Medecine tropicale : revue du Corps de sante colonial最新文献

Control of human rabies in developing countries depends on prevention in dogs. The purpose of this study was to evaluate the cost-saving potential for the public health sector of intervention to control rabies in animal-host reservoirs. An existing deterministic model was adapted to allow study of dog-to-human rabies transmission. Model parameters were fitted to data from routine weekly reports on the number of rabid dogs and human rabies exposures in N'Djamena, Chad. At the onset of study, the estimated effective reproductive ratio (Re) was 1.01 indicating stable low-level endemic rabies transmission. Simulations were performed to determine what effects mass vaccination and culling of dogs would have on the incidence of human rabies. Findings showed that a mass campaign allowing single parenteral vaccination of at least 70% of the canine population would be sufficient to interrupt transmission of rabies to humans for at least 6 years. The cost-effectiveness of mass dog vaccination was compared to that of "postexposure prophylaxis" (PEP) which would not reduce future human exposure. Results showed that a sustained 5-year PEP program together with a dog-vaccination campaign would be as cost-effective as PEP alone. Beyond a time-frame of 7 years, combining parenteral dog vaccination campaigns with human PEP appeared to be more cost-effective than human PEP alone.

Objective: To evaluate the knowledge, attitudes and practices of health care providers (HCP) in Togo regarding prevention of mother-to-child transmission of HIV (PMTCT).

Method: A cross-sectional study was conducted in 22 antenatal clinics with PMTCT programs from January 18 to February 6, 2010. Clinic selection was based on attendance and local factors. Data were collected through interviews conducted by 23 trained investigators.

Results: A total of 97 HCP were interviewed at the 27 selected clinics. Most, i.e., 76%, had received PMTCT training. In terms of knowledge, interview data revealed the following strengths: 83% of HCP identified transmission from mother to child as the main route of HIV transmission in children < 15 years; 87% asserted that HIV-infected pregnant women do not always transmit HIV to their children; 77% knew that the ELISA test was performed after 18 months: and 96% had a clear notion about feeding infants born to HIV-infected mothers. Knowledge assessment revealed the following weaknesses: 30% of HCP had never heard of polymerase chain reaction; 27% said that confidentiality about HIV status was not always necessary; and 22% were unaware that decontamination of equipment using a chlorine solution kills HIV. In addition, interview data revealed the following positive attitudes and practices: 83% of HCP were willing to continue working in a center with a PMTCT program and 87% referred women pregnant for the HIV serology. On the negative side, however, only 27% of HCP summonsed husbands whose wives tested positive for HIV.

Conclusion: This investigation shows that the knowledge, attitudes and practices of HCP in Togo regarding PMTCT is fairly good. However, it also revealed several weaknesses that should be addressed by further training.

The purpose of this report is to describe the first Cameroonian case of disseminated histoplasmosis due to Histoplasma capsulatum capsulatum in association with HIV infection. The patient was a 34-year-old HIV1 infected woman. Diagnosis of histoplamosis was made in post-mortem. The similarity of the clinical symptoms with disseminated tuberculosis makes diagnosis of mycosis difficult. Active and effective care of histoplasmosis is urgently necessary for the HIV infected persons.

After becoming a military doctor at the behest of his father, Ronald Ross was destined to make a discovery of paramout importance, i.e., malaria transmission through mosquito bites. This landmark discovery that was the fruit of a combination of curiosity, tenacity and luck, earned him the Nobel Prize in Medicine.

The purpose of this report is to describe an autochtonous case of visceral leishmaniasis with cachexia, fever, splenomegaly, ascitis and severe anemia observed in an eight-year-old boy from a region in eastern Cameroon outside the traditional disease foci. Diagnosis was confirmed based on demonstration of Leishmania amastigotes on bone marrow smear. The patient was treated with meglumine antimoniate but died on the 6th day of treatment.

The objectives of this descriptive prospective study were to determine the frequency of intrapartum obstetrical transfers, assess the sociodemographic profile of parturients requiring transfer, describe transfer modalities, and assess maternal and newborn outcomes. Study included all patients requiring intrepartum obstetrical transfer to the Ignace Deen University Hospital Gynecology Obstetrics Clinic in Conakry, Guinea from August 1st, 2009 to July 31st, 2010. Out of 3122 deliveries during the study period, intrapartum transfer was required in 220 cases, i.e. 7.05%. Mean patient age was 23.2 years (range, 14 to 44). The risk for intrapartum transfer was higher among multiparous or nulliparous women (incidence, 8.79%) and adolescents (incidence, 10%). Patients requiring transfer were mainly housewives (60%) and uneducated women (57.27%). Most had had an insufficient number (<4) of antenatal examinations (76.36%) and had been examined at peripheral maternity units (62.73%). In 175 cases (79.54%), patients were transferred by taxi. In 191 patients, treatment required surgery including 130 caesarian sections. There were 12 maternal deaths (5.45%) and 45 neonatal deaths out of 242 newborns including 22 twin deliveries (18.59%). Further work is necessary to improve referral and transfer at all levels of the health pyramid.

