[Seroprevalence of Toxoplasmosis among Pregnant Women in Benin: Meta-Analysis and Meta-Regression]. / Séroprévalence de la toxoplasmose chez les femmes enceintes au Bénin : méta-analyse et métarégression.

To assess the seroprevalence of toxoplasmosis among pregnant women in Benin, we conducted a meta-analysis using the PRISMA criteria. Al research published between 1990 and 2018 on toxoplasmosis among pregnant women Benin were eligible. A total of five databases were investigated, and the extracted data were subjected to a meta-analysis under R 3.1 using both random effect model and fixed effect model. The overall prevalence of toxoplasma-specific IgG among pregnant women was 47% (CI 95%: 40-53) and that of specific IgM was 2% (CI 95%: 1-3). The infection rate in urban areas (52%) was significantly higher than in rural areas (33%). The two main risk factors identified by the various eligible studies were the age of the pregnant women and the consumption of raw vegetables. We show that toxoplasmosis is endemic in pregnant women in Benin, implying that primary prevention measures must be put in place by the competent authorities to control this infection.

Afin d'évaluer le niveau de l'infection toxoplasmique chez les femmes enceintes au Bénin, nous avons effectué une méta-analyse selon le protocole PRISMA. Étaient éligibles tous les articles de recherche publiés entre 1990 et 2018 sur la toxoplasmose chez les femmes enceintes en consultation prénatale au Bénin. Au total, cinq bases de données ont été consultées, puis les données extraites ont été soumises à une méta-analyse sous R 3.1 selon les modèles à effet aléatoire et à effet fixe. La séroprévalence de la toxoplasmose chez la femme enceinte était de 47 % (IC 95 % : 40­53) pour les IgG et de 2 % (IC 95 % : 1­3) pour les IgM spécifiques. Le taux d'infection en milieu urbain (52 %) était significativement plus élevé qu'en milieu rural (33 %). Deux principaux facteurs de risque associés à la toxoplasmose ont été identifiés par les différentes études éligibles : l'âge des gestantes et la consommation de crudités. Nous montrons ainsi que la toxoplasmose est endémique chez les femmes enceintes au Bénin, impliquant que des mesures de prévention primaire soient mises en place par les autorités compétentes pour contrôler cette infection.

[Prevalence and factors associated with cryptococcal antigenemia in HIV-infected patients in Cotonou/Benin]. / Prévalence de l'antigénémie cryptococcique et les facteurs associés chez les patients infectés par le VIH à Cotonou au Bénin.

OBJECTIVE: Determine the prevalence of cryptococcal antigenemia and associated factors in HIV-infected patients in Cotonou in order to introduce systematic screening in national guidelines. PATIENTS AND METHODS: This is a cross-sectional, descriptive and analytical study conducted from June to September 2015 in four outpatient treatment centers with adult patients infected with HIV, receiving or not antiretroviral treatment with a number of CD4≤200cell/µL and who have given their informed consent to participate in the study. For each enrolled patient, after signing the informed consent form, it was made a clinical examination and administration of a questionnaire to collect general information, treatment and biological data. Then a blood sample for counting CD4 lymphocytes and the search of cryptococcal antigenemia were done. RESULTS: In total, 355 patients were included in the study with a mean age of 40±10.2years. The overall prevalence of cryptococcal antigenemia is 1.7%. All patient with cryptococcal antigenemia have a CD4 count below 100cells/µL with a majority having CD4 count below 50cells/µL. Body mass index<18.5kg/m2, an alteration of the general condition with a CD4 lymphocyte counts<50cells/µL are the main factors associated with the occurrence of cryptococcal antigenemia. CONCLUSION: This pilot study showed a low prevalence of cryptococcal antigenemia in the study population, but higher in highly immuno-deficient patients with CD4 counts<50cells/µl. Given the results obtained, the introduction of routine screening among patients infected with HIV could be reserved to those with CD4 counts<50cells/µl.

[Place of vulvovaginal candidiasis in the lower genital tract infections and associated risk factors among women in Benin]. / Place des candidoses vulvo-vaginales au cours des infections génitales basses et facteurs de risque associés chez les femmes au Bénin.

