[Predictive value of postural and dynamic walking parameters after high-volume lumbar puncture in normal pressure hydrocephalus]. / Intérêt prédictif de l'évolution des facteurs posturaux et locomoteurs après ponction lombaire soustractive dans l'hydrocéphalie chronique de l'adulte.

INTRODUCTION: Normal pressure hydrocephalus (NPH) was described by Adams et al. (1965). The common clinical presentation is the triad: gait disturbance, cognitive decline and urinary incontinence. Although these symptoms are suggestive, they are not specific to diagnosis. The improvement of symptoms after high-volume lumbar puncture (hVLP) could be a strong criterion for diagnosis. We tried to determine a specific pattern of dynamic walking and posture parameters in NPH. Additionally, we tried to specify the evolution of these criteria after hVLP and to determine predictive values of ventriculoperitoneal shunting (VPS) efficiency. PATIENTS AND METHODS: Sixty-four patients were followed during seven years from January 2002 to June 2009. We identified three periods: before (S1), after hVLP (S2) and after VPS (S3). The following criteria concerned walking and posture parameters: walking parameters were speed, step length and step rhythm; posture parameters were statokinesigram total length and surface, length according to the surface (LFS), average value of equilibration for lateral movements (Xmoyen), anteroposterior movements (Ymoyen), total movement length in lateral axis (longX) and anteroposterior axis (longY). RESULTS: Among the 64 patients included, 22 had VPS and 16 were investigated in S3. All kinematic criteria are decreased in S1 compared with normal values. hVLP improved these criteria significantly (S2). Among posture parameters, only total length and surface of statokinesigram showed improvement in S1, but no improvement in S2. A gain in speed greater or equal to 0.15m/s between S1 and S2 predicted the efficacy of VPS with a positive predictive value (PPV) of 87.1% and a negative predictive value (NPV) of 69.7% (area under the ROC curve [AUC]: 0.86). CONCLUSION: Kinematic walking parameters are the most disruptive and are partially improved after hVLP. These parameters could be an interesting test for selecting candidates for VPS. These data have to be confirmed in a larger cohort.

[Assessment of the availability and use of antivenom in the district of Bamako, Mali, West Africa]. / Évaluation de la disponibilité et l'utilisation du sérum antivenimeux dans le district de Bamako, Mali, Afrique de l'Ouest.

The aim of this study is to describe the difficulties related to problems of supply and use of antivenom serum (SAV) in the district of Bamako. A retrospective study over a span of five years (January 1998-December 2002) and an interview with the staff of various facilities were conducted. The study included 2 wholesalers of pharmaceuticals, 20 private pharmacies, and 2 hospital pharmacies as they were involved in antivenom trades. A market-driving ability survey of driving practice was conducted in 37 community health centers (CHCs) and 4 dispensaries because they performed antivenom treatments during the study period. A total of 3,318 doses of antivenom were bought, including 84.4% by the People Pharmacy of Mali (PPM), a public organization, and 15.6% by Laborex, a private company. These were out of stock in 1999. Three kinds of SAV were ordered: the polyvalent IPSER Africa (1,200 vials or 36.2%), FAV Africa (318 vials or 9.6%), and Sii anti-snake venom polyvalent serum (1,800 vials or 54.2%). Orders from PPM involved IPSER Africa (Pasteur Mérieux Serum & Vaccines) and Sii anti-snake venom polyvalent serum (Serum Institute of India), and those from Laborex involved IPSER Africa and FAVAfrica (Aventis Pasteur). Onehalf of private pharmacies (54.3%) had made at least one order of SAV. The PPM lost 50% of 2,000 vials of SAV in 1996 due to the expiration of vials that were bought. Private pharmacies lost 3.6% of stocks due to expiration. Prices varied depending on the type of service and the point of sale. Costs of vials were 19,440-35,000 CFA francs (29.6-53.4 euros) for Sii antivenom and 50,200-63,000 CFA francs (76.5-96.1 euros) for FAV Africa antivenom. In CHCs, 59.5% of prescribers were unaware of the indications and methods of proper administration of the SAV, 32.3% ignored the existence of SAV, and 30.9% were skeptical about its effectiveness in treatment of envenomation by snakebite.

