Evidence for a mass community effect of insecticide-treated bednets on the incidence of malaria on the Kenyan coast.

The use of insecticide-treated bednets (ITBNs) has been shown to be effective in reducing mortality and morbidity from malaria. However, there is mixed evidence as to whether or not community-wide use of ITBNs engenders a 'mass effect', such that those not sleeping under bednets are offered protection from widespread ITBN use in the area in which they live. We have analysed data collected in Kilifi, Kenya, from a cohort of children followed from birth to investigate how the degree of net usage in the locality of a child affects the risk of developing malaria. This effect was explored using a Cox proportional hazards model. For those not using ITBNs, we found that an increasing level of ITBN usage within the area surrounding each child was associated with a decreasing risk of developing malaria, thus providing evidence in support of a mass community effect. The size and significance of this effect were found to decrease as non-overlapping areas of increasing distance away from a child's home were considered. The effect was significant for areas at distances of up to 1.5 km away from each child

Traumatismes Balistiques Au Chu De Bobo-Dioulasso (Burkina Faso) : A Propos De 39 Cas

Introduction : Cette étude a été menée dans le but de décrire les aspects épidémiologiques, diagnostiques et thérapeutiques des traumatismes balistiques au Centre hospitalier universitaire Sourô Sanou (CHUSS) de Bobo-Dioulasso.Matériel et Méthodes : Il s’agissait d’une étude rétrospective sur 18mois (du 1er janvier 2008 au 30 juin 2009). Elle a concerné tous les patients admis aux urgences chirurgicales du CHUSS pour un traumatisme balistique récent. Les caractéristiques démographiques, diagnostiques ainsi que le traitement et l’évolution à cours terme des patients ont été notés.Résultats : Trente neuf patients répondaient aux critères d’inclusion. Le sexe masculin était le plus touché (87,2%). L’âge moyen a été de 28 ans. Les cultivateurs et les commerçants étaient les principales victimes (71,8%). Le traumatisme était d’origine accidentelle dans 58,9%. Le siège le plus fréquent des lésions a été l’appareil locomoteur avec une prédominance au membre thoracique. Tous les patients ont bénéficié d’un parage des plaies, d’une prophylaxie antitétanique et antibiotique. Les fractures et luxations ont été traitées orthopédiquement dans 10 cas et chirurgicalement dans 5 cas. Sept patients ont été amputés secondairement. Le taux de mortalité intra-hospitalière était de 10,3% (n=4).Conclusion : Les traumatismes balistiques sont peu fréquents dans notre centre mais responsables d’une morbi-mortalité élevée. Une politique rigoureuse de contrôle des armes à feu et une meilleure éducation des populations pourraient réduire l’incidence de ces traumatismes en pratique civile.Mots clés : Traumatisme, Arme à feu, Chirurgie, Bobo-Dioulasso.ABSTRACTBackground: This study was conducted to describe the epidemiology, diagnosis and treatment of gunshot injuries at Sourô Sanou University Hospital in Bobo-Dioulasso.Patients and Methods: This was a retrospective study over 18 months (January 2008 to June 2009). It concerned all patients admitted with a recent gunshot injury. The demographic characteristics, diagnosis and treatment and short-term course of patients were noted.Results: Thirty nine patients were admitted for gunshot injury during the study period. The male was the most affected gender (87.2%). The average age was 28 years. Farmers and traders were the most affected (71.8% of cases). The aetiology of trauma was mostly accidental (58.9%). The most common injury was musculoskeletal (n = 34) with a predominance of upper extremity. We noted 15 cases of fractures and 6cases of dislocation of member, 2 cases of neurotrauma (brain and spinal cord) and 2 cases of digestive visceral lesions. All patients received debridement of wounds, a tetanus and antibiotic prophylaxis.Fractures and dislocations have benefited from a non surgical treatment in 10 cases and surgery and in 5 cases. Seven patients were amputated secondarily. The mortality rate was 10.3% (n=4).Conclusion: Gunshot injury are uncommon but serious in our center. A policy of strict control of firearms and better educated populations could reduce the incidence of such injuries in civilian practice.Keywords: Bobo-Dioulasso, Burkina Faso, Gunshot, Injury, Surgery