Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “AFRICA”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMed2002

Incidence and management of acoustic neuromas in South Africa.

OBJECTIVES: To determine the extent to which the various treatment modalities are used in the management of acoustic neuromas treated in South Africa and to estimate the incidence of acoustic neuromas in South Africa. METHODS: A telephonic survey was conducted of all otorhinolaryngologists, neurosurgeons, and radiotherapy centers in South Africa to determine whether they had treated any patients with acoustic neuromas during the calendar year 2000. RESULTS: One hundred and fifteen patients with acoustic neuromas were treated in South Africa during the calendar year 2000, and 8 patients were referred to other countries for treatment. This resulted in an incidence of approximately 0.3 per 100,000 population per year. There was a marked difference in the incidence between the various racial groups: the incidence was at least 1.76 per 100,000 population per year among whites and at least 0.01 per 100,000 population per year among blacks. Of the 115 patients, 78 (68%) were treated surgically and 24 (21%) by stereotactic radiotherapy. Fourteen (12%) patients had newly diagnosed acoustic neuromas that were managed conservatively in the year concerned. The surgical approach used was middle fossa in 8 (7%) patients, retrosigmoid in 61 (53%) patients, and translabyrinthine in 9 (8%) patients. CONCLUSIONS: The majority of acoustic neuromas in South Africa were treated surgically, mainly by a retrosigmoid approach. The incidence of acoustic neuromas in South Africa was approximately 0.3 per 100000 population per year. There were significant racial differences in the incidence.

Black People↗
PubMed2003

Phylogeography of Rice yellow mottle virus in Africa.

The sequences of the coat protein gene of a representative sample of 40 isolates of Rice yellow mottle virus (RYMV) from 11 African countries were analysed. The overall level of nucleotide diversity was high (approximately 14%). Great geographical distances between the sites where isolates were collected were consistently associated with high genetic distances. In contrast, a wide range of genetic distances occurred among isolates spread over short geographical distances. There was no evidence of long-range dispersal. RYMV diversity in relation to land area was eight times greater in East Africa than in West/Central Africa. West/Central African isolates with up to 9 % divergence belonged to a monophyletic group, whereas the East African isolates with up to 13 % divergence fell into distantly related groups. In East Africa, each Tanzanian strain had a specific and restricted geographical range, whereas West/Central African strains had large and partially overlapping geographical distributions. Overall, our results suggest an earlier RYMV diversification in East Africa and a later radiation in West/Central Africa. The West African situation was consistent with virus adaptation to savanna, forest and other ecological conditions. In contrast East Africa, as exemplified by the Tanzanian situation, with numerous physical barriers (mountain chains, sea channel, lakes), suggested that RYMV strains resulted from divergence under isolated conditions. For RYMV and for two other viruses, phylogenetic relationships were established between isolates from Madagascar and isolates from the Lake Victoria region.

Africa↗
PubMed1996

Assessment of medical technology and the challenge for health reform in Africa.

Introduces an African perspective to existing research and scholarship on the relationship between western medical technology and health care planning in Africa. Examining the broader issues of development and underdevelopment, contends that the present health care system, fashioned after western medical systems (focusing on hospital and curative care), has failed to make significant impact by reducing mortality rates in Africa. Describes the already precarious health conditions in Africa and argues that, while Africa can benefit from the application of western medical technology, the irrelevance of current strategies to people's needs and the widespread abuse of medical resources have rendered western technology ineffective in Africa. Concludes by calling for the creation of a council of technological assessment in Africa to review requirements and recommend to African governments appropriate and efficient medical technologies to meet the health needs of Africans.

Africa↗
PubMed2005

Gaze deviation from contralateral pseudoperiodic lateralized epileptiform discharges (PLEDs).

Pseudoperiodic lateralized epileptiform discharges (PLEDs) usually produce "negative" neurologic findings. This contrasts with seizures which typically induce cortical activation with "positive" clinical manifestations. Gaze preference may arise from ipsilateral frontal eye fields (FEFs) damage because of the unopposed action of an intact contralateral FEF. Epileptic nystagmus (EN) and gaze deviation (GD) can also occur with focal temporo-parieto-occipital or hemispheric seizures in awake or obtunded patients. A patient with old right frontal and parieto-temporal cerebral infarctions manifested leftward gaze preference and deviation (without nystagmus) while alert and talking. Digitized EEG demonstrated PLEDs at approximately 1 Hz over the right fronto-central region, without electrographic seizures. This report illustrates that PLEDs without seizures may excite frontal regions proximate to the FEFs to produce contraversive gaze preference in an awake patient, and discusses putative mechanisms. Gaze deviation, in this case, was the principal clinical feature of PLEDs.

