[Intestinal helminthiasis in school children in Haiti in 2002]. / Helminthoses intestinales en milieu scolaire en Haïti en 2002.

A survey on intestinal helminths in school children was conducted in Haiti in 2002. This first nationwide study involving the entire country was stratified by department according to urban and rural zones using the cluster method. Focusing on elementary school children (n=5792; age range 3 to 20 years), it involved 26 urban and 49 rural schools randomly selected. Stools were preserved in formalin and examined by the Ritchie technique. Thirty-four per cent of stools (1981/5792) tested positive for intestinal helminths with the following parasites identified: Ascaris lumbricoides (27.3%), Trichuris trichiura (7.3%), Necator americanus (3.8%), Hymenolepsis nana (2%), Taenia sp. (0.3%) and Strongyloides stercoralis (0.2%). The helminth prevalence was higher in rural (38.4%) compared to urban areas (30%). There was no significant difference in prevalence by sex and age. The importance of geohelminths changed from one department to another with the highest prevalence found in the Southern department of Grande Anse (73.7%) and the lowest prevalence in the Center department (20.6%). Five out of the country's nine departments had a similar prevalence varying from 25.5% to 28.2%. Intestinal helminthic polyparasitism was observed in a percentage of infested school children comprise between 3.4% and 28.6% according in relation to the geographical area. A program to fight against geohelminths in school children should be initiated as a public health priority. Albendazole is the drug of choice. Frequency of drug distribution should be based on the prevalence of geohelminths in each department.

[One-year assessment of the cholera epidemic in Madagascar, from March 1999 to March 2000]. / Bilan d'un an d'évolution de l'épidémie de choléra à Madagascar de mars 1999 à mars 2000.

The seventh cholera pandemic reached Madagascar in March 1999, 30 years after its appearance in East Africa. Two waves of infection were observed during the first year. The second wave was the stronger of the two. It occurred in the warm rainy season and spread over six provinces of the country. The incidence of cholera was from 0.1% to 2% and the hospital case fatality rate was between less than 2% and 6%, depending on the geographical area and the period. This outbreak has raised the awareness of communities and their leaders with respect to the environmental, practical and cultural factors that increase the risk of diseases transmitted by feces.

[Bancroftian filariasis in Madagascar: persistent endemicity]. / La filariose de Bancroft à Madagascar: une endémie persistante.

A major study was conducted to determine the prevalence of Bancroftian filariasis in 9 health districts located mainly on the east and north coast of Madagascar between 1995 and 1997. The study population included 2524 people 10 years or older. On the east and north coast, the incidence of microfilarial carriers varied depending on location from 7 p. 100 to 47 p. 100 in men and 3 p. 100 to 33 p. 100 in women. The highest incidences, i.e., around 33 p. 100 in both sexes, were observed in the southeastern districts of Ifanadiana, Manakara, and Vangaindrano. In the other districts on the east coast, the highest rates occurred mainly in men, i.e., 47 p. 100 in Vavatenina, 33 p. 100 in East Feneriva, and 33 p. 100 in Mahanoro. Only two districts on the west coast were studied, i.e., Marovoay where the incidence was zero and Ankazoabo where the prevalence was 4 p. 100 for men and 3 p. 100 for women. The results are compared with those of a study carried out in 1958. At 16.22 p. 100, chronic morbidity is relatively common in men but less disabling, i.e. mainly scrotal and member elephantiasis and hydroceles. Chronic morbidity was only 2.26 p. 100 in women, i.e. mainly member elephantiasis. Control of Bancroftian filariasis may be achievable by targeted use of drug prophylaxis and bednets in zones of high prevalence.

[KAP study (knowledge-attitude-practice) on seafood poisoning on the southwest coast of Madagascar]. / Etude CAP (connaissance-attitude-pratique) sur les intoxications par consommation d'animaux marins sur le littoral sud-ouest de Madagascar.

In June and July 1996, a knowledge, attitude and practice survey concerning seafood poisonings was conducted in Tuléar Province, 41 villages spread along 300 km of cost, with some 34,000 inhabitants, were included in the survey. 84 seafood poisonings after fish, shark and turtle meals occurred during the period 1931 to 1995; 14 of them were responsible of deaths. The family of toxic fishes are Clupeidae, Tetraodontidae, Scaridae and Siganidae. Sphyrna lewini is the shark species the most often responsible for poisonings. Three turtle species are involved in poisonings: Eretmochelys imbricata, Chelonia mydas and Dermochelys coriacea. Clinical patterns were related to marine toxins. Although the communities were aware of the risks, there was no change in seafood meal practice. Preventive measures are not very often used. Practical techniques to detect toxins, although very simple, are not systematically carried out. For a better understanding of the seafood poisoning risk in Madagascar, a retrospective survey in the villages located in coastal areas all around Madagascar was to be carried out in 1997. An eco-toxicological survey will likewise probably be organised in an Indian Ocean regional approach.

