Medecine tropicale et sante internationale最新文献

Background & rationale: Burkina Faso has been implementing preventive chemotherapy against lymphatic filariasis since 2001. While 61 health districts (HDs) have stopped mass drug administration (MDA), transmission persists in 9 HDs despite good reported MDA coverage. To validate the reported coverage, an independent post-MDA survey was conducted in Tenkodogo and Fada N'Gourma HDs in September 2018.

Materials & methods: The study population consisted of all persons in the visited communities. The Coverage survey sample builder (CSSB) tool was used to calculate the sample size and to conduct the random selection of households. A total of 30 villages per HD were selected. The investigators were Ministry of Education agents and health workers not involved in MDA. Data were collected on smartphones through the KoBoCollect application regarding age, sex, drug ingestion (ivermectin + albendazole), adverse events, and whether respondents understood MDA guidelines. Stata Version 14 software was used for data analysis.

Results: A total of 3,741 individuals were surveyed, 53.3% were female and the median age was 14 years. Surveyed epidemiological coverage was 74% [95% CI: 72-76.1] in Fada N'Gourma and 79.1% [95% CI: 77.2-80.9] in Tenkodogo, compared to reported coverages of 82.6% and 83% respectively. Village-level coverage ranged from 32.9% to 100% in Fada N'Gourma and from 56.7% to 93.3% in Tenkodogo. In total, 99% of those treated said they had swallowed the drugs in front of the community drug distributor (CDD) and confirmed the use of dose poles. The main reasons for non-treatment were non-visitation of the compound by CDD (54%) and absences during MDA (43%). Results showed that surveyed coverage was lower than reported coverage in both HDs, yet both were above the 65% threshold recommended by WHO. However, major variations of coverage have been noted among villages. Directly observed treatment appeared to have been well respected.

Discussion & conclusion: The main challenges to increase coverage will be the systematic revisiting of households with absentees and the targeting of all households in each village.

Introduction: Snakebite is one of the most deadly neglected tropical diseases in Africa with more than 20,000 deaths reported each year. According to recent data from hospital in Central African Republic studies, the Paoua health district reports between 300 and 400 cases of ophidian envenomation each year. However, no epidemiological study on snakebites has been conducted at national level, nor a control strategy developed. The objective of this study is to describe the epidemiological aspects of snakebites in two rural communities, one located in savannah zone and the other in forest zone (both secondary and primary forest) in order to ensure adequate management of snakebites in these regions.

Method: Prospective community-based study in two health districts in the Central African Republic, the health district of Paoua in savannah area and the health district of Mbaïki in forest area, from December 2019 to January 2021. Snakebites were investigated in the community by selected trained people in charge of reporting data regarding all known cases of snakebites occurring during the study period. The data were actively notified either by health personal or community health workers in order to determine the circumstances and severity of the bite, its management and the clinical course in case of envenomation.

Results: A total of 412 snakebite cases were recorded during the study period, of which 198 cases occurred in the rural community of the forest zone and 214 in the community of the savannah zone. Case fatality rate was 5% in the forest zone and 1% in the savanna zone. The incidence rate of snakebite was significantly higher in savannah children compared to those in the forest (98/100,000 vs. 25.1/100,000; p<0.00001) while this incidence rate was significantly lower from age 45 onwards in the savannah area compared to the forest area (167/100,000 vs. 200/100,000; p=0.02). The case fatality rate of children and adults up to 44 years of age appeared to be significantly higher in the forest zone (7 deaths vs 1 death). Snakebites occurred significantly more frequently during field activities in the savannah zone than in the forest zone (51% vs 26%; p<0.0001). The symptomatology of bites was dominated by edema of the bitten limb and bleeding in the two study areas, compatible with cytotoxic and hemorrhagic syndromes due to viper bites.

Conclusion: With an incidence rate of more than 160 cases per 100,000 inhabitants in the active population aged 15-44 years in rural communities of the forest and savannah zone, snakebites remain a public health problem in Central African Republic. A study on the toxicity of snakebites in Central African Republic is recommended. Besides, it is urgent to make anti-venomous serums available in health facilities in order to reduce the mortality related to the envenomation.

