Malnutrition proteino-energetique chez les enfants de moins de 5 ans du Departement de la Mefou au Cameroun : fevrier-mars 1993

Dans le cadre d'un projet de renforcement des activites de soins de sante primaires du departement de la Mefou; situe dans la province du Centre au Cameroun; une enquete anthropometrique a ete realisee du 4 fevrier au 26 mars 1993. L'echantillon de 1303 enfants ages de 0 a 59 mois; a ete obtenu par un sondage en grappes a deux degres. 24;5 pour cent des enfants presentaient une malnutrition chronique; une insuffisance ponderale et une malnutrition aigue

Paludisme: conduites; attitudes; pratiques et croyances des expatries francais a Yaounde; Cameroun; en 1993

Les expatries francais en poste au Cameroun recoivent une multitude d'informations sur le paludisme: a leur depart de metropole; a leur arrivee au Cameroun; par les collegues; Francais ou non; par les medias. Ces informations sont souvent contradictoires et il leur devient difficile alors d'avoir une connaissance objective de la maladie; de sa prevention et de son traitement. Il a paru de ce fait utile au Centre Medico-Social de Yaounde de conduire une enquete sur les conduites; attitudes; pratiques et croyances (CAPC) des expatries vis-a-vis du paludisme afin d'elaborer en retour une politique d'information adaptee a cette population particuliere. Cette etude a montre que; d'une maniere generale; les expatries francais au Cameroun sont bien informe sur le paludisme; qu'ils prennent une chimioprophylaxie adaptee et qu'ils reagissent correctement face a l'acces palustre

The effect of various recovery modalities on subsequent performance, in consecutive supramaximal exercise.

Different recovery strategies from maximal exercise seem to induce different lactate utilization patterns without significantly affecting performance on one subsequent maximal exercise. It remains unclear however, how varying recovery modalities affects repeated maximal exercise. To study this, we examined in 16 subjects, the influence of passive (P), active leg (L) and active arm (A) twenty minutes recovery periods separating a series of four exhaustive exercises, up to two minutes duration. Significant decreases in performance between the first and fourth exercise were observed in all recovery series but a significant decrease in performance in the second exercise was observed during passive recovery alone (p < 0.01). When the different types of recovery are compared, a more pronounced decrement in performance was found during passive recovery when first and last exercises are compared (p < 0.04). Pedaling duration in each successive exercise was unaffected in A or L but was significantly shorter in P (p < 0.03). Highly significant differences in mean blood lactate kinetics were found for the three recovery patterns used, with more elevated peak and nadir levels in passive recovery, intermediate values in active arm and lowest concentrations in active leg recovery. However, no correlation was found between performance and lactate concentration at the onset of exercise (r = -0.15; p = NS). Mean heart rates were similar throughout the experimental protocol except for a lower cardiac frequency during the last 5 minutes of passive recovery (p < 0.01). Blood hematocrits showed higher hemoconcentrations in repeated exercise during passive recovery (p < 0.01) despite significantly lower total fluid losses in this group. A significant correlation between peak hematocrit and blood lactate was also found (r = 0.67; p < 0.001). We conclude that the type of recovery has a significant effect on blood lactate elimination kinetics, and active recovery is beneficial in the preservation of performance during repeated maximal exercise. Furthermore, plasma shifts across the extra and intravascular spaces are induced by maximal exercise, and appear to closely follow blood lactate kinetics.

Evaluation de la couverture vaccinale du Departement du Mayo-Sava; Province de l'Extreme-Nord; Cameroun; Fevrier 1993

Une enquete de couverture vaccinale a ete menee dans le Departement du Mayo-Sava du 9 au 20 fevrier 1993. Elle a concerne 209 enfants; les deux sexes confondus. Les resultats de cette enquete sont presentes sous trois formes a savoir la couverture avec histoire; la couverture brute et la couverture corrigee. Bien que les objectifs du Programme elargi de vaccination ne soient pas totalement atteints; d'indeniables progres ont ete cependant realises dans le Departement du Mayo-Sava

Epidemiologie de l'infection par le virus de l'hepatite C (HCV) en zone forestiere du Sud-Cameroun: resultats de deux enquetes serologiques

Les auteurs ont mene deux enquetes serologiques en milieu rural forestier du Sud-Cameroun en 1990 et 1992. Ces enquetes ont montre un fort taux de prevalence de l'infection par le virus de l'hepatite C; la relative protection des pygmees Baka; l'atteinte preferentielle des bantous; a partir de 15 ans; avec une rupture de prevalence a 40 ans. Ils emettent les hypotheses d'un phenomene epidemique ancien et d'une transmission sexuelle actuelle

