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Systemic endectocidal drugs, used to control nematodes in humans and other vertebrates, can be toxic to Anopheles spp. mosquitoes when they take a blood meal from a host that has recently received one of these drugs. Recent laboratory and field studies have highlighted the potential of ivermectin to control malaria parasite transmission if this drug is distributed strategically and more often. There are important theoretical benefits to this strategy, as well as caveats. A better understanding of drug effects against vectors and malaria ecologies are needed. In the near future, ivermectin and other endectocides could serve as potent and novel malaria transmission control tools that are directly linked to the control of neglected tropical diseases in the same communities., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Laboratory follow-up of HIV patients in resource-limited settings requires appropriate instruments for CD4 T cell enumeration. In this study, we evaluated the application of a simplified, mobile and robust flow cytometry system, the Apogee Auto 40 analyzer (Auto40) using thermoresistant reagents, for CD4 T cell enumeration. We measured the absolute CD4 counts in fresh whole blood samples from 170 Senegalese subjects, including 129 HIV-positive (HIV+) patients and 41 HIV-negative (HIV-) controls. Based on volumetric primary CD4 gating, cells were stained with commercially available reagents (Easy MoAb CD4;Bio-D, Valenzano, Italy) and analyzed on the Auto40. The results were compared with those from the FACSCount system (Becton Dickinson, San Jose, USA). Repeatability analysis was performed on duplicate testing of 49 samples on both FACSCount and Auto40. The intra-run precision was measured by 10 replicates using 3 clinical blood samples with low, intermediate and high CD4 concentrations. The results from the two instruments were in good agreement. The percent similarity between the results of both instruments was 99%±relative standard deviation of 12.7%. The concordance correlation coefficient was 0.99. The absolute bias and limits of agreement (LOA) between the two instruments, calculated by Bland-Altman analysis, were clinically acceptable (bias: +4 cells/μl; LOA: -111 to +120 cells/μl). The clinical agreement between the two instruments at a cutoff of 200 CD4 cells/μl was 94%. The repeatability of measurements on the Auto40 was also similar to that observed with FACSCount system (bias +0.1 cells/μl, coefficient of variation 2.5% vs bias -1.1cells/μl, coefficient of variation 2.9% respectively). In conclusion, our results indicate that the Auto 40 system, using thermoresistant reagents, is suitable for CD4 T cell enumeration and will be a helpful tool to improve HIV laboratory monitoring in resource-limited settings., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Understanding the processes by which species colonize and adapt to human habitats is particularly important in the case of disease-vectoring arthropods. The mosquito species Aedes aegypti, a major vector of dengue and yellow fever viruses, probably originated as a wild, zoophilic species in sub-Saharan Africa, where some populations still breed in tree holes in forested habitats. Many populations of the species, however, have evolved to thrive in human habitats and to bite humans. This includes some populations within Africa as well as almost all those outside Africa. It is not clear whether all domestic populations are genetically related and represent a single 'domestication' event, or whether association with human habitats has developed multiple times independently within the species. To test the hypotheses above, we screened 24 worldwide population samples of Ae. aegypti at 12 polymorphic microsatellite loci. We identified two distinct genetic clusters: one included all domestic populations outside of Africa and the other included both domestic and forest populations within Africa. This suggests that human association in Africa occurred independently from that in domestic populations across the rest of the world. Additionally, measures of genetic diversity support Ae. aegypti in Africa as the ancestral form of the species. Individuals from domestic populations outside Africa can reliably be assigned back to their population of origin, which will help determine the origins of new introductions of Ae. aegypti.

Ivermectin mass drug administration (MDA) to humans is used to control onchocerciasis and lymphatic filariasis. Recent field studies have shown an added killing effect of ivermectin MDA against malaria vectors. We report that ivermectin MDA reduced the proportion of Plasmodium falciparum infectious Anopheles gambiae sensu stricto (s.s.) in treated villages in southeastern Senegal. Ivermectin MDA is a different delivery method and has a different mode of action from current malaria control agents. It could be a powerful and synergistic new tool to reduce malaria transmission in regions with epidemic or seasonal malaria transmission, and the prevalence and intensity of neglected tropical diseases.

The rapid evolution of HIV-1 is a major obstacle to viral eradication. Early antiretroviral therapy (ART) during primary HIV-1 infection could limit viral diversity. Eighteen patients recently infected with HIV-1 were selected. Nine initiated ART soon after enrolment and nine remained untreated. Replication-competent (RC) viruses were quantified at baseline and after one year of follow-up. Viral diversity in the C2V5 envelope region was evaluated from plasma, peripheral blood mononuclear cells (PBMCs), and cell culture at both time points. The amount of RC virus in the treated group declined (median -5.42 infectious units per million [IUPM]) while it remained stable or increased in the untreated group (median +0.87 IUPM). At one year post infection, we observed a significant increase in diversity for the C2V5 (+0.150%) region, specifically in the hypervariable loops V4 (+0.73%) and V5 (+0.77%), in the untreated group. More importantly, viral diversity did not significantly increase in treated individuals during the first year post infection. Genetic diversity during primary infection remains low through the first year of infection. Early treatment could contribute to a decrease in RC viruses from PBMCs and to limitation of viral diversification in the viral reservoir. These findings may have relevance for the rational design of specific immunotherapeutic strategies.

We evaluated the efficacy and tolerability of a single dose of the split virion AS03-adjuvanted pandemic H1N1 influenza vaccine (A/California/7/2009) in 84 HIV-1 infected individuals. Antibody titers were determined by hemagglutination inhibition assay and by microneutralization. Vaccine was well tolerated. At 21 days post vaccination, 56 (67%) patients had seroconverted. There was no correlation between baseline CD4 cell count (p=0.539) or HIV viral load (p=0.381) and immune response. Other vaccine strategies should be evaluated in this HIV population, to improve response rates., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Aim: Pregnant women HIV infection has main risk the contamination of newborn. MTCT actions permit to reduce that risk., Material and Methods: Our survey has been realized in Gabriel Touré teaching hospital gynecology and obstetrics and pediatric departments. It is about an observational prospective and descriptive survey that spreads on a period from January 2005 to December 2008. Has been included in the study all the HIV positive pregnant women followed in our service and their babies that had received ARV prophylaxis and 18 months of life serology., Results: We recorded 211 HIV positive pregnant women on a total of 9291 childbirths (2.27%). We noted 90.52% of HIV-1 vs 7.11% of type 2. The mother treatment consisted in a tri therapy in 77.25 vs 0.47% of bi anti retroviral and 22.28% of mono anti retro viral therapy. Maternal viral load was undetectable at the moment of delivery in 78.20% of cases. We noted vaginal delivery in 84.36% vs 15.64% of caesarean section. Newborns respectively received 67.32%; 4.88% and 22.92% of bi, tri and mono therapy. They formula-fed in 98.98%. The mother to child HIV transmission rate was 1.98%., Conclusion: HIV prevalence in pregnant patients is relatively height. HARRT in HIV positive mothers associated to bi therapy and formula feeding to their infants permit to obtain low vertical HIV transmission rate.

