Epidemiology and spatio-temporal distribution of gastrointestinal parasites infection and accuracy of FAMACHA test in sheep in traditional farming systems in Burkina Faso.

Blood and faecal samples from 2086 Sahelian and Djallonke sheep have been collected to assess the epidemiology and spatio-temporal distribution of gastrointestinal parasites. A survey with a questionnaire allowed collecting data on individual animal and farms. Faecal samples were analysed using the McMaster technique, while anaemia was assessed using FAMACHA score test and packed cell volume. The overall prevalence of gastrointestinal parasites was 91%, and strongyles (70.7%), Eimeria sp. (60.4%), Moniezia sp. (5.7%), Stronyloides sp. (0.9%) were identified. There was no significant association between the region and strongyles infection (P ˃ 0.05). Animals sampled during the rainy season (n = 565; P = 82.2%, mean EPG = 154.8 ± 12.02) were mostly and heavily infected than those from the hot dry (n = 518; P = 74.2%; mean EPG = 97.7 ± 17.4) and the cold dry season (n = 392; P = 55.5%; mean EPG = 24.5 ± 19.5) (P ˂ 0.05). Females (n = 1027; P = 72.1%; mean EPG = 77.6 ± 17) were most infected than males (n = 448; P = 67.7%; mean EPG = 61.6 ± 19.5) (P ˂ 0.05). Animals that were treated, at most 3 months before sampling (n = 166; P = 61.5%; mean EPG = 41.7 ± 21.4), were less infected than those, which received this treatment after three months before sampling (n = 199; P = 74.8%; mean EPG = 89.1 ± 15.8) (P ˂ 0.05). Data from blood samples indicate that 6.5% of sheep was anaemic (PCV ≤ 19%), while 59.7% was noted anaemic regarding FAMACHA scores. PCV values varied significantly for FAMACHA scores, and the highest mean value was noted for score 1 (27.6) (P ˂ 0.05). The Cohen's kappa score between FAMACHA and PCV was 0.02. These findings suggest that strongyles infections are significantly associated with season, and heavier infections were noted during rainy season.

Trauma of the external genital in children: Emasculation, a paediatric case report.

An 8-year-old boy was brought to the paediatric surgery department having amputated his penis and both testicles during a road traffic accident. Examination of the perinea showed a complete amputation of penis, scrotum and testicles. We performed debridement and skin suture initially. The urethral orifice was catheterized by a 10 F Foley's catheter. I the herein case report, we discuss the incidence, management and complications of genital amputation in a young boy. Moreover, the existing literature in this subject is reviewed.

Les complications de la circoncision au CHU de Yopougon

Circoncision masculine - méthodes

Surgical treatment of femoral diaphyseal fractures in children using elastic stable intramedullary nailing by open reduction at Yopougon Teaching Hospital.

INTRODUCTION: Elastic stable intramedullary nailing (ESIN) has transformed children's femoral shaft fracture treatment, but this technique requires an image intensifier. Without it, open reduction is used to check fracture reduction and pin passage. The aim of this study was to describe our techniques and to evaluate our results at the middle term. HYPOTHESIS: The open reduction and ESIN technique provides satisfactory results with few major complications. PATIENTS AND METHODS: This was a retrospective study that focused on femoral diaphyseal fractures treated in the pediatric surgery unit at Yopougon Teaching Hospital (Abidjan, Côte d'Ivoire) between January 2007 and December 2013. Twenty children older than 6 years of age who underwent open reduction and ESIN without image intensifier assistance were included. Functional outcomes were assessed using Flynn's criteria. Postoperative complications and sequelae were recorded. RESULTS: At the 16-month follow-up, the results were excellent in 11 (55%) cases, good in eight (40%), and poor in one (5%) case. The mean duration of surgery was 71min (range, 57-103 min). The mean time for bone healing was 11.6 weeks (range, 7-15 weeks) and the average time to nail removal was 6 months. Complications included wood infection (n=3), skin irritation (n=3), knee stiffness (n=2), malunion (n=3), scar (n=5), and leg length discrepancy (n=3). DISCUSSION: Open reduction and ESIN yielded satisfactory results with few major complications. This method could be an alternative in low-income countries where the image intensifier is often unavailable. LEVEL OF EVIDENCE: Level IV retrospective study.

