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PURPOSE: In the last 8 years, numerous cohort studies have been conducted to estimate the rate of mother-to-child transmission (MTCT) of HIV. Many of these have faced problems in data collection and analysis, making it difficult to compare transmission rates between studies. This workshop on methodological aspects of the study of MTCT of HIV-1 was held in Ghent (Belgium) in February 1992. STUDY SELECTION AND DATA EXTRACTION: Fourteen teams of investigators participated, representing studies from Central (five) and Eastern Africa (three), Europe (two), Haiti (one) and the United States (three). A critical evaluation of the projects was carried out, under four headings: (1) enrollment and follow-up procedures, (2) diagnostic criteria and case definitions, (3) measurement and comparison of MTCT rates and (4) determinants of transmission. RESULTS OF DATA ANALYSIS: Reported transmission rates ranged from 13 to 32% in industrialized countries and from 25 to 48% in developing countries. However, no direct comparisons could be made because methods of calculation differed from study to study. Based on this review, a common methodology was developed. Agreement was reached on definitions of HIV-related signs/symptoms, paediatric AIDS and HIV-related deaths. A classification system of children born to HIV-1-infected mothers according to their probable HIV infection status during the first 15 months of life, allowed the elaboration of a direct method of computation of the transmission rate and of an indirect method for studies with a comparison group of children born to HIV-seronegative mothers. This standardized approach was subsequently applied to selected data sets. CONCLUSIONS: The methodology can now be applied to all studies with sufficient follow-up and comparisons made between transmission rates. This step is essential for assessing determinants of transmission and for the development of a common approach for the evaluation of interventions aimed at reducing or interrupting MTCT of HIV.

Human immunodeficiency virus type 1 (HIV-1) is transmitted mainly by cell-to-cell contact. We postulated that transmission of HIV-1 through breastmilk could be favoured by the presence of infected cells, by deficiency of anti-infective substances in breastmilk, or both factors. 215 HIV-1-infected women were enrolled at delivery in Kigali, Rwanda; milk samples were collected 15 days, 6 months, and 18 months post partum. HIV-1 IgG, secretory IgA, and IgM were assayed by western blot, for the latter two after removal of IgG with protein G. In the 15-day and 6-month samples, we sought viral genome in milk cells by a double polymerase chain reaction with three sets of primers (gag, pol, and env). HIV-1 infection in the offspring was defined according to serological and clinical criteria. At 15 days, 6 months, and 18 months post partum, HIV-1 specific IgG was detected in 95%, 98%, and 97% of breastmilk samples, IgA in 23%, 28%, and 41%, and IgM in 66%, 78%, and 41%. In children who survived longer than 18 months, the probability of infection was associated with lack of persistence of IgM and IgA in their mothers' milk (adjusted chi 2 for trend, p = 0.01 for IgM and p = 0.05 for IgA). The presence of HIV-1-infected cells in the milk 15 days post partum was strongly predictive of HIV-1 infection in the child, by both univariate (p0.05) and multivariate analysis (p = 0.01). The combination of HIV-1-infected cells in breastmilk and a defective IgM response was the strongest predictor of infection. HIV-1 infection in breastfed children born to infected mothers is associated with the presence of integrated viral DNA in the mothers' milk cells. IgM and IgA anti-HIV-1 in breastmilk may protect against postnatal transmission of the virus.

REB 51 1993 France p. 161-176 Marie-Hélène Congourdeau, Regards sur l'enfant nouveau-né à Byzance. — L'attitude envers le nouveau-né est un bon révélateur des éléments conscients et inconscients d'une culture. Dans la mentalité byzantine, elle exprime de manière privilégiée le conflit entre les composantes chrétiennes et non-chrétiennes. Une enquête dans des sources diverses (droit, droit canon, hagiographie, érotapokriseis, sources historiques et médicales ...) permet de dégager plusieurs attitudes : accueil et rejet (bréphotrophia, infanticide), protection et méfiance (l'enfant non baptisé, proie favorite des démons). Fragile, menacé, menaçant (la naissance multiple ou monstrueuse, funeste présage), proche du néant dont il vient, et où la plupart retournent rapidement, impur jusqu'à son baptême et cependant image de Dieu, le nouveau-né fascine, inquiète, émeut. Il offre aussi à l'Église byzantine l'occasion d'affirmer la spécificité de son anthropologie et de façonner une pratique différente de celle des civilisations antiques., Congourdeau Marie-Hélène. Regards sur l'enfant nouveau-né à Byzance. In: Revue des études byzantines, tome 51, 1993. pp. 161-176.

