CFTR mutations in the Algerian population.

The nature and frequency of the major CFTR mutations in the North African population remain unclear, although a small number of CFTR mutation detection studies have been done in Algeria and Tunisia, showing largely European mutations such as F508del, G542X and N1303K, albeit at different frequencies, which presumably emerged via population admixture with Caucasians. Some unique mutations were identified in these populations. This is the first study that includes a genetic and clinical evaluation of CF patients living in Algeria. In order to offer an effective diagnostic service and to make accurate risk estimates, we decided to identify the CFTR mutations in 81 Algerian patients. We carried out D-HPLC, chemical-clamp denaturing gradient gel electrophoresis, multiplex amplification analysis of the CFTR gene and automated direct DNA sequencing. We identified 15 different mutations which account for 58.5% of the CF chromosomes. We used a quantitative PCR technique (quantitative multiplex PCR short fragment fluorescence analysis) to screen for deletion/duplication in the 27 exons of the gene. Taking advantage of the homogeneity of the sample, we report clinical features of homozygous CF patients. As CFTR mutations have been detected in males with infertility, 46 unrelated Algerian individuals with obstructive azoospermia were also investigated.

[An epidemiological study of health care seeking behavior of children under 5 years of age in Algeria: what lessons for improving the health care system?]. / Etude épidémiologique du recours aux soins curatifs des enfants de moins de 5 ans en Algérie: quelles leçons pour le système de santé?

In many developing countries, dissatisfaction with primary health care has been accompanied by inappropriate use of university teaching hospitals, frequently for benign health problems. This situation is often attributed to the user population who supposedly misunderstands the functioning of health systems. This article describes the health seeking process and outcome of consultations for under-five children in two geographic zones in Algeria (very different in their care networks, and in the socioeconomic and educational characteristics of their populations), using a representative sample of users of public and private health services. During 4 one-week periods in 1991, a cross-sectional study was carried out among families of children and the health personnel they consulted, in all the health structures in the 2 zones. A Franco-Algerian supervisory team prepared consensual definitions of both the seriousness and the urgency of the pathology, as well as of the appropriateness of the health care structure chosen for that condition. The analysis of 1560 consultations shows dysfunctions in the health seeking process: numerous "self-referrals" (94%); unjustified recourse to university hospitals in 29% of cases; important delays before consulting (> or = 1 week in 14% of cases); absence of the mother during the consultation; differences in the mode of recourse according to the child's sex (for equivalent seriousness and urgency, recourse is more frequent to the emergency room and university hospital for boys, but girls are more often hospitalized). Nonetheless, the Algerian supervisors of the research consider that the choice of the health care facility is appropriate in 91% of cases. At the service level, dysfunctions are equally frequent, especially the absence of the transfer of information on the child between different health care professionals. The primary preoccupation of parents is with accessibility (distance, cost), which leads to recommending the revitalizing of small first-line facilities, especially in rural areas, the more so because they are used and appreciated by families.

[Families and children confronting health care practices in Algeria]. / Familles et enfants face à l'activité de soins en Algérie.

This paper describes results of a study on perceptions and behaviors of families concerning care of sick children, within the context of the Algerian health system as it functioned in two zones, Aïn Taya and Tigzirt, in 1991. One hundred twenty families in the two zones were interviewed at home on the health seeking process during a recent illness episode of an under-5 child. Results show families make extensive use of curative health services for children, with apparently little use of traditional medicine, and only initial use of home remedies. Access to public services is often difficult due to distance, while incompetence, long waiting times, favoritism, lack of material, and poor communication with health personnel constitute families' main complaints. Use of private physicians, in spite of costs, is considered a gain in time, and rapport and communication are better. Results of the research among these families are discussed in relation to those from a study carried out at the same time among health professionals, results which show deep dissatisfaction on their part as to the means put at their disposal and with the quality of relationships maintained with the administration on the one hand, and with the client population on the other. Improving the public health sector in Algeria will entail greater investment in the quality of peripheral services, and training of health personnel in better communication skills.

Diagnosis of tuberculosis in children.

