Annales de la Societe belge de medecine tropicale最新文献

A questionnaire survey was conducted in the Dakar region (Senegal) between August and October 1992 to investigate diagnosis and treatment practices for uncomplicated malaria attacks in the health care facilities. The sample consisted of 208 prescribers in the operational sense i.e. 20% of the following professional categories: medical doctors, health care technicians, birth attendants, qualified nurses, and auxiliary nurses. A thick smear was mentioned as a diagnostic element by 23% of the practitioners; chloroquine remained the first choice drug for 80% of the personnel but 13% declared prescribing parenteral quinine for uncomplicated malaria in patients without vomiting; halofantrine and the association sulfadoxine-pyrimethamine-mefloquine are prescribed by respectively 7 and 1% of the personnel, also in the public sector; chloroquine is prescribed in an effective dose (25-40 mg/kg) by 74% of the personnel for adults and by 43% for children; quinine base in a dose below 25 mg/kg by 100% of personnel for adults and by 99% for children; nearly half of the prescribers do not take into account the children's weight; 13% of the practitioners prescribe useless expensive symptomatic treatments and 45 to 73% ignore the price of the common antimalarials, allowing for a 10% error; health care workers have a bad knowledge of the results of chemosensitivity surveys. The development of a national malaria control programme that emphasises permanent training of the health care workers and control of therapeutic information seems mandatory.

Cerebral malaria is one of the major and deadly complications of malaria. In Cameroon, recent reports indicate that severe cases of malaria are increasingly more prevalent, particularly in children. The present study aims at describing the clinical presentation and laboratory findings of cerebral malaria in children in Yaounde. All patients admitted in the paediatric ward of Yaounde Central Hospital with malaria, who presented neurological signs and were tested positive for Plasmodium in their peripheral blood were recruited into the study. 36 cases were enrolled in all, making up 2.7% of all admissions. The patients' median age was 4.5 years. 52.8% were on malaria prophylaxis. Convulsions and coma with preceding hyperthermia were present in more than 90% of the patients. Blood parasites level median was 1.3% on admission. One patient had hypoglycaemia on admission and two others had it later on after admission; 16.7% had neurological sequels at discharge and two children died (5.6%). Delay in diagnosis and initiation of treatment with quinine adversely affected the prognosis of cerebral malaria in the study group.

To try to find effects of malaria on clinical serum activity of certain enzymes, 3 groups of infants--malarial, asymptomatic carrier and normal controls--have been designed. Parasitologic data have been compared with serum concentration of lactate dehydrogenase (LDH), Hydroxybutyrate dehydrogenase (HBDH) alanine aminotransferase (ALT), gamma glutamyl transferase (GGT) and 5'nucleotidase (5'Nu). Results show that only LDH and HBDH are significantly increased. Respective coefficients of correlation r = 0.32 (p < 0.05) and r = 0.39 (p < 0.01) show that increasing in LDH and HBDH are linked to malarial parasite density. LDH and HBDH increasing might therefore constitute a marker of malaria.

An epidemic of dengue fever occurred in Grande Comore island from March to May 1993. Dengue 1 virus has been isolated. The epidemic did not affect the other islands of the archipelago. No compound clinical picture, in particular hemorrhagic, was reported. A random sampling survey conducted towards the end of April showed that 26% of the population aged 5 years old or more had IgM dengue antibodies. The epidemic concerned essentially individuals under 45 years of age. The number of inhabitants of Grande Comore affected by the outbreak can be estimated between 56,000 and 75,000. The results of the sero-epidemiological survey allowed to find the serological scar of two previous epidemics of dengue: the first one around 1948, which may correspond with dengue 1, the other one in 1984, probably with dengue 2.

A very reliable and productive technique for cloning of Plasmodium falciparum in vitro is proposed, as demonstrated by successive limiting dilution of suspensions of asexual erythrocytic forms of the NF 54 strain. The introduction and the study of reliable clones is of extreme importance for a better understanding of the behaviour of the parasite, also in field conditions. The method is rapid, simple and efficient. The growth of the clones was individually monitored and the culture conditions were constantly adjusted during their stay in recipients of increasing size. A yield of 18/96 (18.75%) of provisional clones was obtained, while the supercloning phase resulted in 16/80 (20%) positive cultures. The probability that the latter were derived from a single progenitor is very high (99%). It was shown that three randomly selected clones (A1A9, A1B11, and A1C10) have excellent growth characteristics before and after cryopreservation, and after a longer period of culture in standard conditions.

A novel method for the control of T.b. gambiense trypanosomiasis was evaluated in an endemic focus of Zaïre where a high incidence had persisted despite massive participation in active case-finding surveys based on lymph node puncture. All inhabitants of 3 villages were examined with a card agglutination serological test (CATT), and parasitological examinations were performed on those who were CATT+. Individuals in whom we detected trypanosomes were treated as usual. A lumbar puncture was carried out on CATT+/parasitology- subjects; those whose cerebrospinal fluid showed more than 3 white blood cell (WBC) per mm3 were treated with a full course of melarsoprol while those with a CSF WBC count between 1 and 3 per mm3 were given a single injection of diminazene (7 mg/kg). Three such surveys were performed, with a 6-month interval, during which 282 "serological suspects" received diminazene, 39 "clinical cases" were given melarsoprol and 82 "parasitological cases" were treated according to standard protocols. The annual incidence of trypanosomiasis decreased rapidly from 10.4-41.1/1.000 inhabitants (mean: 17.6/1.000) during the 10 years before the intervention to 1.1-2.6/1.000 (mean: 1.7/1.000) in the 3 years following the intervention. No major adverse effect was seen with diminazene. Among the 282 serological suspects, an elevated CSF WBC count was later documented in 12 individuals, who were all cured with melarsoprol. The incidence increased 5 years after the intervention (7.1/1.000 in 1992), which may have been avoided had we carried out similar interventions in adjacent foci.

In February 1993, four years after their introduction, an assessment was made of the use of clinical flow charts (algorithms) by 16 nurses in charge of primary medical health centers in Northern Cameroon (Diamare Division, Far North Province). A study of the knowledge, attitude and behaviour of the nurses shows the flow charts to be appreciated as a tool for diagnostic aid and for professional training. 11 nurses report an initial systematic use of the flow charts. This associates with the observation of good skills in using the charts, observed among 10 of the nurses, and also with treatment standardisation. Problems in reading the flow charts correctly hinder their systematic use in diagnostic decision making. A retrospective analysis of 800 treatment prescriptions noted in the consultation registers, shows an average rate of treatment standardisation of 75%, varying from 52 to 98% among the different health centers. Three quarters of non standardised treatment is ineffective or inefficient. Specific training is using the flow charts, given in the form of a 4 day seminar to 7 of the nurses concerned, showed no better results, after 4 years, than those obtained during a practical training session of a global nature, taking place in a functional health centre. Basic professional training, as well as previous professional experience influences the performances of the nurses. This study confirms the need to introduce rationalisation in the prescription of treatment, and shows the importance of verifying practical user skills at the end of specific training sessions. It would be advisable to include the principles of clinical algorithms in the teaching programs of medical schools.