[Validity of nonaffective functional psychosis of the DSM IV in a Congolese population. A transversal clinical trial]. / Validité des psychoses fonctionnelles non affectives du DSM IV dans une population congolaise. Une étude clinique transversale.

BACKGROUND: The fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM IV) distinguishes schizophrenia, schizophreniform disorder and brief psychotic disorder only according to the duration of the illness. Thus, the validity of these nosological concepts sounds uncertain. AIM: The aim of this study was to evaluate the validity of the DSM IV concepts schizophrenia, schizophreniform disorder and brief psychotic disorder. POPULATION AND METHODS: Seventy schizophrenics, 68 patients with brief psychotic disorder and 50 with schizophreniform disorder, all Congolese people, selected from the 'Telema' Mental Health Centre and the 'Neuropsychopathological centre of the University of Kinshasa, from 5(th) August 2003 to 14(th) March 2005 were compared with respect to the following clinical parameters: family schizophrenia and brief psychoses history, precipitating psychosocial factors, mode of onset of the disease, clinical syndromes linked to psychoses and general functioning. Statistical analyses included analysis of variances 'one way' (Anova), post hoc Tukey's test, discriminant analysis, and analysis of covariances. RESULTS: Brief psychotic disorder differed from schizophrenia and schizophreniform Disorder in respect with positive syndrome (F=8.76, df=2; 179, p=0.0002), cognitive syndrome (F=3.79, df=2; 179, P=0.024), syndrome of excitement (F=3.23, df=2; 179, P=0.042), general functioning (F=13.73, df=2; 179, P<0.0001), family history of schizophrenia (χ(2)=8.65; P=0.013), precipitating psychosocial factors (χ(2)=19.82; P<0.0001), and mode of onset of the disease (χ(2)=91.3; P<0.0001). Schizophreniform disorder differered from schizophrenia only by a more frequent acute onset and a better general functioning. Two nosological realities were thus distinguishable: brief psychotic disorder and schizophrenia-schizophreniform disorder complex. Surprisingly, negative syndrome could not distinguish brief psychotic disorder from schizophrenia and schizophreniform (F=2.80, df=2; 179, P=0.063). Data of the discriminant analysis based on scores on general functioning, positive, negative, depressive, cognitive and excitement syndromes was conclusive (F=6.41, df=2; 185, P<0.0001) and allowed correct classification rates of 75% for brief psychotic disorder, 48% for schizophreniform disorder, 54% for schizophrenia. Schizophreniform disorder was thus the less distinguishable group; this is in the line with longitudinal studies, which demonstrated the lowest diagnostic stability of this affection, compared with the two other diseases. Total error rate was 41%. CONCLUSIONS: Brief psychotic disorder could constitute a distinct affection from schizophrenia and schizophreniform disorder, whereas schizophreniform disorder and schizophrenia could be the same affection; the first being an acute and "good functioning" form of the second. However, these viewpoints need to be confirmed by data on long-term course. The data of this study validate ultimately a binary model of the major nonaffective functional psychoses, like that of the tenth edition of the International classification of mental and behavioural disorders (ICD-10).

University Students' Perspective of Sexual Harassment: a Case Study of the University of Zambia

Objectives: To determine if sexual harassment was a problem at the University of Zambia (UNZA); to explore UNZA student's perception on the nature of sexual harassment; and determine student's knowledge and understanding about sexual harassment. Design: A cross-sectional study across UNZA. Main outcomes: Occurrence of sexual harassment at UNZA; knowledge; perception and understanding of sexual harassment. Measure: A self-administered questionnaire was developed for the purpose of the study and piloted. The questionnaire included items on perceptions and understanding of sexual harassment; the nature of the environment at UNZA; frequency of the occurrence of sexual harassment; direct experiences and observations of sexual harassment; and formal and informal reporting of sexual harassment. Results: This study found that sexual harassment was a problem at the University of Zambia (UNZA) and female students were more likely to be affected. There was no gender difference on the knowledge about sexual harassment (p=0.27) but there was a significant gender difference in the perception of sexual harassment occurring at UNZA (?2 = 86.51; df= 1; p0.001); there were significantly more female students who perceived a lot of sexual harassment to be occurring at UNZA. More female students also perceived that students were likely to harass other students (p0.01) and students were likely to harass lecturers (p0.001). Conclusion: The problem of sexual harassment at UNZA should not be underestimated; among our recommendation is to formulate a policy on sexual harassment at UNZA

