[Results of anastomotic urethroplasty for male urethral stricture disease]. / Résultats de l'urétroplastie anastomotique pour rétrécissement de l'urètre masculin.

OBJECTIVE: To report our experience with anastomotic uretroplasty (AU) due to male urethral stricture disease (USD) and to identify factors affecting the results. PATIENTS AND METHODS: We conducted a retrospective study over a period of 4 years and 6 months (July 2012 to December 2016). Any subsequent use of endoscopic urethrotomy or new urethroplasty was considered a failure. RESULTS: Forty-eight cases were included. The mean age of patients was 53.5±17.3 years (23-87 years). Urinary retention was the reason for consultation in 42 cases (87.5%). The most common localization of USD was the bulbar urethra (n=45). The mean length of USD was 1.23±0.62cm (0.5-3cm) with a median length of 1cm. The etiology was post-infectious in 56.3% of cases. More than half (58.3%) of patients had already undergone at least one urethral manipulation. After an average follow-up of 21.1±12.6 months (1 to 52 months), the overall success rate was 77.1%. In univariate analysis, length, cause and location of the stricture, age of patient, the presenting symptoms of the stricture, previous urethral manipulation and surgeon experience did not significantly impact on the success rate of anastomotic urethroplasty at one and two years follow-up. CONCLUSION: The AU had provided good results in our practice. The infectious origin of the stricture and previous urethral manipulation did not significantly impact the result of this surgical technique. LEVEL OF EVIDENCE: 4.

[Treatment outcome, survival and their risk factors among new tuberculosis patients co-infected with HIV during the Ebola outbreak in Conakry]. / L'issue du traitement, la survie et ses facteurs de risque chez les nouveaux tuberculeux co-infectés par le VIH pendant l'épidémie d'Ebola à Conakry.

BACKGROUND: Mortality among TB/HIV co-infected patients remains high in Africa. The study aimed to estimate survival and associated factors in a cohort of TB/HIV co-infected patients who started tuberculosis treatment during the Ebola outbreak in Conakry, Guinea. METHODS: A prospective cohort study was conducted from April 2014 to December 2015. TB patients with HIV co-infection were enrolled at the University Hospital of Conakry. Survival and risk factors were analyzed according to Kaplan-Meier's method, log-rank test and Cox's regression. RESULTS: Data from 573 patients were analyzed. From these, 86 (15.0%) died before the end of treatment, 52% occurring within eight weeks of treatment onset. Survival at 4, 12 and 24 weeks after the beginning of the TB treatment was 92%, 86% and 83%, respectively. Independent risk factors associated with death were in the cell CD4 <200 cells/mm3 [adjusted hazard ratio (AHR): 2.25; 95% CI (confidence intervals): 1.16-4.37], opportunistic infections other than TB [AHR: 2.89; 95% CI: 1.39-6.02], and comorbidities [AHR: 4.12; 95% CI: 2.10-8.10]. An increase of one unit in hemoglobin [AHR: 0.81; 95% CI: 0.75-0.91] was protective of death. CONCLUSION: TB/HIV co-infected patients had a higher fatality rate during treatment of tuberculosis. Prevention of opportunistic infections, anemia and proper management of tuberculosis treatment in early comorbidities may improve survival for TB/HIV co-infected patients in restoring immune function.

Chapitre 2. L'autonomisation des comités nationaux d'éthique de la recherche en Afrique : perspective historique et enjeux actuels.

