Strategies should be developed to make cataract services affordable and accessible to the population in the rural areas. There is an urgent need to improve the outcome of cataract surgery. Refractive error services should be provided at the community level.

Status quo data on the age at menarche were obtained on samples of Cameroonian girls living in urban (Yaoundé) (n = 205), suburban (n = 505) and rural areas (n = 201). Mean ages at menarche, estimated by probit analysis, are 13.18 years (SD 1.08) in Yaoundé, 13.98 years (SD 1.55) in the suburban area, and 14.27 years (SD 1.65) in the rural area. The early menarcheal age observed in Yaoundé girls attending 'privileged schools' (12.72 years, SD 1.18) substantiates the hypothesis that in good environmental conditions Africans are as early-maturing as Asiatic or Mediterranean populations. Comparison with retrospective data on age at menarche during previous decades reveals the presence of a clear secular trend towards earlier maturation, at a rate of 2.5-3.2 months per decade, only in the main cities of the country (Yaoundé/Douala) and a lack of temporal variation in rural areas. The degree of urbanization influences maturational age and its evolution, probably through improvements in the nutritional standards.

Abstract. In support of ongoing immunologic studies on immunity to Plasmodium falciparum, demographic, entomologic, parasitologic, and clinical studies were conducted in two Cameroonian villages located 3 km apart. Simbok (population ϭ 907) has pools of water present year round that provide breeding sites for Anopheles gambiae, whereas Etoa (population ϭ 485) has swampy areas that dry up annually in which A. funestus breed. Results showed that individuals in Simbok receive an estimated 1.9 and 1.2 infectious bites per night in the wet and dry season, respectively, whereas individuals in Etoa receive 2.4 and 0.4 infectious bites per night, respectively. Although transmission patterns differ, the rate of acquisition of immunity to malaria appears to be similar in both villages. A prevalence of 50-75% was found in children Ͻ 10 years old, variable levels in children 11-15 years old, and 31% in adults. Thus, as reported in other parts of Africa, individuals exposed to continuous transmission of P. falciparum slowly acquired significant, but not complete, immunity.

Mannan (MAN) extracted from Candida albicans 20A was investigated for its potential as an antigen in the detection of cell-mediated immunity (CMI) in vivo and in vitro and for its ability to modulate CMI when administered intravenously (i.v.). CBA/J mice were either immunized as adults by the cutaneous inoculation of 106 viable blastoconidia or colonized as infants (primed) and then boosted cutaneously as adults. When immunized animals were footpad tested with MAN, highly signfficant delayed-type hypersensitivity (DH) responses were detected. The DH responses to MAN were of a greater magnitude than those noted with the same quantity of cell wall glycoprotein (GP), an ethylenediamine extract of the cell wall which contains both glucan and MAN. In contrast, GP was a better antigen for the detection of CMI responses in an in vitro lymphoproliferative assay with either spleen or lymph node cell suspensions. Mice treated with MAN i.v. prior to the initiation of immunization or between priming and secondary inoculations developed significantly suppressed DH reactions when tested with either MAN or GP. The lowest effective dose of MAN was 250 ,ug, maximum suppression occurred with 500 ,ug, and either dose given 1 week prior to immunization was suppressive. The suppression by MAN was specific for MAN or the MAN-containing GP. Responses to another unrelated candidal antigen, a membrane extract designated BEX, were relatively unaffected. MAN, therefore, was an effective antigen for the detection of CMI in vivo, and its administration i.v. created what appeared to be a MAN-specific suppression since it could be detected with both MAN and a MAN-containing extract from the cell wall. Caution must be exercised in the interpretation of these data, however, since the protein component of each of these extracts has not been characterized with respect to its potential role in the phenomena observed.

Because of the life-threatening, post-treatment reactions that have occurred in patients with loiasis treated with ivermectin, evaluation of a short-course albendazole regimen was undertaken in a Loa-endemic region of Cameroon. In a placebo-controlled, double-blinded, crossover study, 99 subjects with microfilaremia (100-3,3837/mL) were assigned to receive albendazole (400 mg; n = 48) or placebo (n = 51) for three days and were followed for 180 days; at day 180, the groups were crossed over and followed for an additional six months. In those initially receiving albendazole (ALB/PLAC), microfilarial levels decreased significantly by day 90 (P < 0.043), but returned to baseline by day 180. In those receiving albendazole at day 180 (PLAC/ALB), microfilarial levels also decreased following albendazole (P = 0.005). Blood eosinophil and antifilarial IgG levels did not change significantly for either group, although antifilarial IgG4 levels did in the ALB/PLAC group at day 180. Most subjects continued to have elevations in microfilaremia, suggesting that more intensive regimens of albendazole will be necessary to reduce Loa microfilaremia to levels safe enough to allow for ivermectin use.