[Epidemiological Situation of the Human African Trypanosomiasis in the Bilolo Municipality of Central African Republic]. / Situation épidémiologique de la trypanosomose humaine africaine dans la commune de Bilolo en République centrafricaine.

The Human African Trypanosomiasis (HAT) is a disabling and fatal disease caused by a vector-borne parasite still impacting in residual hotbeds. The aim of our study was to update the epidemiological data of HAT in one of Central African Republic foci after the (2012-2014) period of conflict. The survey was carried out in 24 villages in the Bilolo's municipality where 4788 persons were examined by the CATT (Card Agglutination Trypanosomiasis Test) technique. The identified cases were submitted to a serological titration test followed by parasitological testing for confirmation. The cytorachia technique was used for clinical phase determination. The CATT has identified 221 persons, of which 54 were confirmed by serological titration test, giving a seroprevalence of 1.12%. Parasitological confirmation was obtained for 15 patients. Our study showed the abundance of Trypanosoma parasites in the Bilolo municipality. However, since 2007, no case of HAT had been diagnosed in this focus after screening, treatment and vector control.

L'objectif de notre étude est de mettre à jour les données épidémiologiques de la trypanosomose humaine africaine (THA) dans un des foyers connus de la République centrafricaine, après la période de conflit (2012­2014). L'enquête a été réalisée dans 24 villages de la commune de Bilolo où 4 788 personnes ont été investiguées par le CATT (Card Agglutination Trypanosomiasis Test). Les sérums positifs ont été titrés, et une confirmation parasitologique recherchée. La phase clinique a été déterminée par cytorachie. Le CATT a permis d'identifier 221 personnes suspectes dont 54 cas sérologiques (CATT ˃ 1/16), donnant une séroprévalence de 1,12 %. Une confirmation parasitologique a été obtenue pour 15 patients soit un taux de prévalence de 0,36 %. Or, depuis 2007, aucun cas de THA n'avait été diagnostiqué dans ce foyer après des actions de dépistage, de traitement et de lutte antivectorielle.

Diet, Alcohol Consumption and Cognitive Disorders in Central Africa: A Study from the EPIDEMCA Program.

Western research into dementia has focused on finding effective means of prevention, particularly through nutrition. To date, however, little is known about the relationship between diet and cognitive disorders in Africa, where the number of people with dementia is expected to increase most over the coming decades. The objective of the study was to investigate the relationship between diet and alcohol intake and cognitive disorders among elderly people in Central Africa. Between 2011 and 2012, a cross-sectional multicentre population-based study was carried out in rural and urban areas of the Central African Republic (CAR) and the Republic of Congo (ROC). Participants aged ≥65 years were interviewed using the Community Screening Interview for Dementia (CSI-D). Elderly people who performed poorly (COGSCORE≤24.5/30) were clinically assessed by neurologists and underwent further psychometric testing. DSM-IV and Petersen criteria were required for a diagnosis of dementia or mild cognitive impairment (MCI), respectively. A food frequency questionnaire assessed the intakes of dairy products, fruit, vegetables, starches, legumes, oleaginous foods, meat or fish, eggs and sweet foods over the previous three days. We also collected data on alcohol intake. Sociodemographic, vascular, and psychological factors were documented. Multivariate multinomial logistic regression models were used to estimate the associations. In fully adjusted models, a lower consumption of oleaginous foods was associated with MCI (OR=3.7 [1.4-9.9]) and dementia (OR=2.8 [1.0-7.7]) in a rural area of CAR. Alcohol consumption was associated with reduced probability of dementia in CAR (OR=0.3 [0.1-0.8]). In ROC, food groups and alcohol intake were not associated with MCI or dementia. In conclusion, our study provides new data about the association between diet and cognitive disorders in Africa. Further studies should investigate the relationship between diet and cognitive disorders at the level of specific foods rather than food groups.

The nutritional status of older people with and without dementia living in an urban setting in Central Africa: the EDAC study.