Since the 60s, and particularly after various scandals in the 90s, national research ethics committees in Africa have established themselves as key players in the field of international clinical research. Notably based on the principle of double ethical review, their existence has historically been aimed at preventing a form of ethical dumping, a temptation that still exists today on the part of some research promoters. While the international framework of “soft” law has favored their emergence and legitimacy, a legal and regulatory framework of “hard” law is also necessary at local level for each national research ethics committee, to ensure its proper functioning and the optimal fulfillment of its missions. The aim of this article is to analyze the similarities and differences between three national ethics committees in Africa, specifically the CNERS of Guinea, the CNERS of Benin and the CNESVS of Côte d’Ivoire, in terms of status, missions, legal or regulatory ground and, more generally, autonomy. This analysis will enable us, on the one hand, to take account of common logistical difficulties and, on the other, to go beyond differences in legal status and missions to define what enables this type of committee to fully exercise its role(s). Finally, this article proposes to model the various elements that contribute to the autonomy and resilience of a national research ethics committee, around a notion proposed on this occasion: the “circles of autonomy”.

Adult groin hernia surgery in sub-Saharan Africa: a 20-year systematic review and meta-analysis.

PURPOSE: To realize a systematic review to evaluate groin hernia surgery for adults in sub-Saharan Africa. METHODS: We conducted a systematic review and meta-analysis, the primary objective of which was to determine the surgical techniques used for unilateral groin hernia surgery in sub-Saharan Africa. Studies published in the last 20 years were considered. A meta-analysis estimated the pooled prevalence with 95% confidence interval (CI) of mortality, chronic pain and recurrence. A subgroup analysis compared the rate of complications between complicated or uncomplicated hernia. RESULTS: We included 113 articles. The most used technique was Bassini in 40.1%, followed by Lichtenstein in 29.9% and Shouldice in 12.6%. The overall mortality rate was 0.6% (95% CI 0.4-0.9). The pooled recurrence rate was 1.4% (95% CI 1.05-1.9). The pooled rate of chronic pain was 2.7% (95% CI 1.9-3.7). We found that mortality rate for complicated hernias (6.4%) was higher compared to uncomplicated hernias (0.2%). This difference was statistically significant [p ≤ 0.001; OR = 47.7; 95 CI (27.2-83.47)]. CONCLUSION: This review showed that pure tissue repairs are the most used techniques with Bassini and Shouldice as leading procedures. The post-operative rates of recurrence and chronic pain are low. However, there is a high heterogeneity between studies than can underestimate these pooled prevalences. The consultation at complication stage remains frequent and associated with a higher mortality. Futures studies should focus on improving the quality of studies in terms of design and follow-up to increase the degree of evidence.

[Upperurinary Tract Diversion With JJ Stent By Endoscopy : Indications, Results And Morbidity]. / Derivation Du Haut Appareil Urinaire Par Une Sonde Double J Par Voie Endoscopique : Indications, Resultats Et Morbidite.

OBJECTIVE: to report the indications and the results of the upper urinary tract by endoscopic route by a double J probe in our Center. PATIENTS AND METHODS: This was a retrospective mono-centric descriptive study from January 1st 2018 to June 30th 2019 including all patients that had a JJ stent as a type of upperurinary tract diversion. RESULTS: seventy four patients were included. The average age of patients was 43.6 ± 17.5 years. The sex-ratio was 0.6. The obstructive renal colic was the most common operative indication in 62.1% (46) of patients. The etiologies were dominated by urolithiasis with 39.1% (29) of patients. Anesthesia was general in 67.5% (50) and locoregional in 32.5% of patients (24). The procedure was performed without fluoroscopic control (blind) in 66.2% of cases(49), therewere 89.7% case of success (44 patients). The success rate was 86.5% (64) patients and the failure rate 13.5% (10) of patients. Five (6.7%) patients had a postoperative acute pyelonephritis complication requiringremoval of the JJ stent. CONCLUSION: The rise of the double J probe made possible to prepare the ureter, thus facilitating the endoscopic treatment of urinary lithiasis. The complication rate observed in our patients was low. The compliance with the rules of asepsis could reduce these complications.