Aged↗
PubMed1988

Risk factors for infection with human immmunodeficiency virus among European expatriates in Africa.

The pattern of cases of AIDS in Belgium suggests that Europeans infected with human immunodeficiency virus (HIV) acquired the infection in Africa. The prevalence of infection was assessed in Belgian advisers and European expatriates and risk factors for infection defined in a case-control study of expatriate men. Fifteen (1.1%) of 1401 Belgian advisers working in Africa and 41 (0.9%) of 4564 European expatriates living in Africa, were positive for antibody to HIV in a voluntary screening programme in Belgium. Among subjects with antibody to HIV the ratio of men to women was 3:1. These subjects did not have a history of intravenous drug abuse or blood transfusion and only one was homosexual. In a case-control study of 33 expatriate men who had antibody to HIV and 119 controls the men with antibody reported significantly more female sexual partners, who were more commonly local; and significantly more sexual contact with prostitutes in Africa. They had a significantly higher prevalence of history of sexually transmitted disease and had received significantly more injections by unqualified staff in Africa during the previous five years. No specific sexual practices were associated with having antibody to HIV. After multivariate analysis sexual contact with local women (adjusted odds ratio 14.7; 95% confidence interval 2.81 to 76.9), sexual contact with prostitutes (adjusted odds ratio 10.8 (1.6 to 71.9), and injections by unqualified staff (adjusted odds ratio 13.5 (3.7 to 49.8) remained independent risk factors for infection. European expatriates in Africa were at increased risk from infection with HIV and were a means of introducing HIV into the heterosexual population in Europe. Transmission from women to men by vaginal intercourse seemed to be the most probable route of infection.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Randomised controlled trials in Africa of HIV and AIDS: descriptive study and spatial distribution.

OBJECTIVES: To identify and describe randomised controlled trials on HIV and AIDS conducted in Africa and to map their spatial distribution using exact geographic coordinates. DESIGN: Construction and analysis of a database of trials conducted wholly or partly in Africa and reported before 2004. DATA SOURCES: CENTRAL, Medline, Embase, and LILACS. RESULTS: Our comprehensive search yielded 284 distinct records that were potentially eligible for inclusion in the database. Of these, 150 articles reported on 77 eligible trials published or reported from 1987 to 2003. Seven trials were identified exclusively from the CENTRAL database. Trials were conducted in 18 of 48 countries in sub-Saharan Africa. None were conducted in north Africa. Only 19 had a principal investigator located in an African country. Forty two trials assessed prevention and 35 assessed treatment. Most studies were funded by government agencies outside Africa (n = 43), with the pharmaceutical industry providing partial support to 16 of these. The pharmaceutical industry provided full or partial support to a further 18 trials. Only 43 trials reported conducting a power calculation for determining sample size. There was no mention of ethical approval or informed consent in 19 and 17 trials, respectively. CONCLUSION: The relatively small number of HIV/AIDS trials conducted in Africa is not commensurate with the burden of disease. Geographical mapping as an adjunct to prospective trial registration is a useful tool for researchers and decision makers to track existing and future trials.

Africa↗
PubMed2003

HIV/AIDS in Central Africa: pathogenesis, immunological and medical issues.