OBJECTIVES: To determine the nutritional status of elderly African people and to investigate the association between undernutrition and dementia. DESIGN: Door-to-door cross-sectional surveys in the general population. SETTING: Representative districts of Bangui (Central African Republic) and Brazzaville (Republic of Congo). PARTICIPANTS: Population aged over 65 years. MEASUREMENT: Undernutrition was defined as a body mass index <18.5. Anthropometric parameters (arm circumference, waist circumference and triceps skinfold thickness) were measured, and information was gathered on nutritional habits. PARTICIPANTS underwent cognitive screening using the Community Screening Interview for Dementia (CSI-D) and the Five-Word Test. After further neuropsychological testing and neurological examination, the diagnosis of dementia was confirmed according to DSM-IV criteria. Multivariate logistic regression models were applied in order to identify factors associated with undernutrition in populations with or without dementia. RESULTS: 1016 people were included. In the general population, the prevalence of undernutrition was 19.2%. Dementia was found in 7.4% of elderly people. Compared with healthy people, patients with dementia had an increased prevalence of undernutrition (32.0% vs. 17.7%; p = 0.002), lower weight (49.3 ± 10.5 kg vs. 58.4 ± 13.5 kg ; p < 0.001), and lower BMI (20.8 ± 4.1 vs. 22.9 ± 4.8 ; p < 0.001); they were less likely to eat their fill (38.9% vs. 45.9% ; p = 0.001), had more dietary restrictions (36.1% vs. 24.3% ; p = 0.03) and ate less often with their family (66.7% vs. 90.6% ; p < 0.0001). Eating only one meal per day was the sole factor associated with undernutrition in dementia (OR: 7.23 [CI: 1.65-31.7]; p = 0.03). CONCLUSION: The prevalence of undernutrition is high in the older population. The nutritional status of patients with dementia is more impaired than that of healthy patients. However, they are less often malnourished than in French home care settings. This study is the first to look at the nutritional status of at-home patients with dementia in Africa. These comparative data will eventually be used in the development of new nutritional intervention strategies.

[Depression post stroke in Africa: myth or reality?]. / Dépression post accident vasculaire cérébral en Afrique : mythe ou réalité ?

Depression is a complication occurring frequently after a stroke. It negatively affects the physical, cognitive and social recovery. Authors report the results of a casecontrol study section was performed in neurology of the friendship hospital and psychiatry of the general hospital in Bangui, from January to August 2012 to ascertain the existence of a link between stroke and depression in hospitalized patients and to identify factors limiting taken into efficient load. On one hundred five subjects included, thirty five were stroke victims matched with seventy witnesses. The prevalence of post stroke depression was 88.6% (31/35) versus (20/70) 28.5% in controls (p <0.001). This post stroke depression occurred in 58% of men with a sex ratio of 1.4. The mean age of subjects with post stroke depression was 49.1 years, with extremes ranging from 33 to 76 years of age. Most (64.5%) subjects with post stroke depression was no occupation; 71.5% of them had a stroke dating back more than six weeks, and 92% had a motor deficit with a Barthel Index <100. Subjects with stroke suffered mostly moderate depression (48.1%) whereas the controls usually had mild depression (80.4%). This depression was not correlated with motor deficit, or the laterality of the lesion, or cognitive disorder. But, some Central African specificities could explain this phenomenon. These results demonstrate the reality of post stroke depression in Africa, hence the need to think in support of any subject with stroke topic. Moreover, questions about the tools used to evaluate the post stroke depression and the time interval between stroke onset and the onset of depressive symptoms remain and require further consideration.

[Cryptococcal neuromeningitidis in HIV-infected patients in Bangui, in the era of antiretroviral treatment]. / La cryptococcose neuroméningée au cours de l'infection à VIH à Bangui, à l'ère du traitement antirétroviral.