OBJECTIF: rapporter les indications et les résultats de la dérivation du haut appareil urinaire par voie endoscopique par une sonde double J dans notre centre. PATIENTS ET MÉTHODES: Il s'agissait d'une étude prospective mono-centrique de type descriptif incluant tous les patients ayant eu une montée de sonde double J par voie endoscopique en première intention comme type de dérivation du haut appareil urinaire durant la période du 1 janvier 2018 au 30 juin 2019 dans notre centre. RÉSULTATS: Soixante-quatorze patients étaient inclus. L'âge moyen des patients était de 43,6 ± 17,5 ans avec un sex-ratio de 0,6. La colique néphrétique obstructive était l'indication opératoire la plus fréquente, objectivée chez 62,1 % (46) des patients. Une insuffisance rénale aiguë était notée chez 4 % (3) des patients. Les étiologies étaient dominées par la lithiase urinaire, objectivée chez 39,1 % (29) des patients. L'anesthésie était générale chez 67,5 % (50) et locorégionale chez 32,5 % des patients (24).En peropératoire, l'amplificateur de brillance était utilisé chez 33,7 % (25) et 66,3 % (49) des patients n'avaient pas de guidage fluoroscopique. Parmi ces derniers, le taux de succès opératoire était de 89,7 % (44 patients). Le taux de succès était de 86,5 % (64) des patients et le taux d'échec á 13,5 % (10) des patients. Cinq (6,7 %) patients avaient eu une complication postopératoire à type de pyélonéphrite aigue à risque de complication ayant nécessité le retrait de la sonde double J. CONCLUSION: La montée de sonde double J a permis de préparer l'uretère facilitant ainsi le traitement endoscopique des lithiases urinaires. Le taux de complication observée chez nos patients était faible. Le respect des règles d'asepsie contribuerait à diminuer ces complications.

[Impact of care pathway on the delay for initiation of antituberculosis treatment in Conakry, Guinea]. / Influence des parcours de soins sur le début du traitement antituberculeux à Conakry (Guinée).

Complex care pathways can result in detrimental treatment delay particularly in tuberculosis patients. The purpose of this retrospective study was to assess the care pathways followed by tuberculosis patients prior to diagnosis and to assess impact on the delay for initiation of treatment in Conakry, Guinea. A total of 112 patients were interviewed at the time of first admission for pulmonary tuberculosis with positive bacilloscopy. Based on interview data, pathways were classified as conventional (use of health care facilities only) and mixed (use of health care facilities, self-medication, and traditional medicine). The correlation between patient characteristics and type of pathway was assessed by univariate and multivariate analysis and the two groups, i.e., conventional vs. mixed, were compared with regard to delay for initiation of treatment. The care pathway was classified as mixed in two out of three patients. Multivariate analysis showed that this type of pathway was only correlated with schooling (p=0.02). The mean delay for treatment was similar, i.e., 13.4 and 12.8 weeks for conventional and mixed pathways respectively (p<0.68). The percentage of pathways including three consultations at health care facilities was significantly higher in the conventional than mixed group (72% vs. 30%, p<0.001). The main reasons given for delayed use of health care facilities were poor knowledge of tuberculosis symptoms (26%) and high cost of care (12%). The findings of this study indicate that tuberculosis patients follow a variety of care pathways that can lead to delayed treatment. An information campaign is needed to increase awareness among the population and care providers.

[The pentoxifylline, a corticosteroid sparing in the treatment of sarcoidosis: A case report]. / La pentoxifylline, un épargneur de corticoïdes dans le traitement de la sarcoïdose : à propos d'une observation.

INTRODUCTION: The pentoxifylline seems to have some effects on immune cells by inhibiting tumor necrosis factor alpha (TNFα). Its role as a sparing corticosteroids in the treatment of sarcoidosis remains to be defined. CLINICAL CASE: We present the case of a patient with sarcoidosis corticodependent despite the use of azathioprine. It was finally improved clinically, functionally and by a thoracic computed tomography with addition of pentoxifylline. CONCLUSION: When the tolerance of the pentoxifylline is good and there is not a bleeding risk, the benefit-risk in the long term might be interesting in some patients with sarcoidosis corticodependent.