Apport de la mini-colonne echangeuse d'ions au diagnostic des filarioses a microfilaires sanguicoles

Les auteurs ont teste sur 150 adultes volontaires une mini-colonne echangeuse d'ions comparativement a la goutte epaisse dans le diagnostic des filarioses a microfilaires sanguicoles. L'analyse des 143 dossiers exploitables montre une sensibilite identique des deux techniques; mais que l'association des deux offre un gain de sensibilite de 60;5

Effect of different modalities of exercise and recovery on exercise performance in subjects with sickle cell trait.

The sickle cell trait (HbAS) does not seem to affect exercise performance. It remains unclear, however, whether the capability to sustain repeated brief maximal effort and recovery by HbAS subjects, is also preserved. To study this, nine HbAS and nine matched controls underwent on two different occasions, a series of four, approximately 2-min duration, maximal cycle exercise tests separated by 20-min recovery periods of either absolute rest (P) or light pedaling (A) as well as an incremental test to exhaustion. In all tests, work performed, heart rate, blood hematocrit, lactate, and serum creatine kinase (CK), lactate dehydrogenase (LDH), and aspartate aminotransferase (GOT) were measured. Performances were similar in HbAS and HbAA subjects in both the predominantly anaerobic and aerobic exercise series. There were no observable differences in work, power, or heart rate in the two groups both during peak exercise or recovery periods. A significant hemoconcentration was observed during P, with hematocrit increasing in HbAS from 46.4 +/- 0.7% to 48.3 +/- 0.4% at the end of the last recovery period. Similar changes were seen in HbAA. Significantly greater fluid losses were found during A (1.3 +/- 0.2 l in A and 0.6 +/- 0.1 l in P for HbAS; P < 0.001), but fluid losses were similar in each type of recovery in the two groups. Despite similar performance, significantly lower blood lactate concentrations were consistently found in HbAS in each of the three exercise series (P < 0.001). Lower lactate levels in HbAS were observed only at exercise loads above the lactate threshold during the incremental test (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Therapeutic attitudes and malaria in Sanaga Basin (Cameroon)]. / Attitudes thérapeutiques et paludisme dans le bassin de la Sanaga (Cameroun).

In order to evaluate malaria problems such as they are perceived by Sanaga Basin populations in Cameroon, authors appealed to a cluster sample survey on a population sample obtained from a 2 degree population poll in four representative sites. Malaria so defined represents the outstanding endemia by which the most usual therapeutic recourse makes self-medication interfere particularly by amino-4-quinolines. It is convenient to verify the quality of treatment so administered to adapt possibly training objectives of the interested population. In the present context of the chemoresistance extension of plasmodial strains to usual antimalarials, setting up a surveillance system of efficiency is necessary.

[Malaria in Yaounde (Cameroon). Cost and antivectorial control at the family level]. / Le paludisme-maladie dans la ville de Yaoundé (Cameroun). Prise en charge et lutte antivectorielle au niveau familial.

In order to evaluate the financial charges of antivector control and disease at family level for "malaria disease" as perceived by Yaounde inhabitants, the authors carried out a transverse survey on a representative sample of populations derived from sampling surveys at different degrees. Malaria, so defined, represents a dominating endemic for which the yearly financial effort consented by each family amounts to 57,000 FCFA which represents medical care and entailed services as well as the purchase of chemicals for antivector control. The development of more efficient therapeutic behaviours and promotion of greater use of remanent insecticide impregnated bed nets comes in first in setting up training programmes aimed at health personnels and populations who are under their responsibility.

Prevalence de la cecite et de la baisse de vision en zone rurale de foret au Cameroun en 1992

Une enquete transversale avec echantillonnage en grappes; a permis d'estimer la prevalence instantanee des deficiences visuelles en zone rurale de foret au Cameroun. Le taux de prevalence standardise de la cecite bilaterale est egal a 1;2 pour cent; celui de la baisse de vision bilaterale a 4 pour cent et celui de la cecite unilaterale a 1;8 pour cent. La cataracte senile est la cause principale de deficience visuelle. Les opacites corneennes totales ou centrales sont la deuxieme cause de deficience et concernent 8 pour cent de l'ensemble des deficients. Au vu de ces estimations il semble opportun d'envisager l'elaboration d'un programme national de lutte adequat

