Prevalence and perception of schistosomiasis in a periurban school of Bamako in Mali

The prevalence of urinary and intestinal schistosomiasis, the knowledge, attitude and practice (KAP) regarding the disease among both the children and their parents were investigated in Djikoroni para, a Suburban area of Bamako. The prevalence of Schistosoma haematobium and S. mansoni were respectively 69.8% and 8.7%. Compared with the girls, the boys were significantly more infected by S. haematobium (p = 5.10(-3)), but no difference between the sexes was observed for S. mansoni (p = 0.36). Interviews indicated that 88% of children and 91% of adults considered micro-haematuria as a pathology, but did not know anything about intestinal schistosomiasis. The low sensitivity of micro-haematuria (56.8%) and of the criterion "abdominal pains" (66.7%) indicated that they couldn't be relevant diagnosis signs. The symptoms and mode of transmission were generally well understood for S. haematobium but not for S. mansoni. The later parasite, its intermediate host and their interactions were unknown. The main man water contacts are bathing and playing in the Woyowayanko and in the Niger river. Inadequate perception of schistosomiasis contributes to maintain schistosomiasis at a high level of prevalence in Djikoroni.     

Epidemiological aspects of human and animal rabies in the urban area of Bamako, Mali

The district of Bamako is the political and economical capital city of Mali with 1,800,000 inhabitants. The goal of the present retrospective study was to determine the frequency of animal bites, human and animal rabies on the one hand and to determine the frequency and the nature of mad animals on the other hand from January 2000 to December 2003 (4 years). To achieve this goal, we have analysed registers and documents related to rabies in the department of prevention and fight against diseases, the central veterinary laboratory, and also at the lazaret clinic involved in caring for human rabies cases. Human rabies diagnosis has been brought up based upon the following clinical arguments: agitation and lethal hydrophobia within few days following bites by known or unknown animal. Agitation and aggressiveness followed by the animals' death within an observation period of 15 days maximum, allowed to evoke the diagnosis in animals. In Bamako an average of 1470 persons have been bitten each year. In 97.1% of the cases, the mad animal was a dog; cats (1.6%), donkeys, horses, cattle and rats (1.4%) have also been identified on a total of 5870 cases of notified human bites by animals; 10 cases of notified human rabies have been recorded. The dog has been incriminated in 6 cases of human rabies out of 10, in the 4 other cases, it has not been possible to identify the mad animal. Among the 3924 mad animals in observation at the veterinary clinic, 187 have been clinically mad that is 4.8%. The rabies virus has also been researched by direct immunofluorescence in 121 specimens of dead mad animals brain. This research has been positive in 119 cases among which 116 dogs, 2 sheep and 1 cow. Anyway the vaccinal status of people bitten by mad animals has not been clearly established. According to these results, we recommend the implementation of a national specific program to eradicate rabies in Bamako.     

Evaluation of an immunofluorescent-antibody test using monoclonal antibodies directed against Enterocytozoon bieneusi and Encephalitozoon intestinalis for diagnosis of intestinal microsporidiosis in Bamako (Mali)

A 2-month study was carried out in Mali to evaluate an immunofluorescent-antibody test (IFAT) using monoclonal probes specific for Enterocytozoon bieneusi or Encephalitozoon intestinalis. Sixty-one human immunodeficiency virus (HIV)-seropositive adult patients and 71 immunocompetent children were enrolled. Microsporidia were detected in stools from 8 of 61 patients (13.1%) seropositive for HIV. A single species, E. bieneusi, was identified. All the children were negative for microsporidia. The sensitivity and specificity of IFAT were 100% compared with those of PCR, which was used as the "gold standard." Moreover, species identification by IFAT was more rapid and less expensive than that by PCR. These results show the suitability of IFAT for detection of microsporidia in developing countries.     

Prevalence of serologic markers of the hepatitis B virus in pregnant women of Bamako, Mali

A prospective study of the serological markers of hepatitis B virus (HBV) including hepatitis B virus surface antigen (HBsAg) and hepatitis B surface antibody (anti HBs) was conducted over 5 years in Bamako. The aims of this study were to assess the prevalence of HBsAg in pregnant women and to determine the risk of HBV infection for this population. The study involved 829 pregnant women for whom blood samples were collected after the first quarter of pregnancy. HBsAg and anti HBs were detected in all cases by radioimmunoassay. The prevalence of HBsAg and anti HBs in pregnant women was respectively 15.5% and 16.9%. This prevalence of HBsAg, higher than in the general population, points to the fact that pregnant women are a high risk group for hepatitis B infection. In addition, scarification and tattooing practices increase significantly the risk of infection by hepatitis B virus (OR = 2.03; 1.07 < OR < 3.82; chi 2 = 5.62; p: 1%). Thus, we can presumably conclude that infants and new borns in such conditions are largely exposed to hepatitis B virus infection, even though hepatitis B core antibody and hepatitis B e antigen were not investigated for technical reasons. In conclusion, the authors believe that infants and new borns must be systematically immunised against hepatitis B virus infection in Bamako.     