Introduction. The aim of this retrospective, unicentric study over 5 years is to describe the epidemiologic, pathologic, clinic and therapeutic aspects of children treated for Hodgkin lymphoma in our paediatric oncology unit. Patients and Methods. From January 2005 to December 2009, all children under 18 years of age, with Hodgkin lymphoma were included in this study. The treatment protocol was the GFAOP (Groupe Franco-Africain d'Oncologie Pédiatrique) Hodgkin lymphoma treatment protocol. Results. During the study period, 217 cancer cases were diagnosed in our centre. Of these cases, 7 were Hodgkin Lymphoma (LH) (0.04%). The mean age was 11.7 years. The sex-ratio was 6/1. 4% (5/7) of patients were stage IIB and 28.6% (2/7) stage IIIB of Ann-Arbor classification. There were 3 cases (42.8%) of sclero-nodular subtype, 2 cases (28.6%) of lymphocyte-rich classical HL subtype, 1 case (14.3%) of mixed cellularity and 1 case (14.3%) of lymphocyte depleted subtype. With a median followup of 37 months, 5 patients (71.4%) are alive, and 2 patients (28.6%) died. Conclusion. Broader multicentric studies are needed for more accurate data on this malignancy.

The prematurity remains in our developing countries a problem of current events. The deficiency in human resources and the low level of the technical equipment exposes premature babies to a high risk of morbidity and mortality in neonatal period. Those who survive need a closer follow-up after their discharge from hospital. Our objective through this study was to appreciate the quality of following-up premature babies in ambulatory. It was a longitudinal study with descriptive aim which took place from January, 2007 till December, 2008 in the paediatric service of the Teaching Hospital of Cocody. Our population was constituted by 100 premature babies selected in a random way. The premature babies had on average 31,7 weeks of gestationel age. The sex ratio was 0,96. The born weight was between 900 and 2550g. The main causes of prematurity were multiple pregnancies (18 %), malaria (15 %), premature break of membranes (12 %) and éclampsia (10 %). Most of premature babies were hospitalized for a problem of breeding ( 47 %.). The average number of consultation was 6,25. Only 25 children were effectively followed during 12 months with a middleweight of 9112g. The follow-up had been interrupted before 3 months of native age in 31 % of cases and before 3 months of real age in 52 % of cases. The mothers had preferred the feeding in 48 % of cases, but the curves of weight development were superposables whatever the type of food supply. The pathology during the follow-up was dominated by digestive disorders, respiratory infections and anaemia. Forty percent of the premature babies was able to have an haemoglobin test and 8 %, a neuroradiological scraeming. A third of the premature babies (30 %) had been hospitalized again for anaemia (10 %) and respiratory infections (10 %). We recorded 3 deaths. CONCLUSION: The follow-up of premature babies getting out of hospital remains difficult in our context of life. The mothers must be sensitived on the consequences of prematurity and the importance of their follow-up. This follow-up has to be the affair of all, as well parents, health workers that government.

Background: In south-eastern Senegal, malaria and onchocerciasis are co-endemic. Onchocerciasis in this region has been controlled by once or twice yearly mass drug administration (MDA) with ivermectin (IVM) for over fifteen years. Since laboratory-raised Anopheles gambiae s.s. are susceptible to ivermectin at concentrations found in human blood post-ingestion of IVM, it is plausible that a similar effect could be quantified in the field, and that IVM might have benefits as a malaria control tool., Methods: In 2008 and 2009, wild-caught blood fed An. gambiae s.l. mosquitoes were collected from huts of three pairs of Senegalese villages before and after IVM MDAs. Mosquitoes were held in an insectary to assess their survival rate, subsequently identified to species, and their blood meals were identified. Differences in mosquito survival were statistically analysed using a Glimmix model. Lastly, changes in the daily probability of mosquito survivorship surrounding IVM MDAs were calculated, and these data were inserted into a previously developed, mosquito age-structured model of malaria transmission., Results: Anopheles gambiae s.s. (P < 0.0001) and Anopheles arabiensis (P = 0.0191) from the treated villages had significantly reduced survival compared to those from control villages. Furthermore, An gambiae s.s. caught 1-6 days after MDA in treated villages had significantly reduced survival compared to control village collections (P = 0.0003), as well as those caught pre-MDA (P < 0.0001) and >7 days post-MDA (P < 0.0001). The daily probability of mosquito survival dropped >10% for the six days following MDA. The mosquito age-structured model of malaria transmission demonstrated that a single IVM MDA would reduce malaria transmission (Ro) below baseline for at least eleven days, and that repeated IVM MDAs would result in a sustained reduction in malaria Ro., Conclusions: Ivermectin MDA significantly reduced the survivorship of An. gambiae s.s. for six days past the date of the MDA, which is sufficient to temporarily reduce malaria transmission. Repeated IVM MDAs could be a novel and integrative malaria control tool in areas with seasonal transmission, and which would have simultaneous impacts on neglected tropical diseases in the same villages.

In the Tropics, there is substantial temporal and spatial overlap of diseases propagated by anthropophilic mosquito vectors (such as malaria and dengue) and human helminth diseases (such as onchocerciasis and lymphatic filariasis) that are treated though mass drug administrations (MDA). This overlap will result in mosquito vectors imbibing significant quantities of these drugs when they blood feed on humans. Since many anthelmintic drugs have broad anti-invertebrate effects, the possibility of combined helminth control and mosquito-borne disease control through MDA is apparent. It has been previously shown that ivermectin can reduce mosquito survivorship when administered in a blood meal, but more detailed examinations are needed if MDA is to ever be developed into a tool for malaria or dengue control. We examined concentrations of drugs that follow human pharmacokinetics after MDA and that matched with mosquito feeding times, for effects against the anthropophilic mosquito vectors Anopheles gambiae s.s. and Aedes aegypti. Ivermectin was the only human-approved MDA drug we tested that affected mosquito survivorship, and only An. gambiae s.s. were affected at concentrations respecting human pharmacokinetics at indicated doses. Ivermectin also delayed An. gambiae s.s. re-feeding frequency and defecation rates, and two successive ivermectin-spiked blood meals following human pharmacokinetic concentrations compounded mortality effects compared to controls. These findings suggest that ivermectin MDA in Africa may be used to decrease malaria transmission if MDAs were administered more frequently. Such a strategy would broaden the current scope of polyparasitism control already afforded by MDAs, and which is needed in many African villages simultaneously burdened by many parasitic diseases., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Few data are available on factors contributing to sexual activity and condom use in custody settings, particularly among self-identified sexual minority prisoners. To address this gap, we undertook a study of sexual behavior and condom use of 101 randomly-selected men who have sex with men (MSM) and male-to-female transgender inmates in a segregated Los Angeles jail unit that has weekly condom access. Most survey participants (53%) reported anal sex during custody. Although 65% of these reported using condoms, 75% also reported having sex without condoms. Qualitative interviews (n=17) indicate a wide range of reasons for participating in protected and unprotected sex during custody, the use of cues within the custody environment to assess potential partners' HIV status, and support for increased condom availability. Findings also indicate that high-risk sex occurs frequently in this unit and that condom distribution likely prevents a substantial amount of related HIV/STD risk.

