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Aim: We estimated the prevalence of undiagnosed diabetes, analyzed the influence of family history on the occurrence of T2D and evaluated its aggregation pattern in the Mauritanian population., Methods: The prevalence of unknown diabetes was obtained using data compiled from 1278 Mauritanian adults applying a questionnaire and fasting serum glucose tests. Detailed family history of diabetes and clinical characteristics were gathered from 421 T2D patients., Results: The prevalence of undiagnosed diabetes was 4.7 ± 1.2% in the studied population (3.1% in men and 6.4% in women). 27% of T2D patients reported at least one relative with diabetes. Association between family history and diabetes was higher among first degree compared to second degree relatives (p=0.003). We observed more probands with an affected mother than those who have a father with diabetes (p = 0.002), suggesting a preferential maternal effect which did not extend to second degree relatives., Conclusions: These results show that the prevalence of diabetes in the Mauritanian population could be higher than currently thought. Family history screening may be used in the management of this condition in Mauritania., (Copyright © 2012 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Background: The epidemiology of malaria in the Senegal River Gorgol valley, southern Mauritania, requires particular attention in the face of ongoing and predicted environmental and climate changes. While "malaria cases" are reported in health facilities throughout the year, past and current climatic and ecological conditions do not favour transmission in the dry season (lack of rainfall and very high temperatures). Moreover, entomological investigations in neighbouring regions point to an absence of malaria transmission in mosquito vectors in the dry season. Because the clinical signs of malaria are non-specific and overlap with those of other diseases (e.g. acute respiratory infections and diarrhoea), new research is needed to better understand malaria transmission patterns in this region to improve adaptive, preventive and curative measures., Methods: We conducted a multipurpose cross-sectional survey in the city of Kaédi in April 2011 (dry season), assessing three major disease patterns, including malaria. Plasmodium spp. parasite rates were tested among children aged 6-59 months who were recruited from a random selection of households using a rapid diagnostic test and microscopic examination of Giemsa-stained thick and thin blood films. Acute respiratory infection and diarrhoea were the two other diseases investigated, administering a parental questionnaire to determine the reported prevalence among participating children., Findings: No Plasmodium infection was found in any of the 371 surveyed preschool-aged children using two different diagnostic methods. Acute respiratory infections and diarrhoea were reported in 43.4% and 35.0% of the participants, respectively. About two thirds of the children with acute respiratory infections and diarrhoea required medical follow-up by a health worker., Conclusions: Malaria was absent in the present dry season survey in the capital of the Gorgol valley of Mauritania, while acute respiratory infections and diarrhea were highly prevalent. Surveys should be repeated towards the end of rainy season, which will enhance our understanding of the potential changes in malaria transmission in a region known as 'hot spot' of predicted climate change.

Background: In Mauritania, some authors have described a possible high prevalence of hepatitis delta virus (HDV) infection in the 1990s in studies of small-size samples., Objectives: The aims of our study were to assess the prevalence of HDV in HBsAg positive blood donors in Mauritania, to identify the main risk factors for HDV transmission and to analyze genetic diversity of HDV strains., Study Design: From October 2008 to December 2009, 11,100 consecutive blood donors were considered in this study. Among them, 1700 (15.3%) were HBsAg positive and 455 accepted to participate in this study. Demographic, epidemiological, ethnical, clinical and biological data were recorded. HDV screening, i.e., antibodies (HDVAb) and RNA (HDV-RNA) detection, was performed for all of them as well as HDV and HBV genotyping., Results: Ninety/455 (19.78%) donors were HDVAb positive and HDV-RNA was detectable in 56 (62.2%) of them. HDV infection was significantly associated with older age, number of marriages, military profession, residence in the desert and a history of hospitalization. The HDV genotypes of the circulating strains were HDV-1 (89.3%) and HDV-5 (10.7%)., Conclusion: HDV is highly endemic in Mauritanian blood donors indicating that a high number of them will develop chronic hepatitis, cirrhosis or hepatocellular carcinoma. Associated risk factors support nosocomial transmission of HDV. These data underline the need to reinforce HBV vaccination in newborns and in blood donors without HBV markers, together with screening for HDV in HBV-infected individuals., (Copyright © 2012 Elsevier B.V. All rights reserved.)

No recent data are available on hepatitis B virus (HBV) and hepatitis Delta virus (HDV) prevalence in Mauritania. One thousand twenty pregnant women and 946 patients visiting for routine checkups were screened for HBV and HDV infection. Demographic, epidemiological, ethnic, clinical, and biological data were recorded. HBV and HDV genotypes were determined by sequencing and phylogenetic analyses. In the pregnant women and patients cohorts, respectively, the prevalence of HBsAg (10.7% and 18.3%) and anti-HBcAb (66.3% and 76.5%) indicated high HBV endemicity. In pregnant women, exposure to HBV was significantly associated in multivariate analysis with education level, ethnicity, blood transfusion, and occupation. HDV antibodies (HDVAb) were found in 14.7% of pregnant women. In patients, HBsAg was found less frequently in females than in males. Again in multivariate analysis, exposure to HBV was significantly correlated with gender (males), and HDVAb positivity with age and gender. The HBV DNA viral load was >3 log IU/ml in only 10.1% of pregnant women and in 17.3% of patients. HDV-RNA was detectable in 21 (67.7%) of the 31 patients positive for HDVAb, and in 11 of the 16 pregnant women positive for HDVAb (68.8%). The most frequent HBV genotypes were: HBV/D, 53%; HBV/E, 35%; and HBV/A, 12%. Sub-genotyping revealed HBV/D1,/D7, and the recently described/D8. HDV genotypes were: HDV-1, 90.3% and HDV-5, 9.7%. This study confirms the high prevalence of HBV and HDV infections in Mauritania and demonstrates the high genetic diversity of HBV in this country., (Copyright © 2012 Wiley Periodicals, Inc.)

