La rétinopathie du prématuré en Centrafrique : résultats de l'examen du fond d'œil chez 88 nouveau-nés au complexe pédiatrique de Bangui

Introduction. Les auteurs ont examiné les prématurés au Complexe Pédiatrique de Bangui, dans le but d'évaluer les facteurs de risque de survenue de la rétinopathie du prématuré et les modalités de dépistage de cette maladie en Centrafrique. Patients et méthodes. Il s'agit d'une étude transversale prospective analytique de Janvier 2012 à Décembre 2014 à la Clinique Pédiatrique de Bangui. Tous les prématurés nés avant 32 semaines de gestation ou ayant un poids de naissance inférieur à 1500 grammes ont bénéficié d'un examen du fond d'œil à 5 semaines de vie. Le matériel utilisé était composé d'un ophtalmoscope binoculaire indirect Neitz, assorti d'une source d'alimentation électrique portative Zeiss/Opton, de deux lentilles d'examen 20 et 28 dioptries, d'un mydriatique (tropicamide®) et d'un anesthésique de contact. Les lésions observées ont été réparties selon la classification de Calgary. Résultats. 88 prématurés dont 39 garçons (44,3%) et 49 filles (55,7%) ont été étudiés. Leur âge gestationnel moyen était de 29,2 ±2,8 semaines et le poids de naissance moyen de 1205 ± 255 grammes. L'examen a été satisfaisant dans tous les cas. Le diagnostic de rétinopathie a été posé chez 29 (32,95%) prématurés, dont 12 garçons (41,4%) et 17 filles (58,6%), avec une atteinte bilatérale chez tous. 28 enfants sur 31 (90.3%) avaient des lésions minimes ou modérées et toutes ont régressé spontanément sans laisser de séquelle. Dix décès ont été enregistrés durant le suivi. Conclusion. L'ophtalmoscope binoculaire indirect est l'outil de choix pour le dépistage de la rétinopathie des prématurés et le tropicamide peut être utilisé sans effets indésirables pour obtenir une mydriase adéquate. Le poids de naissance et l'âge gestationnel sont deux facteurs de risque à considérer. Le risque semble être le même que l'enfant soit sous oxygène ou non

[Blinding trachoma: results of a prevalence survey in 8 health districts in CAR]. / Le trachome évolutif: résultats d'une enquête de prévalence dans huit préfectures sanitaires en RCA.

Support of visual disabilities in terms of preventive and curative treatment, is a priority for public health in Central African Republic. The lack of recent and reliable data on ocular pathologies in general including trachoma particularly, has led health authorities, in collaboration with partners to undertake an epidemiological investigation to determine the mapping. This study was designed to assess the importance of endemicity in the most sensitive groups within population, including children of 1 to 9 years old. Eight from sixteen health districts in the country, were selected for this survey as a first step. The data collected will assess the real needs in medical and surgical care to develop an appropriate strategic plan of support for this condition on a large scale. This is a cross-sectional descriptive survey carried out in one month, from November 23 to December 26, 2011 in eight health prefectures of the country. The sampling frame was the population of eight health districts. The exhaustive list of villages and demographic data from the national census conducted in December 2003, adjusted by the rate of annual increase of 2.5%has been used. The administrative headquarters of the places of the visited districts leaders were excluded from the sampling frame. A random survey in clusters at two levels made from formed bases. Twenty villages (clusters) in each health district have been drawn according to the proportional probability to the size of the totals cumulative. 12,800 children of both sexes, aged 1 to 9 years have been identified in this investigation and 11,287 were actually examined, or 88.2 %, sex ratio is significantly 1.11. The proportion by age group of the children sampled is stackable to the general population. 26.9 % of TF and 5.9 % TI have been diagnosed. Six from eight districts surveyed are endemic. Three of them had respectively rates of 32.3 %, 47.1 % and 54.3 %.

[Elimination or control of the onchocerciasis in Africa? Case of Gami village in Central African Republic]. / Élimination ou contrôle de l'onchocercose en Afrique ? Cas du village de Gami en République centrafricaine.