Une batterie de tests pour l'evaluation neuropsychologique des psychoses fonctionnelles non affectives chez le congolais

Contexte. Il n'existe pas, à ce jour, un modèle de batterie de tests destiné à l'exploration des troubles neuropsychologiques (cognitifs) des psychoses fonctionnelles non affectives en Afrique ; il n'y a que des batteries neuropsychologiques pour les schizophrènes occidentaux Objectif. L'objectif de cette étude est de déterminer, au sein d'une batterie neuropsychologique pour schizophrènes occidentaux, les tests recommandables à l'étude des troubles cognitifs des psychoses fonctionnelles non affectives dans le contexte culturel congolais. Sujets et méthodes. Les performances cogrutrves de 188 patients congolais présentant les psychoses fonctionnelles non affectives des types schizophrénie, trouble schizophréniforme et trouble psychotique bref, recrutés au centre de santé mentale 'TELEMA' et au Centre Neuro-Psychopathologique (CNPP) de l'Université de Kinshasa ont été comparées à celles de 152 sujets congolais de contrôle. L'analyse des variances 'one way' (ANOVA) et l'analyse des covariances (ANCOVA) ont été appliquées Résultats. Tous les tests utilisés et 90% des variables neuropsychologiques étudiées ont pu faire ressortir l'infériorité cognitive des patients. En plus, ces derniers ont affiché un déficit cognitif diffus, à l'image de celui des schizophrènes. Conclusions. Les différents tests neuropsycho-logiques utilisés sont suffisamment sensibles aux psychoses fonctionnelles non affectives chez les congolais ; ils sont recommandables dans l'exploration neuropsychologique desdites psychoses au sein du contexte culturel congolais. La question de la parenté neuropsychologique des psychoses abordées requiert une étude approfondie

The effect of routine hospital care on the health of hypothermic newborn infants in Zambia.

A prospective cohort study was carried out at the University Teaching Hospital, Lusaka, Zambia, to investigate the prevalence of neonatal hypothermia, type of infant care and incidence of mortality. Two-hundred-and-sixty-one infants, aged 0-7 days, admitted to the pediatric unit during the 'warm' season were recruited to the study. Forty-four per cent of the infants were hypothermic (< 36 degrees C) on admission, and admission hypothermia correlated to admission weight and home delivery in the youngest age group (0-24 hours). Exclusively breastfed infants (age group 1-7 days) were less likely to be hypothermic at admission. 'Hypothermia' was not recorded as an admission diagnosis and no special attention was given to those infants in terms of clinical management. Mean time to reach a body temperature above 35.9 degrees C did not differ between infants kept in a cot and in an incubator. Total numbers of death was 82 (31 per cent) and the mortality was higher in infants who were hypothermic at admission compared to those who were not. This study demonstrates that a change of existing care routines is needed.

The home-based health passport: a tool for primary health care.

PIP: In Zambia, home-based patient records were introduced on a pilot basis in Sesheke district in 1991. First, health workers attended a one-day training session on how to use and maintain the home-based health passports. The passports were available on a fee basis. The sale of health passports created a revolving fund to address health-related stationery (e.g., referral slips) shortages. (These health passports contain curative and preventive records. Health passports for under-five children have a growth chart on its cover while those for older children and adults do not. Health workers enter the immunization status of women and children in the passport.) Four and 16 months after the passports were introduced, household and health facility surveys were conducted to determine the views of patients and health workers about the passports. By four months, 68% of the respondents purchased a passport. This had increased to 91% by 16 months. The average number of passports per household rose from 3.4 to 5.8 between the two surveys. By 16 months, only 16 people (9%) did not have a passport. The price prevented two people (1%) from buying the passport. No one had lost a passport. 16% at four months and 14% at 16 months kept their records at the hospital, largely because they did not want their passport to be damaged (e.g., rain damage). A plastic cover would protect the passport against damage. Confidentiality was not a problem for patients, but health workers were concerned about it. Many respondents (36% at 4 months and 30% at 16 months) considered the passport to be expensive. Between the two surveys, knowledge on the purpose of the growth chart on the children's health passport increased from 38% to 48% (p 0.05). This evaluation was so positive that health passports have been introduced in all districts in Western Province.^ieng

Antibiotic resistance of Escherichia coli and Salmonella from apparently healthy slaughtered cattle and pigs, and diseased animals in Zambia.