Information et politiques de sante

Tout plan de sante englobant tous les services destines a ameliorer ou a sauvegarder l'etat de sante des individus et de la collectivite devrait reserver une place de choix a l'information. En effet; l'information est indispensable dans l'elaboration des politiques de sante en ce sens qu'elle permet d'identifier les problemes; les besoins et les moyens disponibles. Elle favorisera en fin de compte une bonne definition des priorites et de la strategie globale se traduisant par un certain nombre d'objectifs

Enquetes CACP SIDA en milieu scolaire; Gabon (juin-novembre 1990)

Les auteurs rapportent les resultats d'une enquete transversale a passage unique de type CAP sur le SIDA; realisee de juin a novembre 1990 sur un echantillon aleatoire d'eleves d'etablissements scolaires de Port Gentil; Koulamoutou; Lastourville et Lambarene. Les eleves ont une bonne connaissance theorique de la transmission et de modes de prevention du SIDA. Ils connaissent bien le preservatif mais l'utilisent encore trop peu; plus dans un but contraceptif ou comme prevention des MST que par crainte du SIDA pour lequel le 3/4 des lyceens ne s'estiment pas a risque

[Health care accessibility and adequacy of health care system in the Sanaga basin (Central Cameroon)]. / Recours aux soins et adéquation du système de santé dans le bassin de la Sanaga Centre Cameroun.

The authors report on the results of a Survey Carried out in four areas in Center Cameroon. Health gets a major position within the concerns of the population to protect it, they prefer the classical and official system of health Care rather than the primary Health care System. Self-medication is also a preferred solution. In the rural milieu, they often pay a visit to a traditional practitioner. When they have to take a decision, geographical situation and money problem play both a major role.

PIP: A survey was carried out in 4 different locales of the Sanaga River basin of Central Cameroon in mid-1989 to evaluate the felt needs of the population for health care and their reasons for choosing among the health resources available to them. The 4 locales were Edea, an urban industrial complex with 33,000 inhabitants; Mbebe-Kikot, a small village in the tropical forest with 350 inhabitants, Mbandjock, an urban agroindustrial center in the savannah zone with an estimated population of 17,000; and Ntui, a rural agglomeration of around 5000 at the border between the savannah and forest. Mbebe-Kikot had only a health center and the others all had hospitals and a network dispensaries and pharmaceutical depots. Each quarter and village had community health agents trained to provide primary health care. Traditional practitioners were omnipresent in both urban and rural areas. Representative samples of at least 300 persons in 3 of the locales and the entire population of Mbebe-Kikot were interviewed about their illnesses, use of health services, and reasons for their choices. Records of the health facilities serving the survey populations were also examined, but were too incomplete to be of use. The samples included 330 persons in Mbebe-Kikot, 327 in Ntui, and 328 each in Edea and Mbandjock. Nearly 1/3 of respondents reported they had had some sickness in the past month. 70% of all the conditions reported in Ntui and Mbebe-Kikot and 80% in the 2 urban sites led to demands for assistance at a health facility. Malaria was the most common pathology reported, followed by rheumatologic conditions, abdominal pain, cutaneous infections, and bronchopneumopathies. Malaria accounted for 18% of diagnoses with constant rates in all 4 sites. Onchocerciasis is hyperendemic in Mbebe-Kikot, which had a high rate of possibly related diagnoses: 7.3% ocular pathology, 7.0% cutaneous infections, and onchocerciasis in the strict sense 10.3%. 50-60% of those surveyed made a decision about treatment as soon as they became aware of a pathology. The study resulted in 3 major findings. Prevalence rates are high, with acute infections predominating. The demand for care is strong, and almost all individuals seek care. Rates of self-treatment are high, but recourse to community health agents is very rare. The preferred source of care is the official health system, chosen by 50% of the surveyed populations. Rural populations visited traditional practitioners more than did their urban counterparts. Geographical and financial considerations both played major roles in decisions regarding care. The strong preference of the population for the official, curative health system has implications for the government's primary health care program.

[Epidemiology of endemic leprosy in the People's Republic of the Congo. Risk factors and markers]. / Epidemiologie de l'éndemie lépreuse en République Populaire du Congo. Facteurs et marqueurs de risques.

