[Intestinal parasitic diseases and environment in Sahelo-Sudanese towns: the case of Pikine (Senegal)]. / Parasitoses intestinales et environnement dans les villes Sahélo-Soudaniennes: l'exemple de Pikine (Sénégal).

A survey carried out in Pikine (Senegal) on a sample of 5 groups of children drawn from ecologically representative sections of the town confirms the high prevalence in urban areas of Africa of intestinal infection, especially A. lumbricoides (35.6%), T. trichiura (35.4%), and Giardia (43.7%). The prevalence of A. lumbricoides (35.6%), T. trichiura (35.4%), and Giardia (43.7%). The prevalence of A. lumbricoides and T. trichiura are appreciably higher in the oldest sectors of the town or in those with a better sanitary standard: up to 47.7% for Ascaris and 46% for Trichuris. The use of X2 tests and log-linear analysis demonstrates a significant association between Ascaris and Trichuris. The highest prevalence for Giardia (56.8%) were to be found on the outskirts of the town, where the lowest prevalence of Ascaris (21.7%) and Trichuris (22.9%) were noted; moreover, age-based prevalence for the three parasites vary from one ecological area to another. The relationship between the urbanization process, the variation in environmental factors and intestinal parasitic infection, and the operational implications arising from this geographically-based approach are discussed.

Evaluation of the rapid plasma reagin "teardrop" card test for screening of syphilis in field conditions.

BACKGROUND AND OBJECTIVES: The availability of simple diagnostic methods may contribute to more efficient control of sexually transmitted diseases (STDs) in developing countries. For the detection of syphilis, a simple rapid plasma reagin (RPR) "teardrop" assay for finger-prick blood samples was developed in 1962. The reliability of this test is compared with RPR, Treponema pallidum hemagglutination assay (TPHA), and fluorescent treponemal antibody absorption (FTA-Abs) assays performed on venous blood samples. GOAL OF THIS STUDY: To evaluate the potential usefulness of the finger-stick RPR teardrop assay for diagnosis of syphilis in settings with poor medical resources. STUDY DESIGN: Pregnant women evaluated at two health centers in Pikine, Senegal were tested for STDs. The RPR teardrop assay was performed on plasma from blood samples obtained by finger prick, and standard RPR, TPHA, and FTA-Abs procedures were performed on serum obtained by vein puncture. RESULTS: The sensitivity and specificity of the finger-prick RPR teardrop assay were 69.7% and 96.5%, respectively, and its reactivity was correlated with RPR serum antibody titer. CONCLUSION: The finger-prick RPR teardrop assay is not a reliable alternative to the classic serum RPR test.

PIP: Health workers took finger-prick blood samples from at least 452 pregnant women at 2 health centers in Pikine, Senegal, to compare the effectiveness of the rapid plasma reagin (RPR) teardrop card test with that of the standard RPR 18 mm circle card test. Specifically, the researchers wanted to evaluate the RPR teardrop card test's potential usefulness in diagnosing syphilis in areas with poor medical resources, such as developing countries. Just 23 of 48 (47.9%) women who had at least 1 reactive cardiolipin test had positive results for both tests. Among these 48 cases, the RPR teardrop card test correctly identified antibodies of Treponema palladium in 67.6% of cases (sensitivity) and 96.7% of cases who did not have these antibodies (specificity). Among the 402 sera specimens which did not react to the Treponema palladium hemagglutination (TPHA) assay, the RPR teardrop test had a positive predictive value of 97% (33 of 34 cases which reacted to the RPR 18 mm circle test). Among the 402 finger-prick plasma specimens, the plasma RPR teardrop card test correctly identified 388 pregnant women (i.e., specificity, 96.5%) who did not have T. palladium antibodies and 23 of the 33 women (i.e., sensitivity, 69.7%) who did indeed have T. palladium antibodies according to RPR and TPHA results. Its positive predictive value was 62% (23 of the 37 who had a reactive RPR teardrop test). A significant correlation existed between the RPR serum titer and the reactivity of the RPR teardrop test on plasma (p = .005). These findings showed that the RPR 18 mm circle card test performed on serum is a more accurate diagnostic test than the RPR teardrop card test. Thus, the researchers did not recommend the RPR teardrop assay as an alternative to RPR 18 mm circle card test for diagnosing syphilis.

Accuracy of two enzyme immunoassays and cell culture in the detection of Chlamydia trachomatis in low and high risk populations in Senegal.

