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PubMed1999

[Pregnancy and delivery in western Africa. Towards a lower risk motherhood?].

The maternal mortality ratio is the health indicator displaying the greatest disparity between industrialized and developing countries. Medical causes have been better known since a decade ago but the non medical causes must be studied to develop appropriate strategies. Socio-economic causes play an important role but the poor performances of the maternal health services are directly responsible for the great majority of the deaths. The lack of qualified personnel, the poor management of those who are qualified, the misallocation of the rare resources, the poor relationships between health personnels and their clients, the shortages of supplies, essential drugs and blood lead to a poor quality of care to pregnant women. The Safe Motherhood Initiative has led to the development of simple but efficient strategies which would allow to dramatically reduce maternal and neonatal mortality as well as handicaps. This requires a political commitment of the governments of West Africa but, in spite of the strong advocacy of major donor agencies and international organizations, programs have yet to be implemented.

Africa, Western↗
PubMedDate not supplied

[Hemoglobin O Arab in Ivory Coast and western Africa].

The authors report 44 cases of hemoglobin O Arab share out in 3 phenotypes (A O Arab, C O Arab and S O Arab). The study of this abnormal hemoglobin has allowed the following conclusions: The Hb O Arab is a rare mutant of hemoglobin. The heterozygote form A O Arab and the association Hb C--Hb O Arab do not present any clinical and hematological manifestations. The associations Hb S--Hb O Arab brings about a serious hemoglobinopathy which has clinical and hematological features like the sickle-cell disease (SSFA2).

Adolescent↗
PubMed1991

[The epidemiology of yellow fever in Western Africa].

Observations made during the epidemics in Côte d'Ivoire (1982), Burkina Faso (1983), Nigeria (1986 and 1987) and Mali (1987), together with studies conducted in the last 10 years, particularly in Côte d'Ivoire, now make it possible, without calling into question the dynamics of yellow fever virus circulation in space and time, to redefine some features of the pattern suggested in 1977 and refined on a number of occasions up to 1983. The endemicity area is still the region of epizootic and enzootic sylvatic circulation, and contains the natural focus and the endemic emergence zone. --The natural focus is no longer confined to the forest alone, now that transovarial transmission has been demonstrated. --The endemic emergence zone is tending to become conterminous with the endemicity area on account of increasing deforestation. Emergence in forest regions, due to Aedes africanus, is still few and isolated, unlike that observed in savanna regions where A. furcifer is the major vector. The different behaviour of these two vectors and their population dynamics determine the quality of the man-vector contact and are responsible for these two patterns of emergence. --The emergence front limits the endemicity area in the north. Its position varies and depends on annual rainfall patterns. The epidemicity area, where the virus does not circulate before an epidemic and where the immunity status of unvaccinated populations is low, is geographically heterogeneous. It consists of regions to the north of the emergence front and of towns anywhere. It is characterized by high potentials for the development of A. aegypti populations. Only man can introduce the virus into this area. Three types of epidemic are distinguished, depending on the vectors: --Urban epidemics resulting from transmission by a domestic vector. These epidemics always occur within the epidemicity area, either in dry savanna (rural subtype) or in towns (urban subtype). The virus is introduced into the ecosystem by man. Transmission is always strictly interhuman. --Intermediate epidemics consist of two successive phases: first of all there is a series of endemic emergences, followed by interhuman transmission involving A. aegypti. These epidemics can only occur in the endemicity area. --Sylvatic epidemics occur in villages, but only involve the sylvatic vectors. They result from a conjunction of a very large number of emergences for which A. furcifer is almost always mainly responsible, and occur in the endemicity area, usually close to the emergence front. Transmission is never strictly interhuman, as the same vector populations are responsible for epizootic and epidemic transmission.(ABSTRACT TRUNCATED AT 400 WORDS)

Aedes↗
PubMed1990

[Changes in maternal behavior and care practices in migrant women from Western Africa].

A study on the various kinds of behavior in mothering and the ways of taking care of children by 26 migrant mothers coming from West Africa was carried out in order to evaluate and analyze changes in these practices when coming into contact with French society. The data was gathered during observations and interviews in the home setting. Massage techniques and posturo-motor exercises, as well as the physical contact between the adult and the child, and breast-feeding, were examined. Acculturation can be rapid in the ways children are fed. Massage techniques and bodily exercises, which are bound up with the way the child and its development are perceived, are harder to change. Children having gone through these exercises walk significantly earlier than those who haven't. As regards sickness, resorting to modern medicine is obvious, but doesn't basically change the traditional way of interpreting it, which makes of sickness the expression of a disorder affecting the family group in its entirety.

