Prise en charge des accidents vasculaires cérébraux au Sénégal

OBJECTIVES

Because of its acuteness and rapid progress to irreversible injury, stroke is a dramatically high priority medical emergency. The purpose of this prospective study was to ascertain the average time limit for primary management of stroke victims referred to the Senegalese national medical center considered as the final link within the country's healthcare organisation.

PATIENTS AND METHODS

We reviewed the files of 170 patients aged 25-90 (average 61+/-13 years). The sex ratio was 0.68. Seventy percent of the patients resided in the nation's capital, Dakar.

RESULTS

Most of the patients were referred to a medical center late. Admission was before the 6th hour for only one patient and none of the patients were admitted before the 3rd hour. Late treatment was related to the remoteness of medical centers. Among patients residing in Dakar, the first visit occurred between 6 and 24 hours for 30p.cent versus 7.8 p.cent for patients residing in rural areas of the country. Educational level and socio-economic status had no effect on late treatment. None of the patients were given prehospital care. Treatment was essentially symptomatic in patients with hemorrhagic stroke. Anticoagulants or anti-platelet agents were prescribed for patients with ischemic stroke. Only 29.4 p.cent of patients were given rehabilitation care. Mortality was 50.6 p.cent and the rate of dependency 41.7 p.cent.

CONCLUSION

In Senegal, stroke victims receive care too late. This situation arises because of insufficiency of human and material resources and inaccessibility to care centers.

Autosomal-recessive forms of demyelinating Charcot-Marie-Tooth disease

Autosomal-recessive forms of Charcot-Marie-Tooth (ARCMT) account for less than 10% of the families in the European CMT population but are more frequent in the Mediterranean basin and the Middle East because of more widespread consanguinity. Until now, demyelinating ARCMT was more extensively studied at the genetic level than the axonal form. Since 1999, the number of localized or identified genes responsible for demyelinating ARCMT has greatly increased. Eight genes, EGR2, GDAP1, KIAA1985, MTMR2, MTMR13, NDRG1, PRX, and CTDP1, have been identified and two new loci mapped to chromosomes 10q23 and 12p11-q13. In this review, we will focus on the particular clinical and/or neuropathological features of the phenotype caused by mutations in each of these genes, which might guide molecular diagnosis.

Pronostic fonctionnel des accidents vasculaires cérébraux dans les pays en voie de développement : Sénégal

OBJECTIVE

To evaluate the functional outcome in patients followed in the department of neurology of Dakar for stroke.

MATERIALS AND METHOD

Prospective longitudinal observational study from August 2003 to May 2005 included inpatients or outpatients with stroke one month or less from entry confirmed by computed tomography scan. Patients were followed monthly for 12 months. At each visit, data on functional autonomy measured by the Barthel index and the treatments received were collected.

RESULTS

One hundred and seventy patients aged 25 to 90 years (mean 61+/-13 years) were evaluated. The sex ratio was 0.68. A total of 64.7% of strokes involved ischemic cerebral vascular accidents and 35.3% hemorrhagic vascular accidents. Right hemiplegia was present in 55.9%, left hemiplegia in 42.9% and bilateral paresis in 1.2% of patients. A total of 28.8% of patients died between d0 and d30, 50.6% within one year. At entry, the Barthel score was greater than 60 in only 4.7% of patients. After one-year follow-up, 58.3% of the patients had a Barthel score greater than 60, 19.1% had a score between 20 and 40 and 22.6% a score between 40 and 60. Only 53.5% received rehabilitation care. The parameters significantly associated with a functional recovery were age less than 55 years (P<0.05), hemorrhagic vascular accident as opposed to ischemic vascular accident (P<0.05), and earlier rehabilitation care under qualified personnel (P<0.01).

DISCUSSION

Our study shows an important rate of mortality during the first year following stroke and the rather young age of our population. The parameters associated with a better functional recovery are comparable to most of the data in the literature. The results of our study suggest that it is possible to improve functional prognosis after stroke by setting measures of prevention of the risk factors and rehabilitation in the early management of hemiplegia.

[Prognosis of stroke in department of neurology of Dakar]

INTRODUCTION

The general objective of this study was to determine the morbid-mortality of stroke followed in the Department of neurology of Dakar.