The estimated worldwide prevalence of human immunodeficiency virus (HIV) infections topped 52.5 million in June 2003, a mere 20 years after the aetiological agent was shown to be a sexually transmissible virus with a predilection for CD4+ T lymphocytes. More than 22 million people have died of the acquired immunodeficiency syndrome (AIDS) and the condition has in one generation become the most devastating and persistent epidemics in recorded history. More than two thirds of the world total of HIV-infected people live in Sub-Saharan Africa. In Central and Southern Africa at least 20% of the adult population is infected. As these adults die, they leave increasing numbers of orphans. Life expectancy at birth declined by 10 years per decade since the late 1980s to 50 years in the late 1990s, and in Botswana it is estimated to be as low as 33 years by 2010. The epidemic is increasing unabated and prospects for a curative or protective vaccine remain remote. The impact on HIV in Africa has been so profound that it influences political, economic, agriculture/food security, social, education, defence, science and health considerations. The medical and in particular immunology communities in Central Africa have the invidious challenge of on the one hand diagnosing the condition, monitoring its impact and contributing to treatment and management efforts. The science and clinical practice of immunology is challenged to find answers to the epidemic, perhaps including a vaccine. In this review we address the peculiarities of the HIV epidemic in Africa, its epidemiology and immunopathogenesis. We address the effect of the epidemic on individual patients, in their homes, workplaces and the knock-on effects on families and friends of the infected. Respective specialists discuss special groups (women, children) that are predominantly seen in Africa. We also discuss the impact of the epidemic on the clinical practice of medicine in general and challenges faced in the introduction of antiretroviral medicines. We also discuss options available for the diagnosis, treatment and monitoring of HIV-infected patients in this region.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Reconciling the origins of Africa, India and Madagascar with vertebrate dispersal scenarios.

Africa, India and Madagascar were once part of the supercontinent of Gondwana. This land mass began to fragment approx. 170 million years ago, and by 83 million years, all of the major components we recognize today were separated by tracts of water. Madagascar's fossil record and estimates of the timing of the extant vertebrate radiations in Madagascar are not easily reconciled with this history of fragmentation. Fossil faunas that lived prior to approx. 65 million years had a cosmopolitan flavour, but this was lost after the Cretaceous-Tertiary boundary. Phylogenetic reconstructions of most extant Malagasy vertebrate radiations indicate divergence times that postdate the End-Cretaceous (lemurs, tenrecs, cichlid fish) and even the Early Miocene (chameleons, carnivores, rodents). Most biogeographic explanations of these groups rely, therefore, on Simpson's model of sweepstakes dispersal (see also cover figure), but there are significant problems in applying the model to migrations from Africa to Madagascar, although its application is not so intractable between India and Madagascar. Alternative migration routes for consideration lie: (1) along the suite of fracture zones between Antarctica and Africa/Madagascar (known as the Antarctic-Africa Corridor), which may have been exposed episodically above sea level; (2) along a series of submerged basaltic ridges/plateaus with known or suspected continental crust between Antarctica and Africa/Madagascar/India flanking the Antarctic-Africa Corridor (e.g. the Madagascar Ridge, Mozambique Ridge, Conrad Plateau, Gunnerus Ridge); (3) between Africa and Madagascar along the Davie Ridge (parts of which are known to have been exposed episodically above sea level); (4) along the Deccan hotspot corridor between India and greater Africa.

Africa↗
PubMed1991

Systolic blood pressure levels in black populations in sub-Sahara Africa, the West Indies, and the United States: a meta-analysis.

Average systolic blood pressure levels from epidemiological studies conducted on black populations in sub-Sahara Africa were pooled and compared with pooled systolic blood pressure levels from black populations in the northern portion of the Western hemisphere (the West Indies and the United States). Studies published in English that listed systolic blood pressure means and standard deviations and sample sizes in 40-49-year-old men and women were included. Overall, systolic blood pressure levels were higher (p less than 0.05) in blacks from the northern Western hemisphere than in blacks from sub-Sahara Africa for both men (12 mm Hg higher) and women (13 mm Hg higher). The analysis was also conducted on regions within sub-Sahara Africa and in rural and urban subgroups. Systolic blood pressure was lower (p less than 0.05) in East Africa than in the other three regions within Africa for both sexes. Overall, urban blacks within Africa had higher systolic blood pressures (p less than 0.05) than rural blacks for both sexes. In the northern Western hemisphere, rural blacks had higher systolic blood pressures (p less than 0.05) than urban blacks for both sexes. Studies should be designed with standardized methods to unravel these intraracial differences in blood pressure levels.

Adult↗
PubMed2003

Mitochondrial DNA transit between West Asia and North Africa inferred from U6 phylogeography.