National audience

ISSN : 0291-0233 ; http://www.medecine-et-enfance.net/

Five growth models are compared using weight data from 95 rural Congolese infants between birth and 13 months of age. The objective is to find the best model in terms of goodness of fit and distribution of parameter estimates. The Infancy component of the Karlberg model, the Count model, and the Kouchi model, which are all three-parameter models, are tested together with the four- and five-parameter versions of the Reed model. The closest fits are obtained using the Reed models, followed by the Karlberg model, while the Count and Kouchi models provide poor fits. The five-parameter Reed model is not superior to the four-parameter version. Examination of mean residuals by age shows a systematic bias in neonatal weight estimation with the three-parameter models. Mean within- and between-individual correlations are especially high for the Kouchi and Reed models. Extreme skewness is observed for some parameters of the Kouchi model and of the five-parameter Reed model. Despite its high degree of collinearity, the four-parameter linear Reed model should be preferred on weight data between birth and 1 year. The I-component of the Karlberg model could be used between ages 2 and 12 months. © 1992 Wiley-Liss, Inc.

A case-control study for evaluating the risk factors of neonatal tetanus was conducted in a rural area of Senegal under demographic surveillance (Niakhar). Some 45 neonatal tetanus deaths that occurred in the study area between March 1983 and March 1986 were investigated. They were matched with 187 controls. Neonatal tetanus accounted for one-third of all neonatal deaths; mortality from neonatal tetanus was 16/1000 livebirths. The effect of various demographic, socioeconomic, epidemiological and behavioural factors was investigated in a multivariate analysis using linear logistic regression. There was no difference associated with socioeconomic factors between cases and controls. Factors associated with the skill and behaviour of birth attendant and mother were highly significant and were associated with high odds ratio (OR) and included whether the hands of the person cutting the cord were washed with soap (OR = 5.22; p = 0.001); whether the person who dressed the cord was skilled (OR = 4.71; p = 0.012); whether the age of the mother was less than 18 years (OR = 7.03; p = 0.027) and whether the birth attendant arrived before delivery (OR = 4.15, p = 0.023). Conversely, the type of tool used to cut the cord did not have a significant effect (p = 0.239). Data analysis suggests that a main source of Clostridium tetani may be the hands of the birth attendant and that the main mode of contamination may be the dressing of the wound stump. Results suggest that teaching mothers and birth attendants simple hygienic principles and basic techniques may have a significant impact on neonatal tetanus mortality.

Aveugles et sourds à la naissance, les lapins nouveau-nés doivent, comme tous les mammifères nouveau-nés, interagir rapidement avec la mère afin de trouver rapidement une tétine et téter. Cela se produit généralement une seule fois par jour, au cours d’une très brève interaction, en conditions d’élevage comme en milieu naturel. Après les 10-15 j qui suivent la naissance, la relation mère-jeunes évolue progressivement, et conduit habituellement au sevrage entre 4 et 6 semaines. Dans ce contexte de développement rapide des jeunes, les femelles allaitantes et les lapereaux ont développé des adaptations sensorielles, physiologiques et comportementales leur permettant de communiquer, et permettant aux jeunes d’ingérer efficacement le lait puis les aliments solides. Ici, nous présentons quelques-unes de ces adaptations, en prenant des exemples d’études expérimentales conduites par différents groupes au cours des dernières décennies. Cet article est une synthèse du chapitre écrit par les auteurs pour le Congrès Mondial de Cuniculture (Coureaud et al 2008b)., Blind and deaf at birth, rabbit newborns need, as all mammal newborns, to rapidly interact with the mother to find the nipples and suck. This usually occurs only once per day, during an interaction drastically limited in time, both in domestic and natural conditions. After days 10-15, the mother-young interactions change progressively, leading to weaning between 4 and 6 weeks. In this context of rapid development of the young, lactating rabbit females and pups have developed some sensory, physiological and behavioural adaptations allowing them to communicate, and allowing the young to ingest milk then solid food efficiently. Here, we present some of these adaptations, taking examples from experimental studies run by several groups during the last decades. This paper is a summary of a chapter and communication recently presented during the last World Rabbit Congress (Coureaud et al 2008b).

