Assessing allergic rhinitis in developing countries.

BACKGROUND: Allergic rhinitis (AR) affects 5% to 40% of the general population. In developing countries, AR is poorly documented and tracked due to a lack of appropriate diagnostic tools. OBJECTIVE: 1) To validate a questionnaire standardised in industrialised countries to ascertain AR, the Score For Allergic Rhinitis (SFAR), in developing countries; 2) to better understand AR prevalence previously reported from developing countries by comparing results from the SFAR and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires. METHODS: Six African countries were selected for their climates. In each country, 70 individuals with and 30 without nasal symptoms filled out the SFAR and the ISAAC questionnaires. Skin prick tests (SPTs) for allergens were performed by the physician if necessary. RESULTS: The SFAR presented a close match with the gold standard (the physician's diagnosis of AR backed up by SPT where necessary) in terms of various performance parameters. In particular, it showed high sensitivity (0.84) and specificity (0.81). Compared to the ISAAC questionnaire, the SFAR had greater sensitivity and equal specificity. CONCLUSIONS: In the absence of a medical visit, the SFAR is a useful standardised screening instrument for the collection of information needed for the identification of AR in developing countries.

Prevalence of symptoms of asthma, rhinitis and eczema in 13- to 14-year-old children in Africa: the International Study of Asthma and Allergies in Childhood Phase III.

Phase I of the International Study of Asthma and Allergies in Childhood has provided valuable information regarding international prevalence patterns and potential risk factors in the development of asthma, allergic rhinoconjunctivitis and eczema. However, in Phase I, only six African countries were involved (Algeria, Tunisia, Morocco, Kenya, South Africa and Ethiopia). Phase III, conducted 5-6 years later, enrolled 22 centres in 16 countries including the majority of the centres involved in Phase I and new centres in Morocco, Tunisia, Democratic Republic of Congo, Togo, Sudan, Cameroon, Gabon, Reunion Island and South Africa. There were considerable variations between the various centres of Africa in the prevalence of the main symptoms of the three conditions: wheeze (4.0-21.5%), allergic rhinoconjunctivitis (7.2-27.3%) and eczema (4.7-23.0%). There was a large variation both between countries and between centres in the same country. Several centres, including Cape Town (20.3%), Polokwane (18.0%), Reunion Island (21.5%), Brazzaville (19.9%), Nairobi (18.0%), Urban Ivory Coast (19.3%) and Conakry (18.6%) showed relatively high asthma symptom prevalences, similar to those in western Europe. There were also a number of centres showing high symptom prevalences for allergic rhinoconjunctivitis (Cape Town, Reunion Island, Brazzaville, Eldoret, Urban Ivory Coast, Conakry, Casablanca, Wilays of Algiers, Sousse and Eldoret) and eczema (Brazzaville, Eldoret, Addis Ababa, Urban Ivory Coast, Conakry, Marrakech and Casablanca).

A flare-up of tuberculosis due to war in Congo Brazzaville.

Congo Brazzaville, a country with a population of 3 million, experienced a period of war from 1997 to 1999. Before this time the annual increase in numbers of tuberculosis cases was on average 20%; in 2000 it was 84%. This situation had a considerable impact on the activities of the National Tuberculosis Programme. Before the war the diagnostic and treatment centres had notified nearly 100% of new cases of tuberculosis; in 2000 this had dropped to 76.19%, whereas the number of tuberculosis patients had almost doubled, from 5125 in 1999 to 9436 in 2000. New cases of smear-positive pulmonary tuberculosis represent 45% of cases, in comparison with an average of 55% before the war, and extrapulmonary tuberculosis 30% versus 21% before the war. The relapse rate has not changed significantly, by approximately 2%, while the default rate has risen significantly, from 20% to about 26%. The rates of new smear-positive tuberculosis cases who are cured or have completed treatment remain unchanged (70%), while the mortality rate dropped after the war from 6% to 1.23%. The war led to an increase in rates of tuberculosis, particularly in the two main cities, Brazzaville and Pointe-Noire, to which refugees had fled from the rural areas. This resulted in an excessive workload for the health workers. Sustained financial support is needed to reduce tuberculosis transmission in the Congo population.

[Pneumocystis carinii pneumonia in patients with AIDS in the Congo]. / Pneumocystoses observées au Congo chez les malades atteints de SIDA.

Forty-five bronchoalveolar lavages (BAL) were performed in Brazzaville in AIDS patients who did not expectorate acid- and alcohol-resistant bacilli (AARB). All patients presented with respiratory symptoms (cough, dyspnoea or chest pain), and all but 6 of them had abnormal radiography of the chest. Four cases of pneumocystosis were diagnosed (9%); 3 of these patients had interstitial pneumonia and dyspnoea. No AARB was found at microscopic examination of BAL which showed Pneumocyctis carinii; no culture on Löwehstein's medium could be made. The authors consider that the low prevalence of pneumocystosis in Africa, compared with industrial countries, is due to a smaller dissemination of the parasite in Africa rather than to immunodepression which is known to be more pronounced in AIDS patients from industrial countries.

[The cost of pulmonary tuberculosis treatment in the Congo]. / Coût du traitement de la tuberculose pulmonaire au Congo.

The author assesses the cost of treating pulmonary tuberculosis. This is extremely high because there is no standard treatment. The 15 months--course used in the Congo is 2.5 times more expensive than the standardized regimen using WHO drug prices. The author recommends the institution of a better system of treatment of tuberculosis in order to economise and to assure a regular supply of medicines.

[Tuberculosis and HIV infection in a general hospital in Brazzaville]. / Tuberculose et infection à VIH à l'hôpital général de Brazzaville.

To understand the change in disease encountered since the appearance of the epidemic of AIDS, two enquiries have been carried out in the only service for pulmonary tuberculosis in Brazzaville which previously had exclusively treated cases of tuberculosis. The first enquiry showed that amongst 104 patients hospitalised over a 15 month period for respiratory disease and having the clinical criteria for AIDS ultimately confirmed by positive serology for HIV, 46 (44%) were suffering from tuberculosis, 47 (45%) from acute respiratory infections which diminished with simple antibiotic treatment and 11 (11%) with pulmonary disorders whose aetiology could not be exactly specified. The latter 11 patients died from disorders suggestive of opportunistic disease. A second enquiry has been carried out on a sample 86 patients selected at random amongst hospitalised patients. It showed that amongst 48 tuberculous patients 7 were seropositive for HIV and that amongst 38 patients suffering from pulmonary disease 14 were seropositive (36.8%).

PIP: To understand the change in disease which has become apparent since the onslaught of the AIDS epidemic, 2 enquiries have been made in Brazzaville. This facility which had previously treated tuberculosis cases is now the only service for pulmonary tuberculosis. Among 104 patients hospitalized over a 15 month period for respiratory disease and who were ultimately confirmed as displaying clinical signs of AIDS by positive serology for HIV, there were 46 (44%) who suffered from tuberculosis, 47 (45%) who suffered from acute respiratory infections which improved with simple antibiotic treatment, and 11 (11%) with pulmonary disorders whose etiology could not be specified. These 11 patients died from disorders which were suggestive of opportunistic infections. A 2nd enquiry carried out on a sample of 86 patients selected at random among hospitalized patients showed that among 48 tuberculosis patients, 7 were seropositive for HIV and that among 38 suffering from pulmonary disease, 14 (36.8%) were seropositive. (author's modified)