We provide thereafter the title, journal name, authors, institutions and abstracts for papers indexed in the MEDLINE database on medical research conducted in Seychelles, Mauritius, La Réunion and Madagascar. Medical research in other Indian Ocean countries is indeed often very relevant to public health and clinical practice in Seychelles since all islands in the region share numerous common characteristics. On one side, most Indian Ocean regions experience rapid development and will therefore learn from studies on non-communicable diseases in any of them. On the other hand, studies on communicable diseases in any of them present interest to other counries as many infections, even the rarest ones, often occur similarly in several Indian Ocean islands and/or can be easily imported from/to any of them. An overview of published reports also brings a perspective of current health research priorities in the Indian Ocean and may serve as a catalyst for further inter-institutional collaboration. Most publications found in MEDLINE are mentioned except for a few reviews or case reports. For the sake of concision, abstracts have not been displayed or were truncated for some papers related to particularly specialized issues.

(All abstracts can be retrieved from MEDLINE at http://www4.ncbi.nlm.nih.gov/PubMed/).

Seychelles

Human leptospirosis in the Seychelles (Indian Ocean): a population-based study

Am J Trop Med Hyg 1998;59(6):933-40.

Yersin C, Bovet P, Merien F, Wong T, Panowsky J, Perolat P.

Ministry of Health, Victoria, Seychelles; University of Lausanne, Switzerland; Pasteur Institute, Noumea, New Caledonia.

A leptospirosis surveillance program was carried out for 12 months on the entire population of the Seychelles. Diagnosis was assessed by both microagglutination test and polymerase chain reaction (PCR) assay. In this population of 74,331, leptospirosis was clinically suspected in 125 subjects and confirmed in 75 patients (incidence of 101 per 100,000; 95% confidence interval = 79-126). Leptospirosis was more frequent in middle-aged males with environmental exposure. Eight serogroups were identified and Icterohaemorrhagiae (31%) and Hurstbridge (20%) were the most frequent. Hurstbridge, a recently identified new serogroup, was implicated in severe cases and death. Influenza-like forms accounted for 37% of the cases while jaundice, acute renal failure, and pulmonary hemorrhage occurred in 52%, 28%, and 19%, respectively. Death occurred in six patients and was related to pulmonary hemorrhage. The PCR result was positive after completion of treatment in eight patients, suggesting that the administered five-day course of penicillin may be inadequate to eradicate the bacteria.

Effects of prenatal and postnatal methylmercury exposure from fish consumption on neurodevelopment: outcomes at 66 months of age in the Seychelles Child Development StudyJAMA 1998;280(8):701-7.

Davidson PW, Myers GJ, Cox C, Axtell C, Shamlaye C, Sloane-Reeves J, Cernichiari E, Needham L, Choi A, Wang Y, Berlin M, Clarkson TW.

University of Rochester School of Medicine and Dentistry, NY 14642, USA.

CONTEXT: Human neurodevelopmental consequences of exposure to methyl-mercury (MeHg) from eating fish remain a question of public health concern. OBJECTIVE: To study the association between MeHg exposure and the developmental outcomes of children in the Republic of Seychelles at 66 months of age. DESIGN: A prospective longitudinal cohort study. PARTICIPANTS: A total of 711 of 779 cohort mother-child pairs initially enrolled in the Seychelles Child Development Study in 1989. SETTING: The Republic of Seychelles, an archipelago in the Indian Ocean where 85% of the population consumes ocean fish daily. MAIN OUTCOME MEASURES: Prenatal and postnatal MeHg exposure and 6 age-appropriate neurodevelopmental tests: the McCarthy Scales of Children's Abilities, the Preschool Language Scale, the Woodcock-Johnson Applied Problems and Letter and Word Recognition Tests of Achievement, the Bender Gestalt test, and the Child Behavior Checklist. RESULTS: The mean maternal hair total mercury level was 6.8 ppm and the mean child hair total mercury level at age 66 months was 6.5 ppm. No adverse outcomes at 66 months were associated with either prenatal or postnatal MeHg exposure. CONCLUSION: In the population studied, consumption of a diet high in ocean fish appears to pose no threat to developmental outcomes through 66 months of age.

Comments in: JAMA 1998 Aug 26;280(8):737-8; JAMA 1999 Mar 10;281(10):896-7.

Blood thiamin status and determinants in the population of Seychelles (Indian Ocean)J Epidemiol Community Health 1998;52(4):237-42.

Bovet P, Larue D, Fayol V, Paccaud F.

Institute of Social and Preventive Medicine, University of Lausanne, Switzerland; Ministry of Health, Seychelles.

STUDY OBJECTIVE: Micronutrient deficiencies have become rare in industrialised countries as availability of fresh food, supplementation, and fortification have improved but a less favourable situation may still prevail in many developing countries. Blood thiamin status and determinants were therefore investigated in the Seychelles in view of the high incidence of dilated cardiomyopathy and as the staple diet is polished rice that is deficient in thiamin. DESIGN: This was a cross sectional population study using an age and sex stratified random sample. SETTING: Seychelles Islands (Indian Ocean). PARTICIPANTS: A subsample of 206 subjects aged 25-64 years from the population of Seychelles. MAIN OUTCOME MEASURES: Measurement of total thiamin concentration in whole blood using high performance liquid chromatography. Dietary variables measured using a face to face semi-quantitative food questionnaire. RESULTS: Mean (SD) whole blood thiamin concentration was 77.9 (22.4) nmol/l and low concentration (< 70 nmol/l) was found in 37% of the subjects (95% CI: 31%, 44%). Blood thiamin was significantly related to education and diet but not to age, sex, smoking, and body mass index. Blood thiamin was associated positively with meat, vegetable, salad, and tea intake and negatively with alcohol and fish intake. However, no combination of the examined variables could explain more than 15% of the observed variance in blood thiamin values. CONCLUSIONS: These data suggest that the distribution of blood thiamin in the sampled population is shifted to lower values compared with that generally accepted as normal in European populations. Further research should establish the significance of such lower values in this specific population to facilitate clinical and public health action as necessary.

Knowledge, attitudes, and practices on hypertension in a country in epidemiological transitionHypertension 1998;31(5):1136-45.

Aubert L, Bovet P, Gervasoni JP, Rwebogora A, Waeber B, Paccaud F.

Institute of Social and Preventive Medicine, University of Lausanne, Switzerland; Ministry of Health Seychelles.

Assessment of knowledge, attitudes, and practices (KAP) is a crucial element of hypertension control, but little information is available from developing countries where hypertension has lately been recognized as a major health problem. Therefore, we examined KAP on hypertension in a random sample of 1067 adults aged 25 to 64 years from the Seychelles Islands (Indian Ocean). KAP were assessed from an administered structured questionnaire. The age-standardized prevalence of hypertension (screening blood pressure [BP] > or = 160/95 mm Hg or taking antihypertensive medication) was 36% in men and 25% in women aged 25 to 64 years. Among hypertensive persons, 50% were aware of the condition, 34% were treated, and 10% had controlled BP (ie, BP <160/95 mm Hg). Most persons, whether nonhypertensive, unaware hypertensive, or aware hypertensive, had good basic knowledge related to hypertension determinants and consequences, possibly an effect of a nationwide cardiovascular disease prevention program over the last years. However, favorable outcome expectation, positive attitudes, and appropriate practices for hypertension and relevant healthy lifestyles were found in smaller proportions of participants, with little difference between aware hypertensives, unaware hypertensives, and nonhypertensives. Furthermore, hypertensive persons with other concurrent cardiovascular risk factors affecting the overall heart risk knew well the detrimental effects of these other factors but reported making little actual change to control them (particularly regarding overweight and sedentary habits). These data point to the need to maximize the efficiency of hypertension prevention and control programs so that delay in achieving effective hypertension control is minimized in countries experiencing recent emergence of hypertension as a major public health problem.

Semiparametric modeling of age at achieving developmental milestones after prenatal exposure to methylmercury in the Seychelles child development studyEnviron Health Perspect 1998;106(9):559-63.Axtell CD, Myers GJ, Davidson PW, Choi AL, Cernichiari E, Sloane-Reeves J, Cox C, Shamlaye C, Clarkson TW.

Department of Biostatistics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642 USA.

Controversy exists concerning the fetal risk associated with exposure to low-dose methylmercury from maternal fish consumption. Previous studies of the effects of acute prenatal mercury exposure identified delays in achieving developmental milestones among exposed children. This led to public health concern that prenatal low-dose exposure from fish consumption could adversely affect the fetus. We evaluated the effects of prenatal methylmercury exposure (through maternal fish consumption) on the age that children walked and first said words in the main study cohort of the Seychelles Child Development Study. We used semiparametric generalized additive models to identify nonlinearities in the relationships between prenatal exposure and developmental outcomes, after adjusting for covariates, and to evaluate their importance. Very slight delays (<1 day) in walking were seen as mercury levels increased from 0 to 7 ppm, but this effect did not persist at the higher exposure levels represented by the cohort, making it difficult to conclude that a cause and effect relationship existed at the exposure levels seen in this cohort. There was no evidence for any association between prenatal exposure and age at talking.