La toxoplasmosis es una enfermedad parasitaria de distribución mundial, alcanzando tasas de prevalencia elevadas, constituyéndose en un problema de salud pública por las repercusiones que presenta en la salud de la población neonatal. Se realizaron 2 estudios de corte transversal para la determinación de la proporción de madres con anticuerpos anti-#Toxoplasma gondii$ IgG y la proporción de recién nacidos con IgM específicas en dos zonas geofráficas de Bolivia: Yacuiba (Chaco), La Paz y El Alto (Altiplano). (résumé d'auteur)

En los hospitales y centros de salud seleccionados en los departamentos de Tarija y Santa Cruz en Bolivia, se analizaron datos y muestras obtenidas de sangre placentaria durante los meses de marzo a junio de 2005. El estudio revela una prevalencia de paludismo por #Plasmodium vivax$ al momento del parto de 3,7%. Al comparar la proporción de mujeres con ifección palúdica placentaria por #Plasmodium vivax$ al momento del parto, en cada departamento, se observó que existe una prevalencia similar en cada uno de ellos. (résumé d'auteur)

This study aims to typify the Trypanosoma cruzi (sub)lineage(s) in umbilical cord blood of congenitally infected Bolivian newborns, using PCR amplifications of "Region Markers", mini-exon or kDNA fragments followed by hybridization or sequencing. New probes were also designed to distinguish three variants within the TcIId sublineage. The IIb, IId, or IIe T. cruzi sublineages, as well as different variants of the IId sublineage, were detected in infected neonates, whereas mixed infections were not found. The frequencies of the IId sublineage were similar in neonates (95.1%) and adults of the same area (94.1%). The IId-infected newborns displayed either asymptomatic, or severe and fatal clinical forms of congenital Chagas disease, as well as low or high parasitemia. Altogether these data show that T. cruzi DNA polymorphism, based on the presently available markers, is not associated with the occurrence of congenital infection or the development of severe clinical forms of congenital Chagas disease.

Summary background Comparing two surveys performed in Bolivia in 1992–1994 and 1999–2001, we reported a significant decrease in the proportions of severe and mortal forms of congenital Chagas disease. This might be due to a reduction of vectorial density (VD) in maternal residence area, raising the question of a possible causal relationship between such VD, maternal parasitaemia and prognosis of congenital infection with Trypanosoma cruzi. method Comparisons of haematological and parasitological data obtained from Bolivian mothers infected with T. cruzi, and of clinical and biological data obtained from their infected and uninfected newborns, stratified according to VD in the area of maternal residence. results i) Blood hematocrit rates or hemoglobin amounts were within the normal ranges and similar in all the maternal groups, whatever the VD in their areas of residence; ii) mothers living in high VD areas displayed a higher frequency of hemocultures positive for T. cruzi; iii) newborns congenitally infected with T. cruzi, but not uninfected babies born from infected mothers, displayed higher frequencies of very low Apgar scores, low birth weights, prematurity, respiratory distress syndrome or anasarca, as well as higher mortality rates when their mothers lived in areas of high VD. conclusion Frequent bites of blood sucking Reduvidae during pregnancy do not induce maternal anaemia, but, likely through multiple maternal re-infections with T. cruzi, increase maternal parasitemia and worsen congenital Chagas disease. Maternal dwelling in areas of high VD is associated with a serious increased risk of severe and mortal congenital Chagas disease.