Objectives: Plasmodium falciparum and Plasmodium vivax occur in Mauritania. Drug-resistant P. falciparum has been reported, but the drug-resistance status of P. vivax is unknown. The aims of the present study were to determine the prevalence of mutant pvdhfr, pvdhps and pvmdr1 genes and of pvmdr1 gene amplification in P. vivax isolates in Nouakchott, the capital city of Mauritania, and to establish a baseline for molecular surveillance of drug-resistant P. vivax in the country., Patients and Methods: Between 2007 and 2009, 439 febrile patients were screened for malaria in Nouakchott. The sequences of pvdhfr, pvdhps and pvmdr1 markers in 110 P. vivax isolates were determined by direct sequencing of PCR products. The pvmdr1 gene copy number was determined by real-time PCR., Results: The majority of the isolates with a successful PCR amplification (76/86, 88%) were characterized to be of the wild-type pvdhfr genotype, while the remaining 10 isolates carried the S58R and S117N double mutations. All isolates had the wild-type pvdhps genotype SAKAV. For pvmdr1, 75 of 103 (73%) had the wild-type Y976, and 28 (27%) carried the mutant F976. Most (98%) carried the mutant L1076 codon. Of 105 isolates, 102 (97%) had one copy and 3 (3%) had two copies of the pvmdr1 gene., Conclusions: The prevalence of mutations associated with antifolate resistance is low in Mauritania. Further studies are required to determine the roles of pvmdr1 mutations and gene amplification in conferring drug resistance. These data will serve as a baseline for further monitoring of drug-resistant malaria.

Rift Valley Fever (RVF) virus (Family Bunyaviridae) is an arthropod-borne RNA virus that infects primarily domestic ruminants and occasionally humans. RVF epizootics are characterized by numerous abortions and mortality among young animals. In humans, the illness is usually characterized by a mild self-limited febrile illness, which could progress to more serious complications. RVF virus is widespread and endemic in many regions of Africa. In Western Africa, several outbreaks have been reported since 1987 when the first major one occurred at the frontier of Senegal and Mauritania. Aiming to evaluate the spreading and molecular epidemiology in these countries, RVFV isolates from 1944 to 2008 obtained from 18 localities in Senegal and Mauritania and 15 other countries were investigated. Our results suggest that a more intense viral activity possibly took place during the last century compared to the recent past and that at least 5 introductions of RVFV took place in Senegal and Mauritania from distant African regions. Moreover, Barkedji in Senegal was possibly a hub associated with the three distinct entries of RVFV in West Africa.

This work presents the results of the behavioural and serologic survey on HIV/AIDS conducted from December 2007 to December 2008 among the group of STD (sexually transmitted disease) patients, supposed to be at HIV infection risk. In Mauritania, the last survey of HIV seroprevalence among the STD patients goes up to the year 1995 (the prevalence was estimated then to be 0.9%). The goal was to determine the seroprevalence of HIV and syphilis and to gather information on the knowledge, the sexual behaviours on a risk concerning the HIV/AIDS, and the sexually transmitted disease among these patients. The census has been made on over 224 STD patients during the period of the study, without predominance of sex and with a majority of young adults. The prevalence for HIV is 9% and for the syphilis it is 10%. Actually, the condom is widely underused by this group, even in occasional intercourse. The STD patients are a group of risk towards HIV, because of their risk behaviours and low level of knowledge.

Although malaria has become a serious public health problem in Mauritania since the late 1990s, few documented data on its epidemiology exist. The objective of this study was to assess the morbidity of clinical malaria among children in Nouakchott. Three hundred and one febrile children, consulting at three health facilities of Nouakchott, were screened for malaria in 2009 (n=216) and 2010 (n=85). Plasmodium species identification and parasite density were determined by microscopic examination of Giemsa-stained thin and thick films and confirmed by rapid diagnostic test and nested PCR. Of 301 febrile children, 105 (34.9%) were malaria-positive by nested PCR and 87 (28.9%) by microscopy. Plasmodium vivax represented 97.1% (102/105) and P. falciparum accounted for 2.9% (3/105) of positive cases. All positive children under five years old were infected with P. vivax. The highest numbers of malaria positives were found during or shortly after the rainy season and the lowest during the dry season. Fifty-four of 105 (51.4%) malaria cases, all with P. vivax, had never travelled outside Nouakchott. Individuals belonging to the Moors ethnic group represented 97.0% of P. vivax cases. Results of the present study indicate that malaria is endemic in Nouakchott and that P. vivax is the principal causative agent. Regular surveillance is required to monitor malaria prevalence and incidence, and further measures are needed to counter the possible spread of malaria in the country., (Copyright © 2011 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.)

Background: Duffy blood group polymorphisms are important in areas where Plasmodium vivax is present because this surface antigen is thought to act as a key receptor for this parasite. In the present study, Duffy blood group genotyping was performed in febrile uninfected and P. vivax-infected patients living in the city of Nouakchott, Mauritania., Methods: Plasmodium vivax was identified by real-time PCR. The Duffy blood group genotypes were determined by standard PCR followed by sequencing of the promoter region and exon 2 of the Duffy gene in 277 febrile individuals. Fisher's exact test was performed in order to assess the significance of variables., Results: In the Moorish population, a high frequency of the FYBES/FYBES genotype was observed in uninfected individuals (27.8%), whereas no P. vivax-infected patient had this genotype. This was followed by a high level of FYA/FYB, FYB/FYB, FYB/FYBES and FYA/FYBES genotype frequencies, both in the P. vivax-infected and uninfected patients. In other ethnic groups (Poular, Soninke, Wolof), only the FYBES/FYBES genotype was found in uninfected patients, whereas the FYA/FYBES genotype was observed in two P. vivax-infected patients. In addition, one patient belonging to the Wolof ethnic group presented the FYBES/FYBES genotype and was infected by P. vivax., Conclusions: This study presents the Duffy blood group polymorphisms in Nouakchott City and demonstrates that in Mauritania, P. vivax is able to infect Duffy-negative patients. Further studies are necessary to identify the process that enables this Duffy-independent P. vivax invasion of human red blood cells.