Epidemiology of congenital abnormalities in West Africa: results of a descriptive study in teaching hospitals in Abidjan: Cote d'Ivoire

Background: Congenital abnormalities constitute one of the major causes of infant mortality; particularly in developing countries. The aim of this study was to describe the epidemiology of congenital anomalies in Cote d'Ivoire. Materials and Methods: It was a multicentric study of three academic hospitals and the Heart Institute of Abidjan over 10 years. The epidemiologic Data concerned the Parturients; the annual frequency of congenital abnormalities. Distribution of the congenital abnormalities according to the organs; overall mortality and lethality of congenital abnormalities were evaluated. Results: Over 10 years; 1.632 newborns with 1.725 congenital anomalies were recorded. Frequency was 172.5 congenital anomalies per annum. Parturients were less than 35 years in 33% of cases; multigravida in 20%; multiparous in 18% and had a low socio economic status in 96% of cases. Prenatal diagnosis of congenital anomalies was performed in 1.5%. Congenital anomalies were orthopedic in 34%; neurological in 17%; gastrointestinal in 15%; facial in 11.5%; parietal in 13%; urogenital in 9% and cardiac in 0.5% of cases. The overall mortality rate of congenital anomalies was 52% and gastroschisis was the most lethal disease with 100% mortality. Conclusion: This descriptive study reveals the low socio economic status of Parturients with congenital anomalies and their poor prenatal diagnosis. These factors explain the very high mortality of congenital anomalies due to a delay management in our country in which medical expenses were borne by parents and where technical platforms remain obsoletes for good resuscitation and neonatal surgery

Outcomes of conservative treatment of giant omphaloceles with dissodic 2% aqueous eosin: 15 years' experience.

BACKGROUND: The surgical management of giant omphalocele is a surgical challenge with high mortality and morbidity in our country due to the absence of neonatal resuscitation. This study evaluates conservative management of giant omphalocele with dissodic 2% aqueous eosin. MATERIALS AND METHODS: In the period from January 1997 to December 2012, giant omphaloceles were treated with dissodic 2% aqueous eosin. The procedure consisted of twice a day application of dissodic 2% aqueous eosin (sterile solution for topical application) on the omphalocele sac. The procedure was taught to the mother to continue at home with an outpatient follow-up to assess epithelialization. We studied the duration of the hospital stay, the learning curve of the procedure by the mother, the complications, the duration and the percentage of complete epithelialization and the mortality. RESULTS: A total of 173 giant omphaloceles had a conservative treatment with dissodic 2% aqueous eosin. The average hospital stay was 21 ± 6 days. The learning curve by the mother of the procedure was 10 ± 3 days. Complications of treatment were intestinal functional occlusion 22% and omphalocele sac infection 18%. The complete epithelialization of the omphaloceles sac after application of dissodic 2% aqueous eosin was 68.5%. Mortality was observed in 25.5%. CONCLUSION: Conservative treatment of giant omphaloceles by dissodic 2% aqueous eosin is a simple, efficient and a good alternative to surgery. The mother can easily learn its procedure which reduces the duration of hospital stay.

Infections osteo-articulaires (IOA) des nourrissons de moins de 3 ans: particularites cliniques; bacteriologiques; therapeutiques et pronostiques