The cryptococcal neuromeningitis is the most common fungal meningitis infections in the course of HIV/AIDS. This is the number two of opportunist infection of the central nervous system. The authors post the outcomes of a retrospective study conducted related to 122 cases of cryptococcal neuromeningitis observed over for four years ago, in Bangui in the Central African Republic, this at time when antiretroviral treatment has been avaible, corresponding to a prevalence of 6.5%. These infections very aften occur more in female folk, and to patients whose average age is 35 years old, ranging from 18 to 69 years old. The clinical symptoms often found had been headache (98,3.%), fever (95.0%), the impairing of the overall condition of the patient (86.7%) and neck stiffness (85.9%). It makes sense to notice that comorbidity case alowgwith tuberculosis, intestinal candidiasis, bacterial pneumonia and Kaposi's diseases were found out. The screening of the cerebrospinal fluid showed a sound cell count and even low count in 12.2% of cases. Direct examination of cerebrospinal fluid with India ink helps in diagnosis of 97.5% of cases, and the culture carried out from 74 patients was in any case positive. This culture allowed the diagnosis of three patients whose examination along side with India ink has been negative. The CD4 cell count was less than 100/mm(3) in 97.7% of cases. The rate of the fatality cases has been 66.4%, it has been badly impacted by a CD4 count <50/mm(3) and the lack of antiretroviral therapy. Despite the establishment of a national antiretroviral treatment program to do influence the frequency of opportunistic infections whose cryptococcal neuromeningitis, this condition is still present although it is declining. The clinical variability of this disease requires early diagnosis to avoid delayed treatment corollary of a very high mortality as we have observed.

[Epidemiology of dementia in elderly living in the 3rd borough of Bangui (Central African Republic)]. / Épidémiologie des démences chez les personnes âgées dans le troisième arrondissement de la ville de Bangui (République Centrafricaine).

Given the gradual improvement of living conditions and aging, dementia and related syndromes are becoming serious problems in the developing countries. A cross-sectional door to door type study in neighbourhood, was conducted from October 2008 to January 2009, in the general population in Bangui, order to help get a better understanding of the prevalence and risk factors of dementia among people over 65 living in the Central African capital. Of the 496 elderly respondents, 188 had cognitive disorders. After a neuropsychological examination, 40 of these subjects were diagnosed with dementia. The prevalence of dementia was 8.1% (IC 95% = [5.7-10.5]). The average age of subjects with dementia, ranging from 65 to 90 years, was 76.0 ± 7.1 years. There was a significant risk of developing dementia for an increase of ten years old (OR = 2.6, 95% CI [1.5 to 4.5]). The sex-ratio was 6/34. 82.5% of the demented had never attended school. 70.0% showed a state of malnutrition (BMI ≤ 18,5 kg/m(2)), significantly associated with dementia (OR = 3.3; IC 95% = [1.5-7.3]). The blood pressure was high in 67.5% of demented which is significantly associated with dementia (OR = 2.4; IC 95% = [1.1-5.4]). A recent change in financial status was a factor significantly associated with dementia (OR = 6.4; IC 95% = [1.8-22.5]). These results support the existence of dementia in urban Africa. The observed prevalence is close to those found in high-income countries. Further studies should be conducted which includes both the rural and urban Africa, to better understand the problem and solutions consider to comprehensive care and prevention axes adapted to our context.

Epidemiology of peripheral artery disease in elder general population of two cities of Central Africa: Bangui and Brazzaville.

OBJECTIVES: Peripheral artery disease (PAD) is a common condition in Western countries, mostly in the elderly. Little is known about the epidemiology of PAD in Africa. We sought to determine the prevalence of this condition in the elderly in two community-dwelling cohorts in Central Africa. DESIGN: Prospective cross-sectional survey in general population over the age of 65 years in Bangui (Central African Republic) and Brazzaville (Congo). METHODS: We conducted a systematic door-to-door survey in two representative districts of each city. Demographic, clinical and biological data were collected. The ankle-brachial index (ABI) was used to detect PAD (ABI ≤ 0.90). RESULTS: Among the 976 participants, the prevalence of PAD was 15.0% in Bangui and 32.4% in Brazzaville, increasing with age. Adjusted to age, regular alcohol consumption was protective for women in Bangui (OR = 0.50, CI95%:0.25-0.98) and men in Brazzaville (OR = 0.43, CI95%:0.21-0.88). Hypertension was associated with PAD in women (OR = 4.14, CI95%:1.65-10.42 in Bangui and OR = 2.17, CI95%:1.16-4.06 in Brazzaville). Diabetes and smoking showed different associations according to gender and city. CONCLUSIONS: This first population study in Central Africa highlights the high prevalence of PAD in the older population, and emphasizes specificities regarding the risk factors, being different from data published in Western countries.

[Towards the control of the endemic of sleeping sickness in Nola-Bilolo focus, Central African Republic]. / Vers la maîtrise de l'endémie sommeilleuse dans le foyer de Nola-Bilolo en Centrafrique.

