[Clinical management of patients and deceased during the Ebola outbreak from October to December 2003 in Republic of Congo]. / Prise en charge des malades et des défunts lors de l'epidémie de fièvre hémorragique due au virus Ebola d'octobre a décembre 2003 au Congo.

Outbreaks of Ebola virus hemorrhagic fever (EVHF) have been reported since 2001 in the Cuvette Ouest department, a forested area located in the Western North of Congo. At the end of October 2003 a new alarm came from this department which was quickly confirmed as being an epidemic of EVHF. The outbreak response was organized by the ministry of health with the assistance of an international team under the aegis of WHO. The case management of suspect cases was done in an isolation ward set up at the hospital; when patients refused to go to the ward for care they were isolated in their house according to a protocol "transmission risks reduction at home". Safe burials were performed by specialized teams which respected the major aspects of the funeral to allow the process of mourning of the families. An active surveillance system was set up in order to organize the detection of new cases and the follow-up of their contacts. A case definition was adopted. From October 11 to December 2, 2003, 35 cases including 29 deaths were reported, 16 cases were laboratory confirmed. The first four cases had been exposed to monkey meat (Cercopithecus nictitans). The epidemic spread was due to family transmission. The population interpretation of the disease, in particular questions around wizards and evil-minded persons, is a factor which must be taken into account by the medical teams during communication meetings for behavioral change of the populations. The case management of patient in isolation wards to prevent the transmission of the virus in the community remains the most effective means to dam up Ebola virus hemorrhagic fever outbreaks. The good perception by the community of the safe funerary procedures is an important aspect in the establishment of confidence relations with the local population.

Medical anthropology and Ebola in Congo: cultural models and humanistic care.

Seldom have medical anthropologists been involved in efforts to control high mortality diseases such as Ebola hemorrhagic fever (EHF) This paper describes the results of two distinct but complementary interventions during the first phases of an outbreak in the Republic of Congo in 2003. The first approach emphasized understanding local peoples cultural models and political-economic explanations for the disease while the second approach focused on providing more humanitarian care of patients by identifying and incorporating local beliefs and practices into patient care and response efforts.

[Outbreak of Ebola hemorrhagic fever in the Republic of the Congo, 2003: a new strategy?]. / L'épidémie de fièvre hémorragique à virus Ebola en République du Congo, 2003: une nouvelle stratégie?

This article describes the last Ebola haemorrhagic fever (EHF) outbreak that occurred in the Cuvette Ouest Region of the Republic of Congo from January to April 2003. Epidemiological study demonstrated that the first patient, in whom diagnosis was made retrospectively, became ill on December 25, 2002. Subsequently until May 7, 2003, a total of 143 cases were recorded in the Mbomo and Kéllé health districts including 129 fatalities. Thirteen cases were laboratory confirmed and 130 were epidemiologically linked. Fifty-three percent of patients were male. Age ranged form 5 days to 80 years. Transmission involved direct contact with an infected person especially within families. Epidemiological data traced introduction of Ebola virus into the population to three primary cases mainly involving hunters. In all three cases development of the disease followed contact with non-human primates (gorillas) and other mammals (antelope) that had either been killed or found dead. Three health care workers were infected during the epidemic but nosocomial transmission played a minor role in the epidemic. On June 5, the Minister of Health and Population of the Congo Republic officially declared that the outbreak of EHF was over in the Cuvette Ouest Region. The last case was recorded on April 22 in the small village of Ndjoukou.

[Culture, environment and fecal hazards: anthropological observations]. / Culture, environnement et péril fécal: réflexions anthropologiques.

This paper was presented as a tribute to André Dodin, formerly director of the Paris Pasteur Institute's cholera department. It was intended to: - recall representations of what is seen as pure, impure, sullied, dirty ... medical and social interventions depend not only on scientific theories but also on unconscious presuppositions linked to their particular history and culture; - to stress the necessity of reexamining epidemiological chains in fecal peril bearing in mind bodily techniques and the material and symbolic behaviour of the populations concerned; - to insist upon the fact that traditional sanitation techniques do exist and should not be neglected, whether it be to make use of them, avoid or combat them. It is not a question of idealizing local culture, but of becoming acquainted with it so as better to appreciate its role.