[Fatal female genital mutilation in a 10-year-old girl]. / Mutilation génitale féminine fatale chez une fille de 10 ans.

Female genital mutilation (FGM) comprises all procedures involving partial or total removal of the external genitalia and/or any other procedures affecting the female genitalia, for cultural or religious reasons or for nontherapeutic purposes in general. FGM is responsible for a number of short-, medium-, and long-term complications that can engage the vital and functional prognosis, especially in African countries. We report on a case in a 10-year-old girl who underwent genital mutilation, a traditional type of total excision during the neonatal period. She was followed for urethral meatus stenosis, which then was complicated by obstructive chronic kidney failure and urinary sepsis, whose progression was fatal.

Benefit of amoxicillin in differentiating between TB suspects whose initial AFB sputum smears are negative.

SETTING: Out-patient dispensary in Conakry, Guinea, West Africa. OBJECTIVE: To differentiate between pulmonary tuberculosis (PTB) and non-PTB diseases among 204 acid-fast bacilli (AFB) smear-negative adult TB suspects. DESIGN: We derived scores from clinical, serological and radiological findings among PTB suspects aged > or = 15 years who, after having had three AFB-negative smears, were treated for 10 days with amoxicillin (AMX, 1.5 g/day). RESULTS: At the selected cut-off score from model 1 (clinical), sensitivity for PTB was 95%, specificity 40%, negative predictive value (NPV) 84%, and positive predictive value (PPV) 69%. Comparable values from model 2 (clinical + serological + radiological) were: sensitivity 99%, specificity 45%, NPV 97%, and PPV 71%. Results from AMX were better: sensitivity 92%, specificity 93%, NPV 94%, and PPV 91%. Of the 117 suspects who failed to respond clinically and radiographically to AMX and remained AFB smear-negative, 110 (94%) had PTB, confirmed either by positive culture (73 patients) or response to anti-tuberculosis treatment (37 patients). CONCLUSION: The clinical and radiographic response to AMX is better than derived scores at differentiating between PTB and non-PTB in TB suspects presenting to a dispensary in Guinea, a low HIV-seroprevalence country.

Associated tuberculosis and diabetes in Conakry, Guinea: prevalence and clinical characteristics.

SETTING: Anti-tuberculosis centres in Conakry. OBJECTIVES: To determine the prevalence of diabetes mellitus in patients with tuberculosis (TB), identify the associated risk factors and describe the clinical signs of the association of TB and diabetes. METHOD: A total of 388 patients with TB selected by simple random sampling from the register of cases diagnosed in Conakry were examined and administered a capillary blood glycaemia test to detect diabetes. RESULTS: Thirteen cases of diabetes were identified, giving a prevalence rate of 3.35% (95%CI 1.35-5.35). Four (31%) had not been diagnosed before the survey. The diagnosis of diabetes preceded that of TB by an average of 5 years (range 1-9 years). The clinical characteristics of TB (frequent exposure to infection, site and proportion of new and retreated cases) did not differ from one group to another. Increased age (P < 0.0001), obesity (P < 0.005), sedentary lifestyle (P < 0.0004), and previous family history of diabetes (P = 0.04) or obesity (P = 0.04) were significantly associated with diabetes. CONCLUSION: The prevalence of diabetes among TB patients is higher than previously estimated for Guinea. Because of frequent co-morbidity, systematic testing for diabetes among TB patients may be recommended, particularly if risk factors are present.

Treatment outcome of asthma after one year follow-up in health centres of several developing countries.