Amodiaquine dosage and tolerability for intermittent preventive treatment to prevent malaria in children.

Sulfadoxine-pyrimethamine with amodiaquine (SP-AQ) is a highly efficacious regimen for intermittent preventive treatment to prevent malaria in children (IPTc), but the amodiaquine component is not always well tolerated. We determined the association between amodiaquine dosage by body weight and mild adverse events (AEs) and investigated whether alternative age-based regimens could improve dosing accuracy and tolerability, using data from two trials of IPTc in Senegal, one in which AQ dose was determined by age and the other in which it was determined by weight category. Both dosage strategies resulted in some children receiving AQ doses above the recommended therapeutic range. The odds of vomiting increased with increasing amodiaquine dosage. In one study, incidence of fever also increased with increasing dosage. Anthropometric data from 1,956 children were used to predict the dosing accuracy of existing and optimal alternative regimens. Logistic regression models describing the probability of AEs by dosage were used to predict the potential reductions in mild AEs for each regimen. Simple amendments to current AQ dosing schedules based on the child's age could substantially increase dosing accuracy and thus improve the tolerability of IPTc using SP-amodiaquine in situations where weighing the child is impractical.

The Diamniadio Institute for Health Research, Epidemiological Surveillance, and Training (Iressef): One Man's Vision and a Bet on the Future.

To reduce congestion in its capital, Dakar, Senegal decided in 2012 to construct a new city in Diamniadio, in the suburbs. This new urban center, an integral part of the Emerging Senegal Plan (PSE), is a major first step towards the organization of land use planning. The Institute for Health Research, Epidemiologic Surveillance and Training (Iressef) is one of the very first new operational buildings in this new city. Conceived and directed by Professor Souleymane Mboup, Iressef was made possible by the support of the government of Senegal and the GILEAD Foundation. The vision of its sponsors is to make it a hub of excellence for research in the domain of tropical infectious diseases, with expertise and technical equipment and facilities comparable to those in research institutes in developed countries. The existing platforms include, among others, several state-of-the-art laboratories, a health and demographic surveillance system covering a population of 30 000 inhabitants, a clinical trial center, a dynamic community participation program, and a training center. To achieve this vision in the short- and long-terms, Iressef has developed a strategic 5-year plan focusing on two principal objectives, that is: (i) to conduct research programs according to the strictest ethical standards, and (ii) to train an elite group of Senegalese and African scientists, competitive and capable of developing health research in Africa. To attain these objectives, international partners will play an essential role.

[Epidemiological surveillance networks for animal diseases in French-speaking West and Central Africa]. / Les réseaux d'epidémiosurveillance des maladies animales en Afrique francophone de l'Ouest et du Centre.

One of the objectives of the Pan African Programme for the Control of Epizootics (PACE) was to set up epidemiological surveillance networks in African countries. A survey based on a written questionnaire was conducted to review the technical and institutional organisation of epidemiological surveillance networks in nine French-speaking countries, including five in West Africa (Senegal, Burkina Faso, Côte d'lvoire, Togo and Guinea) and four in Central Africa (Cameroon, Central African Republic, Democratic Republic of Congo and Chad). The survey results showed that there are more similarities than differences among epidemiological surveillance networks. In general, they were found to be technically and institutionally well established. However, the two weaknesses of the majority of networks are the inadequate diagnostic capacity of laboratories and the insufficient operationality of steering committees. Epidemiological surveillance should exclusively be the domain of Veterinary Services and it is crucial for ensuring that any change in the health status of an animal population is detected rapidly. However, the networks' continuing survival after external financing ceases is generally not guaranteed because, in many cases, governments fail to fund them adequately.