OBJECTIVE: Determine the place of vulvo-vaginal candidiasis (VVC) in the lower genital infections and seek risk factors among women in Benin. PATIENTS AND METHODS: The study was conducted in the laboratory of mycology of Hôpital de la Mère et de l'Enfant Lagune (Homel) from 1st March to 31st July, 2013. It involved all the women who were asked a vaginal swab and gave their consent in written form. After administration of a questionnaire, the vaginal samples were collected with sterile cotton swabs for a test with potassium hydroxide, an estimation of vaginal pH, direct microscopic examination, fresh, and after a Gram stain and culture on Sabouraud-chloramphenicol, ordinary agar and fresh blood agar. RESULTS: One hundred and thirty-one women were included in the study period. Clinical signs were dominated by vaginal discharge (74.8%), followed by vulvar pruritus (51.9%) and dyspareunia (36.6%). Culture on Sabouraud was positive in 51 cases or 38.9%. Candida albicans was isolated in 96.1% of cases, against 3.9% of Candida glabrata. The risk factors involved were: pregnancy, antibiotics, synthetic underclothing and frequent wearing tight pants. In addition of Candida, Gardnerella vaginalis was found in 36.6% of samples with an association with C. albicans in 28.2% of cases. CONCLUSION: This study showed that vulvovaginal candidiasis is the leading cause of lower genital tract infections in women in Benin with involvement of several risk factors which research is needed to develop appropriate preventive measures.

[Epidemiology of urinary schistosomiasis among school children in Péhunco area, Northern Benin. Malacological survey]. / Épidémiologie de la schistosomose urinaire chez les enfants scolarisés de la commune de Péhunco dans le Nord Bénin: prospection malacologique.

Schistosomiasis is a public health problem in Benin but prevalence estimates vary widely. Parasitological (from May to September 2010) and malacological surveys (from September 2010 to June 2012) were conducted to determine the current status of urinary schistosomiasis among 1 585 schoolchildren from 18 primary schools of Péhunco area, North-West Benin, using two parasitological tests. Pupils were enrolled with a mean age of 11 years (from 7 to 16 years-old age) and 51.48% of them were girls. Urines samples were examined using both urine reagent strips and filtration method. Structured questionnaires were used to identify environmental and socio-economic factors. Malacological surveys were conducted to ascertain general freshwater snail diversity and specific diversity of the schistosome host snails. The results showed a general prevalence of 29.40% with boys (36.67%) significantly more affected than girls (22.55%). Among the 844 collected snails, 5 species freshwater snails were identified: two species known as potential schistosome intermediate host snails, Bulinus forskalii and B. globosus, and three species known as non-schistosome transmitting snails Lymnaea natalensis, Physa marmorata and Melanoides tuberculata. B. forskalii was a most largely distributed snail and none of snails were found naturally infected by schistosome. No freshwater snails were found naturally infected by schistosome.

[Evaluation of a rapid diagnostic test in the diagnosis of toxoplasmosis in pregnant women in Cotonou (Bénin)]. / Évaluation d'un test de diagnostic rapide pour le diagnostic de la toxoplasmose chez les femmes enceintes à Cotonou (Bénin).

The aim of the study was to evaluate the performance of the ImmunoComb® Toxo IgG and ImmunoComb® Toxo IgMassays (rapid diagnostic test) in the laboratory diagnosis of toxoplasmosis in pregnant women in Cotonou. We interviewed 266 pregnant women, who first answered an epidemiological questionnaire, and collected blood samples for measurement of IgG and IgM anti T. gondii antibodies with the ImmunoComb toxo assays and with the ARCHITECT CIMA method. The sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated to determine the performance of the rapid test. The seroprevalences of IgG against T. gondii by CIMA technique and rapid test were respectively 48.9% and 48.5%. The prevalence increased with age. Performances for IgG were: sensitivity 97%, specificity 100%, PPV 100%, NPV = 97.10%. For IgM, Sensitivity: 33.3% Specificity: 100%, PPV 100%, NPV = 99.2%. Seroprevalence obtained shows that about half of the study population is not immune against T. gondii and requires regular serological monitoring until delivery. According to these results, and given the needs of toxoplasmosis diagnosis on the field characterized by an important decrease of immunized women, this test may be recommended in the laboratory diagnosis of toxoplasmosis in peripheral levels of the health pyramid.

