[Ophthalmologic complications due to human immunodeficiency virus infection at Bamako (Mali)]. / Complications ophtalmologiques de l'infection par les virus de l'immunodéficience humaine (VIH) à Bamako (Mali).

AIDS ocular complications have been researched in 70 hospitalised patients in the two main hospitals of Bamako (Mali) during one year (1992-1993). Men were predominant (sex ratio 1.6). HIV1 infections (67%) were most frequent than HIV1 + HIV2 (21.4%) or HIV2 infections (11.4%). Most of the patients were on the WHO's clinical stage III; 34% of them had ocular complications, quite often non infectious: cotonous nodules (10%), vascularitis (5.7%) and retineous haemorrhages (4.3%). Ocular opportunistic infections were rare: only one case of toxoplasmic chorio-retinitis was reported. Ocular complications were observed with all types of HIV. Vascular abnormalities were observed in the stage II or IV of AIDS and seemed, in Bamako, as a serious sign during the AIDS course.

[Course of trachoma under treatment with 1% oxytetracycline ophthalmic solution]. / Evolution du trachome sous traitement par collyre à l'oxytétracycline 1%.

PURPOSE: In order to optimize the trachoma treatment duration, we carried out a prospective study to observe the disease course over a long period of treatment by a 1% oxytetracycline (chlorhydrate) suspension. METHODS: The study involved 50 children between 2 and 12 years living in three Malian villages. The existence of an active trachoma was clinically characterized by the presence of at least 5 follicles associated with a papillary hypertrophy of the upper tarsal conjunctiva. The treatment was administered daily 4 times a day, for two months. All patients were examined before being treated, then on the 15th, 30th and 60th day. The presence and the importance of the follicles, papillae and trachomatous scarring were scored. During treatment, no patient manifested a case of follicular score aggravation. The moderate cases reacted more rapidly than the severe ones. In most cases the reduction in the number of follicles became evident only after two weeks of treatment. On the other hand, the inflammatory hyperplasia diminished rapidly from the 15th day. The cicatricial score was constant and pre-existing scars were not aggravated. After treatment, 33 patients out of 50 (66%) could be considered cured. CONCLUSION: The analysis of data suggests that a longer period of treatment would have led to a higher healing percentage. In fact, all forms of intense trachomatous inflammation, likely to cause blindness, diminished before the end of the control period.

[Xerophthalmia. Identification of populations at intermediate risk]. / Xérophtalmie. Identification des populations à risque intermédiaire.

In developing countries, vitamin A deficiency (VAD) is a major contributor to child blindness and is associated with increased mortality. We assessed the vitamin A status of a Sahelien population and evaluated the correlation between the various criteria used to score xerophthalmia. The survey was carried out between June 1992 (the end of the dry season) using a representative sample of 906 children between the ages of 3 and 7 years in the district of Douentza. The population sample was selected by a two stage cluster sampling method (villages and then households). Vitamin A status was evaluated using clinical, histological and nutritional criteria. Clinical examination included testing for night blindness (XN), Bitot's spots (X1B) and corneal scars (XS). The Impression Cytology with Transfer (ICT) test described by Amedee-Manesme was used for histological analysis. Cases of follicular trachoma were recorded because of the possible influence of active trachoma on the findings of the ICT test. Nutritional status was determined by measuring the height for weight ratio according to the National Center for Health Statistics criteria. The prevalence of XN was 2.7% (1.6-3.7), significantly higher than the WHO threshold for a public health problem. The prevalence of X1B was 0.5% (0.1-1.2), and no corneal scars were detected. 31.7% of the children were suffering from malnutrition, but malnutrition did not correlate with any of the ophthalmological indicators of a public health problem. Among the 842 readable ICT tests, 265 were abnormal (31.4% of the total, 28.2-34.5). This incidence of abnormal results was unexpectedly low, in the light of the clinical results, and well below the threshold value of 50% suggested by Carlier.(ABSTRACT TRUNCATED AT 250 WORDS)

[The cost of the surgical treatment of cataracts at the African Institute of Tropical Ophthalmology (Bamako, Mali)]. / Coût de la cure chirurgicale d'une cataracte à l'Institut d'ophtalmologie tropicale de l'Afrique (Bamako, Mali).

In developing countries, cataracts are a serious public health problem. There are a large number of patients, an estimated 3 millions in Africa alone, awaiting operations. However, the number of surgical interventions is small for a variety of reasons, including the cost. To try to reduce the cost of surgery, we analysed the various elements involved at the African Institute of Tropical Ophthalmology (AITO) in Bamako (Mali). The route followed by the patient, from contact with the health service through to post-operative health care was analysed in terms of individual jobs, supplies and equipment required. The unit cost of each of these elements was assessed using an adapted calculation method. The results show that the cost of the removal of the lens at the AITO is 15,200 FCFA (or $56). Installing an intra-ocular lens significantly improves the outcome for a similar cost (16,500 FCFA or $60). The relative costs of various elements were as follows: food, 32%, the suture, 12%; and equipment only 13%. Thus, to reduce the overall cost of surgery for cataracts, ambulatory surgery should be organised, with efforts to reduce the costs of suture. High quality equipment should be used, because its life-span is such that it can be amortised over a long period.

