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The purpose of this prospective study conducted from March to December 2000 in the Internal Medicine Department of the Sanou Souro University Hospital in Bobo-Dioulasso, Burkina Faso was to evaluate the epidemiological, clinical, biological and prognostic features of severe malaria in adult patients according to their HIV status. During the study period HIV testing was performed in 37 of the 72 adults with confirmed severe malaria. Findings were positive in 12 cases and negative in 25. The mean age of the 12 seropositive patients with severe malaria was 32.4 +/- 2.8 years and most (50%) had used self-prescribed antimalarial treatment. The most common reasons for seeking medical care were fever, headache and deterioration of general health. The main manifestations of severe malaria were coma (n=4), generalized seizure (n=4) and circulatory collapse (n=4). Six patients (50%) presented two severe manifestations. Mean parasitemia at the time of admission was 4066 parasites/microl for seropositive subjects versus 8563 parasites/microl for seronegative subjects. Outcome of malaria included 4 deaths and 8 recoveries in the seropositive group versus 2 deaths and 23 recoveries in the seronegative group. Comparison with the group of 25 seronegative patients presenting severe malaria demonstrated no significant difference in mean age (p=0.96), self-prescribed antimalarial treatment (p=0.50), parasitemia upon admission (p=0.28), or mortality (p=0.07). However co-infected patients were found to have a higher incidence of anemia (P=0.01) and never presented certain manifestations of severe malaria. Further studies of co-infection by HIV infection and malaria (especially severe malaria) is needed given the high human and economic impact of these two diseases in sub-Saharan Africa.

From March to December 2000, we carried out a prospective study in the emergency and the internal medicine wards of Bobo-Dioulasso central hospital (Burkina Faso). Among 280 adults with clinical diagnosis of severe malaria, only 60 were confirmed to have severe forms of malaria after the laboratory investigations. Most of these patients (49 cases) were living in the city. The average age was 29.2 years +/- 13.1. At hospital admission, the average temperature was 39.1 degrees C +/- 1 and signs of severe malaria were dominated by impaired consciousness (43 cases), multiple convulsions (6 cases) and severe anaemia (6 cases). Two of these signs were associated in the third of patients. The average parasite density at admission was 11,660 parasites per microliter. 85% of patients hospitalized recovered, 8% died and 7% escaped. The control thick smear at day 3 showed that 23% of patients were still positive. At day 7 none of them was positive. Malaria in adults in urban area is a phenomenon which needs to be assessed and followed in African big towns.

A retrospective study covering ten years (1987-1996) was conducted to assess the epidemiology, clinical features and management of cancrum oris (noma) in children from Burkina Faso. Fifty nine (59) children were admitted with cancrum oris at the paediatrics and maxillo-facial surgery units of Bobo-Dioulasso, the second town of Burkina Faso. The hospital prevalence of noma is 1.5/1000. 81% of the cases were in the 1 to 5 years age group and 58% were females. Predisposing factors include poverty, lack of immunization, malnutrition, bad oral hygiene, measles and parasitic diseases. The cheek was involved in 31% of the cases. Cure was obtained in 80% of patients after medical and surgical treatment. However, many sequels were observed. Post operative outcome is complicated by the children's growth and often results in retractions, recurrence of ulcers or constriction. Psychological and social problems are associated. Management is difficult in our setting because of the lack of information, cost of the treatment and the absence of well-equipped plastic surgery units.

A questionnaire survey was conducted in the Dakar region (Senegal) between August and October 1992 to investigate diagnosis and treatment practices for uncomplicated malaria attacks in the health care facilities. The sample consisted of 208 prescribers in the operational sense i.e. 20% of the following professional categories: medical doctors, health care technicians, birth attendants, qualified nurses, and auxiliary nurses. A thick smear was mentioned as a diagnostic element by 23% of the practitioners; chloroquine remained the first choice drug for 80% of the personnel but 13% declared prescribing parenteral quinine for uncomplicated malaria in patients without vomiting; halofantrine and the association sulfadoxine-pyrimethamine-mefloquine are prescribed by respectively 7 and 1% of the personnel, also in the public sector; chloroquine is prescribed in an effective dose (25-40 mg/kg) by 74% of the personnel for adults and by 43% for children; quinine base in a dose below 25 mg/kg by 100% of personnel for adults and by 99% for children; nearly half of the prescribers do not take into account the children's weight; 13% of the practitioners prescribe useless expensive symptomatic treatments and 45 to 73% ignore the price of the common antimalarials, allowing for a 10% error; health care workers have a bad knowledge of the results of chemosensitivity surveys. The development of a national malaria control programme that emphasises permanent training of the health care workers and control of therapeutic information seems mandatory.