[Schistosomiasis and soil-transmitted helminthiasis among schoolchildren of Nikki and Pèrèrè, two northeastern towns of Benin]. / Schistosomose et géohelminthoses dans le nord-est du Bénin: cas des écoliers des communes de Nikki et de Pèrèrè

Infection with schistosomiasis and soil-transmitted helminthiasis are widespread in sub-Saharan Africa and the burden of disease associated with parasites is enormous. A study was performed to determine the transmission and prevalence of human schistosomiasis and soil-transmitted helminthiasis among school children of Nikki and Perere, two north eastern towns of Benin, bordering Republic of Nigeria. Parasitological investigations by urine filtration and Kato-Katz conducted on 1,344 school children indicated a mean prevalence of S. haematobium and S. mansoni 48.44% and 0%, respectively, in the children of Nikki area and 45.24% and 4.11% in Perere area. Only schoolchildren of Sonon locality were infected by S. mansoni with a mean prevalence rate of 36.24%. KatoKatz tests releaved five species of soil-transmitted helminths: Ankylostoma duodenale (8.16% and 6.73%), Ascaris lumbricoides (6.26% and 2.30%), Enterobius vermicularis (1.09% and 1.97%), Trichuris trichiura (1.97% and 1.90%) and Strongyloides stercoralis (2.04% and 0.99%), respectively, in the schoolchildren of Nikki and Perere areas. The malacological investigations carried out in the freshwater points of each visited locality highlighted the presence of four species of freshwater snails known as intermediate host of schistosome: Biomphalaria pfeifferi, Bulinus forskalii, B. globosus and B. truncatus.Two B. globosus and B. pfeifferi collected in Sonon locality were naturally infected by schistosome, indicated the importance of their two species of snail in schistosome transmission cycle.

[Assessment of a rapid diagnostic test and portable fluorescent microscopy for malaria diagnosis in Cotonou (Bénin)]. / Évaluation d'un test de diagnostic rapide et d'un microscope à fluorescence portable pour le diagnostic du paludisme à Cotonou (Bénin).

The aim of the study was to determine the accuracy of a rapid diagnostic test (SD Bioline Malaria Ag P.f/ Pan®) and fluorescent microscopy (CyScope®) in confirming presumptive malaria diagnosis in Cotonou. Thick blood smear was used as the reference technique for comparison. Testing was conducted on persons between the ages of 6 months and 70 years at two hospitals from June to October 2010. If malaria was suspected in the sample by the nurse based on clinical findings and sent to laboratory for confirmation, one thick smear, one rapid diagnostic test and one slide for the fluorescent microscopy were performed. All tests were read in hospital laboratories involved with the quality control of thick blood smear in the parasitology laboratory of National University Hospital of Cotonou. A total of 354 patients with clinical diagnosis of malaria were included. Malaria prevalence determined by thick smear, rapid diagnostic test and fluorescent microscopy was 22.8%, 25.4%, and 25.1% respectively. The sensitivity, specificity, positive and negative predictive values compared to the thick smears were 96.3, 95.6, 86.7, and 98.9% for rapid diagnostic test; and 97.5, 96.7, 89.8, and 99.27% for fluorescent microscopy. With these performances, these tests meet acceptability standards recommended by WHO for rapid tests (sensitivity > 95%). These two methods have advantages for the confirmation of malaria diagnosis in peripheral health structures that lack the resources to conduct diagnosis confirmation by the thick blood smear.

Assessment of microbial larvicide spraying with Bacillus thuringiensis israelensis, for the prevention of malaria.

OBJECTIVES: The aim of this study was to assess the contribution of microbial larvicide spraying, Bacillus thuringiensis israelensis, as prevention strategy against malaria. METHODS: An experimental study consisted in spraying B. thuringiensis israelensis in a district during 1 year has been conducted. Another district (control) was not sprayed. Eight hundred and two children were evaluated, thick drop and swab examination was performed for those presenting with fever. The larval density was calculated in their habitats as well as larvicide remanence. Capture of mosquitoes with human bait allowed determining human exposure to bites at night, and identifying anopheles after dissection. RESULTS: The incidence of pediatric malaria was 13.8% in the sprayed district and 31.4% in the control district. The parasitic load ranged from 2000 to 42,000 parasites/µL in the sprayed district and 2000 to 576,000 parasites/µL in the control district. Plasmodium falciparum was the most frequent (97.8%) plasmodial species. In the control district, at least 20 larvae by liter of water were counted; anopheles larvae were found in 11 larval habitats out of 15 (73.33%). The human exposure to anopheles bites at night was 14.25 in the sprayed district and 33.13 in the control district. The remanence of B. thuringiensis israelensis was estimated at 9 days in the sprayed district. CONCLUSION: The larvicide B. thuringiensis israelensis may be used in vector control strategy for the prevention of malaria.