The purpose of this report is to describle the first documented case of pneumocystosis in Gabon. Diagnosis was confirmed based on microbiological methods in a 59-year-old immunodepressed HIV-positive man. Diagnosis was further documented by observation of Pneumocystis jiroveci cysts in the broncho-alveolar lavage (BAL) after Gomori-Grocott color reaction. The patient responded well to treatment with Cotrimoxazole, corticoids and oxygen.

Malnutrition and undernourishment are widespread in the Sahelian region of Africa. The purpose of this study was to assess nutritional status and associated risk factors among nomadic and sedentary rural women on the southeast bank of Lake Chad. It was a repeated cross-sectional study based on semi-structured interviews and anthropometric measurements. A total of 734 women including 398 nomads and 336 sedentaries were randomly selected. Only non-pregnant women were included for calculation of the body mass index. Results showed a higher prevalence of malnutrition among nomadic women than sedentary women during the dry season: 48% (95% CI: 42-53) versus 16.2% (95% CI: 12-20). Obesity was observed in 4% (95% CI: 2.4-7) of sedentary women versus 0% of nomadic women. These rates were similar during the wet season. Malnutrition rates differed significantly (p<0.01) between the two groups within each season but not between seasons within each group. The average household dietary diversity score (HDDS) determined on a scale of 12 was low in both nomadic and sedentary women: 4.5 (95% CI: 4.4-4.6) and 5.1 (95% CI: 5.0-5.3) respectively. Malnutrition was significantly correlated with HDDS, number of children and ethnic group.

Objective: The purpose of this study was to determine the epidemiological profile of colorectal cancer in Gabon and to describe its clinical and laboratory features.

Material and methods: This retrospective monocentric descriptive study was based on all cases of colorectal cancers managed at the Libreville Hospital Center during the 10-year period from September 1996 to September 2006. Study endpoints included epidemiological characteristics, anatomoclinical forms and diagnostic methods.

Results: A total of 51 cases were included. Mean patient age at time of diagnosis was 48 years. The sex ratio was 1.3 with a female predominance. Mean duration of symptoms ranged from 6 months to 1 year. Abdominal pain and digestive disturbances were the most common manifestations. Lower digestive-tract endoscopy was performed in 49 patients. The tumor was located at rectosigmoid junction in 80% of cases. Lieberkühnian adenocarcinoma accounted for 98% of cases.

Conclusion: Initially described in industrialized countries, colorectal cancer is now being reported in developing regions, even though data from the literature and Gabonese cancers register (1984-93) indicate otherwise. It often involves young adults. The rectum was the most frequent site in this study. Delayed diagnosis is the main reason for poor prognosis. Education to improve awareness of early clinical signs as well improvement of diagnostic facilities should allow early detection and better prognosis of colorectal cancer in Africa.

Although salmonellosis is a common endemo-epidemic disease in Benin, there is a paucity of data about it. The purpose of this cross-sectional study was to determine the incidence of major salmonellosis requiring hospitalizaton and to describe its epidemiological, clinical, and serologic features as well as treatment and outcome. Consecutive cases observed at the Medical Department of Parakou University Hospital in Benin between January 1, 2005 and December 31 2007 were included. Salmonellosis was defined on the basis of clinical and serological criteria. Among the 2,520 patients hospitalized during the study period, salmonellosis was diagnosed in 135 (5.4% [95% CI 4.5%-6.3%]). Highest incidences were observed in January, July, October and November. The main symptoms were headache, fever, fatigue and abdominal pain. The Salmonella typhi serotype was identified in 94.8% of patients. Two patients presented co-infection, i.e., Salmonella typhi with paratyphi A in one case and Salmonella typhi with paratyphi B in the other. Fluoroquinolones were used for treatment in 79.3% of patients. Outcome was favorable in 62.2%. The main complications were,typhoid digestive perforation in 11.1%, and gastrointestinal bleeding in 8.1%. The mortality rate was 4.4% (n=6). These data are consistent with previous reports in the literature and confirm the frequency and severity of salmonellosis in Benin.