Maternal mortality remains one of the major problems in public health today especially in developing countries where maternal mortality is estimated to be between 500 and 1000 deaths for 100,000 live births. In 1987, the safe motherhood initiative was launched with the objective of reducing maternal mortality by 50% within ten years. One of the methods introduced to reduce the high incidence of maternal and neonatal mortality in developing countries, is the partogram, a visual means used in evaluating a normal delivery. It acts as an early warning system, allowing for the early detection of abnormal evolution in labour as well for the mother as for the foetus. This instrument was introduced in all the maternity wards in Niger in 1990 by the Ministry of Public Health. A study was conducted in one of the maternities of the capital to ascertain the effectiveness of this new instrument to both the mother during labor and the newborn child. 1299 women in labor, primi-and multiparous, participated in the study. Two groups were formed: one consisted of women that delivered prior to the introduction of the partogram, the second group was comprised of women who delivered after its introduction. The results of this study have shown that the introduction of the partogram: reduces the amount of time that a women is in labor, improves the follow-up care the pregnant woman receives, results in a more timely decision made by the health official, and consequently, a prompt referral to a specialised center. The authors estimate that, if used correctly, the introduction of this instrument can have along with other appropriate measures, a considerable impact in the reduction of maternal and neonatal mortality.
The authors describe the extension of an outbreak of bacillary dysentery among the Rwandese populations seeking refuge in the region of Goma, Zaire during August 1994. Analysis of the epidemiological surveillance data and of the bacteriological laboratory results of the Bioforce, show that this epidemic was probably facilitated by the preceding cholera outbreak. In such circumstances, rapid sterilization of the virus reservoir, by short course treatments, might be beneficial in limiting the extension of the epidemic.
Active case detection in health centres and epidemiological surveys made it possible to determine the extent of onchocerciasis endemic regions in Burundi. The largest endemic region, in the north-west of the country, covers almost totally the province of Cibitoke and partially the adjoining province oi Bubanza. The population at risk is 330 000. The endemic region in the south-west of Burundi covers more than one third of the province of Bururi and has 230 000 people at risk. The smallest endemic region is in the province of Rutana (south-east), where 52 000 people live.
We report on the prevalence of schistosomiasis and geohelminth infections in Mali, Central West Africa, based on data from the National Schistosomiasis Control Programme of Mali (1982-1991) and from our recent surveys (1992-1993). Combined national figures and regional data are presented from both surveys. Schistosomiasis showed an overall prevalence of 30.1%, with lowest prevalence in Sikasso Region and highest prevalence in Segou Region. Ascaris lumbricoïdes (0.12%) and Trichuris trichiura (0.42%) were comparatively rare, but hookworm infections were more widespread (8.0%). No hookworm infections were detected in the arid northern Region and the highest prevalence (18.7%) was encountered in the humid south of the country. There was a significant positive relationship between the prevalence of hookworm infection and total annual rainfall per region. Overall the prevalence of concurrent infections with schistosomes and hookworms was significantly less than expected, although there were regional differences which were discussed in the light of local variations in climatic and other factors likely to affect transmission.
The classical clinical picture of amoebic infection of the liver consists of fever, right upper quadrant pain and hepatomegaly. In recent years, the widespread availability of ultrasound and serology made an early diagnosis possible, which could result in less prominent clinical pictures. Thirty six cases of liver amoebiasis diagnosed in Antwerp between 1985 and 1992, were reviewed. Three patients acquired their infection in Belgium. For the other patients, the average delay between arrival in Belgium and the first symptoms was 5.64 months. The classical triad of clinical signs (fever, right upper quadrant pain and hepatomegaly), was observed in only 13.9% of the patients, whereas it was much more frequent in earlier studies (68-75%). The right lobe was the most frequently affected (94%). The colour of the liquid, obtained by puncture, was brown in 61% of patients in whom it was reported. Amoebic cysts were found in the stools of only one patient. Amoebic serology was initially negative in only one patient, but became positive on second testing. Chest X-rays were abnormal in 34% of the patients. All patients who develop unexplained fever during the year after a stay in tropical countries should undergo an abdominal ultrasound examination and serological testing for Entamoeba histolytica.
In this study, we compared four T. evansi detection tests (Direct examination, Card Agglutination mouse inoculation and Polymerase Chain Reaction (PCR) in a natural infection of dairy cattle in central Thailand. The samples for PCR amplification were collected either in microfuge tubes or on microscope slides and the amplification results were compared. Collecting the samples on slides was faster and more convenient than collection in tubes. Comparable results were obtained from PCR amplification of both tube- and slide collected samples, processed twelve to fourteen days after collection. PCR was the most sensitive of the methods under comparison, using the mouse inoculation test as golden standard. The specificity of the PCR test under study is further discussed in this paper.
The epidemiology of hepatitis C (HCV), especially on the African continent, is not well known. In this study, we investigated the presence of antibodies to HCV in 685 out-patients, seen in several health care centers or hospitals in different regions in Burundi from January to February 1991. Serological tests of the second generation were used. The global prevalence varied from 3.2% to 14.1% according to the center. Urban seroprevalence tended to be higher than rural prevalence. Also, with increasing age, a higher prevalence was observed. Anti-HCV antibodies were absent in patients younger than 21, while specific antibodies were detected in 23.1% of patients older than 50. Although the prevalence in men (10.4%) was higher than in women (7.4%), this difference was nor statistically significant. Taking into account the selection of subjects participating in this evaluation, the results can not be extrapolated to the general population. No association between HCV and human immunodeficiency virus (HIV) was seen in this study. In contrast to previously described results from studies using reagents of the first generation, no cross-reactions were observed with anti-malarial antibodies.
In a longitudinal study we have observed the fluctuation in density of two Anopheles populations responsible for malaria transmission in a village built on a brackish lake. The two A. gambiae complex species are A. melas and A. gambiae s.s. The former is the most abundant (88%). The brackish lake ecosystem gives to both species possibilities of adaptation. The salt water species of the A. gambiae complex, A. melas, was found to be tolerant to waters with very low salinity. On the other hand, A. gambiae s.s. was found to support relatively high salinity rates. Both specimens live together the whole year round but their frequencies vary with the inundation of the lake. During inundation the salt rate decreases and A. melas eventually disappears. Transmission is low, seasonal and short on the lake. It is perceptible between March and August. The inoculation rate (11 infected bites per man/year) is lower than what we have observed in other lagoon areas of Benin, or even in the city of Cotonou (33 infected bites per man/year). The low malaria transmission on the lake is probably due to the presence of an important population of A. melas with low infection rates and the widespread use of bed nets.
An analysis was made of the mating scar pattern of female Glossina palpalis palpalis Robineau-Desvoidy and Glossina fuscipes fuscipes Newstead. Measurements on fifty permanent preparations of the mating scars of females reared in the laboratory revealed significant differences in the length, width and in the distance between the centers of the mating scars of the two species. Plotting the distance between the centers of the two mating scars against the ratio width/length resulted in a 93% separation of the two species. It is proposed that this technique could be used during field surveys to expose possible cross-breeding in nature or as a tool in the entomological evaluation of a tsetse eradication campaign where one species is released in the habitat of the other.
