Normal values of sudomotor function assessed by electrochemical skin conductance in African population.

BACKGROUND: Dysfunction of small nerve fibers remains a major public health concern. Subjects suspected of having small nerve fiber damage need to undergo reliable tests to confirm the diagnosis. Sudomotor function test is a reliable noninvasive exploration for detecting peripheral neuropathies. Nevertheless, the normal reference values derived from the sudomotor function test are not known in the African population. The objective of this study was therefore to describe the normal values of Electrochemical Skin Conductance (ESC) measured by the sudomotor function test in healthy African subjects. MATERIALS AND METHODS: Between December 1st, 2021 and May 31st, 2022, ESC was measured in 475 healthy subjects (median age: 42 [31-53] years, 46% men) using a sudomotor function test, in the hands and feet. Investigators proposed the examination and received participants' consent; demographic, anthropometric, biological, and clinical data were obtained before the test. Data on 475 healthy study participants who underwent sudomotor function testing was collected and analyzed. The sociodemographic (age, sex), anthropometric (weight, height, waist circumference, body mass index), diastolic blood pressure, systolic blood pressure, heart rate, and electrochemical skin conductances of the hands and feet were assessed. RESULTS: ESC values were statistically higher in men compared to women (right hand ESC: 70 [60-78] versus 63 [53-72], left hand ESC: 72 [61-80] versus 68 [57-75], right foot ESC: 77 [82-99] versus 72 [64-79], ESC left foot: 76 [68-82] versus 72 [62-78] respectively). ESC values were significantly inversely correlated with age (right hand ESC: r=-0.12, P=0.006; left hand ESC: r=-0.11, P=0.01; right foot ESC: r=-0.37, P<0.0001; ESC left foot: r=-0.38, P<0.0001). ESC values measured in feet were significantly inversely correlated with body mass index (right foot r=-0.22, P<0.0001; left foot r=-0.21, P<0.0001). CONCLUSION: This study reports normal reference values for ESCs according to age and gender in the healthy African population. Progressive decrease in ESC with aging is confirmed by our data. The value of ESC seems lower in the African population than in other reported ethnicities. This finding needs to be further explored in additional studies.

Epidemiological time-trend of amyotrophic lateral sclerosis (ALS) over two decades: The French population-based register of ALS in Limousin (FRALim register).

INTRODUCTION: Population-based registers are key to understanding disease patterns. Taking advantage of the long-standing operation of the French register of amyotrophic lateral sclerosis (ALS) in Limousin (FRALim register), we sought to determine the time trends in incidence, clinical features and survival of ALS patients from 2000 to 2020. METHODS: FRALim register included incident cases through multiple sources of ascertainment. A capture-recapture method was used to assess the exhaustiveness of case ascertainment. Crude and standardized incidences were calculated per 100,000 person-years of follow-up (PYFU). Time-period was divided (period 2000 to 2010 and period 2011 to 2020) to compare incidence rates and clinical features. Survival was analyzed using Kaplan-Meier method. Cox proportional hazards model was performed to calculate hazards for the time periods. RESULTS: Overall, 501 incident cases were identified during 21 years. The overall crude incidence was 3.26 (95% CI 2.97 to 3.55) per 100 000 PYFU. The exhaustiveness of the register was estimated at 98.8% (95% CI 97.4-99.6%) by capture-recapture analysis. Several fluctuations were observed without a consistent trend over the last two decades. The crude and standardized incidences were higher in males than females. The peak of incidence was observed in the 75-79 years age band. Almost one-third of the cases exhibited a bulbar onset. There were significant differences in clinical features between time periods. Four hundred and ninety-one cases were included in the survival analysis. The median survival time from diagnosis was 16.0 months (95% CI 14.3 to 17.7 months). Patients in the last decade experienced a lower risk of dying but the difference did not reach statistical significance (adjusted HR: 0.89 (95% CI 0.73 to 1.08, P=0.229). CONCLUSION: We provided reliable epidemiological data over two decades. We showed that incidence has been relatively stable, while clinical variability was observed. A slight improvement in survival time was found in the last decade but it was not statistically significant. Further quality register data are needed to improve our understanding of ALS epidemiological trends.