Introduction: Syphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis occurs only in 0.6 percent of patients. A resurgence of syphilis cases has been observed for several years in many countries, especially in HIV-infected subjects. These patients often present with concomitant primary and secondary lesions or extensive presentations of syphilis.

Case reports: We report 2 patients with syphilitic uveitis diagnosed and treated at the department of infectious diseases at the University hospital of Marrakech. Ocular involvement was inaugural in both HIV patients. Each had a specific treatment, but none had a complete recovery of visual function; the first patient was treated by ceftriaxone and the second one was treated by penicillin.

Conclusion: Syphilis must be discussed in all patients diagnosed with uveitis or papillitis. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Although not evidence-based, prompt therapy may lead to functional recovery. Ceftriaxone could be a suitable alternative to penicillin in the treatment of early syphilis in HIV-infected patients. This treatment has a concomitant effectiveness even for asymptomatic forms of neurosyphilis. Ocular syphilis is a form of neurosyphilis and requires neurosyphilis therapy regardless of when it develops after primary infection.Conventional syphilis staging is of little use in understanding ocular syphilis. Co-infection between HIV and ocular syphilis is common, but does not affect response to a neurosyphilis regimen of penicillin in the short term.

Introduction: A benign tumor of middle-aged women, mucinous cystadenoma accounts for about 20% of tumors of the ovary. It can reach very large sizes.

Clinical observation: We report the case of a 42-year-old patient received for a voluminous abdomino-pelvic mass. The examination found a soft, rounded, fairly mobile abdomino-pelvic mass going up to the level of the xiphoid appendix with a light skin and collateral venous circulation. Imaging showed a circumscribed fluid formation occupying the abdomino-pelvic cavity of 40.1 x 29 x 25.7 cm developed at the expense of the ovary. A laparotomy brought to light a voluminous cyst at the expense of the left ovary with fluid content cowardly adhering to the abdominal wall and intimately to the left proboscis. The uterus and right adnexa were unremarkable. We performed a left adnexectomy with satisfactory hemostasis taking away the cyst. The adnexectomy piece weighed 13.5 kg. The surgical follow-ups were simple. Anatomo-pathological examination confirmed a mucinous cystadenoma of the ovary.

Conclusion: Mucinous cystadenoma of the ovary is a benign tumor which can reach very large volumes. Its treatment is surgical and the follow-ups are usually simple.

Background: Malaria is a parasitic disease caused by a hematozoan of the genus Plasmodium. Early diagnosis followed by effective treatment is one of the keys to control this disease. In Madagascar, after more than 60 years of use for the treatment of uncomplicated malaria, chloroquine (CQ) was abandoned in favor of artesunate + amodiaquine (ASAQ) combination because of high prevalence of CQ treatment failure. Surveillance based on the assessment of therapeutic efficacy and genetic markers of resistance to antimalarials is therefore essential in order to detect the emergence of potentially resistant parasites as early as possible. In this context, our study aimed to genotype the Plasmodium falciparum chloroquine resistance transporter gene or Pfcrt and Plasmodium falciparum multidrug resistance gene 1 or Pfmdr1 in isolates collected from children in the district of Vatomandry.

Methods: A total of 142 P. falciparum isolates collected during active case detection of malaria in children under 15 years old, between February and March of 2016 and 2017 in Vatomandry district, were analyzed. Pfcrt (K76T codon) and Pfmdr1 (N86Y codon) genotyping was carried out by polymerase chain reaction followed by enzymatic digestion (restriction fragment length polymorphism) or PCR-RFLP.

Results: The successful rates of amplification of Pfcrt and Pfmdr1 genes were low, around 27% and 39% respectively. The prevalence of isolates carrying the mutant Pfcrt K76T codon and the mutant Pfmdr1 N86Y codon was 2.6% [95% confidence interval (95% CI): 0.1 - 15.0%] and 36% [95% CI: 23.7 - 49.7%] respectively.

Conclusion: Despite the limited number of samples analyzed, our study highlighted the circulation of isolates carrying both the mutant Pfcrt K76T and Pfmdr1 N86Y alleles. Although the prevalence of mutations in Pfcrt and Pfmdr1 genes that we observed was low, other studies should be carried out in order to follow the evolution of these markers in time and space. The use of more sensitive methods will better characterize P. falciparum strains circulating in Madagascar. Artesunate-amodiaquine is used as a first-line treatment for uncomplicated malaria in the country; it is also crucial to monitor the other codons, i.e. 184 and 1246 of the Pfmdr1 gene, implicated in the resistance of P. falciparum to amodiaquine in Africa.