Prenatal methylmercury exposure and children: neurologic, developmental, and behavioral researchEnviron Health Perspect 1998;106 Suppl 3:841-7. Myers GJ, Davidson PW.

Department of Neurology, University of Rochester School of Medicine and Dentistry, New York 14642, USA.

Mercury is present in the earth's crust and is methylated by bacteria in aquatic environments to methylmercury (MeHg). It is then concentrated by the food chain so predatory fish and sea mammals have the highest levels. Thus, consuming seafood leads to exposure. MeHg readily crosses the placenta and the blood-brain barrier and is neurotoxic. The developing fetal nervous system is especially sensitive to its effects. Prenatal poisoning with high dose MeHg causes mental retardation and cerebral palsy. Lower level exposures from maternal consumption of a fish diet have not been consistently associated with adverse neurodevelopmental outcomes. However, most studies have considerable uncertainty associated with their results. Two large controlled longitudinal studies of populations consuming seafood are underway that are likely to determine if any adverse effects can be identified. No adverse associations have been found in the Seychelles, where exposure is mainly from fish consumption. In the Faroe Islands where exposure is primarily from consumption of whale meat and not fish, adverse associations have been reported. The Seychelles population consumes large amounts of marine fish containing MeHg concentrations similar to commercial fish in the United States. Current evidence does not support the hypothesis that consumption of such fish during pregnancy places the fetus at increased neurodevelopmental risk.

Mercury in fishScience 1998;279(5350):459, 461 (letter).

Clarkson T, Cox C, Davidson PW, Myers GJ.

Comment on Science 1997 Dec 12;278(5345):1904-5.

Diabetic eye disease: a natural history study

Eye 1997;11 ( Pt 4):547-53.

Taylor RH, Jones HS, Dodson PM, Hamilton AP, Kritzinger EE.

Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK.

In previous studies on diabetic retinopathy it has not been possible to relate risk factors to reduced vision because of the influence of vision-preserving treatment. Demographic data, cardiovascular risk factors and ocular features from the diabetic population of the Seychelles are described. Diabetic retinopathy in this population had not been modified by laser treatment. The population described consists of entirely type 2, maturity onset diabetics. Using a multivariate logistic regression model, the risk factors were deduced for three outcome variables: (1) reduced vision, defined as 6/36 or worse in both eyes; (2) the presence of diabetic retinopathy; and (3) the presence of maculopathy, preproliferative and proliferative retinopathy, grouped as severe retinopathy. Insulin treatment was associated with all outcome variables, duration from diagnosis of diabetes with retinopathy of all forms, and increasing age with reduced vision and severe retinopathy. Hypertensive diabetic patients were twice as likely to have reduced vision as compared with non-hypertensive diabetic individuals.

Frequency and impact of autosomal dominant polycystic kidney disease in the Seychelles (Indian Ocean)

Nephrol Dial Transplant 1997;12(10):2069-7.

Yersin C, Bovet P, Wauters JP, Schorderet DF, Pescia G, Paccaud F.

Department of Internal Medicine, Victoria Hospital, Seychelles; University of Lausanne, Switzerland.

BACKGROUND: As little such data is available in African populations, we investigated the prevalence of ADPKD and the impact of the disease in the Seychelles islands, where approximately 65% of the population is of African descent and 30% of Caucasian or mixed descent. METHODS: Prevalent cases were identified over a 3-year period by requesting all the doctors in the country (most of them are employed within a national health system) to refer all presumed or confirmed cases and by systematically examining the family members of all confirmed cases. The diagnosis was based on standard criteria including ultrasonographic findings and family history. RESULTS: Forty-two cases were identified in this population of 74,331 inhabitants, a total prevalence (per 100,000 total population) of 57 (95% CI, 41-76). All but one of the cases were of Caucasian descent so that the prevalence rates of the disease in the populations of Black and Caucasian descents were respectively 2 (0-11) and 184 (132-249). The prevalence rates of the gene(s) carriers were estimated to be 75 (45-117) in the total population respectively 6 (0-33) and 236 (140-372) in the Black and Caucasian populations. Haplotype analysis in 58 cases from three families showed a common DNA fragment in all affected individuals. Cases had significantly higher blood pressure compared to the general population and 21% had serum creatinine higher than 120 mumol/l. Among the established pedigrees, mean age of death between 1960 and 1995 (haemodialysis was introduced in 1992) was younger in subjects with than those without ADPKD (50.5 vs 67.7 years; P < 0.001). CONCLUSIONS: In the Seychelles, ADPKD clusters in the Caucasian population (possibly a founder effect), is rare in individuals of black descent, and is associated with substantial clinical and survival impact.

Effects of prenatal methylmercury exposure from a high fish diet on developmental milestones in the Seychelles Child Development StudyNeurotoxicology 1997;18(3):819-29.Myers GJ, Davidson PW, Shamlaye CF, Axtell CD, Cernichiari E, Choisy O, Choi A, Cox C, Clarkson TW.

University of Rochester School of Medicine and Dentistry, NY 14642, USA.

Mercury is widespread in the environment and exists in several physical and chemical forms. Prenatal exposure to methylmercury disrupts brain development. The most common mode of prenatal methylmercury exposure is maternal fish consumption. Studies of human prenatal exposure in Iraq following maternal ingestion of methylmercury treated grain suggested that maternal hair mercury concentrations above 10 ppm may be related to delayed developmental milestones and neurological abnormalities. This level of exposure can be achieved by frequent consumption of fish. The Seychelles Child Development Study analyzed developmental milestones similar to those determined in Iraq in a large controlled, prospective study of children exposed prenatally to methylmercury when their mothers ate fish. As part of this ongoing study, cohort children were evaluated at 6.5, 19, 29, and 66 months of age. At 19 months care-givers were asked at what age the child walked (n=720 out of 738) and talked (n=680). Prenatal mercury exposure was determined by atomic absorption analysis of maternal hair segments corresponding to hair growth during the pregnancy. The median mercury level in maternal hair was 5.8 ppm with a range of 0.5-26.7 ppm. The mean age (in months) at walking was 10.7 (SD = 1.9) for females and 10.6 (SD = 2.0) for males. The mean age at talking (in months) was 10.5 (SD = 2.6) for females, and 11.0 (SD = 2.9) for males. After adjusting for covariates and statistical outliers, no association was found between the age at which Seychellois children walked or talked and prenatal exposure to mercury. Normal ages at achievement of the developmental milestones walking and talking were found in Seychellois toddlers following prenatal exposure to methylmercury from a maternal fish diet. These results do not support the lowest effect levels in young children following prenatal methylmercury exposure predicted by the dose response analysis of the Iraq data. More detailed studies in older children are needed to determine if there are adverse effects in fish eating populations.

Mauritius

Assessing the contribution of age-sex differentials in causes of death due to infectious and parasitic diseases to the trends in age-sex differentials in life expectancy in Mauritius

Soc Biol 1998 Fall-Winter;45(3-4):260-72.

Bah SM. Central Statistical Service, Pretoria, South Africa.

This study applies two methodologies to Mauritian life tables and cause-of-death data: (1) the decomposition of sex differentials in life expectancy using Arriaga's approach and (2) the estimation of the effect of marginal reduction in deaths from infectious and parasitic diseases on life expectancy using Keyfitz's methodology on cause-specific entropy and that of Nanjo. The findings in this paper support earlier findings about the importance of the period 1969-1976 in the mortality transition in Mauritius, a period in which sex differentials in life expectancies reached a peak level. The results suggest that the driving force behind those sex differentials in life expectancy was the sex differential in mortality in infectious and parasitic diseases, first among the young (ages below 10 years) and second among the older population (ages above 50 years). If the decline in mortality due to infectious and parasitic diseases was differentially greater in the older ages compared to the younger ages, that difference would have gone a long way toward reducing the magnitude of the historic peak sex differential in life expectancy achieved in 1976.

Diabetic neuropathy in Mauritius: prevalence and risk factors

Diabetes Res Clin Pract 1998 Nov;42(2):131-9.

Shaw JE, Hodge AM, de Courten M, Dowse GK, Gareeboo H, Tuomilehto J, Alberti KG, Zimmet P.

International Diabetes Institute, Melbourne, Victoria, Australia.

The study of diabetic neuropathy has been primarily in Europids, despite the high prevalence of diabetes in other populations. We set out to ascertain the prevalence of diabetic neuropathy and its risk factors in the island nation of Mauritius. Population surveys were carried out in 1987 and 1992 in Mauritius to establish the prevalence of Type 2 diabetes. In the second survey, vibration perception threshold (VPT) was also measured at the great toe in 847 subjects with diabetes, 204 subjects with impaired glucose tolerance and 127 subjects with normal glucose tolerance. Neuropathy was defined as levels of VPT exceeding the mean plus 2 standard deviations defined separately for three age groups of Mauritian non-diabetic subjects. Risk factors for neuropathy were identified cross sectionally from the 1992 data, and longitudinally from the 1987 data. Neuropathy was detected in 8.3% of the 847 diabetic subjects (12.7%) of those with known diabetes, and 3.6% of those with newly diagnosed diabetes). Logistic regression identified diabetes duration (odds ratio [95% CI]; 1.08 [1.04-1.13] per year, P=0.0002), treatment with insulin or oral hypoglycaemic agents (2.63 [1.36-5.09], P=0.004) and greater height (1.36 [1.19-1.57] per 5 cm, P < 0.001) as risk factors for neuropathy, in the cross sectional analysis. In the longitudinal analysis, diabetes duration (1.11 [1.05-1.18] per year, P=0.001), fasting glucose (1.12 [1.03-1.22] per mmol/l, P=0.01) and height (1.23 [1.03-1.45] per 5 cm, P=0.02) were associated with neuropathy. A lower 2-h plasma insulin was also associated with neuropathy in the longitudinal analysis. The prevalence of diabetic neuropathy in Mauritius is the lowest reported for any population, but the risk factors associated with it are similar to those previously found.

