[Medical waste incinerator constructed with locally produced materials: experience during the immunization campaign 2002 against measles in Douala, Cameroon]. / Incinérateur de déchets médicaux à base de matériaux locaux: expérience de la campagne 2002 de vaccination anti-rougeole à Douala, Cameroun.

UNLABELLED: Incineration is still the method of choice for disposal of biomedical waste. Combustion at 800+ degrees C eliminates all risk of injury by reducing the waste to ashes and destroying all microorganisms. The purpose of his report is to present a modular double-chambered incinerator in conformity with recommendations for developing countries. The incinerator described here provides the following advantages: suitability for low-cost artisanal construction, excess-air combustion, low risk of accidents and contamination, after-burner for smoke, energy efficiency, easy operation/maintenance, and safety. It is made from locally produced clay bricks reinforced with a steel frame and features two chambers for combustion and post-combustion. It functions on a batch basis with a 2-hour cycle. The immunization campaign against measles that was carried out in 5 districts of Douala in December 2002 produced 800,000 self-disabling syringes with needles. These by-products were immediately discarded in cardboard safety boxes (5-liter capacity, 1 kg) that were taken to the incinerator and burned at the rate of two batches per day. RESULTS: The construction cost of the incinerator was 3,500,000 FCFA (5,300 euros). A total of 5,816 boxes were incinerated, i.e., 29,080 litres, 872,400 syringes, 6,281 kg. Incineration required 126 batches over a period of 11 weeks. The ashes (240 litres, i.e. 0.8% of the total incinerated volume) were virtually free from solid residue. Fuel consumption was negligible. Smoke was never excessive, thick or odorous. Temperatures measured during preliminary trials were always above 800 degrees C. According to the WHO, toxic emissions are negligible if incineration is carried out at temperatures higher than 700 degrees C for less than 2 hours a day. Further study will be necessary to confirm this preliminary experience with regard to temperature control and smoke/ash composition and to test the incinerator in various climatic and operating conditions.

[Impact of parental attitudes on infant vaccinal coverage in Benin]. / Influence de certaines caractéristiques parentales sur la couverture vaccinale des nourrissons au Bénin.

Few studies have addressed the impact of parental attitudes on vaccinal coverage in early childhood. The purpose of this descriptive-analytical transverse study was to assess this problem in a cohort of parents with a 12- to 23-month-old child randomly identified by cluster analysis in five communities in the Oueme department. Data were collected using a questionnaire and tabulation sheet. Statistical analysis was performed by logistic regression using the stepwise digression method. Most of the 438 parents in the study cohort (74.2%) were between 21 and 35 years of age. More than half had not attended school and less than 20% were unemployed. The proportion refusing vaccination for their children was 35% among parents who had to walk more than 30 minutes back and forth to the health care facility and 38% among parents who had poor knowledge about vaccination. The refusal rate was 1.4 times higher for parents with no education than for parents who had attended school (P=0.005). Poor parental knowledge about vaccination was significantly correlated with refusal of vaccination (p<0.001). This study suggests that communication strategies aimed at enhancing parental knowledge and understanding about vaccination should be promoted at health care facilities as well as through other channels, e.g., news media and public events such as social and religious gatherings.

[Epidemiology of juvenile insulin-dependent diabetes in Algeria (Wilaya of Oran)]. / Epidemiologie du diabète insulinodépendant juvénile en Algérie (Wilaya d'Oran).

In order to precise the prevalence and incidence of IDDM in a well characterized population, we have ascertained between 1979 and 1988 all juvenile diabetic patients living in the department of Oran (Wilaya of Oran), Algeria, aged less than 20 years at the date of Dec. 31th 1988 who had onset of the disease before 15 years old. Cross comparisons of the data obtained both by a IDDM registry and a questionnaire sent to the practitioners show an excellent correlation. A total of 173 families was studied, including 155 Simplex Families (SF), and 18 Multiplex Families (MF). The prevalence was 0.27 p. 1000 among children aged less than 15 years. The annual incidence (mean = 4.4 p. 100,000) increased regularly from 1.6 p. 100,000 in 1981 to 8.1 p. 100,000 in 1988. The prevalence of IDDM among siblings was 3.8%. The birth order of index cases (first affected siblings) was lower in MF (3.0 +/- 0.4) than both in index cases of SF (4.0 +/- 0.3; p less than 0.01) and in secondary affected siblings of MF (4.8 +/- 0.05; p less than 0.001). The frequency of 2nd degree consanguineous marriages (between first cousins) was greater among the IDDM families compared with control families: 25% vs 11% (RR = 2.9; p less than 0.001).

Incidence of Campylobacter infection in infants in western Algeria and the possible protective role of breast feeding.

A case-control study aimed at comparing the incidence of campylobacter infection with that of other enteropathogens in infants was performed in Oran, Western Algeria. During a one-year period, infants consulting in a health centre were included if they had acute diarrhoea. The controls comprised infants going to the same centre for vaccination. Butzler medium Virion was used to look for thermophilic campylobacters. Campylobacters were isolated in 17.7% of the 411 patients and in 14.9% of the 247 controls. No statistically significant difference was found after stratification by age. In contrast, other enteropathogenic bacteria were rarely present. Among the potential factors of clinical expression of infection, breast feeding appeared to have a protective effect which was higher for campylobacter diarrhoea than that observed for other causes of diarrhoea. These data contrast with those previously published in Bangladesh and could be an incentive for promoting breast feeding in this country, where the tradition is decreasing far below the standard which is generally accepted.

