A partnership in epidemiological research.

Four medical research teams completed ten epidemiological investigations in Djibouti and thus provided the country's Ministry of Health with valuable information on infectious disease risks. A major factor contributing to the success of the work was the high degree of cooperation between the Ministry, a United States naval medical research unit, and the World Health Organization as coordinator.

PIP: Epidemiologic research has the potential to complement public health technical assistance programs and to provide health planners with information on priority areas for intervention. This potential was documented in Djibouti, where a US naval medical research unit conducted 10 epidemiologic investigations preliminary to the planning of a national acquired immunodeficiency syndrome (AIDS) control program. Data were collected on human immunodeficiency virus (HIV) prevalence and incidence in high-risk populations, the comparative performance of HIV screening assays, attitudes and practices relevant to sexually transmitted diseases, viral hepatitis markers, the prevalence of arboviral infections, the nature and drug susceptibility of microbial pathogens associated with infectious diarrhea and Neisseria gonorrhoea, the epidemiology of malaria, and the ecology of sandflies in relation to human leishmaniasis. These findings were utilized in the setting of priorities and the planning of disease control measures. Baseline epidemiologic data are now available, and national research capabilities have been strengthened so that further research on AIDS , malaria, and diseases such as leishmaniasis can be conducted. The success of this experience was in large part due to the cooperation and coordination between the research unit, the Ministry of Health, and a World Health Organization Collaborating Center on AIDS.

Low prevalence of HIV infection in Djibouti--has the AIDS epidemic come to a stop at the Horn of Africa?

To determine if the HIV-epidemic had reached Djibouti by autumn 1987, we investigated 645 subjects belonging to various risk groups; 150 were patients with a disease compatible with acquired immune deficiency or with a mycobacterial infection, 115 were young males having a sexually transmitted disease, 295 were female prostitutes, and 69 were villagers from a rural area; the remaining 16 belonged to other groups. All subjects answered an epidemiological questionnaire and had their serum tested for evidence of HIV antibodies. Eight sera were HIV-antibody positive by both ELISA and Western blot. Of these, 2 were from young men while 6 were from young women who admitted to prostitution. This accounts for an HIV seropositivity rate of 2.0% +/- 1.6% in the prostitute population. Also, one antibody-positive subject was positive for circulating HIV antigen. Seven of the seropositive individuals had no general complaints or abnormal clinical signs. The eighth subject was a 28 year old man in hospital for pneumonia. We conclude that in Djibouti, in late 1987, the prevalence of both AIDS and HIV infection in high risk individuals was much lower than that reported from other East African countries.

[Knowledge of sexually transmitted diseases and attitudes towards them in populations at risk in Djibouti]. / Connaissances et attitudes envers les maladies sexuellement transmissibles dans des populations à risque à Djibouti.

Sexually transmitted diseases (STDs) are an increasing public health problem in Djibouti. The authors have attempted to obtain basic information on the level of knowledge concerning STDs and on the sexual behaviour of highly sexually promiscuous individuals for use in the organization of future STD control programmes; the information was obtained from a population of 213 bar hostesses, 66 unlicensed prostitutes, and 115 male sufferers from STDs. The level of knowledge of these diseases was very high among the prostitutes and the bar hostesses, except that little was known about syphilis by the bar hostesses; the male sufferers were relatively ignorant concerning both syphilis and AIDS. Medical and paramedical personnel do not figure among the sources given for knowledge of STDs. On the other hand, friends play an important role in this knowledge, especially among unlicensed prostitutes. The second most frequently instanced source was radio and TV. The bar hostesses and the unlicensed prostitutes often exhibited distinct social characteristics. Neither education nor marriage appeared to prevent men from contracting STDs. The use of condoms is extremely rare among STD patients and not very common among unlicensed prostitutes. Half the bar hostesses report their frequent use.

Viral hepatitis markers in Djibouti: an epidemiological survey.

A serosurvey involving 656 individuals revealed that hepatitis A infection was virtually universal in Djibouti in 1987, and more than half of the people investigated had serum markers of hepatitis B infection. The rate of chronic HBsAg carriers was 7.3% and was higher for males than for females. Both HBsAg and anti-HBs positivity rates were directly related to increasing age. No uniform mechanism could be found to account for transmission of the hepatitis B virus, and no correlation was noted between HBV-marker status and sexual promiscuity or the classic blood exposure risks. However, a significant association existed between the abuse of khat and the chronic HBsAg carrier state.