PIP: Diagnosis of tuberculosis (TB) in children is usually based on presumptions from several elements: clinical picture and course, x-rays, tuberculin test, and culture of pathology later on. TB is usually found in a child because of symptoms of primary disease, or through case-finding of a contact. TB is children is often a primary infection and may be gradual or acute in onset. Some of the symptoms of primary TB are low-grade fever, pallor, fatigue, and anorexia. The child may have erythema nodosum, a yellow module on the conjunctiva, hilar or mediastinal lymphadenopathy, a primary TB complex on the lung (3-10 mm), segmental density, or a positive PPD test. Children with pulmonary disease do not have adult-type cavity lesions, but may have a primary cavity that drains into the bronchi, mechanical complications, fistulas, or atelectasis. Acute TB often appears as meningitis. The pathognomonic signs are cerebrospinal fluid high in lymphocytes with very high albumin (0.6-2 g) and low glucose (0.4-0.2 g/l). TB organisms are rarely seen, but may be cultured. TB meningitis is also notable for choroidal tubercles, which are yellow nodules visible in the fundus. These presumptive signs, as well as increasing neurological findings, prompt immediate treatment. Children also may have acute miliary TB, marked by high fever, gastrointestinal symptoms, hepatosplenomegaly, dyspnea, cyanosis, and respiratory distress, with characteristic diffuse grainy spots on the chest x-ray. A child may have both conditions and may also have localized TB infection elsewhere. Thus, clinical findings may point to possible cultures of urine, gastric lavage, pleural fluid or biopsy, pericardial fluid, bone marrow, or ascitic fluid, any of which should be cultured to rule out other causes. The most common sites for extra-pulmonary TB are cervical nodes, spine, knee. shoulder, hip and peritoneum. Pelvic and urinary tract infections are rare in children.^ieng

An Algerian experiment: short chemotherapy for tuberculosis.

PIP: 427 Algerian children aged up to 15 years were treated at the Pediatric Clinic of the Beni-Messour University Hospital Centre, Algiers, between July 1979-January 1985 with a 6-month multi-drug course for tuberculosis (TB). TB was diagnoses by clinical and x-ray findings in 56% and confirmed bacteriologically in the rest. Those with pulmonary, meningeal, osteoarticular, or renal TB received isoniazid and rifampicin daily for 6 months with streptomycin and pyrazinamide for the first 2 months. Those with primary TB, regional lymphadenitis, pleural, peritoneal, or other localized TB received the same drug regimen without initial streptomycin. 372 children completed the course, and, of these, all were cured, 99% definitely so. There were 3 relapses. Children who did not complete the drug treatment included 7 who died due to TB, 4 of them pulmonary and 3 meningeal; 1 who had drug toxicity; 17 who stopped treatment and were lost to follow-up; 30 who were lost to follow-up after completion of treatment and 5 who died of unrelated causes. The only adverse reactions were transient elevated liver transaminase in 4.6, and 1 case of jaundice in a child who received an accidental overdose. Besides its effectiveness, this short course treatment was considered beneficial because only 4% discontinued and were lost to follow-up, compared to 15% of a prior group given a 12-month treatment course.^ieng

[Epidemiologic aspects of acute respiratory infections in children less than 6 months of age through a retrospective study in Algiers--Algeria]. / Aspects épidémiologiques des infections respiratoires aiguës chez des enfants de moins de 6 ans à travers une étude rétrospective à Alger--Algerie.

Personal medical files of 874 children from 0 to 4 years old monitored in a Maternal and Child Health Center were reviewed. Acute respiratory infections (ARI) represent about 37% of the total of these outpatients. Annual frequent occurrence of ARI has been estimated at 2.13 per child/per annum among babies less than 1 year old, and diminishes regularly with age to reach 0.74 per child/per annum in the age group 3-4 years. ARI were a motive for medical advice more frequent among boys than girls (p less than 0.01). Distribution of ARI according to their level shows that ARI above glottis represent 46% of total ARI, this percentage increasing with age. Approximately 63% of these ARI were treated by antibiotics.

Diarrhoea control: the experience of a health team in a primary care unit, Algeria.

PIP: This article reports the experiences of a primary health care unit located in Algeria's Zeralda district in the control of diarrhea. Curative and preventive care is provided to the adult and child populations of the district by a medical and paramedical team. The overall goal of the diarrheal control program, initiated in 1980, is to combat mortality from diarrhea in children under 2 years of age. Intermediate goals include improvement of care provided to infants with diarrhea, early hospitalization of cases of diarrhea, improvement of contacts between the primary care unit and the hospital, and prevention of diarrhea. Children in the target group are located through use of a register of children living in the district, and their families are sent cards containing information on diarrhea and its control. Children are followed from the 1st day of consultation for diarrhea until the 30th day after the episode. Record keeping and careful follow-up are stressed. In 1983, 335 children 18 months of age or younger (47% of the target population) consulted health structures in Zeralda for diarrhea. About 1/3 of children fail to return for follow-up visits. This is attributed both to long waits in the clinic and the fact that children are usually cured by the time of this visit. The number of children hospitalized for acute dehydration has declined from 33 in 1980 to 18 in 1983; the number of deaths from dehydration declined from 16 to 8 in this same period.^ieng

[The rupture of the pleura: a serious complication of hydatid cyst of the lung in children (author's transl)]. / La rupture dans la plèvre: une complication grave de l'hydatidose pulmonaire de l'enfant.

The authors report 5 cases of rupture of hydatid cyst into the pleural cavity observed among 336 patients operated for hydatid cyst of the lung during a 13-year period. Three cases were spontaneous ruptures and two were the result of repeated pleural tappings. One case among the spontaneous ruptures was presented with a picture of acute surgical abdomen. There were no death among the five patients.