Approximately one million newborn babies die every year as a result of birth asphyxia in developing countries. The objectives of this study are to develop the management of birth asphyxia and to establish a community-based surveillance system of vital events in rural areas of Oueléssébougou, Mali. Traditional birth attendants, female leaders of village associations and village health workers were trained to carry out communication activities designed to change behaviours in the management of birth asphyxia. The study has improved health facility-based delivery (from 80 to 93%) and the identification of birth asphyxia (11 to 12% new born babies have been resuscitated). As a result of training and supervising community actors, the quality of delivery is improved and neonatal mortality is reduced.

Background: As access to antiretroviral drugs increases in developing countries, it will become increasingly important to monitor the emergence of resistance and to define the molecular pathways involved to identify optimal therapeutic regimens., Methods: We performed genotypic resistance testing on plasma obtained from 101 HIV-infected treatment-naïve individuals from Mali. Genotyping was carried out using the Virco protocols and HXB2 was used as the reference strain., Results: CRF02&#95;AG was the most common subtype, present in 71.3% of our patient population. Other subtypes included B, C, G, CRF06&#95;CPX, CRF09&#95;CPX, CRF01&#95;AE, A2/CRF16&#95;A2D, A1 and CRF13&#95;CPX. A total of 9.9% [95% confidence interval (CI) 6.9-12.9%] of patients had at least one resistance mutation. The prevalences of mutations conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 5% (95% CI 0.7-9.2%), 6% (95% CI 1.3-10.6%) and 0%, respectively. The most frequent mutations were T215A/Y for NRTIs and K103N/T for NNRTIs. One patient harboured three NRTI resistance mutations and one NNRTI mutation. This is the first reported case of multi-drug-resistant viral transmission in Mali. Polymorphisms at protease codons 10I/V and 33F potentially associated with resistance were observed in 18.8% and 1% of patients, respectively. Several polymorphisms in the C-terminal domain of reverse transcriptase were observed: A371V (in 63.4% of patients), G335D (76.2%), E399D (10.9%) and G333E (1%)., Conclusion: Primary resistance was seen in 9.9% of subjects, which is higher than previously reported in Mali. Taking into consideration other polymorphisms in protease such as L10I/V and 33F, primary resistance could reach 28.7% (95% CI 19.9-37.5%). Our study reflects the need to monitor the evolution of resistance on a regular basis and trends of transmitted resistance.

Most US jails and prisons do not provide condoms to prisoners because of concerns about possible negative consequences. Since 1989, the jail system of San Francisco, California, has provided condoms to male prisoners through 1-on-1 counseling sessions. Given the limitations of this approach, we installed, stocked, and monitored a free condom-dispensing machine in a jail to examine the feasibility of this method of providing condoms to jail prisoners. After the machine was installed, we observed increases in prisoners' awareness of programmatic access to condoms and in their likelihood of having obtained condoms. Particularly large increases in condom uptake were reported among those in high-risk groups. Sexual activity did not increase, custody operations were not impeded, and staff acceptance of condom access for prisoners increased.

Unlabelled: Neonatal morbidity and mortality is a real concern in our context. Several factors including the organization of the reference contribute to it. Our work was aimed at studying the conditions of newborns transfer of the towards the service of pediatrics of teaching hospital Gabriel Touré., Material and Methods: Our study proceeded from October 15th, 2006 to January 15th, 2007 in the unit of neonatology of the service of Pediatrics of the CHU of the Hospital Gabriel Touré. It was a cross sectional and descriptive study. All the newborns referred by a health structure were included., Results: We included 760 referred newborns out of 1072 neonatal admissions which means a frequency of reference of 71%. In 91.6% of the cases, the newborn were referred on the very day of their birth. Prematurity (29%), perinatal anoxia (24%), respiratory distress (13.9%) were the main reasons for reference. In no case, the service of pediatrics was contacted in advance by the referring health agent. More than half of the cases (58.6%), the public transport was used. Ambulance car transported 17.4% of the newborns. All the newborns came held in the arms of a member of their family. The referring agent was a physician in 70.3% of cases. Hypothermia was found for all the newborns (759/760) when being received. More half of the newborns (56.4%) had a small weight at birth and the quarter (25.8%) was resuscited. Lethality was 32%. Mother illiteracy, small weight at birth, the outborn birth were factors related to neonatal mortality., Conclusion: In our context, the reduction of neonatal morbidity and mortality has to go through an improvement of the reference system.

Objectives: To evaluate the virological response and to describe the resistance profiles in the case of failure after 6 months of first-line highly active antiretroviral therapy (HAART) in HIV-1-infected children living in resource-limited settings., Patients and Methods: Ninety-seven HIV-1-infected children who started two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) (mainly zidovudine/lamivudine/nevirapine) in Mali were prospectively studied. Virological failure (VF) was defined as loss to follow-up, death or HIV-1 RNA viral load (VL) of >400 copies/mL at 6 months. When VL was >50 copies/mL, a genotypic resistance test was performed., Results: Among the 97 children, median age at antiretroviral initiation was 31 months and the majority were in WHO clinical (77.3%) and immunological (70.1%) stage III or IV. At month 6, 44% of children had VL > 400 copies/mL (61% VF). Among the children with detectable VL, 30/37 genotypic resistance tests were available, 8 with wild-type viruses and 22 with resistance mutations (73%): 19 M184V/I, 21 NNRTI mutations and only 3 thymidine analogue mutations (TAMs) (K70R, D67N and L210W in three distinct viruses). At failure, 6/8 children with wild-type viruses had a VL of <1000 copies/mL whereas 21/22 with resistant viruses had a VL of >1000 copies/mL., Conclusions: Under NNRTI-based regimens, early detection of VF could allow the reinforcement of adherence when VL was <1000 copies/mL, because in most of these cases no resistance mutations were detected, or a change to a protease inhibitor-based regimen if VL was >1000 copies/mL. The low frequency of TAMs suggests that most NRTIs can be used in a second-line regimen after early failure.

Chromosomal inversions are prevalent in mosquito species but polytene chromosomes are difficult to prepare and visualize in members of the tribe Aedinii and thus there exists only indirect evidence of inversions. We constructed an F(1) intercross family using a P(1) female from a laboratory strain of Aedes aegypti aegypti (Aaa) and a P(1) male Aedes aegypti formosus (Aaf) from a strain collected from south-eastern Senegal. Recombination rates in the F(2) offspring were severely reduced and genotype ratios suggested a deleterious recessive allele on chromosome 3. The F(2) linkage map was incongruent in most respects with the established map for Aaa. Furthermore, no increased recombination was detected in F(5) offspring. Recombination rates and gene order were consistent with the presence in Aaf of at least four large inversions on chromosome 1, a single small inversion on chromosome 2 and three inversions on chromosome 3.