When health makes the headlines. Press, elite complicities and health globalisation in Bamako, Mali

To overcome the socio-medical failures observed in Africa's health services, researchers and practitioners of public health often mention the necessity to resort to counter-powers. But, what are precisely these counter-powers? To analyse the problem, we describe the treatment of health issues in the Bamako press during one year. The analysis of various processes (external references, lack of training, insufficient deontological standards, "elite" complicity among journalists and health directors) allows us to underline the complexity of the links between the press and health. The economic flows related to the economy of development "projects" in particular with AIDS, encourage the journalists to see themselves as "educationalists" of populations rather than spokesmen for their claims or difficulties. Two consequences follow. First of all the press counter-power has to be developed in the case one wishes to see it as the expression of "the voice of the voiceless" and a good help to make an "informal" evaluation of the quality of health cares by users. But, more generally within this context of globalisation of health, instead of encouraging the expression of a "popular" criticism, newspapers work out a system of mutual legitimacies and social connivances among local "elites". Far from contributing to the improvement of the health system by looking actively into the problem leading to a modernity under control, health journalism disconnects the discourse from its referent and contributes to discredit "political" language. This journalistic construction of the insignificance is one of the principal political effects of this medical journalism instrumentalized by institutions of development.     

Report on intestinal parasitosis in adults in an urban population of the Central African Republic

The authors point out the frequency of intestinal parasitism in Bangui, biggest town and capital of the CAR. Out of 3,352 samples, 1,570 were found positive. The main parasites found were: Ankylostoma duodenale, 26,7%; Schistosoma mansoni, 20,8%; Entamoeba histolytica, 18,2%. The authors underline the polyparasitism. They also emphazide the differences with another study carried out in Algiers and surrounding areas.     

Malaria and anemia of pregnancy in an African savanna zone. Epidemiological, hematological, biological and immunological study of 2 villages of the Bamako region, Republic of Mali

An haematological, biological, parasitological and immunological study about anaemia of pregnancy was carried out in two rural village of Mali Republic, where P. flaciparum malaria is hyper-endemic. The 25 pregnant women found in the villages were compared with 23 controls. One could observe that anaemia more often normochromic and regenerative usually appears during the second trimestre of pregnancy. Only a few cases with haemaglobin levels below 8 g. % are hypochromic. Serum transferrin levels were slightly higher among pregnant. None among 31 bone marrows examined showed megaloblastic changes. Haptoglobin levels below 10 mg. % were observed in 3/4 of the pregnant women versus 1/4 in controls. Like some others, this study confirms the primary responsability of malaria haemolysis in the aetiology of anaemia of pregnancy and the interest of systematic chemoprophylaxis, at least from the third month of pregnancy. Vitamin and iron therapy is to consider therafter in hyper-endemic areas of P. falciparum malaria when nutritional problems are not predominant.     

The prevalence and diagnosis of headache in an urban practice

During a six-month study, one person in every 24 of the practice population consulted us about headache. There were more than twice as many females as males, and the largest group of females was in the 20 to 40 year age group.

The majority of patients were managed entirely in the practice; only 10·4 per cent were investigated and four per cent were referred to hospital. The commonest cause was tension. Two patients had headaches due to serious pathology and one of these died.

     

Neuromeningeal cryptococcosis in non-HIV patients to CHU ward of Point G in Bamako (Mali): 3 case report

We report 3 clinical observations of neuromeningeal cryptococcosis which occurred without any immunodepression related to HIV infection. Our patients were male. They did not present any particular medical history indicating a diagnosis of cryptococcosis. Nevertheless we found a professional exposure to the risk of inhalation of C. neoformans capsules. The diagnosis was based on presence of encapsulated yeast of Cryptococcus in the direct exam by China ink and culture on Sabouraud medium. CD4 lymphocytic count was done in two patients (case 1:899 cells/mm3; case 2:347 cells/mm3). Idiopathic lymphocytopenia was noted in one case. Co-morbidity of 5. pneumoniae meningitis was reported in one patient (case 3). Treatment was based on injectable amphotericin B in monotherapy (case 1), followed by perfusion of fluconazole cure (case 2). Case 3 was treated by perfusion of amphotericin B associated with ceftriaxone (case 2). No secondary prophylactic treatment was administered. Evolution was favorable after follow-up of 5 years (case 1) and of 4 years (case 2). The third patient died during hospitalization.     