[A randomized clinical trial comparing the effectiveness and tolerability of artemisinine-naphthoquine (Arco®) and artemether-lumefantrine (Coartem®) in the treatment of uncomplicated malaria in Benin]. / Essai clinique randomisé comparant l'efficacité et la tolérance de la combinaison artémisinine-naphthoquine (Arco®) et artéméther-luméfantrine (Coartem®) dans le traitement du paludisme simple au Bénin.

The Ministry of Health recommended in Benin, since 2004, artemisinin-based combination, artemether-lumtefantrine (Coartem®), therapy for the treatment of uncomplicated malaria. To resolve the difficulties related to observance, we are interested in a new combination, artemisinin-naphthoquine (Arco®). A study was conducted to assess and compare the efficacy and tolerability of the fixed combination artemisinin (125 mg)-naphthoquine (50 mg), a single-dose drug, administered one day versus artemether (20 mg)-lumefantrine (120 mg).The clinical assessment was a single-blinded, two-arm, randomized trial comparing Arco® combination as a single-dose regimen and three-day regimen of Coartem® for the treatment of uncomplicated falciparum malaria, from july to october 2008 and may to september 2009, with 28 days of follow-up in children. PCR genotyping was used to classify re-infection or recrudescence. The primary outcome measures for efficacy were cure rates on days 3, 7, 14, 21 and 28. Secondary outcomes included parasite clearance time and fever clearance time. The main outcome measures for safety were incidences of post-treatment clinical and laboratory adverse events. A total of 174 patients (84 in Arco® group and 90 in Coartem® group) were evaluated for clinical and parasitological outcomes. The cure rate was 98.8% for Arco® and 100% for Coartem® on day 28, with no statistically significant difference. Fever clearance was obtained within 24 hours in both groups. The parasite clearance is obtained at 48 hours in Arco® group and at 60 hours in Coartem® group. Both treatments were well tolerated without major side effects. This study therefore concluded that the combination of artemisinin-naphthoquine is as effective and well tolerated as the combination artemether-lumefantrine in the treatment of uncomplicated malaria in Benin children. This medication administered in single dose is therapy of choice to reduce compliance problems during malaria treatment and also to facilitate community-based care of malaria.

[Evaluation of the use of insecticide-treated nets and intermittent preventive treatment in three health zones in Benin]. / Évaluation de l'utilisation des moustiquaires imprégnées d'insecticide et du traitement préventif intermittent dans trois zones sanitaires au Bénin.

This study aims to evaluate the results of the Project to Support the Fight against Malaria in the departments of Mono and Couffo in Benin on insecticide-treated nets (ITNs) use by children under 5 years and pregnant women and the coverage by Intermittent Preventive Treatment (IPT) with Sulfadoxin-Pyrimethamin (SP). This assessment is made from two household surveys. The first at the start up and the second after fifteen months of implementation. The availability of ITN in households and their use by pregnant women and children under 5 years have increased respectively from 8, 5 and 4% in 2005 to 24, 31 and 16 % in 2006. The percentage of pregnant women under IPT with sulfadoxine-pyrimethamine (SP) is 10% while 21% of pregnant women received at least one dose of SP. The availability of ITN in households and their use by children under 5 years and the prevention of malaria during pregnancy remains a concern in these health areas. The promotion of long lasting insecticide treated nets with effective communication strategies for behavior change could improve the results. Research on causes of poor compliance of IPT should be emphasized as well as strengthening management of drugs in health centers.

[Evaluation of the quality of malaria management during the transition period of political change in Benin]. / Evaluation de la qualité de la prise en charge des paludismes au cours de la période de transition de changement de politique au Bénin.

The purpose of this retrospective study in 2006 was to evaluate the impact of control activities implemented within the framework of "Roll Back Malaria (RBM) program" on the medical indicators. Study was based on review of the files of children between 0 and 14 years treated in pediatric outpatient or hospital facilities for malaria confirmed by the thick drop smears from January 1, 2001 to December 31, 2005. A total of 1589 files were reviewed. Data was collected using a standardized form. From 2001 to 2005, the number of children treated for uncomplicated malaria seesawed while the number treated for complicated malaria increased. Proper treatment of uncomplicated malaria went from 58.78% in 2001 to 15.38% in 2005. In all study years, quinine was the most-used drug for uncomplicated malaria. Treatment of complicated malaria also improved from 40% in 2001 to 90.61% in 2005. Although malaria-related mortality remained low (< 2%), the death rate increased from 2001 to 2005. Proper treatment of uncomplicated malaria still poses a challenge using quinine indicated in complicated malaria cases. Based on these findings, it appears urgent for the MNCP to intensify training activities at the medical facilities. This is the only means of achieving the strategic goals of "initiative RBM".

