The stories of 'snake children': killing and abuse of children with developmental disabilities in West Africa

BACKGROUND

Killing and abuse of children with disabilities are covert phenomena, occurring in some developing regions, such as in some African countries. Similar to the practice of ritual killing of spirit children in Ghana, the phenomenon of the snake child in Cote d'Ivoire (known as Ivory Coast), is the ritual abandonment or killing of children with intellectual disability (ID).

METHOD

This study is a qualitative ethnographic investigation into understanding this phenomenon. Three major questions were of interest: (1) Who are the snake children? (2) How are these children viewed and treated? (3) What are ways of changing negative attitudes towards children with developmental disabilities?

RESULTS

The practices of killing, abandonment and abuse of children with disabilities take place in Cote d'Ivoire today, although the extent is not known.

CONCLUSION

Killing and abuse of children with ID are explained within the context of indigenous African religions, animism and folk culture. The concept of disability 'otherness' and inferiority is also explored as a framework for reflection and ethical debate.

A nephrotic syndrome of tropical origin: case report and short review of the aetiology

We present a case of nephrotic syndrome in a 38-year-old man of Ivorian origin. In the search of the cause of his illness an infection with Plasmodium malariae (P. malariae) was diagnosed by serology and by microscopy of a Giemsa thin blood smear which revealed rare gametocytes of P. malariae. Proteinuria significantly diminished within three months after antimalarial treatment. Antibodies against Schistosoma were detected as well. Examination of kidney biopsy revealed a discrete mesangioproliferative glomerulonephritis. This case highlights that a thorough history-taking may be essential and that infectious diseases should be included in the differential diagnostic thinking process when a nephrotic syndrome is diagnosed.

Traditional practices and medicinal plants use during pregnancy by Anyi-Ndenye women (Eastern Côte d'Ivoire)

The use of plants during pregnancy is a common practice in Africa. In Côte d'Ivoire, despite modern antenatal medical prescriptions, most pregnant women resort to traditional medicine to ensure foetus development and facilitate childbirth. Yet, there is not enough research on the African traditional medicine concerning this aspect of health. Therefore, the plants used by pregnant women need to be better known in order to offer integrated antenatal care. This study analyzes the salience of plants used, the associated practices and reasons of such practices by pregnant women in Yakassé-Féyassé, an Anyi-Ndenye town of the Eastern Côte d'Ivoire. Methods include an ethnobotany survey (freelist method, interview with pregnant women during their antenatal consultation and with specialists). The survey led to a list of 75 plants distributed in 3 class of salience. In addition, 90.3 % of pregnant women use these practices which are nevertheless ignored by Midwives during antenatal visits.

Progressive disseminated histoplasmosis among human immunodeficiency virus-infected patients from West-Africa: report of four imported cases in Italy

We report four imported cases of progressive disseminated histoplasmosis (PDH) due to Histoplasma capsulatum variety capsulatum in Human Immunodeficiency Virus-infected patients from West Africa. This report highlights the need to consider diagnosis of PDH among patients with acquired immunodeficiency syndrome who originate from West Africa and present with a prolonged febrile illness and very low CD4 count.

Compartmental syndrome of the upper limb due to Moraxella lacunata infection: a link to patera foot syndrome?

We report a case of compartmental syndrome of the left upper limb secondary to a severe Moraxella lacunata infection, an unusual pathogen, occurring in a young black male immigrant to the island of Gran Canaria, Spain. We propose a pathophysiological relationship with patera foot syndrome.

Sociopolitical crisis and the reconstruction of sustainable periurban agriculture in Abidjan, Côte d'Ivoire

This article examines the effects of the post-2002 sociopolitical crisis in Abidjan, Côte d'Ivoire, on urban and peri-urban agriculture. Based on the case study of Abidjan, it argues for a conceptualization of sustainability that includes social as well as environmental dimensions and focuses on coping strategies of producers and merchants. In Abidjan, these strategies included internal migration within the city and its periphery, the use of organic fertilizers, and changes in market structure. The study illustrates how such strategies allowed producers to continue to supply produce to the market, despite the difficulties of war.

Post-malaria neurological syndrome--two cases in patients of African origin

Post-malaria neurological syndrome (PMNS) defined by a post-infective encephalopathy occurring within 2 months after an episode of Plasmodium falciparum infection is still a debated entity. We describe 2 cases of PMNS in 2 patients of African origin, born and living in France. Both patients had severe P. falciparum infection, followed by PMNS. They recovered with no sequelae. These are the first-reported cases of PMNS in patients of African ethnicity and living in France.

Imported and autochthonous histoplasmosis in Italy: new cases and old problems

In the past the Italian soil was considered as a low-endemic pabulum for H. capsulatum var. capsulatum and only few autochthonous cases of histoplasmosis were reported in Italy, especially in the Po valley. The aim of the paper was to evaluate this possibility by reviewing the literature and providing our own personal data. Four additional cases of histoplasmosis were observed during 1999-2003 in AIDS immigrant or in Italian citizens, and in travellers to endemic areas. One of the AIDS patients was an autochthonous case of histoplasmosis. The Italian literature was reviewed. Recent cases and literature data confirm the possible autochthonous presence of histoplasmosis in Italy, especially in the Northern regions.

Subcutaneous ivermectin as a safe salvage therapy in Strongyloides stercoralis hyperinfection syndrome: a case report

Strongyloides stercoralis hyperinfection syndrome due to the acceleration of the autoinfective cycle of the nematode is a life-threatening form of the infection occurring in immunocompromised hosts. Intestinal ileus, which is commonly encountered in this form, may reduce the bioavailability and thus the efficacy of oral anthelminthic drugs used in the treatment of the S. stercoralis hyperinfection syndrome. We report the efficacy and safety of subcutaneous administration of ivermectin in a patient infected with human T cell lymphotropic virus type I with S. stercoralis hyperinfection syndrome who was unresponsive to an oral combination of ivermectin and albendazole.