[The plague in Madagascar: epidemiologic data from 1989 to 1995 and the national control program]. / La peste à Madagascar: données épidémiologiques de 1989 à 1995 et programme national de lutte.

After briefly reviewing the history and epidemiological cycle of the plague in Madagascar, we report a detailed analysis of 5,927 suspected cases of plague observed from 1989 to 1995 (average of 846 cases per year). Of those, 1,337 individuals (average of 191 cases per year) were confirmed (by isolation of Yersinia pestis) or indicated to be probable for plague (by positive smears). Since 1994, we observed an increasing number of confirmed and probable cases (252 cases in 1995). Most of the cases occurred between October and April in the central highlands, inside a geographical triangle limited by Alaotra lake, Itasy lake and the city of Fianarantsoa. Two exceptional epidemics occurred in the harbor of Majunga in 1991 and 1995. The bubonic plague was the most frequent clinical from (91.3%), with primarily an inguinal localization (67.8%). The mean case fatality rate was 19% of the confirmed or probable cases (14.8% for the bubonic form and 57.1% for the pneumonic form). The bubonic plague was significantly more frequent between the ages of 5 and 14 years, as compared to the general population, while the pneumonic plague was more frequent over 15 years of age. Males were more effected by the bubonic form, as the sex ratio (m:f) was 1.3. The national control program for plague is being strengthened to improve 1) the patient's early diagnosis and care system; 2) the measures for the prevention of epidemics; 3) the epidemiological surveillance; and 4) the studies on the biology of the plague vectors, rodents and fleas, and the agent, bacilli, in Madagascar.

[Intoxication by marine animal venoms in Madagascar (ichthyosarcotoxism and chelonitoxism): recent epidemiological data]. / Intoxications par animaux marins vénéneux à Madagascar (ichtyosarcotoxisme et chélonitoxisme): données épidémiologiques récentes.

If seafood poisonings are well documented in the Pacific region, they are not often reported in the Indian Ocean. In Madagascar, fishermen and people living in coastal areas are traditionally aware of seafood poisonings. Mass intoxications were described in the sixties, including lethal cases following sardine ingestion. From 1989 to 1993, 28 ichtyosarcotoxism cases, mainly ciguatera occurring in children, were reported in Tulear hospital. From July 1993 to May 1996, nine seafood poisoning outbreaks occurred in coastal villages after turtle, shark and sardine meals. Clinical symptoms were related to marine toxins. For turtle intoxications, gastro-intestinal symptoms are the most frequently seen (acute stomatitis, dysphagia, vomiting and diarrhea), with case fatality rates around 7%. For shark intoxications, the most frequent symptoms were neurologic (paresthesia specially peribuccal and extremities), and gastro-intestinal (diarrhea and vomiting), with specific case fatality rates varying from 0% to 30%. For sardine intoxication, symptoms were gastro-intestinal (vomiting) and neurologic (paresthesia), and from the two intoxicated people one died. Two previously unknown biotoxins were isolated from the liver of a shark responsible for a mass poisoning, namely carchatoxins. For the turtles, the search of chelonitoxin is under way. For the sardines, clupeotoxin was isolated. Because of the frequency and the gravity of collective seafood poisonings occurring in recent years, the Ministry of Health has implemented a Seafood Poisoning National Control Programme. This programme is based on three major strategies: the setting of an epidemiological surveillance network, the prevention of the communities through educational programmes, and the development of research on marine eco-environment.

[Annual risk of tuberculosis infection in Madagascar: study from 1991 to 1994]. / Le risque annuel d'infection tuberculeuse à Madagascar: étude réalisée de 1991 à 1994.

This article reports the results of a national tuberculin skin test survey of childhood age group. The survey period was from december 1991 to june 1994. For the calculation of annual risk of tuberculous infection, 1544 schoolchildren, aged 6 to 10 years old, without scare related to BCG, were included. The antigen used was tuberculin PPD Mérieux; in order to define a mode of positivity, this tuberculin was first tested with 250 confirmed pulmonary tuberculous patients: the mode was 16mm. With the hypothesis of a cut-off point of positivity at 14 mm, the prevalence of tuberculous infection was found at 9.6% (with a confidence interval of 1.6%); then, the annual risk of tuberculous infection was calculated at 1.21% (from 1% to 1.42%). With the hypothesis of a mode at 16 mm, the prevalence of tuberculous infection was found at 10.2% (with a confidence interval of 2.3%); then, the annual risk of tuberculous infection was calculated at 1.29% (from 0.97% to 1.59%). Considering separately two age groups, the annual risk was 1.25% for 6-8 years old children and 1.32% for 9-10 years old children. In conclusion, the authors stress the important constraints in the achievement of such a survey in developing countries. Though the difficulties that arised, the standardised methodology used in this survey gives reliable information. These results could be compared with those of future surveys using the same methodological approach.

