[Iron supplementation associated with malaria prevention among pregnant women in Abidjan]. / Traitement martial associé à la prophylaxie du paludisme chez la femme enceinte à Abidjan.

BACKGROUND: Despite the demonstrated efficacy of iron supplements and malaria prevention, the effectiveness of antenatal care programs for prevention of anaemia (haemoglobin rate<11 g/dL) in pregnant women is low in West Africa. Apart from the issue of availability and despite low cost, the major reason evoked is the lack of motivation of pregnant women and health care professionals. In this study, iron supplements and malaria prophylactics were provided free of charge during pregnancy. The treatment was proposed at the first antenatal visit, with the objective of not interfering with routine practice of birth attendants and women in latter antenatal visits. METHODS: Haemoglobin rates were measured and Plasmodium falciparum tested for among pregnant women in four maternity units in Abidjan. The tests were carried out at inclusion during the first antenatal visit and during immediate post-partum in 631 pregnant women who delivered in one of the four wards. Considering the objective of the study, compliance was assessed for the month prior to delivery. RESULTS: Despite an habitual decrease in iron deficiency at the end of pregnancy, haemoglobin rates in the study population increased from 10.4 g/dL at inclusion to 10.9 g/dL during post-partum. Prevalence of anemia consequently decreased from 62.8% to 49.4% (p<0.01). A similar increase of 0.7 g/dL was observed among women stating a regular (57%) or irregular (36.9%) compliance with the protocol. A decrease of 0.4 g/dL (s.t.: 1.8 g/dL) was observed among women stating a lack of compliance with the protocol (5.6%). The prevalence of anaemia according to compliance was consequently 43.1%, 49.7% and 70.1% (p=0.02). Severe anaemia (<8 g/dL) at inclusion was an independent risk factor for post-partum anaemia although a 2.9 g/dL increase (s.t.: 2.0 g/dL) was observed in the latter (p<0.01). However, the 11 g/dL threshold was not reached. CONCLUSION: It is therefore important to reinforce the availability of treatments to prevent anaemia in pregnant women due to their demonstrated efficiency as a part of routine antenatal activities.

[Malaria in expatriates in Abidjan]. / Le paludisme chez les expatriés à Abidjan.

This study was carried out in 1998 to assess attitudes and practices with regard to prophylaxis for malaria in expatriate families with children attending French and international schools in Abidjan, Cote d'Ivoire. Data was obtained for a total of 4990 subjects of various ages. Forty point five percent of families reported use of drug prophylaxis. Use of drug prophylaxis decreased with age (69.2 p. 100 up to 1 year versus 34.5 p. 100 after 15 years). The proportion of subjects using bednets was 7.5 p. 100. Some subjects reported use of ineffective or dangerous substances such as pyrimethamin alone (17.5 p. 100) or amodiaquin. The incidence of reported malarial attacks increased in function of the length of stay in the country (50 p. 100 after 15 years). The most effective method of drug prophylaxis appeared to be a chloroquin and proguanil combination which was used by 25.4 p. 100 of subjects. The incidence of malarial attacks in subjects using this combination was 20.8 p. 100 as compared to 43.2 p. 100 in subjects using no drug prophylaxis. Forty-seven percent of the study population reported use of other preventive measures but none correlated with a decrease in the number of malaria attacks. Information concerning preventive measures is readily available but sometimes contradictory. Information provided locally seems to be the most effective but not always the best adapted. To increase the awareness among expatriates, it will be necessary to provide more accurate information about effective preventive measures especially regarding bed nets and drugs. The suggested optimal duration of chemoprophylaxis is unclear but this study shows that there is no difference between those that do or do not use it when the length of stay exceeds ten years.

[Infectious hazards in military personnel in operations.]. / Les risques infectieux chez les militaires en opération.

Military personnel in operations have always paid a high toll to infections, particularly epidemics. Currently, 40 000 servicemen serve overseas in various missions and operations of various durations in various countries. Infectious hazards persist in spite of the implementation of preventive measures. They are primarily due to poor sanitation, promiscuous living conditions, and the operational situation : bacterial diarrhea, amoebiasis, viral hepatitis A and E are relatively frequent. Others are due to the tropical environment ; malaria remains a concern due to its chemoresistance ; bilharziosis can also cause small epidemics, cutaneous leishmaniasis is not rare in Guyana. Exceptional but serious infections are observed. Infectious hazards associated with warfare are reviewed : biological warfare, infections of wounded, burnt and irradiated soldiers.

[Drinking water for troops in the field]. / Alimentation en eau des troupes en campagne.

To provide for Armed Forces' water wants, drinking water is only used. Its production is not an easy thing in military operations. Armed Forces must use their own production means. Four new individual and collective field purification systems adapted to manpower, will been soon in use in the French Army. Filtration or distillation processes always with chlorine addition are used. The results give satisfaction in bacterial epuration; nevertheless chemical and nuclear risks are not controlled except in case of distillation mechanism associated with ion resins exchanging and charcoal filtration.