SETTING: Seven selected out-patient clinics caring for asthma patients in Algeria, Guinea, Morocco, Syria, Turkey and Vietnam. DESIGN: Evaluation of treatment outcomes after one year of follow-up of a cohort of asthma patients consecutively enrolled in a prospective study evaluating routine practice. RESULTS: Among 310 asthma patients registered, the following outcomes were recorded after one year of follow-up: 95 (31%) successful, 61 (20%) under control, 35 (11%) failed, 116 (37%) defaulted and 3 (1%) transferred. Among the 167 (53.9%) patients still on treatment after one year there was a substantial increase in the proportion of patients classified as intermittent at the end of treatment (from 11% to 53%), with a decrease in all categories of persistent asthma (from 34% to 12% for mild, 45% to 28% for moderate and 10% to 8% for severe asthma). CONCLUSIONS: While patients' quality of life can be improved if they follow regular treatment, the key challenge in providing care is to ensure that patients adhere to their treatment.

Implementation of asthma guidelines in health centres of several developing countries.

SETTING: Nine selected out-patient clinics caring for asthma patients in Algeria, Guinea, Ivory Coast, Kenya, Mali, Morocco, Syria, Turkey and Vietnam. DESIGN: Prospective enrolment of consecutive patients considered by the practitioner to have asthma with evaluation of adherence of the practitioner with recommended standard case management, including proportion of patients confirmed to have asthma, proportion in whom severity was correctly graded and proportion in whom treatment with inhaled corticosteroids corresponded to severity grade. RESULTS: Of 499 consecutive patients, 456 (91%) were enrolled and evaluated. The diagnosis was confirmed in 263 (58%). Agreement between the practitioner and the guidelines in assigning grade of severity was moderate overall (kappa = 0.42). It was higher for assignment of grade using symptoms (K = 0.51), but poor for assignment of grade using peak expiratory flow (PEF) rate (kappa = 0.29), with practitioners tending to underestimate the severity. Agreement between the practitioners' assessment of severity and treatment with inhaled corticosteroids was poor (kappa = 0.18), with underutilisation of inhaled corticosteroids. CONCLUSIONS: Practitioners caring for asthma patients in this study tended to underutilise the PEF rate in assessing their patients and underutilised treatment of patients with inhaled corticosteroids.

Serological markers of pulmonary tuberculosis and of response to anti-tuberculosis treatment in a patient population in Guinea.

The aim of the study was to evaluate serological correlates of active tuberculosis and of response to antituberculosis treatment in a cohort of HIV-negative patients with pulmonary tuberculosis studied at diagnosis and during treatment at the Service de Pneumo-Phtisiologie, Centre Hospitalier-Universitaire Ignace Deen, Conakry, Republic of Guinea. Two similar cohorts of HIV-negative healthy households of patients and healthy community controls were included in the study. Plasma samples were obtained from 168 untreated tuberculosis patients, 167 healthy household controls, and 168 healthy community controls. Serial plasma samples were also obtained from the tuberculosis patients at 2 and 8 months after initiation of chemotherapy. IgG antibody levels were measured by an enzyme-linked immunosorbent assay (ELISA) using ten purified M. tuberculosis antigens. ELISA results were analysed by comparing geometric means of data. Of the ten antigens tested, five (14kDa Ag, 19kDa Ag, AlaDH, MS, and MPT83) elicited similar antibody responses in untreated TB patients and controls. In contrast, levels of three antibodies (ESAT-6, LAM, and 38kDa Ag) were higher in untreated TB patients than in household or community controls (p<0.0001). Levels were higher in untreated patients than in community controls also for the anti-Rv2626c antibody (p = 0.0001) and, at a lower significance level, for the anti-FdxA antibody (p<0.025). Antibody levels against ESAT-6 and Rv2626c decreased during therapy, while antibody levels to the 38 kDa antigen and LAM increased during therapy; FdxA antibody levels did not vary with treatment. Neither severity of presentation nor chest X-ray patterns affected levels of these antibodies before treatment. In contrast, after the 8-month therapeutic course, patients who presented with moderate/severe disease had higher levels of anti-ESAT-6, anti-FdxA, and anti-38kDa antibodies than those of patients with mild disease onset. Patients with bilateral lung lesions had significantly higher anti-38kDa and anti-LAM levels, both at diagnosis and after 8-month treatment, than patients with lesions involving only one lung. Antibodies to alanine dehydrogenase and malate synthetase measured at initiation of treatment were higher in tuberculosis patients who subsequently failed therapy than in those who were cured. The main conclusions of the study are: a) plasma levels of antibodies to a number of M. tuberculosis represent serological correlates of active disease; b) these correlates are affected in an antigen-specific fashion by anti-tuberculosis treatment; c) particular serological markers may be predictive of treatment outcome.