Prevalence of stroke survivors in Parakou in northern Benin: A door-to-door community survey.

INTRODUCTION: Stroke is a major public health problem with a high burden in Sub-Saharan Africa. We aimed to determine the prevalence of stroke in Titirou in Parakou. METHODS: It was a cross-sectional study using a door-to-door survey in Titirou (Parakou) from 15 march to 15 October 2016 and included 4671 adults. We did a two stages survey. In the first stage the World Health Organization (WHO) tool for the diagnosis of stroke in community was used. In the second phase all suspected cases underwent neurological exam and sometimes brain CT-scan. The WHO definition was used for the diagnosis of stroke. We recorded the socio-demographic data and the vascular risk factors. The prevalence was standardized on age according to the WHO type population. Multiple logistic regression was done to identify associated factors and estimate the adjusted prevalence ratio (aPR) and their 95% confidence interval (CI). RESULTS: The mean age of the subjects was 27.7±12.9 years with a sex ratio of 0.97. After screening 161 were suspected and 54 confirmed cases, the overall prevalence of stroke in Titirou was 1.156 per 100,000 inhabitants [95% CI: 0.850 to 1.426]. The age-standardized prevalence of stroke was 3223 cases per 100,000 inhabitants. The associated factors were age (aPR 1.7 [1.5-1.9] for 10 years), history of hypertension (aPR: 64.8 [46.1-108.9]), diabetes mellitus (aPR: 4.5 [1.6-12.3]), low consumption of fruits and vegetables (aPR: 2.3 [1.2-4.4]), history of heart disease (aPR: 6.0 [2.6-13.7]), family history of stroke (PR: 4.6 [2.1-10.0]). Among the 54 subjects who had a stroke 10 were able to perform the brain CT-Scan: 40% were hemorrhagic and 60% ischemic stroke. CONCLUSION: Our study showed a high prevalence of stroke in Titirou and suggested urgent action for prevention.

Hypermetabolism is a deleterious prognostic factor in patients with amyotrophic lateral sclerosis.

BACKGROUND AND PURPOSE: The aim of this study was to investigate patients with amyotrophic lateral sclerosis in order to determine their nutritional, neurological and respiratory parameters, and survival according to metabolic level. METHODS: Nutritional assessment included resting energy expenditure (REE) measured by indirect calorimetry [hypermetabolism if REE variation (ΔREE) > 10%] and fat mass (FM) using impedancemetry. Neurological assessment included the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised score. Survival analysis used the Kaplan-Meier method and multivariate Cox model. RESULTS: A total of 315 patients were analysed. Median age at diagnosis was 65.9 years and 55.2% of patients were hypermetabolic. With regard to the metabolic level (ΔREE: < 10%, 10-20% and >20%), patients with ΔREE > 20% initially had a lower FM(29.7% vs. 32.1% in those with ΔREE ≤10%; P = 0.0054). During follow-up, the median slope of Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised tended to worsen more in patients with ΔREE > 20% (-1.4 vs. -1.0 points/month in those with ΔREE ≤10%; P = 0.07). Overall median survival since diagnosis was 18.4 months. ΔREE > 20% tended to increase the risk of dying compared with ΔREE ≤10% (hazard ratio, 1.33; P = 0.055). In multivariate analysis, an increased REE:FM ratio was independently associated with death (hazard ratio, 1.005; P = 0.001). CONCLUSIONS: Hypermetabolism is present in more than half of patients with amyotrophic lateral sclerosis. It modifies the body composition at diagnosis, and patients with hypermetabolism >20% have a worse prognosis than those without hypermetabolism.

Evaluation of the application of the European guidelines for the diagnosis and clinical care of amyotrophic lateral sclerosis (ALS) patients in six French ALS centres.