[Clinical and tomographic aspects of 29 cases of phakomatosis in Guinea]. / Aspects clinique et scannographique de 29 observations de phacomatoses en Guinée.

The purpose of this report is to describe 29 cases of phakomatosis including 18 cases of tuberous sclerosis (Bourneville) and 11 cases of neurofibromatosis (von Recklinghausen) observed over a 10-year period at the Neurology Department of the University Hospital Centre in Conakry, Guinea. Findings during this period were consistent with those classically reported in the literature: high frequency of advanced skin lesions coalescing into massive tumours, occurrence of seizures of all types and development of a wide variety of complications as a result of late diagnosis. Our experience underscores the need for follow-up and surveillance of these patients by somatic studies based on neurological, ophthalmologic and tomographic data depending on clinical findings.

[Identification of anopheles breeding sites in the residual foci of low malaria transmission «hotspots¼ in Central and Western Senegal]. / Identification des gîtes larvaires d'anophèles dans les foyers résiduels de faible transmission du paludisme « hotspots ¼ au centre-ouest du Sénégal.

Malaria incidence has markedly declined in the Mbour, Fatick, Niakhar and Bambey districts (central and western Senegal) thanks to a scaling up of effective control measures namely LLINs (Long Lasting Insecticide Treated Net), ACTs (Artesunate Combination Therapy) and promoting care seeking. However malaria cases are now maintained by foci of transmission called hotspots. We evaluate the role of anopheles breeding sites in the identification of malaria hotspots in the health districts of Mbour, Fatick, Niakhar and Bambey. Surveys of breeding sites were made in 6 hotspot villages and 4 non-hotspot villages. A sample was taken in each water point with mosquito larvae by dipping method and the collected specimens were identified to the genus level. Additional parameters as name of the village and breeding sites, type of collection, original water turbidity, presence of vegetation, proximity to dwellings, geographic coordinates, sizes were also collected. Sixty-two water collections were surveyed and monitored between 2013 and 2014. Temporary natural breeding sites were predominant regardless of the epidemiological status of the village. Among the 31 breeding sites located within 500 meters of dwellings in hotspots villages, 70% carried Anopheles larvae during the rainy season while 43% of the 21 breeding sites located at similar distances in non-hotspot villages carried Anopheles larvae during the same period (P = 0.042). At the end of the rainy season, the trend is the same with 27% of positive breeding sites in hotspots and 14% in non-hotspots villages. The breeding sites encountered in hotspots villages are mostly small to medium size and are more productive by Anopheles larvae than those found in non-hotspot area. This study showed that the high frequency of smallest and productive breeding sites around and inside the villages can create conditions of residual transmission.

Safety of Seasonal Malaria Chemoprevention (SMC) with Sulfadoxine-Pyrimethamine plus Amodiaquine when Delivered to Children under 10 Years of Age by District Health Services in Senegal: Results from a Stepped-Wedge Cluster Randomized Trial.

BACKGROUND: It is recommended that children aged 3 months to five years of age living in areas of seasonal transmission in the sub-Sahel should receive Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) during the malaria transmission season. The purpose of this study was to evaluate the safety of SMC with SPAQ in children when delivered by community health workers in three districts in Senegal where SMC was introduced over three years, in children from 3 months of age to five years of age in the first year, then in children up to 10 years of age. METHODS: A surveillance system was established to record all deaths and all malaria cases diagnosed at health facilities and a pharmacovigilance system was established to detect adverse drug reactions. Health posts were randomized to introduce SMC in a stepped wedge design. SMC with SPAQ was administered once per month from September to November, by nine health-posts in 2008, by 27 in 2009 and by 45 in 2010. RESULTS: After three years, 780,000 documented courses of SMC had been administered. High coverage was achieved. No serious adverse events attributable to the intervention were detected, despite a high level of surveillance. CONCLUSIONS: SMC is being implemented in countries of the sub-Sahel for children under 5 years of age, but in some areas the age distribution of cases of malaria may justify extending this age limit, as has been done in Senegal. Our results show that SMC is well tolerated in children under five and in older children. However, pharmacovigilance should be maintained where SMC is implemented and provision for strengthening national pharmacovigilance systems should be included in plans for SMC implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT 00712374.

