The PREMAP Study: prevalence and risk factors of dementia and clinically diagnosed Alzheimer's disease in Provence, France. Prevalence of Alzheimer's Disease in Provence.

The PREMAP Study investigated the prevalence and risk factors of dementia and Alzheimer's Disease (AD) in a random sample of 1062 residents 70 year old or more, living in south-eastern France (private homes and institutions). All persons living in institutions for the elderly (n = 258) and community dwellers (n = 804) scoring less than 24 points on the MMSE (18.4%) were invited to undergo a medical evaluation at home by a qualified neurologist using the CERAD battery. We found 177 cases of dementia (9.2%), including 82 cases of AD (5.5%). Prevalence of AD increased significantly with age and was higher among women (OR: 4.24) and persons with no formal educational level (OR: 2.47). While a MMS score less than 24 was more frequent among persons with a foreign native language (OR: 3.05), the OR and AD was not significantly associated with native language. The proportion of AD among persons suffering from senile dementia was 45% among elderly living in institutions and 69% among those living in the community. Prevalence rates in south-eastern France are similar to the average rates for Europe. This study underlines the need to investigate the relationships between native language, MMSE and AD on the one hand, and the link between a low MMSE score and institutionalisation of patients suffering from AD on the other.

[Effect of hygiene measures, water sanitation and oral rehydration therapy on diarrhea in children less than five years old in the south of Ivory Coast]. / Effet de l'observance des mesures d'hygiène, d'approvisionnement en eau et de la thérapie par voie orale sur les diarrhées chez les enfants de moins de 5 ans dans le sud de la Côte d'Ivoire.

The purpose is to assess the impact of compliance with measures of hygiene and water supply and oral rehydration on the diarrhoea with under 5 years of age in four villages of southern Côte d'Ivoire. The method used is to compare morbidity and mortality of children, firstly between two groups of villages without such measures, secondly in two villages before and after implementing them. Initially, an exhaustive survey has determined the incidence rate of diarrhoea, the proportion of deaths resulting from such diarrhoea as well as the mortality rate 1988. Two similar survey were made in 1990 and 1992. The results show a 50% reduction of the incidence rate of diarrhoea and a 85% reduction of the proportion of deaths related to diarrhoea in the villages with intervention. The mortality rate to diarrhoea was likewise reduced by 85%. These results show the importance of the improvement and accessibility to drinkable water and hygiene in the prevention of diarrhoea in areas children.

[Impact of improved sanitary conditions and domestic hygiene on the incidence of ascaridiasis and ancylostomiasis in children two to four years old in the rural zones of Ivory Coast]. / Impact de l'assainissement et de l'hygiène domestique sur l'incidence de l'ascaridiose et de l'ankylostomose chez les enfants de 2 à 4 ans dans les zones rurales de Côte d'Ivoire.

The purpose of this study is to assess the impact of improvement measures for hygiene and water supply, installation of latrines and health education on the incidence of ascaridiasis and ankylostomiasis with 2 to 4 years old children in some villages of southern Côte d'Ivoire. The method used is the comparison of children carrying parasites before and after intervention. Initially in 1988, the stools of all children aged from 2 to 4 were collected and examined in order to look for the presence of parasites in the stools. Two identical inquiries were made in 1990 and 1992. The results show a reduction of the rate of incidence for ascaridiasis by 75% and ankylostomiasis by 82%. They demonstrate the importance of an appropriate evacuation of excreta, of an education of mothers and of domestic hygiene in the process of prevention of children parasitosis.

[Water supply, excrement disposal and diarrheal diseases in rural zones of Ivory Coast]. / Approvisionnement en eau, evacuation des excreta et maladies diarrhéiques dans les zones rurales de Côte d'Ivoire.