BACKGROUND AND PURPOSE: Our objective was to evaluate the extent to which the 2005 recommendations of the European Federation of Neurological Sciences (EFNS) on the multidisciplinary management of amyotrophic lateral sclerosis (ALS) are followed in clinical practice. METHODS: This was a multicentre observational study involving six French ALS referral centres receiving prevalent and incident cases. Recommendations were translated into ad hoc questions referring to key aspects of management, and their application was evaluated by a clinical research assistant who independently examined the medical charts (MCs). When necessary, an independent board-certified neurologist answered the questions based on examination of the MC and interview of the caring neurologist. Questions regarding diagnosis and communication were put to patients in a self-administered questionnaire. RESULTS: In all, 376 patients [176 incident, 200 prevalent cases; median age at diagnosis 62.8 years (interquartile range 55.7-72.3); sex ratio 1.37; 27.3% bulbar onset] were included. All the topics covered in the recommendations were evaluated: diagnostic delay (e.g. mean 13.6 months, associated with age and onset); breaking the news (e.g. criteria for communication quality were satisfactory in more than 90%); multidisciplinary and sustained support (e.g. clinic visits were scheduled every 2-3 months in 90%). Also considered were whether riluzole had been offered, symptom management, genetic testing, ventilation, communication defects, enteral nutrition, palliative and end-of-life care. Characteristics associated with poor compliance with some guidelines (schedule of visits, delayed riluzole initiation) were also identified. CONCLUSION: This is the first evaluation of the application of the EFNS recommendations for the management of ALS in a nationwide sample. The results allow us to highlight areas for improvement.

Epidemiology of amyotrophic lateral sclerosis: A review of literature.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of motor neurons, resulting in worsening weakness of voluntary muscles until death occurs from respiratory failure. The incidence of ALS in European populations is two to three people per year per 100,000 of the general population. In Europe, crude prevalences range from 1.1/100,000 population in Yugoslavia to 8.2/100,000 in the Faroe Islands. Major advances have been made in our understanding of the genetic causes of ALS, whereas the contribution of environmental factors has been more difficult to assess and large-scale studies have not yet revealed a replicable, definitive environmental risk factor. The only established risk factors to date are older age, male gender and a family history of ALS. Median survival time from onset to death is usually 3 years from the first appearance of symptoms. Older age and bulbar onset are consistently reported to have poorer outcomes. However, there are conflicting data regarding gender, diagnostic delay and El Escorial criteria. The rate of symptom progression has been revealed to be an independent prognostic factor. Psychosocial factors and impaired cognitive function are negatively related to ALS outcome, while nutritional status and respiratory function are also related to ALS prognosis. The effect of enteral nutrition on survival is still unclear, although noninvasive positive pressure ventilation (NIPPV) has been found to improve survival. These findings have relevant implications for the design of future trials.

Knowledge, attitudes, and behavior among key people involved in the employment of people with epilepsy in southern Benin.

PURPOSE: This study aimed to investigate knowledge, attitudes, and behavior among individuals working to achieve, or promote, the employment and retention in employment of people with epilepsy (PWE) in Benin. METHODS: We interviewed 300 subjects using a self-administered questionnaire. RESULTS: Knowledge: 93% had heard of epilepsy; 8.8% had at least one person with epilepsy (PWE) in their family; and 67.3% had witnessed a person having epileptic seizures. Attitudes and behavior: 95.3% and 95%, respectively, expressed their views that PWE should be able to enter mainstream education and that PWE should marry; 76.4% considered PWE equal to themselves; and 28.6% reported they would not hire a PWE. We found some associations between demographic characteristics and knowledge, attitudes, and behavior among respondents. A few unhelpful aspects of knowledge, attitudes, and behavior were identified. CONCLUSIONS: Our study showed a fairly high level of accurate knowledge of epilepsy, but some misperceptions and unhelpful attitudes and practices toward PWE in Benin were noted. This study's findings can be used to help plan appropriate strategies based on correcting misperceptions concerning inclusion and retention in employment of PWE in Benin.

