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PubMed2000

Eradication of poliomyelitis in countries affected by conflict.

The global initiative to eradicate poliomyelitis is focusing on a small number of countries in Africa (Angola, Democratic Republic of the Congo, Liberia, Sierra Leone, Somalia, Sudan) and Asia (Afghanistan, Tajikistan), where progress has been hindered by armed conflict. In these countries the disintegration of health systems and difficulties of access are major obstacles to the immunization and surveillance strategies necessary for polio eradication. In such circumstances, eradication requires special endeavours, such as the negotiation of ceasefires and truces and the winning of increased direct involvement by communities. Transmission of poliovirus was interrupted during conflicts in Cambodia, Colombia, El Salvador, Peru, the Philippines, and Sri Lanka. Efforts to achieve eradication in areas of conflict have led to extra health benefits: equity in access to immunization, brought about because every child has to be reached; the revitalization and strengthening of routine immunization services through additional externally provided resources; and the establishment of disease surveillance systems. The goal of polio eradication by the end of 2000 remains attainable if supplementary immunization and surveillance can be accelerated in countries affected by conflict.

Adolescent↗
PubMed2001

Surveillance of mortality during a refugee crisis--Guinea, January-May 2001.

Since 1990, the republic of Guinea (2000 population: 7.5 million) has accepted 390,000-450,000 refugees from Sierra Leone and Liberia. During this 10-year period, refugees have lived in small villages scattered throughout rural southeastern Guinea. During September-December 2000, attacks by armed factions in Guinea led to the widespread displacement of refugees living in the southeastern camps; the refugees subsequently were transferred to safer camps in the northwest. Approximately 280,000 refugees initially were estimated to have been displaced. After the attacks, the number of refugees relocated was approximately 58,000. This report demonstrates methods used to calculate mortality rates when large populations are displaced. The findings indicate that the number of refugees in Guinea before the relocation probably was overestimated. The mortality rates calculated using conservative denominator numbers did not meet the definition of an emergency phase of a complex emergency, and mortality rates were lower for refugees compared with baseline rates for the local population. Accurate methods are needed to estimate population size in complex emergencies to provide resources to vulnerable groups.

Guinea↗
PubMed2001

Management of cancer pain--a survey of current practice in West Africa.

A comprehensive management plan for cancer pain is yet to be formulated in the West African sub region despite the priority that the World Health Organisation (WHO) has devoted to the problem over the past decade. As a prerequisite to our cancer pain management curriculum development a structured questionnaire on cancer pain management practice was administered to 80 Fellows attending the Annual Scientific Conference of the West African College of Surgeons in 1996. They were asked how often they treated cancer patients, the causes of cancer pain, their methods of assessment and therapeutic measures and complications of management techniques. Forty-four fellows from Nigeria, Ghana, Liberia and Sierra Leone, all consultants and trainers, responded to the questionnaire. About 80% of them treated cancer patients all the time. Specific anti-cancer therapy such as surgery, chemotherapy and hormone therapy were available in the four countries but radiotherapy was only available in two centers in Nigeria. The respondents estimated that 70-90% of their patients had severe pain at presentation. Pain was thought by 52% of respondents to be due to cancer and its treatment while 47% thought it was due to cancer and the fear of dying. Pain assessment was mostly by the verbal rating scale, only 20% included psychological measurement in their schedules. Oral preparations of strong opioids were not available in most countries andfor severe pain, the parenteral route was employed. Only 18% knew about the 'by the clock' dosing schedule. The study revealed that the standard of practice of the respondents falls below accepted practice. There is thus an urgent need for the formal education of personnel involved in the care of these patients.

Africa, Western↗
PubMed1973

Infant mortality in Africa.

The latest available statistics show that the lowest infant mortalities in African countries have been reported in Rhodesia (122/1000), Kenya (132/1000), Liberia (137/1000), Togo (127/1000), and Mali (123/1000). An unusually low death rate was reported from the island of Maurice, 65/1000. Other countries have mortalities well above 130/1000. Leading the list with the highest infant mortalities were Ethiopia with 190/1000, Ivory Coast with 195/1000, Dahomey with 221/1000, Guinea with 246/1000, Niger with 200/1000, Upper Volta with 270/1000, Central Africa with 190/1000, Gabon with 229/1000, and Zambia 259/1000.