MATERIALS AND METHODS

This prospective and longitudinal studywas carried out from August 2003 at May 2005 and concerned 170 patients hospitalized or seen in external consultation for cerebral vascular accident confirmed by the cerebral tomodensitometry. All the patients were subjected to a protocol allowing determining the sociodemographic data, the therapeutic itinerary, the nature and the mechanism of stroke. The follow-up was monthly for 12 months.

RESULTS

The patients were old 25 to 90 years. The mean age was 61 +/- 13 years. The sex-ratio is 0.68. The ischemic cerebral vascular accidents represented 64.7% against 35.3% for the hemorrhagic vascular accidents. In 71.7 the AVCH was related to arterial hypertension. For the AVCI, a cardiopathy emboligene was objectified in 16.36% of the cases. The HTA constituted the principal factor of risk and was observed in 63.53% of the cases. The mortality rate was 28.8% (between j0 and j30) and 50.6% at one year. The age constitutes a factor of bad prognosis. For the sex the statistical analysis shows a no significant difference (p = 0.703). The repetition of stroke constitutes a factor of bad prognosis. 52.4% of the patients having an antecedent of stroke had died precociously. Mortality was higher in the AVCH with p = 0.043. The existence of disorders of conscience of start constituted a factor of bad vital prognosis. Among the 84 survivors after one year of follow-up, 49 had found their functional autonomy and 35 kept after-effects.

CONCLUSION

Stroke is responsible for a strong mortality. The advanced age, the repetition of cerebral vascular accident, the hemorrhagic nature of the cerebral vascular accident constitutes factors of bad vital prognosis.

[Evaluation of the cost of stroke management in Dakar, Senegal]

The purpose of this one-year cross-sectional study conducted in 1997 was to estimate the direct cost of stroke management in the Neurology Department of Fann University Hospital in Dakar, Senegal. Data were collected about the type of care services required and related spending. Cost analysis was made in CFA Francs (CFAF), the Senegalese currency (1 USD = 500 CFAF in 1997). A total of 1260 patients were hospitalized in the department including 383 for stroke (30.4%). Mean age was 60.8 +/- 14.2 years and men accounted for 49.2% of the population. The mortality rate was 46.2% among hospitalized patients. A total of 33,573 medical acts were carried out including 12,052 (35.9%) for stroke management. The direct cost of stroke management was 32,614,442 CFAF with a mean cost of 78,426 CFAF per patient. The cost was 18,839 CFAF in the patient care unit (57.8%) and 4,954,635 CFAF in the neuroradiology unit (15.2%). The cost of health care personnel was 19,373,172 CFAF (59.4%) and the cost for drugs and other medical products was 8,253,246 CFAF. Health education programs aimed at increasing awareness of risk factors are needed to reduce the cost of stroke management in this difficult economic period.

[Peripheral neuropathies and antiretroviral drugs. Preliminary results]

INTRODUCTION

In order to appreciate the antiretroviral drugs impact in the HIV positive patients with peripheral neuropathy, a clinical, electrophysiological and neurpathological study of nerve biopsies was performed.

PATIENTS AND METHODS

A group of 8 HIV seropositive patients with peripheral neuropathy was compared with an other group of 10 HIV seropositive patients treated with multiple antiretroviral drugs. Electrophysiological examination with motor nerve conduction velocity (MNCV) mesure of the median and the sciatic popliteal nerve was followed by nerve biopsy. Nerve fragments carried out the neuropathological technics for morphological examination.

RESULTS

Eighteen seropositive HIV patients (16 HIV-1 and 2 HIV-2) were included in this study. Six patients among them had motor and sensitive neuropathy of the four limbs and 2 patients had sensitive neuropathy associated with pyramidal signs. In fine, 1 patient had sensitive neuropathy with distal amyotrophy of the four limbs. Slow MNCV was observed in all the patients and more severe in the lower limbs. Nerve were unexciting in the lower limbs in 2 patients. Nerve biopsy showed severe axonal loss in all the patients treated but one. They associated axonal lesion in 5 cases and myelinated lesions in 2 cases. Two patients non treated had normal nerve biopsy. Axonal loss was mild in 2 cases and very severe in one case associated with non inflammatory demyelinated lesions.

CONCLUSION

we observed more severe and more frequent nerve lesions in treated patients than in no treated patients, as at the clinical, electrophysiological and neuropathological examination. Antiretroviral drugs cause more frequently pain motor and sensitive neuropathies at usual posologies. The occurence of recrudescence of pain peripheral neuropathy under antiretroviral treatment allows to reconsider drugs posologies.

