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West Africa has probably the highest levels of maternal mortality in the world. A new method has been developed by the Institute of Tropical Medicine of Antwerp (Belgium) that gives an estimate of the Uncovered Obstetrical Need. This technique tested in different Western African countries has been now evaluated also in an urban medical district in Niamey, capital of Niger, for the year 1999. The uncovered obstetrical need has been estimated at 15 major Obstetrical Interventions for this period; this means that 15 pregnant women didn't undergo a major surgical intervention necessary to save their life and that they probably died because of this non-intervention. We met quite a lot of problems with this new method: (i) the first problem is related to the difficulty to obtain correct demographic information: it is very difficult to estimate population growth in urban african areas, present population and number of attended births. (ii) The second difficulty came from sociocultural habits: primipare women in Niger go back to their family to deliver (and the place where their family lives is not necessarily the same as the place where they stay with their husband); it is quite possible that a number of primipare women needing a major surgical intervention didn't undergo this intervention because they delivered in their home village (and perhaps died there). (iii) At last, the estimation of a reference rate (calculated at 0.9% for Niger) implies that all women needing a major obstetrical intervention in Niamey, and having a theoretical easy access to medical infrastructures (first line as second line hospitals) present themselves when having a major obstetrical problem. This is probably "wishful thinking". The interest of this new method lies in the fact that it is a cheap technique and easy to put into practice ... provided that one disposes of medical infrastructures that collect correctly all necessary medical information.

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The aim of our study in Niger was to compare the seroprevalence of hepatitis C in a rural "normal" population and in a group of patients presenting at the hospital with signs of chronic liver disease: to estimate this seroprevalence, we used 4 second generation ELISA screening and 3 confirmatory tests (LIA, RIBA and PCR); genotyping was performed on PCR positive sera, using Inno-LIPA HCV. We could not find a statistically significant difference (Fisher's exact test) between the two groups of healthy and sick people (2.5 versus 5.4% for seroprevalence and 2.5 versus 3.2% for viremia). Our study didn't find any relationship between hepatitis C infection, blood transfusion or surgery; other major ways of transmission of hepatitis C have to be considered. The predominant genotype detected was 2a.

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La mortalite maternelle reste un des grands problemes de sante publique. On estime qu'a l'echelle mondiale ; un demi million de femmes meurent chaque annee des problemes (souvent evitables) lies a la grossesse. L'ampleur du probleme reste mal connue dans beaucoup de pays par manque d'un systeme fiable d'enregistrement des naissances et des deces. En reponse aux imperfections des techniques classiques de collecte de donnees; differentes methodes d'estimation indirectes de la mortalite maternelle ont ete developpees dont une est la methode indirecte des soeurs. Cette methode a ete appliquee a trois reprises au Niger

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Maternal mortality remains one of the major problems in public health today especially in developing countries where maternal mortality is estimated to be between 500 and 1000 deaths for 100,000 live births. In 1987, the safe motherhood initiative was launched with the objective of reducing maternal mortality by 50% within ten years. One of the methods introduced to reduce the high incidence of maternal and neonatal mortality in developing countries, is the partogram, a visual means used in evaluating a normal delivery. It acts as an early warning system, allowing for the early detection of abnormal evolution in labour as well for the mother as for the foetus. This instrument was introduced in all the maternity wards in Niger in 1990 by the Ministry of Public Health. A study was conducted in one of the maternities of the capital to ascertain the effectiveness of this new instrument to both the mother during labor and the newborn child. 1299 women in labor, primi-and multiparous, participated in the study. Two groups were formed: one consisted of women that delivered prior to the introduction of the partogram, the second group was comprised of women who delivered after its introduction. The results of this study have shown that the introduction of the partogram: reduces the amount of time that a women is in labor, improves the follow-up care the pregnant woman receives, results in a more timely decision made by the health official, and consequently, a prompt referral to a specialised center. The authors estimate that, if used correctly, the introduction of this instrument can have along with other appropriate measures, a considerable impact in the reduction of maternal and neonatal mortality.

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Maternal mortality remains one of the major public health problems nowadays. Each year, all over the world, half a million women die of pregnancy-related complications most of which could be avoided. In spite of enormous efforts at handling this problem, the results have been small. In many countries, the extent of the problem is virtually unknown for lack of reliable birth and mortality data. Where vital statistics are incomplete or non-existent, one should have recourse to other sources of information. In reaction to the classic, yet inadequate methods of collecting information, indirect techniques for estimating maternal mortality have been developed. One of these procedures is the sisterhood method: using this technique, researchers are able to deduce indicators of maternal mortality based on the proportion of sisters, who, once reached childbearing age, survived or died during pregnancy, childbirth or postpartum. The authors tested this method in Niger in a rural area with difficult access to primary health care. They noted a maternal mortality rate of 1,050 every 100,000 live births. This practical and simple method of estimating maternal mortality in a given area, at a relatively low cost, could readily be incorporated into routine medical activities.

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The authors report results obtained after combination of a serological diagnostic test and the early treatment of suspected cases (a person with a positive serological test without parasitological confirmation) in an area in Zaire where sleeping sickness caused by Trypanosoma brucei gambiense is endemic. The serological test used was Testryp CATT, having a very high sensitivity and quite a high specificity, which is easy to handle in the field and which permits results to be obtained on the spot. The treatment employed was a medication active in the first stage of the disease (hematolymphatic stage), safe to handle, with few side effects and easy to administer (diminazine). This strategy was applied for one year in the area from Fankana-Kalakitini in the Bandundu region in Zaire. The entire population was examined with the classical methods, combined with the serological test Testryp CATT, and this every six months. People positive for the serological test (but negative for the parasite) received one injection of the proposed medication; but people in whom parasites were found got classic treatment. After this period, we were able to demonstrate a clear decline in the incidence rate of new cases (parasite positive), but also in seropositivity rates in the general population. The authors believe that in a circumscribed area where the disease is endemic, the combination of a serological test and early treatment of suspected cases can rapidly diminish the incidence of the disease to an acceptable level.

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The authors report the results of 32 patients with sleeping sickness due to Trypanosoma brucei gambiense treated with DFMO (DL-alpha-difluoromethylornithine), an inhibitor of polyamine biosynthesis. Between those patients, there were 5 new cases, 1 reinfection, and 26 cases with a primary, a secondary resistance or a relapse. 26 cases got DFMO only per os, but six others received first DFMO for two weeks by the intravenous way, followed by three weeks of DFMO per os. The secondary effects were never very severe and never prompted a definitive discontinuation of treatment. 12 cases were followed for a period of 24 months, 16 for a period between 1 and 18 months and 4 patients died during the study (3 during treatment and one 8 months afterwards), but we don't think that DFMO was the cause of death. Out of the 12 cases followed for two years, 11 were in perfect health at the end of this period (one case can be considered as a secondary resistance to DFMO, but it could have been a reinfection as well). For the 16 cases followed for a period less than two years, we found a very fast disappearance of trypanosomes from body fluids, immediately after the beginning of treatment, and a significant amelioration of clinical signs. After this study, the authors estimate that DFMO given orally provides as good results as DFMO given in a combined therapy. But the oral way seems much easier to administer and much cheaper in rural areas.(ABSTRACT TRUNCATED AT 250 WORDS)

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