A national prevalence survey of leprosy was made in june 1989 in Popular Republic of Congo: authors report results. The prevalence rate is 5.8% +/- 2.6% among people more than 15 years of age, and 10.5% of all forms are multibacillary. All patients are under DDS monotherapy. One overwhelming risk factor is leprosy antecedents in the family history; active case-finding and surveillance of contacts are recommended.

[Malaria and surgery: which prophylaxis?]. / Paludisme et chirurgie. Quelle prophylaxie?

The authors report on a study carried out at the Centre Hospitalier universitaire (University Hospital) of Yaounde (Cameroon). Such a study aimed at to check interest of systematic malaria chemoprophylaxis during the peri-operative phase in general surgery. 61 patients were divided in two groups by random allocation with and without quinine chemoprophylaxis. All of them were monitored clinically and parasitologically during the peri-operative phase. Results show that in both groups, only patients already positive before surgical intervention presented clinical malaria signs, biologically confirmed; malaria attack was more frequent and more severe in the group without quinine. No malaria attack was observed in patients of both groups in which thick smear was negative in pre-operative phase. The authors suggest that any patient during the pre-operative phase, be tested to find out Plasmodium falciparum. If the test is positive, so chemoprophylaxis with quinine be prescribed. But such a medication is valuable only in urban endemic zone.

[Evaluation of practice and costs of vector control on a family level in Central Africa. II. Douala City (Cameroon), July 1988]. / Evaluation des pratiques et des coûts de lutte antivectorielle à l'échelon familial en Afrique centrale. II. Ville de Douala (Cameroun), juillet 1988.

A Knowledge, Attitude, Practice survey was carried out in July 1988 in Douala city, by cluster sampling and household visits. 98% of these households declared being disturbed by mosquitoes (bites, diseases, noise); 91% of families are using a vector control method; the main methods are: bed-nets (48%), insecticide sprays (39.5%) and mosquito coils (36.7%). The average cumulated expense by households for vector control (116.6 ECU/year) and care for diseases attributed to mosquitoes (147.4 ECU/year) was evaluated at the equivalent of about 3 months of "minimum monthly wages". More than 90% of people interviewed would accept buying and using an insecticide impregnated bed-net provided that the price of such a product be lower than the current habitual price for ordinary bed-nets. The distribution of the impregnation technique must be made at the level of impregnation centres, which should start impregnating the existing bed-nets and take care of informing the public.

[Uncomplicated attack of malaria in an area with high resistance to chloroquine. I. Evaluation of a short treatment with quinine]. / L'accès palustre simple en zone de haut niveau de résistance à la chloroquine. I. Evaluation d'un traitement court par la quinine.

The good results achieved in the treatment of malaria with a 7 and 5 days one of quinine (orally dose 8 mg/kg/8 h), incited the authors to try a 3 days long treatment at the same dose. They experimented this protocol on hospitalised children. All patients were free of parasites at day 7 with an average residual concentration quinine of 2.7 +/- 0.8 mg/l. Among the 7 patients with malaria at day 14, 4 didn't require another treatment and 2 presented new infestation. 50% of plasmodial isolated strains were chloroquine resistant and 40% amodiaquine resistant. The efficiency of this protocol could be in favour of its larger use.

[Uncomplicated malaria attack in an area with high resistance to chloroquine. 3. The use of second-choice oral drug treatment]. / Accès palustres simples en zone de haut niveau de résistance à la chloroquine. 3. Emploi de traitements de deuxième intention, par voie orale.

This study appreciated the efficiency of uncomplicated malaria second line treatment (P. falciparum) in an area with high level of chemoresistance. No therapeutic failure was found with sulfadoxine-pyrimethamine (Fansidar), and mefloquine-sulfadoxine-pyrimethamine (Fansimef), in contrast with a rate of 8% with quinine. The authors discuss the place of these therapeutic, in the treatment of malaria.

[Endemic leprosy in the People's Republic of Congo. An epidemiological and behavioral analysis]. / L'endémie lépreuse en République Populaire du Congo. Analyse épidémiologique et comportementale.

The authors report the results of a national prevalence survey of leprosy made in 1989 in Popular Republic of Congo. Leprosy is essentially found in rural areas and frequently causes disabilities. The prevalence rate is 5.8 +/- 2.6% among people more than 15 years of age, and 10.5% of all forms are multibacillary. All patients are under DDS monotherapy. One overwhelming risk factor is leprosy cases in the family history; active case-finding and surveillance of contact cases are recommended. Generally, leprosy is poorly understood by the general population; an educational effort is necessary.