[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.

Analyse du financement du systeme de sante au Congo

En 1993; la Banque Mondiale a consacre son desormais traditionnel Rapport sur le developpement dans le monde au theme de la sante et plus particulierement a investir dans la sante. C'est dire l'importance de ce probleme; de la sante bien sur en tant que facteur essentiel de developpemnt mais aussi de son financement: on sait que le manque croissant de ressources financieres est une des causes essentielles de la deterioration de la qualite des soins en Afrique sub saharienne et le Congo n'y echappe malheureusement pas

Ameliorer les prestations de sante primaire en zone urbaine : articulation de la formation et de la supervision dans les centres de sante integres de Brazzaville

Le projet d'appui aux structures existantes initie dans le cadre de la cooperation sanitaire entre la France et le Congo a permis de cerner les problemes lies a la gestion; a la formation et la rehabilitation de ces structures. L'objectif majeur de cette action a ete en effet de diminuer la morbidite et la mortalite maternelle et infantile. Ce projet dont l'axe fondamental a ete la formation et la supervision a donc permis en 1990 a 850 personnes de beneficier de cette formation par le biais des seminaires

Ameliorer les prestations de sante primaire en zone urbaine : ameliorer la gestion des ressources financieres dans les centres de sante : l'exemple de Brazzaville

Une analyse de la gestion financiere des centres de sante conduite a Brazzaville a mis en evidence la contribution importante de la communaute et a permis de proposer un nouveau mode de gestion des ressources. Les recettes moyennes theoriques declarees sont de 398000 FCFA par mois; dont 20 pour cent sont reservees a l'interessement des agents. Sur la solde 40 pour cent sont reservees aux directions de tutelle et le reste sert au fonctionnement propre du centre. Les auteurs montrent que dans la pratique; les sommes restant au niveau du centre ne permettent pas de couvrir efficacement les depenses de fonctionnement. Pour permettre une utilisation optimale des ressources et ameliorer les services offerts par les centres; l'assainissement de la gestion reste un prealable indispensable. Le projet appui aux centres de sante de Brazzaville; grace au developpement d'un instrument de recueil d'information et a la mise en place d'une supervision; a fait des propositions aux directions concernees pour ameliorer l'efficacite des procedures et renforcer la capacite de gestion des centres en tenant compte des realites

Ameliorer les prestations de sante primaire en zone urbaine : rationaliser l'information sanitaire en zone urbaine : l'exemple des centres de sante de Brazzaville

La necessite de disposer d'informations sanitaires fiaibles a conduit le projet appui aux centres de sante de Brazzaville du FAC a mettre en place un nouveau systeme d'information sanitaire dans les centres de sante. L'accent a ete mis sur la simplication du recueil; la performance des indicateurs utilises; et la fiabilite des donnees. Au niveau du centre un guide d'interpretation permet une auto-evaluation et la mise en evidence des disfonctionnements; en relation avec les equipes de supervision. Ce systeme a ete elabore avec l'ensemble des acteurs. Il reste evolutif et ouvert a l'integration de grands programmes

Irrigation, schistosomiasis, and malaria in the Logone Valley, Cameroon.

Field studies of a rice irrigation project in Mayo-Danai, North Cameroon permitted a direct comparison between pre- and post-development data relating to schistosomiasis and malaria infection. A stratified sample of 4,000 inhabitants, representing 8% of the population living in 28 areas at the time of the first survey, was investigated 5 times between 1979 and 1985. Due to the significant population increase since 1982, 1,500 persons were added to the initial sample. The prevalence of schistosomiasis and malaria remained constant over the 6 years. No changes in the transmission sites were observed. Malacological investigations showed a decrease in the snail population in the project area. Sanitation activities (i.e., drain cleaning and well construction) and decreased rainfall contributed to this situation. The prevalence of infection among the migrants was low. High prevalence of schistosomiasis was found only in villages located along a previously contaminated temporary river.

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.

[Comparative study of the malaria indices in Nanga-Eboko, Yaounde and Edea (Cameroon)]. / Etude comparée des indices paludométriques à Nanga-Eboko, Yaoundé et Edéa (Cameroun).

The authors report the results of sample surveys carried out in september 1986 in Yaounde and Nanga-Eboko and in january 1987 in Edea (Cameroon) to evaluate the main malarial indexes among 0-15 years old children. These investigations suggest that malaria is hypoendemic in Yaounde and mesoendemic in Nanga-Eboko during the rainy months. In Edea malaria is hyperendemic.

[Impact of the African year of vaccination on vaccine coverage in Cameroon]. / Impact des journées africaines de vaccination sur la couverture vaccinale au Cameroun.

The efficiency of the African Year of Immunization has been studied in Cameroon by the evaluation of the nationwide coverage thanks to two cluster sample surveys carried out in rural and urban areas. The results are compared to those of previous surveys.

[Sampling surveys: an objective method of evaluating the prevalence of leprosy in an endemic zone]. / Les enquêtes par sondage: une méthode objective d'évaluation de la prévalence de la lèpre en zone d'endémie.

The authors submit a simplified sample survey methodology designed to evaluate prevalence rates of leprosy. The system proposed uses a cluster sampling technique. A cluster is a randomly selected group of households. In each household visited by the epidemiological teams all the inhabitants of the target-group are interviewed and examined. Various samples sizes are used (from 6500 to 12,000 peoples) according to the expected prevalence rate of the studied area. All the new cases detected through these surveys are notified to the National Departments in charge of leprosy programmes. Two surveys are already achieved (Equatorial Guinea, Cameroon), a third one in on the way.

[The expanded vaccination program in Cameroon: status of the intermediate objectives and future prospects]. / Le programme élargi de vaccination au Cameroun: état de réalisation des objectifs intermédiaires et perspectives d'avenir.

The authors report the results of nine sample surveys for the evaluation of the immunization coverage program carried out in urban and rural areas in Cameroon. The halfway target of 30% is reached in urban areas and approached in rural areas. The achievement of the target (85%) will need the solution of more and more intricate problems and the participation of the whole national community.

[Evaluation of the clinical, parasitological and immunological indices of malaria in the Bonny's Bay area of Central Africa]. / Evaluation des indices cliniques, parasitologiques et immunologiques du paludisme dans la région de la Baie de Bonny en Afrique Centrale.

The authors report the results of 4 sample surveys carried out in Equatorial Guinea and Cameroon in the Bonny's Bay area, to evaluate the main malarial indexes. In rural and semi-rural areas one notice a high rate of fever attacks and splenomegaly. Parasitaemia is more important in rural areas than in urban areas and is decreasing where the therapeutic pressure is strong and long-lasting. Immunological indexes are high everywhere.