HLA-DQA1 and DQB1 alleles in French and Algerian type 1 diabetic subjects.

Some alleles of the HLA-DQB1 and DQA1 loci are preferentially associated with susceptibility to type 1 (insulin-dependent) diabetes mellitus (IDDM). Analysis of the HLA-DQ genetic profile may therefore become important for the screening of subjects at risk of IDDM. However ethnic variations in the genetic profile can occur and require background knowledge of the HLA-DQ allelic distribution before screening campaigns. In the present work, HLA-DQA1 and DQB1 genes have been analyzed, after PCR amplification of the genomic DNA, in French and Algerian control subjects (a total of 148) and diabetic patients (a total of 107). Allelic distributions have been investigated in view of a) possible inter-ethnic differences; b) identification of risk and protective alleles and c) the prevalence of DQB1 aspartate 57 negative and DQA1 arginine 52 positive alleles in control and diabetic groups. The DQB1 allelic distribution was similar in both control groups; alleles negative for aspartate at position 57 were 48% in French and 50% in Algerian. In both diabetic groups, the prevalence of alleles negative for aspartate at position 57 was significantly higher: 91% (French) and 81% (Algerian) (p less than 0.001). A majority of patients were homozygote for DQB1 Asp 57 negativity: 83% (French) and 63% (Algerian). The highest relative risk was associated with HLA-DQB1 0201/0302 heterozygosity. The HLA-DQA1 allelic distribution was also similar in French and Algerian controls. Alleles positive for arginine (ARG+) at position 52 were 50% (French) and 57% (Algerian) of controls. In both diabetic groups the prevalence of alleles positive for arginine at position 52 was significantly higher: 78% (French) and 84% (Algerian).(ABSTRACT TRUNCATED AT 250 WORDS)

The HLA-DRB1*0405 haplotype is most strongly associated with IDDM in Algerians.

Insulin-dependent diabetes mellitus (IDDM) in Caucasians is strongly associated with HLA-DR3-DQ2 and DR4-DQ8. In order to investigate the HLA class II associations with IDDM in Algerians, we have used polymerase chain reaction (PCR) and sequence specific oligonucleotide analysis (SSO) to identify DQA1, DQB1, and DRB1 alleles, haplotypes and genotypes in 50 unrelated IDDM patients and 46 controls from a homogeneous population in Western Algeria. Both DRB1*0301-DQA1*0501-DQB1*0201 (DR3-DQ2) and DRB1*04-DQA1*0301-DQB1*0302 (DR4-DQ8) haplotypes were found at increased frequencies among the patients compared to controls (45% vs. 13%, RR = 5.5, Pc < 10(-5) and 37% vs. 4%, RR = 12.9, Pc < 10(-4), respectively). Among the latter, in contrast to other Caucasian populations, only DRB1*0405-DQA1*0301-DQB1*0302 was significantly increased in the Algerian patients (25% vs. 1% in controls, RR = 30.3, Pc < 10(-3). Accordingly, the highest risk of disease was observed in DRB1*0301-DQA1*0501-DQB1*0201/DRB1*0405-DQA1+ ++*0301-DQB1*0302 heterozygotes (34% in patients vs. 0% in controls; RR = 49; Pc < 10(-3). This observation and its comparison with DR-DQ haplotypes in other ethnic groups suggest that the DRB1*0405 allele which encodes an Asp57-negative beta chain may contribute to IDDM susceptibility in a similar way as Asp57-negative DQ beta chains.

HLA DQA1 and DQB1 study in Algerian type 1 diabetes families.

The distribution of HLA class II alleles associated with insulin-dependent diabetes mellitus (Type 1) in the Algerian population is poorly known. We have typed 36 Algerian Type 1 diabetic probands and their families using DQA1 and DQB1 oligonucleotide probes. Fifty-nine parental haplotypes non transmitted to diabetic offspring served as controls. The frequencies of DQA1 and DQB1 alleles and haplotypes and their associations with Type 1 diabetes were, except minor differences, similar to those reported in French. Susceptibility DQA1 (Arg52+) and DQB1 (Asp57-) alleles were significantly increased among patients versus controls (90% vs 53%, RR = 8.4, p < 10(-6), and 94% vs 64%, RR = 9.4, p < 10(-5), respectively). 85% of Type 1 diabetics versus 34% of control haplotypes were either DR3DQw2 or DR4DQw8 susceptibility haplotypes (DQA1 Arg52+, DQB1 Asp57-) (RR = 10.8, p < 10(-7). 75% of the probands vs 14% of the controls (RR = 18, p < 10(-5)) and 73% of affected siblings versus 24% of unaffected siblings (RR = 8.4, p < 0.02) possessed a genotype composed of these two susceptibility haplotypes in the homozygous or heterozygous state. 42% of the probands were DR3DQw2/DR4DQw8, corresponding to Hardy-Weinberg expectations. The lack of excess of heterozygotes could be due to the consanguine families in this sample, as among the patients with consanguine parents the frequency of DR3, 4 heterozygotes was lower (27% vs 48% in non-consanguine patients, NS) and that of DR3 homozygotes increased (45% vs 12%, respectively, p < 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)