BACKGROUND: World-wide phylogeographic distribution of human complete mitochondrial DNA sequences suggested a West Asian origin for the autochthonous North African lineage U6. We report here a more detailed analysis of this lineage, unraveling successive expansions that affected not only Africa but neighboring regions such as the Near East, the Iberian Peninsula and the Canary Islands. RESULTS: Divergence times, geographic origin and expansions of the U6 mitochondrial DNA clade, have been deduced from the analysis of 14 complete U6 sequences, and 56 different haplotypes, characterized by hypervariable segment sequences and RFLPs. CONCLUSIONS: The most probable origin of the proto-U6 lineage was the Near East. Around 30,000 years ago it spread to North Africa where it represents a signature of regional continuity. Subgroup U6a reflects the first African expansion from the Maghrib returning to the east in Paleolithic times. Derivative clade U6a1 signals a posterior movement from East Africa back to the Maghrib and the Near East. This migration coincides with the probable Afroasiatic linguistic expansion. U6b and U6c clades, restricted to West Africa, had more localized expansions. U6b probably reached the Iberian Peninsula during the Capsian diffusion in North Africa. Two autochthonous derivatives of these clades (U6b1 and U6c1) indicate the arrival of North African settlers to the Canarian Archipelago in prehistoric times, most probably due to the Saharan desiccation. The absence of these Canarian lineages nowadays in Africa suggests important demographic movements in the western area of this Continent.

Africa, Northern↗
PubMed2006

Sixth Africa Malaria Day in 2006: how far have we come after the Abuja Declaration?

Each year on the 25th April Africa and the rest of the world commemorate Africa Malaria Day as was agreed upon at the African Summit on Roll Back Malaria held in Abuja, Nigeria on 25th April 2000. The summit also called upon the United Nations to declare the period 2001-2010 a decade for malaria. The 1st Africa Malaria Day was commemorated with the theme "Communities Play a Central Role in Tackling Malaria". The 6th Africa Malaria Day was observed in 2006 with the theme "Get Your ACT Together" and the slogan "Universal Access to Effective Malaria Treatment is a Human Right". This article by the Secretariat of the Multilateral Initiative on Malaria (MIM) was also part of the commemorations for the day. MIM was founded in 1997 as an alliance of institutions and individuals concerned with the malaria problem, and aiming at maximizing the impact of scientific research on malaria through strengthening African research capacity and coordinated global collaboration. The MIM Secretariat has been hosted in rotation by the founding institutions, and is being hosted for the first time in Africa by the African Malaria Network Trust (AMANET) in Dar es Salaam, Tanzania. This article reviews the malaria situation in Africa six years after the Abuja Declaration, highlighting the disease burden trends, failures, achievements, challenges, and the way forward.

Africa↗
PubMed2000

[The role of female veterinarians in Africa].

While the number of female veterinary students has reached figures as over 80% in the Netherlands and other European countries, the number of female veterinary students in Africa is also changing but still at a slower pace. Still nowadays, according to UNICEF, two-thirds of primary school age children, denied their right to basic education, are girls. In addition, especially in rural areas in Africa, there are only few secondary schools, so that children, either have to travel over large distances on a daily basis or have to live away from their families. As girls, already from an early age play an important role in the daily household routine, they are often not allowed to leave for schooling. There used to be less than 10 veterinary faculties in Africa during the first half of the 20th century. These faculties were located in South Africa, Sudan, Egypt and Nigeria. For many years, African veterinarians were also trained in western countries (UK, France, USA) or in former communist countries (Russia, Ukraine, Romania, Hungary Eastern Germany, Cuba) depending on the existence of historic or political links. A long stay abroad made it more difficult for female students, especially for those with children. Still nowadays, female veterinarians in Africa are mostly working for the veterinary departments mainly in the urban areas. Another area where many female veterinarians can be found are governmental diagnostic and research laboratories as well as training institutions such as veterinary faculties or agricultural colleges. Generally the salaries at these institutions are very low and therefore their male colleagues have gradually shifted to work in the private sector with more competitive salaries (private clinics, sector pharmaceutical companies, development projects, (agricultural) banks, etc). As still in most societies, women tend to follow their husbands, most female veterinarians are bound to find employment where their husbands are based. In addition, as most postgraduate training required a prolonged stay abroad, women encountered difficulties in leaving their families behind to improve their career perspectives. Gradually, there has been an increase of possibilities of post-graduate training in the African region as well as the introduction of a modular system and perspectives for training over the internet. These developments will clearly be beneficial for women, as it will enable them to follow post-graduate training without leaving their families for extended periods. Gradually, also female veterinarians in Africa are becoming empowered and recognise their capabilities. The understanding of the importance of gender aspects especially with regard to animal husbandry practices has opened up new opportunities for female veterinarians to work in extension services and as health promoters. The access to further education is the key to expanding their professional perspectives.