Africa↗
PubMedDate not supplied

Africa: support for family planning grows.

African countries, generally regarded as among the world's most cautious on family planning matters, may be the most dramatic growth area for family planning projects over the next few years, according to the Kenya-based Regional Director for Family Planning International Assistance (FPIA), PPFA's own worldwide aid program. In a recent status report to FPIA's New York headquarters, L. Robinson, a U.S. citizen and former Peace Corps volunteer who recently left FPIA to join the staff of the new House Committee on Population, forecasts a near-tripling of FPIA-funded projects in 1978 - from 7 to 19. Most of the potential new projects - in Nigeria, Togo, Liberia, Tanzania, and Sierra Leone - will involve the addition of family planning services to existing maternal and child health delivery systems, with emphasis upon the training of physicians and other medical, counseling, and educational personnel. Other prospective projects include family life education for adolescents in Cameroun and Ghana, and a full-scale rural, mobile services delivery program in Tunisia. Behind these promising prospects is what Mr. Robinson sees as a quiet but deliberate move by several governments - including Sierra Leone, Togo, and Cameroun - towards accepting family planning as an integral component of maternal and child health services. The moves in Cameroun and Togo are especially significant since both are French-speaking, and traditionally "pro-natalist and somewhat hostile to family planning." The pattern of change in these and other countries tends to be somewhat slow and low-keyed, he notes; most governments "prefer not to have explicit official policies and programs, but rather to allow the gradual evolution of private services becoming an integral part of government-administered health and medical facilities." And even in some countries where government policies remain highly restrictive - Ivory Coast, e.g., where laws prohibit family planning except when necessary on medical and health grounds - many druggists stock a variety of contraceptives, all available to individuals and couples upon request. FPIA's current program in Africa, as in other regions, has 2 principal components: distribution of family planning commodities and supplies (more than $500,000 worth of commodities have been distributed in African countries over the past 3 years), and financial and technical support of service and educational projects. Of the current projects, 2 are in Egypt and Kenya, 2 in Ethiopia, and 1 in the Sudan. In one of the most advanced of these - a project in Kenya designed to introduce family life education into the nation's primary and secondary schools - project leaders recently completed and presented to the Ministry of Education a comprehensive package of syllabi, curriculum texts, and teaching guides.

Africa↗
PubMedDate not supplied

The problem of choosing model life tables for African countries.

"This study seeks to investigate contemporary practice among mortality analysts whereby the South Model life table in the Coale Demeny system is used for analysing mortality data for countries in the North African subregion while the corresponding North Model is used for Sub-Saharan African countries. The two analytical methods proposed...are discussed and empirically tested with pertinent data from Algeria and Egypt (North Africa) and Liberia, Togo, Reunion and Mauritius (Sub-Saharan Africa)." The above practice is not completely validated. "It is therefore suggested that rather than use a predetermined model life table for analysing mortality data in African countries, the methods used in the study should first be applied to determine the model type that best fits the specific country data situation." (summary in FRE, ITA)

Africa↗
PubMed1990

"Ghana faces ecological disaster".

The rate of deforestation in Ghana is alarming and urgent steps need to be taken to reverse the trend, Robert D. Mann, a British tropical agriculturist, has warned. He says, "There will be further disintegration of the local climate, deterioration of soil fertility and reduced food-crop production, if the present trend of denudation by felling trees and uncontrolled bush fires is not halted and reversed." Mann, who has conducted research on "deforestation, drought and famine in Africa" was in Ghana recently to speak on the "role of the Church in West Africa in stimulating action to combat desertification". Representatives of protestant churches in Ghana, Togo, Liberia, Gambia, Nigeria, Cote d'Ivoire and Sierra Leone attended the 3-day conference which was organized by the Overseas Department of the British Methodist Church. It was to enable participants to share perspectives on the nature, scale and seriousness of the deforestation problem. Participants also exchanged experiences on village-based projects for promoting tree planting and agro-forestry, and developed strategies for the rural development programs. Robert Mann noted that Ghana was not only affected by its proximity to the Sahel, but also by its own deforestation. The situation in Ghana, once renowned for her extensive forests and woodland, has now drastically changed. By 1980/81 the area of closed forest had been reduced to 17,000 sq km from 47,9000 sq km in 1937/38. He said in 1939 the volume of wood exported from Ghana was 42,450 cubic meters but it rose to 1,471,600 cubic meters by 1987. Such activities, Mann said, put severe strain on the environment and affected both the economy and sociocultural basis of the country.

