very high level (3.8/10,000 pers.). This rapid increasing is function of new diagnostics facilities. The leptospirosis epidemiology is not different from anywhere else in tropical countries, but the complicated cases are an important problem in public health in the island. The actual development of collective hygienic equipment is indispensable for any progress.

[Perinatal and infant mortality in French Guyana. Evaluation of a regional maternal and child health care policy]. / Mortalite perinatale et infantile en Guyane. Evaluation d'une politique regionale de sante maternelle et infantile.

PIP: High rates of infant and perinatal mortality in Guyana compared to France led to implementation of a regional maternal and child health policy in Guyana beginning in 1981. Additional personnel, improved equipment, administrative changes, and training activities were designed to reduce the perinatal mortality rate from 36 to 26/1000 and the infant mortality rate from 35 to 25/1000 over 2 years. Each death certificate was analyzed according to a systematic protocol to determine whether the mortality objective was being met and to identify epidemiological factors involved in each death. Rates of perinatal and infant mortality respectively declined from 37.6 and 36.3 in 1978 and 36.3 and 38.0 in 1982 to 27.3 and 25.3 in 1983. Half of the deaths occurred in 2 regions which accounted for only 1/4 of all births. The socioeconomic environment was considered good in 30% of cases, bad in 30%, and not known in 40%. Age did not play an important role in the deaths. 59% of the mothers had had at least 4 prenatal consultations. During pregnancy, 62% of cases had hypertension and toxemia, threatened premature labor, urinary infection, or anemia. Fetomaternal infections or syphilis were found in 16 of 62 deaths, maternal hypertensive disease in 15, acute fetal distress in 14, congenital malformations and placental pathology in 6, other causes in 8, and unknown causes in 3. 39 of the 62 infants were premature. Most of the term babies died from acute fetal distress or fetomaternal infection, causes directly related to labor, while the premature babies succumbed to uteroplacental pathology, syphilis, or indeterminate causes. Among 32 neonatal deaths and 26 postneonatal deaths respectively, 11 and 1 were caused by maternofetal infection, 8 and 0 by pathologies of pregnancy, 8 and 4 by pathologies of labor and delivery, 4 and 4 by congenital malformations, 1 and 11 by infections, 0 and 5 by nutritional problems, and 0 and 1 by accidents. The results appear to indicate that the maternal and child health policy initiated in 1981 has succeeded in improving perinatal surveillance and health care. Efforts should be continued to improve management of labor and delivery to avoid acute fetal distress and to improve health care in the regions with disproportionately high rates of perinatal and infant mortality.^ieng

[High prevalence of antiHTLV-1 antibodies in the Boni, an ethnic group of African origin isolated in French Guiana since the 18th century]. / Haute prévalence d'anticorps anti HTLV-1 chez les Boni, groupe d'origine africaine isolé depuis le XVIIIe siècle en Guyanne Française.

Antibodies to HTLV-1 (ELISA test using disrupted virus) were studied in different ethnic groups in French Guiana, including 135 blood donors from Cayenne, 97 Boni Blacks and 57 Wayana Indians from Maripasoula area, and 57 Hmong from Cacao village. We observed significant differences between Boni Blacks and Wayana Indians, having respectively 10.3% versus 0% of high antibody titers. The Hmong, recent refugees from Kampuchea, exhibited an intermediate level (3.5%) of infection. These results favour an African origin of HTLV-1 and raise, for the Hmong, the question of an infection acquired in Guiana.