Population-based epidemiology of amyotrophic lateral sclerosis (ALS) in an ageing Europe--the French register of ALS in Limousin (FRALim register).

BACKGROUND AND PURPOSE: The main objective of establishing the French register of amyotrophic lateral sclerosis (ALS) in the Limousin region (FRALim), was to assess the incidence of ALS, in this ageing region of Europe, over a 12-year period (2000-2011). METHODS: Patients were included if they lived in Limousin at the time of diagnosis of ALS according to El Escorial revised criteria and were identified by at least one of the following sources: (i) the French national body coordinating ALS referral centres; (ii) public and private hospitals in the region; (iii) health insurance data related to long-term diseases. RESULTS: The FRALim register identified 279 incident cases (2000-2011). The crude and European population standardized incidences of ALS were as high as 3.19/100,000 person-years of follow-up (95% CI 2.81-3.56) and 2.58/100,000 person-years of follow-up (95% CI 2.27-2.89) respectively. Median age at onset was 70.8 years (interquartile range 63.1-77.1). The standardized sex incidence ratio (male/female) was 1.3 overall, but 1.1 under the age of 65 years, 1.7 between 65 and 75 years and 1.9 above 75 years. The exhaustiveness of the register has been estimated at 98.4% (95% CI 95.6-99.4) by capture-recapture analysis. CONCLUSION: It was possible for the first time in France to monitor accurately the incidence of ALS over a long time period. It appears to be in the upper range of data reported in western countries. Patterns displayed here might anticipate the epidemiology of ALS in ageing western countries.

The prevalence and subjective handicap of epilepsy in Ilie--a rural riverine community in South West Nigeria: a door-to-door survey.

BACKGROUND: The prevalence of epilepsy is high in tropical countries, particularly in Africa with an estimated mean prevalence of 15 per 1000. There is lack of recent data on epilepsy prevalence in Nigeria. The main objective of this study was to determine the prevalence of epilepsy in Ilie in South West (SW) Nigeria, and the secondary objectives were to determine the clinical characteristics, the seizure types with electroencephalography (EEG) recording, the pattern of treatment, and to evaluate the subjective handicap of people with epilepsy (PWE). MATERIALS AND METHODS: The study, which was descriptive cross-sectional, was carried out in Ilie, a rural community in South West Nigeria, using a simple random sampling technique. The survey was done in 2 phases from January 2013 to April 2013. Phase 1: Door-to-door screening using the WHO Neuroscience Research Protocol to detect neurological disorders by health workers. Phase 2: Individuals with positive screening had complete neurologic examination by neurologists as well as an EEG recording. The questionnaires for survey of epilepsy in tropical countries and subjective handicap of epilepsy were administered to all PWE. RESULTS: Two thousand two hundred twelve individuals from 231 households were screened during the first phase, and 33 cases of neurologic diseases were detected. During the second phase, 10 cases were confirmed to be epilepsy by neurologists, thus giving a crude lifetime prevalence of 10/2212=4.5/1000 population (95% CI=2.30-8.04). CONCLUSIONS: The prevalence of epilepsy in Ilie in South West Nigeria is rather low compared with previous figures from studies in rural Africa.

Epidemiology of peripheral artery disease in elder general population of two cities of Central Africa: Bangui and Brazzaville.