The synthesis and characterization of the binary complex of copper(II) with the antiepileptic drug valproic acid sodium salt (Valp) and the related ternary complex with 1,10-phenanthroline (phen) are reported, as well as the anticonvulsant properties of the latter. The characterization was carried out by means of elemental analyses, infrared (IR), UV-visible (UV-vis) spectrophotometry and Electron Paramagnetic Resonance (EPR). The X-ray crystal structure of the mononuclear complex bis(2-propylpentanoate)(1,10-phenanthroline)copper(II) [Cu(Valp)(2)phen] is showed for the first time. It crystallized in C2/c space group with unit cell dimensions of a = 14.939(1) A, b = 19.280(1) A, c = 9.726(1) A, beta = 97.27(2) degrees , V = 2778.8(4) A(3) and Z = 8. The carboxylates bond in an asymmetric chelating mode and the copper atom adopts a highly distorted octahedral coordination, characterized by the sum of the angles of 365.9 degrees around Cu(II) and its nearest atoms in the CuN(2)O(2) + O(2) chromophore instead of the expected 360 degrees for a basal square planar geometry found in most Cu(II) complexes. Molecules assemble three by three through slipped pi-pi stacking of the aromatic phen with respectively 3.519 and 3.527 A distances, in a head-to-tail arrangement. Studies of the anticonvulsant properties of this bioligand chelate evidenced its lack of efficacy in preventing MES-induced seizures. Interestingly, complex 4 protected mice against the Minimal Clonic seizures at doses that do not cause Rotorod toxicity, with an ED(50) documenting very potent anticonvulsant activity in this model of seizure, a particularly useful pharmacological profile of activity for the treatment of Petit Mal seizures.

In Bamako, Mali, where surveillance revealed a high incidence of Haemophilus influenzae type b (Hib) invasive disease, Hib conjugate vaccine was introduced into the Expanded Program on Immunization and the impact assessed. Annual confirmed Hib hospitalizations for infants 0-11 months of age fell from 175/10(5) to 44/10(5) (P < 0.001); among infants 6-7 months of age Hib hospitalizations fell from 377/10(5) to 69/10(5), (82% decrease, P < 0.001). Invasive Streptococcus pneumoniae hospitalizations remained unchanged. In a baseline serosurvey, only 3/200 infants 6-7 months of age (1.5%) had protective anti-polyribosylribitol phosphate (PRP) titers > or = 0.15 microg/mL and 1(0.5%) had >or = 1.0 microg/mL. In serosurveys 18 and 30 months after vaccine introduction, 168/201 (84%) and 184/200 (92%) infants, respectively, had titers > or = 0.15 microg/mL and 141/201 (70%) and 163/200 (82%) had titers > or = 1.0 microg/mL. Introduction of Hib vaccine led to rises in anti-PRP seroprevalence, significant reductions in Hib disease, and all-cause hospitalizations, whereas S. pneumoniae disease remained unchanged.

Background: Aedes aegypti, the "yellow fever mosquito", is the primary vector to humans of the four serotypes of dengue viruses (DENV1-4) and yellow fever virus (YFV) and is a known vector of Chikungunya virus. There are two recognized subspecies of Ae. aegypti sensu latu (s.l.): the presumed ancestral form, Ae. aegypti formosus (Aaf), a primarily sylvan mosquito in sub-Saharan Africa, and Ae. aegypti aegypti (Aaa), found globally in tropical and subtropical regions typically in association with humans. The designation of Ae. aegypti s.l. subspecies arose from observations made in East Africa in the late 1950s that the frequency of pale "forms" of Ae. aegypti was higher in populations in and around human dwellings than in those of the nearby bush. But few studies have been made of Ae. aegypti s.l. in West Africa. To address this deficiency we have been studying the population genetics, subspecies composition and vector competence for DENV-2 of Ae. aegypti s.l. in Senegal., Methods and Findings: A population genetic analysis of gene flow was conducted among 1,040 Aedes aegypti s.l. from 19 collections distributed across the five phytogeographic regions of Senegal. Adults lacking pale scales on their first abdominal tergite were classified as Aedes aegypti formosus (Aaf) following the original description of the subspecies and the remainder were classified as Aedes aegypti aegypti (Aaa). There was a clear northwest-southeast cline in the abundance of Aaa and Aaf. Collections from the northern Sahelian region contained only Aaa while southern Forest gallery collections contained only Aaf. The two subspecies occurred in sympatry in four collections north of the Gambia in the central Savannah region and Aaa was a minor component of two collections from the Forest gallery area. Mosquitoes from 11 collections were orally challenged with DENV-2 virus. In agreement with the early literature, Aaf had significantly lower vector competence than Aaa. Among pure Aaa collections, the disseminated infection rate (DIR) was 73.9% with a midgut infection barrier (MIB) rate of 6.8%, and a midgut escape barrier (MEB) rate of 19.3%, while among pure Aaf collections, DIR = 34.2%, MIB rate = 7.4%, and MEB rate = 58.4%. Allele and genotype frequencies were analyzed at 11 nuclear single nucleotide polymorphism (SNP) loci using allele specific PCR and melting curve analysis. In agreement with a published isozyme gene flow study in Senegal, only a small and statistically insignificant percentage of the variance in allele frequencies was associated with subspecies., Conclusions: These results add to our understanding of the global phylogeny of Aedes aegypti s.l., suggesting that West African Aaa and Aaf are monophyletic and that Aaa evolved in West Africa from an Aaf ancestor.

Objectives: Evaluate the efficiency of the treatment of pain by analgesic according to World Health Organization (WHO)., Patients and Methods: We made a descriptive and analytic study in majors sickellers in pain crisis admitted in the service of paediatric of the hospital Gabriel Touré Bamako from January 2005 to January 2006. The efficiency of the treatment by painkiller was evaluated at second hour and at the 24 hour., Results: Our study concerned 70 children with major of sickle cell of both sexes and aged from 6 to 15 years in pain crisis. In 87.1% pain disappeared with painkillers palier I (paracetamol) and 12.9% had necessitated to pass to palier II (buprenorphine) an 64.3% our patients the pain disappeared in a period less than 12 hours with an average of 3 hours against only 35.7% soothed in a period more than 12 hours with average of 64 hours 3 minutes. Pain from the head and limbal region were the most sensible to the treatment., Conclusion: The treatment of pain by palier according to who is efficient in children sickeller.

Socially constructed ideas of gender norms and values attached to sexuality need to be considered when aiming to build the young people's capacity to adopt HIV preventive behaviours. We conducted ten focus groups and sixteen individual interviews to explore sexual norms among youth in Bamako. Premarital sex, multiple partnering, condom use and transactional sex were discussed. The findings suggest that young people's sexual norms are shaped by kin or authoritative elders as well as by external influences coming from Western culture. Sexual norms are differentially constructed by men and women and are in contradiction with those of older generations. Views on premarital sex, condom use and transactional sex generated controversy among men and women, as well as among more sexually conservative or progressive youth. However, there was general rejection of multiple partnerships. Empowering youth to pursue open debates on sexuality may be an avenue for HIV/AIDS prevention in Mali.