[Management of malaria in Benin: evaluation of the practices of healthcare professionals following the introduction of artemisinin derivatives]. / Prise en charge du paludisme au Bénin: évaluation des pratiques professionnelles suite à l'introduction des dérives d'artémisinine.

In 2004 the policy for malaria management in Benin changed when the National Malaria Coordination Program (NMCP) introduced artemisinin-based combination therapy (ACT) for treatment of uncomplicated malaria. Up to that time, chloroquine had been used for first-line therapy against uncomplicated malaria and sulfadoxine pyrimethamine had been used in case of failure. Artemisinin derivatives have been used for monotherapy in Benin since 2002. The purpose of this transverse study carried out among public and private centers in Cotonou from March 16 to May 17, 2005 was to determine the impact of the switch to ACT on the practices of healthcare professionals. Medical centers were randomly selected from each stratum after identification and stratification of all facilities in the healthcare pyramid. A survey questionnaire was sent to healthcare workers. A total of 690 health workers responded to the questionnaire. Most responders (95.5%) were familiar with artemisinin but a lower percentage (89.6%) prescribed them. Responders were less knowledgable about ACT drugs and Coartem was the best known combination in the minds of prescribers. Biological diagnosis was available for 50% of patients. Artemisinine (derivates) were mainly prescribed as a second choice treatment and as monotherapy whether for severe or uncomplicated malaria. They were prescribed to pregnant women in 34.6% of the cases. Dosage was incorrect in 26.1% of cases in adults and 20.9% of cases in children. These findings indicate that more effort is needed to inform healthcare workers. This is especially urgent since the country is now considering revising its malaria management policy to make ACT available at all levels of the healthcare system. An effective information campaign must be set up to ensure that health workers and drug retailers throughout the country are duly informed of the new malaria treatment policy.

Prise en charge du paludisme au Benin : evaluation des pratiques professionnelles suite a l'introduction des derives d'artemisinine

la politique de prise en charge du paludisme au Benin a change en 2004 par l'introduction des combinaisons therapeutiques a base d'artemisinine (CTA) par le Programme National de Lutte contre le Paludisme (PNLP) pour le traitement du paludisme simple. Avant cette date; la chloroquine etait le medicament de premiere intention de prise en charge du paludisme simple avec la sulfadoxine pyrimethamine en cas d'echec. Par ailleurs; les derives d'artemisinine etaient utilises en monotherapie au Benin depuis 2002. Afin d'etudier l'evolution des comportements therapeutiques de prise en charge du paludisme par les agents de sante; une etude transversale a ete realisee aupres du personnel de sante du secteur public et prive de la ville de Cotonou du 16 mars au 17 mai 2005. Les formations sanitaires ont ete tirees au sort dans chaque strate apres recensement et stratification de toutes les formations sanitaires selon la pyramide sanitaire. L'enquete a utilise un questionnaire adresse aux agents de sante. Au total 690 agents de sante ont ete enquetes. Les derives de l'artemisinine sont connus de 95;5des agents de sante enquetes mais ne sont prescrits que par 89;6d'entre eux. Les CTA sont moins connues et le Coartemr reste la combinaison la mieux connue des prescripteurs. Un diagnostic biologique etait disponible dans la moitie des cas. Les derives de l'Artemisinine sont prescrits surtout en deuxieme intention et en monotherapie que ce soit pour le traitement du paludisme simple ou du paludisme grave. Ils sont prescrits chez la femme enceinte dans 34;6des cas. Les posologies sont incorrectes dans 26;1des cas chez l'adulte et dans 20;9des cas chez l'enfant. Ces resultats justifient l'intensification de la formation des agents de sante; d'autant plus que le pays envisage dans le cadre du changement de sa politique de prise en charge du paludisme; de rendre disponible les CTA a tous les niveaux de la pyramide sanitaire. Un systeme de communication efficace doit etre mis en place en vue d'une large diffusion de la nouvelle politique de traitement

