Socio-Cultural Representations and Therapeutic Itineraries of Parents of Autistic Children Followed in the INSP’s Children’s Mental Health Services

Pervasive developmental disorders (PDD) remain little known to populations in developing countries. In black Africa their social representations remain strongly influenced by local belief systems. The general objective of this study was to understand the perceptions and representations of Ivorian parents vis-à-vis PDD. This was a mixed (qualitative and quantitative) prospective cross-sectional study with a descriptive aim that involved a sample of 49 parents. The sampling was of the qualitative type by multiple cases with reasoned choice by saturation. Our results showed that male parents were mostly aged between 40 - 49 years (48.98%) with a higher level of education (67.34%) while mothers were mostly aged between 30 - 39 (61.22%) and a higher level (30.61%). Autistic children were negatively perceived by their parents: either as a source of psychological suffering (82.85%), or as mysterious children who sacrificed their parents (44.66%), or as “bobo” children (mute children in common Ivorian language) (16.66%) or like rude children (13.34%). The supposed origin of the disorder according to the parents was mystical-religious (60.94%);natural (25%);hereditary (6.25%). In 6.25% of cases, PDD were assumed to be of unknown or iatrogenic origin attributable to vaccination (1.56%). 75.51% of parents said that in addition to conventional medical therapies, they also used traditional therapies. The use of this therapeutic alternative would be linked to the perceptions and beliefs that feed the socio-cultural representations of our respondents.

Frequency of the C677T Polymorphism of MTHFR, G20210A of Prothrombin and R506Q of Factor V Leiden in Type 2 Diabetics in Abidjan

In Africa, the prevalence of diabetes is escalating and remains a concern due to the numerous complications it causes. Vascular damage associated with diabetes leads to a prothrombotic state observed in diabetic individuals. Diabetes is a complex and multifactorial disease involving genetic components. With the aim of preventing complications and contributing to an efficient management of diabetes, we investigated genes likely to lead to a risk of thrombosis, in particular the C677T of MTHFR, G20210A of prothrombin, and R506Q of factor V Leiden in type 2 diabetics in Abidjan receiving ambulatory care. A descriptive cross-sectional study was carried out on consenting type 2 diabetic patients. Mutation detection was carried out using the PCR-RFLP method employing restriction enzymes. Hemostasis tests (fibrinogen, D-dimers, fibrin monomers, and von Willebrand factor) were performed using citrate tubes on the Stage? Star Max automated system. Plasminogen activator inhibitor was assayed by ELISA method, and biochemical parameters were determined using the COBAS C311. The study population consisted of 45 diabetic patients, 51.1% of whom presented vascular complications, mainly neuropathy. Disturbances in hemostasis parameters were observed, with 15.5% of patients showing an increase in fibrin monomers. Mutation analysis revealed an absence of factor V mutation (factor V Leiden) and of G20210A mutation of the prothrombin gene. However, 15.6% of subjects had a heterozygous C677T mutation of MTHFR, with 57% of them being anemic. The exploration of biological and genetic factors associated with thrombotic risk is of significant interest in the optimal management of African type 2 diabetics.

Direct Cost of Severe Malaria Treatment Borne by the Families of Children Aged 0 - 5 Years at the Fana Reference Health Centre, Mali

Introduction: Malaria is both a disease caused by poverty and a cause of poverty. Malaria is the leading cause of morbidity and mortality in Mali and is among the ten countries with the highest number of malaria cases and deaths. The objective was to estimate the direct economic cost borne by families in the treatment of severe malaria in children aged 0 - 5 years at the CSREF in Fana. Methodology: The study was cross-sectional, conducted from July 2017 to June 2018 with inclusion criteria and prospective data collection. The methodology was based on estimating the direct economic cost of severe malaria. Results: The sample consisted of 109 cases out of a total of 944 hospitalizations;59% of whom were boys and the 25 - 36 month age group was the most affected. The complications frequently encountered were severe anemia (50 cases) or 45.8%;convulsions (35 cases) or 32.1% and finally severe sepsis (8 cases) or 7.3%. The average direct cost was 25,324 Franc CFA (58.95 US Dollars) of which 66% represented the costs of medicines and consumables against 4% for the consultation. This cost was more than half the minimum wage in Mali. Conclusion: Despite the difficulties in estimating the cost in hospitals, the results obtained give us an estimate of the economic burden borne by families in the management of severe malaria cases among children in the district of Fana. Support is needed for parents in the fight against malaria in rural Mali.