Background: Sub-Saharan Africa has seen dramatic increases in the numbers of people treated with antiretroviral therapy (ART). Although standard ART regimens are now universally applied, viral load measurement is not currently part of standard monitoring protocols in sub-Saharan Africa., Methods: We describe the prevalence of inadequate virological response (IVR) to ART (viral load >or= 500 copies/mL) and identify factors associated with this outcome in 606 HIV-positive patients treated for at least 6 months. Recruitment took place in 7 hospitals and community-based sites in Bamako and Ouagadougou, and information was collected using medical charts and interviews., Results: The overall prevalence of IVR in treatment-naive patients was 12.3% and 24.4% for pretreated patients. There were no differences in rates of IVR according to ART delivery sites and time on treatment. Patients living farther away [odds ratio (OR) = 2.48; 95% confidence interval (CI) 1.40 to 4.39], those on protease inhibitor or nucleoside reverse transcriptase inhibitor regimens (OR = 3.23; 95% CI 1.79 to 5.82) and those reporting treatment interruptions (OR = 2.36; 95% CI 1.35 to 4.15), had increased odds of IVR. Immune suppression (OR = 3.32, 95% CI 1.94 to 5.70) and poor self-rated health (OR = 2.00; 95% CI 1.17 to 3.41) were also associated with IVR., Conclusions: Sufficient expertise and dedication exist in public hospital and community-based programs to achieve rates of treatment success comparable to better-resourced settings.

Our work aimed to propose a manual method of counting CD4 T lymphocytes which is an alternative magnetic immunoseparation followed by a reading with a fluorescence microscope as an alternative to the automated flow cytometry. This alternative technique is easier for use, less expensive and could answer the difficulties encountered for the monitoring CD4 T cells count in developing countries. The specific objectives were: 1) to train the technicians of the peripheral sites in order to make the numeration of the CD4 T lymphocytes more accessible at the peripheral level; 2) to equip the sites with necessary facilities for the T lymphocytes CD4 count; 3) to put in place a system of quality control permitting the reliability of the results. A hundred and fifty patients have been enrolled in three care services for people living with HIV/AIDS in Dakar. This population was constituted of 119 seropositive and 31 seronegative patients acting as control group to have some patients with high rates of T lymphocytes CD4. For the follow-up at peripheral level, the patients were constituted of the active line of the patients living with HIV/AIDS supported in the targeted sites. The measurements allowed studying concordances for different rates of lymphocytes: 0 to 199, 200 to 499 and over 500 cells by mm3. The results showed also a very good correlation (r = 0.97 or r = 0.98 according to the operator) between the two methods for CD4 rates inferior to 500 cells by mm3 among both the negative group and the HIV positive patients. We also discussed the profit of decentralization for the program and the patient, as well as the setting up of an external quality control to validate the alternative technique. According to the results, the Dynabeads is well correlated with the Facscount. It is a technique that can be used as an alternative in the zones with limited resources, low prevalence and for a small number of samples.

We developed an instrument for HIV/AIDS behavioral surveillance applicable to youth living in urban West Africa. The instrument includes a comprehensive set of constructs borrowed from the sociocognitive theory of planned behavior as well as measures of parental and peer communication An exploratory (n=189) and validation sample (n=342) of young men and women living in Bamako were interviewed. Scale construct validity was assessed via factor analysis and multiple linear regressions and internal consistency was assessed using Cronbach's coefficient. All constructs had high internal consistency, scales' structure was relatively stable, and associations between different components of the questionnaire were in the predicted directions. Gender, sexual experience and education were significantly associated with attitudes and perception of control. Furthermore, attitudes, perceived behavioral control, perceived norms, and peer communication significantly predicted condom use. This questionnaire offers a valid and reliable tool for assessing young people's sexual behavior in an urban West African setting.

The goal of this study was to develop an instrument and assess the degree of satisfaction regarding HIV/STIs services for women working in, associated with, or living in or nearby, prostitution environments. This study took place in seven West-African countries (Benin, Burkina Faso, Ghana, Mali, Niger, Senegal, Togo) participating in the West Africa Aids Program (AIDS3). A validated six-dimension questionnaire was used to interview 698 women. The main inclusion criterion was having had recourse to adapted services offered through the AIDS3 program in the last six months. Results showed that women surveyed are satisfied overall. Two dimensions scored low: 'Technical skills perceived' and 'Accessibility'. Regression analyses showed that those most satisfied were women who had used the adapted services many times and women connected with community groups. Although these results are consistent with results published previously in other contexts, they now allow the AIDS3 program to consider the voices of women rarely listened to: West-African women living and working in prostitution environments.

Objectives: Limited data exist about prostate cancer screening in Africa. The goal of this study was to describe the distribution of prostate-specific antigen (PSA) values in an unselected population of Senegalese men being screened for prostate cancer, and to assess the role of PSA screening tests in the early detection of prostate cancer in this population., Patients and Methods: We undertook a cross-sectional study in a community outreach setting with 113 unselected Senegalese men. Participants completed a questionnaire, underwent a digital rectal examination (DRE), and provided a blood sample for PSA testing. The questionnaire focused on demographic data, voiding problems, PSA values, and cigarette smoking. The Kruskal-Wallis test and the Fisher exact test were used to describe differences in PSA values among the groups., Results: The median age of the participants was 65 years (range, 36-87 years). Five percent of the men knew about PSA screening and 3% had ever been tested for PSA. The median PSA value overall was 1.28 ng/ml (range, 0.14 ng/ml-50.16 ng/ml). In the first 3 age quartiles (< 55, 55-64, and 65-72 years), the median PSA increased with age (1.0, 1.3, and 2.3 ng/mL, respectively; p = 0.012) as did the percentage of men with PSA > or = 4.0 ng/ml (4%, 7%, and 28%, respectively; p = 0.034). The percentage of men with a PSA > or = 4 ng/ml was higher in the abnormal versus normal DRE group (p = 0.023), while the median PSA was lower in the smoking versus nonsmoking group (p= 0.022). We found no relationship between PSA and occupation or ethnic group., Conclusion: PSA screening is not widely used in Senegalese men. In this sample, the likelihood of having an abnormal PSA increased with age and was more common in men with abnormal DREs. These results may motivate additional studies to determine if wider use of PSA testing in this population could lead to the detection of more prostate cancer cases and improve clinical outcomes among cancer cases.

Introduction: The calcitonin is the most specific and the most sensitive marker of medullary thyroid carcinoma (MTC) both for screening and postoperative follow-up of the patients. Its measurement is made either remotely , or after stimulation of pentagastrin secretion which the answer is amplified at the carrier of CMT. The aim of this study was to estimate a chimioluminescent method by comparing it with an immunoradiological method, manual, used as reference. Correlation study was done., Materials and Methods: Two hundred and sixty three serums (263) were tested among which 64 resulting of healthy subjects and 199 resulting of patients affected) by medullary thyroid carcinoma. Statistical analysis of results was made by a study of correlation with the software OriginLab version 7.0. The manual technique used as reference method is radioimmunological (Elsa hCT, international Cisbio, Gif on Yvette, France). It was compared with a chimioluminescent technique (Nichols Advantage, Nichols Institute Diagnostics, CA, the USA)., Results: The coefficients of correlation obtained between both tests were: r = 0.76 (exactness study), r = 0.91 (after stimulation), r = 0.95 and 0.79 (staged samples), r = 0.99 (M TC patients)., Conclusions: Both techniques correlate strictly and significantly. The correlation coefficients we obtained show us that Nichols Advantage Calcitonin is completely reliable and sensitive for the measurement of the hCT in the follow-up of the CMT.