Contexte. Dans les pays industrialises; les IoA sont prises en charge tres rapidement au debut des manifestations cliniques contrairement aux pays en developpement ou elles sont traitees tard au stade subaigu ou chronique. L'objectif de cette etude etait de decrire les IAo chez les enfants de moins de 3 ans afin de definir leurs particularites cliniques; d'identifier les bacteries en cause. Patients et methode. Sur une periode de 11 ans; de Decembre 2002 a Janvier 2013; nous avons collige des dossiers d'Infections osteo Articulaires (IoA) d'enfants au Centre Hospitalier Universitaire de Yopougon Abidjan Cote d'Ivoire. Les donnees cliniques concernaient; le delai de consultation; les portes d'entrees; la symptomatologie clinique (signes generaux; signes fonctionnels; signes physiques); Les parametres etudies etaient cliniques; biologiques; bacteriologiques; therapeutiques et evolutifs. Resultats. Au total; nous avons collige 105 dossiers d'Infections osteo Articulaires (IoA) d'enfants de 0 a 36 mois. Les resultats de l'hemoculture ont ete positifs dans 22%; ceux de la ponction articulaire ont ete positifs dans 51;5%; ceux de la ponction metaphysaire dans 22% et ceux du prelevement de la porte d'entree dans 60% . Les bacteries isolees etaient; le staphylococcus aureus dans 54%; Salmonella dans 23%; Klebsiella pneumoniae dans 19%; Pyocianique dans 4%. L'antibiogramme a montre une sensibilite des bacteries isolees dans 100% des cas aux Aminosides; aux Fluoroquinolones; a la Fosfomycine; aux Imipenemes et aux Glycopeptides. La sensibilite aux Betalactamines etait de 60%. Conclusion. Il faut eviter les betalactamines en mono antibiotherapie de premiere ligne au cours des IAo chez les nourrissons de moins de 3 ans. Nous suggerons l'utilisation d'une mono antibiotherapie avec amoxicilline acide clavulanique qui vise l'elimination du Kingella Kingae premiere bacterie en cause au cours des infections orL des nourrissons mais aussi a cause de l'acide clavulanique pour eliminer les staphylocoques dores producteurs de betalactamase

Delayed treatment of supracondylar elbow fractures in children.

BACKGROUND: Supracondylar fractures are the most common elbow fractures in children and are usually treated on an emergency basis, using percutaneous pinning. However, the treatment is often delayed in areas where healthcare resources are scarce. HYPOTHESIS: Delaying treatment does not influence the perioperative complication rate. MATERIALS AND METHOD: We retrospectively reviewed the medical charts of 89 children aged 2 to 15 years in whom surgery for extension-type supracondylar elbow fractures was delayed by more than 48 hours. The 53 boys and 36 girls with a mean age of 6 years 9 months had severe fracture displacement (28 stage III and 61 stage IV according to Lagrange and Rigault classification scheme). Mean time to treatment was 4.5 days (range: 2-17 days). Open reduction and crossed K-wire fixation via the posterior approach were performed in all 89 patients. Postoperative complications and sequelae were collected. Functional outcomes were evaluated using Flynn's criteria. RESULTS: Outcomes were satisfactory in 74 (83.2%) of patients. Postoperative complications occurred in 13 (14.6%) patients and consisted of surgical site infection (n=7, 7.8%), iatrogenic nerve injury (n=3, 3.4%), and reoperation (n=3, 3.4%). At last follow-up after a mean of 5 months, three (3.4%) patients had cubitus varus and one had a recurrent fracture due to massaging. Elbow motion was limited in 11 (12.4%) patients. No case of compartment syndrome was recorded. DISCUSSION: Despite an average time to surgery of 4.5 days, the outcome was satisfactory in 83% of cases. Delayed treatment was not associated with an increased rate of perioperative complications. LEVEL OF EVIDENCE: Level IV, retrospective study.

Elastic stable intramedullary nailing in paediatric traumatology at Yopougon Teaching Hospital (Abidjan).

CONTEXT: Elastic stable intramedullary nailing has revolutionised the treatment of fractures in children. AIM: To report our experience with this current technique of management of fractures in children. METHODS AND MATERIALS: A retrospective study of all children with fractures treated by this method from November 2003 to June 2006 at the Paediatric Surgery Department of Yopougon Teaching Hospital, Abidjan, Côte d'Ivoire. Data were recorded from their medical charts regarding demographics, fracture patterns, associated injuries, morbidity, and outcome. RESULTS: A total of 38 children (14 boys; mean age, 11.7 years; range, 9-15 years) with 41 fractures, sited at femur (n=15), humerus (n=8), tibia and fibula (n=6), forearm (n=7), and radial neck (n=5), associated with other injuries in 7 cases, were enrolled in the study. The mean interval for surgery was 6.8 days. Open reduction was required 5 times (12.1%). The hospital stay was in the range 5-12 days. Minor adverse events were 1 (2.4%) early tibial loss of reduction, 3 (7.3%) skin irritations and 2 (4.8%) transient knee limitations. Complications (17.3%) included 2 axial (4.8%) and 1 rotational (2.4%) femoral malunions below 15°; 3 elbow (7.3%) and 1 knee stiffness (2.4%) in openly reduced cases. Solid consolidation was achieved in all cases, with no disturbance in standard union times. At a mean follow-up period of 16 months (range, 9-28 months), all but 3 patients with opened joints recovered full range of motion, and none showed either limp and gait anomalies or re-fracture after removal of wires. CONCLUSION: Elastic stable intramedullary nailing in children fractures is easy to perform and has little complications if a proper technique is used.