Antibodies to the E2 protein of GB virus C/hepatitis G virus: low prevalence in Asian countries

Zentralbl Bakteriol 1998 Nov;288(3):415-9.

Ross RS, Viazov S, Da Villa G, Schmitt U, Tacke M, Ofenloch-Haehnle B, Roggendorf M.

Institute of Virology, University of Essen, Germany.

Epidemiological investigations of GB virus C (GBV-C)/hepatitis G virus (HGV), an infectious agent discovered in 1995/1996, are facilitated by a recently developed immunoassay for the detection of antibodies to the viral envelope 2 protein (anti-E2). We used this assay to establish GBV-C/HGV prevalence in seven European, African, and Asian countries. A total of 1579 serum samples from healthy adults lacking prior exposure to known parenteral risk factors was screened. Anti-E2 positivity ranged from 13.6% (Italy) to 7.7% (Mauritius) in the European and African countries investigated. Anti-E2 prevalence was exceedingly low in the Philippines and Sri Lanka. This observation might be attributable to socio-economical and demographic factors. PMID: 9861685, UI: 99078678

Do leptin levels predict weight gain?-A 5-year follow-up study in Mauritius. Mauritius Non-communicable Disease Study Group

Obes Res 1998 Sep;6(5):319-25

Hodge AM, de Courten MP, Dowse GK, Zimmet PZ, Collier GR, Gareeboo H, Chitson P, Fareed D, Hemraj F, Alberti KG, Tuomilehto J.

International Diabetes Institute, Melbourne, Australia.

OBJECTIVE: To investigate whether relative baseline leptin levels predict long-term changes in adiposity and/or its distribution. RESEARCH METHODS AND PROCEDURES: In a longitudinal study of 2888 nondiabetic Mauritians aged 25 years to 74 years who participated in population-based surveys in 1987 and 1992, changes in body mass index (BMI), waist/hip ratio (WHR), and waist circumference were compared between "hyperleptinemic," "normoleptinemic," and "hypoleptinemic" groups. "Relative leptin levels" were calculated as standardized residuals from the regression of log10 leptin on baseline BMI to provide a leptin measure independent of BMI. Analyses were performed within each sex. A linear regression model was used to assess the effect of standardized residuals on changes in BMI, WHR, and waist circumference, independent of baseline BMI, age, fasting insulin, and ethnicity. RESULTS: After adjusting for age and baseline BMI by analysis of covariance, there was no difference in changes in BMI, WHR, or waist circumference between men with low, normal, or high relative leptin levels. Among women, there was a significant difference in deltaWHR across leptin groups, such that the largest increase occurred in the "normal" leptin group. For both men and women, the linear regression models explained approximately 10% of variation in dependent variables, and the only significant independent variables were age, BMI, and being of Chinese origin, compared with Indian origin. DISCUSSION: These findings do not support a role for leptin concentration in predicting weight gain or changes in fat distribution in adults over a 5-year period.

Occupational status and cardiovascular disease risk factors in the rapidly developing, high-risk population of Mauritius

Am J Epidemiol 1998 Jul 15;148(2):148-59.

Pereira MA, Kriska AM, Collins VR, Dowse GK, Tuomilehto J, Alberti KG, Gareeboo H, Hemraj F, Purran A, Fareed D, Brissonnette G, Zimmet P.

Division of Epidemiology, University of Minnesota, Minneapolis, USA.

This study examined the relation between occupation and cardiovascular disease (CVD) risk factors in 2,795 individuals between ages 35 and 54 years from the rapidly developing island nation of Mauritius. Participants attended a 1992 population-based survey of noncommunicable disease (89.1 % response rate). Occupational status, physical activity in the previous year, cigarette smoking, and alcohol consumption were assessed by questionnaire. Anthropometric and metabolic measures included body mass index (kg/m2),waist-to-hip ratio, fasting serum high density lipoprotein cholesterol and low density lipoprotein cholesterol (LDL cholesterol), triglycerides, 2-hour postload plasma glucose and serum insulin concentrations, and blood pressure. In comparison with professional/skilled workers, age-adjusted means of insulin and glucose, LDL cholesterol, triglycerides, and systolic and diastolic blood pressures were significantly (p < 0.05) lower, and the age-adjusted mean for high density lipoprotein cholesterol was significantly higher for unskilled men. In women, risk factors other than LDL cholesterol varied significantly (p < 0.05) across occupational categories, with homemakers tending to have the least favorable profile. Unskilled workers reported significantly more physical activity (p < 0.01), alcohol consumption, and cigarette smoking (men only) (p < 0.05) than did the other groups. Adjustment for multiple covariates revealed an independent association between occupational status and most CVD risk factors, with physical activity attenuating this association. These results elucidate mediating behaviors of CVD risk across occupational categories that could be applied to intervention strategies in Mauritius.

Comments in: Am J Epidemiol 1998 Jul 15;148(2):160-3

Ethnic differences in ischaemic heart disease and stroke mortality in Mauritius between 1989 and 1994

Ethn Health 1998 Feb-May;3(1-2):45-54.

Vos T, Gareeboo H, Roussety F.

Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine.

OBJECTIVE: To measure ethnic differences in overall, cardiovascular, ischaemic heart disease and stroke mortality in the Republic of Mauritius. DESIGN: Analysis of vital registration mortality data from 1989 to 1994 among Hindus, Muslims, Chinese and Creoles, aged 30-64 years, presented as age-standardized mortality rates, proportional mortality ratios and standardized mortality ratios. RESULTS: During the six year period of analysis 10,657 deaths were recorded in men and 5008 in women. Mortality rates from ischaemic heart disease in Mauritian men are above the average of those found elsewhere. Ischaemic heart disease mortality in women and stroke mortality in both sexes are among the highest recorded in the world. Due to large ethnic differences in overall mortality, which could not be explained by the uncertainty about the exact population size by ethnic group, proportional mortality ratios are an inadequate measure of differential mortality between ethnic groups. 'Best' estimates of standardized mortality ratios indicate that in comparison to Hindus as the 'standard' population: (i) Creole women have lower ischaemic heart disease (by 34%) and stroke (by 22%) mortality; (ii) Creole women have lower ischaemic heart disease mortality (by 19%); (iii) Muslim men have lower stroke mortality (by 51%) and similar ischaemic heart disease mortality; (iv) Chinese men and women have markedly lower ischaemic heart disease (by 48% and 70%, respectively) and stroke mortality (by 54% and 48%, respectively). CONCLUSION: The mortality rates of ischaemic heart disease and stroke of all ethnic groups in Mauritius, with the exception of the small Chinese ethnic minority, are very high by international standards. This pleads against differential allocation of resources for prevention strategies despite considerable differences in mortality rates from cardiovascular diseases between ethnic groups.

Maternal exposure to influenza in pregnancy and electro-dermal activity in offspring: a further study from Mauritius

Psychophysiology 1998 Jul;35(4):438-42.

Venables PH.

University of York, Heslington, UK.

This study examined the effect of mothers' exposure to the 1957 A2/Singapore influenza virus in the first, second, and third trimesters of pregnancy on the electrodermal activity of their 15-year-old offspring. The epidemic occurred during cold months of the year. The results show that maternal viral (and cold) exposure during all trimesters of pregnancy produced a lower frequency of nonspecific electrodermal responses and diminished responsivity to 75-db and 90-db tones as compared with the offspring of mothers who were not exposed. However, there was a critical effect of second trimester exposure as indicated by an increase in frequency of nonresponses to orienting tones. The findings are compared with those from an earlier study from Mauritius involving 3-year-old children in which the effects of exposure to the 1968 A2/Hong Kong virus were examined and in which the effect of could exposure could be examined separately because viral exposure occurred during the hot months.

[Human diseases transmitted by Culicidae in southwest Indian Ocean islands]

Bull Soc Pathol Exot 1998;91(1):99-103.

Julvez J, Ragavoodoo C, Gopaul AR, Mouchet J.

Laboratoire d'entomologie de Maurice, Hopital Victoria, Candos.