During September-October 2010, an unprecedented outbreak of Rift Valley fever was reported in the northern Sahelian region of Mauritania after exceptionally heavy rainfall. Camels probably played a central role in the local amplification of the virus. We describe the main clinical signs (hemorrhagic fever, icterus, and nervous symptoms) observed during the outbreak.

Fasciolosis caused by Fasciola hepatica and Fasciola gigantica (Platyhelminthes: Trematoda: Digenea) is considered the most important helminth infection of ruminants in tropical countries, causing considerable socioeconomic problems. From Africa, F. gigantica has been previously characterized from Burkina Faso, Senegal, Kenya, Zambia and Mali, while F. hepatica has been reported from Morocco and Tunisia, and both species have been observed from Ethiopia and Egypt on the basis of morphometric differences, while the use of molecular markers is necessary to distinguish exactly between species. Samples identified morphologically as F. gigantica (n=60) from sheep and cattle from different geographical localities of Mauritania were genetically characterized by sequences of the first (ITS-1), the 5.8S, and second (ITS-2) Internal Transcribed Spacers (ITS) of nuclear ribosomal DNA (rDNA) genes and the mitochondrial Cytochrome c Oxidase I (COI) gene. Comparison of the sequences of the Mauritanian samples with sequences of Fasciola spp. from GenBank confirmed that all samples belong to the species F. gigantica. The nucleotide sequencing of ITS rDNA of F. gigantica showed no nucleotide variation in the ITS-1, 5.8S, and ITS-2 rDNA sequences among all samples examined and those from Burkina Faso, Kenya, Egypt and Iran. The phylogenetic trees based on the ITS-1 and ITS-2 sequences showed a close relationship of the Mauritanian samples with isolates of F. gigantica from different localities of Africa and Asia. The COI genotypes of the Mauritanian specimens of F. gigantica had a high level of diversity, and they belonged to the F. gigantica phylogenically distinguishable clade. The present study is the first molecular characterization of F. gigantica in sheep and cattle from Mauritania, allowing a reliable approach for the genetic differentiation of Fasciola spp. and providing basis for further studies on liver flukes in the African countries., (Copyright © 2011 Elsevier Inc. All rights reserved.)

A study was performed to appreciate the importance of malaria in the low valley of the Senegal River North Bank in Mauritania. The malaria incidence was assessed among patients visiting the regional hospital of Rosso (Trarza region) for a "presumptive malaria", a diagnosis assigned by the clinicians based on fever and other suggestive symptoms of malaria. The malaria prevalence rate was also measured in schoolchildren. A total of 1431 febrile outpatients were sampled for thick and thin blood films, between December 2004 and March 2005, August and November 2005, and April and July 2006. The average malaria prevalence rate was 2.5% (36/1431). It varied from 0.7% (4/576) for the period from December 2004 to March 2005 to 3.8% (18/475) from August to November 2005 and 2.1% (8/380) from April to July 2006. Of the 1040 school children of 6 to 14 years of age, the average malaria parasite prevalence rate was 0.9% (9/1040). It was 0.4% (1/224), 1.7% (7/413) and 0.2% (1/402), Respectively, in February 2004 (cold and dry season), October 2005 (rainy season) and June 2006 (hot and dry season). These very low levels of malaria endemicity and incidence are comparable with those recorded in the same area on the (South) bank of the river in Senegal. In this context of unstable malaria, characterized by the absence or a low level of natural immunity of the population, an effective monitoring is essential for an early detection and a damming up of the malaria epidemic blazes that likely occur.

The purpose of this article is to describe the findings of a study carried out in a cohort of 610 schoolchildren aged 6-15 years to determine the prevalence of urinary schistosomiasis in Wilaya of Gorgol. The schistosomiasis prevalence rate was high ranging from 1.3 to 30.1% depending on location and from 7.9 to 13.7% according to age. Parasite loads up to 14 eggs/10 mL were measured. Children living in the wet zone were significantly more infected than those living in the intermediate and dry zones (p = 0.005). However, no significant difference in prevalence was found according to age (p = 0.258). Infection rate and parasite burden were correlated with exposure in terms of frequency of contact with permanent water sources. Schoolchildren in frequent contact with breeding grounds were more vulnerable to urinary schistosomiasis. Areas along the riverbank were more affected than areas located away from the river or permanent water sources.

The purpose of the report is to describe the results of a survey conducted among schoolchildren in Mali and Mauritania to evaluate the efficacy of an awareness campaign (essentially poster-based) on illegal street medicines. Under teacher supervision, a total of 3,182 schoolchildren (n=) completed a written questionnaire. Analysis of responses demonstrated that campaign was effective since 61% of the pupils had seen the posters in pharmacies and 61% had spoken about them with their parents. More than 84% of the pupils had already heard about the dangers associated with illegal medicine. Despite a number of disparities especially with regard to the price and dangers of illegal street medicine, the schoolchildren were knowledgeable about rules of conservation and outlets for purchase of legal medicine. The responses obtained from schoolchildren from Nouakchott and those attending private schools were generally better than those obtained from schoolchildren from Bamako and those attending the public schools.