Sleeping sickness is more prevalent in three historical regions of Central African Republic. Control measures were organized by the colonial authorities through health services to fight against this disease and other major diseases. Multivariate analysis and the government helped in controlling the disease in the focus of Nola-Bilolo, which was formerly hyperendemic. The authors report the results of the control measures that resulted in the extinction of the disease in this outbreak. This is a retrospective study from 1991 to 2008, and the data were collected from the National Program to fight against human African trypanosomiasis in Bangui and in the diagnostic and treatment center of Nola. It was highly endemic, with more than 300 cases recorded in the year 1991. The average number of cases was 200.8 per year between 1992 and 1998. Less than 50 cases per year were recorded from 2000 to 2006, and no cases have been detected since 2007. 69.35% of the patients were actively screened. 5,000 conical deltamethrin-impregnated traps (Gouteux and Lancien) had been used in 15 districts in the city of Nola and 46 surrounding villages by 20 trappers fully supported by the program. This is an example of regular active mass screening. Systematic treatment of detected cases and well-conducted vector control measures give hope to the affected populations to live peacefully in order to contribute to the development of their country.

Evaluation des manifestations neurologiques et psychiatiques de la trypanosomiase humaine africaine en deuxieme phase dans le foyer de L'Ouham; Republique Centraficaine

La trypanomiase humaine africaine (THAo) demeure encore un reel probleme de sante publique en Afrique. Le diagnostic de la THA est difficile et la maladie est letale sans traitement specifique .Cette maladie evolue en 2 phases ; hemo-lymphatique et neurologique ; De plus ; le diagnostic de l'atteinte nerveuse est difficile aux stades precoces avec le risque soit d'attribuer les traitements neurotoxiques au stade hemo-lymphatique et /ou d'engendrer des rechutes tardives quand le stade nerveux n' a pas ete identifie. Cependant; la nature; la duree les consequences et la liaison des manifestations neuropsychiatriques avec le traitement n'ont jamais ete etudiee precisement; le plus souvent par absences de procedure standardisee d'evaluation. Les auteurs ont effectue un recueil standardise des manifestations neurologiques et psychiatriques au cours de la THA en utilisant des echelles habituelles en clinique de neurologie et de psychiatrie et proposer un canevas de prise en charge afin de proposer des procedures simples et standardisees aux agents de sante des foyers de trypanosomiase. L'anxiete; la depression ainsi que les signes neurologiques ont pu etre depistes avec l'echelle de Goldberg; Minimental Test et le NeuroPsychiatric Inventory

[Intermittent claudication: sign of epidemiological transition in Gabon]. / L'asymétrie tensionnelle humérale, reflet de la transition épidémiologique au Gabon.

Africa is in the midst of an epidemiological transition characterized by an increase in degenerative illnesses, in particular cardiovascular disease, and a decrease in infectious illnesses. In this context it is of critical importance to develop simple and effective low-cost tools to identify subjects at high risk for cardiovascular events. Screening for subclavian artery stenosis (SAS) could provide a useful risk indicator. The prevalence of SAS in the general population over the age of 40 years in Gabon is 5.1 %, which is close to prevalence values observed in industrialized countries. Presence of SAS has been associated with hypertension (OR: 5.79, 95% CI: 2.21-15.2; p < 0.05) and male gender (OR 2.34, 95% CI: 1.13-4.83; p < 0.05). These data confirm the epidemiological shift towards cardiovascular diseases and suggest that screening for SAS could be useful to identify subjects at high risk for cardiovascular events who could benefit from preventive strategies.

[Outbreak of konzo disease in health region No. 2 of the Central African Republic]. / Résurgence de la maladie de konzo dans la région sanitaire n(o) 2 en République centrafricaine.

INTRODUCTION: Konzo is a neuromyelopathy characterized by permanent spastic paraparesis, linked to a subacute poisoning by cyanide found in cassava. The purpose of the study is to describe the epidemiological aspects of konzo in health region No. 2 in the Central African Republic. METHOD: A descriptive cross-sectional study was conducted among patients collected during a one-month period (July 16 to August 16, 2007) of active surveillance for acute flaccid paralysis. RESULTS: Eighty-one cases of konzo were identified during the study period, representing a prevalence of 10 per 100,000. Mean age of patients was 10.7+/-7.7 years. Children and women were most affected. The main warning signs were fatigability (97.6%), tremor (88.9%), walking difficulty (100.0%), dysarthria (67.9%) and a loss of visual acuity (65.4%). The predominant neurological signs were lower limb paresis (90.0%) and hyperesthesia (66.7%). CONCLUSION: Konzo is a serious public health problem in this region of the Central African Republic. A prevention program should be set-up.