[Diabetic neuropathies in Neurological Clinic of Dakar]

INTRODUCTION

Common diabetic mellitus complication, neuropathies present various clinical forms. OBJECTIVE to evaluate the hospital frequency and clinical features of diabetic neuropathies.

PATIENTS AND METHOD

It is a retrospective study concerning peripheral neuropathies observed in "clinique neurologique" of Dakar between January 1991 and December 2001 in diabetic patients treated for a long time. Inclusion criterion are distal and/or proximal sensitive and/or motor neuropathies with abolition or reduction of patellar reflex. Are excluded neuropathies of others aetiologies. Electrophysiological examination with motor conduction velocity measure is performed in about half of them . One neuro-muscular biopsy was performed using current neuropathological examination including teased fiber technic.

RESULTS

17 cases of peripheral neuropathy are observed on 10,000 documents (0.17%). They were 11 males and 6 females, aged from 27 to 77 years (means 56.41). Among them, 10 cases of distal motor sensitive neuropathy are identified; 2 cases of sensitive neuropathy, 3 cases of pure motor neuropathy and 2 cases of multiple mononeuritis neuropathy with dysautonomic disorders of sphincter and genital type in one of them. Glucose serum level was between 1.25 to 4.25 g/l . Diabetes was 18 months to 20 years of duration at the moment of admission . Normal serum level glucose was rapidly obtained with insulin treatment. The evolution was favourable in 82.9% of cases under anti-diabetic treatment, vitamin B and kinesitherapy.

CONCLUSION

diabetes mellitus neuropathies are rare in "Clinique n eurologique" of Dakar where diverse clinical forms are observed. Favourable outcome in most of cases occurred when serum glucose equilibration is rapidly obtained.

[Epidemiological and clinical aspects of amyotrophic lateral sclerosis in neurological clinic of Dakar]

In Africa, little data has been published in Amyotrophic lateral sclerosis (ALS). We conducted a retrospective survey among the in-patients from December 1993 to March 2000 in the Department of Neurology of the University Hospital. This study reported epidemiological and clinical data of ALS. ALS has been diagnosed by El Escorial criteria. 33 patients were 16 to 77 years old. Parental consanguinity was found in 15.2%. On the basis of diagnosis criteria, ALS in our patients were established in 57.6% of cases, probable in 30.3% of cases, possible in 9.12% and suspected in 3% of cases. Evolution after hospitalisation is unknown for the majority of patients. Only one patient died after 12 months of evolution.

[Composite-bonded bridges reinforced with Ribbond THM ribbon: an alternative of choice to other temporary prosthetic methods]

In the presence of anterior unitary tooth loss, the therapeutical arsenal of the practitioner remains the implant solution. But, at the young patients who have not completed their growth, it's necessary to pass by a transitional stage. The bonded bridges reinforced by a polyethylene fibbers splint such as Ribbond THM constitute an alternative of choice to solve the aesthetic damage in the short and medium term while waiting for the prosthesis with implant. It's a similar case that is reported through this article.

[Pilot prospective study of prosthesis needs at the prosthesis service of the CCTOS of Abidjan]

Studies on the dental health in Ivory Coast showed that the specific needs in prosthesis are numerous. Are there covered? What are the rates of the prosthetic consumption? It is to this question that the authors of the present work wanted brought a beginning of answer through a pilot prospective survey on the prosthetic demand to the service of prosthesis of the CCTOS of Abidjan. This survey was about 150 patients of all sex and all age come specifically for prosthetic rehabilitation, during the active period of February to April 1994. It takes out again of this survey this following results: from a general epidemiological point of view, the women are more numerous than the men, with an access frequency of 56%. Most topics are young, with an age between 20 and 30 years. The "social" rates that convenient the CCTOS attract the patients whose economic income is little important gladly or that are deprived of a health insurance. The prosthetic antecedents show that more than 65% of the topics never carried mainly a prosthesis for lack information or for lace money. Among the topics that already underwent a prosthetic treatment, prosthesis associate partial resin is the more frequently recovered in spite of an interesting rate of fixed prosthesis (37% of carriers). The clinical data reveal that aesthetic remains the main motive of the consultation, with 58% of demands and the prosthesis associate resin is in more of 70% of the cases the chosen therapeutic option.