Acculturation↗
PubMed1990

[Yellow fever in Western Africa, 1973-1987. Observed facts--studies realized, campaign, prevention and forecast].

This global analysis of the situation is based on a review of notifications, observations and studies concerning yellow fever in 16 of 17 countries of the West African subregion (Algeria is not affected for the years 1973-1987). In view of this analysis and the epidemiological picture, the author proposes a plan of concerted action to confine yellow fever to its monkey-to-monkey cycle in the wild. Official notifications vary greatly from one country to the next. Any of five major causes could explain this: ecological and ethological conditions that favour circulation of the virus in the wild and man-to-man transmission to different extents; the immune status of the populations; the difficulty of diagnosing especially isolated cases; lack of means for investigation; and negligence. The quantity and gravity of human cases are systematically underestimated, sometimes to a great extent. Lack of resources and difficulty of diagnosis, but also in many instances the attitude of the population, can account for this. Modern means of investigation, faster intervention by specialists, and better knowledge of how the virus is transmitted, have shown recently an increasing gap between notifications and the actual situation. Research and monitoring programmes are particularly important. The programmes under way in Senegal and Côte d'Ivoire have already resulted in considerable improvement in the action against epidemics. Because of these programmes, our knowledge of the very complex pattern of viral circulation is improving, thereby helping us develop systems for prevention and enabling us to forecast epidemics. Priority areas for study and research are: (i) Basic programmes for detailed study of all the topotypes of the virus, and identification of the viral amplification cycles that recur over several years. Such studies are under way in Senegal and Côte d'Ivoire. They would be particularly useful in Ghana and in Nigeria, where the taxonomy and bioecology of A. africanus s.l. should also be studied. (ii) Surveys of sylvatic vectors should show, for the endemic zones of each country, the type of contact between sylvatic vectors and man in both rural and wild biotopes. (iii) A complete map of the Stegomyia foci with an assessment of their potential epidemic risk (an analysis of the productivity of the sites depending on their type). (iv) Assessment of the immune status of the populations of the various ecosystems of each country, taking account of past or present vaccination strategies. There are several prevention strategies to choose from. The author advocates preparation of a scientifically based, subregional plan for optimum cost effectiveness.(ABSTRACT TRUNCATED AT 400 WORDS)

Africa, Western↗
PubMed1989

[Volvulus of the pelvic colon. Apropos of 59 cases in the western Africa savannah area].

The authors describe their experience after treatment of 59 cases of volvulus of the pelvic colon. This disorder is frequent in West Africa and affects the protein deficient malnourished population. A definite predominance of volvulus occurred during the dry season between December and April, perhaps related to a diet richer in cellulose or deficient in water. There was a delay in presentation at the Hospital Center; necrosis of the twisted loop, the age of the patient and multiple associated conditions all contributed to the severity of this condition. Treatment had three aims: removal of the obstruction, reestablishment of continuity and avoidance of recurrence. Indications were dictated by the patient's general condition and the vascular status of the loop of bowel. It is reasonable to attempt reduction via intubation if the loop of bowel appears viable. Success enables a colectomy to be performed after a preparation, while failure necessitates surgical correction of ideally colectomy in a one stage procedure. On the other hand, a gangrenous loop necessitates colectomy without untwisting, with closure of the distal end using the Hartmann technique and with reestablishment of continuity 3 weeks later.

Adolescent↗
PubMed1987

[Surveillance of the sensitivity of Plasmodium falciparum to chloroquine in Western Africa: value of in vivo tests using 5 and 10 mg/kg].

Studies on the in vivo sensitivity of Plasmodium falciparum strains to chloroquine were carried out on shrub savanna areas of Burkina Faso, West Africa and were conducted from 1982 to 1986 in asymptomatic malarial school children. From the result of 431 in vivo tests using a single dose of only 5 or 10 mg/kg b. w. chloroquine base, it was concluded that there was a high sensitive response of P. falciparum to chloroquine. In areas where clinical resistance has not been established, and where there is a high sensibility in the response of P. falciparum to chloroquine, in vivo studies with a single dose of 5 or 10 mg/kg are probably able to detect a decrease of sensitivity before the appearance of clinical resistance to higher regimens.

Africa, Western↗