Aetiological factors of Budd-Chiari syndrome in Algeria

AIM: To study the clinical presentation of Budd-Chiari syndrome(BCS) and identify the aetiologies of this disease in Algeria. METHODS: Patients with BCS, hospitalised in our unit from January 2004 until June 2010 were included and the aetiological factors were assessed. Patients presenting a BCS in the setting of advanced-stage cirrhosis or a liver transplantation were excluded from the study. The diagnosis was established when an obstruction of hepatic venous outflow(thrombosis, stenosis or compression) was demonstrated. We diagnosed myeloproliferative disease(MPD) by bone marrow biopsy and V617 F JAK2 mutation. Anti-phospholipid syndrome(APLS) was detected by the presence of anticardiolipin antibodies, anti-β2 glycoprotein antibodies and Lupus anticoagulant. We also detected paroxysmal nocturnal haemoglobinuria(PNH) by flow cytometry. Celiac disease and Behcet disease were systematically investigated in our patients. Hereditary anticoagulant protein deficiencies were also assessed. We tested our patients for the G20210 A mutation at Beaujon Hospital. Imaging procedures were performed to determine a local cause of BCS, such as a hydatid cyst or a liver tumour.RESULTS: One hundred and fifteen patients were included. Mean follow up: 32.12 mo. Mean age: 34.41 years, M/F = 0.64. Chronic presentation was frequent:63.5%. The revealing symptoms for the BCS were ascites(74.8%) and abdominal pain(42.6%). The most common site of thrombosis was the hepatic veins(72.2%). Involvement of the inferior vena cava alone was observed in 3 patients. According to the radiological investigations, BCS was primary in 94.7% of the cases(n = 109) and secondary in 5.2%(n = 6). An aetiology was identified in 77.4% of the patients(n = 89); it was multifactorial in 27%(n = 31). The predominant aetiology of BCS in our patients was a myeloproliferative disease, observed in 34.6% of cases. APLS was found in 21.7% and celiac disease in 11.4%. Other acquired conditions were: PNH(n = 4), systemic disease(n = 6) and inflammatory bowel disease(n = 5). Anticoagulant protein deficiency was diagnosed in 28% of the patients(n = 18), dominated by protein C deficiency(n = 13). Secondary BCS was caused by a compressing hydatic cyst(n = 5) and hepatocellular carcinoma(n = 1). CONCLUSION: The main aetiologic factor of BCS in Algeria is MPD. The frequency of celiac disease justifies its consideration when BCS is diagnosed in our region.

Do Pregnant Teens Have Higher Risk of Intimate Partner Violence than Pregnant Adult Women in Mexico?

Objective: The objective of the study is to estimate the prevalence of Intimate Partner Violence (IPV) and identify factors linked to it in pregnant Mexican adult and adolescent women. Methods: Data were gathered by the National Survey of Violence against Women (2006), applied to women between the ages 15-49, users of Mexican public health institutions. Multinomial logistic regression analyses were performed to explore the significant factors associated with IPV against pregnant women. Results: Both adolescent and adult study participating women showed a 24% prevalence of current IPV (during the previous 12 months). The study’s multivariate model for adult women revealed the following as main predictors for IPV: a woman’s agreement with traditional gender roles (OR = 4.35, CI95% = 2.20 - 8.60), and women with a history of childhood sexual abuse (OR = 2.76, CI95% = 1.68 - 4.55). The main predictor of IPV in pregnant adolescents was their partners’ frequency of alcohol consumption: often/usually (OR = 6.49, CI95% = 2.18 - 19.33). Conclusion: To this date, Mexico has not been able to guarantee universal screening methods for IPV as a part of prenatal care protocols. The phenomenon of IPV towards pregnant women neither has been followed-up by further research nor has been identified as a public health problem in spite of the seriousness of its implications for women and their offspring.

Pediatric Nursing Care and Its Practices in Three Health Care Facilities

Introduction: Pediatric nursing cares are among the most important care needed referring to the category of patients. A gap of the best practice in Pediatric Nursing Care (PNC) had been publically a major problem of health and raises the rate of morbidity and mortality. The lack of nursing guidelines, low level of studies, experience at work and low economic status of Health Care Facilities (HCFs) were the main problems assessed in these three HCFs (HUCK, VNC and MHK) in this study. The purpose of this study is to assess the knowledge of nurses during their practices in Pediatric Wards of HCFs and to provide a better contribution. Method: A descriptive study design was used in this study during the period of one month. 43, 25 and 30 nurses were selected among 98 nurses by using Dilman formula. A questionnaire with 5 parameters was distributed. Data were typed using Microsoft ward and analyzed using Statistical Package for Social Scientists version 16 software (SPSS). Results: The current study found that the majority of nurses don’t know to make the best nursing diagnosis neither the factors related to the implementation of EBP in PNC. The nurses have shown different barriers often met during their practices. The all process of nursing diagnosis was not recognized with the average of 97.6% of nurses. Conclusion: Even if the nurses have some experience at work they express their weakness based on low level of study, lack of knowledge and trained professionals on work and the pediatric nursing guidelines.

