[Postpartum family planning at the district hospital of the commune II of Bamako, Mali]

Postpartum family planning is the prevention of pregnancy during the 12 months following childbirth.

OBJECTIVE

To study the use of contraceptive methods in the postpartum period in the obstetrics gynecology department of the district hospital of the commune II of Bamako.

MATERIALS AND METHODS

We conducted a descriptive and analytical cross-sectional study with prospective data collection from January 1, 2019 to December 31, 2020. All women who had given birth who had chosen and benefited from a contraceptive method were included. The statistical test used was Fisher's test with a significance level set at 5%.

RESULTS

In 2 years, the contraceptive prevalence in the postpartum was 26.1%. More than 2/3 of counseling (61%) was done during prenatal consultations, 8% during the latency phase, 26% in the immediate postpartum and 5% during the postnatal visit. The most chosen methods were implants (47.1%), intrauterine device (29.6%), miro-progestin pills (12.5%), injectable progestogens (8%) and condoms (3.2%).

CONCLUSION

Postpartum family planning contributes to increasing contraceptive prevalence.

[Knowledge, attitudes and practices of Bamako media Men' on family planning]

INTRODUCTION

Contraceptive prevalence is low in Mali. The information provided by the media men can help to increase or decrease the use of contraceptive methods.

OBJECTIVE

To study the knowledge, attitudes and practices of Bamako media Men on family planning.

MATERIAL AND METHODS

We carried out a descriptive cross-sectional study with prospective data collection from June 1 to August 30, 2019. It concerned journalists and presenters of 15 radio and 6 televisions in Bamako.

RESULTS

During the 3 months, 615 media Men agreed to participate in this study. These are men and women from 36 to 45 years old in 37.2% of cases, married in 81.3% of cases. The radio with 85.5% was their main source of information on family planning. They all knew at least one contraceptive method. The best-known methods were pills (94.3%), injectables (57%) and implants (49.1%). They were in favor of the practice of family planning in 77.2% of cases, 76.9% had already used a method and 56.7% had already hosted a program on family planning.

CONCLUSION

Media men are essential in the transmission of information. The quality of the information provided by these Media men can be influenced by their personal perceptions and attitudes. Their better involvement in the promotion of family planning can help to increase contraceptive prevalence.

Effect of three types of oils and their level of incorporation on sensory quality of sorghum cookies

Lipid (oil and fat) is one of the basic and important components used in the production of cookies. It plays several roles in their composition and a judicious choice of this ingredient makes it possible to have cheap, delicious and very nutritious cookies. This study aimed to evaluate the effect of refined cottonseeds oil (RCO), refined palm oil (RPO) and red (or crude) palm oil (CPO) on sorghum (Sorghum bicolour var. Gampela) cookies. Oils were incorporated at levels of 16%, 20% and 24%. Cookies quality were evaluated based on quantitative sensory profile, sensory acceptability, preference classification and paired-comparison test. The results of sensory profile tests showed that the sensory descriptors ranged from very low to medium intensity (1.33 to 3.83 on a scale of 5). Both acceptability and classification tests showed that cookies produced with 20% of refined oil (RCO and RPO) and those with 16% of CPO were the most preferred and RCO and RPO with 20% of the oil were appreciated as control cookies produced with 20% of margarine. The colour, texture and fat impression had most influenced the consumers’ preferences. RCO, RPO and CPO exhibit the potential to be used as substitutes to margarine to produce sorghum cookies.

[Epidemiology and prognosis of eclampsia in Bougouni]

OBJECTIVES

The objectives were to describe the epidemiological and prognostic aspects of eclampsia in the Bougouni reference health center.

METHODS

This was a transversal prospective, descriptive study from January 1 to December 31, 2015 in the gynecology-obstetrics department of Bougouni reference health center. Were included, all pregnant or postpartum women diagnosed with eclampsia during the study period.