[AIDS and AIDS: anthropological analysis of opinions relative to the death of AIDS patients in a district of Bangui (June 1994)]. / SIDA et SIDA: analyse anthropologique d'opinions relatives aux décès de sidéens dans un quartier de Bangui (Juin 1994).

Anthropological analysis and presentation of a corpus of information gathered during an ethnological survey on aids led in June 1994 in the district Jean XXIII, Bangui. The personality of the investigator-informator ( = Ego = the second author), and thus his subjectivity, are parameters deliberately considered for the presentation and analysis of the obtained data. The inquiry consists in making a list and gathering explanations of deceases ascribed to aids in this district, among a population made up by a representative part of the investigator's "social body": i.e. his nuclear family, members of his extended paternal, maternal and in-law families, past and present regular extra-matrimonial sexual partners, networks of former and present neighbours, friends and colleagues; that is to say a whole formal and informal community with changing outlines, which acts a fundamental role when misfortune, bad luck and disease appear.

[AIDS and Aids: anthropological observations apropos the AIDS phenomenon in Lobaye, Central African Republic]. / SIDA et Sida: réflexions anthropologiques à propos du "phénomène sidaique" en Lobaye, en République centrafricaine.

Human infestation by retrolentivirus which are incriminated in human disease called AIDS turns to be a "serious endemic". Once adequate medicine and vaccine discovered, it could perhaps be jugulated or eradicated in ethno-ecosystems combining a high socioeconomic level and a heavy attendance of efficient biomedicine. These criteria fit in neither with Quarter, nor with Third World, nor with worlds which do not think or live Health, Illness, Death, Misfortune in the same terms than those inspired by biomedical philosophies. Native logic apprehends AIDS as any form of sequence of misfortune, without taking care of its physiopathologic and epidemiologic specificity.

[Nutritional survey in Upper Volta. 2. Risk factors associated with malnutrition]. / Enquête nutritionnelle en Haute-Volta 2. Facteurs de risque associés à la malnutrition.

Malnutrition-associated risk factors have been studied in Upper Volta following a multivariate statistic analysis performed with a computer (Manova). The multiple correlation coefficients for 7 predictors were 0.14 for the children and 0.34 for the women. Results show that the nutritional situation worsens when the density of the population leads to an over exploitation of the land in the North West. Two different life-styles, i.e. cattle breeding and agriculture determine strikingly different nutritional situations among women and children. Family factors are also important to the nutritional status of the children.

[Nutritional survey in Upper Volta. I. Importance and forms of malnutrition]. / Enquête nutritionnelle en Haute-Volta. I. Importance et formes de la malnutrition.

The nutritional status of a randomly selected sample population has been investigated in Upper Volta in 1978. The estimated mortality rate among the preschool children population (0-5 years) is as high as 39%. Up to 6% of the children 0-9 years old were found to be wasted and stunted. Older children and adults are regularly underweight although their muscular arm circumference is an average acceptable by reference to international standard. The prevalence of anemia in the whole population is round 30% and case of xerophthalmia may be observed in the country.

[Malnutrition aspects of South Mali farmers (author's transl)]. / Aspects de la malnutrition chez les paysans du Sud du Mali.

The results of a nutritional survey with two passages performed in July-August 1978 and March-April 1979 by ORANA in South Mali are presented: mild or moderate protein-energy malnutrition, anemia and specific deficiencies are everywhere present, but the situation deteriorates quickly from a season to the other and it is possible to characterize ecological, economic or cultural situations where nutritional status of the populations is worse than other. Among them the current economic modifications which are accompanied by nutritional modifications were emphasized as the need to consider this aspect in all development projects.