[Role of Anopheles funestus in the transmission of malaria in the south of Madagascar (Ampanihy district)]. / Rôle d'Anopheles funestus dans la transmission du paludisme dans le Sud de Madagascar (District d'Ampanihy).

The authors reported the results of paludometric and entomological studies carried-out for two years: 1995-1996 in two localities: Ampanihy and Ankilimivory located in the South of Madagascar. These studies followed a suspect malaria epidemic in Ankilimivory in June and July 1994; the population plasmodic index was of 45%. In April 1995, this data was of 35% in Ampanihy and of 15% in Ankilimivory. Entomological studies carried out in April 1996 allowed to find Anopheles funestus in Ankilimivory and Anopheles gambiae l. s. in the two localities. Both the endemicity of malaria and the role of A. funestus had to be taken into account in the southern part of Madagascar. Until now, rare epidemics in this area were thought to occur only when climatic conditions were favorable, mainly during the rainy season. However, other factors, linked with the development could also facilitate the upset of epidemics, e.g.: irrigation programmes.

[Preliminary results in the clinical, epidemiological and parasitological study of Bancrofti filariasis in Madagascar]. / Résultats préliminaires de l'enquête épidémio-clinique et parasitologique sur la filariose de Bancroft à Madagascar.

In 1958, a large study on the distribution of Bancroft filariasis was set up in Madagascar. In order to update these data, the authors have studied in the same areas the parasitological and clinical prevalence of Bancroft filariasis. Here are the preliminary results of this study, concerning 1862 people, aged 10 years and more. The mean prevalence rate of microfilaria-carriers was of 22.9%, and the average parasitic density was of 3.6 parasits/20 microliters of blood. The prevalence rate of chronic clinical symptoms was of 14.7% for men (elephantiasis, hydroceles, chyluria) and of 2% for women (elephantiasis). These were usually mild symptoms, which very little impact on way of life.

[Difficulties in the realization and implementation of a national survey on the Annual Risk of Tuberculosis Infection in Madagascar]. / Difficultés dans la réalisation et l'exploitation d'une enquête nationale sur le Risque Annual d'Infection tuberculeuse à Madagascar.

The authors describe on the basis of their own experience, the difficulties that may arise during the achievement of a nationwide survey of the Annual Risk of Tubercular Infection and the analysis of the results. They stress the need of a close methodology at all stages of the survey, from conception to analysis, in order to get reliable and comparative results.

[A malaria epidemic in the south of Madagascar?]. / Une épidémie de paludisme dans le sud de Madagascar?

Authors record the results of entomological and paludometric studies which were run on July 1994 in Ampanihy (Southern Madagascar), since an epidemic of malaria occurred in that region. Although the risk of epidemic malaria is described in the Southern Madagascar, paludometric indexes found in these surveys are pertinent with a mesoendemic malaria. The entomological survey found. A gambiae complex and A. funestus. Complementary surveys are proposed to improve the knowledge of the epidemiology of malaria in this area.

[Study of malaria vectors in the south-west of Madagascar]. / Contribution à l'étude des vecteurs du paludisme dans le sud ouest de Madagascar.

The authors describe the results of an entomological study run in December 1994 in the little town of Bezaha (South-Western Madagascar). The observed entomological indexes are those of an intensive malaria transmission area. The authors suggest to organize a longitudinal entomological survey along with a clinical and parasitological study. They also point out the fact that they found two microfilariae Wuchereria bancrofti in an Anopheles funestus female.

[Mass food poisoning after eating sea turtle in the Antalaha district]. / Intoxication alimentaire collective par consommation de tortue de mer dans le district d'Antalaha.

In December 1994, a mass food poisoning through ingestion of turtle affected about 60 persons, on the north-eastern coast of Madagascar. The prevailing clinical signs were digestive (nausea, vomiting, dysphagia, acute stomatitis) and might persist during several weeks. The poisoning attack rate was 48% with a lethality of 7.7%. Such accident, even if rare in Madagascar, requires a structured organization to control sea products poisoning and to set up adequate prevention measures.

[Anti-scorpion control in the governorship of Sidi Bouzid (Tunisia)]. / Lutte anti-scorpionique dans le gouvernorat de Sidi Bouzid (Tunisie).

The authors describe the incidence, the clinical aspects and the epidemiology of scorpion poisoning in the area of Sidi Bouzid. They expose and propose public health measures which should diminish the incidence of stings, and the number of hospitalisations and deaths. Improvement of housing and food hygiene, education of the population are essential.