Selenium status in pregnant women of a rural population (Zaire) in relationship to iodine deficiency.

Endemic myxoedematous cretinism has been associated with combined selenium and iodine deficiency in several areas of Zaire. To determine selenium and iodine status across the country, serum selenium and thyroid function parameters including urinary iodide were determined at prenatal clinics in 30 health centres of rural villages distributed over the whole country. Only in Bas-Zaire was the mean serum selenium level similar to that in non-deficient areas (80-120 ng/ml); in the regions of Bandunda and Kasai levels were marginally decreased (55-80 ng/ml), and in Kivu, Haut-Zaire, Equateur and Shaba they were marginally or moderately decreased (< 55 ng/ml). The frequency of abnormally low urinary iodide (< 5 micrograms/dl) varied from 20% in the region of Bas-Zaire to 50% in Kasai (P < 0.001), and to still higher percentages in the 5 other regions of Zaire (Bandundu, 57%; Kivu, 63%; Equateur, 72%; Shaba, 76%; Haut-Zaire, 84%). With the exception of Bas-Zaire, biochemical maternal hypothyroidism (serum TSH > 5mU/l) was present in every region, with a frequency ranging from 3% in Kivu to 12% in Equateur. Iodine deficiency affects most of the Zairean population and requires public health measures on a larger scale than previously estimated. Combined iodine and selenium deficiency affects Equateur, Haut-Zaire and Kivu, where endemic myxoedematous cretinism occurs, but also Shaba, where it was not previously described. Besides combined iodine and selenium deficiency which is permissive, another factor (thiocyanate?) must be taken into account to explain the peculiarly elevated prevalence of endemic myxoedematous cretinism in Central Africa.

Technique traditionnelle de sevrage dans la zone de sante de Basankusu

Des encadreurs de sante et de developpement ont ete utilises comme informateurs cles pour decrire la technique traditionnelle de sevrage dans la zone de sante rurale de Basankusu. Les donnees qualitatives obtenues ont ete discutees en seance pleniere devant les encadreurs de la zone de sante de Bolomba; voisine de Basankusu. La conduite du sevrage dans ce milieu rural est satisfaisant a bien d'egards. L'allaitement au sein exclusif se pratique jusqu'a 5 mois. Le sevrage est progressif et s'etend au dela de 18 mois. La chikwangue; aliment de sevrage de base est premastique par la mere avant la consommation par l'enfant. Il faut neanmoins deplorer la faible utilisation des cereales combinees aux legumineuses; aliment pourtant cultive dans la region pour le sevrage. Cette defaillance pourrait donc constituer une matiere pour l'education nutritionnelle

J-shaped relationship between mortality and admission blood pressure in black patients with acute stroke.

AIM: The charts of 388 patients admitted for a recent stroke at the University of Kinshasa Hospital, Department of Medicine, were analysed to assess the case fatality rate and its determinants. RESULTS: During the hospitalization period (average 31 days), 169 deaths (44%) were recorded. Mortality was higher (P<0.05) in women (54%) than in men (42%), in haemorrhagic (61%) than in ischaemic (26%) strokes, and in patients with depressed consciousness, motor deficits, tachycardia or atrial fibrillation on admission. Mortality increased with advancing age, the depth of coma, the severity of motor deficit and the plasma glucose level on admission. Plasma glucose, urea and the leucocyte count were higher in patients who died than in survivors. Patients with and without a history of hypertension, diabetes or stroke recurrence had similar mortality rates. The latter tended to be higher in smokers and alcohol consumers. Using logistic regression analysis, depressed consciousness (P<0.001), tachycardia (P<0.001), plasma urea on admission (P<0.05) and a history of alcohol consumption (P<0.05) emerged as significant predictors of mortality. Admission systolic/diastolic blood pressure was similar in those who died (177 +/- 41/104 +/- 26 mmHg) and in survivors (171 +/- 41/101 +/- 23 mmHg). However, in the whole study population and in subgroups of patients who were comatose or conscious on admission, mortality showed a J-shaped relationship to admission systolic blood pressure with low rates in the range 160-199 mmHg before and after adjustment for age and sex, higher rates being observed for higher or lower blood pressure ranges. CONCLUSIONS: Depressed consciousness, ECG abnormalities, delayed admission and elevated plasma urea predict a high case fatality rate whereas systolic blood pressure within the range 160-199 mmHg appears to be optimal for survival in the patient group studied.

[Initial arterial pressure and prognosis of cerebrovascular accidents]. / Pression artérielle initiale et pronostic de l'accident vasculaire cérébral.

The present study analysed the charts of the patients admitted for acute stroke and assessed the relation between stroke mortality and initial blood pressure. Of the 388 patients admitted, 169 (44%) died. Mortality increased with advancing age and was higher in women, in hemorrhagic stroke (61%), and in patients with severe neurological deficit on admission. Average blood pressure on admission did not differ between the patients who died and those who survived. However, mortality was 42, 32, 57 and 62% in patients whose admission systolic blood pressure was, respectively, less than 160 mmHg, 160 to 199 mmHg, 200 to 249 mmHg and 250 mmHg or more. It described a similar curve when four categories of admission diastolic blood pressure were constituted. The data indicate a high case fatality rate in stroke patients. Mortality was higher in women; it increased with age and severe neurological deficit. The relation of stroke mortality to admission blood pressure suggests that it is not the lowest in patients with the lowest blood pressure, but in those with blood pressure level allowing the best brain perfusion after the onset of stroke.

