[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.

[Preoperative diet and complete dentures in Ivory Coast]. / Diététique préopératoire et prothèse adjointe totale en Côte d'Ivoire.

The toothless patients of developing country are a real problem of nutrition. The practitioners are in the habit of doing the prostheses restoration wit hoof thinking of alimentation. In this work, authors show the energetic and protein malnutrition of the toothless patients of Cote d'lvoire and propose a hyperprotein diet with their alimentation habit in order to prepare the psychic and physic site who must receive complete prostheses.

The epidemiology of hepatitis A infection in Palestine: a universal vaccination programme is not yet needed.

In Palestine, there has been an increase in the reported incidence of acute hepatitis A virus (HAV) infection since 1995. Since overt clinical disease occurs only among adults, questions were raised whether or not a shift in the epidemiology of HAV has occurred. This is generally characterized by a decrease in the overall incidence rate and a shifting in the mean age of infection towards adolescence and early adulthood. The need for a vaccination programme is being discussed. To resolve this issue, we examined the prevalence of anti-HAV in a representative sample of 396 school children in the Gaza Strip. The prevalence of anti-HAV was 93.7% (95% CI: 91.3, 96.1%). Stratifying the prevalence by age showed that 87.8% (95% CI: 78.6, 97%) were HAV antibody positive by the age of 6. By the age of 14, almost 98% (95% CI: 92.7, 100%) were HAV antibody positive. This means that the majority of HAV infection is still taking place in early childhood, when it is usually asymptomatic and of little clinical significance. The results refuted the shifting epidemiology theory and we recommend that a vaccination programme against HAV infection is not yet needed. Alternative explanations for the increase in reported cases are discussed.

[Effects of vitamin A supplementation on nutritional markers on the follow-up of malnutrition in children]. / Effets de la supplémentation en vitamine A sur les marqueurs de la nutrition dans la prise en charge de la malnutrition de l'enfant.

Prospectively assessment of vitamin A supplemented during a follow-up of a protein-energy malnutrition rehabilitation included serum retinol, Retinol Binding Protein (RBP) and prealbumin (PA) determination. This study was conducted during one month on a group of 36 vitamin A (200,000 IU) supplemented malnourished children and 32 age-and sex-matched malnourished children receiving only a nutritional regimen. Determinations were carried out at days 0, 15 and 30. Protein marker concentrations increased steadily in supplemented children as compared to those in the untreated group (p < 0.05, Student's t test). On the other hand, serum concentrations of the two proteins progressively regained normal values in the vitamin A supplemented group. Data also showed that retinol supplementation in conjunction with an appropriate nutritional diet is effective in raising serum concentrations of vitamin A and its binding proteins to normal levels. Therefore, we concluded that the results of this study demonstrates the importance of vitamin A supplementation in the management of these deficiency states.

Relationship between plasma retinol and infectious diseases in the elderly. A case-control study.

This study assessed the relationship between plasma retinol deficiency and infectious diseases. The plasma retinol, anthropometric (Body Mass Index, triceps skinfold thickness, mid-arm muscle circumference) and biological indices (proteins, albumin, transferrin, prealbumin, retinol binding protein) of protein-energy malnutrition of 63 patients with infectious diseases (ID) were compared to those of two control groups of similar age: 527 patients with other diseases (C1) and 92 healthy people (C2). Plasma retinol, albumin, transferrin and prealbumin were significantly lower in the ID group than in the C1 group. A lower body mass index was noted in men only. The ID and C1 groups had lower values for all indices (except for mid-arm muscle circumference). The ID group had lower albumin, transferrin, and prealbumin than the C1 group. The percentage of patients with plasma retinol below 300 microg/l was higher in the ID group (48.0% in men, 39% in women) than in the C1 group (25.0 and 21.5%); the odds ratio adjusted on age and sex equaled 2.46, 95% CI (1.39-4.37). It was lower than 2% in the C2 group. The results obtained with multiple regression analysis showed that, in the patients, the association between plasma retinol and infectious diseases remained significant when age, sex, anthropometric and biological indices were taken into account. Consequently, it is useful to check up the food intake habits of the elderly.

An evaluation of salt intake and iodine nutrition in a rural and urban area of the Côte d'Ivoire.