Progress towards reducing mortality and malnutrition among children <5 years of age has been less than needed to achieve related Millennium Development Goals (MDGs), so several international agencies joined to 'reposition children's right to adequate nutrition in the Sahel', starting with an analysis of current activities related to infant and young child nutrition (IYCN). The main objectives of the situational analysis are to compile, analyse, and interpret available information on infant and child feeding, and the nutrition and health situation of children <2 years of age in Mauritania as one of the six target countries (Burkina Faso, Chad, Mali, Mauritania, Niger, Senegal). These findings are available to assist countries in identifying inconsistencies and filling gaps in current programming. Between August and November of 2008, key informants responsible for conducting IYCN-related activities in Mauritania were interviewed, and 46 documents were examined on the following themes: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, prevention of mother-to-child transmission of human immunodeficiency virus (HIV), management of acute malnutrition, food security, and hygienic practices. Mauritania is on track to reaching the MDG of halving undernutrition among children <5 years of age by 2015. National policy documents, training guides, and programmes address nearly all of the key IYCN topics, specifically or generally. Exceptions are the use of zinc supplements in diarrhoea treatment, prevention of zinc deficiency, and dietary guidelines for preventing mother-to-child transmission of HIV. Substantial infrastructure capacity building was also recently implemented in nutritionally high-risk regions, and increases were reported in exclusive breastfeeding rates among children <6 months. The recent National Behaviour Change Communication Strategy is intended to address the needs of adapting programme activities to local needs. Despite these noteworthy accomplishments, the prevalence of acute malnutrition remains high, mortality rates did not decrease as malnutrition rates decreased, the overall prevalence of desirable nutrition-related practices is low, and human resources are reportedly insufficient to carry out all nutrition-related programme activities. Very little nutrition research has been conducted in Mauritania, and key informants identified gaps in adapting international programmes to local needs. Monitoring and evaluation reports have not been rigorous enough to identify which programme activities were implemented as designed or whether programmes were effective at improving nutritional and health status of young children. Therefore, we could not confirm which programmes might have been responsible for the reported improvements, or if other population-wide changes contributed to these changes. The policy framework is supportive of optimal IYCN practices, but greater resources and capacity building are needed to (i) support activities to adapt training materials and programme protocols to fit local needs, (ii) expand and track the implementation of evidence-based programmes nationally, (iii) improve and carry out monitoring and evaluation that identify effective and ineffective programmes, and (iv) apply these findings in developing, disseminating, and improving effective programmes., (© 2011 Blackwell Publishing Ltd.)

A lesional study on human hydatidosis (localization, fertility of cysts, protoscolex viability, and histological structure) focused on 63 human hydatid cysts from patients operated at CHN of Nouakchott was conducted during the period 1997-2007. The authors report the following results: the annual surgical incidence rate was in the order of 1.2% per 100,000 inhabitants. The lung was the primary localization of cyst (52%) followed by the liver (33%), spleen (4%), brain (3%), heart (2%), breasts (2%), kidney (2%), diaphragm (1%), and peritoneum (1%). The pulmonary cysts were larger and more fertile (76%) with protoscoleces also more viable (70%) compared with liver cysts (67-62%). The histology of hydatid cysts revealed in most cases a histological structure consistent with that described in the literature: thick cuticle, membrane proligeous, and capsules visible.

A study was performed to determine the transmission and prevalence of human schistosomiasis in the Mauritanian side of the Senegal River basin. Parasitological investigations by Kato-Katz and urine filtration conducted on 1,259 school children indicated a mean prevalence of S. haematobium--29.0%, 25.9% and 34.3%, respectively, in the children of the lower, middle and high valley. Only the school children of the lower delta valley were infected by S. mansoni with a mean prevalence rate of 21.5%. The malacological investigations carried out in the water points of each visited village highlighted the presence of B. pfeifferi, B. senegalensis, B. globosus, B. umbilicatus, B. truncatus and B. forskalii. The last three species are announced for the first time in the Mauritanian side of the Senegal River. The laboratory snail infection experiments indicate that B. senegalensis and B. globosus are the most important intermediate hosts for S. haematobium in the Mauritanian side of the Senegal River basin. However, an incompatibility between the oasis strains of S. haematobium and the snails of the lower valley was noted. In the middle valley and high valley, the infection of the school children takes place during the rainy season, because of the creation of the temporary water points, in the lower valley; the transmission seems to be continuous.

Unlabelled: The objective of this study was to describe the epidemiologic profile of urinary incontinence of the African woman of three Sub Saharan African countries., Material and Methods: A multicentric study summarized the epidemiological data collected in female from Nouakchott, Dakar and Ndjamena using a questionnaire. All participants filled an anonymous questionnaire including demographic data and marital status, medical, surgical, gynecological and obstetrical history and the characteristics of the urinary incontinence., Results: Overall, 3021 questionnaires were distributed, only 2070 answers (69%) could be processed. Mean age of the overall population was 28 years. Adult women aged less than 30 years accounted for 56% of the study population. The age group 30-49 years accounted for 42% of the population and only 2% of the study group had more than 50 years. The prevalence of incontinence was 367 cases over 2070 (17,7%). The types of incontinence found were: urgency in 28.6% of cases, stress incontinence in 38.4% of cases and mixed in 33% of cases. Approximately 23,9% of nulliparous and 23,5% of the multiparous had urinary incontinence. The leakage was occasional in 75% of the cases and regular in 25% of the cases. According to gravity, in 31% of cases the volume of urines lost necessitated a change of underwear. Of the women presenting urinary incontinence, 85 (23%) consulted a doctor. A psychosocial repercussion was found in 31% of the cases., Conclusion: Urinary incontinence is much more frequent in our areas than it was thought to be because it was rarely acknowledged., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

According to the 2008 report on global AIDS epidemic, 33 millions of people are living with HIV/AIDS. Subsaharian Africa is the most affected part of the world. The first case of AIDS in Mauritania was reported in 1987. The national prevalence of HIV/AIDS in the country is estimated at less than 1%. The HIV serosurveillance among pregnant women started in country in 2001. This work has focused on HIV sentinel surveillance among pregnant women in antenatal clinics, attending health centres in different wilayas (regions) of the country in order to assess evolution of prevalence between 2001 and 2007. An anonymous and non-correlated method is used for this survey. A questionnaire was administered and venous sampling made for eligible women. Analyses were performed with an algorithm based on two screening tests (ELISA) and another test for confirmation (New Lav Blot). Despite some disparities between the sites considered, the results have shown a low prevalence rate (between 0.1 and 1.48). The average prevalence of HIV infection samples collected increased from 0.57% [0.34-0.80] in 2001 to 0.61% [0.40-0.82] in 2007 with 95% confidence interval. Statistical analysis showed no significant changes between 2001 and 2007 at all these sites. HIV1 is the most frequent type with a proportion of 93.5% in 2007. After several years of classic HIV sentinel surveillance, and to better understand disparities between sites, we recommend a second generation sentinel surveillance (behavioural and serological) approach.