OBJECTIVES: Peripheral artery disease (PAD) is a common condition in Western countries, mostly in the elderly. Little is known about the epidemiology of PAD in Africa. We sought to determine the prevalence of this condition in the elderly in two community-dwelling cohorts in Central Africa. DESIGN: Prospective cross-sectional survey in general population over the age of 65 years in Bangui (Central African Republic) and Brazzaville (Congo). METHODS: We conducted a systematic door-to-door survey in two representative districts of each city. Demographic, clinical and biological data were collected. The ankle-brachial index (ABI) was used to detect PAD (ABI ≤ 0.90). RESULTS: Among the 976 participants, the prevalence of PAD was 15.0% in Bangui and 32.4% in Brazzaville, increasing with age. Adjusted to age, regular alcohol consumption was protective for women in Bangui (OR = 0.50, CI95%:0.25-0.98) and men in Brazzaville (OR = 0.43, CI95%:0.21-0.88). Hypertension was associated with PAD in women (OR = 4.14, CI95%:1.65-10.42 in Bangui and OR = 2.17, CI95%:1.16-4.06 in Brazzaville). Diabetes and smoking showed different associations according to gender and city. CONCLUSIONS: This first population study in Central Africa highlights the high prevalence of PAD in the older population, and emphasizes specificities regarding the risk factors, being different from data published in Western countries.

[Methodology of neuroepidemiological studies in tropical countries: a challenge?]. / Méthodologie des études neuroépidémiologiques dans les pays tropicaux : un challenge ?

The purpose of this paper is to highlight the difficulties of applying neuroepidemiological methods in low income countries or developing countries, which are mostly tropical countries, taking advantage of the experience of the Institute of Neuroepidemiology and Tropical Neurology, which was created in Limoges in 1982. These difficulties could be related to several aspects: methodological, logistical, political or economical, linked to ethical issues, even difficulties to publish the studies. However, concept and neuroepidemiological methods should stay the same worldwide, even if their translation into practice could sometimes raise some problems in developing countries. Study protocol should be more detailed. Some specific epidemiological methods could be useful. Collection of data should be standardized. True cooperation at every level is needed for these researches to be valid.

[Epidemiology of dementia in elderly living in the 3rd borough of Bangui (Central African Republic)]. / Épidémiologie des démences chez les personnes âgées dans le troisième arrondissement de la ville de Bangui (République Centrafricaine).

Given the gradual improvement of living conditions and aging, dementia and related syndromes are becoming serious problems in the developing countries. A cross-sectional door to door type study in neighbourhood, was conducted from October 2008 to January 2009, in the general population in Bangui, order to help get a better understanding of the prevalence and risk factors of dementia among people over 65 living in the Central African capital. Of the 496 elderly respondents, 188 had cognitive disorders. After a neuropsychological examination, 40 of these subjects were diagnosed with dementia. The prevalence of dementia was 8.1% (IC 95% = [5.7-10.5]). The average age of subjects with dementia, ranging from 65 to 90 years, was 76.0 ± 7.1 years. There was a significant risk of developing dementia for an increase of ten years old (OR = 2.6, 95% CI [1.5 to 4.5]). The sex-ratio was 6/34. 82.5% of the demented had never attended school. 70.0% showed a state of malnutrition (BMI ≤ 18,5 kg/m(2)), significantly associated with dementia (OR = 3.3; IC 95% = [1.5-7.3]). The blood pressure was high in 67.5% of demented which is significantly associated with dementia (OR = 2.4; IC 95% = [1.1-5.4]). A recent change in financial status was a factor significantly associated with dementia (OR = 6.4; IC 95% = [1.8-22.5]). These results support the existence of dementia in urban Africa. The observed prevalence is close to those found in high-income countries. Further studies should be conducted which includes both the rural and urban Africa, to better understand the problem and solutions consider to comprehensive care and prevention axes adapted to our context.

Alteration of nutritional status at diagnosis is a prognostic factor for survival of amyotrophic lateral sclerosis patients.