Africa↗
PubMed2003

Palm fruit in traditional African food culture.

The centre of origin of the oil palm is the tropical rain forest region of West Africa. It is considered to be the 200-300 kilometre wide coastal belt between Liberia and Mayumbe. The oil palm tree has remained the 'tree of life' of Yoruba land as well as of other parts of southern West Africa to which it is indigenous. The Yoruba are adept at spinning philosophical and poetical proverbs around such ordinary things as hills, rivers, birds, animals and domestic tools. Hundreds of the traditional proverbs are still with us, and through them one can see the picture of the environment that contributed to the moulding of the thoughts of the people. Yoruba riddles or puzzles were also couched in terms of the environment and the solutions to them were also environmental items. They have a popular saying: A je eran je eran a kan egungun, a je egungun je egungun a tun kan eran: 'A piece of meat has an outer layer of flesh, an intermediate layer of bone and an inner layer of flesh'. What is it? A palm fruit: it has an outer edible layer, the mesocarp; then a layer of shell, inedible, and the kernel inside, edible. The solution to this puzzle summarises the botanical and cultural characteristics of the palm fruit.

Africa, Western↗
PubMed2006

Post-traumatic stress disorder, survivor guilt and substance use--a study of hospitalised Nigerian army veterans.

OBJECTIVES: To investigate the prevalence of post-traumatic stress disorder (PTSD) and survivor guilt in a sample of hospitalized soldiers evacuated from the Liberian and Sierra-Leonean wars in which Nigerians were involved as peace keepers. The relationships between PTSD, survivor guilt and substance use were also investigated. DESIGN: A socio-demographic data questionnaire, the PTSD checklist and a validated World Health Organization substance use survey instrument were used to obtain data from the subjects. SETTING: The study took place at the 68 Nigerian Army Reference Hospital, Lagos, Nigeria, which was the base hospital for all casualties from the Liberian and Sierra-Leonean operations. SUBJECTS: All hospitalised patients from the military operations during a 4-year period (1990-1994) who were physically capable of being assessed were included in the study. RESULTS: The prevalence rate for PTSD was found to be 22% and survivor guilt was found in 38% of the responders. PTSD was significantly associated with long duration of stay in the mission area, current alcohol use, lifetime use of an alcohol/gunpowder mixture, and lifetime cannabis use. Survivor guilt was significantly associated with avoidance of trauma-related stimuli but not duration of combat exposure. CONCLUSIONS: Although the sample studied was specific, PTSD might be quite common and probably undetected among Nigerian military personnel engaged in battle in Liberia and Sierra-Leone. Detection of such persons through deliberate screening in military community studies should help to alleviate the symptoms since good intervention methods are now available. Primary prevention efforts with regard to alcohol and cannabis use should help to reduce the incidence of PTSD.

Adult↗
PubMed1991

Fifteen new canestriniid mites (Acari, Astigmata, Canestriniidae) associated with beetles of the Colydiidae and Cetoniinae (Scarabaeidae) (Insecta, Coleoptera).

Two canestriniid genera: Tamarangia, Kahoorangia and the following species are newly described: Sandrophela dittae from Colydium sp., Borneo, Tamarangia nimfae from Pachnoda thoracica, Etiopia, T. fabiolae and T. flawiani from P. marginata, Sierra Leone, Kahoorangia almae from P. carmelita, South Africa, Paraphagella ingridae and Cetonicola orestesi from Tmesorrhina iris, Liberia, P. indirae, Cetonicola isadorae and Boetophela erhardi from Chelarrhina savagei, Cameroon, P. odae and C. maritae from Stephanorrhina guttata, Congo-Brazzaville, Boetophela sybillae from Goliathus alborignatus, Tanzania, B. symeoni from Elasocheilon heterospila, B. silvanae from Geynodonta laeviplaga, Tanzania.

Africa↗
PubMedDate not supplied

[The results of serological research to determine hepatitis A and B markers in the blood sera of the population of the Republic of Guinea].