Most nurses will not go to another county and provide healthcare education, but will care for patients from other countries and faiths who practice traditions that impact how they manage their illness. This author shares his experience in Mauritania, which provides an excellent example for understanding issues in cross-cultural diabetic education. Universal principles for cross-cultural health education are offered.

Background: Malaria is one of the main motives for outpatient consultation and hospitalization in Mauritania. However, its incidence remains unclear because of diagnostic problems and insufficient epidemiological data., Methods: Between April and August 2007, a study on malaria incidence was carried out in Nouakchott city. A total of 237 febrile outpatients, from all Nouakchott districts, attending the two main hospitals of the city were investigated. Finger prick and blood dried filter paper samples were performed to prepare thick and thin films and nested-PCR for malaria parasite species identification and density. The accuracy of diagnosis of 'presumptive malaria', assigned by clinicians and based on fever and other malaria suggestive symptoms, was assessed. Entomological investigations based on morphological and molecular characterization of Anopheline species were conducted in Dar Naïm district., Results: Malaria prevalence rate was 25.7% (61/237), the majority of positive blood slides as well as nested-PCR products were due to Plasmodium vivax 70.5% (43/61) and Plasmodium ovale 24.6% (15/61). Two malaria patients, both with P. vivax, have never travelled out of Nouakchott and seem likely to have been autochthonous (3.3%). Of the 237 individuals included in the survey, 231(97.5%) were clinically diagnosed and treated as malaria cases. 26.4% of clinically diagnosed cases were positive for Plasmodium using microscopic examination and PCR. Thus, false positive cases constituted 73.6% (170/231) of the clinically diagnosed malaria cases. The search for mosquito vectors in Dar Naïm district allowed morphological and molecular identification of Anopheles arabiensis and Anopheles pharoensis., Conclusion: This study demonstrates that, during the hot and dry season, Plasmodium species responsible of recurrent malaria (P. vivax and P. ovale) are the dominant species in Nouakchott city and autochthonous malaria cases exist but are rare. Clinical diagnosis of malaria has a very low positive predicted value. The systematic use of microscopy-based diagnosis and/or rapid diagnostic tests should be considered to appropriately manage malaria and non-malaria cases.

This article provides an overview of hospital-based rates of caesarean delivery in 18 Arab countries and the association between these rates and selected demographic and socioeconomic characteristics. Data on caesarean section were based on 2 of the most recent national hospital-based surveys in each country and on published studies based on hospital samples. High levels of caesarean delivery were found in Egypt (26% in 2003), followed by Sudan (20% in 1993). Six countries and the West Bank area of Palestine had rates >15% and 11 countries and Gaza had rates between 5% and 15%. The findings indicate an increasing trend of caesarean section delivery in the region. Policies aiming at reducing surgical deliveries should seek to identify and address these risk factors.

Cystic hydatid disease is a zoonotic parasitic disease caused by the cestode Echinococcus granulosus and represents a major public health problem in many countries around the world, including North Africa. E. granulosus exists as a series of genetic variants or strains which differ in a wide variety of criteria that impact on the epidemiology, pathology and control of cystic hydatid disease. Nucleotide sequencing of the mitochondrial rrnS gene was here used to characterize 38 E. granulosus isolates collected from different regions and hosts in Tunisia and Mauritania. The results obtained reveal a significant genetic differentiation between E. granulosus hydatid cysts identified as belonging to the G1 genotype and to the G6/G7 cluster using the rrnS gene as marker, and indicate the circulation of the common sheep strain (G1) in all host species from Tunisia and the camel/pig strain cluster (G6/G7) in camel from Mauritania. Other investigations, using this method, are necessary for further genetic analysis of a wider range of isolates from different host species in order to more fully understand the genetic structure of E. granulosus populations and their transmission dynamics in this and neighbouring African countries.

In October 2003, 9 human cases of hemorrhagic fever were reported in 3 provinces of Mauritania, West Africa. Test results showed acute Rift Valley fever virus (RVFV) infection, and a field investigation found recent circulation of RVFV with a prevalence rate of 25.5% (25/98) and 4 deaths among the 25 laboratory-confirmed case-patients. Immunoglobulin M against RVFV was found in 46% (25/54) of domestic animals. RVFV was also isolated from the mosquito species Culex poicilipes. Genetic comparison of virion segments indicated little variation among the strains isolated. However, phylogenetic studies clearly demonstrated that these strains belonged to the East-Central African lineage for all segments. To our knowledge, this is the first time viruses of this lineage have been observed in an outbreak in West Africa. Whether these strains were introduced or are endemic in West Africa remains to be determined.

The seroprevalence against heartwater for maure zebus coming from Mali and Mauritania is analysed by indirect ELISA using the major antigenic protein number 1-B (MAP1-B). Sero-epidemiological results realized on maure zebu cattle give a good adequation between the abundance or absence of the vector tick in the two countries for 98% of prevalence in Mali (infected area) and 0% of prevalence in Mauritania (non infected area).

This study assessed prenatal influenza exposure in relation to pregnancy complications and delivery complications. Participants of this study consisted of a community sample of all mothers of 1,795 children who were a birth cohort recruited at age 3 in a prospective longitudinal project in Mauritius. The onset of the 1968-1972 A2/Hong Kong influenza epidemic in January 1970 was established from officially published death rates and newspaper records. Data on pregnancy and delivery complications were derived from hospital and clinic records. The study found that prenatal exposure to influenza was associated with increased delivery complications, F(1,351) = 12.2, P = 0.001. There was no effect of influenza exposure on pregnancy complications. The findings have implications for theories on both the development of schizophrenia and other behavior processes. From a public health perspective, reducing influenza exposure in young women of childbearing age might be a critically important first step in the prevention of adverse psychiatric outcomes associated with obstetric complications.

