Endemic goitre: a research protocol elaboration for eradication.

The iodine deficiency (ID), which affects 1 person out of 6, is relatively neglected by the responsible of Public Health Service, particularly in developing countries. Consequences of ID are far from being negligible: mental retardation, hypofertility, hyperplasia, carcinoma, early ageing and, in very exposed areas, endemic cretinism. Nevertheless, eradication is easy and cheap but it requires rigorous protocols and control of results. The elaboration of these protocols is complex because it must be adapted to environment, population and financial possibilities of concerned countries. Based on our experience in this field, we propose a combined protocol, between the Public Health too liberal approach and that of too expensive research, which can be adapted to several situations.

Epidemiology and prophylaxis of endemic goitre in the Bwa village of Sirao (Mali).

A study was conducted in Mali, in some villages exposed to iodine deficiency disorders (IDD). To treat and, above all, prevent endemic goitre, Lipiodol UF was dispensed in two ways: by intra-muscular injection (475 mg I) or by oral administration (48 mg I to 240 mg I). In two cases, hormone levels regained normal values and thyroid hypertrophies regressed significantly. Nevertheless, the impact of the treatment on the size of the goitres seems to be in favour of injections; which is probably due to the fact that in the village which received Lipiodol UF per os, many goitres were nodular.

Treatment by iodized oil (Lipiodol UF) of a population in Mali suffering from endemic goiter.

In order to reduce the prevalence of goiter in a village of Mali liable to iodine deficiency, an iodized product (Lipiodol Ultra Fluide) was orally administered to their inhabitants. Taking into account a series of demographic variables and goiter types, a protocol was conducted using Lipiodol at three different dosage levels. Six months after the treatment, the hormone levels regained normal values, whereas only the smallest dose reduces the volume of goiters significantly.

Haemoglobinopathies C and S in the Dogons.

The distribution of haemoglobins C and S was studied in a population of caste and non caste Dogons living in villages located on the plateau and scree regions in the Sangha department of Mali. Results showed a 15.77% prevalence of haemoglobinopathy AC. Haemoglobin C was found in both plateau and scree villages and equally among caste and non caste Dogons, while the homozygous form CC was absent in non Dogons. The prevalence of haemoglobinopathy AS was extremely low with a calculated frequency of 3.05%, allele S being restricted to areas where one is likely to encounter populations other than the Dogon people. Homozygotes SS were not detected and the phenotype SC was only rarely identified. An overall analysis of these data not only suggests that allele S is of recent introduction in the Dogons but also raises the question as to whether their origin is not the voltaic rather than the Manding plateau. Studies of marriage patterns and haplotypes currently in progress should enable resolution of this controversy.

[Prevention of iodine deficiency disorders in children in the rural African zone]. / Prévention des troubles dus aux carences en iode chez les enfants en zone rurale Africaine.

The effectiveness of iodinated silicone polymers placed in bore wells for combating goiter in children under 15 years of age was evaluated in two villages in Mali. Of the 581 included children, 367 did and 214 did not receive supplemental iodine. Overall, follow-up data at one year were available for 86% of study subjects. At baseline, Goiter was present in 43.3% of the children in the supplemental iodine group and in 69.2% of controls. Stage G1B predominated in both sexes. After one year, 36% of the goiters had resolved in the supplement group. Effectiveness of iodine supplementation was greater in young children with small goiters. Urinary iodine levels returned to normal by the third month. Iodine levels in the supplemented water remained above 50 micrograms/l throughout the year; daily intake of iodine was 50 to 100 micrograms. In the unsupplemented village, 21 new cases of goiter occurred, for an annual incidence of 40%.

[Does human distomiasis due to Fasiola gigantica exist in the delta of the Niger river in Mali? (apropos of a serological survey)]. / La distomatose humaine à Fasciola gigantica existe-t-elle dans la zone inondée de l'Office du Niger au Mali? (à propos d'une enquête sérologique).

Finding of specific anti-Fasciola antibodies in persons living in the central area of the delta of Niger shows that human fascioliasis is a reality in Mali. Fasciola gigantica, the single species affecting livestock is probably the parasite concerned. We think that this parasitic disease in humans is underestimated, obscured by schistosomiasis which is hyperendemic in the country. Complementary studies are much needed for better identification of the problem.

[Prevalence of hepatitis B virus in women of childbearing age in Mali]. / Prévalence du virus de l'hépatite B chez les femmes en age de procréer au Mali.

A serological investigation on adult female in Mali show a high degree of positivity of hepatitis B virus (HBV) markers, of which 42% HBs Ag +. Only 6% exhibit active replication. The low prevalence of anti-HBs (+) with a high degree of anti-HB (+) explain a high incidence of infection with a low immune response to HBs antigen. The existence of anti-Delta (+) asymptomatic carriers is an additional support to a vaccination programme.

[Evaluation of the health status of nomadic and semi-nomadic populations of the Gourma-Mali: epidemiologic approach. II. Overall results and conclusions]. / Evaluation de l'état sanitaire des populations nomades et semi-nomades du Gourma-Mali--approche épidémiologique II.--Résultats globaux et conclusion.

The authors report the main clues of morbidity, infant mortality, fecundity as well as the main endemic affections detected in the nomadic and seminomadic populations in Gourma that they have noticed during a descriptive epidemiological investigation. The worse clues of general morbidity come from children and among the ethnic groups studied from those of the Tamachèques and the Maures. Malaria, brucellosis, treponematosis (bejel) have a high rate of frequency. The few cases of tuberculosis detected incidentally encourage to search for the real effect of this affection. Urinary schistosomiasis is present in Gossi where durable ponds exist. Intestinal helminthiasis, tineas, and hemoglobinopathies seem not to be problems of public health in the area. Pterygiums and conjunctivitis are frequent while trachoma is absent in Gourma.

[Evaluation of the health status of nomadic and semi-nomadic populations of the Gourma-Mali: epidemiologic approach. I. Introduction, material and methods]. / Evaluation de l'état sanitaire des populations nomades et semi-nomades du Gourma-Mali--approche épidémiologique. I.--Présentation-matériel et méthode.

The authors set out the methodology and the practical way used in transverse epidemiological investigation with a descriptive aim which was made in natural area: Gourma-Mali. This part of the Sahel, hard to reach, is placed deep in the bend of the Niger river. The population is estimated at 100.000. The weather, ecological and human conditions have been unsettled by the drought. Sometimes, it was difficult to collect the data among the nomadic and seminomadic populations (Tamachèques, Peuls, Maures, Bellahs, Sonraïs). This investigation shows well the practical problems that this kind of study sets out in difficult bioclimatological and ethnological conditions.