OBJECTIVES: The aims were to analyse changes in nutritional parameters from diagnosis of amyotrophic lateral sclerosis (ALS) to death and to assess their relationships with survival at the time of diagnosis and during follow-up. METHODS: 92 ALS patients were included and clinically assessed every 3 months (ALS functional rating scale, manual muscular testing, forced vital capacity, weight, BMI, percentage weight loss). Bioimpedance was performed to evaluate body composition (fat-free mass, fat mass and hydration status) and phase angle. Survival analyses were performed from diagnosis to death or censoring date using a Cox model. RESULTS: The evolution of nutritional parameters in ALS patients was marked by significant decreases in weight, BMI, fat-free mass and phase angle, and increased fat mass. The authors identified an adjusted 30% increased risk of death for a 5% decrease from usual weight at time of diagnosis (RR 1.30; 95% CI 1.08 to 1.56). During follow-up, the authors identified adjusted 34% (95% CI 18% to 51%) and 24% (95% CI 13% to 36%) increased risks of death associated with each 5% decrease in usual weight and each unit decrease in usual BMI, respectively (p<0.0001). Malnutrition during the course was related to a shorter survival (p=0.01), and fat mass level was associated with a better outcome (RR 0.90 for each 2.5 kg fat mass increment). CONCLUSIONS: Nutritional parameters of ALS patients worsened during evolution of the disease, and worse nutritional status (at time of diagnosis or during the course) was associated with a higher mortality. This study offers some justification for studying the use of therapeutic nutritional intervention to modify the survival of ALS patients.

[Social representations of cardiovascular disease in the Tanvè Health Study (TAHES) cohort in Benin]. / Représentations sociales des maladies cardio-vasculaires dans la cohorte Tanvè Health Study (TAHES) au Bénin.

OBJECTIVE: To describe the social representations associated with cardiovascular diseases (CVD) in the village of Tanvè in Benin. METHODS: Focus groups discussions and semi-structured interviews were conducted among participants of Tanvè Health Study (TAHES) cohort. Audio recordings were made during the interviews, as well as some note-taking. Data were organized by themes and analyzed to identify key representations that underlie attitudes and health care practices. RESULTS: A total of 19 subjects (including 11 women) participated in 2 focus groups and 17 (including 5 women) in individual interviews. Etymologies of CVD's names evoke either clinical signs (example: ''tesisi glô mɛ'' [can't stand up]), guessed etiology (example: ''kuvitɔ zɔn'' [ghosts' disease]) or a local adaptation of a biomedical name (example: ''a'tension'' [from hypertension]), to cite the example of stroke. According to beliefs about etiology, diseases were classed as ''simple'' or "organic" diseases ("azɔn yaya") and ''supernatural'' or ''induced'' diseases linked to "azé" [immaterial witchcraft] or "bô" [material bewitchment]. Chronic or recurrent diseases usually end up in the ''supranatural'' category and induce the consultation of "bokɔnɔ᷉" (diviner) or other religious for diagnosis. Health care seeking refer to modern medicine, "amanɔn" (leaf-based care), "bokɔnɔ᷉" or traditional religious (various rites) and Christians (prayers). CONCLUSION: Social representations of CVD in this community are based on ancestral beliefs, but are also influenced by modern knowledge. Taking them into account could improve quality of health to fulfill communities' care needs.

Multiple sclerosis and solar exposure before the age of 15 years: case-control study in Cuba, Martinique and Sicily.

Few studies report a protective role of childhood solar exposure to multiple sclerosis. Our objective was to confirm the protective role of childhood solar exposure in multiple sclerosis in Cuba, Martinique and Sicily. This was a matched case- control study, and cases met Poser criteria for clinically, laboratory (definite, probable) multiple sclerosis. Controls were resident population, without neurological disorder, living close to cases (within 100 km), matched for sex, age (+/-5 years), residence before age 15. We recruited 551 subjects during a 1-year period (193 cases, Cuba n = 95, Sicily n = 50, Martinique n = 48; 358 controls). Some (89%) met definite clinical multiple sclerosis criteria (relapsing remitting form (with and without sequel) (74%), secondary progressive (21%), primary progressive (5%)). Odds ratios in a uni-variate analysis were: family history of multiple sclerosis (5.1) and autoimmune disorder (4.0); wearing shirt (3.5), hat (2.7), pants (2.4); sun exposure causing sunburn (1.8); sun exposure duration (1 h more/day; weekends 0.91, weekdays 0.86); bare-chested (0.6); water sports (0.2). Independent factors in the multivariate analysis were family history of multiple sclerosis (4.8 (1.50-15.10)), wearing pants under sunlight (1.9 (1.10-3.20)), sun exposure duration (1 h more/ day, weekdays 0.90 (0.85-0.98), weekends 0.93 (0.87-0.99)), water sports (0.23 (0.13-0.40)). We conclude that outdoor leisure activities in addition to sun exposure reports are associated with a reduced multiple sclerosis risk, with evidence of dose response.