Correction: Safety of Seasonal Malaria Chemoprevention (SMC) with Sulfadoxine-Pyrimethamine plus Amodiaquine when Delivered to Children under 10 Years of Age by District Health Services in Senegal: Results from a Stepped-Wedge Cluster Randomized Trial.

[This corrects the article DOI: 10.1371/journal.pone.0162563.].

[Models for calculating the cost of operational expenditure for a health centre in Senegal]. / Coûts de fonctionnement d'un centre de santé au Sénégal: modalités de calculs.

The transformation of a health post into a health centre generates new services which mobilise different resources. The objective of this work is to propose a budgetary forecasting model for this specific type of case, one which is recurrent although seldom documented. As a preliminary step, the quarterly operational costs were determined, and the "complete costs method" (or the homogeneous sections method) was utilised for this purpose. In the second phase, the "pre-established costs method" was used to set the budget forecasts. The amount to be recovered by the health committee for a three month period of operation is estimated at 1,574,967 F CFA (equivalent to approximately 2,400 Euros), representing 42% of the total cost. The states assures the contribution of public funds to cover 54.2% of the cost, and the commune of Kanel furnishes 3.8% of the total cost, however only in the form of in-kind contributions or other material resources. The overall estimated budget for the year 2004 is estimated at 14,835,425 F CFA (about 22,615 Euros) of which 57.6% is expected to be received from the state.

[Acceptability of indoor residual spraying in the Central-Western of Senegal]. / Étude de l'acceptabilité de l'aspersion intradomiciliaire d'insecticide à effet rémanent dans le centre-ouest du Sénégal.

The recent decline of malaria transmission in central-western of Senegal after a scaling up of control measures gives an open window for interventions toward malaria elimination. As a consequence, malaria transmission is now occurring as hotspots. The aim of the project is to evaluate whether target control measures combining indoor residual spraying (IRS) with chemoprophylaxis can virtually eliminate malaria in hotspots. Targeted villages located in four (4) health districts (Mbour, Fatick, Niakhar and Bambey) were sprayed in august 2013 with Actellic® 300 CS (Pirimiphosmethyl). Our objective in this study is to evaluate the acceptability of IRS in the population. IRS is a very complex intervention that requires strong adhesion of populations. After its implementation, 370 households have been interviewed. The results of this survey showed good acceptability of IRS using Actellic® 300 CS, with 97.8% of beneficiaries who declared that IRS is good and even excellent for the community. Despite inconveniences that may arise during intervention, including the preparation of structures to be treated, 98% of respondents were not disturbed in their daily activities. 98.6% of responders declared that sprayers were working with professionalism and almost all households (99.7%) are willing to accept IRS next year. The survey revealed a good acceptability of indoor residual spraying in hot spots located in central-western of Senegal; spraying with Actellic® 300 CS did not cause a problem to the targeted populations. Finally, there is great satisfaction in the population due a huge reduction of mosquito nuisances.

Increased long term mortality associated with rash after early measles vaccination in rural Senegal.