[Factors linked to delayed diagnosis of tuberculosis in Conakry (Guinea)]. / Facteurs liés au retard du diagnostic de la tuberculose à Conakry (Guinée).

Untreated smear-positive pulmonary tuberculosis constitutes a reservoir of infection which is highly contagious. The present study was conducted in Conakry, Guinea, to determine the different options which are available when seeking treatment or care, and to ascertain the average delay in diagnosis of pulmonary tuberculosis and the main factors linked to the delay in diagnosis after the initial onset of symptoms. Through a cross-sectional study, 113 consecutive patients with smear-positive pulmonary tuberculosis were interviewed through the use of a questionnaire. The median total delay from the onset of symptoms of pulmonary tuberculosis until the diagnosis was 11 weeks. This delay period exceeded 4 weeks for 90 of the patients (80%). The average delay linked to the conventional health care system was double that of the one at the fault of the patient (6 weeks versus 3 weeks, respectively). 54% of the patients had initially resorted to non-conventional care. To shorten this mean delay period, it is necessary to both strengthen the professional abilities and skills which train for one to better to detect tuberculosis and to sensitize the population to the subject matter and information on the illness and its symptoms.

Investigation of the risk factors for tuberculosis: a case-control study in three countries in West Africa.

BACKGROUND: Host-related and environment-related factors have been shown to play a role in the development of tuberculosis (TB), but few studies were carried out to identify their respective roles in resource-poor countries. METHODS: A multicentre case-control study was conducted in Guinée, Guinea Bissau, and The Gambia, from January 1999 to March 2001. Cases were newly detected smear positive TB patients. Two controls were recruited for each case, one within the household of the case, and one in the community. RESULTS: Regarding host-related factors, univariate analysis by conditional logistic regression of 687 matched pairs of cases and household controls showed that TB was associated with male sex, family history of TB, absence of a BCG scar, smoking, alcohol, anaemia, HIV infection, and history and treatment of worm infection. In a multivariable model based on 601 matched pairs, male sex, family history of TB, smoking, and HIV infection were independent risk factors of TB. The investigation of environmental factors based on the comparison of 816 cases/community control pairs showed that the risk of TB was associated with single marital status, family history of TB, adult crowding, and renting the house. In a final model assessing the combined effect of host and environmental factors, TB was associated with male sex, HIV infection, smoking (with a dose-effect relationship), history of asthma, family history of TB, marital status, adult crowding, and renting the house. CONCLUSION: TB is a multifactorial disorder, in which environment interacts with host-related factors. This study provided useful information for the assessment of host and environmental factors of TB for the improvement of TB control activities in developing countries.

[Prevalence and morbidity of G6PD deficiency in sickle cell disease in the homozygote]. / Prevalence et morbidite du deficit en g6pd au cours de la drepanocytose homozygote.

Sickle cell disease and G6PD deficiency have similar prevalence of 8 to 10% in Senegalese population. Our objectives were to determine the prevalence of G6PD deficiency in Hb S carriers and normal subjects, and to assess the interaction of G6PD deficiency on clinical severity of sickle cell disease. G6PD activity was measured in 319 sickle cell patients and in 318 subjects without HbS. Clinical severity was compared in male homozygous sickle cell patients (11 with G6PD deficiency and 19 without deficit). In homozygous sickle cell patients, the G6PD status was assessed after correction of reticulocyte count following the micro-centrifugation method of Herz. We found that prevalence of G6PD deficiency was higher in sickle cell disease patients (21.6 %) than in normal subjects (12.3 %) (p = 0.001). No difference was found in the two groups of male sickle cell disease patients concerning number of vaso-occlusive crisis, number of transfusion, frequency of infectious episodes, number of chronic complications, disturbances on patient's activity and total index severity.