The results of examinations of sera from apparently normal urban and rural residents of the Guinea Republic (GR) for markers of viral hepatitis A (anti-HAV) and B (HBsAg) are presented. The number of HBsAg-positive subjects was 16 +/- 1% (1199 serum specimens were examined by direct enzyme immunoassay, EIA, and HI test), the rate of HBsAg findings in sera from children (less than 16 years) and adults (greater than or equal to 16) did not differ significantly (p less than 0.05). The rate of a HBsAg carrier state did not depend on sex and residence of the subjects under study (p less than 0.05). The detection rate of total (IgM + IgG) anti-HAV antibody was 67 +/- 2% (812 serum specimens were examined by a variant of EIA block). The detection rate and titres of anti-HAV in children were higher than in adults, and in urban residents higher than in rural subjects (p less than 0.05). The results of detection of HBsAg and total anti-HAV antibody in the sera of GR residents are close to those obtained in examinations of sera from the populations of countries bordering GR in Western Africa (Senegal, Mali, Liberia) and are typical of Africa as a whole.

Africa, Western↗
PubMed1990

Ivermectin--clinical trials and treatment schedules in onchocerciasis.

Initial clinical trials with ivermectin were performed in patients with both roundworm infestation and onchocerciasis. Obvious clinical safety allowed for rapid progression through 5-30-50-100-150-200 mcg/kg in infected patients. Initial studies showed some effect at 50 mcg/kg; subsequent double-blind controlled studies, either with placebo or diethylcarbamazine (DEC), confirmed the efficacy of ivermectin as well as further defining its safety profile. Absence of adverse eye findings or serious systemic reactions justified the further open trials. Studies of patients treated at 6, 12, or 18 month intervals showed a long lasting effect of ivermectin in reducing skin microfilaria counts. Phase III studies confirmed safety and efficacy and further refined the dose to 150 mcg/kg every 12 months. Large trials in Liberia and other countries in West Africa, and subsequently under Onchocerciasis Control Program (OCP), included approximately 120,000 persons carefully followed during which few patients with serious adverse experiences were reported. These extensive field trials confirmed the relative safety allowing for broad distribution of ivermectin in programs not able to provide physician monitoring.

Animals↗
PubMed1990

In vivo and in vitro effects of extracts from Cassia aubrevillei in onchocerciasis.

A traditional herbal drug, called "Ganna Ganna", is used in rural areas of Liberia to treat onchocerciasis. It is prepared from the bark of the "Ganna Ganna" tree, which was identified as Cassia aubrevillei. An aqueous extract was prepared from the bark according to informations from local people and its effects on microfilaria (mf) density and pruritus were studied in eleven patients with onchocerciasis. In four patients a 1.8-4.8 fold increase in mf density was observed after three weeks and in two patients mf counts dropped to almost zero. Histology and embryogram of adult worms, isolated after treatment, revealed no significant changes. All patients reported a rapid decline of pruritus and this effect lasted for up to three months. The in vitro effect of different extracts on mf viability was tested. The alcoholic extract gave the best results, killing mf within 24 h at concentrations of 50 micrograms/ml. Chrysophanic acid, an anthraquinone identified in the drug, also showed good in vitro microfilaricidal activity. It is concluded, that "Ganna Ganna" could be a useful adjuvant in the therapy of onchocerciasis and that further evaluation of the drug seems promising.

Adult↗
PubMed1989

The spread of chloroquine-resistant malaria in Africa. Implications for travelers.

Spreading from 2 countries in 1978 to at least 29 in 1988, chloroquine-resistant Plasmodium falciparum malaria has become a significant concern for travelers to Africa. The spread of chloroquine resistance has been documented by sporadic case reports and by isolated population surveys, which do not always completely reflect the risk of infection for travelers using chloroquine prophylaxis. Surveillance of Peace Corps volunteers in West Africa indicates that as of January 1, 1989, P falciparum malaria resistant to chloroquine prophylaxis had spread as far west as Liberia, with only limited risk in Sierra Leone and to the north and west of Sierra Leone. Monitoring the incidence of malaria in highly exposed expatriates provides early warning of the emergence of drug-resistant P falciparum malaria and can provide data to guide recommendations for travelers.

Africa↗
PubMed1988

Histological examination of adult Onchocerca volvulus and comparison with the collagenase technique.