International audience; Although pregnant farm animals can encounter different stressors on numerous occasions, studies on the physiological effects of repeated stress during gestation on females and their offspring are quite recent and still scarce. The present experiment was performed to study the effects of repeated transportations on some physiological parameters in pregnant goats and to determine whether repeated exposure to prenatal stress resulted in alterations in the hypothalamic-pituitary-adrenocortical (HPA) axis and the sympatho-adrenomedullary (SAM) system of their offspring. Twenty-six goats were assigned to one of two treatments during the last five weeks of gestation: 9 series of 55 min of transport (n = 13) or no transport (n = 13). During transport, the goats were physically and visually isolated from their congeners. Transport in isolation induced a large increase in plasma concentrations of cortisol, glucose and non-esterified fatty acids, which confirms that it is a very stressful situation for goats. Moreover, the goats did not become accustomed to the stressor. Gestation length, birth weight, litter weight and growth of the kids were not modified by treatment. Cortisol concentrations tended to be higher in prenatally stressed kids than in control kids 1 h after birth ($P < 0.10$) and the opposite was observed at 48 h of age ($P < 0.10$). Indeed, the decrease in cortisol concentrations between 1 and 48 h was greater in prenatally stressed kids than in control kids (time $\times$ treatment interaction, $P < 0.01$). The effect of prenatal stress on the HPA axis did not persist, since in older kids cortisol concentrations were not modified by treatment. At one month of age, prenatally stressed kids showed a higher medulla weight ($P < 0.05$) and tended to show a higher phenylethanolamine N-methyl transferase activity ($P < 0.10$) than control kids. Therefore, repeated transport in isolation is an important stressor in pregnant goats and can affect the HPA axis and the SAM system of their offspring.; Effets physiologiques de transports répétés pendant la gestation chez la chèvre et le jeune chevreau. Alors que les animaux d'élevage rencontrent fréquemment des agents stressants pendant leur gestation, ce sujet a reçu peu d'attention. Nous avons étudié les effets de transports répétés sur certains paramètres physiologiques de chèvres gestantes et tenté de déterminer si l'exposition répétée à un stress prénatal entraîne des altérations de l'axe corticotrope et du système catécholaminergique de leurs chevreaux. Vingt-six chèvres ont été réparties dans deux traitements pendant les 5 dernières semaines de gestation : 9 transports de 55 min en étant physiquement et visuellement isolées de leurs congénères (n = 13) ou absence de transport (n = 13). Le transport en isolement a induit une augmentation importante des concentrations plasmatiques en cortisol, glucose et acides gras non-estérifiés, ce qui confirme que c'est un agent stressant important pour la chèvre. De plus, les chèvres ne se sont pas habituées au traitement. La durée de gestation, le poids de naissance et de portée et la croissance des chevreaux n'ont pas été modifiés. Les concentrations de cortisol ont eu tendance à être plus élevées chez les chevreaux stressés prénatalement (SPN) que chez les témoins 1 h après la naissance ($P < 0,10$) et l'inverse a été observé chez les chevreaux âgés de 48 h ($P < 0,10$). La diminution des concentrations de cortisol entre 1 h et 48 h a été plus importante chez les chevreaux SPN que chez les témoins (interaction temps $\times$ traitement : $P < 0,01$). L'effet du stress prénatal sur l'axe corticotrope n'a pas persisté chez les chevreaux plus âgés. À l'âge d'un mois, le poids de la médullo-surrénale a été plus élevé ($P < 0,05$) et l'activité de la phényléthanolamine N-méthyl transférase a eu tendance à être augmentée ($P < 0,10$) chez les chevreaux SPN par rapport aux témoins. Par conséquent, le transport répété en isolement est un agent stressant important chez la chèvre gestante et peut modifier l'axe corticotrope et le système catécholaminergique des chevreaux.