The taxonomic and phylogenetic status of Echinococcus granulosus strains are still controversial and under discussion. In the present study, we investigated the genetic polymorphism of E. granulosus isolates originating from three countries of Africa, including a region of Algeria, where the common G1 sheep and the camel G6 strains coexist sympatrically. Seventy-one hydatid cysts were collected from sheep, cattle, camels, and humans. Two mitochondrial markers (cox1 and nad1) were used for strain identification. Two nuclear markers (actII and hbx2) were used to study the possible occurrence of cross-fertilization. Despite the heterogeneity observed among the G1 isolates, they were all localized within one robust cluster. A second strong cluster was also observed containing all of the G6 isolates. Both strains appeared as two distinct groups, and no cases of interbreeding were found. Thus, the attribution of a species rank can be suggested. We also found the Tasmanian sheep G2 strain for the first time in Africa. Because of the slight variations observed between the common sheep and the Tasmanian sheep strains, further studies should be carried out to elucidate the epidemiological relevance of this genetic discrimination.

Objectives: The aim of this study is to describe the epidemiological profile of congenital heart diseases in Mauritanian children., Material and Methods: Our population was composed of children referred by the different cardiologists of the country on the occasion of two missions of pediatric cardiologists in December 2001 and November 2002. All patients had physical examination, chest radiogram, electrocardiogram, and echocardiogram., Results: There were 84 patients aged between 2 months and 16 years. Mean age was 6.1 +/- 5.0 years. Forty eight children (57.1%) were males and 36 (43.9%) females (sex ratio was 1.3). Ventricular septal defect (17%), tetralogy of Fallot (13%) and pulmonary stenosis (12%) were the predominant pathologiese. Surgery was initially indicated for in 61 infants (73%), realized in 22 of them (26%) and considered out of date in 10 patients (12%)., Conclusion: Congenital heart diseases pose a major problem of treatment in Mauritania. They are dominated by the left to right shunts. The age of diagnosis is relatively late (6 years) exposing to the risk of complications. Therefore, a team of paediatric cardiologists on the spot and the setting up of cardiovascular surgery facilities are necessary.

Prevalence of epilepsy in developing countries is considered to be 2 to 5 times superior to the industrialized countries. In tropical areas, the diagnosis of epilepsy is still reliant on the clinic and requires a precise semiological description. A good epidemiological and clinical research requires standardized and validated screening tools. The objective of this work was to evaluate the validity of the screening module of the investigation questionnaire on epilepsy in tropical areas, in Nouakchott, Mauritania. All the patients included in the study were examined at first by a neurologist, then directed towards an investigator who asked the 5 screening items of the investigation questionnaire. Any person answering "yes" at least one question was regarded as "suspected of epilepsy" by the investigator. Secondly the neurologist re-examined the subjects and confirmed the diagnosis. The sensitivity and the specificity of the module of screening were calculated. On the whole, 236 patients were included in the study 131 had answered "yes" at least one of the questions of the module of screening and was regarded as "suspected" of epilepsy (55.5%) by the questionnaire. The diagnosis of epilepsy was made for 82 subjects by the neurologist. The sensitivity of the module of screening of the epilepsy was 95.1% (CI 95%: 87.3-98.4) and specificity was 65.6% (CI 95%: 57.5-72.9). The screening module of the investigation questionnaire of epilepsy in tropical zones, made up only by 5 questions, has diagnosis qualities acceptable and comparable with those reported in the literature. The use of this tool integrated in a more general questionnaire of investigation of the. epilepsy proves to be an essential instrument in conducting epidemiologic studies in epileptology' in tropical zones.

Following an outbreak of Rift Valley fever (RVF) in south-eastern Mauritania during 1998, entomological investigations were conducted for 2 years in the affected parts of Senegal and Mauritania, spanning the Sénégal River basin. A total of 92 787 mosquitoes (Diptera: Culicidae), belonging to 10 genera and 41 species, were captured in light traps. In Senegal, Culex poicilipes (41%) and Mansonia uniformis (39%) were the most abundant species caught, whereas Aedes vexans (77%) and Cx. poicilipes (15%) predominated in Mauritania. RVF virus was isolated from 63 pools of Cx. poicilipes: 36 from Senegal in 1998 and 27 from Mauritania in 1999. These results are the first field evidence of Cx. poicilipes naturally infected with RVFV, and the first isolations of this virus from mosquitoes in Mauritania - the main West African epidemic and epizootic area. Additional arbovirus isolates comprised 25 strains of Bagaza (BAG) from Aedes fowleri, Culex neavei and Cx. poicilipes; 67 Sanar (ArD 66707) from Cx. poicilipes; 51 Wesselsbron (WSL) from Ae. vexans and 30 strains of West Nile (WN) from Ma. uniformis, showing differential specific virus-vector associations in the circulation activity of these five arboviruses.

This study is to evaluate the consequences of consanguinity and social factors on infanto-youthful mortality and fertility in Mauritanian ethno groups. Thereafter we studied the correspondence between the methods of all the studied variables. The analysis of a sample of 2413 couples obtained according to the quota method showed that the infanto-youthful death rate in Soninkes and the Poulard ones was higher in the consanguineous groups than in the non consanguineous ones. On the other hand, in Maures. Wolofs and black Maures the difference is not significant. For all the Mauritanian ethno groups the consanguineous couples had averages of fertility significantly higher than those of non consanguineous. Analysis of the correspondences revealed two groups. The first was formed by the related ones. The second by the non-related ones. Each group formed a unit with other specific demographic characteristics.