Analyse de la situation des parasitoses en milieu scolaire à Dangbo au Bénin

Dans le cadre de la mise en œuvre d'une stratégie de lutte intégrée contre les parasitoses en milieu scolaire, une étude transversale et descriptive a été réalisée dans la commune de Dangbo. L'objectif est de faire une analyse de la situation des parasitoses (paludisme, bilharziose uro génitale, géohelminthioses) chez les enfants d'âge scolaire. Patients et méthodes : L'approche par questionnaire a été utilisée auprès des élèves de huit écoles âgés de 7 à 12 ans. Des prélèvements de sang, de selles et des urines ont été effectués pour la réalisation d'une goutte épaisse, d'un examen d'urines par filtration ainsi qu'un examen des selles par la technique de KATO- KATZ. Résultats : La prévalence globale des parasitoses est de 74,80%. La parasitose la plus fréquente est la bilharziose (58,18%) suivie du paludisme (40,30%) et enfin des parasitoses intestinales (2,27). Le paludisme demeure la parasitose dont les signes et les moyens de prévention sont les mieux connus. Parmi les facteurs favorisants, nous pouvons citer, la nature de l'eau utilisée, la mauvaise connaissance des causes et des moyens de prévention des parasitoses, la défécation et l'élimination des urines dans la nature, le milieu écologique. Conclusion : Cette étude suggère la mise en place d'une stratégie intégrée de lutte prenant en compte des séances d'Information, Education, Communication sur l'aménagement et l'assainissement du milieu, les causes et les mesures de prévention afin de réduire la prévalence de ces parasitoses en milieu scolaire et dans la communauté

[The re-emergence of the human African trypanosomiasis in Kerou, Benin]. / Le réveil de la trypanosomose humaine africaine à Kérou, Bénin.

Located in the northern part of Bénin, the district of Kérou is an historical HTA focus of the 60s formerly called the "Atacora focus". This survey was conducted in 2001 to determine the prevalence of HAT in Kérou. The methodology consisted in a cross-sectional survey based on random sampling with two levels of stratification. 3367 persons were included (i=5%). After a screening based on CATT test with total blood test, the examination of trypanosomae was performed with QBC on the subjects that have some persistent antibodies above serum dilution at 1/4, followed by lumbar puncture. For 3367 surveyed subjects, the CATT seroprevalence test with total blood sample is 4.2% and it is 2.4% with serum dilution at 1/8. The research of trypanosomae with QBC is positive in 48 patients and the prevalence is 1.4%. The community survey conducted among 106 positive persons with CATT test serum at 1/4 dilution has revealed that 71 (67%) persons have never left the area since their birth. The HAT is actually emerging in Atacora district in the north of Bénin, especially in Kérou.

Effets de la chloroquine sur la thyroide de rat

Depuis les observations de Marine vers les annees 1950; le goitre colloide est considere comme etant le resultat de l'accumulation de colloide apres l'arret de la stimulation de la glande prealablement hy-perplasique. Nous avons injecte ou administre par voie orale; 1mg de chloroquine a des rats Wistar pendant 1 ou 3 jours. D'autres rats ont d'abord recu le 6 - Propyl - 2 Thiouracil (0;25) dans leur ali-mentation avant l'administration de la chloroquine. Les rats ont ete peses ainsi que leur thyroide. Les coupes histologiques ont ete traitees au PAS. Nous avons observe une augmentation des poids moyen absolu et relatif; un goitre colloide et parfois des depots de substance fibrinoide. Ces observa-tions font suggerer un blocage de l'endocytose par la chloroquine. L'usage de la chloroquine au long cours pourrait etre implique dans la pathogenie du goitre dans les regions d'endemie palustre

[Monitoring and assessment indicators in 2001 of "Roll Back Malaria" initiative in Benin]. / Indicateurs de suivi et d'evaluation en 2001 de l'initiative <> au Benin.

Within the context of WHO/CDS/RBM/2000, a survey was conducted in 2001 by the National Malaria Control Program of Benin. Following a well-thought-out choice, the survey took place simultaneously in health areas corresponding to epidemiological regions. Morbidity due to malaria is very high among children under five years admitted in external clinic (44.3% of cases) and (46.5%) for hospitalization. The crude rate of mortality is 129%. The use of non-impregnated bednet is usually met in three health areas, where 47.4% of the household have at least one non-impregnated bednet versus 5.4% of household with impregnated bednets. Percentage of pregnant women sleeping under an impregnated bednet and following chemoprophylaxis is respectively 43.3% and 3.8%. Results obtained at the end of this database survey in 2001 have facilitated the definition of indicators of the process, results and impact which remain very useful for the implementation of the monitoring and assessment system of "Roll Back Malaria" in Benin.