OBJECTIVES: To examine whether clinical symptoms, including rash, were more common after measles immunization compared with placebo and to study the association between postvaccination symptoms and later mortality. DESIGN: Examination of side effects in the 3 weeks after immunization in a trial of high titer and standard titer measles vaccines. PATIENTS: Two hundred twenty-four children randomly selected to be included in the surveillance for diarrhea, fever and rash. RESULTS: There was no difference in fever and diarrhea between recipients of high titer vaccines and recipients of placebo. However, high titer recipients tended to have more measles-like rashes than placebo recipients [relative risk, 2.12 (range, 0.90 to 5.03)]. Among recipients of high titer vaccines, children who presented a rash had higher mortality in the following 5 to 7 years than those who did not develop rash [mortality rate ratio, 3.85 (range, 1.52 to 9.79)]. High titer recipients without a rash had the same mortality as children in the placebo group who were given standard doses of measles vaccine at 10 months of age [mortality rate, 0.76 (range, 0.35 to 1.62)]. CONCLUSIONS: These observations suggest that in this particular study, rash after high titer measles vaccine may identify children who received a particularly high dose of vaccine or children with more severe and persistent postvaccination immunosuppression. Whether high titer vaccine is more likely than standard titer measles vaccine to provoke such reaction is not known, given that we did not compare side effects after different titers of measles vaccine. Future trials of live measles vaccine should monitor the development of rash.

Poor serologic responses five to seven years after immunization with high and standard titer measles vaccines.

BACKGROUND: Few data exist on the persistence of measles antibodies after vaccination of West African infants. Therefore we examined measles antibody titers 5 to 7 years after children in rural Senegal had received high titer Edmonston-Zagreb (EZ-HT), high titer Schwarz (SW-HT) or standard titer Schwarz (SW-STD) measles vaccines in infancy. METHODS: Children had received either high titer vaccines at 5 months of age or standard titer at 10 months of age. Finger prick blood samples were tested for measles antibody 5 to 7 years later by the hemagglutinin inhibition test. RESULTS: Persistence of antibody after high titer vaccines was poor with the result that 39 and 50% of the EZ-HT and the SW-HT groups had low titers of hemagglutinin inhibition measles antibodies (< or =125 mIU/ml). Nineteen percent of the children in the SW-STD group had low titers which is a lower prevalence than in the high titer groups [relative risk (95% confidence intervals), 0.05 (0.28 to 0.88) vs. EZ-HT; relative risk, 0.38 (0.22 to 0.66) vs. SW-HT]. Geometric mean (95% confidence interval) antibody titers in children with detectable values were 616 (435 to 871) in the EZ-HT, 1106 (616 to 1866) in the SW-HT and 1271 (871 to 1741) mIU/ml in the SW-STD groups, respectively. Multivariant regression analysis showed that mean titers were 2.00 (1.03 to 3.89) times higher for children with low prevaccination antibody titers (< or =125 mIU/ml) and 3.06 (1.90 to 4.94) times higher if blood was collected in the rainy season. INTERPRETATION: Given the rapid decline in antibody titers over a 5- to 6-year period in an area where measles vaccine coverage was high, it seems likely that multiple dose immunization schedules will be needed in the future to maintain protective antibody concentrations (>125 mIU/ml) in West Africa. The role of subclinical boosting by exposure to natural measles and the possible role of malaria, which increases immunoglobulin turnover, in influencing long term antibody persistence after vaccination deserve further investigation.

Seroconversions in unvaccinated infants: further evidence for subclinical measles from vaccine trials in Niakhar, Senegal.

BACKGROUND: Increases in measles antibodies without rash-illnesses have been documented in previously vaccinated children exposed to measles cases. The phenomenon has been incompletely evaluated in young unvaccinated infants with immunity of maternal origin. METHODS: Monthly cohorts of newborns were prospectively randomized to vaccine and placebo control groups during a trial of high-titre vaccines in Niakhar, Senegal. Measles antibodies were assayed in blood samples of enrolled children collected at 5 months old, when controls received a placebo injection, and at 10 months, when the placebo group was given measles vaccine. Intensive prospective surveillance for measles was conducted throughout the trial. RESULTS: One-fifth (n = 53) of the placebo controls seroconverted, with known exposure to a measles case in only three of them. None of the seroconverters developed a measles-like rash. Sixteen-fold or greater increases in titres were noted in about one-quarter of them. Compared with placebo controls who did not seroconvert, seroconverters were more likely to have had exposure to a measles case and to travel, more likely to be boys than girls, and had significantly lower baseline antibody titres. Measles was endemic in the study area throughout the trial. Seroconversions did not adversely effect subsequent nutritional indices or mortality. CONCLUSIONS: Although laboratory errors and inadvertent injection of vaccine rather than placebo may have played some role, they do not fully explain the above observations, which are consistent with subclinical measles in the seroconverters. The possible role of subclinical measles in occult transmission, its potential effect on the type and duration of subsequent immunity, and its impact on response to primary vaccination need to be determined.