We examined the types of marriage between husband and wife and their frequency as well as the intensity of consanguinity for the Mauritanian ethnic groups. Then we evaluated for all the population, the variations of each of these dimensions according to the dates of marriage. The analisys of a sample of 2413 couples obtained according to the quota method showed that the Mauritanian population presents a strong family endogamy of about 47.20%. The Wolofs and the Poulards present pourcentages of marriages between blood relations of about 74.47% and of 55.74% respectively. On the other hand, for the Maures, black Maures and Soninkes, the proportions of marriages between blood relations are of the order of 41.25%, 30.52% and 46.99% respectively. This same analysis has also shown that the Mauritanian ethnic groupes present high apparent coefficient of consanguinity. They are of a level of unions between unequal cousins (1 /32) for (1/64) for others. The evaluation of endogamy practices in function of marriage dates (from 1921 to 1991) shows and for all the population a decline tendency in the pourcentages of consanguine marriages, and at the level of a whole Mauritanian population.

From February to August 2003, 38 persons were infected with Crimean-Congo hemorrhagic fever (CCHF) virus in Mauritania; 35 of these persons were residents of Nouakchott. The first patient was a young woman who became ill shortly after butchering a goat. She transmitted the infection to 15 persons in the hospital where she was admitted and four members of her family. In Nouakchott, two disease clusters and 11 isolated cases were identified. The case-fatality ratio was 28.6%. Of the patients not infected by the first case-patient, almost half were butchers, which suggests that the primary mode of animal-to-human transmission was direct contact with blood of infected animals. The hospital outbreak alerted health authorities to sporadic cases that occurred in the following weeks, which would have probably gone otherwise unnoticed. Studies must be conducted to determine the potential risk for continued sporadic outbreaks of CCHF in humans and to propose prevention measures.

The current situation of endemic malaria in Mauritania is not clear since, in most health centres, suspected malaria cases are not confirmed by parasitological analysis and diagnosis is based on clinical symptoms alone. To obtain reliable data about malaria in this country, thin and thick blood smears were taken from patients with symptoms compatible with the illness, who attended two hospitals: Polyclinic of Nouakchott, which serves one-third of the country's population, where a malaria infection rate of 18.5% (77 of 446) was recorded; Plasmodium falciparum caused 61.85% of these, P. vivax 35.5% (28/77). In Kaedi Regional Hospital, provincial capital of the endemic Gorgol region, a prevalence of 25.49% (106 of 416) was recorded, with P. falciparum as the sole pathogenic species. Of the 77 cases of malaria diagnosed in Nouakchott, nine (seven of P. falciparum and two of P. vivax) were considered as endemic to the city. These cases were all children under 8 years of age except for one adult who had never left the capital, and this is the first time that cases endemic to this city have been detected.

Despite its diminishing efficacy because of increased resistance, chloroquine remains the primary antimalarial agent in many endemic areas. Evidence is mounting that point mutations on the Pfcrt and possibly the Pfmdr1 genes are conferring plasmodial resistance to chloroquine. In 1998, atypically strong rainfalls led to an increased activity of falciparum malaria in Mauritania that affected non-endemic regions bordering the Saharan desert. An in vivo study on chloroqine resistance was combined with studies for molecular markers of drug resistance. Detection of Pfmdr1-76-tyrosine showed an increased odds ratio (2.91) for resistance (P = 0.0195). However, by use of this codon alone, sensitivity for detection of resistance was 60.6%, and specificity was 65.3%. In comparison, detection of the K76T mutation at Pfcrt showed a very high sensitivity (100%) while specificity remained relatively low (65.4%). For the combination of mutations on both genes, the odds ratio for detection of resistance increased to 5.31 (P = 0.0005). Here, sensitivity was again decreased to 60.6% while specificity increased to 76.9%. The results of this study suggest that detection of Pfcrt T76 can be applied for predicting chloroquine resistance in epidemiologic settings with sufficiently high sensitivity to make it an attractive alternative to time- and labor-consuming in vivo trials. Additional testing for Pfmdr Y76 provides increased specificity to this approach.

Mauritania lies between West-Central Africa where human cystic echinococcosis (CE) is considered extremely rare and West Maghreb where CE accounts for a real public health problem. Until 1992, Mauritania was considered as human CE-free even through CE seemed well known in livestock. In 1992, the introduction of ultrasonography led to the diagnosis of the first human CE cases. In 1997, a veterinary study revealed that dogs living around Nouakchott were commonly infected by Echinococcus granulosus. To assess E. granulosus transmission and to identify the most relevant animal reservoir responsible for human CE emerging in Mauritania, a simultaneous eco-epidemiological and molecular biology approach was performed. The fieldwork included sample collection and investigation of relationship between intermediate hosts, definitive hosts and humans. Typing of E. granulosus strains was performed using comparison of polymerase chain reaction (PCR)-amplified DNA sequences with one nuclear (BG 1/3) and 2 mitochondrial (COI, NDI) targets. Results show that the 'camel' strain is actually infectious to humans and circulates between intermediate hosts including camels and cattle. It is suggested that preventive measures at slaughtering places could reduce human contamination.

We performed a study of hemoglobin in 700 blood donors attending the Centre Hospitalier National de Nouakchott in Mauritania. We detected 116 cases of anomalies corresponding to a global prevalence of 16.6%. The analysis of the samples studied showed that 72.3 % of the donors were Blacks and 28.7 % were White Maurs ( Maures blancs). In the Black population the prevalence of hemoglobinopathies is 21.44% whereas among the White Maurs it is 4.47%. In this study, the six ethnic groups that constitute the Mauritanian population were also represented in the sample, but with different numbers. We noted some differences in the repartition of anomalies among these groups. The hemoglobin anomalies that were found are sickle cell anemia, beta-thalassemia, and delta-variant, all in heterozygous form. Geographical repartition revealed that the hemoglobin abnormalities are mostly encountered in the Southeast and the Southwestern parts of the country, which could be considered areas of high risk for hemoglobinopathies.