OBJECTIVE: To evaluate the habitual salt intake of individuals living in the Côte d'Ivoire, and to monitor the iodine nutrition of adults, schoolchildren and pregnant women one year after implementation of a universal salt iodisation programme. DESIGN: A three day weighed food records with estimation of food intake from a shared bowl based on changes on body weight, determination of sodium and iodine concentrations in 24 h (24 h) urine samples from adults, and determination of urinary iodine in spot urines from schoolchildren and pregnant women. SETTING: A large coastal city (Abidjan) and a cluster of inland villages in the northern savannah region of the Côte d'Ivoire. SUBJECTS: For the food records: 188 subjects (children and adults) in the northern villages; for the 24 h urine collections: 52 adults in Abidjan and 51 adults in the northern villages; for the spot urine collections: 110 children and 72 pregnant women in Abidjan and 104 children and 66 pregnant women in the north. MAIN RESULTS: From the food survey data in the north, the total mean salt intake (s.d.) of all age groups and the adults was estimated to be 5.7 g/d (+/- 3.0), and 6.8 g/d (+/- 3.2), respectively. In the 24 h urine samples from adults, the mean sodium excretion was 2.9 g/d (+/- 1.9) in the north and 3.0 g/d (+/- 1.3) in Abidjan, corresponding to an intake of 7.3-7.5 g/d of sodium chloride. In the north the median 24 h urinary iodine excretion in adults was 163 microg/d, and the median urinary iodine in spot urines from children and pregnant women was 263 microg/l and 133 microg/l, respectively. In contrast, in Abidjan the median 24 h urinary iodine was 442 microg/d, with 40% of the subjects excreting > 500 microg/d, and the median urinary iodine in spot urines from children and pregnant women was 488 microg/l and 364 microg/l, respectively. Nearly half of the children in Abidjan and 32% of the pregnant women were excreting > 500 microg/l. CONCLUSION: Based on the estimates of salt intake in this study, an optimal iodine level for salt (at the point of consumption) would be 30 ppm. Therefore the current goals for the iodised salt programme--30-50 ppm iodine appear to be appropriate. However, in adults, children and pregnant women from Abidjan, high urinary iodine levels--levels potentially associated with increased risk of iodine-induced hyperthyroidism--are common. These results suggest an urgent need for improved monitoring and surveillance of the current salt iodisation programme in the Côte d'Ivoire.

[Protein profile in malnutrition states of the Ivory Coast child]. / Profil protétique dans les états de malnutrition de l'enfant Ivoirien.

Prospectively assessment of nutritional status, besides anthropometric parameters measurements, included determination of the following plasma proteins: albumin, transferrin, retinol-binding protein and thyroxine-binding prealbumin, usually regarded as useful indices of protein depletion states. Patients' inflammatory or infectious diseases were investigated by measuring the two most reliable acute-phase reactants (orosomucoid and c-reactive protein). This study was conducted on a group of 56 pediatric patients malnourished and 54 age- and sex-matched healthy subjects as controls. Data showed a higher prevalence of inflammatory process during the course of malnutrition as revealed progressive but severe alteration of the Prognostic Inflammatory and Nutritional Index (PINI) or CRP x a1-GPA/Alb x TBPA. On the other hand, kwashiorkor and marasmus seemed to be a precipitating cause of infectious or/and inflammatory process. We, therefore, conclude that the PINI scoring system should be for the pediatricians, a sensitive and precious tool allowing the correct follow-up of inflammatory pole in nutritional disorders in developing countries.

[Immune response as a function of the nutritional status in young children 1 to 3 years of age in the south of Ivory Coast]. / Contribution à l'étude de la réponse immunitaire en fonction du statut nutritionnel chez le jeune enfant de 1 à 3 ans dans le sud de la Cote-d'Ivoire.

177 children between 1 and 3 years (74 well-nourished, 55 suspected of protein/calorie deficiency, 48 under nourished) were vaccinated (tuberculosis, diphtheria, tetanus, whooping-cough, polio); one month after the third dose of DTWC polio, we proceeded to apply the Merieux multitest and to check for intradermal reaction to the tuberculin: This study has shown that the Merieux multitest gives results comparable to the classical intradermal method with tuberculin. The multitest makes it possible to explore simultaneously seven different antigens under perfectly comparable conditions from the standpoint of precision and standardization (diphtheria, tetanus, tuberculin, Streptococcus, Proteus, Trichophyton and Candida). This exploration has shown that there is no significant difference in terms of the nutritional condition of the children. Well-nourished children, under-nourished children and children suspected of a deficiency react in the same manner to antigenic attractions whether vaccinal or spontaneous. This study would seem to suggest, therefore, that the nutritional conditions of a child need not to be taken into account when administering a vaccine.