RESULTS

The frequency of eclampsia was 2.54%. They were adolescent girls in 50% of cases, primigest in 62.5% of cases, unschooled in 67.5% of cases, having not performed any antenatal care in 70% of cases. Eclampsia occurred in antepartum in 37.5% of cases, in 5% in perpartum and in 57.5% in postpartum. Therapeutically, nicardipine with 72.5% and nifedipine with 22.5% were the antihypertensive drugs used. As for anticonvulsants, magnesium sulfate (MgSO4) was used in 92.5% and diazepam in 7.5%. The maternal-fetal prognosis was marked by 2.5% of maternal death, 27% of prematurity and 27.5% of fetal death in utero.

CONCLUSION

Eclampsia is a dreadful pathology with serious maternal and fetal complications.

[Spontaneous triple pregnancy on bicicatricial uterus in the referral health center of commune II of Bamako, Mali]

The trimellar pregnancy on bicicatricial uterus is a rare situation. It can be associated with many maternal-fetal complications. Given these risks, some teams opt for an embryonic reduction. We report a case of spontaneous trimellar pregnancy on bicicatricial uterus. This was a 38 year-old patient, third pregnancy, second birth, 2 alive with a history of 2 caesareans. The evolution of the pregnancy was marked by a urinary tract infection at 34 weeks of gestation. The caesarean section performed at 36 weeks of gestation allowed the birth of 3 newborns, 2 of which were females in 2000 and 1900 grams, and one male weighing 2400 grams. The postpartum was marked by a rapidly resolved eclampsia crisis.

[Materno-Fetal Prognosis Of Anemia In Bougouni]

GOAL

The goal was to assess the maternal-fetal prognosis of anemia in pregnant women in the Bougouni reference health center.

METHODS

We carried out a prospective descriptive and analytical cross-sectional study from January 1 to December 31, 2013 at the Bougouni reference health center. It covered all pregnant women with a hemoglobin level below 11g/dl regardless of the outcome of the pregnancy.

RESULTS

The prevalence of anemia in pregnant women was 33.2%. They were women married to peasants in 88.6% of cases, unschooled in 93.2% of cases, having not done antenal care in 56.8% of cases. Malaria was the most common etiology in 75% of cases. Anemia was severe in 61.4% of cases. The maternal-fetal prognosis was dominated by 3.3% of maternal death, 12.5% of abortion, 7.6% of prematurity and 6.8% of fetal death in utero.

CONCLUSION

Anemia in pregnant women is the source of many maternal-fetal complications.

[Pregnancy And Delivery In The Large Multiparous In The Reference Health Center Of Commune II Of Bamako, Mali]

AIM

The aim was to compare the maternal-fetal prognosis of pregnancies in large multiparous with that of other parities.

MATERIALS AND METHODS

We conducted a case-control study from March 1st, 2014 to February 1st, 2015. It concerned all parturients admitted in our service during the study period. We have chosen 1 case for 2 witnesses. All the large multiparous were included as cases and as witnesses the primiparous, the pauciparous and the multiparous who gave birth just before and after the case. The statistical test was the Chi2 with a significance level at 5%.

RESULTS

The frequency of pregnancy in the large multiparous was 4.93%. They were housewives in 84% of cases, unschooled in 74.7% of cases. The maternal-fetal outcome was dominated by uterine rupture in 0.6% of cases, immediate postpartum hemorrhage in 9.8% of cases, vicious presentations in 5.5% of cases and cord prolapse in 6.8% of cases.

CONCLUSION

Large multiparity is common in our practice. It is a high-risk pregnancy because of its many maternal-fetal complications.

[Infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré]

OBJECTIF

the purpose of this work was to study the infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré (CHU G. Touré).

PATIENTS AND METHODS

This was an epidemiological, descriptive, and analytical study carried out in the gynecology-obstetrics department of G. Touré University Hospital, from April 11, 2016 to August 29, 2016 (4 monthset 18 days), with a prospective collection of data that focused on the characteristics clinical and laboratory-based care-associated infections in patients during their hospitalization. Included in the study were all hospitalized patients (operated or not) in the gynecology obstetrics department, who agreed to participate in the study. The criteria used to diagnose the infection associated with care were those of the CDC Atlanta and making a thick drop in our context. Operative wound monitoring was performed until the 30th postoperative day.