Background: In a multicentred cohort of patients on antiretroviral therapy (ART) in Burkina Faso and Mali, we analysed the prevalence of HIV drug resistance mutations in patients failing a modified directly observed therapy (mDOT) protocol., Methods: Patients on ART >6 months and with viral load (VL) >500 copies/ml were enrolled in a mDOT protocol. Genotypic resistance testing was performed on pre- and post-mDOT plasma samples of patients who still had VL >500 copies/ml after mDOT., Results: Eight hundred and one patients from seven sites participated in the study. One hundred and thirteen patients (14.1%) had VL >500 copies/ml. Most patients were treated with lamivudine along with zidovudine or stavudine and efavirenz or nevirapine. Genotypes were available for 46 patients. The predominant HIV-1 subtypes were CRFO2&#95;AG in 26 (56.5%) and AGK/K/AK in 12 (26.1%) patients. The prevalence of drug resistance mutations by class were as follows for nucleoside reverse transcriptase inhibitors: 1841/V (82.6%), 215Y/F (32.6%), 219E/Q (19.6%), 70R (19.6%), 67N (21.7%), 41L (15.2%) and 151M(2.2%). For non-nucleoside reverse transcriptase inhibitors the prevalence was: 103N (50%) and 181C/I (19.6%). Phylogenetic analysis showed that, although the genetic distances were small among isolates, there was no clustering of a particular subtype in a specific region and that the high prevalence of AGK subtype in our drug-resistant population was not due to a circulating resistant strain., Conclusion: Although CRFO2&#95;AG is the dominant clade in the Burkina Faso/Mali region, isolates with subtype K reverse transcriptase were frequent in our cohort. Drug resistance mutation pathways in subtype K reverse transcriptase need to be further evaluated in a larger cohort of non-B HIV-infected individuals.

We evaluate a new pump-probe mode-mismatched thermal lens (TL) scheme for the measurement of nonlinear absorption in nitrobenzene, benzene, and chloroform. In this new scheme the pump beam is focused in the presence of a collimated probe beam. Values of the nonlinear absorption coefficients of the materials studied for the wavelength of 532 nm are reported, and we compare the proposed technique with the well-known open Z-scan method.

Background: Blackwater fever is a rare but serious form of malaria in children. Diagnosis relies on clinical symptoms and on the color of the urines., Objectives: To describe blackwater fever in children, a disease whose prevalence seems to be increasing., Method: We report 3 cases of blackwater fever observed in our institution., Results: In 2 cases, acute renal insufficiency with oligoanuria was observed. In all the 3 cases, treatment with quinine was stopped and replaced by injectable artemether. Evolution was dependent on renal function, and included in 1 patient neurological sequels consisting in aphasia., Conclusion: Blackwater fever is a severe affection whose diagnosis should be evoked using the color of urine. Evolution is usually favorable in the pediatric population, when adequate care can be provided.

Most newborn deaths are associated with birth asphyxia (40%), low birth weigt and prematurity (25%) and infections (20%). In Mali, in the Community Health Centers (CSCOM) exercises a staff composed of the nurse chief of health centers (ICPM) assuring the supervision of the matrons that is charged in pregnancy and the newborn. An investigation KAP (Knowledge, Attitudes and Practises) initiated in order to assess the knowledge and the practices of the community health centers agents on birth asphyxia. The survey was cross-sectional and that took place in September 2004. Have been included in the study the matrons, the nurse chief available at the time of the survey. The multiplicity of the names mentioned among which Ninakili dégou (27,3%) and Niominè (15,2%) are the most frequent and show the necessity of a qualitative investigation to find a name. Prolonged labor more than 12 hours (73,3%) and the stained amniotic liquid (63,3%) are the most recognized signs during labor making fear the birth asphyxia. In our survey the prolonged labor (63,7%), the infection/malaria of mother (60,7%) and the Dystocic delivery (45,5%) were the mostly reported causes of birth asphyxia. The pale or bluish coloration (69,7%), the irregular or lack of breath (69,7%), the lack of cry (63,6%) were known as the main signs of birth asphyxia. We noted some good practices as aspirating with a bulb (69,7%) and clearing upper ways with a finger covered with gauze (30,3% ); doing the mouth to mouth (51,5%); stimulating the newborn (66,7%). The improvement of the neontatal mortality requires the training of the staff and the equipment of the centers in small simple materials of resuscitation.

Anemia is a common and life threatening pathology among new born babies from premature. It has the potential to delay the child's growth if appropriate care if not taken. In order to improve care to new born babies with anemia, we carried out a retrospective study on a group of 195 records obtained from the neonatology ward and from 46 outpatients in the CHU of Cocody between January 2001 and December 2003. At the end of the study, we made the following reports: Incidence of early anemia is 17.5% and several risk factors are involved such as absence of anemia and malaria prophylaxis during pregnancy. Anemia whether it is secondary or early is often masked. Palor is observed in small proportions among anemic prematures at birth. Thus, cell blood chemistry is important to confirm the diagnosis. Early anemia is generally normochrome normocytaire and secondary one is hypochronic. Care about anemia cases must rely on clinical data as well as bioiogical and epidemiological data. Early iron supplementation (2 to 3 iron element mg/kg/day) could prevent late and secondary anemia in non-anemic prematures at birth.

By using degenerate primers deduced from conserved patterns in the flavivirus polymerase gene, a novel RNA virus was discovered in Rhipicephalus ticks sampled from members of the family Bovidae in Senegal. It was named Ngoye virus (NGOV) after the location from which it was isolated. Viral particles could be observed by electron microscopy, but isolation in vertebrate or invertebrate cell lines or by intracerebral infection of newborn mice remained unsuccessful. This is atypical of recognized arboviruses. The characterization of 4176 nt of the non-structural genes revealed that NGOV is a novel flavivirus species. It forms a distinct phylogenetic lineage related distantly to previously identified members of the genus Flavivirus. Analysis of genetic data suggested that the processing of the NGOV polyprotein and the organization of its replication complex are similar to those of flaviviruses. Together with other recent data, these findings suggest that a large number of viruses related distantly to 'classical' arthropod-borne flaviviruses remain to be discovered.

Objective: To evaluate whether single-dose treatments are as effective as standard therapy in the syndromic management of vaginal discharge., Methods: A randomized controlled effectiveness trial compared single-dose tinidazole plus fluconazole (TF) with treatment for 7 days with metronidazole plus 3 days of treatment with vaginal clotrimazole (MC) among 1570 women presenting with vaginal discharge at primary health care institutions in Ghana, Guinea, Mali and Togo. Participants were randomly allocated to one of the two treatments by research nurses or physicians using precoded envelopes. Effectiveness was assessed by symptomatic response on day 14. CLINICAL IDENTIFIER ClinicalTrials.gov NCT00313131., Findings: The two treatment regimens had similar effectiveness: complete resolution was seen in 66% (TF) and 64% (MC) and partial resolution in 33% (TF) and 34% (MC) of participants (P = 0.26). Effectiveness was similar among subgroups with vulvovaginal candidiasis, Trichomonas vaginalis vaginitis or bacterial vaginosis. The two treatment regimens had a similar effectiveness among human immunodeficiency virus (HIV)-infected (TF: n = 76, 71% complete resolution, 28% partial; MC: n = 83, 72% complete resolution, 25% partial, P = 0.76) and HIV-uninfected women (TF: n = 517, 68% complete, 32% partial; MC: n = 466, 65% complete, 33% partial, P = 0.20). Cervical infections with Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium were uncommon among women not involved in sex work, were associated with bacterial vaginosis or T. vaginalis vaginitis, and did not alter response to treatment with agents active against vaginal infections. Four-fifths of women not relieved by a single dose of TF had a favourable response when MC was administered as second-line treatment., Conclusion: Single-dose TF is as effective as multiple-dose MC in the syndromic management of vaginal discharge, even among women with HIV-infection. Given its low price and easier adherence, TF should be considered as a first-line treatment for vaginal discharge syndrome.