This study was designed to determine the incidence of diarrhea over a 15 day period in children below 4 years living in villages in a rural area of Côte d'Ivoire and to identify possible correlation with water supply and excrement disposal. In this exhaustive cross-sectional household survey, each person caring for a child between the ages of 0 and 4 years was interviewed at home using an open, pretested survey with questions concerning diarrhea, water supply, and excrement disposal. Responses were authenticated by on-site observations made by surveyors. The study population included 1151 care providers and 1260 children between 0 and 4 years of age. Diarrhea had occurred in 27.7% of children within the 15 days prior to questioning, i.e. an annual incidence rate of 3.1 episodes per child after seasonal correction. Age was a risk factor for diarrhea since the incidence of diarrhea was inversely proportional to age. The number of episodes increases up to 6 months, stabilizes at a maximum of 37 to 38% until 36 months, and then gradually decreases to 6% between 53 and 59 months. Diarrhea was more common in children whose care provider was illiterate, the relative risk being 1.22. There was also a correlation between occurrence of diarrhea and age of the care provider since older providers were more likely to be illiterate. Use of a technique to prevent water from splashing out during transport was correlated with diarrhea. Children whose care providers used leaves or plastic covers to prevent splashing during transport had more episodes of diarrhea (30%) than the those whose care providers did not use these techniques (23%). The place where stool pots were emptied was also related to diarrhea. Disposal behavior was strongly correlated with literacy of the care provider, with the site of disposal being relevant only if the provider was illiterate. In view of these findings, we conclude that educating women, teaching child care providers about healthy eating habits in children as young as 5 months, and informing families about proper water storage and excrement disposal would reduce the incidence of diarrheal disease in village children.

[Study of hypertension in the Ivory Coast urban milieu]. / Etude de la tension artérielle en milieu urbain Ivoirien.

The authors carried out a sample survey in the town of Abidjan to rate high blood-pressure in adult. They evaluate the prevalence rate of high blood-pressure at 13.4%. In this study one may consider as a risk factor: age, obesity, illiteracy, either in isolation and as a matter of course the three together. The role of age as confounding factor appears essential in pluri-factorial analysis and has to be systematically taken into account at the occasion of further studies.

[Current role of doxycycline in the chemoprophylaxis of Plasmodium falciparum malaria]. / Place actuelle de la doxycycline dans la chimioprophylaxie du paludisme à Plasmodium falciparum.

In countries where chemoresistance of Plasmodium falciparum is high (group III), mefloquine must be advocated for malaria prophylaxis for a stay less than 3 months. If it is more and particularly in Indo-china peninsular countries (Thailand, Birmania, Kamputchéa, Laos, Vietnam) and in Amazonia, advocated chemoprophylaxis is doxycycline 100 mg per day. Authors remind action mechanism, contraindication and side effects of this drug. Others publications underline the good tolerance of doxycycline now used by 1,400 french soldiers staying for 6 months with United Nations Organisation in Kamputchéa. An evaluation of tolerance and efficiency of this chemoprophylaxis is now in progress.

Susceptibility of African isolates of Plasmodium falciparum to artemisinin (qinghaosu).

We studied in vitro susceptibility of 79 African strains of Plasmodium falciparum to artemisinin, chloroquine, quinine, mefloquine and halofantrine and the potential cross-resistance among the drugs. Most strains presented an 50% inhibitory concentration (IC50) of artemisinin below 26 nmol/liter. A positive correlation between IC50S of artemisinin and those of quinine, mefloquine and halofantrine was observed. Cross resistance between artemisinin and other antimalarials may limit its use as a replacement drug.

Seroprevalence of HIV infection in the general population of the Côte d'Ivoire, West Africa.

A seroepidemiological survey to determine the prevalence of human immunodeficiency virus (HIV) infection in the general population of the Ivory Coast was carried out in February 1989. Sera were collected from subjects between 15 and 65 years old in urban areas (not including Abidjan) and rural areas using the cluster sample technique. A total of 1,700 people were tested in urban areas, and 125 (7.3%) were HIV positive. This rate varied significantly with age and sex; a maximum rate of 16.3% was observed among men between 35 and 44 years old. In rural areas, a total of 3,199 people were tested, and 159 (4.9%) were positive for HIV; the highest rate (10.7%) was noted in the men aged 25-34 years. The high seroprevalence recorded in the general population in urban and rural areas is compatible with the incidences of acquired immune deficiency syndrome (AIDS) cases reported in hospitals all over the country.

[Manpower in Madagascar and training: evaluation of vaccination coverage by cluster sampling in a rural Malagasy environment]. / Bioforce à Madagascar et formation: evaluation de la couverture vaccinale par sondage en grappe en milieu rural malgache.

To assess the immunization coverage, a cluster sampling survey in Malagasy rural areas has been carried out at the occasion of an in-service training in Expanded Programme on Immunization (E.P.I.) organized for 15 Health Medical Inspectors. Leading results are: 17% of children have received B.C.G. immunization. 15% have received D.T.C. 4% have received oral poliomyelitis immunization.