South-West Indian Ocean islands were inhabited at the beginning and free from all kind of vector. In Madagascar, Mayotte, Moheli and Anjouan, malaria vectors were carried by the first settlements. According to epidemics, the anopheles arrived in 1867 in Mauritius, 1869 in La Reunion and 1920 in Grande Comore. Rodrigues, Saint-Brandon and the Seychelles are still free from malaria vectors in the coastal part of Madagascarcar and in Comores archipelago, malaria is stable with a permanent transmission. Unstable malaria is seasonaly transmitted in the high territories of Madagascar; it was the same in Mauritius and Reunion island before the eradication campaign. Lymphatic filariasis is quoted in Madagascar, but Comores archipelago is an area with high transmission. The incidence of the disease is moderate in La Reunion and Mauritius and very low in Chagos and Seychelles archipelagos. There is no transmission in Rodrigues and St Brandon. Epidemics of dengue were described during the second part of the XIXth century in Mauritius and La Reunion, then in 1943 in Mayotte. But the disease was controlled in the fifties by the antimalaria campaign. A new epidemy appeared in Seychelles by the end of 1976 and then in Reunion and Mauritius next year. An isolated outbreak was described in Grande Comore only in 1994.

[Malaria in Mauritius]

Bull Soc Pathol Exot 1998;91(1):94.

Ragavoodoo C.

Ministere de la sante, Pamplemousses, Ile Maurice.

Malaria on Mauritius is an imported illness. The persistence of vector anopheles, the increase in numbers of foreigners passing through as well as Mauritians coming from malaria-infected areas and the fact that Mauritius is in an unstable malaria zone, subject to climatic hazards, such as hurricanes, are so many reasons justifying the structures of epidemiological surveillance in order to avoid the return of malaria to Mauritius. The various methods of surveillance are the following: a) active detection of cases (i) among people, Mauritians or foreigners, coming from malaria-infected zones, who are regularly visited, (ii) for every persons suffering from fever; b) passive detection in health centers; c) in vivo test for chloroquino-resistance for all cases of Plasmodium falciparum; d) entomological surveillance Such methods are costly but effective, since no case of malaria among locals was reported from 1990 to 1995, except for a few cases in 1992.

[HIV in Mauritius]

Bull Soc Pathol Exot 1998;91(1):67.

Pyndiah MN, Jowaheer B, Perumal J, Deepchand K, Ghurburrun P

Laboratoire de virologie, Hopital Victoria, Candos, Ile Maurice. [Medline record in process]

The goal was to prevent the risk of HIV transmission by blood transfusion and to follow the evolution of HIV among different populations. The detection of HIV antibodies is carried out by the ELISA method and the positive cases are confirmed by the Western blot. From September 1987 to June 1996, of 136,242 blood units taken from donators, 11 (0.007%) were positive and for 17,186 people with a high risk factor (drug addicts, multi-sexual parteners or frequentation of prostitutes), 79 (0.5%) were contaminated by HIV. Among 5882 imprisoned detainees, 17 (0.3%) tested positive. For the same period, 25 cases of aids were registered among HIV positives of whom 29 died. HIV was introduced into Mauritius relatively late and has progressed slowly. Until now, no case of viral transmission through blood transfusion has been recorded. PMID: 9559167, UI: 98219921

[The island of Mauritius: insularity, tropicality, modernity, a dialogue in the form of a lesson]

Bull Soc Pathol Exot 1998;91(1):46-51.

Amat-Roze JM UFR de geographie, universite de Paris, Sorbonne.

Mauritius, a lost volcanic island in the Indian Ocean situated at the 20th degree of latitude, is a tiny state which got its independence in 1968. The isolation, the tropicality, the demographic boom, the ethnic diversity and the absence of raw materials could funnel this peaceful beauty to become a hot-bed of desperation and violence. This place which is one of the most densely populated areas, is an example of modern democracy and cultural coexistence. Owing to a skillful and pragmatic politic, its leaders have transformed handicaps into trump cards. The allocation of a part of the GNP for social and hygienic investments had been the locomotive pulling the train of improvements and raising the standard of living for the inhabitants. The ageing population, the rapidity of evolution the demographic and health transitions are expression of this skillful politic. In less than twenty years, this island conquered underdevelopment and proved that there is no tropical fatality when a programme of health accompanies development.

[Incidence of cancer in Mauritius in 1989-1993]

Bull Soc Pathol Exot 1998;91(1):9-12.

Manraj SS, Mustun H, Ghurburrun P, Laniece C, Salamon R.

Laboratoire central, Candos, Ile Maurice.

Systematic registration of cases of cancer was introduced in Mauritius as of 1989. This article analyzes the data concerning the incidence and mortality of the disease from 1989 to 1993. At the end of each year, the archives of the Central Laboratory of Hospitals, the admissions register at the only center for radiotherapy, the discharge resumes of patients classified as suffering from cancer of all the regional hospitals and the archives of the Medical Assistance Service regarding treatment abroad were examined and information drawn from them in order to fill out the information form of the cancer register (10 items per case). For the period studied, 4293 new cases of cancer were detected of which 1784 (41.6%) among men. The main organs affected were, for men: the lungs (12%), the mouth/pharynx (10%), and the stomach (8%); for women: the breast (24%), the cervix (21%), and the ovaries (6%). The incidence of cancer has increased at an annual average of 8% for both sexes, reaching in 1993 the standard (world) incidence of respectively 106 and 122 cases per 100,000. Over the same period, cancer rose to 2nd to 3rd place in causes of death, accounting for approximately 8 to 9% of deaths. The ratio of mortality/incidence is 0.85 among men and 0.58 among women. The distribution of cancer according to age, location and ethnic group points to interesting and significant results which can be subsequently compared to that of other countries in the region. The second phase of registering cancer in Mauritius is presently being undertaken.

Prevalence and risk factors for diabetic retinopathy in the multiethnic population of Mauritius

Am J Epidemiol 1998 Mar 1;147(5):448-57.

Dowse GK, Humphrey AR, Collins VR, Plehwe W, Gareeboo H, Fareed D, Hemraj F, Taylor HR, Tuomilehto J, Alberti KG, Zimmet P.

Public Health Division, Health Department, Perth, Australia.

This study examines the prevalence of, and risk factors for, diabetic retinopathy in Asian Indian, Chinese, and Creole Mauritians in whom there is an increasing prevalence of non-insulin-dependent diabetes mellitus (NIDDM). As part of a population-based survey on the Indian Ocean island of Mauritius in 1992, glucose tolerance was classified using a 75-g oral glucose tolerance test on 6,553 persons. Subjects with newly diagnosed (n = 358) or known diabetes (n = 388), and a random sample of one in four subjects with impaired glucose tolerance (n = 165), had stereoscopic 45 degrees retinal photographs taken of three fields in the right eye after mydriasis. Photographs were graded according to a modified version of the Airlie House criteria. The prevalence of nonproliferative and proliferative retinopathy was: 14.5% and 0.3%, respectively, in newly diagnosed diabetic subjects; 42.0% and 2.3%, respectively, in known diabetic subjects; and 9.1% and 0%, respectively, in persons with impaired glucose tolerance. Muslim Indians had the lowest prevalence of retinopathy (10.8% and 34.0% for new and known diabetes, respectively), but after adjusting for other factors, this was significantly different only to Creoles (18.8% and 53.8%, respectively). Univariate analysis revealed significant differences between diabetic subjects with and without retinopathy in mean age, body mass index, fasting and 2-hour plasma glucose levels, systolic and diastolic blood pressure, fasting triglycerides, serum creatinine, and urinary albumin levels. For known diabetes, mean duration of diabetes and the proportion using insulin were also greater in those with retinopathy. Multivariate analysis using logistic regression confirmed that increasing duration of diabetes, fasting plasma glucose, systolic blood pressure, and urinary albumin concentration, and decreasing body mass index, were independently associated with retinopathy. The high prevalence of diabetic retinopathy observed in all major ethnic groups in Mauritius portends a serious public health problem, given the relative recency of the NIDDM epidemic in that country and the limited resources for laser photocoagulation. Strategies to minimize this problem among those already known to have diabetes should include strict control of plasma glucose and blood pressure. PMID: 9525531, UI: 98184443

Is there a relationship between leptin and insulin sensitivity independent of obesity? A population-based study in the Indian Ocean nation of Mauritius

Int J Obes Relat Metab Disord 1998 Feb;22(2):171-7.

Mauritius NCD Study Group. Zimmet PZ, Collins VR, de Courten MP, Hodge AM, Collier GR, Dowse GK, Alberti KG, Tuomilehto J, Hemraj F, Gareeboo H, Chitson P, Fareed D.

International Diabetes Institute, Melbourne, Victoria, Australia.