[Predominant occlusal function during lateral mandibular movements in the black African patient]

The research of the predominant occlusal function during mandibular movements of laterality at the topic African melanoderme, drove authors of this survey to: select 52 healthy topics (11 women and 41 men), aged of 22 to 33 years old observe and note at every topic the presence and the nature of contacts or their possible absence of the working side during the movement of deduction. Observations done as well directly in mouth, that on models put in semi-adaptable articulators, permitted to note that the function of posterior group is more the recovered so much at women that at men, at the young adults and at adults.

[Aflatoxins in food: tests of decontamination of peanut cakes by ionizing treatment]

The efficacy of ionising treatment for decontaminating peanut cakes was tested. The influence of cakes water content and the effect of ionisation dose rate were studied. The results obtained after a reverse phase liquid chromatographic determination of B1, B2, G1 and G2 aflatoxins have revealed an important contamination of the peanut cakes (up to 1000 ppb of total aflatoxin's contents). After ionising treatment at 25 kGy, the aflatoxins degradation in peanut cake's was less important in dried samples (about 5-10% at 0.55 water activity: aw) than in the humid ones (40-60% degradation at 0.95 water activity). At this dose, any indicative difference of the degradation rate of aflatoxins, with regard to the ionising process was observed. The efficacy of ionising treatment for decontaminating peanut cakes could probably be improved, however the economic interest of such process as alternative of the treatment with ammonia is questionable.

[Pesticide bioaccumulation: measurement and levels of organochlorine residues in products of vegetable origin]

Because of their lipophilic properties and their persistence, organochlorine pesticides residues can be accumulated in human body by consuming regularly plants products. This study consisted of the monitoring of the contamination level of pesticides residues from various plants products, in order to assess the long- term intoxication risk to which Senegalese consumer is exposed ant identify throughout these plants some indicators of atmospheric pollution. The chromatographic analysis of medicinal plants, fruits and vegetables extracts showed that they could be contaminated by organochlorine residues. About ten of these pesticides residues were found confirming that the analysed plants were really contaminated. The residues level in medicinal plants (from 0.1 to 45 micrograms/kg) were widely below the maximum allowed concentrations and were also lower than those in fruits and vegetables (from 0.1 microgram/kg to 460 micrograms/kg). Heptachlorine residues contents of tomatoes and citrus fruits were higher than FAO/WHO norms, so that, a regular monitoring of the plants products is recommended for better protection of consumers.

[Cerebral palsy in Dakar]

The objective of the study was to describe risks factors of cerebral palsy and to determine clinical forms. From November 1998 to July 2000,we conducted a prospective study to select outpatients showing cerebral palsy symptoms: so 93 children with age between 5 months and 11 years old entered on this study. For 44.08% cerebral palsy was related on pregnancy abnormalities, 32.26% have central nervous system infection and 8.6% have convulsions unknown cause . The cause of cerebral palsy was untraceable in 13.98% of the cases. 82.8% of the children have cerebral palsy associated with other handicaps. The commonest type of cerebral palsy was spastic forms (74.2%) followed by hypotonic cerebral palsy (16.13%), dystoniaathetosis and ataxic forms in 5.37% and 4.3% of the cases respectively. The overall prevalence of epilepsy was 46.23%. The other handicaps were neurosensoriel abnormalities (visual impairment, deafness), speech disorders and behavioural problems. Computerised tomography (CT), performed in 45 cases showed cortical/subcortical atrophy as the commonest brain lesions. The electroencephalographic abnormalities were identified frequently.

[Charcot-Marie-Tooth disease associated with a pyramidal syndrome: clinical, electrophysiological, and neuropathological study of neuro-muscular biopsies in 14 cases]