Two enzyme immunoassays (EIAs), Chlamydiazyme (CZ; Abbott Laboratories) and Pathfinder (PF; Kallestadt), were compared with a cell culture technique in the detection of cervical Chlamydia trachomatis infection in 670 women in urban settings in Senegal (377 pregnant women and 293 prostitutes). Positive CZ and positive PF specimens were tested a second time using a monoclonal antibody blocking technique. True positive specimens were defined as those positive on culture or positive on EIA with confirmation of the result after blocking. Using this definition, the prevalence of genital chlamydial infection was 14.6% and 14.3% in pregnant women and prostitutes respectively. An important difference between the two populations was that the pregnant women were younger than the prostitutes, which might explain the fact that the prevalence of infection among the pregnant women was as high as that among the prostitutes, although the age-adjusted prevalence was higher among prostitutes than among pregnant women. The chlamydial detection rates of cell culture, CZ and PF were 62% (26/42), 69% (29/42) and 86% (36/42) respectively in prostitutes and 76% (42/55), 40% (22/55) and 53% (29/55) respectively in pregnant women. Agreement between the tests was 89%, 85% and 88% for culture/CZ, culture/PF and CZ/PF respectively. However, when data were adjusted for chance agreement, kappa coefficients were 0.40 for culture/CZ, 0.34 for culture/PF and 0.48 for CZ/PF. These results indicate that the accuracy of the EIAs and cell culture may vary greatly in different populations: both EIAs showed a distinctly higher detection rate than culture in prostitutes and a significantly lower detection rate in pregnant women.(ABSTRACT TRUNCATED AT 250 WORDS)

[Sexually transmitted diseases in the female population of Pikine, Senegal]. / Maladies sexuellement transmissibles dans la population féminine à Pikine, Sénégal.

The prevalence of some sexually transmitted disease is determined in 250 gynaecology patients and in 200 pregnant women seen in primary health centers in Pikine, Senegal. The main reason for consultation at gynaecology is infertility. Gonorrhoea and Chlamydia trachomatis infection are present respectively in 1.5% and 7% of pregnant women and in 4.4% and 7.6% of gynaecology patients. Human papillomavirus infection, determined by DNA extraction and hybridization technique, is seen in 4% of obstetric and in 1.2% of gynecology patients. Cytological anomalies is found in 5.5% of pregnant women and in 4.8% of gynecology patients.

[Neisseria gonorrhoea in Pikine (Senegal): survey of antibiotic sensitivity]. / Neisseria gonorrhoea à Pikine (Sénégal): surveillance de la sensibilité aux antibiotiques.

The antimicrobial sensitivity of 96 strains of Neisseria gonorrhoeae, isolated in 1987-88 in Pikine, Senegal was determined. Twenty four percent of isolates produced beta-lactamase (PPNG). Among the beta-lactamase negative strains, 27% showed a decreased sensitivity to penicillin (MIC 0.125-0.25 mg/l) and 3% were resistant (MIC greater than or equal to 0.5 mg/l). Seventeen percent of isolates showed a decreased sensitivity to thiamphenicol (MIC 1-4 mg/l) and 7% were moderately resistant to tetracycline (MIC 2-4 mg/l). All isolates were sensitive to spectinomycin and sensitive to moderately sensitive to kanamycin. During an earlier survey performed in 1981, chromosomal resistance to tetracycline was not seen and only 4% of strains were beta-lactamase positive. These results suggest a decreasing antimicrobial sensitivity of N. gonorrhoeae in Pikine. Spectinomycin can be used as a first choice antimicrobial and thiamphenicol may be recommended as a valuable alternative treatment of gonorrhoea in Pikine, Senegal.

Financing urban primary health services. Balancing community and government financial responsibilities, Pikine, Senegal, 1975-81.

It is difficult to prejudge a community's capacity to satisfy its basic human needs, because no satisfactory method has been developed to predict the potential resources of a poor community. To improve their health conditions, all people, even poor, have some resources available. When they can manage themselves and be involved in decision making, they can become very efficient and contribute many material and human resources needed to organize health facilities in situations where the government fails to provide for wide-ranging needs, especially in the new cities. This was demonstrated by our experiment in Senegal between 1975 and 1981. This paper discusses the respective roles and responsibilities of the communities and the government in terms of: the process of setting up and carrying out the project in Pikine and the stages of community participation; and the pre-conditions for successful co-management in a primary care organization financed in a large part by the community.

Epidemiology of seasonal falciparum malaria in an urban area of Senegal.

A 15-month longitudinal survey was carried out to examine entomological and parasitological aspects of human malaria transmission in Pikine, a city located in the Sudan savanna zone on the Cap Vert peninsula in the west of Senegal. The anopheline population was sampled twice weekly indoors by night human bait capture. During the same period, thick and thin blood films were collected from 296 children at 2-month intervals. Anopheles arabiensis was the only species responsible for transmission of Plasmodium falciparum. The parasite rate showed a positive correlation with both the entomological inoculation rate and the vectorial capacity. In Pikine, malaria is epidemic and probably unstable, and the population enjoys a variable degree of immunity.