OBJECTIVE: It has been shown previously in smaller studies that fasting serum leptin and insulin concentrations are highly correlated, and insulin sensitive men have lower leptin levels than insulin resistant men matched for fat mass. We have examined the association between insulin resistance (assessed by fasting insulin) and leptin after controlling for overall and central adiposity in a population-based cohort. DESIGN: Leptin levels were compared across insulin resistance quartiles within three categories of obesity (tertiles of body mass index (BMI)). Partial correlation coefficents and multiple linear regression models were used to assess the relationship between leptin and fasting insulin after adjusting for BMI and waist to hip ratio (WHR) or waist circumference. SUBJECTS: Subjects were normoglycemic participants of a 1987 non-communicable diseases survey conducted in the multiethnic population of Mauritius. 1227 men and 1310 women of Asian Indian, Creole and Chinese ethnicity had normal glucose tolerance and fasting serum leptin measurements. RESULTS: Mean serum leptin concentration increased across quartiles of fasting insulin in each BMI group and gender, after controlling for BMI, WHR and age. Furthermore, fasting insulin was a significant determinant of serum leptin concentration, independent of BMI and WHR, in both men and women. Similar results were found if waist circumference replaced BMI and WHR in the model. CONCLUSION: These results suggest that insulin resistance/concentration may contribute to the relatively wide variation in leptin levels seen at similar levels of body mass or alternatively, leptin may play a role in the etiology of insulin resistance. Further studies will be important to determine whether the hyperleptinemia/insulin resistance relationship has a role in the natural history of obesity, Type 2 diabetes mellitus and the other metabolic abnormalities associated with insulin resistance.

Asthma mortality in Mauritius: 1982-1991

Ann Allergy Asthma Immunol 1997 Nov;79(5):423-6.

Fakim N, Subratty AH, Manraj M, Surrun SK, Hoolooman K.

SSR Center for Medical Studies and Research, Faculty of Science, University of Mauritius, Reduit, Mauritius.

BACKGROUND: Bronchial asthma is a common problem in the island of Mauritius and its prevalence seems to be increasing. OBJECTIVE: In order to appreciate the magnitude of the problem, patterns of asthma mortality were studied during a period of 10 years. METHOD: All death certificates issued in the island from 1982 to 1991 were reviewed and all cases of asthma deaths were selected. RESULTS: The global asthma mortality rate was found to be 20/100,000 in 1982, and it decreased to 12/100,000 in 1991. Similarly the asthma death rate for the 0 to 4 year age group decreased from 20/100,000 in 1982 to 5/100,000 in 1991. For the 5 to 34 year age group, it decreased from 2.6/100,000 in 1982 to 1.02/100,000 in 1991. There was no statistically significant difference between the various ethnic groups. CONCLUSION: Our study showed that in a developing country such as Mauritius asthma death rates may be high but may show decreasing trends. Nevertheless, it is generally perceived that the prevalence of the disease is increasing.

Low resting heart rate at age 3 years predisposes to aggression at age 11 years: evidence from the Mauritius Child Health Project

J Am Acad Child Adolesc Psychiatry 1997 Oct;36(10):1457-64

Raine A, Venables PH, Mednick SA.

Department of Psychology, University of Southern California, Los Angeles 90089-1061, USA.

OBJECTIVE: Previous studies indicate that low resting heart rate is probably the best-replicated biological correlate of childhood antisocial and aggressive behavior. Nevertheless, there have been few longitudinal tests of this relationship, little control over potential confounds and mediators, and no test of its cross-cultural generalizability. This study tests the hypothesis that low resting heart rate at age 3 years predicts aggression at age 11 years. METHOD: Resting heart rate at age 3 years was assessed in 1,795 male and female children from Mauritius. Aggressive and nonaggressive forms of antisocial behavior were assessed at age 11 years using the Child Behavior Checklist. RESULTS: Aggressive children had lower heart rates than nonaggressive children (p < .001). Conversely, those with low heart rates were more aggressive than those with high heart rates (p < .003). There were no interactions with gender or ethnicity. Evidence was found for specificity of low heart rate to aggressive forms of antisocial behavior. Group differences in heart rate were not attributable to 11 biological, psychological, and psychiatric mediators and confounds. CONCLUSIONS: It is concluded that low resting heart rate, a partly heritable trait reflecting fearlessness and stimulation-seeking, is an important, diagnostically specific, well-replicated, early biological marker for later aggressive behavior.

Maternal exposure to influenza and cold in pregnancy and electrodermal activity in offspring: the Mauritius Study

Psychophysiology 1997 Jul;34(4):427-35.

Venables PH.

Department of Psychology, University of York, Heslington, UK.

Data are in conflict concerning whether a mother's exposure to influenza in pregnancy gives rise to an increased probability that her offspring will develop schizophrenia. In Northern Hemisphere studies, exposure to influenza and cold tend to be confounded. The present study, carried out in Mauritius, examines the effect of maternal exposure to the virus and separately to cold on aspects of electrodermal activity that have been shown in other studies to be related to schizophrenia. The findings are that maternal exposure to influenza in the second and third trimesters gives rise to children who at the age of 3 years show electrodermal hyperresponsivity, whereas exposure to cold in the same periods gives rise to children who tend to be hyporesponsive. In both instances, exposure tends to produce lower levels of tonic activity than in those not exposed to the virus or to cold.

[Cancer incidence in Mauritius (1989-1993)]

Rev Epidemiol Sante Publique 1997 Jun;45(3):257-9.

Manraj SS, Mustun H, Ghurhurrun P, Laniece C, Salamon R

Laboratoire Central, Candos, Ile Maurice.

Heart rate and skin conductance in behaviorally inhibited Mauritian children

J Abnorm Psychol 1997 May;106(2):182-90

Scarpa A, Raine A, Venables PH, Mednick SA

Department of Psychology, University of Georgia, Athens 30602-3013, USA.

This study tested predictions that inhibited versus uninhibited children exhibit higher heart rate (HR) and skin conductance (SC) arousal. Mauritian children (N = 1,795) were tested at age 3 and classified as inhibited, middle, or uninhibited on the basis of social behavior. HR level and several SC measures were obtained immediately before or during a tone task. Inhibited children displayed significantly higher HR and SC levels and longer SC latency relative to uninhibited children. Results remained regardless of ethnicity, gender, height, weight, respiratory complaints, or crying behavior. Findings suggest that HR and SC levels may be early indicators of inhibited or uninhibited behavior at age 3 and support the notion of heightened sympathetic reactivity due to limbic arousal in inhibited children. PMID: 9131838, UI: 97278578

Fall in cholesterol after changes in composition of cooking oil in Mauritius

Chandrasekharan N, Sundram K.

Comment on: BMJ 1997 Feb 15;314(7079):516; BMJ 1995 Nov 11;311(7015):1255-9; BMJ 1996 Oct 26;313(7064):1044-6.

Reform of the public health sector in the Republic of Mauritius

Health Estate J 1997 Mar;51(2):18-9.

Ring B.

Distribution and prevalence of major risk factors of noncommunicable diseases in selected countries: the WHO Inter-Health Programme

Bull World Health Organ 1997;75(2):99-108.

Berrios X, Koponen T, Huiguang T, Khaltaev N, Puska P, Nissinen A.

Department of Public Health, Catholic University of Chile, Santiago, Chile.

The Inter-Health Programme was launched in 1986 by WHO, with the collaboration of a coordination centre (National Public Health Institute, Finland) to control and prevent chronic noncommunicable diseases (CNCDs) among adults. Programmes for action were organized based on the concept that most major CNCDs share common risk factors and that those that are lifestyle related are modifiable through efficient interventions using multifactorial strategies involving community participation and behaviour changes carried out at the primary health care level. Twelve countries from all WHO Regions have joined the programme. A baseline survey was undertaken in all countries with a common protocol, following the criteria and methods employed in the MONICA Project. Altogether 36815 men and women aged 35-64 years were included in the present analysis from the following Inter-Health countries: Chile, China, Cyprus, Finland, Lithuanian SSR, Malta, Mauritius, Russian SFSR, United Republic of Tanzania, and USA. In addition to individual country analysis, centralized analysis was carried out at the Finnish National Public Health Institute and the Department of Community Health, Kuopio University, Finland. Reported here are the mean values of blood pressure, body mass index, and serum total cholesterol as well as specific prevalences of smoking, hypertension, obesity, and hypercholesterolaemia.

[The development of public health education: the Mauritius experience]

Sante 1997 Jan-Feb;7(1):47-51.

Salamon R et al. JFR de Sante publique, Universite Victor-Segalen Bordeaux, France.

A public course has been initiated in 1990 in Mauritius for covering the national growing needs of public health specialists. This training course was organized jointly by the Ministry of Health, the University of Bordeaux II and the French Cooperation. The first session was organized in 1995, a second one in 1996. This training course is targeted to the medical doctors who are in charge of the management of health services at the district level. It is divided in two parts: A six-weeks intensive training course performed in Mauritius that include formal teaching and practical exercises in small groups for a total of 210 hours. The curriculum is mainly targeted on the various aspects of management as the management of health information (biostatistics epidemiology and computing), the management of human resources, financial resources and material resources. In addition to these main topics, there is an introduction to pedagogy, communication skills and applied research methodology. Following this six-weeks, training the students come back to work in their country and have 8 months to perform a thesis supervised by a local public health specialist. The subject of the thesis has to be closely related with one of the topic taught and should provide an obvious improvement for the public health situation in the district where this physician is acting. In 1995, 22 candidates attend to the course (13 from Madagascar, 4 from Mauritius, 3 from Comoros, 1 from Angola, 1 from Equatorial Guinea and 1 from Tchad), 19 had successively completed all the modules and got the diploma of public health delivered by the University of Bordeaux II. This diploma has been recognized as an equivalent to a master in public health in Mauritius. The 97 session will probably extend the number of students up to 40, divided in 4 subgroups for practical exercises.