International audience; Les objectifs de cette étude sont les suivants : il s'agit de décrire et d'analyser du point de vue médical et organisationnel la prise en charge de la rupture prématurée des membranes (RMP) avant 34 semaines d'aménorrhée (SA), dans les différentes maternités de la région Rhône-Alpes (filières de soins et attitude obstétricale et pédiatrique), et les résultats chez l'enfant en termes de mortalité et de morbidité. Notre recherche en réseau s'articule autour d'un double objectif : répondre à une question médicale en termes de prise en charge d'une pathologie difficile (la RMP avant 34 SA) et comprendre le fonctionnement et l'articulation des établissements délivrant des soins obstétrico-pédiatriques d'une région.

International audience

Les soins aux petits enfants s'inscrivent dans un contexte socio-culturel bien précis. La connaissance de ce contexte est indispensable pour comprendre les logiques qui soutendent tant les soins préventifs que les traitements proposés en cas de maladie. L'étude des soins aux petits enfants moose de la ville de Ouagadougou révèle que les pratiques en vigueur sont largement déterminés par la perception des maladies du réseau social dans lequel est intégrée la jeune mère et où la vielle femme conseillère occupe une place centrale dans le type de soins et le choix des traitements. (Résumé d'auteur)

On ne pose plus la question de sécurité alimentaire en termes de production agricole insuffisante aujourd'hui et la question de la régulation des échanges est devenue cruciale. Le marché est impuissant dans cette tâche, en Afrique notamment où des politiques agro-alimentaires sont nécessaires malgré l'impuissance des états. (Résumé d'auteur)

La transmission de la mère à l'enfant du virus de l'immunodéficience humaine (VIH) est la cause majeure de l'extension à la population pédiatrique de l'épidémie d'infection par le VIH. Depuis le début de la pandémie, trois millions d'enfants de par le monde seraient nés infectés par le VIH. Le poids que supportent les pays en développement dans cette épidémie est considérable puisque de 90 à 95% des femmes susceptibles de transmettre à leurs enfants le VIH vivent dans ces régions. Aussi, la prévention de la transmission de la mère à l'enfant du VIH doit être élevée à un rang de priorité dans ces pays. Dans les pays industrialisés, le traitement antirétroviral par l'azidothymidine (AZT), assorti de la suppresssion de l'allaitement au sein des nouveau-nés, a prouvé son efficacité pour réduire cette transmission. Mais plusieurs obstacles empêchent d'appliquer automatiquement ces méthodes dans les pays en développement : la complexité de la stratégie thérapeutique expérimentée ; la lourdeur de la logistique à mobiliser ; le coût global rédhibitoire ; le danger que constitue la suppression de l'allaitement au sein des enfants ; l'ignorance de l'efficacité du traitement par l'AZT dans une population où l'allaitement maternel est général et où circulent d'autres sous-types de VIH ; l'appréhension de la population générale pour les questions relatives à l'infection par le VIH ; la prévalence élevée de l'anémie maternelle. Il apparaît clairement que les interventions capables d'avoir un impact décisif dans la réduction de la transmission de la mère à l'enfant du VIH sont celles qui seraient applicables dans le système actuel des structures de santé et qui seraient sûres, acceptables, efficaces et d'un coût abordable. Trois d'entre elles ont ce potentiel : le traitement de la mère par des drogues antirétrovirales selon un schéma court couvrant la période périnatale ; la désinfection, pendant la période périnatale, de la filière génitale par des antiseptiques virulicides ; la supplémentation en vitamine A des femmes enceintes et des enfants... (D'après résumé d'auteur)

The analysis of components of the remedies given to Gouro babies in Ivory Coast to keep them chubby (to put on weight/child/drug) and of the diseases that these remedies are supposed to protect them from, show that, although drugs or diseases vary according to families, this variability allows -for each entity (nosological category or plant)- a space of acceptability in which variations occur by contiguity according to the polythetic mode. The analysis of the symptomatology of the diseases on one hand and the range of activity on the other hand, shows congruent structures if the analysis is considered from a relevant point of view, that of body deterioration and patients. The aim is to avoid impairment of the vital fluids after a loss of fluids due to diarrhea or dryness due to fever. The ethnopharmacological survey must use the symptomatology and the semiology of the studied medicine. (Résumé d'auteur)