Evolution de la trypanosomiase humaine africaine en Republique Centrafricaine

La trypanosomiase humaine africaine (THA) ou maladie du sommeil est une affection redoutable qui fit jadis beaucoup de ravages au sein de la population de differentes regions d'Afrique dont celle de la Republique Centrafricaine (RCA). Elle pose un probleme de sante publique en Afrique sub-saharienne. Cette etude retrospective nous a permis de decrire l'evolution de la maladie dans les differents foyers de la Centrafrique de 1998 a 2008. Durant cette periode; 8086 nouveaux patients ont ete recenses sur les 175243 personnes examinees; soit un taux de prevalence de 4;61. Les femmes etaient plus atteintes (66;65) que les hommes avec un sex-ratio de 1;5. La tranche d'age la plus touchee est celle de 20 a 29 ans (45;3). La majorite des malades depistes etaient en deuxieme phase (58). On a observe une resurgence d'un ancien foyer au nord du pays. La deterioration des systemes de sante; l'abandon ou l'affaiblissement des programmes de lutte; l'instabilite sociopolitique avec les mouvement incessant des populations sont les principaux facteurs expliquant cette flambee. Le depistage et le traitement couples a la lutte antivectorielle permettront a moyen de reduire significativement la prevalence de la THA en Centrafrique

[Bacterial meningiditis in adult patients in Central African hospitals]. / Les méningites bactériennes de l'adulte en milieu hospitalier centrafricain.

Bacterial meningitidis of the adult remain frequent and serious affections in spite of therapeutic progress. The authors report results from a retrospective study of 502 cases over 5 years. Hospital prevalence was 12.1%. These infections occur during the dry season between November and April in 75% of the cases. An important peak was observed in March, that is to say 24.5%. Patients' average age was 34.7 years old with extremes ranging from 15 to 80. The isolated micro-organisms were: the pneumococcus (45.2%), the meningococcus (14.5%), salmonella (1.6%) and the Haemophilus influenzae (1.2%). Meningitidis decapitated by a preliminary antibiotherapy represented 37,5%. Seroprevalence of the HIV infection during this work was 55.1%. Patients suffering from pneumococcus meningitis were contaminated by the HIV in 51.7% of the cases. Those suffering from meningococcus infection were infected with HIV in 52.9% of the cases. Those presenting meningitidis to Haemophilus influenzae and salmonellas had contracted the HIV respectively in 83% and 87.5% of the cases. The average duration of hospitalization was 14.2% days. The average mortality rate was 31.7% for the pneumococcus, 30. 1% for the meningococcus one. 53.4% of the patients recovered.

High mortality rates among patients with tuberculosis in Bangui, Central African Republic.

PIP: Survival time until death was investigated in a prospective cohort of 224 tuberculosis patients from Bangui, Central African Republic, who were randomly selected from among 1492 such patients registered in 1993 and 1994. 6 patients (2.7%) presented with extrapulmonary tuberculosis, 186 (83%) were smear-positive, and 139 (62%) were infected with HIV-1. 23 (10.3%) had multidrug-resistant tuberculosis strains. The treatment regimen (isoniazid, rifampicin, ethambutol, and pyrazinamide for 2 months, followed by isoniazid and ethambutol for another 6 months) was successful in 46.4% of HIV-infected patients compared with 67.1% of HIV-negative patients. At the end of 8 months, 39.1% of HIV-infected patients but only 8.2% of HIV-negative patients had died. 24 months after the start of tuberculosis treatment, the cumulative death rate was 58% in HIV-seropositive patients compared with 20% in seronegative patients. Median life expectancy to death among HIV-infected tuberculosis patients was 15 months. Decreased survival was significantly associated with HIV-seropositivity, older age, failure to complete the full treatment regimen, and a low CD4 cell count. Multidrug-resistant tuberculosis was not linked to increased mortality.^ieng