Is leptin sensitivity the link between smoking cessation and weight gain?

Int J Obes Relat Metab Disord 1997 Jan;21(1):50-3

Hodge AM, Westerman RA, de Courten MP, Collier GR, Zimmet PZ, Alberti KG.

International Diabetes Institute, Melbourne, Australia.

The known association between smoking cessation and weight gain, and the suggested role of leptin in the control of body weight, led to the present study which examined the association between smoking and serum leptin concentrations. Mean serum leptin levels, independent of body mass index (BMI), were calculated in male smokers and non-smokers from Nauru, Western Samoa and Mauritius. Smokers were generally leaner than non-smokers, and of similar ages. Levels of physical activity and glucose tolerance status were similar for smokers and non-smokers in Nauru and Western Samoa, while in Mauritius smokers were more active and less likely to be diabetic. Leptin concentrations in smokers were significantly lower than in non-smokers, even after adjusting for BMI, waist/hip ratio (WHR) or waist girth (P < or = 0.04). This association was independent of diabetes status. Smoking, via nicotinic mechanisms, may modify the sensitivity of hypothalamic leptin receptors and consequently modulate leptin synthesis and reduce body weight.

La Réunion

[Respiratory manifestations of leptospirosis. A retrospective study of 91 cases (1978-1984)]

Rev Pneumol Clin 1998 Dec;54(6):382-392.

Courtin JP et al. Service de Pneumologie et Maladies Infectieuses, Centre Hospitalier Sud Reunion, Saint-Pierre, La Reunion.

Leptospirosis, an ubiquitous zoonotic disease, is a systemic infection usually producing fever with hepatorenal involvement, meningoenephalitis, and hemorrhage. Respiratory manifestations are less well known but have been described in certain regions such as Southeast Asia or the Reunion Island. From January 1978 through December 1994, 154 cases of documented leptospirosis were admitted to the South Reunion Hospital Center. Pulmonary involvement was observed in 91 of these cases (59.1%) with hemoptysis (37.4%) and radiological evidence of bilateral reticulonodular infiltration (40%). Extra-pulmonary manifestations in most cases suggested leptospirosis at admission. Thirteen consecutive patients underwent endoscopy explorations with bronchoalveolar lavage: intra-alveolar hemorrhage was evidenced in all cases. This highly typical pattern of cytolysis would emphasize (20.8%) when the classical extra-pulmonary signs are too discrete to suggest the diagnosis. In this series, 10 patients required ventilatory assistance and 2 were given corticosteroid boluses for massive hemoptysis. Mortality due to leptospirosis is two-fold higher in cases with pulmonary involvement.

[Hepatitis B in the Indian Ocean]

Bull Soc Pathol Exot 1998;91(1):44.

Roblin X, Gauzere BA, Paganin F.

Service de medecine interne, C. H. D Felix Guyon, Saint-Denis, La Reunion, France.

The study of the prevalence of the HBs antigen in the Indian Ocean islands allows the classification in the three usual groups, that reflect the social and economical levels. Further studies should measure the expected decline of prevalence of the antigen HbS, in fast-growing economy islands (Mauritius, Mayotte).

POEMS syndrome, steroid-dependent diabetes mellitus, erythema elevatum diutinum, and rheumatoid arthritis as extramedullary manifestations of plasma cell dyscrasia

Am J Kidney Dis 1998 Apr;31(4):E3.

Albitar S et al. Hemodialysis Center, Ste Clotilde de La Reunion, France.

[Role of Cahuzac's operation in clubfoot varus equina revision surgery]

Rev Chir Orthop Reparatrice Appar Mot 1998 Nov;84(7):638-645.

Laville JM, Bussieres F. Service de Chirurgie Infantile, CHD F. Guyon, La Reunion.

[First familial form of Crohn's disease in Reunion Island]

Gastroenterol Clin Biol 1998 Oct;22(10):838-839.

Verger P et al.

[MELAS syndrome in a five year-old child: clinical, biological and genetic characteristics]

Arch Pediatr 1998 Sep;5(9):1000-1003.

Edmar A et al. Service de pediatrie, centre hospitalier general, Saint-Pierre-de-la-Reunion, France.

[Cerebral venous thrombosis in the Ile de la Reunion. A series of 20 patients]

Neurochirurgie

Monnin L et al. UF Neuro-Anesthesie Reanimation, Centre Hospitalier Sud Reunion, Saint-Pierre, La Reunion.

Twenty cases of cerebral venous thrombosis (CVT) are reported. A significant majority of patients were young women receiving oral contraceptives. In the puerperium CVT were frequent and delayed; the number of septic lateral sinus thrombosis was the same as in the occidental countries. The clinical picture was not specific, and idiopathic intracranial hypertension or pseudotumor cerebri were not frequent. Focal signs were the most frequent clinical manifestations. The clinical course, of deep CVT was not as severe as previously reported. Due to the lack of MRI, only CT scan was performed for all patients. More than 50% showed direct signs of CVT (cord sign and delta sign). The diagnosis of CVT was confirmed by cerebral angiography. Early systematic treatment by heparin was used with neither appearance nor aggravation of hemorrhagic infarcts being observed. The outcome was favorable in 60% of the cases, except for venous hemorrhagic infarction.

Epidemiology of end-stage renal failure in Reunion Island (results from the registry of the Indian Ocean Society of Nephrology)

Nephrol Dial Transplant 1998 May;13(5):1143-1145.

Albitar S, Bourgeon B, Genin R, Schohn D, Fen-Chong M, Serveaux MO, Chuet C.

BACKGROUND: End-stage renal disease (ESRD) on long-term dialysis is a substantial problem in Reunion because of the high incidence and prevalence of this disease due to non-insulin-dependent diabetes mellitus (NIDDM) and systemic arterial hypertension. SUBJECTS AND METHODS: In 1996 the renal study group of the Indian Ocean Society of Nephrology established a regional registry of end-stage renal failure (ESRD) on long-term dialysis. The present report summarizes data obtained from this registry. RESULTS: In 1996, there were 125 patients who were initiated on long-term dialysis, 657 patients on dialysis with a mean age 52 +/- 17 years, and 110 patients with a functioning kidney graft. The incidence rate of ESRD was 188 per million population (p.m.p.) and the prevalence rate of this pathology was 1155 p.m.p. The sex ratio (F/M) was 1.4/1. The two most common causes of ESRD were NIDDM in 33.6% and systemic arterial hypertension in 27.5%. The mean Kt/V value was 1.47 +/- 0.23 and the mortality rate was 8.1% per year. CONCLUSION: The results demonstrate high incidence and prevalence rates of ESRD mainly as a result of NIDDM and systemic arterial hypertension.

[Human diseases transmitted by Culicidae in southwest Indian Ocean islands]

Bull Soc Pathol Exot 1998;91(1):

Julvez J et al. Laboratoire d'entomologie de Maurice, Hopital Victoria, Candos.

South-West Indian Ocean islands were inhabited at the beginning and free from all kind of vector. In Madagascar, Mayotte, Moheli and Anjouan, malaria vectors were carried by the first settlements. According to epidemics, the anopheles arrived in 1867 in Mauritius, 1869 in La Reunion and 1920 in Grande Comore. Rodrigues, Saint-Brandon and the Seychelles are still free from malaria vectors in the coastal part of Madagascarcar and in Comores archipelago, malaria is stable with a permanent transmission. Unstable malaria is seasonaly transmitted in the high territories of Madagascar; it was the same in Mauritius and Reunion island before the eradication campaign. Lymphatic filariasis is quoted in Madagascar, but Comores archipelago is an area with high transmission. The incidence of the disease is moderate in La Reunion and Mauritius and very low in Chagos and Seychelles archipelagos. There is no transmission in Rodrigues and St Brandon. Epidemics of dengue were described during the second part of the XIXth century in Mauritius and La Reunion, then in 1943 in Mayotte. But the disease was controlled in the fifties by the antimalaria campaign. A new epidemy appeared in Seychelles by the end of 1976 and then in Reunion and Mauritius next year. An isolated outbreak was described in Grande Comore only in 1994.

[Importation of Plasmodium falciparum malaria, in Reunion Island, from 1993 to 1996: epidemiology and clinical aspects of severe forms]

Bull Soc Pathol Exot 1998;91(1):95-98.

Gauzere et al. Service de reanimation, Centre hospitalier departemental Felix Guyon, La Reunion, France.

Located in the Indian ocean, Reunion island, a French overseas territory, is free of malaria since the 1960's. As malaria is still highly endemic in the neighbouring countries, imported cases are averaging 130 to 150 cases per year. (...)In Reunion island, imported P. falciparum still accounts for a high rate of morbidity and few fatalities, despite a sophisticated curative health system. Delay in diagnosis and institution of an appropriate treatment is frequent in non-immune persons who develop fever and non-specific symptoms. It markedly increases the risk of complications and death from falciparum malaria as well as morbidity cofactors. Emphasis must be placed on appropriate information of health personnel and travellers. (Excerpts)

[Insularity and epidemic risks in Reunion]

Bull Soc Pathol Exot 1998;91(1):52-55.