Prevalence of migraine in a rural community in south Benin.

Migraine is a very common neurological disorder worldwide. Its prevalence is lower in developing countries. There were no data concerning the general population in Benin. We aimed to determine the prevalence of migraine in a rural community of Benin. A cross-sectional study was conducted in a rural area of Abomey from February to April 2003 and included 1113 persons selected by a two-stage survey. A case was defined according to International Headache Society criteria (1988). Of the 1113 persons, 37 had migraine. The lifetime prevalence of migraine was 3.3% (male 2.2%, female 4.0%). The peak prevalence was found in persons in the second decade of life. Higher levels of education were associated with migraine. Migraine without aura was the more frequent form (67.5%). The most frequent triggers of migraine were annoyance (73.0%), exposure to the sun (73.0%), heat (65.0%) and anxiety (51.4%). The low prevalence rate of migraine in Benin confirmed the results of the few available African studies. The disease is severe and occurs in a young population and could lead to a high socio-economical burden.

[Management of stroke in sub-Saharan Africa: current issues]. / Prise en charge des accidents vasculaires cérébraux en Afrique subsaharienne.

In sub-Saharan Africa, stroke is likely to present an increasingly important public health problem with a larger relative share of overall morbidity and mortality. Overall, sub-Saharan Health Care is characterized by a lack of human resources, lack of facilities for special investigations, and especially an absence of specific programs addressing the prevention of cardiovascular conditions. Current data on the epidemiology of stroke in sub-Saharan Africa, although sparse and fragmentary, indicate a comparatively high incidence of cerebral hemorrhage associated with high blood pressure, while ischemic stroke in black Africans still appears to be related primarily to small artery disease, HIV infection, and sickle cell disease. With urbanization, the role of large-vessel atherosclerosis is increasing. It is thus essential to coordinate government funding, health care professionals and development agencies to address this rising health problem. Access to health care needs to be better structured, and screening programs should be developed in order to identify and treat vascular risk factors. Improved training of health care professionals is also required in the areas of prevention, diagnosis and management of stroke. Implementation of best-practice recommendations for the management of stroke adapted to the specificities and resources of African countries would help rationalize the scarce resources currently available.

[Outbreak of konzo disease in health region No. 2 of the Central African Republic]. / Résurgence de la maladie de konzo dans la région sanitaire n(o) 2 en République centrafricaine.

INTRODUCTION: Konzo is a neuromyelopathy characterized by permanent spastic paraparesis, linked to a subacute poisoning by cyanide found in cassava. The purpose of the study is to describe the epidemiological aspects of konzo in health region No. 2 in the Central African Republic. METHOD: A descriptive cross-sectional study was conducted among patients collected during a one-month period (July 16 to August 16, 2007) of active surveillance for acute flaccid paralysis. RESULTS: Eighty-one cases of konzo were identified during the study period, representing a prevalence of 10 per 100,000. Mean age of patients was 10.7+/-7.7 years. Children and women were most affected. The main warning signs were fatigability (97.6%), tremor (88.9%), walking difficulty (100.0%), dysarthria (67.9%) and a loss of visual acuity (65.4%). The predominant neurological signs were lower limb paresis (90.0%) and hyperesthesia (66.7%). CONCLUSION: Konzo is a serious public health problem in this region of the Central African Republic. A prevention program should be set-up.