RESULTS

We recorded 200 patients, including 138 operated and 62 nonoperated patients, of which 30 patients developed a care-associated infection at a rate of 15%. The mean age of the patients who presented an infection was 32.52 years ± 13.36 years against 29.36 years ± 10.28 years for the patients who did not present the infection. Seven point five percent of the evacuees had an infection associated with care. The most common types of infections were surgical site infection with 56.60% followed by malaria with 23.30% and urinary tract infection with 20.00%. Escherichia coli and Acinetobacter baumaniiwere the most recovered germs. Isolated organisms were 100% resistant to Amoxicillin, 88.88% were resistant to Ciprofloxacin and 77.77% were resistant to Amoxicillin + Clavulanic acid. The average duration of hospitalization for patients who developed the infection was 14.70 days with extremes of 5 and 46 days. The mortality rate was 1.50%. The average cost of management of patients who developed the infection was 119837 FCFA; the extremes were 17750 and 825750 FCFA and the standard deviation of 174998 CFA francs.

CONCLUSION

the infections associated with the care remain frequent in our service and dominated by the infections of the operating site. The isolated organisms were all 100% resistant to Amoxicillin in 88.88% Ciprofloxacin.

[Pregnancy and delivery for women aged 40 years and over at the reference health center of commune II of Bamako district, Mali]

GOAL

The aim of this study was to compare the maternal-fetal prognosis of pregnancies at 40 years of age and above with that of pregnancies obtained before 40 years of age in the obstetric gynecology department of the reference health center of commune II of Bamako district.

MATERIALS AND METHODS

This was a prospective cohort study that was conducted at the maternity ward of Reference Health Center of Commune II of Bamako district from 1st January to 31 December 2012. Were included in our study as patients exposed, all the pregnant women of 40 years and over and as unexposed patients, pregnant women aged 20-39 who gave birth in our service. Teenage pregnancies were not included in this study. The statistical tests used were Pearson's Khi2 and Fisher's test with a significance level of 5%.

RESULTS

The frequency of pregnancy among women aged 40 and over was 1.68%. These were large multiparas unschooled patients in 60% of cases, with hypertension in 6.7% of cases. Pregnancy in her patients was associated with a high rate of caesarean section in 16.7% of cases, term overrun in 6.7% of cases, seat presentation in 6.7% of cases, macrosomia in 6.7% of cases and fetal malformation in 1.7% of cases.

CONCLUSION

Slight account of its many maternal-fetal complications, pregnancies in women 40 years and older deserve special attention.

[Caesarean at the Gabriel Touré University Hospital of Bamako: factors of morbi-mortality]

INTRODUCTION

Following the progress made regarding anesthesia reanimation, caesarean have become a much safer procedure. However, factors of mobi-mortality are still numerous. The main objective of this study was to analyze the factors of morbi-mortality arising during a caesarean.

PATIENT AND METHOD

A retrospective cross-sectional study was conducted from January 2007 to December 2011 in the gynecology-obstetric and anesthesia reanimation services of the Gabriel TOURE University Hospital. The analysis looked at the medical files of women undergoing a caesarean and hospitalized in the gynecology-obstetric and anesthesia reanimation services. Data analysis was carried out with SPSS.19 (Statistical Package for Social Sciences) and the Epiinfo.7 softwares. Chi² tests were performed to compare frequencies where a value of p≤0.05 was considered statistically significant.

RESULTS

269 medical files were analysed. Mean age was of 28.46 ± 6.702. The most frequent peroperative morbidity factors were cardiovascular. Death rate was of 5.2%. The most frequent cause of these deaths was eclampsia. Factors influencing morbi-mortalities were iterative caesareans and urgency of the caesarean. The evacuated mothers had presented complications in 37.3% of cases.

CONCLUSION

The caesarean is a procedure that is not sufficiently safe in our services and there are a lot of factors of mobi-mortality.