Michault A. Laboratoire de bacteriologie-parasitologie-virologie, Hopital de Saint-Pierre de La Reunion.

The risks of epidemics in Reunion island depend on determining or favourable factors. The determining factors, links in the epidemic chain, may or may not exist but they can be introduced from the outside. The risk of importing these factors is especially important when the exchanges with the epidemic zones are easy and frequent. Reunion island, at the moment exempt from certain pathologies such as malaria, dengue-fever and urinary Schistosomiasis, is a good example. However, if the presence of these determining factors is necessary, that is not enough in itself. Other factors come into play; in particular physical (leptospirosis) or socio-economic conditions (cysticercosis, intestinal parasitic diseases). The latter play a major role in the hygienic conditions and also in the research and prevention which are easier on an island.

[Prevalence of thyroid cancer in Reunion from scintigraphic data]

Bull Soc Pathol Exot 1998;91(1):22-25.

Montury et al. CHD Felix Guyon, Saint-Denis, La Reunion.

This work is a retrospective two years study of thyroid cancer, diagnosed in Reunion Island, using scintigraphic cold regions. Between April 1993 and April 1995, 1,364 thyroid scintigraphic studies were performed in the CHD F. Guyon at Saint Denis, Reunion). These studies resulted from all types of indication and of them 691 had cold regions, with 22 thyroid cancers among them, (i.e. a prevalence of 3.20% of cold areas). Analysis of these cancers allowed recognition of various characteristics. A large majority (82%) were in females, whose median age at the time of diagnosis was 49 years (as opposed to 48 years for the male patients). (...)Anatomical pathology investigation indicated six were papillary, five mixed, three vesicular nodule, four microcarcinoma, one each of anaplastic, one follicullar thyroid carcinoma, and two were metastases. (...) Some thought before detailed involvement should be given to the setting up of a team, trained in needle cell biopsy, and an associated metabolic radiotherapy facility, so allowing appropriate procedures and follow up for thyroid cancers in this "Department". (Excerpts)

[Registry of cancer in Reunion: data of the first five years of registration (1988-1992)]

Bull Soc Pathol Exot 1998;91(1):13-16.

Grizeau P, Vaillant JY, Begue A.

Cellule epidemiologie, prevention et education pour la sante - Conseil general, St-Denis de la Reunion, France.

After explaining the purposes of a general cancer register in Reunion Island and describing objectives and running, main results from 1988 to 1992 are introduced. Comparison with EUROCIM network shows that cancer standardized incidence (all sites) in Reunion Island is at the same level as in Martinique and lower than in other registers. Nevertheless some cancers are particularly frequent. For men, as for most European registers, lung cancer (15%) is the most frequent diagnosed cancer, followed by esophagus and stomach cancers. Reunion Island belongs to areas with highest incidence rates for esophagus cancer. Breast cancer (21%), despite a lower incidence than in Europe, is still the first female cancer, followed by cervix cancer (18%) which incidence, as in Martinique, is very high. We don't notice high discrepancies between mortality rates and incidence rates in Reunion Island during that period.

[Patent and occult intra-alveolar hemorrhage in leptospirosis]

Rev Mal Respir 1998 Feb;15(1):61-67.

Du Couedic L et al. Service de Pneumologie, CH Saint-Denis, CHD Felix-Guyon, Reunion.

PURPOSE: Pulmonary involvement (PI) is common in leptospiral infection, usually characterized by hemoptysis and diffuse bilateral infiltrates on chest radiographs. Alveolar haemorrhage (AH) has already been proved by autopsy and some case-reports with fiberoptic bronchoscopy (FB) and bronchoalveolar lavage (BAL). The purpose of this study was 1/to evaluate the incidence of AH in leptospirosis 2/to define the impact of BAL on the early diagnosis of the infection. PATIENTS AND METHODS: FB with BAL were performed in 23 consecutive patients with leptospirosis (13 patients with patent signs of PI: group 1, 10 patients without: group 2). AH was defined by a percentage of siderophages > or = 20% and/or a Golde score > 100 and/or an haemorrhagic aspect of BAL fluid. Culture tests were performed on specific medium. RESULTS: We diagnosed AH in all patients of group 1 and in 7 patients of group 2. Filaments were seen in 6 specimens of BAL fluid, initially thought to be leptospires, but culture tests were negative. CONCLUSION: AH is identified in all cases of leptospirosis with PI. Occult AH often occurs to patients without any respiratory symptom. Physicians should consider leptospiral infection in the differential diagnosis of AH. Culture-tests for leptospirosis in BAL do no help in diagnosing leptospirosis.

[Angiostrongylus in the infant at Reunion and Mayotte. Apropos of 3 cases of eosinophilic meningitis including 1 fatal radiculomyeloencephalitis with hydrocephalus]

Bull Soc Pathol Exot 1997;90(5):331-332.

Graber D et al. Service de pediatrie, Centre hospitalier departemental F. Guyon, St. Denis, France.

We report the first case of Angiostrongylus cantonensis infection in the French island of Mayotte (Comoro Islands) and we confirm the presence of this disease in Reunion island. In this Indian Ocean area, eosinophilic meningitis occurs most of the time in infants with sometimes severe radiculomyeloencephalitic forms. The origin of these occasionally massive infections is the giant African snail Achatina fulica. For a child with meningitis living in Reunion or Mayotte, or coming back from these 2 islands, Angiostrongylus cantonensis infection must be evoked, especially if there is a blood eosinophilia. Since efficiency of antiparasitic treatment is nowadays not proved, information must be given to people living in exposed areas in view to limit incidence of this disease.

[Natural history of chromoblastomycosis in Madagascar and the Indian Ocean]

Bull Soc Pathol Exot 1997;90(5):312-317.

Esterre P et al. Institut Pasteur, Madagascar.

The natural history of chromoblastomycosis was studied in Madagascar by analysing the characteristics of 1323 confirmed cases observed since 1955, including 45 patients receiving a new antifungic drug (terbinafine) during a multicentric study organized in 1995. Madagascar is the most important focus in the world (global prevalence of about 1 for 8500 inhabitants), with few sporadic cases in the other islands of the Indian Ocean (La Reunion, Comoro islands and Mayotte). (Excerpts)

Injuries in a problematic socioeconomic context: a population-based study in Reunion, Indian Ocean, 1993-1994

Int J Epidemiol 1997 Oct;26(5):1033-1040.

Masson F et al. Departement d'Anesthesie Reanimation, Centre Hospitalier Universitaire, Bordeaux, France.

BACKGROUND: This study was designed to estimate the incidence and describe the characteristics of injuries during a one-year period in the French island of Reunion, Indian Ocean, a defined geographic population with socioeconomic problems. METHODS: Cases were injuries from accidents (unintentional injuries), self-inflicted injuries (suicides and attempted suicides), or injuries purposely inflicted by other people, that resulted in hospital admission or death. Patients and injury characteristics were recorded prospectively, alternately every other week, in all emergency rooms on the island; all death certificates were studied. RESULTS: The overall annual incidence of injuries was 1578 per 100,000 residents. The three main causes of injury were (i) falls on the same level (23.6%), (ii) poisoning (23.0%) and (iii) traffic accidents (21.5%). Of the traffic accident cases, 44% were motorcyclists (mostly mopeds) and more than half of the cases were 15-25 years old. Suicides and attempted suicides accounted for 80.9% of poisonings, 35.5% of immediately fatal injuries, and 19.6% of non-fatal injuries. Homicides and assaults accounted for 8.3% of all injuries. The employment rate was lower for injured patients than in the total Reunion population (standardized ratio for males: 74; P < 0.001). Half of the injured hospitalized patients had an Injury Severity Score < 5 and 8 days after hospitalization, 83.5% of patients had returned home. CONCLUSION: Injury epidemiology may be affected by different demographic, socioeconomic, cultural and geographical factors. Targeted studies are therefore necessary to guide injury prevention measures.

Common origin of human T-lymphotropic virus type-I from Iran, Kuwait, Israel, and La Reunion Island

J Med Virol 1997 May;52(1):77-82.

Voevodin A, Gessain A. Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.

(…) The determination of the T-->C 4783 and T-->C 6569 markers in HTLV-I isolates of different geographical/ethnic origin may be useful for the reconstruction of the routes of HTLV-I spread from the Middle East and/or Indian subcontinent to other regions of the world and, possibly, for gaining insights into the origin of HTLV-I in Asia.

[Epidemiology of suicide attempts in Reunion Island]

Rev Epidemiol Sante Publique 1997 Mar;45(1):23-28.

Duval G, Baillet A, Catteau C. Centre Hospitalier Rene Dubos, Pontoise.

In order to specify the epidemiological characteristics of attempted suicides on Reunion island, a quantitative study was carried out, using Emergency Room registers of all the hospitals on the island. This enabled collection of 9526 files. The results revealed a high proportion of suicide attempts (335/100,000/year), particularly prevalent in rural areas to the south of the island. There was a tendency towards over representation of women, though less distinct than in Europe, as well as an abnormally frequent use of pesticides or herbicides. Medication and violent means were not used as often as in France. These outcomes, in particular the very high frequency (especially in the rural areas of the south), along with the significance of medico-psychological factors, should be taken into account by anthropologists, linguists, clinical specialists, in order to help determine preventive measures.