Objective To compare the anthropometric characteristics of children with and without HIV-1 infection. Methods In a prospective cohort study of 218 children born to HIV-1 seropositive mothers and 218 children born to HIV-1 seronegative mothers in Kigali, Rwanda, 3 groups were compared: infected children (n = 46); uninfected children born to seropositive mothers (n = 140); and uninfected children born to seronegative mothers (n = 207). Weight, height and head circumference were measured at birth, every 3 months during the first year of life and every 6 months thereafter. The weight-for-age, height-for-age, weight-for-height and head circumference-for-age mean z scores were calculated. Results The weight-for-age, height-for-age and head circumference-for-age mean z scores were lower among HIV-infected children than among uninfected ones at each time period. The reduction in the weight-for-age mean z score was the greatest between 12 and 36 months. The reduction in the height-for-age mean z score of HIV-infected children was persistently below 2 SD after 9 months of age. On the other hand the weight-for-height mean z score was not consistently lower in HIV-infected children when compared with uninfected ones. The anthropometric characteristics of uninfected children born to seropositive mothers were similar to those of children born to seronegative mothers. Conclusions In this study HIV-infected children were more frequently stunted (low height-for-age) than uninfected ones. Wasting (low weight-for-height) was not common among HIV-infected children.

Cet article fait partie du dossier : Le déterminisme génétique du développement musculaire; National audience

Les Indiens du haut pays mixtèque, tout comme d'autres Indiens du Mexique, prennent particulièrement soin des jeunes accouchées. Un certain nombre de travaux portent sur la grossesse et l'accouchement au Mexique, mais le thème du post-partum a été peu étudié en profondeur, bien que les indigènes insistent sur le danger et l'importance des soins à cette période. Dans ce travail, la conception, la grossesse et l'accouchement sont décrits à titre introductif, tandis que les pratiques du post-partum sont analysées en détail : la période de repos de 20 ou 40 jours, le régime alimentaire particulier, l'abstinence sexuelle, les diverses précautions et prohibitions, les soins corporels, les tisanes, les bains de plantes et surtout, le bain de vapeur, à fonction à la fois thérapeutique et rituelle. L'article pose le problème de l'analyse des données touchant aux pratiques corporelles féminines, difficilement verbalisées. Il amorce également une comparaison avec les pratiques des pays industrialisés occidentaux et suggère de puiser dans les pratiques et les connaissances des sociétés dites "traditionnelles" pour remédier aux dépressions post-partum. (Résumé d'auteur)

International audience

Prospective cohort studies indicate that 13-45% of human immunodeficiency virus type 1 (HIV-1)-infected pregnant women transmit the virus to their infants. Although factors that influence perinatal transmission are not well understood, drug and immunotherapy trials to interrupt transmission are underway. The identification of women most at risk is essential for prevention, counselling, and medical intervention. We assessed 70 HIV-1-infected pregnant women enrolled in a prospective study of perinatal transmission in Brazzaville, Congo. The relations between maternal health status, antibody levels to selected HIV-1 structural antigens at delivery, and infant outcome were explored. Independent of clinical stage, higher maternal antibody titres to peptides corresponding to the V3 region of gp120 and the immunodominant domain of gp41 were correlated with a higher risk of perinatal transmission. In a logistic regression model, the predicted risk of transmission for symptom-free women whose antibody titres to V3 and gp41 were lowest was 0·02, whereas it was 0·88 for symptomatic women whose antibody titres to V3 and TMSP18 were highest. These associations may give new insight into the mechanisms of perinatal transmission and they may also provide a powerful means of identifying women who would most benefit from intervention trials to halt perinatal transmission.