[Accidents of circumcision in children in Abidjan, Côte d'Ivoire]. / Accidents de circoncision chez l'enfant à Abidjan, Côte d'Ivoire.

Circumcision is the most common surgical procedure carried out in boys in our countries. It is performed by medical members but also by traditional practitioners. Circumcision is considered as a benign operation but its complications are common, sometimes severe and the treatment delicate. Authors reported 35 cases of circumcision's complications in boys, aged of 2 days to 14 years old who were circumcised by traditional practitioners and by medical members. The most frequent complications were urinary meatus stenosis (17 cases), haemorrhage (5), total glans section (3), urethral fistula (3), and incomplete circumcision (3). These complications were caused by traditional practitioners in 19 cases, paramedical members in 11 cases, and 5 cases by physicians. Among these complications, fistula and amputation had required delicate surgical procedure. All the stenosis were treated by meatal plasty and fistula were sutured with one recurrence. Partial glans section underwent Mathieu's procedure and the total sections were referred to the plastic surgeon. Authors recommend surgical procedure for circumcision which must be performed in medical center or by well trained practitioners.

Reproductive characteristics of Ethiopian highland sheep. II. Genetic parameters of semen characteristics and their relationships with testicular measurements in ram lambs.

A study was conducted to investigate the effect of season on, and to estimate heritabilities of, and genetic correlations among, semen and spermatozoa characteristics and the relationship of these characteristics with measures of testicular or scrotal size in 6-, 9- and 12-month old ram lambs of Menz and Horro sheep breeds indigenous to Ethiopian highlands. A total of 278 ram lambs with substantial pedigree information were involved in the study. There was improvement in all semen and spermatozoa traits with age, the means at 12 months being consistently superior to values at 6 and 9 months of age. There were no significant breed differences in any of the traits studied, except semen volume at 9 months (0.67, S.E. 0.07 for Horro versus 0.39, S.E. 0.05ml for Menz) and proportion of dead spermatozoa at 12 months (0.18, S.E. 0.03 versus 0.23, S.E. 0.02, respectively). Season was significant (p<0.05) for most of the traits studied, and differences were attributed primarily to nutrition. Semen collected in the wet season had higher spermatozoa concentration while samples collected in the dry season had higher proportion of abnormalities. After correcting for differences in total spermatozoa abnormalities, the wet season (of collection) had the highest spermatozoa output (volumexconcentration) in 12-month old ram lambs. Heritability estimates varied substantially in magnitude, ranging from zero to over 0.4. Traits with non-trivial heritability estimates were mass motility at 9 months (0.32, S.E. 0.11), individual motility at 9 months (0.32, S.E. 0.12) and at 12 months (0.16, S.E. 0.12) and proportion of abnormal spermatozoa at 9 months (0.35, S.E. 0.13). Genetic correlations among semen and spermatozoa characteristics, as well as correlations with testicular measurements, were medium to high and generally favourable, but were associated with large standard errors. The genetic correlations of scrotal circumference with semen volume (0.55, S.E. 0.11), mass motility (0.62, S.E. 0.20), individual motility (0.54, S.E. 0.12), concentration (0.25, S.E. 0.04) and proportion of abnormal spermatozoa (-0.75, S.E. 0.24) in 12-month old rams indicated that selection based on this trait, which is highly heritable and easy to measure and can be measured early in life, should have appreciable favourable correlated response in semen quality and spermatozoa production.

Reproductive characteristics of Ethiopian highland sheep. I. Genetic parameters of testicular measurements in ram lambs and relationship with age at puberty in ewe lambs.

