Oral lesions associated with HIV infection as classified by the WHO Collaborative Centre for Oral manifestation of HIV were studied in 83 heterosexual AIDS patients in Kinshasa, Zaire. One or more lesions were fungal (94%), bacterial (33%) and viral (23%). Neoplasm was found in 12% of cases while lesions of unknown etiology in 14%. As location of those lesions, the palate, lips, tongue and the buccal mucosae mostly predominate as sites. The findings from this study were clinically similar to those reported in AIDS in other areas.

Background: In the Democratic Republic of Congo, it was reported in 1995 that the routine coverage for BCG was as low as 47%, and that it was 27% for DPT3, 28% for OPV3 and 39% for measles vaccine. The trend also was declining unevenly. This study aimed to determine the reasons for such low coverage, examining the socio-demographic characteristics of mothers and health system factors such as health services barriers. It further sought to assess the knowledge, attitudes and practices of mothers associated with routine immunisation. Methods: In 1999, a cross-sectional household survey applied a systematic sampling technique in a sample of eight out of the 22 health zones that then served the population of Kinshasa. These were dichotomised into low-and high-coverage health zones, based on BCG immunisation coverage. Mothers of children aged from zero to four years were the respondents to a standardised questionnaire. Results: A total of 1 613 children aged zero to four years participated in the study. Awareness of immunisation and its importance in protecting a child against diseases was universal, although most mothers could not tell exactly against which diseases. Mothers had positive attitudes towards immunisation (98%). Coverage based on the immunisation card, however, was as low as 37%, indicating a discrepancy between the high level of knowledge and positive attitudes, with the observed low immunisation coverage. The father's education and the mother's experience of an EPI-targeted disease in the family emerged as significant predictors of complete immunisation of the child. The father's involvement and the mother's ability to cite signs of severity of EPI diseases were associated with the child's vaccination status in the high-coverage health zone. The mother's vaccine-related knowledge was a predictor of immunisation status only in the low-coverage zone. Conclusion: Different factors determine the complete vaccination status, depending on whether the child lives in a zone with low or high routine EPI coverage. For example, the father's involvement is associated with the child's vaccination status in the highcoverage zone, but not in the low-coverage zone. Programmes and policy makers should take these factors into account when designing strategies to increase immunisation coverage. This article has been peer reviewed. Full text available at www.safpj.co.za

In Lisala, Equateur province, Zaire, 25 patients from 21 pedigrees were identified with human T-lymphotropic virus type 1 (HTLV-1) associated tropical spastic paraparesis (TSP). In the 10 (48%) pedigrees with additional genuine TSP cases established mainly by history, seven of 10 patients' mothers, no fathers or spouses, one of 59 surviving offspring, five of 105 siblings, and six other close blood relatives had TSP. A child may develop TSP before its mother. Three familial cases were in paternal relatives only. In total, 39 cases (11 men, 28 women) were identified in this population of about 50,000. Half were in the Mundunga minority of < 10% (p < 0-001). The data suggest maternal transmission of HTLV-I and enhanced TSP susceptibility in those infected due to familial, probably genetic factors. CentreNeuropsychopathologique, University of Kinshasa,

We assessed the relationship between key trace elements and neurocognitive and motor impairments observed in konzo, a motor neuron disease associated with cassava cyanogenic exposure in nutritionally challenged African children. Serum concentrations of iron, copper, zinc, selenium, and neurotoxic lead, mercury, manganese, cadmium, and cobalt were measured in 123 konzo children (mean age 8.53 years) and 87 non-konzo children (mean age 9.07 years) using inductively coupled plasma mass spectrometry (ICPMS). Concentrations of trace elements were compared and related to performance scores on the Kaufman Assessment Battery for Children, 2nd edition (KABC-II) for cognition and Bruininks-Oseretsky Test, 2nd edition (BOT-2) for motor proficiency. Children with konzo had low levels of selenium, copper, and zinc relative to controls. Selenium concentration significantly correlated with serum 8,12-iso-iPF2α-VI isoprostane (spearman r = 0.75, p < 0.01) and BOT-2 scores (r = 0.31, p = 0.00) in children with konzo. Elemental deficiency was not associated with poor cognition. Mean (SD) urinary levels of thiocyanate were 388.03 (221.75) μmol/l in non-konzo compared to 518.59 (354.19) μmol/l in konzo children (p < 0.01). Motor deficits associated with konzo may possibly be driven by the combined effects of cyanide toxicity and Se deficiency on prooxidant mechanisms. Strategies to prevent konzo may include dietary supplementation with trace elements, preferentially, those with antioxidant and cyanide-scavenging properties.

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