Plasmodium falciparum clinical malaria in Dielmo, a holoendemic area in Senegal: no influence of acquired immunity on initial symptomatology and severity of malaria attacks.

Six hundred eighty-nine Plasmodium falciparum malaria attacks were observed during a three-year period among 226 inhabitants of the village of Dielmo, Senegal, an area of high malaria transmission. Malaria attacks were defined as clinical episodes with fever (body temperature > or = 38.0 degrees C) or reporting of fever or headache or vomiting, associated with a parasite:leukocyte ratio above an age-dependent pyrogenic threshold identified in this population. The symptom frequencies were tested against age, gender, and parasite density using a random-effect logistic regression model and the study of distinguishable clinical presentations was carried out by multi-correspondence analysis. There was little difference between the severity of symptoms during the initial course of attacks in young children and adults, and this severity was not correlated with the duration of the pathologic episode. It was not possible to distinguish objectively different malaria attack types according to the severity of clinical manifestations. In contrast, the duration of fever, symptoms, and parasite clearance were significantly longer among the youngest children than among the oldest children and adults. These findings suggest that of the two components of protective immunity, anti-parasite immunity and anti-toxic immunity, only the first would play a major role as age increases. They suggest also that the initial clinical presentation of malaria attacks is not predictive of the level of protective immunity.

Incidence of clinical malaria in pregnant women exposed to intense perennial transmission.

The interaction between pregnancy and malaria attacks was investigated from 1990 to 1994 among women in the village of Dielmo, a holoendemic area in Senegal where malaria transmission is intense and perennial. Clinical and parasitological data collected during the daily follow-up of 48 pregnancies among 31 women were compared with those collected from the same women using the same methods during the year which preceded or followed their pregnancy. The parasite prevalence, mean and maximum parasite density in Plasmodium falciparum infections were significantly higher during pregnancy. The incidence rate of malaria attacks was, on average, 4.2 times higher during pregnancy than during the control period. Although most pregnancies were not associated with a malaria attack and the incidence of malaria attacks decreased as the number of previous pregnancies increased, a significant increase in risk of malaria attacks among multigravidae was noted until the fifth pregnancy.

Reducing the oral quinine-quinidine-cinchonin (Quinimax) treatment of uncomplicated malaria to three days does not increase the recurrence of attacks among children living in a highly endemic area of Senegal.

A 3 d shortened course of the quinine-quinidine-cinchonin association Quinimax was compared to the usual 7 d regimen for routinely treating 462 acute uncomplicated Plasmodium falciparum malaria attacks in 72 children under the age of 10 years in Dielmo, a holoendemic village in Senegal. 25 mg/kg Quinimax salt daily, given in 3 equal doses, improved clinical status in 99.6% of the patients receiving the course and in all of those treated for 7 d. Even if the 3 d course did not systematically eliminate parasitaemia, reducing oral Quinimax treatment of uncomplicated malaria from 7 to 3 d did not increase the recurrence of attacks, even among the youngest children. Both the quinine sensitivity of the Senegalese strains of P. falciparum and the partial acquired immunity of the children were probably responsible for the absence of any difference between the courses. Oral Quinimax for 3 d is a possible alternative regimen to chloroquine and sulfadoxine-pyrimethamine for treating uncomplicated malaria in highly endemic areas of Africa where clinical resistance to these drugs exists.