Effects of climatological parameters in modeling and forecasting seasonal influenza transmission in Abidjan, Cote d'Ivoire

Background

In temperate regions, influenza epidemics occur in the winter and correlate with certain climatological parameters. In African tropical regions, the effects of climatological parameters on influenza epidemics are not well defined. This study aims to identify and model the effects of climatological parameters on seasonal influenza activity in Abidjan, Cote d’Ivoire.

Methods

We studied the effects of weekly rainfall, humidity, and temperature on laboratory-confirmed influenza cases in Abidjan from 2007 to 2010. We used the Box-Jenkins method with the autoregressive integrated moving average (ARIMA) process to create models using data from 2007–2010 and to assess the predictive value of best model on data from 2011 to 2012.

Results

The weekly number of influenza cases showed significant cross-correlation with certain prior weeks for both rainfall, and relative humidity. The best fitting multivariate model (ARIMAX (2,0,0) _RF) included the number of influenza cases during 1-week and 2-weeks prior, and the rainfall during the current week and 5-weeks prior. The performance of this model showed an increase of >3 % for Akaike Information Criterion (AIC) and 2.5 % for Bayesian Information Criterion (BIC) compared to the reference univariate ARIMA (2,0,0). The prediction of the weekly number of influenza cases during 2011–2012 with the best fitting multivariate model (ARIMAX (2,0,0) _RF), showed that the observed values were within the 95 % confidence interval of the predicted values during 97 of 104 weeks.

Conclusion

Including rainfall increases the performances of fitted and predicted models. The timing of influenza in Abidjan can be partially explained by rainfall influence, in a setting with little change in temperature throughout the year. These findings can help clinicians to anticipate influenza cases during the rainy season by implementing preventive measures.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3503-1) contains supplementary material, which is available to authorized users.

[Problem of the referral-for-referral system of obstetrical emergencies and the community involvement in the Bamako district]

AIMS

This study aims to evaluate the difficulties of the referral-for-referral system in the V municipality sanitary district of Bamako.

PATIENTS AND METHOD

A descriptive cross-sectional study was carried out from 5th September to 5th November 2011 in the sanitary district of the V municipality in Bamako. Included in the study were patients referred or evacuated for obstetrical care in the health center during the period of study. Not included were the patients referred or evacuated from other sanitary districts and patients referred or evacuated or self-referred for no obstetrical reasons. Data was recorded on the Excel 8.0 software and analyzed on the software packages Epi info 3.5.3 and STATA.

RESULTS

During the period of study we recorded 1824 deliveries among which 180 fit the inclusion criteria. During our study 92.2% of references were adequate; 78.3% were justified and 72.2% were opportune. Only the sanitary district of the V Municipality had paid its quotation due at the time of the study.

CONCLUSION

Our study showed that inadequate logistics and the lack of involvement of communities hamper the proper functioning of the referral system.

[Hysterectomy: indications and advantages of the vaginal route in Mali]

The purpose of this report was to determine the frequency of hysterectomy and describe its indications and outcomes. A retrospective, descriptive study related to active hysterectomy of was conducted at the reference health centre of commune V in Bamako, Mali from January 1st, 2004 to December 31st, 2008. All hysterectomy patients with complete medical files were included. A total of 172 files were identified including 152 that were complete. Hysterectomy accounted for 1.38% of all interventions during the study period. The procedure was carried out in emergency in 0.14% and electively in 13.39%. Mean patient age was 47.9 +/- 11.7 years; 89 patients were older than 45 years. The indications for hysterectomy were complicated uterine fibroids in 82 patients, genital prolapse in 44, adenomyosis in 10, obstetrical hysterectomy in 13 and cervical dysplasia in 3. The abdominal route was used in 100 patients (65.8%) and the vaginal rout in 52 (34.2%). The duration of the procedure and hospital stay was longer after hysterectomy by the abdominal (p<0.05). Perioperative complications were observed in 17% of patients after abdominal hysterectomy versus 7.69% after vaginal hysterectomy. Two maternal deaths due to hemorrhagic shock were observed after obstetrical hysterectomy. Hysterectomy is a frequent intervention that is not without complication risks. Choice of route depends on the indication and skill of the operator. Although endoscopic surgery is still difficult to perform in developing countries, development of vaginal hysterectomy is necessary to reduce perioperative complications.