Useful clues to the presence of smear-negative pulmonary tuberculosis in a West African city.

OBJECTIVE: Tuberculosis suspects with negative sputum smears for acid-fast bacilli (AFB) may have either pulmonary tuberculosis (PTB) or some other pulmonary disease (non-PTB). The aim of this study was to improve the differentiation between PTB and non-PTB. DESIGN: We enrolled 396 tuberculosis suspects 15 years of age or older who had cough of 21 days or longer and three negative AFB smears. Non-PTB was diagnosed by clinical and radiographic responses to amoxicillin; smear-negative PTB was diagnosed by positive culture for Mycobacterium tuberculosis or response to antituberculosis chemotherapy. RESULTS: Multivariate analysis, without X-ray variables, of 79 patients with a final diagnosis of non-PTB and 110 patients with smear-negative PTB indicated that age less than 37 years, family contact with TB, never having been married, loss of weight, lack of expectoration, human immunodeficiency virus (HIV) seropositivity, and tuberculin reactivity were significantly associated with PTB. When the initial X-ray findings were included, age younger than 37 years, lack of expectoration, HIV seropositivity, and tuberculin reactivity remained in the model, and cavitation and patchy densities were significantly associated. CONCLUSION: The response to 10 days of amoxicillin and certain demographic, clinical and radiographic characteristics are useful in separating non-PTB from PTB in tuberculosis suspects with negative AFB smears.

Affordability of inhaled corticosteroids as a potential barrier to treatment of asthma in some developing countries.

SETTING: The cost and availability of the medications required for the treatment of asthma may represent potential barriers to effective management. METHOD: A survey of prices and policies for components of asthma treatment in 1998, in Algeria, Burkina Faso, Ivory Coast, Guinea, Mali, Syria, Turkey and Vietnam. RESULTS: Medications were consistently available in only four of the eight countries studied. The cost of essential medications for standard case management varied by over five times for beclomethasone and by over three times for inhaled salbutamol. In all but two countries, the cost of one year of drugs for treatment of a moderate, persistent case exceeded the monthly salary of a nurse in that country. The essential drugs list included inhaled salbutamol in five of eight countries and beclomethasone in three of eight. The costs of medications were lower where generic preparations were available and, to a lesser extent, where the medications are on the essential drugs list. CONCLUSIONS: The cost and availability of medications vary widely, and may represent an important barrier to effective management in some low and middle income countries.

The prevalence of diabetes mellitus in three population groups in the Republic of Mali.

Three different adult population groups in Mali were screened for diabetes mellitus by means of a post-prandial blood glucose determination. The prevalence of diabetes for the entire population sampled was found to be 1-4%. Diabetes mellitus was strongly suspected in an additional 8-4%. The prevalence of elevated post-prandial blood glucose levels was found to be the lowest (5-1%) among a group of Bambara farmers who live an active rural life and whose total daily caloric intake is less than 1,000 on the average, only half of it provided by carbohydrates.

Incidence of and beliefs about trypanosomiasis in the Senegal River Basin.

A survey was conducted for trypanosomiasis of 10,875 persons living in 56 villages in the Senegal River Basin in Mali. The incidence of the disease was found to be 137.9/100,000. An interview survey was simultaneously undertaken in order to elucidate local beliefs about the disease. Although trypanosomiasis is recognized as a distinct disease entity once the late stage has developed, there is no knowledge of its relationship to tsetse flies. It is common knowledge that hunters who frequent riverine forest galleries and forested savanna often contract the disease. Their frequent and intense exposure to Glossina sp. is not viewed as having any relationship to their contracting the disease.