L'infestations des plancentas par les #Plasmodium$ a été étudiée pendant huit mois en 1991 chez 1040 parturientes à l'hôpital de Bobo-Dioulasso (Burkina F o). Le taux d'infestation était de 6,5 % en période de faible transmission et de 24,5 % en période de forte transmission. #P. falciparum$ était présent dans toutes les infestations. 38 % des parturientes de moins de 18 ans et 26 % des primipares étaient infestées. Le suivi régulier des consultations prénatales, l'appartenance à un bon niveau socio-économique sont apparus des facteurs associés à un taux d'infestation bas. L'emploi de moustiquaires de lit est lié à une protection contre l'infection placentaire même après élimination des facteurs socio-économiques confondants. (Résumé d'auteur)

Rapid growth occurs during fetal and neonatal development. The duration and quality of intrauterine development affect neonate body composition. Weight is routinely used to assess and monitor the nutritional status of newborns. Any weight loss or gain in hospitalized newborn infants may reflect shifts in water balance rather than changes in body mass, and have strong implications for investigating the nutritional status of newborns. It is, however, difficult to measure the body composition of newborns. Bioelectrical impedance analysis (BIA) is a relatively new technique for estimating body composition. It is based on the fact that the conduction of an applied electrical signal is far greater in fat-free tissues (because of water and electrolyte content) than in fat. BIA has been gaining wide usage for the estimation of body composition in adults1,2, and should be a very suitable method for use in children, because of its noninvasiveness, simplicity and reliability.

Objective. The results of developmental testing of 218 children born to human immunodeficiency virus (HIV)-seropositive mothers and infected or uninfected themselves were compared with those of 218 children born to HIV-seronegative mothers in an ongoing cohort study in Kigali, Rwanda. Methods. When the children were 6, 12, 18, and 24 months of age, a specific neurodevelopmental examination was performed blindly by study physicians assessing gross motor development, fine motor development, language acquisition, and social contacts. Results. Only one acute severe HIV-related encephalopathy was identified among the 50 infected children. The proportion of abnormal neurologic examinations in HIV-infected children varied from 15% to 40% according to age and was always higher than in HIV-uninfected children born to HIV-seropositive and seronegative mothers (≤5% or less of abnormal examinations at each time period). fter excluding those children with clinical ac-quired immunodeficiency syndrome (AIDS) from the analysis, the proportion of abnormal examinations in infected children was 12.5% at 6 months, 16% at 12 months, 20% at 18 months, and 9% at 24 months of age and was still more frequent than in HIV-uninfected children. The developmental delay was principally due to significantly lower gross motor scores. Conclusions. HIV-1-infected children are more frequently developmentally delayed than uninfected children during the first 2 years of life in this African population. This developmental delay is related to the AIDS stage of pediatric HIV infection.

To determine the effect of chloroquine chemoprophylaxis during pregnancy on birth weights, a randomized trial was carried out in 1987 and 1988 in Banfora, Burkina Faso (West Africa). Seven hundred forty-five randomly selected women treated with chloroquine sulfate were compared to with 719 controls who received no treatment. In spite of an unquestionable effect of chloroquine in preventing placental infection (4.1% infected placentas in the treated group versus 19.0% in the controls), the mean difference in birth weights between the two groups (6 g) was not significant. The difference in the proportion of low birth weight (LBW) newborn babies in two groups (16.3% versus 16.4%) was also not significant. However, there was a strong relationship between placental infection and birth weight (the mean birth weight difference between infected and uninfected placentas was 113 g, and the proportion of LBW babies was 26.0% in infected placentas versus 14.8% in uninfected placentas). The small difference in birth weights observed between the two groups may be due to the fact that the prevalence rate of placental infection is low and that prophylaxis is effective only on a portion of the subjects in the treated group. It may also indicate that malaria is only one of several risk factors responsible for LBW. The relatively small increase in birth weight, the expected poor acceptance of mass prophylaxis, and the spreading of chloroquine-resistant Plasmodium strains should be considered before extending malaria chemoprophylaxis to all pregnant women. It might be worth considering to limit prophylaxis to primigravidae.