[Burundi: humanitarian mission (January-April 1994)]. / Burundi: mission humanitaire (Janvier-Avril 1994).

The 1993 assassination of the President of the Republic of Burundi led to a bloodbath resulting in the killing of 700 000 people and 300 000 refugees in camps scattered throughout the country. After the emergency surgery phase, the French cooperation which was in charge of health care in the Gitega sector requested a humanitary mission. Two public health physicians, a polyvalent clinical physician, and two field nurses were sent. All were armed service personnel. From January to April 1994, after a preliminary assessment of the situation, this mission took charge of health services as well as administrative services for the population of the region including some 10 000 refugees. Epidemiologic surveillance was carefully organized. During the first quarter of the year, there were 2451 declared cases of bacterial dysentery, 6738 cases of malaria-like fever including 25% confirmed by paristological findings on a study of 60 consultants, 87 cases of measles, and 1306 cases of conjunctivitis. There were no cases of cholerea or meningoccoal meningitis. A food support program was started when it was noted that the overall rate of acute malnutrition among refugee children under the age of 5 years was 25% (weight/height ratio less than minus 2 standard deviations or observation of edema). At the present time the situation in the sector is back to normal and the health care system is operating satisfactorally. However the situation in neighboring Rwanda could have adverse effects on the political stability of Burundi.

Ameliorer les prestations de sante primaire en zone urbaine : articulation de la formation et de la supervision dans les centres de sante integres de Brazzaville

Le projet d'appui aux structures existantes initie dans le cadre de la cooperation sanitaire entre la France et le Congo a permis de cerner les problemes lies a la gestion; a la formation et la rehabilitation de ces structures. L'objectif majeur de cette action a ete en effet de diminuer la morbidite et la mortalite maternelle et infantile. Ce projet dont l'axe fondamental a ete la formation et la supervision a donc permis en 1990 a 850 personnes de beneficier de cette formation par le biais des seminaires

Ameliorer les prestations de sante primaire en zone urbaine : ameliorer la gestion des ressources financieres dans les centres de sante : l'exemple de Brazzaville

Une analyse de la gestion financiere des centres de sante conduite a Brazzaville a mis en evidence la contribution importante de la communaute et a permis de proposer un nouveau mode de gestion des ressources. Les recettes moyennes theoriques declarees sont de 398000 FCFA par mois; dont 20 pour cent sont reservees a l'interessement des agents. Sur la solde 40 pour cent sont reservees aux directions de tutelle et le reste sert au fonctionnement propre du centre. Les auteurs montrent que dans la pratique; les sommes restant au niveau du centre ne permettent pas de couvrir efficacement les depenses de fonctionnement. Pour permettre une utilisation optimale des ressources et ameliorer les services offerts par les centres; l'assainissement de la gestion reste un prealable indispensable. Le projet appui aux centres de sante de Brazzaville; grace au developpement d'un instrument de recueil d'information et a la mise en place d'une supervision; a fait des propositions aux directions concernees pour ameliorer l'efficacite des procedures et renforcer la capacite de gestion des centres en tenant compte des realites

Ameliorer les prestations de sante primaire en zone urbaine : rationaliser l'information sanitaire en zone urbaine : l'exemple des centres de sante de Brazzaville

La necessite de disposer d'informations sanitaires fiaibles a conduit le projet appui aux centres de sante de Brazzaville du FAC a mettre en place un nouveau systeme d'information sanitaire dans les centres de sante. L'accent a ete mis sur la simplication du recueil; la performance des indicateurs utilises; et la fiabilite des donnees. Au niveau du centre un guide d'interpretation permet une auto-evaluation et la mise en evidence des disfonctionnements; en relation avec les equipes de supervision. Ce systeme a ete elabore avec l'ensemble des acteurs. Il reste evolutif et ouvert a l'integration de grands programmes

[Epidemiological study of bancroftian filariasis in the Logone Valley (North Cameroon) (author's transl)]. / Etude epidémiologique de la bancroftose dans la Vallee du Logone (Nord Cameroun).

In the Logone Valley, Yagoua and the surrounding area, the prevalence of the bancroftian filariasis was measured by means of determinating the microfilarian rate: 22,1 p. 100 in males and 9,8 p. 100 in females. The immunofluorescence test on D viteae frozen sections showed the presence of antibodies in 61,5 p. 100 of the males and 68,2 p. 100 of the females. A balance between the microfilarial rate and the percentage of inhabitants with specific antibodies was observed. Parasitological and immunological examinations appeared to be complementary. The microfilarial density is 19 microfilariae/20 microliter of blood in males and 13 microfilarae/20 microliter in females. Elephantoid extremities of scrota was observed in 13,2 p. 100 of the adult males, all of them having more than 40 years of age. Females are less affected than males. At the beginning of the rainy season, females of A. gambiae were the mosquitos the most frequently caught in the houses.