Increased risk of high-grade cervical squamous intraepithelial lesions and invasive cervical cancer among African women with human immunodeficiency virus type 1 and 2 infections

To assess the risk of prevalent high-grade cervical squamous intraepithelial lesions (HSILs) or invasive cervical cancer (ICC) associated with human immunodeficiency virus (HIV) type 1, HIV-2, and human papillomavirus (HPV) infections, HIV load, and CD4 cell count, we studied 4119 women attending an outpatient clinic in Senegal. HIV infection was associated with increased rates of cervical infection with high-risk HPVs. Among women infected with high-risk HPVs, those with HIV-1 (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.0-4.8), HIV-2 (OR, 6.0; 95% CI, 2.1-17.1), or dual HIV infection (OR, 8.0; 95% CI, 2.0-31.5) were more likely to have HSILs or ICC diagnosed than were HIV-negative women; this association was not observed among women not infected with high-risk HPVs. Among women with HIV, higher HIV plasma RNA loads and lower CD4 cell counts were associated with high-risk HPV infection and degree of cervical abnormality. Furthermore, HIV-2-positive women were more likely to have HSILs (OR, 3.3; 95% CI, 0.9-12.4) or ICC (OR, 7.9; 95% CI, 1.1-57) than were HIV-1-positive women.     

Risk factors for maternal mortality: results of a case-control study conducted in Conakry (Guinea).

OBJECTIVE: To assess the risk factors of maternal mortality in an urban area of West Africa (Conakry, capital of Guinea). METHOD: A case-control study where 102 maternal deaths were compared with 338 control women who had given birth and survived, during 1 year (from July 1, 1989 to June 30, 1990). RESULT: Of all the socio-demographic variables studied, only a low family income (R = 2.6; 1.1-6.5) was found to be a risk factor for maternal death In the obstetrical part of the survey, neither parity nor the number or location of pre-natal consultations constituted risk factors. However, the presence during pregnancy or delivery of signs of infection (R = 3.7; 1.4-9.8), anemia (R = 2.1; 1.1-4.1), hypertension (R = 19.8; 5.8-67.8) and dystocia (R = 9.0; 3.7-21.5) were found to be the main predictive risk factors of maternal death. The maternal mortality risk was multiplied by 12 if the women had had a cesarean section, and by 4 in the case of complications in the post-partum period. CONCLUSION: To achieve substantial reductions in maternal mortality levels, work must be done on these specific risk factors, and future programs must urgently be concentrated on a higher standard of pre-natal monitoring, obstetrical emergency facilities and training of obstetrical staff.     

Epidemiology of eye injuries in Abidjanian children

Eye injuries, most of them preventable, are particularly severe in Africa, because of the risks of infection and delay in treatment. We report a 16-month (March 1997-June 1998) prospective observational survey of eye injuries in children up to the age of 15 years at Treichville-Abidjan University Hospital. During this period, 62 children were treated for these injuries. Ocular traumas represented 4% (n = 245) of new admissions in ophthalmology, and 29% of these injuries occurred in children. The sex ratio was 5:2 boys to girls, and their mean age was 8.66 +/- 3.56 years. Eye injuries occurred most often during play (84%, n = 52). More than 85% (n = 53) of children were alone or without adult supervision at the time of the injury. The causal agent was most often wood (35%) followed by metal (29%). The mean time from injury to hospital admission was 1.8 +/- 0.77 day. Only 19% of patients were admitted the day of injury. Most patients (66%) first sought treatment in a primary care centre. More than 70% (n = 44) of injuries necessitated hospitalisation. Open eyeball wounds were the most common injury (53%) and were associated with endophthalmitis in 16%. The mean recovery of visual acuity was 0.1. At admission, 40 of the injured eyes (64.5%) had monocular blindness; six recovered, for a final blindness rate of 55%. Injuries associated with wooden objects had a final blindness rate of 77% and play-related injuries 63%. The primary posttraumatic sequelae were corneal scars. Eyeball phthysis (14.5%) was secondary to 8 open wounds of the eyeball and one postcontusion retinal detachment. Eye injuries remain a major cause of monocular blindness in children in Cote d'Ivoire. Most of them can be prevented by relatively simple measures including supervision of children and rapid hospitalisation when injury occurs.     

Senegalese grandmothers promote improved maternal and child nutrition practices: the guardians of tradition are not averse to change

The vast majority of community nutrition/health programs in developing countries focus on women of reproductive age (WRA) and a few explicitly involve senior women, or grandmothers. In Senegal, as in many other places, older, experienced women play an influential role in household maternal and child health (MCH) matters. Formative research in Serer villages revealed their importance and this was taken into account in an action research nutrition education (NE) project in which grandmothers were encouraged to promote improved nutritional practices related to pregnancy (e.g. decreased work and improved diet) and infant feeding (e.g. breastfeeding and complementary feeding). A participatory communication/empowerment education approach was used involving songs, stories and group discussion. Quantitative and qualitative data were collected to both document and evaluate the intervention. Triangulation of the evaluation data suggests that 12 months after the intervention was initiated there were significant improvements in grandmothers' nutritional knowledge, in their advice to WRA, and in the nutrition-related practices of these younger women associated both with pregnancy and infant feeding. For example, in the pre-test only 20% of grandmothers stated that they advise pregnant women to decrease their workload whereas in the post-test 87% reported giving this advice. At the same time, 91% of WRA in villages with the grandmother strategy reported having decreased their workload during their last pregnancy whereas in villages with NE activities for WRA but not with grandmothers, only 34% of younger women reported having done so. These findings provide evidence of grandmothers' ability to learn, to integrate new information into their practices and to positively influence the practices of WRA. These results support the need for future MCH programs, in different cultural contexts, to involve grandmothers and in so doing to build on their intrinsic commitment to family well-being.     

Epidemiology of malaria in a village of Sudanese savannah area in Mali (Bancoumana). 2. Entomo-parasitological and clinical study

We carried out five cross sectional surveys between 1993 and 1994 to assess the epidemiology of malaria in the village of Bancoumana, located in the Sudanese savannah areas of Mali. Each survey included a collection of entomological, clinical, parasitological and immunological data. The study population involved 1600 children from six months to 9 years of age. The main vector was Anopheles gambiae s.l., man bite rate and entomological inoculation rate were maximum respectively in August (peak of the transmission season) and October (end of transmission season). Plasmodium. falciparum was the main parasite species observed. Spleen enlargement rate, parasite rate, gametocyte rate and parasite density varied significantly with age and season. The parasite rate, gametocyte rate and parasite density were significantly low in October 1994 compared with October 1993 while the entomologic parameter did not show any variation over the two years. This reduction of parasitologic index between 1993 and 1994 may be related to an increase of anti-malarial drug use in the population. Our results show that malaria is hyperendemic in the village of Bancoumana.