[Not Available]

INTRODUCTION : An estimated 300 to 500 million clinical cases of malaria occur each year worldwide, 90% in Africa, mostly among young children. In Cote d'Ivoire, malaria is 46.03% of disease states and 62.44% of hospital admissions. In children under 5 years, it is 42.67% of the reasons for consultation and 59.68% of hospital admissions. In pregnant women, it represents 22.91% of disease states and 36.07% of hospital admissions. In Africa, traditional medicine is the first resort for the vast majority of people, because of its accessibility both geographically, economically and culturally. However, some modern practitioners show an attitude of distrust of traditional medicine and its players, calling them irrational. This work had set out to assess knowledge, attitudes and practices of traditional healers in the uncomplicated and complicated in the context of collaboration between traditional and modern medicine for the optimal management of critical cases. MATERIALS AND METHOD : The study focused on traditional healers practicing in the city of Abidjan. The study was conducted using individual interviews over a period of 30 days. The interviews were conducted in local languages, with the assistance, if necessary, translators. For data collection, we used a questionnaire containing four items: the socio-demographic characteristics of traditional healers, their knowledge on malaria, diagnostic practices and traditional therapies. RESULTS : Of the 60 healers and included in the study, only six were women (10%), a sex-ratio of a woman to 9 men. 66.7% of respondents traditional healers are herbalists and 25% of naturopaths.Only 8.3% were spiritualists. The etiology of malaria most commonly cited by the traditional healers were mosquito bites (16.7%), food (1.7%), solar (1.7%) and fatigue (1.7%) . 25% of traditional healers are associated with mosquitoes, sun and fatigue. Symptomatology most cited were fever (100%), dark urine (86%), the yellow or pale conjunctiva (80%), vomiting (71.7%), nausea (58.3%) and abdominal pain (48.3%). Traditional healers recognized three types of malaria: the white shape, form yellow / red and the black form. Traditional healers malarious patients surveyed were receiving both first (58.3%) than second-line (41.7%). 78.3% of them practiced an interview and physical examination of theirpatients before the diagnosis. In 13.3% of cases they were divinatory consultation. Medications used to treat malaria were herbal in 95% of cases. The main sign of healing was the lack of fever (58.3%). 90%of traditional healers interviewed referring cases of malaria black (severe malaria). This reference is made to modern health facilities (90.2%). 68.3% of respondents practiced traditional healers of malaria prophylaxis among pregnant women and children under 5 years.CONCLUSION : A description of clinical malaria by traditional practitioners in health is not very far from that of modern medicine. Nevertheless, the logics of our respondents are etiological more complex and linked to their cultural context. The management of cases is made from medicinal plants in treatment failure patients are usually referred to modern health facilities. The involvement of traditional healers in the detection and quick reference risk cases can contribute to reducing child mortality due to severe malaria.

[Knowledge, attitude, and practice of traditional healers on the topic of malaria in the city of Abidjan]

INTRODUCTION

An estimated 300 to 500 million clinical cases of malaria occur each year worldwide, 90% in Africa, mostly among young children. In Cote d'Ivoire, malaria is 46.03% of disease states and 62.44% of hospital admissions. In children under 5 years, it is 42.67% of the reasons for consultation and 59.68% of hospital admissions. In pregnant women, it represents 22.91% of disease states and 36.07% of hospital admissions. In Africa, traditional medicine is the first resort for the vast majority of people, because of its accessibility both geographically, economically and culturally. However, some modern practitioners show an attitude of distrust of traditional medicine and its players, calling them irrational. This work had set out to assess knowledge, attitudes and practices of traditional healers in the uncomplicated and complicated in the context of collaboration between traditional and modern medicine for the optimal management of critical cases.