Escherichia (E.) coli and Salmonella (S.) choleraesuis (subsp. choleraesuis and subsp. salamae) from apparently healthy slaughtered cattle and pigs in 1989 in Zambia, were examined for antibiotic resistance and the presence of conjugative R plasmid. Salmonella strains from diseased animals (cattle, chickens, leopards, lions and warthogs) were similarly tested. The majority of the cattle had been nomadically kept in so-called "traditional farms" while all the pigs were from commercial farms. More pigs (39%; 41/105) harboured drug-resistant E. coli than cattle (6.7%; 7/105). Moreover, the number of drug-resistant E. coli was higher among strains from pigs (31.2%; 49/157) than cattle (4.2%; 7/167). For both cattle and pigs, drug resistance was more frequently observed against tetracycline, streptomycin, sulfadimethoxine and ampicillin than other antibiotics and the single resistance pattern occurred most frequency, especially among pig E. coli strains. Drug-resistant Salmonella was recorded in 3.6% (1/28) of strains from slaughtered cattle and 31.3% (10/32) of those from diseased animals. Drug-resistant E. coli from pigs and cattle carried R plasmid at high frequency.

Antimicrobial effects of a new carboxyquinolone drug, Q-35, on five serogroups of Leptospira interrogans.

New carboxyquinolone drugs, including the recently developed Q-35, were evaluated for their in vitro potency against five serogroups of Leptospira interrogans. Q-35, ofloxacin, ciprofloxacin, and tosufloxacin showed MICs (0.05 to 0.20 microgram/ml) comparable to those of tetracycline. However, MBCs of these drugs varied between 10- and 100-fold above the MIC for most strains tested. Q-35 was shown to be active against L. interrogans in vitro as judged by the MICs obtained.

Interet de la mesure de la pression arterielle ambulatoire chez l'enfant suspect d'hypertension arterielle en milieu tropical

La prise en charge d'un enfant suspect d'hypertension arterielle reste difficile dans les centres hospitaliers ou la mesure de la pression arterielle n'est pas systematique a la consultation. Hormis le fait que la pression arterielle compte parmi les signes vitaux a prelever obligatoirement aupres de chaque patient; les auteurs insistent sur le grand interet de cette mesure pour le suivi a cours et long terme d'une hypertension chez l'enfant et l'adolescent

Clinical presentation of HIV/AIDS in the high risk neonate in Zambia.

A prospective case series study was conducted Jan 1991-Oct 1991 on 108 neonates admitted to NICU, Lusaka. 90 patients satisfied inclusion criteria, 45 cases and 45 controls. Symptomatic seropositive babies born to seropositive mothers presented with failure to thrive, fever, persistent or recurrent thrush, severe Sepsis and large liver. Tendency to prematurity among cases was high. Diarrhoea, Sepsis and Haemolytic Anaemia appear to be terminal signs. Neonates suffer the most aggressive form of HIV/AIDS, with symptomatic cases dying 3-4/52 of onset of symptoms. Over one quarter of the mothers were symptomatic. Congenital malformations and Lymphadenopathy were not significantly associated. Microcephaly occurred in association with failure to thrive and was not an isolated finding.

Case report: cholera in a preterm neonate.

Falling standards of sanitation resulted in the first outbreak of cholera in Lusaka, Zambia, during the rainy season, February 1990. A total of 2166 cases were handled with 128 (5.9%) deaths. One hundred and eight (108) children, including one preterm neonate, were admitted to the University Teaching Hospital. The neonate went to the Neonatal Intensive Care Unit.

Hysterical manifestations in Africa and Europe. A comparative study.

A group of 30 black African patients and a group of 30 occidental patients, all presenting a hysterical structure, were compared with regard to clinical manifestations, provoking psychosocial stressors and histrionic personality traits. Cultural characteristics in several areas are discussed as possible explanations of the differences found.

[Hysterical manifestations in Black Africa. Pilot study conducted at the Neuro-Psycho-Pathology Center, Kinshasa]. / Les manifestations hystériques en Afrique Noire. Une étude-pilote menée au CNPP Kinshasa.

In a retrospective study on twenty Zairese patients, presenting a hysterical personality structure, the different forms of decompensation have been described and classified according to the DSM III criteria. Even taking into account the inconstancy of hysterical manifestations and the use of criteria not adapted to the local context, some of the described syndromes seem rather atypical. Such findings should stimulate the African psychiatry to develop its own nosographical criteria.