[Carriage of HBs antigen in New Caledonia. Study according to ethnic group]. / Le portage de l'antigène H. B. s. en Nouvelle-Calédonie. Etude selon l'ethnie.

Owing to 2,772 New Caledonian blood donors and pregnant women, a study was made of the salient features of the H. B. s. antigen carrier state; percentages of carriers showed no difference according to the age and a slight difference between sexes. These percentages proved to be quite different according to ethnic groups. Smaller rates of carriers were found among Europeans (1.1%) than among Melanesians (7.6%) as well as Polynesians (7.7%). There is a relation between H. B. s. carrier state and positive treponema serology, the latter occurring more frequently among melanesian and polynesian groups.

[Training in epidemiology at the Institute of Tropical Medicine of the Army Health Service. Experience over 4 years]. / La formation en épidémiologie à l'Institut de Médecine Tropicale du Service de Santé des Armées. Une expérience de 4 ans.

The authors described the training in epidemiology received by 185 Army medical doctors attached for instruction to the I.M.T.S.S.A. since 1981. Statistical methodology, basic epidemiology, and applied epidemiology are taught in such way that Army medical doctors are better capable of rationalizing and strengthening their action of prevention in their posting either in France or seconded to developing countries. Description of pedagogical targets is underlined as well as methodology of control and evaluation of progress towards these targets. The authors are also able to appreciate, in terms of the level of capacity of the personnel trained, the severity of the consequences either of a strengthening of the pedagogical targets or of a reduction. When the reform of medical education and training imposes very often such an alternative, the authors point out how the leading opinion of the ones who utilize the services of the personnel should be taken into full consideration prior to any decision.

[Evaluation and epidemiologic surveillance of nutritional deficiencies. Principles and application to elementary health units]. / Evaluation et surveillance épidémiologique des déficits nutritionnels. Principes et application aux formations sanitaires élémentaires.

The authors briefly describe some anthropometric, biologic and clinical nutrition indicators used to assess the severity of malnutrition. Problems related to selection of population samples and framework for possible action against malnutrition are also indicated. For transverse evaluation, they suggest to utilize the cluster sampling method recommended by W.H.O. for studying vaccine coverage. The main indicator of nutritional status is then the brachial perimeter qualitatively evaluated with Shakir's strip. To monitor epidemiological importance of malnutrition, they suggest to take into account: the figures indicated by the maternities (birth weight), the figures indicated by M.C.H. and school health (ratio of malnourished children--weight average by age and sex), the figures indicated by specialized hospital departments such as pediatrics, nurseries... They insist upon seasonal factors and evaluation of the rate of coverage of the target population by maternities, M.C.H. and school health, in order to correctly read the declared figures.

[A proposal for an epidemiologic indicator. Apropos of 118 cases of Kaposi's disease]. / Propositions pour un indicateur épidémiologique. A propos de 118 cas de maladie de Kaposi.

On the basis of 118 cases of Kaposi's sarcoma observed in different African countries, the authors study the distribution of this disease according to age and sex. They suggest a test to compare various populations independently of their behaviour versus medical structures. The test is based on a simultaneous study of Kaposi's sarcoma and malignant melanoma. It includes the calculation of a sex- standardised ratio.

[New cases of chromoblastomycosis: importances of anatomo-pathologic examinations]. / Nouveaux cas de chromoblastomycose: intérêt de l'examen anatomopathologique.

Several cases of chromoblastomycosis have been observed, for 7 years, in the laboratory of Pathology, in the IMTSSA . Their various aspects are described. The diagnosis includes three stages: clinic, mycology and pathology. The most frequent clinical lesions have been observed on the legs. Often, they were like a malignant tumour (carcinoma). The fungal investigation, by direct research of fungi in the lesions, is carried out scarcely, because it is difficult. It should be completed by cultures, in order to isolate the pathogenic agent, but its identification is not possible, if it is not carried out by a laboratory of mycology. The most simple technique , adapted to tropical areas, is the pathological examination. It reveals several points of interest: by analyzing the cutaneous lesions (in order to eliminate a carcinoma)--observing the intensity of the inflammatory reaction--but, first of all, the discovery of the thick-walled dark cells. Two techniques are usual, for staining, but they could be improved by using other special techniques, in order to analyse more carefully the lesions.