MATERIALS AND METHOD

The study focused on traditional healers practicing in the city of Abidjan. The study was conducted using individual interviews over a period of 30 days. The interviews were conducted in local languages, with the assistance, if necessary, translators. For data collection, we used a questionnaire containing four items: the socio-demographic characteristics of traditional healers, their knowledge on malaria, diagnostic practices and traditional therapies.

RESULTS

Of the 60 healers and included in the study, only six were women (10%), a sex-ratio of a woman to 9 men. 66.7% of respondents traditional healers are herbalists and 25% of naturopaths.Only 8.3% were spiritualists. The etiology of malaria most commonly cited by the traditional healers were mosquito bites (16.7%), food (1.7%), solar (1.7%) and fatigue (1.7%) . 25% of traditional healers are associated with mosquitoes, sun and fatigue. Symptomatology most cited were fever (100%), dark urine (86%), the yellow or pale conjunctiva (80%), vomiting (71.7%), nausea (58.3%) and abdominal pain (48.3%). Traditional healers recognized three types of malaria: the white shape, form yellow / red and the black form. Traditional healers malarious patients surveyed were receiving both first (58.3%) than second-line (41.7%). 78.3% of them practiced an interview and physical examination of theirpatients before the diagnosis. In 13.3% of cases they were divinatory consultation. Medications used to treat malaria were herbal in 95% of cases. The main sign of healing was the lack of fever (58.3%). 90%of traditional healers interviewed referring cases of malaria black (severe malaria). This reference is made to modern health facilities (90.2%). 68.3% of respondents practiced traditional healers of malaria prophylaxis among pregnant women and children under 5 years.

CONCLUSION

A description of clinical malaria by traditional practitioners in health is not very far from that of modern medicine. Nevertheless, the logics of our respondents are etiological more complex and linked to their cultural context. The management of cases is made from medicinal plants in treatment failure patients are usually referred to modern health facilities. The involvement of traditional healers in the detection and quick reference risk cases can contribute to reducing child mortality due to severe malaria.

[Epidemiogic and clinical profile of severe pre-eclampsia at the university hospital of Gabriel Touré]

AIMS

To determine the epidemio-clinical profile of severe pre-eclampsia.

PATIENTS AND METHOD

It was about a transversal study done from November 2005 to juin 2006 at the teaching hospital Gabriel Touré. Were included pregnant women with severe pre-eclampsia. Statistical analysis compared the proportions and means, the proportions were compared using the chi (2 with) P < 0,05 considered significant.

RESULTS

during the period of study, 130 cares of severe pré-eclamsia were brougthbto gether among 1667 pregnant women, which was 7,8 %.The mean age was 17.15 years with extremes of 15 and 42 years. The most frequent signs of severe preeclampsia were the association of epigastrium pain, nausea, vomiting and headaches in 54- 62 %.

CONCLUSION

Ther profile type severe pre-eclampsia is 17 years old pregnant women, of an uterus height between 33 and 36 cm, with an insuffisant number of prenatal consultation.

VAGINAL HYSTERECTOMY IN THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY OF THE Point "G" HOSPITAL

Our survey consisted in evaluating the prevalence, specifying the indications and describing per and post - operation complications of vaginal hysterectomy in the Department of Gynecology and Obstetrics of the National Hospital of "Point G ". We conducted a descriptive retrospective survey on 58 cases of vaginal hysterectomies performed in that Department from 1995 to December 2000. Vaginal hysterectomies represented 27.3% of all hysterectomies done in the Department. The mean age of the patient was of 56 +/-2 years. The mean parity was 8. In 91.4% of cases this intervention was a step of the cure of a 3rd degree genital prolapsus. Ménométrorragia represented 5.2%, myomatus delivered by the cervix represented 1.7% and high rank cervical dysplasis was 1.7%. Per and post - surgery complications were dominated by perineal infections (5.2%), hemorrhage (1.7%) and urine retention (1.7%). The mean length of hospitalization was of 7+/-2 days. Vaginal hysterectomy is praticable in our context and secondary morbidity remains within acceptable limits. Because of its advantages this technique must be popularized.

