TRADITIONAL UVULECTOMY IN NIGER - A PUBLIC-HEALTH PROBLEM

Although traditional uvulectomy, a procedure which consists of cutting away a part of the uvula, has been reported in several sub-Saharan Af rican countries, in Maghreb and in Israel, epidemiological and anthrop ological data on this practice are rare. Severe complications may requ ire hospitalization. The goal of this study was to assess the prevalen ce of this traditional procedure in Niamey, capital of Niger, the inci dence of its severe complications and the beliefs and practices relate d to it. By the age of 5, 19.6% of the children in our survey had unde rgone uvulectomy. Severe complications of uvulectomy represented 7.8/1 000 cases of hospitalization for children under 15 years of age. Compl ications were infections (including tetanus), hemorrhage and passage o f the cut piece of uvula further down the respiratory tract. The child ren who had undergone uvulectomy belonged significantly more often to the Hausa ethnic group (66.2%) than to the majority Zarma ethnic group (18.3%) or to the other ethnic groups (15.5%). This can be explained by the fact that, in some Hausa subgroups, uvulectomy is systematicall y performed on the 7th day after birth, during the naming ceremony, to prevent death due to a 'swelling of the uvula'. In the other Hausa su b-groups and in the other ethnic groups, uvulectomy is solely a curati ve practice, both for children and adults, for vomiting, diarrhea, ano rexia, the child's rejection of the breast, growth retardation and fev er. Uvulectomy is performed in Niger by the barbers, whose functions a re also to perform specialized surgery. These traditional surgeons cla im there is no risk to this practice. However, this study showed that incidence of severe complications (for cases admitted in the hospital) was low but that the risk of death was high for complicated cases. A dialogue between medical institutions and the barbers associations sho uld be initiated.