Background: Second-generation surveillance for HIV includes measures of high-risk behaviors among the general adult population and sex workers (SW). Questionnaires are prone to social desirability biases because individuals minimize the frequency of behaviors not expected from them., Objective: Determine whether the prostate-specific antigen (PSA) could be used as a biological marker of unprotected intercourse., Methods: We measured the presence of PSA in vaginal secretions of women who were (n = 508) or were not (n = 658) SW presenting with vaginal discharge in health facilities of Ghana, Togo, Guinea, and Mali. The cutoff for a positive assay was determined as > or =0.4 microg/L based on a subsample of 95 non-SW claiming abstinence for 3 months., Results: A positive PSA assay was correlated with infections with Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium. Among non-SW, a positive PSA was more common among those with HIV, but less frequent in those better educated. Among SW and non-SW, women from Ghana were less likely to have a positive PSA and had a lower prevalence of sexually transmitted infections than those from elsewhere., Conclusions: PSA can be used as a biological marker of unprotected intercourse, allowing interventions to target efforts on those at highest risk.

Benzodiazepines are relatively well-tolerated medicines but can induce serious problems of addiction and that is why their use is regulated. However, in developing countries like Senegal, these products are used without clear indications on their prescription, their dispensation or their use. This work focuses on the prescription of these medicines with a view to make recommendations for their rational use. Benzodiazepine prescription was studied with psychiatrists or neurologists and generalists in 2003. Specialist doctors work in two Dakar university hospitals and generalists in the 11 health centres in Dakar. We did a survey by direct interview with 29 of 35 specialists and 23 of 25 generalists. All doctors were interviewed in their office. The questionnaire focused on benzodiazepine indications, their pharmacological properties, benzodiazepines prescribed in first intention against a given disease and the level of training in benzodiazepines by doctors. Comparisons between specialists and generalists were made by chi-square test. Benzodiazepines were essentially used for anxiety, insomnia and epilepsy. With these diseases, the most benzodiazepines prescribed are prazepam against anxiety and insomnia and diazepam against epilepsy. About 10% of doctors do not know that there is a limitation for the period of benzodiazepine use. The principal reasons of drugs choice are knowledge of the drugs, habit and low side effects of drugs. All generalists (100%) said that their training on benzodiazepines is poor vs. 62.1% of specialists, and doctors suggest seminars, journals adhesions and conferences to complete their training in this field. There are not many differences between specialists and generalists except the fact that specialists prefer prazepam in first intention in the insomnia treatment where generalists choose bromazepam. In addition, our survey showed that specialists' training in benzodiazepines is better than that of generalists. Overall, benzodiazepine prescription poses problems particularly in training, and national authorities must take urgent measures for rational use of these drugs.

We report here the discovery, isolation, and chemical and preliminary biological characterization of a new antibiotic compound, 7-O-malonyl macrolactin A (MMA), produced by a Bacillus subtilis soil isolate. MMA is a bacteriostatic antibiotic that inhibits a number of multidrug-resistant gram-positive bacterial pathogens, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and a small-colony variant of Burkholderia cepacia. MMA-treated staphylococci and enterococci were pseudomulticellular and exhibited multiple asymmetric initiation points of septum formation, indicating that MMA may inhibit a cell division function.

The accidental intoxications constitute more and more a serious problem among young children in the developing countries because of their frequency and difficulties for taking care of those victims. The objective of our work was to study acute intoxications among children in order to determine the frequency, to identify the products in question and to determine the impact of those accidents in the future life of the victims. The study was carried out in the Paediatric Service of the CHU Gabriel Touré from January 2001 to June 2002. We enrolled 89 children from 0 to 15 years of age. Information on our patients was recorded on investigational questionnaire and completed with data from their entry and hospitalization records. Among 8237 children hospitalized during the study period, 89 of them had acute intoxication i.e. 1.08%. Children less than five years of age were more frequent with 85.4% with a male prevalence of 61.8%. Antimalarial drugs and petroleum were the most accused products. Administration of milk and provoked vomiting were the attitudes and practices of the entourage of the victims when intoxication occurs. The evolution was favourable in 67.2% of the cases with a hospital lethality of 13.7%.

The geometries and the static dipole (hyper)polarizabilities (alpha, beta, gamma) of a series of aromatic anions were investigated at the ab initio (HF, MP2, and MP4) and density functional theory DFT (B3LYP) levels of theory. The anions chosen for the present study are the benzenethiolate (Ph-S-), benzenecarboxylate (Ph-CO2-), benzenesulfinate (Ph-SO2-), benzenesulfonate (Ph-SO3-), and 1,3-benzenedicarboxylate (1,3-Ph-(CO2)2(2-)). For benzenethiolate anion, additional alpha, beta, and gamma calculations were performed at the coupled cluster CCSD level with MP2 optimized geometries. The standard diffuse and polarized 6-31+G(d,p) basis set was employed in conjunction to the ab initio and DFT methods. Additional HF calculations were performed with the 6-311++G(3d,3p) basis set for all the anions. The correlated electric properties were evaluated numerically within the formalism of finite field. The optimized geometries were analyzed in terms of the few reports about the phenolate and sulfonate ions. The results show that electron correlation effects on the polarizabilities are very important in all the anion series. Was found that Ph-SO2- is highly polarizable in terms of alpha and beta, and the Ph-S- is the highest second hyperpolarizable in the series. The results of alpha were rationalized in terms of the analysis of the polarization of charge based in Mulliken atomic population and the structural features of the optimized geometries of anions, whereas the large differences in the beta and gamma values in the series were respectively interpreted in terms of the bond length alternation BLA and the separation of charge in the aromatic ring by effects of the substitution. These results allowed us to suggest the benzenesulfinate and benzenethiolate anions as promising candidates that should be incorporated in ionic materials for second and third-order nonlinear optical devices.

Background/aims: The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and antibiotics in trachoma-endemic areas in seven world regions., Methods: A population model was applied to follow the lifelong impact on individuals receiving trachoma control. Intervention costs and effectiveness estimates were based on a combination of primary data collection and literature review., Results: Providing trichiasis surgery to 80% of those who need it would avert over 11 million DALYs per year globally, with cost effectiveness ranging from I$13 to I$78 per DALY averted across regions. Mass antibiotic treatment of all children using azythromycin at prevailing market prices would avert more than 4 million DALYs per year globally with cost-effectiveness ranging between I$9,000 and I$65,000 per DALY averted. The intervention is only cost-effective if azythromycin is donated or becomes available at reduced prices. Mass treatment of all children with tetracycline and targeted treatment with azythromycin are not cost-effective., Conclusions: As individual components of the SAFE strategy, trichiasis surgery for trachoma is a cost-effective way of restoring sight in all epidemiological sub-regions considered, as is the use of azythromycin, if donated or at reduced prices. Large study uncertainties do not change study conclusions. The results should be interpreted in the context of the overall SAFE strategy to address issues of sustainability.