The authors return the results of a transverse prospective survey whose goal was to value the impact of struggle against the onchocerciasis after 20 years of distribution of ivermectin in a village of the Central African Republic. A transverse prospective survey with a descriptive and analytic aim of a sample of 393 topics aged of more than 5 years residing in Gami Village since more of 2 years and having benefitted the ivermectine in the last distribution that took place 10 months before. The epidemiological, clinical and parasitologic data introverted have been compared to the results of the previous investigations in the village. The parameters improved distinctly during the 20 years (1990-2010) notably the microfilarian indication (88% in 1990 against 19% in 2010), the middle microfilarian density (54 against 0,7), the CMFL Indication (39 against 0,67), the Knuttgen indication moved of the trance of age of 5-9 years to the one of more than 45 years since 1998), the cystic indication (36% against 8%), the ocular lesions (31% against 4%) of which onchocercian (28% against 2%), serious ocular lesions (16% against 1,3%), rate of blindness (9% against 0,8%), rate of meadow-blindness (9% against 0,8), important loss of vision (3% against 0,0%), ocular lesions in children of 6-10 years old (6% against 0,3%). These data permit to speak of control but not of elimination of the onchocerciasis in the grouping villager of Gami because of the persistence of the microfilarian indications susceptible to maintain the transmission of where necessity to pursue the struggle.

L'endemie filarienne dans la ville de Bangui; Republique Centrafricaine

Dans les pays intertropicaux; les filarioses posent de sante publique; touchant environ150 millions de sujets dans le monde. La Republique Centrafricaine; a l'instar des autres pays tropicaux; n'est pas epargnee par ce fleau. Deux types de filarioses font l'objet de preoccupation a cause de leurs consequences socio-economiques et medicales; la dracunculose et l'onchocercose .Deux programmes de lutte sont en cours d'execution mais toutes les regions ne sont pas entierement couvertes.les objectifs specifiques de ce travail prospectif qui a dure 5 mois etaient de determiner la prevalence des filarioses dans la capitale et etudier les profils epidemiologiques et les aspects cliniques des personnes atteintes dans les Arrondissements et quartiers de Bangui choisis au hasard. Les sujets jeunes de 15 a 44 ans etaient 266 sur les 323 sujets de l'etude; soit 82 ; 4. Le sexe masculin representaient 44.Le prurit etait present dans 87;6des cas ; la gale 31;4;les nodules 8; 7et les depigmentations des jambes ; 15 ;5des cas .La gale etaient surtout observee dans le septiemea arrondissement .Les microfilaires dermiques etaient retrouvees dans 36; 84des cas avec une predominance masculine (57 ;5) et le septieme Arrondissement etaient plus touche que les autres .Les microfilaires sanguine etaient retrouvees dans 15 ; 79des cas .Pour ces filarioses ; Bangui est une ville mesoendemique avec cependant une forte prevalence dans les quartiers proches du Fleuve

[Treatment of ocular lesions due to Elapidae venom spitting in Central African Republic: epidemiological and clinical aspects]. / Prise en charge des lésions oculaires dues au crachat de venin d'Elapidae en République centrafricaine: aspects épidémiologiques et cliniques.

This survey concerns 16 patients admitted to Bangui teaching national hospital center, coming from Ngakobo health center 450 km from the South East of Bangui, between September 2001 and May 2002. All of them have undergone a basic ophthalmological examination 16 patients have been hospitalised in the service of ophthalmology among them, 11 didn't go to the consultation. All the 16 patients were males, 18 to 46 years old. Five of them had bilateral corneal lesions and eleven patients presented unilateral lesions. Two patients had a corneal perforation at admission. The initial visual acuity of the concerned eye was estimated between LP(-) and 3/10th. The visual acuity valued after exit was LP(-) to 6/10. Four patients out of sixteen (two eyes with bilateral lesions and two with unilateral lesion) (six eyes) received as initial treatment, water rinse on the spot of the accident, then a local treatment by antibiotics administrated in the dispensary of the Ngakobo Province. Eight patients (two bilateral and six unilateral lesions) received a traditional treatment while five of them received it before their transfer to Bangui and 3 patients just before their arrival in Bangui. Four patients (five eyes) had no treatment at all. The nature of this traditional treatment, often of mineral and vegetal origin has not been specified. The main after-effects are corneal opacities, varying according to size, localization and gravity. At the beginning, 9 cases out 16 are generally diffused and superficial keratitis. After some days of treatment, 8 cases developed into corneal opacity freeing thus the visual axis. 3 cases of keratitis developed into a purulent melting then to a corneal perforation. Elapidae's spits on the eye are frequent in sugar cane cultivation areas. They can provoke some severe erosive corneal lesions, in absence of adequate and early management. The administration of traditional treatment most often complicates the clinical issue. Nursing staff, medical personnel and family should pay attention to the ocular toxicity of these septic matters and to the first cares provided to the patient before his early transfer to hospital.

