[Problems with envenomations in Guinea]. / Problématique des envenimations en Guinée.

Only a few years after its creation, the Kindia Pasteur Institute (currently Institut de Recherche de Biologie Appliquée de Guinée, IRBAG), owing to its geographical situation, began regularly supplying the Paris Pasteur Institute with snake venom for manufacturing antivenom. The diversity of the biotopes in Guinea due mainly to the diversity of vegetation (savannah, forest, mangrove) and altitudes (coastal zone, mountains of Fouta-Djalon and mountain of High Guinea), induces a wide variety of the herpetological fauna. Envenomations are consequently a significant cause of morbidity and mortality in a country where agriculture is an important economic activity. Unfortunately, precise statistics for envenomations are unavailable. A retrospective study was performed based on IRBAG registers (1980-1990). A total of 584 snakebites were reported with a 2.2% case fatality rate. Between 1997 and 1999, 379 cases of snakebites were reported with 18.2% death, mainly due to the lack of antivenom, and 2.1% amputations. By combining the fang marks and victim or relative assessments, we were able to identify most of the snakes involved in the envenomations: Naja (21.3%), Bitis (15%), Dendroaspis (12.4%) and Causus (12.9%). In 38.2% of the cases, the snake was not identified. This survey confirmed that envenomations are a problem in Guinea. However, more studies are necessary to appreciate the real importance of the herpetological Guinean fauna and its consequences on morbidity and mortality in order to improve the management of envenomations.

[Contribution to the study of mosquitoes (Diptera: Culicidae) of Guinea: Fauna and distribution]. / Contribution à l'étude des moustiques (Diptera: Culicidae) de la Guinée. Faune et distribution.

The authors report the results of ten years of entomological research conducted in Guinea. During this period, 84,000 larvae and 66,000 adult mosquitoes belonging to 8 different genera were captured and identified according to species or species groups. Mosquito fauna in Guinea includes almost all the known vectors of malaria and filaria in West Africa (see tables I-IV) as well as many of the known vectors of arboviruses. Four methods were used for capturing the insects, the most efficient being the use of a net in vegetation which succeeded in trapping 83% of the species described.

The Bamako Initiative in Benin and Guinea: improving the effectiveness of primary health care.

The objective of the health system revitalization undergone in Benin and Guinea since 1986 is to improve the effectiveness of primary health care at the periphery. Second in a series of five, this article presents the results of an analysis of data from the health centres involved in the Bamako Initiative in Benin and Guinea since 1988. Data for the expanded programme of immunization, antenatal care and curative care, form the core of the analysis which confirms the improved effectiveness of primary health care at the peripheral level over a period of six years. The last available national data show a DPT3 immunization coverage of 80% in 1996 in Benin and 73% in 1995 in Guinea. In the Bamako Initiative health centres included in our analysis, the average immunization coverage, as measured by the adequate coverage indicator, increased from 19% to 58% in Benin and from less than 5% to 63% in Guinea between 1989 to 1993. Average antenatal care coverage has increased from 5% in Benin and 3% in Guinea to 43% in Benin and 51% Guinea. Utilization of coverage with curative care has increased from less than 0.05 visit per capita per year to 0.34 in Guinea and from 0.09 visit per capita per year to 0.24 in Benin. Further analysis attempts to uncover the reasons which underlie the different levels of effectiveness obtained in individual health centres. Monitoring and microplanning through a problem-solving approach permit a dynamic process of adaptation of strategies leading to a step by step increase of coverage over time. However, the geographical location of centres represents a constraint in that certain districts in both countries face accessibility problems. Outreach activities are shown to play an especially positive role in Guinea, in improving both immunization and antenatal care coverage.

Health seeking behaviour and household health expenditures in Benin and Guinea: the equity implications of the Bamako Initiative.