[Clinical and immunological profile of HIV infected patients in Cotonou, Benin]. / Profil clinique et immunologique des patients infectés par le VIH dépistés à Cotonou, Bénin.

OBJECTIVES: This study had for aim to identify the clinical status and the level of immuno-deficiency of HIV-infected patients on their first visit. METHODS: One hundred and thirty-six HIV+ patients were prospectively evaluated from November 1, 2001 to May 31, 2002. RESULTS: One hundred and thirty-four were infected with HIV1 and two with HIV2. The mean age on the first consultation was 37 +/- 2 years. The m/w sex ratio was 0.9. 46.3% were stage C. The main clinical symptoms were: weight loss (88%), fever (80%), cough (71%), diarrhea (51%). BMI was normal in 70% and KI > or =80% in 57% of the cases but immuno-deficiency was severe with CD4 cells count <200 per mm3 in 69%. The main diseases were digestive candidiasis (53%), pneumonia (18%), tuberculosis (12%), non-determined pneumonia (29%), prurigo (20%), zona (16%), cryptosporidiosis (4%), cerebral toxoplasmosis (3%), and Kaposi's sarcoma (1%).

A randomized, double-blind study on the efficacy and safety of a practical three-day regimen with artesunate and mefloquine for the treatment of uncomplicated Plasmodium falciparum malaria in Africa.

A randomized, double-blind, parallel-group study in 104 hospitalized patients with acute, uncomplicated Plasmodium falciparum malaria was performed in West and Central Africa from March to July 2001. Patients were randomized to receive simultaneous dosing (artesunate 200 mg/d plus mefloquine 250 mg/d from the first to the third day [investigational group]) or sequential dosing (artesunate 200 mg/d for 3 d plus mefloquine 250 mg on the second and 500 mg on the third day [reference group]). Patients were followed-up for 28 d, and clinical and parasitological outcomes were assessed. The 14-d cure rate was 100% in the investigational group and 98% in the reference group with no recrudescence until day 28. Mean times to fever and parasite clearance were similar between the 2 groups (32 h vs. 26 h and 45 h vs. 48 h) and tolerability was good in both groups. The number of patients with vomiting was statistically significantly lower in the investigational group compared to the reference group (3.8% vs. 19.2%, P = 0.014). A 3-d once-daily co-administration of artesunate and mefloquine starting on day one offers a practical dosing regimen, which is highly effective and well tolerated in patients with uncomplicated P. falciparum malaria.

[Preliminary evaluation of morbidity due to S. haematobium and S. mansoni in the area of the future Adjarala Dam in Benin]. / Evaluation préliminaire de la morbidité liée à S. haematobium et à S. mansoni dans la zone du futur barrage d'Adjarala au Bénin.

The aim of this study was to provide a preliminary assessment of morbidity due to schistosomiasis in the area of the future Adjarala Dam in Benin. We included 412 schoolchildren from five villages in the study. The mean age of the children was 9.4 +/- 2.3 years and the sex ratio (F/M) was 0.94. These children underwent parasitological examination. The children provided urine samples, which were examined by eye, filtered and tested for blood and protein. Stool samples were examined using Kato's technique and an ultrasound scan of the urinary tract was performed. We carried out a survey of snails at the possible transmission sites of all the villages, with a view to identifying the intermediate hosts. We detected S. mansoni and S. haematobium in the area. Urinary schistosomiasis was mesoendemic (prevalence of 19.7%) whereas schistosomiasis due to S. mansoni was hypoendemic (prevalence of 3. 9%). Ultrasound scans showed that 28% of the children had bladder lesions and that 2.5% were carriers of hydronephrosis. We compared the diagnostic performances of the various indirect indicators of morbidity. We found that a history of hematuria was the most sensitive indicator (88%) but that the sensitivity of this indicator differed significantly according to the sex of the child. Hematuria >= 1+ was the most effective indicator. Snail surveys showed that Biomphalaria pfeifferi and Bulinus globosus were present in the area.