[Diabetic pregnancy in Senegal (years 1980 to 1989)]. / La grossesse diabétique au Sénégal (Années 1980 à 1989).

INTRODUCTION AND OBJECTIVES: Diabetic Pregnancy Prognosis in Seventies is it better in Eighties because of Patient Education? METHODOLOGY: Retrospectively, since 1980 to 1989, in Women in status to breed, Diabetic Pregnancy was screened in our Department. W.H.O.'s (1980) Diabetes Mellitus Criterias, PEDERSEN's Criterias, White's Classification were used. Studied Parameters were etiologic factors (age, type, Diabetes oldness and control), former and present Evolution of Pregnancies (term and pregnancy's product). RESULTS: A--In Global Study, 15.07% Diabetic Pregnancies were observed: 22 (37%) Insulin Dependent and 38 (63%) Non Insulin Dependent. The global mean of age was 31 years; Diabetic Mellitus was less than 10 years old in 90% cases whatever the type. Their control was not good (Glycemic Control < 1.4 g/l in less than 50%). Diabetes complications were nephropathy (13.6% and 8%), retinopathy (13.6% and 18.5%), arterial hypertension (0% and 26.32%), cetoacidosis (31.42% and 0%), urinary tract infection (18% and 0%) respectively in Insulin Dependent and Non Insulin Dependent Pregnancies. Near a third (31.6%) of Insulin Dependent and a third (33.41%) for Non Insulin Dependent were of D, F, H White's Class. Multipares were often Non Insulin Dependent and inversely Insulin Dependent frequently paucipare. Former Pregnancies had near 25.5% interrupted term in Insulin Dependents. Present Pregnancies have given 28.5% and 32% of Normal Children: 14.25 and 12% of Abortions and 14.25% and 6% of Spontaneous Premature Parturitions respectively in Insulin Dependents and Non Insulin Dependents. B--In Analytic Study of Foetopathies, bad Prognosis Factors were high Maternal Age, Multiparity, bad Glycemic Control whatever Diabetes type. For Insulin Dependent, Negligency was added and for Non Insulin Dependent, Obesity, Arterial Hypertension and all PBSP. DISCUSSION AND CONCLUSION: A relatively mild Diabetic Pregnancy Prognosis in our areas with limited means has been observed despite of Patients Education.

[New cases of leprosy at the Marchoux Institute: a comparative study 1988-1997]. / Nouveaux cas de lèpre à l'Institut Marchoux (Bamako, Mali).

BACKGROUND: The prevalence of leprosy had declined greatly over the last decade. The purpose of this work was to determine whether changes in the epidemiology, clinical and bacteriological patterns occurred among patients with leprosy treated at the Marchoux Institute in 1988 and in 1997. PATIENTS AND METHODS: We conducted a descriptive cross-sectional study, reviewing retrospectively all files of patients with leprosy seen in 1988 in comparison with a prospective series of leprosy patients seen in 1997. Only new cases of leprosy, prior to treatment and with skin and/or nervous lesions irrespective of the bacilloscopy results, were included in the two series. RESULTS: We included 93 patients among 246 patient files in 1988. There were 119 new cases in 1997. The following variables showed changes: mean delay to consultation (41.2 months in 1988 versus 26.1 months in 1997; patient's suspicion of having leprosy (93 patients in 1988 versus 22 in 1997); notion of contact (35 cases in 1988 versus 45 in 1997). Multibacilli leprosy predominated over paucibacilli leprosy in 1988 (51 versus 42 cases). This trend was inverted in 1997 (44 versus 75) (p<0.009). Patients with grade 2 handicap were more numerous in 1988 (20 cases versus 2 cases, p<0.001). CONCLUSION: These findings demonstrate a change in the epidemiology, clinical and bacilloscopic pattern of patients with leprosy from 1988 to 1997.