A study was conducted to estimate heritabilities of, and genetic correlations among, body weight (WT) and testicular measurements - scrotal circumference (SC), testicular diameter (TD), testicular length (TL) and epididymal diameter (ED) - in ram lambs between 6, 9 and 12 months old, and relationship of the testicular traits with age at puberty in ewe lambs (AP). Two fat-tailed sheep breeds, the Horro and Menz, indigenous to the Ethiopian highlands were studied. Experimental lambs were produced by mating 250 oestrus-synchronized ewes of each breed to 10 sires in a single-sire mating system over three mating periods which produced, for this study, a total of 361 ram lambs and 148 ewe lambs, with substantial pedigree information, in two dry seasons (October/November 1992 and 1993) and one wet season (June/July 1993). Mean AP was 322.7 days. Breed was not significant (P0.05) for all testicular measurements, except ED at 9 months for which the Horro had a higher (P<0.01) value (20.6, s.e. 0.38 versus 19.3 s.e. 0.30). Horro ewe lambs had their first oestrus 28 days earlier (P<0.05) than the Menz. Heritability estimates were obtained from a sire model (M1) and from an individual animal model with additive direct and maternal effects (M2). The maternal effect was not fitted in M2 for AP. Repeatability and heritability estimates were also obtained by analysing records at the three ages in a repeated measures model (M3). M1 and M2 heritability estimates were generally low to moderate but were associated with large standard errors. Heritability estimates for testicular measurements were generally similar to those for WT. Among the testicular measurements, SC had the highest heritability estimates at 6 (0.45, s.e. 0.24 for M1) and at 12 months (0.41, s.e. 0.21 and 0.41, s.e. 0.20 for M1 and M2, respectively). Model 3 heritability estimates were 0.29 (s.e. 0.14), 0.24 (s.e. 0.12), 0.09 (s.e. 0.07), 0.11 (s.e. 0.08) and 0.12 (s.e. 0.08) for WT, SC, TD, TL and ED, respectively. Only repeatability estimates for WT (0.34, s.e. 0.02) and SC (0.25, s.e. 0.03) were significant. Heritability of AP was estimated at 0.16 (s.e. 0.21) by M1 and 0.14 (s.e. 0.19) by M2. Genetic correlations of AP with testicular measurements, especially with SC (-0.57, s.e. 0.38 and -0.78, s.e. 0.33, at 9 and 12 months, respectively) and TD (-0.72, s.e. 0.33 and -0.83, s.e. 0.48), were desirable and generally high. Adjustment of testicular measurements for liveweight consistently resulted in a reduction in estimates of heritability and genetic correlations. SC was suggested as the most appropriate selection candidate for the genetic improvement of both male and female reproductive performance in these breeds.

Coenurus cerebralis infection in Ethiopian highland sheep: incidence and observations on pathogenesis and clinical signs.

An investigation was carried out at Debre Berhan, Ethiopia, between 1996 and 1997, into the epidemiology of coenurosis in Menz and Horro breeds of sheep. A total of 37 heads from clinically sick and 183 heads from apparently healthy sheep were examined post mortem for the presence of the cystic larvae of Taenia multiceps, of which 37 and 5 heads, respectively, contained 1 to 8 coenurus cysts (diameter 0.8 to 6.5 cm). The bladder worms were located in the cerebral hemisphere in 96% of the cases (43% and 57% for left and right, respectively), 4% being in the cerebellum. Prediction of cyst locations based on the direction of circling and head deviation had a 62% success rate. A retrospective study generated from the health record book at the ILRI Debre Berhan Station in 1992-1996 (199 Horro and 174 Menz) revealed that the incidence of coenurosis ranged from 2.3% to 4.5%. There was no significant breed difference in the incidence. The age of the affected sheep ranged from 4 to 96 months, with a mean of 19.3 months, and 72% of the cases were within the range of 6 to 24 months. In a complementary survey on necropsied stray dogs, 8 out of 17 were positive for Taenia spp. Both studies confirm the endemicity of coenurosis at the ILRI Debre Berhan Research Station. Appropriate strategies for the control of coenurosis are suggested.

Development and survival of infective larvae of nematode parasites of sheep on pasture in a cool tropical environment.