A rare clinical form of Charcot-Marie-Tooth (CMT) disease, estimated at less than 5% by a good many authors, it remains unknown at the neuropathological and genetic level. The prevalance of this form in our areas estimated at 16% allows to discuss its clinical, electrophysiological and neuropathological particularities. To define clinical electrophysiological and neuropathological criteria of neuromuscular biopsies of CMT associated with a pyramidal syndrome. forteen patients presenting a CMT disease associated with a pyramidal sign, sometimes sensory troubles pes cavus and ear and at times eye trouble, an electrophysiological exploration allowed to measure the motor conduction velocity (MCV) of the median nerve and the external popliteal sciatic. A neuromuscular biopsy on the peroneal nerve was performed in all patients with their free consent or that of their parents or relatives when necessary. Semi-thin cuttings coloured with toluidine hue were examined under photonic microscope with x10, x40, and x100 enlargements and the study of the dissociated nervous fibres (teasing) was curried out. The 14 patients aged 8 to 37 years (average 23+/-0.5). 7 females and 7 males clinically presented a CMT disease with a pyramidal syndrome Sensory troubles existed in 8 cases, a lesion of the cranial nerve was observed in 8 cases (II and VII) parental consanguinity existed also in 9 cases. The MCV of the median nerve were more > 40 m/sec in 8 cases whereas in 2 cases they were < 40) m/sec. All muscles showed an atrophy of neurogenous type. In 4 cases the nerves were histologically normal on semi-thin cuttings and <<teasing>>. There were axonal degeneration lesions in 2 cases only and demyelinating lesions in 6 cases. No onion bulb lesion as observed nor images of regeneration (cluster). The CMT disease associated with a pyramidal syndrome is a clinical entity which constitutes a heterogenous group at the clinical, electrophysiological and anatomo-pathological and probably genetic level. A dominant autosomal transmission and some recessive forms were isolated but the chromosomic anomaly involved remains to be defined.

[The reliability of class A alginate impressions]

The class A alginates present very good properties of dimensional precision and reproduction of details, comparable to those of the reversible hydrocolloïdes and certain elastomeres used for the realization of secondary prints of precision in fixed prosthesis and in removable prosthesis. Besides, their application is easier and they are costless. The valorization of these print materials could certainly contribute to reduce the cost of comes back of prostheses in countries under developed where the weak power economic populations constitute a brake to the access to cares of health. To exploit qualities of these print biomaterials well, it agrees to manage correctly the parameters of their application. To this effect, the present survey puts in evidence that the maximum delay of stream that guarantees the good dimensional stability of these class A alginates is of 45 minutes in the hot and humid climatic tropical country conditions.

[Localized benign pleural mesothelioma observed at the Dakar University Hospital]

We report two cases of localized benign pleural mesothelioma with different clinical features. Neuropsychiatric symptoms, including coma, hemiplegia, seizures and misbehavior predominated in the first case, associated with hypoglycemia. The symptoms in the second case were essentially respiratory (cough, dyspnea, and chest pain). Treatment consisted in thoracotomy and complete surgical resection. Histopathology revealed fusiform cells and collagen stroma. These two cases illustrate the diversity of clinical expression of benign localized pleural mesothelioma and confirm their complete resolution after surgical treatment.

Ten years of research activities on tropical parasitology of dromedaries, cattle, and small ruminants in Mauritania

In the past, the essential part of the activity of the parasitology laboratory of the Centre National d'Elevage et de Recherches Vétérinaires (CNERV) was represented by diagnostic work that enabled the construction of an inventory of local parasitic fauna and a good collection of specimens. However, the small and irregular number of samples each year, led us to switch our activities in 1990 toward work that could better justify the existence of CNERV. We started work on applied research topics, such as tick-borne diseases, helminthology (nemathelminths and plathelminths), and trypanosomosis. These results were valorized through scientific publication and communication at international meetings. The most valuable information was conveyed to herders.

[Contamination by aflatoxins of local peanut oils prepared in Senegal]

Aflatoxins are mycotoxins produced by certain strains of fungus (Aspergillus) which develop in peanut seeds. Peanut oil and peanut meal are widely used in Senegal. The risk of intoxication is quite real. We determined aflatoxin contamination levels in peanut oil and food prepared by small scale production plants in the Kaolack and Diourbel regions of Senegal. High performance liquid chromatography (HPLC) of the different samples showed that 80% of them were contaminated. Aflatoxin B(1), B(2), G(1) and G(2) were detected. The pattern of contamination was similar for the two regions. Aflatoxin B(1) was prevalent and found in over 85% of the samples. The mean content of this mycotoxin (the most dangerous toxin) was about 40 ppb, a value which largely exceeds specifications for allowable levels.