Maternal behavioural risk factors for severe childhood diarrhoeal disease in Kinshasa, Zaire.

This study examines the relationship between severe diarrhoeal disease and maternal knowledge and behaviours related to hygiene and sanitation. Some 107 paediatric cases admitted to two hospitals in Kinshasa, Zaire in 1988 were matched on age and nearest-neighbour status to 107 controls. Personal interviews and observational methods were used to assess knowledge and behaviours related to hygiene and sanitation. Cases and controls had equivalent socioeconomic status, demographic profiles and access to water and sanitation facilities. However, cases generally exhibited lower levels of knowledge and less sanguine sanitary practices than did controls. Of particular interest was the finding that very specific behavioural items distinguished cases from controls. The disposal of the child faeces and household garbage and mother's knowledge that poor caretaker cleanliness was a cause of diarrhoea in children showed the strongest associations with risk of diarrhoea. There was an exponential relationship between the number of these items a mother answered incorrectly and the odds of diarrhoeal disease. The risk attributable to these three variables was as high as 70%. These findings provide further support for the view that focused educational interventions may have a substantial impact on the occurrence of severe diarrhoeal disease in low-income countries.

PIP: Data on 107 children (mean age 12 months) with severe diarrhea admitted to Mama Yemo Hospital and Kalembelembe Children's Hospital in Kinshasa, Zaire, between March and November 1988 were compared with 107 age- and neighborhood-matched controls to determine the significance of maternal behavioral risk factors as determinants of severe diarrheal disease. The 2 groups were essentially of the same socioeconomic class. 97% of all children had access to latrines, especially pit latrines in the family compound. About one third of the children did not have access to piped water within their compounds. Mothers of controls had slightly higher levels of formal education than did case mothers (p = .07). The number of hygienic and sanitary questions that mothers did not answer correctly grew exponentially as did the odds of severe diarrheal disease. The multiple logistic regression analysis indicated that mothers' knowledge of the significance of child caretaker cleanliness was strongly related to severe diarrheal disease (odds ratio [OR] = 2.56; p = .01). Unsanitary disposal of child feces and garbage were also significant predictors of severe diarrheal disease (ORs = 2.69 and 2.92, respectively; p = .001). These 3 behavioral factors were responsible for up to 70% of the severe diarrhea cases. Thus, health education initiatives focusing on these 3 behaviors could eliminate as much as 70% of the cases.

Focal and segmental glomerulosclerosis in nephrotic syndrome: a new profile of adult nephrotic syndrome in Zaire.

In order to assess renal pathology, 92 clinically well-documented cases of nephrotic syndrome (NS) in adults (median age: 29) were systematically biopsied upon admission to the University Hospital of Kinshasa, between 1986 and 1989. All biopsies were paraffin embedded and histologically assessed by the routine methods of light microscopic examination. Histologic lesions were classified according to standard criteria. Focal and segmental glomerulosclerosis (FSG) was found in 41% of patients. The remaining 59% included minimal epithelial disease or minimal change nephropathy (MCN) responsive to corticosteroid therapy (14%), proliferative glomerulonephritis (PGN) (11%), membranous glomerulopathy (MGP) (10%), amyloidosis (10%), membrano-proliferative glomerulonephritis (MPGN) (8%), and "end stage kidney" (ESK) (7%). These results strikingly indicate the high prevalence of FSG. In comparison with previous findings from the same milieu, there is a seven-fold increase of this entity (41% versus 6%). The findings herein reported define a new histologic profile of NS in Zaire, characterized by the predominance of FSG. While in the past the vast majority of NS (52%) were putatively related to the intercurrent parasitic diseases, among which malaria was the chief etiology, similar associations were less important. Instead, no definite causative agent emerged for this apparently idiopathic condition. Further epidemiological and morphological intercorrelation studies, as well as the studies aimed at the relationships with AIDS, are in progress, with the purpose of identifying putative etiologies and risk factors responsible for the increase of FSG in Zaire.

The impact of oedema on anthropometric measurements in nutritional surveys: a case study from Zaire.

Six surveys for protein-energy malnutrition were carried out in sequence in Bas-Zaire beginning at the end of 1978 at the estimated height of the famine and continuing throughout the recovery period. Utilizing a stratified multi-stage sampling technique, over 1000 children aged 6 months to 6 years were measured anthropometrically and examined for the presence or absence of bilateral pedal oedema in each survey. The proportions of children who were less than 80% of the reference median weight-for-height and who had oedema decreased, respectively, from 12.8% and 14.4% initially to 2.1% and 1.8% in the final survey. The proportion of oedematous children who were found to be not less than 80% of the reference median weight-for-height was high, varying from 71.7 +/- 7.0% to 94.4 +/- 10.6%. The importance of these findings for the interpretation of anthropometric data from nutritional surveys in developing countries is discussed.