Familial correlation of immunoglobulin G subclass responses to Plasmodium falciparum antigens in Burkina Faso

Host genes are thought to determine the immune response to malaria infection and the outcome. Cytophilic antibodies have been associated with protection, whereas noncytophilic antibodies against the same epitopes may block the protective activity of the protective ones. To assess the contribution of genetic factors to immunoglobulin G (IgG) subclass responses against conserved epitopes and Plasmodium falciparum blood-stage extracts, we analyzed the isotypic distribution of the IgG responses in 366 individuals living in two differently exposed areas in Burkina Faso. We used one-way analysis of variance and pairwise estimators to calculate sib-sib and parent-offspring correlation coefficients, respectively. Familial patterns of inheritance of IgG subclass responses to defined antigens and P. falciparum extracts appear to be similar in the two areas. We observed a sibling correlation for the IgG, IgG1, IgG2, IgG3, and IgG4 responses directed against ring-infected-erythrocyte surface antigen, merozoite surface protein 1 (MSP-1), MSP-2, and P. falciparum extract. Moreover, a parent-offspring correlation was found for several IgG subclass responses, including the IgG, IgG1, IgG2, IgG3, and IgG4 responses directed against conserved MSP-2 epitopes. Our results indicated that the IgG subclass responses against P. falciparum blood-stage antigens are partly influenced by host genetic factors. The localization and identification of these genes may have implications for immunoepidemiology and vaccine development.

Human malaria: segregation analysis of blood infection levels in a suburban area and a rural area in Burkina Faso

The genetic control of blood infection levels in human malaria remains unclear. Case control studies have not demonstrated a strong association between candidate genes and blood parasite densities as opposed to surveys that have focused on severe malaria. As an alternative approach, we used segregation analyses to determine the genetic control of blood parasitemia. We surveyed 509 residents (53 pedigrees) in a rural area and 389 residents (41 pedigrees) in an urban area during 18 months. Each family was visited 20 times and 28 times in the urban area and in the rural area; the mean number of parasitemia measurements per subject was 12.1 in the town and 14.9 in the village. The intensity of transmission of Plasmodium falciparum was 8-fold higher in the rural area than in the urban area. Using the class D regressive model for both populations, we found that blood parasite densities were correlated between sibs. We obtained strong evidence for a major effect, but we found that the transmission of this major effect was not compatible with a simple Mendelian model, suggesting a more complex mode of inheritance. Moreover, there was a strong interaction between major effect and age, suggesting that the influence of the putative major gene may be more prominent in children than in adults. Further nonparametric linkage studies, such as sib pair analysis, that focus on children would help us better understand the genetic control of blood infection levels.

High immunoglobulin G2 (IgG2) and low IgG4 levels are associated with human resistance to Plasmodium falciparum malaria

There is accumulating evidence for a role of immunoglobulin G (IgG) in protection against malarial infection and disease. Only IgG1 and IgG3 are considered cytophilic and protective against P. falciparum, whereas IgG2 and IgG4 were thought to be neither and even to block protective mechanisms. However, no clear pattern of association between isotypes and protection has so far emerged. We analyzed the isotypic distribution of the IgG response to conserved epitopes and P. falciparum blood-stage extract in 283 malaria-exposed individuals whose occurrence of infection and malaria attack had been monitored for about 1 year. Logistic regression analyses showed that, at the end of the season of transmission, high levels of IgG2 to RESA and to MSP2 epitopes were associated with low risk of infection. Indeed, IgG2 is able to bind FcgammaRIIA in individuals possessing the H131 allele, and we showed that 70% of the study subjects had this allele. Also, high specific IgG4 levels were associated with an enhanced risk of infection and with a high risk of malaria attack. Moreover, specific IgG2 and IgG3 levels, as well as the IgG2/IgG4 and IgG3/IgG4 ratios, increased with the age of subjects, in parallel with the protection against infection and disease. IgG4 likely competes with cytophilic antibodies for antigen recognition and may therefore block cytotoxicity mediated by antibody-activated effector cells. In conclusion, these results favor a protective role of IgG3 and IgG2, which may activate effector cells through FcgammaRIIA, and provide evidence for a blocking role of IgG4 in malarial infection and disease.