Gastrointestinal helminthiasis: prevalence and associated determinants in domestic ruminants of district Toba Tek Singh, Punjab, Pakistan

The objective of the present study was to determine the prevalence and associated determinants (e.g., sex, age, on-farm management and husbandry) of gastrointestinal (GI) helminths in the domestic animals of district Toba Tek Singh, Punjab, Pakistan. For this purpose, 1,140 cattle, 1,140 buffaloes, 660 goats, 840 sheep, and 156 camels were randomly selected and their fecal samples were screened every other week for a year using a modified floatation technique. The samples positive for strongyle-type eggs had the parasite species identified using coproculture. It was found that the prevalence of GI helminths was significantly higher (P < 0.05) in sheep (44.17%; 371/840) than in other livestock. Sheep were followed in order by goats (40.15%; 265/660), buffaloes (39.82%; 454/1,140), and cattle (33.68%; 384/1,140). The important helminth species identified were Fasciola (F.) gigantica, Fasciola hepatica, Haemonchus contortus, Toxocara vitulorum, Trichostrongylus spp., Oesophagostomum spp., Ostertagia spp., Cooperia spp., Strongyloides spp., Moniezia spp., and Trichuris spp. The prevalence of GI helminths except F. hepatica and F. gigantica was significantly higher in grazing animals, females (P < 0.05) and young (P < 0.05) of all the host species when compared with stall-fed animals, males and adults, respectively. Using ponds and rivers/canals as drinking water were found to have significant influence (P < 0.05) on the prevalence of GI helminths. The results provide a baseline data for planning future research and control strategies against GI helminthes.     

Prevalence of hypo- and hypermagnesemia in an Iranian urban population

Background: Magnesium (Mg) plays an important role in metabolic processes and its deficiency or excess could adversely affect metabolism. Although magnesium deficiency and excess is associated with a variety of medical conditions, the prevalence of hypo- and hypermagnesemia have not been reported in an Iranian urban population.

Subjects and methods: This cross-sectional study was performed on 1558 subjects (754 males and 804 females), randomly selected from among participants of the Tehran Lipid and Glucose Study (TLGS). Serum Mg level was measured by flame atomic absorption spectrophotometry. Hypo- and hypermagnesemia were defined by serum Mg < 0.75 mmol/L and Mg>1.04 mmol/L, respectively, and sub-optimal serum Mg concentrations were defined by serum Mg < 0.8 mmol/L.

Results: The prevalence of hypomagnesemia was 4.6% in the total population, being more prevalent in females (6.0%) compared to males (3.2%) (p < 0.05). The overall prevalence of hypermagnesemia was 3.0% and it was more prevalent in males (3.2%) than females (2.7%) (p < 0.05). Sub-optimal Mg levels were found in 14.6% of the total population.

Conclusions: The data show a relatively high prevalence of abnormal levels of serum Mg, among a general population; levels which may contribute to the pathophysiology of several diseases.     

Frequency and characteristics of ocular trauma in an urban population

All patients presenting with ocular trauma to the emergency room of a large inner-city hospital during a 2-month period were prospectively examined and interviewed. Of 3,627 trauma visits, ocular trauma accounted for 126 (3%). There were 514 trauma admissions; 26 (5%) of these were for ocular trauma. Bilateral injuries were encountered in 35 (27.6%) of the 126 patients. Patients in early adulthood (18 to 30 years) sustained the most eye injuries (36.9%) whereas elderly people had the fewest (1.6%). Males sustained ocular injuries more frequently than females (3.5:1) and blacks more frequently than Hispanics (2.4:1). Assault was predominantly the most common circumstance of injury (51.2%). Alcohol or drug use (26.7%) and belonging to a gang (6.2%) were other factors found to be uniquely related to ocular injury in this particular socioeconomic environment.     

The prevalence of bacterial intestinal pathogens in a healthy rural population in southern India

In a one-year prospective survey bacterial intestinal pathogens unassociated with diarrhoeal episodes were isolated from 20.5% of stool samples from 48.5% of a stratified random sample of the population of a village in southern India. Campylobacter jejuni was the pathogen most frequently isolated, followed by enteropathogenic serotypes of Escherichia coli. The incidence of diarrhoea in the study population was lower than the frequency of isolation of bacterial intestinal pathogens. It is necessary to understand the prevalence of intestinal pathogens in this ecosystem to know the dynamics of intestinal infection and the pathogenesis of diarrhoea.     

Helicobacter pylori infection in an urban African population

We have studied 221 adults drawn from an impoverished urban population with high human immunodeficiency virus (HIV) seroprevalence (35%) to determine the prevalence of gastroduodenal pathology and its relationship to serological markers of Helicobacter pylori virulence proteins and other potential environmental and immunological determinants of disease including HIV infection. Eighty-one percent were H. pylori seropositive, and 35% were HIV seropositive. Urban upbringing and low CD4 count were associated with a reduced likelihood of H. pylori seropositivity, as was current Ascaris infection, in keeping with recent evidence from an animal model. One hundred ninety-one adults underwent gastroduodenoscopy, and 14 had gastroduodenal pathology. Mucosal lesions were a major cause of abdominal pain in this population. While the majority of patients with gastroduodenal pathology (12 of 14) were seropositive for H. pylori, none were seropositive for HIV. Smoking was associated with increased risk of macroscopic pathology, and a history of Mycobacterium bovis BCG immunization was associated with reduced risk. Antibodies to H. pylori lipopolysaccharide were associated with pathology. HIV infection was associated with protection against mucosal lesions, suggesting that fully functional CD4 lymphocytes may be required for the genesis of gastroduodenal pathology.