[Seroprevalence of cysticercosis, taeniasis and swine infection on Reunion Island in 1992]

Med Trop (Mars).

Chamouillet H et al. Faculte de Medecine, Limoges, France.

Cysticercosis is a parasitic disease commonly observed in developing countries in Latin America, Africa, and Asia. Many cases involving cerebral injury have been reported on Reunion Island, a French department in the Indian Ocean. The present article describes the findings of a seroprevalence survey performed from September 1990 to May 1992 using an ELISA technique. Out of a total of 1010 individuals randomly selected from the voter registration records of the island's 24 polling districts, 993 agreed to be interviewed and undergo blood testing. Samples from 14 individuals were positive for cysticercosis, indicating a seroprevalence of 1.4% with 95% confidence interval from 0.7 to 2.1%. Seropositive individuals were evenly distributed throughout the island with no statistical difference regarding sex and age. A retrospective study showed that diagnosis of taeniasis was uncommon (less than 0.02% of stool examinations for parasites). Meat inspection records showed that no pork had be seized due to taeniasis since 1993 but raising of pigs by private citizens without veterinarian control is still widespread. Living conditions are improving and eradication of endemic cysticercosis seems achievable by enforcing zoning codes and educating people about the need for proper meat handling and treatment of taeniasis.

Madagascar

[Dengue, arbovirus and migrations in the Indian Ocean]

Bull Soc Pathol Exot 1998;91(1):56-59.

Zeller HG. Institut Pasteur, Antananarivo, Madagascar.

An arbovirus requires a competent haematophagous arthropod for transmission from one vertebrate to another susceptible host. Air transportations allow quick transfers from place to place and the diffusion of potential vectors or infectious hosts. The merchandise transportation by containers allowed the diffusion of Ae. albopictus from Asia through Africa and America. Emerging arbovirusis may occur in zones where they do not exist. Dengue which originally was located in southeastern Asia, is the most important arbovirusis in the world. The occurrence of dengue haemorrhagic fever (DHF) in Asia and America, mostly in urban areas, increased the global concern about dengue. Likewise, cases of DHF are not reported in Africa and in the Indian Ocean southwestern islands. The principal vector of dengue, Aedes aegypti, was present during the dengue 1 outbreak in Comoros, in 1993. In the other islands, only few specimens of Ae. aegypti are observed, and described mostly as none anthropophilic forms. The role of Ae. albopictus as vector of dengue was suspected and reported during outbreaks in Seychelles and Reunion island in 1977-1978. Yellow fever, present in Africa mostly in restricted areas, is absent in Asia. Japanese encephalitis considered as an emerging disease in India could expand through the islands. Rift valley fever, with periodic epizootics in domestic ungulates in Africa, was described as a new disease in Madagascar in 1990-1991. Crimean-Congo haemorrhagic fever is also present in Madagascar. Humans can be infected by vector bite or by handling infectious animal products. The distribution of other viruses (West Nile, Sindbis, Wesselsbron or Chikungunya) is discussed.

[Drug resistance of Plasmodium falciparum along the borders of the highlands in Madagascar: outlook for a national control program]

Med Trop (Mars) 1998;58(3):261-265.

Milijaona R et al.

Laboratoire du Paludisme, Institut Pasteur, Antananarivo, Madagascar.

Resistance of Plasmodium falciparum to chloroquine was first suspected in Madagascar in 1975 and later confirmed in vivo and in vitro. (…). The three villages studied were located along the borders of the highlands between the plateaus and coastal areas. In vivo tests showed that the incidence of chloroquine resistance was 0% in Mahakary, 32% in Ankazobe and 30% in Saharivo. Clinically, however, treatment was unsuccessful in only 16% and 8% of cases respectively. In vitro tests demonstrated chloroquine sensitivity in 79% of the 153 strains tested. No resistance to quinine or halofantrine was observed. In vitro tests indicated an onset of resistance to mefloquine. Although the success rate of chloroquine treatment is nearly 80%, spread of strongly chloroquine-resistant strains is a risk especially in subjects with mild immunity to malaria.

Epidemiology of emerging/re-emerging antimicrobial-resistant bacterial pathogens

Curr Opin Microbiol Opin Microbiol.

McCormick JB.

Institut Pasteur, 28 Rue du Dr Roux, F-75724 Paris, France.

F1 antigenaemia in bubonic plague patients, a marker of gravity and efficacy of therapy

Trans R Soc Trop Med Hyg 1998 Sep;92(5):572-573.

Chanteau S, et al. Institut Pasteur, Antananarivo, Madagascar.

Reversibility of Schistosoma mansoni-associated morbidity after yearly mass praziquantel therapy: ultrasonographic assessment

Trans R Soc Trop Med Hyg 1998 Jul;92(4):451-453.

Boisier P et al., Institut Pasteur de Madagascar, Madagascar.

Factors determining compliance with tuberculosis treatment in an urban environment, Tamatave, Madagascar

Int J Tuberc Lung Dis 1998 Nov;2(11):891-897.

Comolet TM et al. Direction Regionale de la Sante, Conakry, Guinea.

(…) RESULTS: Default appears to be significantly linked to transportation time, the sex of the patient, patient information and the quality of communication between patients and health workers. False addresses given by patients are both a methodological bias and a risk factor for future default. CONCLUSION: Improved communication skills and attention from the medical staff could encourage more patients to complete their TB treatment.

[Effect of praziquantel on the uro-nephrologic complications of urinary bilharziasis]

Nephrologie 1998;19(6):347-351.

Rasendramino MH et al. Centre hospitalier universitaire Befelatanana, Antananarivo.

[Prevalence of uro-nephrologic complications of urinary bilharziasis in hyperendemic focus in Madagascar]

Nephrologie 1998;19(6):341-345.

Rasendramino MH et al. Centre hospitalier universitaire Befelatanana, Antananarivo.

[Update on plague in Madagascar]

Med Trop (Mars) 1998;58(2Suppl):25-31.

Chanteau S et al. Institut Pasteur de Madagascar.

After a thirty year period of successful control, bubonic plague showed the first signs of return in Madagascar where a fatal outbreak occurred in Antananarivo in 1978. A second outbreak was observed in Mahajanga in 1991 after more than a half century. In 1997, 459 confirmed or presumptive cases were reported, as compared to 150 to 250 cases during the last years. However the actual extent of this recrudescence must be placed in the perspective of a more efficient control program that has led to better reporting of suspected cases and availability of more accurate diagnostic techniques. Recent research has led to the development of highly effective immunological diagnostic tools (detection of antibodies and F1 antigen) allowing not only better surveillance of the disease in man and animals but also renewed study of the epidemiological cycle in the current environment. In this regard the capacity of several endemic fleas as vectors and the role of the rat Rattus norvegicus and the musk shrew Suncus murinus are currently under investigation. Genetic study of strains collected from 1936 to 1996 has demonstrated the appearance of 3 new ribotypes of Yersinia pestis since 1982 in the zones of strongest plague activity in Madagascar. A strain showing multiresistance to standard therapeutic antibiotic agents was isolated in 1995. Bubonic plaque is a priority health problem in Madagascar but remains a major concern for the rest of the world.

[Malaria in Antananarivo: evaluation of a post-epidemic situation]

Sante 1998 Jul;8(4):257-264.

Jambou R et al. Institut Pasteur de Madagascar.

Antananarivo is located in the highlands of Madagascar and was, until some years ago, thought to be a malaria transmission-free zone. However, between 1985 and 1990, several malaria cases occurred in the suburbs of Antananarivo. Numerous malaria cases have since been reported by health workers each year, but there is insufficient epidemiological information about the cause and origin of the transmission, because cases are rarely. Our findings confirm that malaria cases are mostly associated with a history of travel in areas with high levels of malaria transmission, particularly the coastal regions of Madagascar. Nevertheless, a low level of transmission may persist and lead to further outbreaks of malaria in the future, due to the presence in the area of Anopheles arabiensis. (Excerpts).

Ascaris lumbricoides intensity in relation to environmental, socioeconomic, and behavioral determinants of exposure to infection in children from southeast Madagascar

J Parasitol 1998 Jun;84(3):480-484.

Kightlinger LK, Seed JR, Kightlinger MB.

Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill 27599-7400, USA.

Ascaris lumbricoides worm counts were examined as the outcome products of exposure proxy variables. A survey of 663 children, 4-10 yr old, living in southeastern Madagascar revealed prevalences of 93% for A. lumbricoides, 55% for Trichuris trichiura, and 27% for hookworm. Worm expulsions were conducted on 428 of these children; the data revealed an overdispersed distribution of A. lumbricoides, with an arithmetic mean of 19.2 worms per child. A concurrent socioeconomic household survey was conducted by visitation and interview. Exposure to infection was assessed by environmental, demographic, behavioral, and socioeconomic indicators. Ascaris lumbricoides aggregations were associated with gender, housing style, ethnicity, and agricultural factors. The results suggest that exposure and infection are ubiquitous in this child population, and that A. lumbricoides intensity is influenced by gender-related behavioral and environmental factors that contribute to exposure.