Africa↗
PubMed2003

A heart-healthy and "stroke-free" world through policy development, systems change, and environmental supports: a 2020 vision for sub-Saharan Africa.

The vision of a heart-healthy and "stroke-free" world is achievable through the aggressive prevention and control of cardiovascular risk factors. In sub-Saharan Africa, a region plagued by infectious and parasitic diseases, nutritional deficiencies, and excessive maternal and perinatal morbidity and mortality, the prevention of cardiovascular diseases (CVD) and risk factors is rarely on the public health agenda. In Africa, however, as recently documented by the World Health Organization's Africa Regional Office, CVD and other chronic non-communicable diseases are on the increase and already represent a significant burden on public health services. Age-specific mortality and morbidity associated with CVD and chronic diseases are higher in sub-Saharan Africa than in established market economies. Correspondingly, adverse trends in risk factor profile are beginning to appear especially in many urban centers in sub-Saharan Africa. Addressing and reversing these trends will take more than just targeting individuals and their behaviors and lifestyle choices. More importantly, to support heart-healthy choices, emphasis must be placed on policy development, systems changes, and issues in the social environment factors such as the need to strengthen legislation and regulatory mechanisms, which control the leading risk factors (eg, tobacco, physical inactivity, and poor nutrition). We must develop and conduct heart-healthy and "stroke-free" initiatives to take place in diverse community settings: schools, worksites, communities, and healthcare systems. In addition, public health capacity and infrastructure must be strengthened to provide adequate surveillance and the assurance that best practices are implemented. Action is needed to integrate health promotion, risk factor control and disease prevention within the primary healthcare setting. Above all, population-based approaches must be used to promote education and awareness of the importance of CVD risk factors. In sub-Saharan Africa, where most people have no more than one CVD risk factor, a unique opportunity exists for primordial prevention, ie, preventing the development of risk factors in the first place. The policy and environmental change strategies discussed provide a road map to a heart-healthy and "stroke-free" future.

Africa South of the Sahara↗
PubMed2004

Caries status and treatment needs in South Africa: report of the 1999-2002 National Children's Oral Health Survey.

A third national children's oral health survey was conducted in South Africa between July 1999 and June 2002. OBJECTIVE AND METHODOLOGY: One of the objectives of the survey was to determine the prevalence and severity of dental caries and the treatment needs for dental caries in 4- to 5-, 6-, 12- and 15-year-old South African school children. The sample comprised 30876 children from the nine provinces of South Africa. RESULTS: The results of the survey show that 39.7 per cent of the 6-year-old group were caries free. This figure, 39.7 per cent, is below the goal of 50 per cent set by the Department of Health for 6-year-old children in South Africa for the year 2000. The DMFT of 1.1 for the 12-year-old group on the other hand was below the goal of 1.5 set for South Africa for the year 2000. The highest DMFT/dmft scores were recorded in the Western Cape Province and the lowest in the Limpopo Province. More than 80 per cent of caries in children go untreated while the greatest need for treatment in South African school children was for preventive services, restorations and extractions. The results for the 12-year-old-group show a reduction in dental caries severity in the permanent dentition in that the DMFT decreased from 2.5 in 1982 to 1.1 for the current survey. CONCLUSIONS: Although dental caries severity in South Africa is classified as low by WHO standards, the high levels of untreated caries in all age groups in South Africa is a cause for concern.

Adolescent↗
PubMedDate not supplied

Histoplasmosis in Africa: a review.

Classical histoplasmosis caused by Histoplasma capsulatum var. capsulatum, and African histoplasmosis caused by H. capsulatum var. duboisii are both endemic in Africa. In South Africa, only classical histoplasmosis caused by Histoplasma capsulatum var. capsulatum is known to occur and cases are seen frequently. It occurs sporadically in several other African countries. Histoplasma capsulatum var. capsulatum is known to occur naturally in caves inhabited by bats in some parts of South Africa, namely, Transvaal and Cape province, Zimbabwe and Tanzania. Outbreaks of histoplasmosis have been reported in cave explorers. Surveys of histoplasmin skin sensitivity carried out in Africa have shown the rate of positive reactors to be from 0.0% to 28%. African histoplasmosis caused by H. capsulatum var. duboisii is prevalent in Western and Central Africa, and in the island of Madagascar between the Kalahari and Sahara deserts, that is between latitudes 20 degrees North and 20 degrees South of the Equator. A natural reservoir of this fungus in soil admixed with bat guano has been found in a bat cave in a rural area, viz. Ogbunike in Anambra State of Nigeria. The clinical features and epidemiology of the two forms of the disease in Africa are reviewed.