Curative and preventive care utilization in Bamako Initiative health centres in Guinea and Benin increased significantly. Service based data and household survey results are compared and interpreted to evaluate the equity aspects of the Bamako Initiative programmes in these settings. Improvements in the use of preventive services are shared by the richer and poorer groups of the population. Inequities are more apparent regarding curative area. An important part of the population is not using Bamako Initiative Health Centres for financial reasons. However, the poor were found to use these Health Centres relatively more than richer socio-economic groups. Challenges of the future are identified and recommendations made as to how to tackle the problem of true indigence.

[Informal care of malaria: determinants of demand and supply inventory. A study conducted in Touba City (Senegal)]. / Soins informels dans le paludisme déterminants de la demande et inventaire de l'offre. Etude menée dans la ville de Touba (Sénégal).

In Senegal, identifying the determining factors of the informal health care demand for malaria on the one hand and the supply's inventory in that condition on the other hand, are prerequisites to the definition of any realistic pharmaceutical policy. Wanted to make these parameters available in the city of Touba which shows religious and administrative particularities as compared to the rest of Senegal, by conducting a study on malaria morbidity and by submitting to people and informal health care providers two different questionnaires. Besides a malaria morbidity rate of 7.4%, the resort to informal health care was linked to economic reasons for 64% of householders resorting to this type of health care. Sociocultural determining factors were also identified. Among health care providers whom community's request is important, we observed the relevance of the malaria regular diagnosis as compared to established references. However we did not observed it as far as treatment and chemoprophylaxis are concerned. The supply is done along underground lines. The training of these informal health care providers and their integration in the general health care system should be considered.

[The fauna and ecology of blackflies (Diptera, Simuliidae) in the Republic of Guinea]. / Fauna i ékologiia moshek (Diptera, Simuliidae) Gvineiskoi Respubliki.

Twenty-nine Simulium species were recorded in the Republic of Guinea. The geographical distribution of the blackfly species in its areas is shown in the paper. The most probable vector of Onchocerca volvulus are S. damnosum s. str and S. sirbanum which predominate in the landscapes of Sudan and Guinea savannas. S. yahense, S. soubrense, and S. sanctipauli are likely to be vectors in the forest-savannas and tropical rain forests.

[Integration of the Expanded Program on Immunization into primary health care: examples of Benin and Guinea]. / Intégration du PEV aux soins de santé primaires: l'exemple du Bénin et de la Guinée.

Since 1986, two West African countries have been delivering immunizations within the framework of reorganized peripheral health systems. This revitalization is based on strategies which are implemented by an increasing number of African countries under the name "Bamako Initiative". It aims at providing universal access to a minimum package of maternal and child health priority interventions starting with immunizations, pre and perinatal care, oral rehydration for diarrhoea, treatment of malaria and acute lower respiratory infections. Within this package, immunization has been given high priority. Several strategies aimed at improving immunization coverage have been implemented: services have been reorganized so that any child or woman making contact with the health system receives immunization if needed. Health information systems have been revised so as to allow for active individual follow up and better management of health centre resources. Health staff have been given training in management and a biannual monitoring/microplanning process at health centre level has been introduced. The goal of monitoring is to enable health personnel to identify the obstacles to attaining optimum coverages with the priority interventions and to select locally appropriate corrective strategies. Health centres have also been provided with a motorcycle allowing for regular outreach activities. To cover the running costs of the services (mainly restocking of drugs, running and maintenance of the cold chain and the motorbike, and staff incentives), financial contribution from local communities have been sought through a fee-for-treatment system. Prices have been set at an affordable level by limiting the number of drugs to a minimal list purchased under generic names by international tendering procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

[A new species of mosquitoes for Guinea Aedes (Aedimorphus) pseudotarsalis van Someren]. / Novyi dlia Gvinei vid komarov Aedes (Aedimorphus) pseudotarsalis van Someren.

The Aedes pseudotarsalis mosquito that is new in Guinea was found in the Middle Guinea (the Fouta-Djallon mountains) in the prefectures of Pita and Kindia in October 1990. The preimaginal phases of this species were collected in the late rainy period in the small temporary water reservoirs (in the erosive hollows), in the axils of herb leaves and in the tanbarks of trees in the vicinities of populated areas.