Buruli's ulcer: three cases diagnosed and treated in France

The authors report three cases of skin ulcer, called Buruli's ulcer. This is a tropical disease, caused by Mycobacterium ulcerans. The diagnosis is often belated, because the infection is rare in Europe. Diagnosis is based on the clinical aspects, and can be confirmed by a biopsy and a molecular study. A culture is needed to test antibiotics. Treatment is always surgical, including a wide excision of all lesions, and specific oral antibiotics for 6 months.

[The sleep of Africans and Europeans in the Ivory Coast: questionnaire study]

Sleep behaviour has been extensively studied with questionnaires in industrialised countries to investigate the epidemiology of sleep-wake disorders. However, only few attempts have yet been made to examine sleep behaviour of people living in Africa. Although, a large number of studies in hot or cold environments have used short-term exposures, reporting disrupted sleep for most of them, long-term exposures to stressful thermal environments are rare in the literature. Prior to the present investigation, we used questionnaires to analyse the effects of seasonal heat increase on perceived sleep behaviour and sleep quality in young native African students in Niger [7], even though these methods of investigation are by no means as accurate as polysomnographic recordings. The hypothesis was that sleep behaviour may be influenced by climatic variations in a hot dry tropical climate. Such climatic variations have been shown to induce seasonal heat acclimatisation marked by changes in body temperature rhythms in the hot versus the cool season [13]. Sleep behaviour was examined during two 7-day periods in January ("cool-dry" season, 88 subjects) and May ("hot-dry" season, 53 subjects). The questionnaire was completed after night sleep and/or naps. The subjects slept an average of 7 1/2 hours a day, most of them having afternoon naps. They experienced no major seasonal variation in their sleep behaviour, but for an increased number of awakenings during the hot season. Restorative quality of sleep scored lower after a nap than after nocturnal sleep. Therefore, general sleep characteristics were not modified by seasonal temperature variations in African native students, perhaps because of the limited changes in daylight under the low latitude of Niamey. Another investigation was carried out using the same 12-item questionnaire in Abidjan on 78 medical students who did not have a nap [9]. Contrary to the Niamey students, the Abidjan subjects adopted short duration sleep schedules, without any effect on the subjective quality of the restorative properties of their sleep.

[Hybrid pathologies: difficulties in intricate clinical cases]

Following two cases of young patients, issued of african immigration or mixed franco-african couple, and presenting antisocial acts, the authors are wondering about the relationship between identity and ethnic troubles. They think it may be a clinical "message" of troubles, joining cultural distress and separation anxiety, on an obvious oedipian found.

Importance of migrants infected with Onchocerca volvulus in west African river valleys protected by 14 to 15 years of Simulium control

A study was done to determine the importance of human migration from non-controlled endemic onchocerciasis foci to the river valleys that have been protected for the past 14 to 15 years by the vector control operations of the Onchocerciasis Control Programme in West Africa. The aim of the study was to assess the contribution of migrants to the prevalence and intensity of infection in villages from 5 major river valleys and their potential role in causing relapse of transmission once the vector is allowed to return. In Burkina Faso the migrant population varied from 0.0% to 18.1% of the village population, and averaged 4.9%. Migrants accounted only for 0.6% of the population in Ghanaian and Ivorian villages along the Black Volta river. The prevalence of infection was significantly higher in migrants (8.2%) than in non migrants (1.1%) in the surveyed villages in Burkina Faso, and 1.5% of migrants had infections with more than 16 microfilariae per snip as against 0.2% of non migrants. Nearly all infected migrants came from the south of the Côte d'Ivoire. The study shows that human migration has caused the importation of Onchocerca volvulus from non-controlled areas. However, the epidemiological importance of this phenomenon is limited because of the very small number of infected migrants per village while two-third of the infected migrants are believed to be infected with the less pathogenic forest strain of the parasite. Because migration patterns changes geographically and over time similar studies will be continued on a regular basis.

Migration studies in the onchocerciasis controlled areas of West Africa

The possible impact of human migration from onchocerciasis endemic areas located beyond the borders of the "Onchocerciasis Control Programme in West Africa" to the area protected by this project was studied. The aim of this exercise was to assess the contribution of immigrants to the prevalence and intensity of infection of the human population protected by vector control activities and their potential role in generating transmission once the vector is allowed to repopulate the programme area. Data were collected in Southern Mali and the North, South, East and West of Burkina Faso. In Southern Mali a statistically significant difference in prevalence between migrants and non migrants was found only for migrants from Ivory Coast (p = 0.04). In Burkina Faso no statistically significant difference in prevalence and intensity of infection between migrant and non migrant was found with the exception of the villagers in the North, a marginal area for the parasite (p = 0.004). These findings suggest that immigrants will not constitute on important threat for the northern section of the well protected area of the Onchocerciasis Control Programme when the vector is allowed to repopulate the river valleys.

[Two cases of pentastomiasis observed in Paris (author's transl)]

The observations of two black African patients seen among 940 hospitalized patients are reported. Intraabdominal calcified larvas, probably of Porocephalus (Armillifer) armillatus were found in both patients. The cycle of this Pentostomida is recalled. Attention is drawn to the role of snake slime in accidental contamination of human beings. In man, this parasitic infection is almost always asymptomatic and detected fortuitously on roentgenograms, or during surgery or necropsy.