Serological HLA class I alleles in Senegalese blood donors detected HBs Ag positive

We analysed the HLA class I alleles in 96 blood donors HBs Ag positive compared with 93 healthy control individuals (HBs negative). The most frequent HLA-A, -B, -C alleles found were, A23 (33.6%); A2 (25%); A30 (25%); B8 (31.5%); B7 (16.3%); B58 (11.9%); B35 (11.9%); B49 (11.9%); B53 (10.8%); Cw7 (39.1%); Cw3 (36.9%); Cw4 (36.9%). Significant differences (P<0.001) were found between the blood donors and the controls for the following HLA alleles, A1; A23; B8 and Cw3. The detection of HBe antigen was positive in 26/84 blood donors. It was observed a significant difference (P<0.01; odds ratios (OR)=6.25) between positive and negative HBe antigens blood donors for HLA-A1 allele.

[Prognostic value of cytokines and HLA markers in patients with cerebral malaria in Senegal]

41 patients senegalese patients suffering from clinically defined severe malaria were studied in the intensive medical care unit of the Hôpital Principal in Dakar, Senegal. All of these individuals lived in Dakar, an area of low and seasonal Plasmodium falciparum transmission. In this study, we aim to determine in one hand, the cytokine levels of TNF-alpha, TNF-alpha sRI, TNF-alpha sRII, IL-2 sR, IL-6, IL-6 sR, and IL-10 to evaluate their prognostic value in the course of the disease; in the other hand, the influence of the HLA-DR alleles in the susceptibility to get severe malaria. At the day of admission (day 0) and 3 days later, one or two blood samples were collected for each patient to assess different biological parameters. Plasma samples were tested for cytokines cited above by ELISA (Medegenix EASIA kits) and DNA samples for HLA-DR by PCR-SSP genotyping. The concentrations of all the cytokines and/or their receptors were significantly increased at day 0 in the patients who died (TNF-alpha = 455 +/- 480 pg/ml, IL6 = 511 +/- 396 pg/ml) and decreased rapidly in the patients who survived from the disease (TNF-alpha = 354 +/- 629 pg/ml, IL6 = 453 +/- 706 pg/ml). A fatal issue seems likely related to the age of patients (20 +/- 12 years for surviving patients and 31 +/- 16 years for patients who died) and the kinetic of the cytokines. Significant differences were observed (pc < 0.001) between patients with severe malaria and a control group for the following HLA alleles: DR3, DR10 and DR13. The HLA-DR13 allele was found positively and highly associated with severe malaria.

[HLA-DQ allele typing in a Senegalese population: comparative study of serology and PCR-SSP]

In this study, we compared the serological standard typing method and the DNA genotyping PCR-SSP for the characterization of HLA-DQ alleles in a senegalese population. For this purpose, 120 individuals leaving in Dielmo were typed using the microlymphocytotoxicity assay and the PCR-SSP DQ low Resolution method. A discordance of 42.5% (51/120) was found between these two methods. Thirty % (36/120) of serological typed persons failed to be typed by PCR-SSP method whereas 1% (1/120) assigned by PCR-SSP failed to be characterized by serology. Advantages and limits of these two typing methods and also the genetic background of our study population were valid arguments to comment our findings. The PCR-SSP, as suggested by several authors, is reliable, accurate and fast for HLA class II alleles characterization. Nevertheless, it needs, to become an alternative HLA typing method, available primers adapted to genetic background of study population.

Cooperia pectinata and C. punctata, parasites of the abomasum of cattle in northern Cameroon (Central Africa)

Cooperia pectinata Ransom, 1907 and C. punctata von Linstow, 1907 are common trichostrongyles of zebu cattle in Africa. Their intestinal localization within the digestive tract is considered by many authors to be exclusive. Nevertheless, some limited surveys in Malagasy, Mauritania, The Gambia and Cameroon reported the presence of both Cooperia species in the abomasum. The present survey was carried out in a slaughterhouse of northern Cameroon on 17 zebu cattle and confirms the infection of the small intestine and the abomasum by the two species within the total number of cattle examined. Abomasal infections especially with Cooperia punctata were heavier than those in the intestine. Due to the movements of herdbreeders in Central Africa, and to the preliminary results obtained in Mauritania, The Gambia, Burkina Faso and Malagasy, abomasal localization of C. pectinata and C. punctata may be encountered in very large areas of Africa, and that cooperiosis may contribute together with Haemonchus species to the digestive disorders involving the abomasum.