Africa↗
PubMed1991

[Risky practices associated with HIV infection of seamen who travel in sub-Saharan West Africa].

We report the results of the epidemiological and serological studies concerning HIV-1 and HIV-2 infections carried out in a group of 203 seamen who visited the sub-Saharan area (west coast of Africa). The following risky practices were detected: history of drugs abuse 8 (3.9%), transfusion 3 (1.5%), use of parenteral medicines in Africa 80 (39.4%), surgery in Africa 41 (20%), tattoos 18 (8.9%). Sexual behavior: stable couple 180 (88.7%), number of sexual couples 4.2 +/- 6, contacts with prostitutes 108 (53%), contacts with prostitutes in Africa 83 (40.9%), others heterosexual contacts 58 (28.6%), homosexual 1 (0.5%), history of VD 34 (16.7%), 94% of the seamen never (or occasionally) used the preservative with theirs couples and 73% of them didn't use it with others contacts. Four seamen were HIV-1 (+): contacts with prostitutes in Africa 2, use of parenteral medicines in Africa 1 and drugs abuse 1. We observed a high prevalence of risky practices associated with HIV-1 infection between seamen population. It is interesting to remark the importance of heterosexual transmission and the use of parenteral medicines.

Acquired Immunodeficiency Syndrome↗
PubMed1978

Cystic fibrosis in Southern Africa. Including the preparation of a register of carriers and potential carriers.

Little has been published on cystic fibrosis (CF) in Whites in southern Africa, and no figures as to incidence exist. A register of CF patients, their parents (obligatory carriers), siblings, uncles, aunts and first cousins (potential carriers) has been compiled for southern Africa. The degree of co-operation shown by colleagues and by families whose addresses have been provided by them, and possible reasons for non-co-operation are discussed. From the numbers and birth dates of patients a rough estimate of the incidence in the Republic of South Africa, South West Africa and Rhodesia has been made. In all three regions, but especially in South Africa, incidence is likely to have been underestimated. Details available from the register include the number of CF patients alive and dead, those who presented with meconium ileus, the number of affected patients per family, consanguinity among the parents or grandparents, the frequency with which identical surnames were encountered, and the sibship sizes of all those on the register. Towns and districts with a population rich in the CF gene are mentioned. The number of potential carriers has been determined, so that they can be screened when a practicable detection test is devised. The register has answered a number of questions about CF in southern Africa. It has focused attention on the disease in the region and played a major catalytic role in the formation of the Southern African Cystic Fibrosis Association.

Child↗
PubMed1993

[Comparison of hospital prevalence of rheumatic heart diseases and acute rheumatic arthritis in France and Africa].

This study reports the results of a multicentre enquiry performed in France in 1990 which included 41,242 adults hospitalised in Cardiology Units, 33,907 children hospitalised in Pediatric departments and 8,868 soldiers. A comparative enquiry was also carried out in North Africa (Tunis) and West Africa (Abidjan, Ouagadougou). The results of the French arm of the enquiry showed that rheumatic heart disease (RHD) has become very rare in adults (3.1% of all cardiac disease) and that it tends to occur in older subjects (average 54.4 years of age). There is practically no RHD in young adults. This decreased prevalence of RHD is confirmed in children in whom this diagnosis represents only 0.04% of cases of all cardiac disease--of which 87.5% are of extra-European origin. In contrast, there is a high frequency of RHD in Tunisia (29.3%) and West Africa (13.2% in Abidjan and 13% in Ouagadougou). The disease remains active as is shown by the age of affected adults in Africa (average 21 and 27 years of age). The results also show a reduction to a very low prevalence of acute rheumatic fever in French pediatric departments (0.005%). The authors discuss the reasons for the persistence of endemic infection in Africa: virulence of the streptococcus, predisposing factors (HLA group?), geographic factors and, above all, socioeconomic factors and difficulties in obtaining treatment and prophylaxis. A movement of international cooperation is suggested in order to combat RHD in Africa, especially with regards to its prevention in childhood.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