Emergy Evaluation of Treatment Methods for Solid Medical Waste in Bujumbura-Burundi

Introduction: Treatment of solid medical waste (SMW) is a complex task requiring the proper practices with specific treatment methods corresponding to each type of SMW during pretreatment and final treatment. This study targeted three treatment methods identified as the main used by the majority of health care facilities (HCFs) and treating a large amount of SMW. It aimed: 1) to evaluate the current practices by calculating the emergy investment and emergy costs that are required to treat one ton of SMW through the three treatment methods and 2) to evaluate and compare better technologies and provide policy suggestions for the final treatment of SMW in Burundi. Materials and Methods: This study used the emergy methodology to evaluate the relative efficiencies of three treatment methods used for to treat SMW in twelve HCFs in Bujumbura. Results and Conclusion: The total emergy input was 1.36E+20 seJ/yr, 3.54E+17 seJ/yr, and 1.681E+18 seJ/yr for low temperature incinerator, landfill and organic pit, respectively. Conclusion: Rapid improvement of organic pit by ensuring its maintenance, the gradual replacement of low temperature incinerator by high temperature incinerator with air control pollution and landfill by sanitary landfill are highly recommended by respecting its maintenance (fence, roof and monitoring evaluation) for reducing the risk.

GIS-Based Model for Mapping Malaria Risk under Climate Change Case Study: Burundi

Malaria is one of the largest problems threatening global public health that is expected to increase in the future under climate change due to associated warming and wetter conditions. This will exacerbate disease burden in Burundi as one of sub-Saharan African countries, where 2 million cases of malaria were reported in 2015. This highlights the need for developing a methodology for mapping malaria risk under climate change and delineating those regions that may potentially experience malaria epidemics in the future. Malaria transmission and distribution are generally determined by a wide range of climatic, topographic and socioeconomic factors. The paper in hand is intended to map malaria risk in Burundi under climate change up to 2050. For this purpose, a GIS-based model was developed for mapping malaria as a function of various climatic and topographic determinants of malaria. The developed GIS-model was used in mapping malaria risk under current climatic conditions. Thereafter, the produced risk map was validated compared to malaria morbidity data in Burundi at health district level. Finally, the GIS-model was applied to map malaria risk in the future under RCPs 2.6 and 8.5 scenarios up to 2050. It was found that about 34.6% and 44% of Burundi land surface will be highly vulnerable to malaria risk by 2050 under RCPs 2.6 and 8.5 scenario, respectively. Also, it was noted that such highly vulnerable areas are distributed mainly in northern parts of the country. The suggested GIS-based model for mapping malaria risk under climate change can contribute largely to more informed decision-making and policy making process in terms of planning for intervention and control malaria risk. This in turn can support reducing disease burden and improving resilience to climate change.

Incidenee and time-varying predictors of HIV and sexually transmitted infections among male sex workers in Mexico City

Background:Male sex workers are at high-risk for acquisition of sexually transmitted infections(STIs),including human immunodeficiency virus(HIV).We quantified incidence rates of STIs and identified their time-varying predictors among male sex workers in Mexico City.Methods:From January 2012 to May 2014,male sex workers recruited from the largest HIV clinic and community sites in Mexico City were tested for chlamydia,gonorrhea,syphilis,hepatitis,and HIV at baseline,6-months,and 12-months.Incide nee rates with 95%bootstrapped confide nee limits were calculated.We examined potential timevarying predictors using generalized estimating equations for a population averaged model.Results:Among 227 male sex workers,median age was 24 and baseline HIV prevalence was 32%.Incidence rates(per 100 person-years)were as follows:HIV[5.23;95%confidence interval(CI):2.15-10.31],chlamydia(5.15;95%CI:2.58-9.34),gonorrhea(3.93;95%CI:1.88-7.83),syphilis(13.04;95%CI:8.24-19.94),hepatitis B(2.11;95%CI:0.53-4.89),hepatitis C(0.95;95%CI:0.00-3.16),any STI except HIV(30.99;95%CI:21.73-40.26),and any STI including HIV(50.08;95%CI:37.6062.55).In the multivariable-adjusted model,incident STI(excluding HIV)were lower among those who reported consistently using condoms during anal and vaginal intercourse(odds ratio=0.03,95%CI:0.00-0.68)compared to those who reported inconsistently using condoms during anal and vaginal intercourse.Conclusions:Incidence of STIs is high among male sex workers in Mexico City.Consistent condom use is an important protective factor for STIs,and should be an important comp on ent of interventions to prevent incide nt infect i ons.