A Rift Valley fever outbreak occurred in Mauritania in 1998. Seroepidemiologic and virologic investigation showed active circulation of the Rift Valley fever virus, with 13 strains isolated, and 16% (range 1.5%-38%) immunoglobulin (Ig) M-positivity in sera from 90 humans and 343 animals (sheep, goats, camels, cattle, and donkeys). One human case was fatal.

While the population structure of Plasmodium falciparum is well analysed in selected areas with high malaria endemicity in East and West Africa, only limited data are available for low endemicity regions bordering the Saharan desert. This is one of the first studies for the Sahel, where atypically strong rainfalls in 1998 and 1999 led to a severe outbreak of falciparum malaria in south-east Mauritania. During a study on in vivo-drug resistance against chloroquine we collected blood samples of patients with fever in two medical centres located in non-endemic and hypoendemic areas. We analysed 386 samples by polymerase chain reaction for infection with P. falciparum, and 173 (45%) tested positive. The isolates were genotyped for three polymorphic genetic markers: merozoite surface protein 1 (MSP1), MSP2 and glutamate-rich protein (GLURP). Differences between the two regions could be shown in either number of clones per infection or in their distribution on the different allelic groups. While the mean minimal number of clones in the non-endemic region around Aioun was 1.57, blood samples collected in the hypoendemic region around Kobeni showed multiple infections with an average of 2.34 clones (P < 0.001). In addition, clear differences between endemic regions were apparent in three of the investigated allelic groups: RO33 of the MSP1 gene and FC and Indochina of the MSP2 gene.

The increasing resistance of Plasmodium falciparum in the treatment of uncomplicated malaria with pyrimethamine/sulphadoxine has been associated in several studies with the occurrence of point mutations in the genes of dihydrofolate reductase (DHFR) and dihydropteroate synthetase (DHPS). In this study, the prevalence of these mutations was examined in samples from south-east Mauritania, where atypically strong rainfalls in 1998 and 1999 led to a severe outbreak of falciparum malaria. We analysed 386 samples by polymerase chain reaction (PCR) for infection with P. falciparum, of which 162 (41.97%) were positive. These isolates were examined for point mutations in the genes of DHFR (codons 16, 51, 59, 108 and 164) and DHPS (codons 436, 437, 540, 581 and 613) by nested PCR and subsequent mutation-specific restriction enzyme digest. We found a low overall prevalence of DHFR gene mutations (up to 18.6% of isolates), but a high overall prevalence of DHPS gene mutations (up to 49.1% of isolates). Thus, emerging resistance to antifolate drugs may be expected to develop soon in the investigated area. This study demonstrates the utility of simple, relatively rapid and inexpensive molecular methods and their application in surveillance programmes. Testing for prevalence of point mutations conferring antifolate resistance might help to identify the developing of drug resistance at a very early stage.

666 patients are observed at the external consultation of cardiology from january to june 1996: 227 are obese (34.08%), 187 (82.38%) of whom are women, and 40 men (17.62%), the age average of patients is 40.97 years (between 14 years and 91 years) and the weight average is 84.63 Kg (between 61 Kg and 154 Kg). The body mass index is more than 35 (morbid obesity) in 24.67% of cases (22.91% of whom are women, and 1.76% are men. The other risk factors found are: High blood pressure = 72 cases (31.72%) are obese and having high blood pressure 53 (23.35%) of whom female and 19 (8.37%) are male. 104 (23.69%) cases of high blood pressure are lean (9.11% women, 14.58% men). There is a significantly statistic between the two groups. Diabetes: 9 obese patients are diabetic (2.64% female, and 1.32% male. 1.94% of lean patient are diabetic. We notice a significantly statistic differences between the two groups. For other risk factors we find: 1.76% of tobacco dependent patients are obese where as 3.64% are lean. 0.88% of hypercholesterolemia and 0.44% of hyper uricemia.

It is about a retrospective study dealing with the place of tuberculous spondylitis with discitis among medullary wounds hospitalized in our service from January 1995 to June 1998 and their medical care. Twenty reports have been done making: 30.30% of our medullary wounds. We have noted a male prevalence and precocity. The flaccido-spastic paraplegia with sensitive level prevails the clinical chart (45%) this in correlation with thoracic and lumbar localization predominance (75%) at the radiography. All patients have had for their benefit an anti-tuberculous treatment and eleven among them had also tetracosactide (synactène retard). This has allowed us to observe a quick recovery of the motor deficit for nine patients: 81.8% of the patients who have had the therapeutic association; 45% of the whole. No patient had an operation.

This preliminary survey was intended to collect transversal data to ensure a better understanding of the hepatitis B and C epidemiology in Mauritania. The authors have studied the seroprevalence rate of HBs antigen and HCV antibodies among 349 blood donors. Data of this study showed that anti-HCV antibody was detected in 1.1% and HBs antigen in 20.3% blood donors.

We investigated thyroid abnormality in Mauritania by carrying out a prospective ultrasound study of 171 patients. One hundred and thirty four patients underwent thyroid hormone determination (T3, T4 and TSH) and 123 had complementary plain film X rays of the chest and neck. These ultrasound examinations accounted for 3.8% of all ultrasound examinations performed over the study period. Thyroid abnormalities were more frequent in young adults aged 20 to 40 years (67.4%) and in women (83%) in Mauritania. Thyroid diseases affected people from savanna and mountain regions in particular. Diffuse goiters were the most frequent problem (76.3%) and most were multinodular or heterogeneous forms with necrosis or hemorrhage. One case of homogeneous diffuse goiter was found to be an infiltrating vesicular adenocarcinoma with metastatic adenopathy. Nodular goiters were mostly cystic, with septation (51.9%) and could be mistaken for hydatid cysts, which are endemic to the region. Further study of these aspects of thyroid diseases in Mauritania are required.