The methods used for the assessment of adult Onchocerca volvulus by histology are described. Based on the results of several studies, mainly in Liberia and Burkina Faso, the morphology of the adult filariae in histological sections is represented as far as it is relevant for the evaluation. Especially are described the morphological alterations due to old age of the worms, to chronic hyperreactivity of the human host (sowda) and effects of the macrofilaricidal suramin and of microfilaricidal drugs. Quantitative results are reported on untreated adult O. volvulus from various countries, the changes of the worm population during 12 years of vector control in Burkina Faso and the effects of suramin, diethylcarbamazine, metrifonate, and ivermectin. The data from the histological examinations are compared with those gained from the examination of worms isolated by the collagenase technique in the same studies.

Aging↗
PubMed1988

The relationship between innate susceptibility to Onchocerca, and haemolymph attenuation of microfilarial motility in vitro using British and west African blackflies.

The effect of haemolymph from individual flies of differing species of Simulium were compared in their ability to attenuate Onchocerca microfilariae in vitro. Small maintenance systems, each of 3-4 microliters total volume, were set up in Terasaki plates. Three British species of greatly differing susceptibilities to Onchocerca lienalis (Simulium ornatum, S. equinum and S. vernum) were compared in their effect on O. lienalis. Three forms of the S. damnosum complex from Liberia (S. yahense and 2 geographical variants of S. soubrense) were similarly compared in their effects on O. volvulus microfilariae. The more refractory species in both sets of experiments were found to significantly reduce the in vitro motility of the microfilariae more than the susceptible species. It is proposed that this innate variation in in vitro attenuation, may be caused be humoral haemolymph proteins. Such an assay, perhaps in a modified form could be used in predicting vector susceptibility. It could also be used to analyse mechanisms responsible for variation in susceptibility, of different S. damnosum complex members, to the geographical forms of O. volvulus.

Africa, Western↗
PubMed1988

Cell-mediated immune responses in human infection with Onchocerca volvulus.

Mechanisms involved in modulation of the immune response in persons with chronic Onchocerca volvulus infection are poorly understood. In this study in vitro reactivity of PBMC to O. volvulus antigen (Ovag), streptolysin O (SL-O) and the mitogen PHA was tested in 62 infected individuals (INF), 17 persons living in the endemic area with exposure to the infection, but with no detectable infection (END), and 7 healthy controls (CTRL) in Liberia, West Africa. Mean blastogenic responses to Ovag were minimal and did not differ between the groups. There was, however, heterogenous reactivity to Ovag in the INF and END. For example, individuals with a history of therapy, and half of those less than 17 yr old who were tested, showed high responses. No significant differences in the response to SL-O or PHA were detected between the groups. IL-2 production in response to Ovag was minimal in the majority of infected subjects. Exogenous IL-2 was found to cause a significant increase in mean responses to Ovag and SL-O in INF and END only. Similarly, Ovag did not stimulate IL-1 production in most INF, whereas stimulation with LPS led to significantly greater production of IL-1. Depletion of plastic and nylon wool adherent cells did not increase responses to parasite-related antigen in INF, END or CTRL; however, responses to SL-O were augmented in INF, an effect that was also observed in CTRL. Finally, depletion of CD8 or CD16 cells in INF by C lysis did not increase blastogenic responses. These results indicate that cell-mediated immunity to parasite-related Ag as reflected in lymphocyte responses in vitro is diminished in infected individuals, and that this may be caused by defects in T cell activation.

Animals↗
PubMedDate not supplied

Application in clinical epidemiology of new advances in immunology and molecular biology of malaria.

The first purpose was to study the sensitivity of a spot hybridization assay for P. falciparum with a DNA probe. This assay was compared with light microscopy for the detection of low-grade parasitemia. The second purpose was to study in clinically immune individuals the seroreactivity, against a newly identified P. falciparum antigen, deposited in the erythrocyte membrane during merozoite invasion (Perlmann et al., 1984). This antigen is considered to be a potential component in a future vaccine against the blood stage of the parasite. In a holoendemic village in Yekepa area, Northern Liberia, 28 adult men with a high degree of protective immunity against malaria, were shown to have repeatedly low-grade parasitemias of varying density. The spot hybridization assay with the DNA probe was highly sensitive in detecting parasitic infection. The sensitivity was comparable to that of the examination of a blood film for about 15 min by an experienced microscopist. The seroreactivity against Pf 155 antigen varied between a high positive titer to negativity in different subjects, but the reactivity was constant over a period of 15 months for each subject despite numerous new infections and comparable protective immunity against malaria infection.

Adult↗