Objective: The aim of this study was to establish the overview of current dermatosis in children in dermatological consultation in Lomé and to deduce the evolutionary trend of these dermatoses between 1992 and 2020.

Method: This was a retrospective descriptive study concerning patients aged 0 to 15 years seen in consultation in the public dermatological services of Lomé from January 1, 2010 to December 31, 2019. The reasons for consultation were reviewed and classified into groups of dermatosis (immunoallergic, infectious, inflammatory, tumoral …). The results of this series were compared with those of a similar study carried out in 1992.

Results: During the study period, 3 767 children attended showing dermatological condition (14.2% of the dermatological consultations were pediatric). The average age of the patients was 7.4 years and the sex ratio M/F was 0.7. July, August and September were the months with the highest number of consultations. The top three reasons for consultation were eczema (26.6%), prurigo strophulus (15.3%) and atopic dermatitis (4.9%). 51.3% of skin diseases in children were represented by immunoallergic dermatoses, followed by infectious dermatoses 23.6%. The predominant infectious dermatoses were fungal (34.4%) and bacterial (30.3%). Between 1992 and 2019, there was an increase in the prevalence of immunoallergic dermatoses and a reduction in infectious dermatoses.

Conclusion: Immunoallergic dermatoses are predominant and clearly increasing among children seen in dermatological consultations in Lomé.

In Côte d'Ivoire, a country of 28 million inhabitants in West Africa, a survey conducted by the Ministry of the Family in 2018 showed the extent of gender-based violence (GBV) in the Greater Abidjan area (5 million inhabitants), the country's economic capital. The social workers employed for this work were mobilized during the Covid-19 pandemic to raise awareness and help the population fight against SARS-CoV-2. The results collected by these workers during the first period (January 2019 - February 2020) and the second period (March 2020 - April 2021) are the subject of this article.From the first period to the second, the number of rapes increased from 41 to 77, sexual assaults from 4 to 7, physical assaults from 139 to 171, and forced marriages from 4 to 7. In total, the social workers helped 303 victims during the pre-pandemic period and 402 during the pandemic. This evolution varies from municipality to municipality in the Greater Abidjan area, and is not related to the number of inhabitants per municipality and without any link with the frequency of Covid-19 in each municipality. Despite possible biases, this study highlights a major health problem, GBV, and demonstrates the probable negative effects of the pandemic.

Background: The Ghana Neglected Tropical Diseases control program aimed to raise population awareness on soil-transmitted helminth (STH) infections and achieve a 100% coverage of preventive chemotherapy (PCT) by 2020. This study aims at determining the factors associated with the knowledge of school-age children and describing their perceptions at Krachi East Municipal in Ghana.

Patients and methods: It was a cross-sectional study. Children and their caregivers were selected from 8 communities following a two-stage stratified sampling. Descriptive statistics and binary logistic regression were performed at a 5% significance level.

Results: 352 children and their caregivers were surveyed, mainly from Dambai (66.48%). The median age was 11 (IQR: 9-12) years and the children aged 7-14 years. About half of the children were males (53.13%) and most caregivers were females (66.48%). Most children perceived a benefit associated with PCT (94.89%). The proportion of children perceiving a health risk did not differ significantly from those not perceiving a risk (49.72% vs 50.28%; p=0.8802). In general, children had poor knowledge (91.19% vs 8.81%; p<0.0001). Good knowledge was associated with ethnic group [Guan: aOR=3.96 95%CI 1.11-14.12; p=0.034], child age [(11-12 years: aOR=6.05 95%CI 1.21-30.22; p=0.026); (13-14 years: aOR=8.19 95%CI 1.64-40.89; p=0.010)] and caregivers' sex (Female: aOR=2.97 95%CI 1.02-8.66; p=0.046) in the adjusted model.

Conclusion: Younger children and male caregivers seem to have low knowledge of intestinal worms and PCT. Therefore, they must get more attention regarding health education.