[Tick bite fever in West Africa: difficulties in diagnosis of an emerging disease]. / La fièvre récurrente à tique d'Afrique de l'Ouest: difficultés diagnostiques d'une maladie émergente.

West African tick bite fever is a prevalent emerging zoonosis from the coast of Senegal to Chad. It is characterized by recurrent fever in association with a deteriorating clinical state. It is now the second most common vector-borne disease in Senegal. The purpose of this report is to describe one case and to review the main clinical and epidemiological features of this disease.

[Imported malaria in Moselle: 75 cases in three years]. / Paludisme d'importation en Moselle: à propos de 75 cas en trois ans.

PURPOSE: Imported malaria frequency is increasing in France. Moselle, a north-east French county, with high concentration of servicemen going in endemic areas, follows the same trend. METHODS: Clinical, epidemiological aspects and treatment of all malaria attacks diagnosed over 3 years (from 1st january 1996 to 31st january 1999) were studied. Data pertaining to antimalaria prophylaxis and the reasons for prophylaxis failure were analyzed. RESULTS: Seventy-five patients developed a paroxysmal episode of malaria. No severe malaria and no death were noted. Ninety-six percent of the patients came from Africa (96%), 64% of them coming from western Africa (Ivory coast, Senegal, and Togo). Plasmodium falciparum was responsible for 90% of the cases. Giemsa staining, quantitative buffy coat diagnosis system and parasight rapid dipstick antigen capture assay help guide diagnosis. Halofantrine (64%) and quinine (28.6%) were used as curative treatment. Investigation about prophylactic means showed than 37.9% of interviewed patients did not comply with the preventive treatment. The primary prophylaxis (avoiding bites) was in existent or badly done. CONCLUSION: Although the best choice for chemoprophylaxis is still debated, travelers going to endemic areas should be aware of the risks for malaria and persuaded to take a preventive treatment, even though its efficacy may not be complete. They also should wear insecticide-treated clothes in order to decrease the number of potentially infective mosquito bites.

Morbidite et mortalite diarrheiques au Congo

Les auteurs rapportent une enquete par sondage de morbi-mortalite realisee au Congo du 20 juillet au 10 aout 1994 aupres des menages. L'objet de l'etude etait de determiner l'importance epidemiologique des maladies diarrheiques chez les enfants de moins de cinq ans. Il est apparu a la lumiere des resultats; qu'au Congo; chaque enfant presente en moyenne 2;6 plus ou moins 0;3 episodes diarrheiques par an. Le taux d'incidence de la diarrhee sur deux semaines etait de 131 plus ou moins 16;5 pour mille. La prevalence instantanee etait de 42;7 plus ou moins 2;1 pour mille. Le taux annuel global de mortalite representait 19;2 plus ou moins 5;1 pour mille; le taux specifique de mortalite etant de 4;8 plus moins 2;1 pour mille. Les deces associes a la diarrhee representaient un pour centage de 25 plus ou moins 9;1 pour cent. Par ailleurs; l'etude a releve que l'utilisation de la solution de rehydratation orale et de la therapie par rehydratation orale (TRO) demeure encore faible par rapport aux objectifs fixes par le programme national de lutte contre les maladies diarrheiques. Les auteurs recommandent de promouvoir l'allaitement maternel ainsi que l'utilisation de la TRO au niveau du systeme de sante; en particulier dans les hopitaux de reference et au niveau des menages en se basant sur l'information; l'education et la communication

[The role of environmental factors in the current recrudescence of human African trypanosomiasis]. / Rôle des facteurs environnmentaux dans la recrudescence actuelle de la trypanosomiase humaine africaine.

The authors highlight the major target for the prevention of human african trypanosomiasis (HAT) i.e. decrease of parasites reservoir. For this purpose, they state that it is necessary to detect HAT patients, to treat them, and to break down the contact between human and vectors. Then, they review the environmental factors that could be involved in the HAT outbreak. A political direction would strengthen the HAT prevention by the increase of resources attributable to the disease. But, choice of priorities is based on technical criteria which are not in favour of HAT. Many difficult situations, occurring at the borders of concerned states, are restricting factors for a global and co-ordinated prevention. Moreover, internal political disturbances and local conflicts lead to a mismanagement of health care departments. These conflicts lead also to a migratory flow of populations; thereafter, the individuals have no access to medical structure. Beside the economical and political factors, some others have a great importance: human behavior, estimation of risk by the authorities, psychological perception of the disease by the population. The part of these different factors must be perfectly identified to avoid any disturbance in the actions of HAT prevention. The least failure leads to a quick increase of parasites transmission, and the HAT control has to start all over again.

[The evaluation of sexual behavior and knowledge of AIDS in the schools of Burkina Faso. A Knowledge, Attitude, Belief and Practice (KABP) survey in Banfora among 474 adolescents of 14-to-25-years old]. / Evaluation du comportement sexuel et des connaissances sur le SIDA en milieu scolaire au Burkina Faso. Enquête connaissances, attitudes, croyances et pratiques (CACP) à Banfora sur 474 adolescents de 14 à 25 ans.