Genetic dissection of Plasmodium falciparum blood infection levels and other complex traits related to human malaria infection

There is accumulating evidence of host genetic control in malaria infection and, in humans, some genes have been associated with severe malaria. Nevertheless, other important genes controlling blood infection levels, malarial disease and immune responses are likely to be identified. In this paper, we focus on segregation and linkage analyses of blood infection levels in an urban population living in Burkina Faso. We found evidence of a complex genetic control and a linkage to chromosome 5q31-q33. The identification of genes controlling complex traits related to malaria infection should be helpful in understanding protective mechanisms and the relationship between infection, malaria attacks and severe malaria.

[Analysis of the genetic factors controlling malarial infection in man]

Genetic factors have clearly been shown to play a role in controlling malarial infection in animal models. There is now also increasing evidence for the genetic control of malaria in man. We carried out a segregation analysis based on blood parasite load phenotype for a population of the town of Bobo-Dioulasso (Burkina-Faso). This analysis demonstrated a strong genetic effect. Our results were not consistent with the segregation of a major gene and thus suggest that parasite load is under the control of minor genes. The genetic effect was stronger in children than in adults. We carried out a regression analysis in children and found that there was an association between the phenotype for blood parasite load and the q31-33 region of chromosome 5. We identified a gene in this region, Pfil1 (Plasmodium falciparum infection levels 1), which accounted for almost 50% of the variance in blood parasite load and which played a fundamental role in the control of infection. The 5q31-33 region contains several genes encoding cytokines that regulate T lymphocytes. The identification of genes controlling malarial infection opens up new possibilities for preventive and treatment strategies. It should be possible in the near future to identify individuals at risk of malaria, who would derive the greatest benefit from preventive and therapeutic measures. Finally, a deeper understanding of these genes controlling protective immune responses could be of value for the development of vaccines.

Malaria in humans: Plasmodium falciparum blood infection levels are linked to chromosome 5q31-q33

Plasmodium falciparum malaria remains a major cause of morbidity and mortality in many tropical countries, especially those in sub-Saharan Africa. Human genetic control of malaria infection is poorly understood; in particular, genes controlling P. falciparum blood infection levels remain to be identified. We recently evidenced the existence of complex genetic factors controlling blood infection levels in an urban population living in Burkina Faso. We performed, on 153 sibs from 34 families, sib-pair linkage analyses between blood infection levels and chromosome 5q31-q33, which contains numerous candidate genes encoding immunological molecules. Our results, obtained by means of the two-point Haseman-Elston (HE) method and a nonparametric (NP) approach, show linkage of parasitemia to D5S393 (P=.002) and D5S658 (P=.0004). Multipoint analyses confirmed linkage, with a peak close to D5S658 (P=.0013 and P=.0007 with the HE and NP methods, respectively). The heritability of the locus was .48, according to the two-point results, and .43, according to the multipoint results; this indicates that its variation accounted for approximately 45% of the variance of blood infection levels and that the locus plays a central role in the control of parasitemia. The identification of the gene is, therefore, of major interest in understanding the mechanisms controlling P. falciparum parasitemia.

Certain anti-CD34 monoclonal antibodies induce homotypic adhesion of leukemic cell lines in a CD18-dependent and a CD18-independent way

CD34 is a highly glycosylated type I membrane protein expressed by early hematopoietic progenitor cells as well as by endothelial cells and a subset of bone marrow stromal cells. CD34 is thought to play an important role during early hematopoiesis, although its function is unknown. We demonstrate that triggering of CD34 results in a rapid and vigorous homotypic adhesion in CD34+ cell lines, thereby providing evidence for a cell-cell adhesion function of CD34. The cellular adhesion event, induced by only two anti-CD34 mAb, (Immu-133 and QBend-10) was dependent on metabolic energy, an intact cytoskeleton and the presence of divalent cations. Analysis of antibody inhibition experiments indicated that the aggregation process partially involved the CD18 molecule.