Urbanisation and vitamin A deficiency in children: comparison between a traditional district and a new settlement in Mali.

OBJECTIVES: The purpose of this study was to assess the vitamin A status of pre-school urban children and to compare the situation between a traditional district and a new settlement after two decades of intense urbanisation. SUBJECTS AND METHODS: A cross-sectional stratified survey was carried out in Bamako, Mali, on a representative sample of children (aged 4-6 years). 532 children were involved from a traditional district and 453 from a new settlement (NS). The vitamin A status was assessed by: clinical indicators (ophthalmic examination), subclinical indicators (questionnaire looking for night blindness, impression cytology with transfer test (ICT), modified relative dose response test (MRDR), and a diet inquiry about vitamin A intakes. Acute malnutrition was assessed by a weight/height measure. RESULTS: In both districts, all the clinical indicators were below the WHO criteria that define a public health problem. Both the ICT test, respectively 19 and 21% of abnormal tests, and the MRDR, 67.3 and 73.1% of tests > or = 0.06, indicated a subclinical vitamin A deficiency as defined by WHO thresholds. During the preceding week only four children in NS had consumed vitamin A-rich food less than seven times. No significant difference between the two districts was found either for clinical or subclinical indicators (p > 0.5). CONCLUSION: Despite a rapid urbanisation, the vitamin A status of the children seemed to be rather homogeneous among the different districts. The population remained vulnerable with peripheral depletion and low hepatic stores of vitamin A. The urban children should be carefully monitored regarding vitamin A status.

Health education and antibiotic therapy in trachoma control.

The objective of this study was to confirm whether the combination of a health education programme with a mass treatment campaign was able to improve the effectiveness of trachoma control. An open controlled clinical trial with a 2 x 2 factorial design was carried out. Four villages, matched for size and epidemiological, economic and social conditions, were included in the study. The first village received mass treatment with 1% oxytetracycline eye drops combined with a specific health education programme. The second village received only a health education programme. The third village received only mass treatment and the fourth village did not receive any intervention during the study (control village). 1810 subjects were enrolled of whom 76% were successfully followed for 6 months. The incidence of new cases ranged between 1.6% and 14.2%. In this study the combination of a health education programme with mass treatment failed to increase the cure rate. There was even a negative interaction (P = 0.03). The best results were obtained in the village where antibiotic treatment was used alone, both in terms of cure rate (82%) and reduction of C trachomatis transmission. These results suggest that the addition of a health education programme does not systematically improve the performances of a mass treatment campaign. The efficacy of this combination depends essentially on the capacity of the community to modify its hygiene behaviour.

[Effect of water supply on the incidence of trachoma: preliminary results of a prospective study in Mali]. / Effet de l'adduction d'eau sur l'incidence du trachome: résultats préliminaires d'une étude prospective au Mali.

This prospective study (January 1993-January 1994) was carried out in two groups of villages of the district of Ouelessebougou (Mali). The objective of the study was to assess the impact of installing water supply boreholes on the incidence of trachoma. A prospective group of 4 villages, where boreholes were sunk at the beginning of the study, was compared to a control group of 4 villages where there are no boreholes. The examination concerned children below the age of 10 years (N = 700) and was carried out using binocular loupes, according to the simplified procedure for trachoma grading proposed by the WHO. Our results show that in the prospective group, the annual rate of incidence of inflammatory trachoma was 8% (cl: 5.8-10.7) while in the control group it was 14% (cl: 9.6-10.9). RR: 0.58 (0.37-0.90). Likewise the rate of spontaneous healing was 12% (Cl: 9.1-14.9) in the prospective group and 5% (cl: 2.4-9) in the control group. Relative Risk was 2.60 (1.36-4.9). These statistically significant results show that the risk of contracting trachoma is reduced by half in the villages where a borehole has been sunk.

[Tropical conjunctivitis: infectious etiology and validation of its clinical features]. / Conjonctivites tropicales: étiologie infectieuse et validation des caractères cliniques.

173 nontrachomatous conjunctivitis studied at the I.O.T.A. in Bamako, Mali, have shown a majority of bacterial aetiology, especially gram-negative. 1 out of 10 conjunctivitis was due to virus, mostly to adenovirus. 4% of the cases were due to Chlamydia Trachomatis. The try of validation of the clinical characters in comparison with the etiology has shown that Chemosis was an indicator of a bacterial conjunctivitis (OR = 2.4) and that the lack of purulent discharge was in connexion with the presence of a keratitis (OR = 7.7). On the one hand the frequency of gram-negative bacteria, on the other hand the potential gravity of the conjunctivitis in tropical area, would justify the use of gentamycin at first in nontrachomatous conjunctivitis.