The results of a survey carried out in 1990 on the knowledge, attitudes, beliefs, and practice (KABP) concerning AIDS are presented and discussed. The population surveyed was a random sample of 474 secondary school students (SSS), aged 14-25, in Banfora (Burkina Faso). Among the SSS, a high level of general knowledge about AIDS as a sexually transmitted disease (92.2%) and about condoms (83.1%) is noted. More specific knowledges however, such as the notion of seropositivity, is less well understood (36.7%). Their sources of information are essentially the radio (57.8%) and newspapers (45.4%). The SSS are afraid of AIDS and report that they have changed their behaviour (71.7%). Sexual experiences at young age and risky sexual behaviour (no use of condoms) are however reported. The place of residence, religion, and job and income of their parents or other relatives they are living with, seem to have no effect on the age of the first sexual experience. At present, the SSS of Banfora are aware of the AIDS problem but have not changed their sexual behaviour accordingly, even if they report having done so. The SSS are a prime target population group for any AIDS prevention program.

Experience de recouvrement des couts medicamenteux au CHNSS; Burkina-Faso

En Afrique au Sud du Sahara; les services de sante souffrent d'une baisse constante des budgets alloues. Les ministres de la sante de la region africaine ont adopte en 1987; sous l'egide de l'OMS; une strategie de recouvrement des couts au niveau du district sanitaire; appelee initiative de Bamako. Le probleme du financement des prestations au niveau des hopitaux reste a resoudre. Une experience de recouvrement des couts medicamenteux est menee dans le service de pediatrie du Centre Hospitalier National Souro Sanou de Bobo-Dioulasso (Burkina-Faso) depuis novembre 1989; a partir d'un stock de medicaments fournis par l'UNICEF

[Campaign against human African trypanosomiasis in the focus of Douala (Republic of Cameroon). The value of Testryp CATT]. / Lutte contre la trypanosomiase humaine africaine dans le foyer de Douala (République du Cameroun). Intérêt du Testryp C.A.T.T.

The focus of African human trypanosomiasis at Douala was evaluated in 1973 for the last time. The authors report on the results of their prospective survey. The methodology was characterized by utilizing Testryp C.A.T.T. as immunological case finding field test. 11,614 people were surveyed and 5 positive CATT revealed. But such results have be weighted by the rate of people present (52.2%) and by the fact that the selected area was not fully covered. On the other side, the authors examine the operational feasibility of Testryp CATT as immunological case finding field test. Over almost 12,000 tests performed, the feasibility appears very good.

[Evaluation of morbidity, mortality and therapeutic procedures in diarrheal diseases of young children in Cameroon]. / Evaluation de la morbidité, de la mortalité et des conduites thérapeutiques relatives aux maladies diarrhéiques chez les jeunes enfants au Cameroun.

The authors report the results of 3 sample surveys carried out in Cameroon and designed to determine the diarrhoeal morbidity, mortality and treatment rates in children under five years of age living in urban and rural areas, under different types of climate.

[Evaluation of the clinical, parasitological and immunological indices of malaria in the Bonny's Bay area of Central Africa]. / Evaluation des indices cliniques, parasitologiques et immunologiques du paludisme dans la région de la Baie de Bonny en Afrique Centrale.

The authors report the results of 4 sample surveys carried out in Equatorial Guinea and Cameroon in the Bonny's Bay area, to evaluate the main malarial indexes. In rural and semi-rural areas one notice a high rate of fever attacks and splenomegaly. Parasitaemia is more important in rural areas than in urban areas and is decreasing where the therapeutic pressure is strong and long-lasting. Immunological indexes are high everywhere.

[Antibiotic resistance of strains of Vibrio cholerae eltor isolated in Douala (Cameroon)]. / Résistance aux antibiotiques des souches de Vibrio cholerae eltor isolées à Douala (Cameroun).

Endemic cholera has been prevalent in Douala since 1972, with sudden epidemic outbreaks occurring every two years during the dry season. The massive and systematic use of chemoprophylaxis since April, 1983 has led to the selection of strains of Vibrio cholerae eltor that are resistant to sulphamide and tetracycline. During the 1984-1985 epidemic, 89.3% of the isolated strains were resistant to sulphamides, 87.5% to a sulfamethoxazole-trimethoprim combination and to the 0/129 disk, 55.3% to tetracycline, 91.1% to chloramphenicol, 73.2% to streptomycin and 94.6% to ampicillin. The epidemic aspect of this multiple resistance to antibiotics raises the issue of the role of a group C incompatibility resistance plasmid. As regards prophylaxis, until hygiene conditions can be improved, which is the only way cholera can be eradicated from our region, vaccination with oral vaccines such as that of the Institut Pasteur seems to be the best way of preventing further epidemics.