The development and survival of nematode parasites of sheep were studied in a cool tropical environment of the highlands of Ethiopia on 24 plots serially contaminated with Haemonchus contortus, Longistrongylus elongata and Trichostrongylus colubriformis eggs over a period of 2 consecutive years from June 1993 to May 1995. The availability of infective larvae was monitored by monthly pasture sampling and larvae recovery. Infective larvae were recovered from the herbage collected from the plots contaminated in June, July, August, September and October of both years. The longevity of infective larvae varied between two and six weeks when eggs were deposited on pasture in June and October, respectively. During the dry and short rainy season (November through May), eggs failed to develop into L3 stage. It is suggested that the long period (7 to 8 months) of lack of development of trichostrongylid infective larvae on the pasture can be efficiently used in a strategic treatment programme to interrupt transmission of H. contortus, L. elongata and T. colubriformis in sheep in this environment.

Breed and season effects on the peri-parturient rise in nematode egg output in indigenous ewes in a cool tropical environment.

A study was carried out at the International Livestock Research Institute (ILRI) Debre Berhan Research Station in Ethiopia from 1992 to 1995 to compare the peri-parturient rise (PPR) in faecal nematode egg counts (FEC) in ewes of two indigenous sheep breeds. A total of 1439 Menz and 1347 Horro ewes were single sire mated following oestrus synchronization to lamb in the wet and dry season. Three ewe treatment groups were constituted as mated/lactating/undrenched; mated/lactating/drenched; unmated/undrenched for three wet and three dry lambing seasons. All ewes grazed naturally contaminated pasture. Levels of faecal egg output were monitored at mating, 3 months after mating, 2 weeks before lambing, 4, 8 and 12 weeks post-lambing. A significant PPR in FEC occurred 2 weeks before lambing and peaked at 4 weeks post-parturition in ewes lambing just before the beginning of the dry season (October/November). There was no significant increase in FEC when lambing occurred before the onset of the long rainy season (May/June). The PPR in this study was associated with both lactation and seasonal availability of third-stage infective larvae on pasture. There was no consistent breed difference in FEC during the six sampling periods from mating to weaning. Faecal cultures and worm counts from both breeds confirmed the presence of Longistrongylus (Pseudomarshallagia) elongata, Trichostrongylus spp.and Haemonchus contortus. The role of the peri-parturient rise of FEC in ewes in gastrointestinal nematode transmission is discussed.

The epidemiology of nematode infections in sheep in a cool tropical environment.

The epidemiology of nematode infections in Menz sheep was studied in the highlands of Ethiopia at the International Livestock Research Institute (ILRI), Debre Berhan Research Station, using a series of tracer lambs grazing contaminated pasture for either 4, 16, 32 or 48 weeks from July 1992 to June 1994. The basic nematode seasonal infectivity pattern was expressed in terms of relative numbers of third-stage larvae (L3) available on pasture for different months. Data from faecal nematode egg counts, pasture larval recoveries and worm counts from the tracer lambs were used to investigate the infectivity pattern. Four nematode species of economic importance: Longistrongylus (Pseudomarshallagia) elongata, Trichostronglylus colubriformis, Haemonchus contortus, and Dictyocaulus filaria, were recovered from sheep. The largest numbers were recovered during the wet season (i.e. July to November) with peaks in late August and early September. During this 2 year study period, the seasonal pattern of sheep gastrointestinal nematodes was clearly defined. An important finding was that conditions during the short rainy season (i.e. March-May) were not conducive to the development and survival of nematode eggs and the free-living stages, hence little or no transmission occurred. Rainfall and humidity seemed to be the most important factors for the development of eggs and free-living stages. The period of acquisition of third-stage larvae from pasture was found to be relatively short, suggesting that a strategic control programme is feasible with minimal anthelmintic use. Results from the studies are discussed in relation to control strategies.

Preliminary observations on helminth parasite populations of the dromedary in northern Mali.

An abattoir survey on gastrointestinal parasites of the dromedary (Camelus dromedarius) was carried out in March/April 1987 in northern Mali. Parasitological examination of the digestive tract contents of 11 dromedaries revealed that Haemonchus longistipes was the predominant parasite with a prevalence as high as 85.7%. The genera Impalaia, Trichostrongylus, Cooperia, and Oesophagostomum were also recovered, but with a lower level of infection and frequency. The larval stage of the canine cestode Echinococcus granulosus was recorded in a single instance.

[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.