Sickle cell anemia does not cause martial deprivation per se, but may worsen when iron deficiency exists, notably in tropical zone where infectious diseases and malnutrition are endemic mainly during childhood. This study was aimed to assess iron deficiency prevalence among children with sickle cell disease (SCD) and to determine the best parameters for its diagnosis. In addition to classical parameters, we measured transferrine's soluble receptors which can reveal an iron deficiency, either isolated or associated to another condition since its level is not influenced by chronic anemia. Assays were carried out in 40 homozygous SCD patients, aged 3 to 18 years, having an hemoglobin level < 11 g/dL and in 30 age-paired controls assumed to be healthy and having a negative Emmel test and an hemoglobin level < 11 g/dL. The results showed hyposideremia (serum iron < 60 microg/dL) in 17.5% of the patients. Ferritinemia, transferrinemia as well as total iron fixation capacity were in the normal range for the majority of SCD patients in spite of the frequency of hyposideremia and microcytic anemia (20%). Transferrine's saturation coefficient was low in 22.5% of patients, which can be due to martial deprivation or to inflammatory status. These results confirm the limitations of usual biochemical parameters in the diagnosis of iron deficiency in homozygous drepanocytosis. Soluble receptors' levels were increased in 60% of controls; that proves that iron deficiency prevalence is high in our countries. Higher levels were found in 97.5% of patients. However, receptors' levels are increased during haemolysis, thus it is difficult to ascertain the origin of the increase, but taking into account its index value can reduces misinterpretation. In addition, considering simultaneously microcytosis, hypochromia, transferrine's soluble receptor level and its index, we can speculate that martial deficiency occurs in 20% of SCD patients, a percentage close to the 17.1% obtained by other authors using only the combination of microcytosis and hypochromia. It results from this study that associating microcytosis and hypochromia could validly assess iron deficiency during drepanocytosis., (Copyright John Libbey Eurotext 2003.)

Objectives: To measure prevalence and risk factors for cervical infections among a large sample of women consulting for vaginal discharge in west Africa and to evaluate its syndromic management through a two visit algorithm., Methods: In 11 health centres in Bénin, Burkina Faso, Ghana, Guinée, and Mali 726 women who presented with a vaginal discharge without abdominal pain and who denied being a sex worker (SW) were enrolled. Cervical samples were tested for the detection of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) with polymerase chain reaction (PCR) assays. All participants were treated with single dose (2 g) metronidazole and clotrimazole cream for 3 days. They were randomised to be told either to come back on day 7 only if there was no improvement in the discharge (group A), or to come back on day 7 regardless of response to treatment (group B)., Results: Overall, the prevalence of NG and CT was only 1.9% (14/726) and 3.2% (23/726) respectively. Risk factors previously recommended by the WHO were not associated with the presence of cervical infection, with the exception of the number of sex partners in the past 3 months. When taken together, these risk factors had a positive predictive value of only 6.4% to identify cervical infections. Prevalence of cervical infection was not higher in women who came back on day 7, regardless of the strategy used. Prevalence of NG/CT was lower in Ghana and Bénin (5/280, 1.8%), where comprehensive interventions for SW have been ongoing for years, than in the three other countries (27/446, 6.1%, p = 0.01)., Conclusions: NG and CT infections are uncommon in west African women who consult for vaginal discharge and who are not SW. Syndromic management of vaginal discharge should focus on the proper management of vaginitis. The control of gonococcal and chlamydial infection should be redesigned around interventions focusing on sex workers.

Objective: To estimate the population health effects, costs and cost effectiveness of selected cataract surgery interventions in areas of the world with different epidemiological profiles., Methods: Effectiveness estimates are based on a review of the literature taking into account factors such as operative failure, complications and patient non-compliance. A population model was applied to follow the lifelong impact on individuals having cataract surgery. Costing estimates are based on primary data collected in 14 epidemiological subregions by regional costing teams and on a literature review. Costings were estimated for different geographical coverage levels using non-linear cost functions., Findings: Intra- and extra-capsular cataract surgeries are cost-effective ways to reduce the impact of cataract-blindness. Extra-capsular cataract surgery is more cost-effective than intra-capsular surgery in all regions considered. Providing extra-capsular cataract surgery to 95% of those who need it (95% coverage level) would avert over 3.5 million disability-adjusted life years (DALYs) per year globally. The cost-effectiveness ranges from 57 International dollars (1 dollar) per DALY in the WHO South-East Asia Region where there is high overall child and adult mortality to 1 dollar 2307 per DALY in the WHO Western Pacific Region where there is low overall child and adult mortality., Conclusion: Extra-capsular surgery for cataracts at a high level of coverage is the most cost-effective way of restoring sight in all epidemiological subregions considered. Analysts from countries within a region are encouraged to further contextualize the results based on their own country's specific parameters.

Gaucher's disease is a recessive autosomal disorder caused by an inherited deficiency of betaglucocerebrosidase. We report here the case of an 8 month old child, fourth in a family of four children, who presents the neuropathic form of the disease. The dosages of betaglucosidase activity using C (14 ) techniques have confirmed the diagnosis, and allowed the detection of the disease in the elder brother. Both parents were considered as responsible for the transmission of this disease to their progeny. The type 2 Gaucher's disease is rare in black population, and may be associated with phenotypes heterogeneity.

With the interruption of larva treatments done by OCP as part of onchocerciasis control in West Africa, Simulium came back in abundance in forest regions and savannah fertile valleys. In addition to the severe discomfort, nuisance by Simulium is in certain cases incompatible with land use. Since ground treatment of larval breading sites using insecticides is not always possible or efficient, it is therefore a necessity to develop other methods among which individual protection against Simulium bites. The general objective of our study was to evaluate different vegetable oil compound repellent formulas against Simulium bites. Activities were carried out in savannah zone (Niakaramandougou) and in forest zone (Soubré) in Côte d'Ivoire. The methodology consisted in catching blackflies on volunteers whose legs were rubbed with a repellent. Gobi raw oil and coconut, palm nut and gobi formulas (lotions and creams) were tested. During each session, which lasted from 07:00 am to 12:00 and from 03:00 pm to 06:00 pm, one person did not apply any repellent and was used as the control person. The results of our experimentations show that for a given zone (savannah, forest), a repellent (coconut, palm nut, gobi) and a compound (shea butter, vaseline), there is no significant difference between protection rates obtained with lotions (maximum: 21 bites/person/day) and those obtained with creams (maximum: 30 bites/person/day). In other respects, the lotion of a given repellent seems to be efficient in savannah as in the forest, in protecting against Simulium bites. It is the same situation with creams. So, repellents can be an efficient solution against Simulium nuisance. However, experimentations should continue to confirm the high repellency of tested formulas, proceed to the identification of principles and evaluate the toxicity and irritant effect of repellents to be applied on the skin.