[Ocular injuries in children aged 0-15 years: epidemiological and clinical aspects at the Bangui National Teaching Hospital]. / Les traumatismes oculaires chez les enfants âgés de 0 à 15 ans. Aspects épidémiologiques et cliniques au Centre National Hospitalier Universitaire de Bangui.

PURPOSE: Ocular injuries in children are frequent and are an ophthalmological emergency. If not managed sufficiently early, these lesions may cause definitive partial loss of vision or blindness. In this survey, the authors analyze different epidemiological and clinical aspects of ocular injuries at the Bangui National Teaching Hospital in the Central African Republic to increase the awareness of children's parents, guardians, and care-takers. PATIENTS AND METHODS: A prospective study was conducted on 194 cases in the ophthalmology department over a period of 3 years, and included children aged 0-15 years. A total of 197 eyes were examined by the same practitioner, comprising 191 unilateral ocular injuries and three bilateral injuries. RESULTS: Of the children examined, 59% were males and 41% were females, with a sex ratio of 1.3. The age group with the highest exposure (39.3%) was between 5 and 10 years. Punishments (25.9%), accidents during games (19.3%) and fights (18.8%) were the main sources of these ocular injuries. Consultation most often occurred long after the incident. Only 2.0% were seen before the 6th hour and 43.7% between 48 hours and 1 week. The clinical picture was dominated by bruises posing a therapeutic problem: 25 hyphemas (12.7%), 19 conjunctival injuries (9.6%), 19 lens dislocations with or without vitreous loss (9.6%), 18 trauma-induced cataracts (9.4%), and 15 eye lid injuries with or without lachrymal duct ruptures (7.6%). The most serious injuries were cornea injuries with or without hernia of the iris (19.8%) and nine globe dislocations (4.5%). CONCLUSION: The frequency and gravity of the lesions identified, the severity of the injuries and the delay in treating these injuries show that the public authorities, parents and child care-takers need more information in order to reduce the frequency of these accidents.

Onchocerciasis and epilepsy: a matched case-control study in the Central African Republic.

The occurrence of epileptic seizures during onchocercal infestation has been suspected. Epidemiologic studies are necessary to confirm the relation between onchocerciasis and epilepsy. A matched case-control study was conducted in dispensaries of three northwestern towns of the Central African Republic. Each epileptic case was matched against two nonepileptic controls on the six criteria of sex, age (+/-5 years), residence, treatment with ivermectin, date of last ivermectin dose, and the number of ivermectin doses. Onchocerciasis was defined as at least one microfilaria observed in iliac crest skin snip biopsy. A total of 561 subjects (187 cases and 374 controls) were included in the study. Of the epileptics, 39.6% had onchocerciasis, as did 35.8% of the controls. The mean dermal microfilarial load was 26 microfilariae per mg of skin (standard deviation, 42) in the epileptics and 24 microfilariae per mg of skin (standard deviation, 48) in the controls. This matched case-control study found some relation (odds ratio = 1.21, 95% confidence interval 0.81-1.80), although it was nonstatistically significant.

PIP: Epileptic seizures are frequent in neurocysticercosis and may occur during cerebral malaria. Findings are reported from a matched case-control study conducted in March 1996 in the savannah woodland region of northwest Central African Republic to determine whether any relation exists between Onchocerca volvulus infestation and epilepsy. About 70% of the study region's inhabitants are infested with O. volvulus. Each epileptic case was matched against 2 nonepileptic controls on the criteria of sex, age, residence, treatment with ivermectin, date of last ivermectin dose, and the number of ivermectin doses. Onchocerciasis was defined as at least 1 microfilaria observed in iliac crest skin snip biopsy. 187 cases and 374 controls were included in the study. 39.6% of the epileptics and 35.8% of the controls had onchocerciasis. The mean dermal microfilarial load was 26 microfilariae per mg of skin in the epileptics and 24 microfilariae per mg of skin in the controls. The relation between O. volvulus infestation and epilepsy was statistically nonsignificant.