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Biomedical subjects

J P Chippaux

Publications and source records attributed to J P Chippaux.

At least 19 recordsLinked to original sources
PubMed2006

Low malaria morbidity in a cohort of Senegalese children with free access to health structures.

We report the impact of the free access to health facilities on malaria morbidity in children from two to 15 years old, during a malaria transmission season in Niakhar, Senegal. Between July and December 2002, 227 malaria attacks occured in 566 children. Only one case of severe malaria was observed and no death has been reported. Our results demonstrate furthermore that easier access to health facilities and to early treatment is playing a key role in malaria control.

Adolescent↗
PubMed2006

[Venomous and poisonous animals--I. Overview].

Venomous animals that are able to innoculate or inject venom and poisonous animals that cannot inject venom but are toxic when ingested belong to all zoological groups. They can be encountered worldwide in any ecosystem on land and at sea but they are more common and more dangerous in tropical areas. This first article of a series to appear in the next issues of Medecine Tropicale presents an overview of species involved in envenomations and poisonings. In addition to a brief reviewing geographic risks and circumstances in which bites, stings or ingestion occur, some information is provided about antivenim therapy, the only etiological treatment.

Amphibians↗
PubMed2006

[Venomous and poisonous animals. II. Viper bites].

Vipers are the main cause of the snake envenomations on all continents except Australia where they are none. Viper envenomation may lead to a minimal inflammatory syndrome with clinical (pain, edema) and biological (hyperleukocytosis, proteinuria) manifestations that may be accompanied by hypotension or shock. Emergency situations are due to hemorrhagic syndrome. In frequent cases in which envenomation is limited to a dramatic decrease in coagulation factors without clinical manifestations, severe local or systemic hemorrhage may occur especially if treatment is delayed. Necrotic complications around the bite or in distant vital organs are not uncommon and require careful medical and surgical surveillance. Intravenous antivenom therapy is the only effective treatment. It should be given as soon as possible but can be effective even when administered several days after the bite.

Animals↗
PubMed2005

[Ophidian envenomations and emergencies in Sub-Saharan Africa].

In West Africa, the ophidian envenomations constitute a frequent medico-surgical emergency that has been identified both by health officers and the patients themselves or their circles. Yet, their management is highly insufficient. The impact of this event is extremely underestimated. A compilation of recent studies has allowed the assessement of the annual number of snakebites at more than one million among which 500,000 envenomations. There would be about 20,000 deaths each year among which only a small part is reported by the national health departments. The circumstances and context of the accidents do not favor a care management of these cases. The bites often occur in remote countryside, far from dispensaries and even more from hospitals. The consultation delays are very important, between 4 and 48 hours. In addition, the patients are often reluctant to choose the therapeutic course: 50 to 90% of them are willing to consult a traditional practitioner first. The clinical table, in theory relatively simple, is not correctly analyzed by health officers: the respiratory distress after a cobra envenomation is only treated exceptionally by an artificial respiration although life-saving and haemorrhagic syndromes are only diagnosed after the haemorrhages externalisation. The treatment is ill-codified and still remains unknown by most of health officers. The antivenom, which is the only efficient etiologic treatment, is not available. Less than 1% of the needs are now covered and the treatment cost corresponds to several months of a farmer family's income. Three important issues prevail now in West Africa:--A more precise epidemiological evaluation of the envenomation accidents would help to identify the needs;--A better availability of drugs and particularly of antivenom would significantly reduce the mortality;--An appropriate training of health staff, particularly those working in peripheral health centres, would lead to the development of intensive cares. Thus, it is expected to reduce by 90% the mortality rate in the next ten years.

Africa South of the Sahara↗
PubMed2005

[Methodology for household surveys: the case of two investigations carried out (example of Bandafassi, Senegal)].

The survey area of Bandafassi, in Eastern Senegal, was the subject of two studies each allowing to measure the risk of bite and death consecutive to a snakebite in a rural area. Two different methods were being used to carry out these investigations. Although both were based on the visit of households, the sample of the first study was designed to be representative of the population (the zone of study of Bandafassi is the subject of a regular demographic follow-up since 1970) while the second study was carried out by interviewing the concession (groups of households) heads. Therefore, the analysis of these surveys must take into account the sampling discrepancies. In spite of the different methodologies, similarities in the results obtained validate both methods and permitted to explain the small variations observed and to measure bias relative to this type of investigations.

Data Collection↗
PubMed2005

[Appraisal of snakebite incidence in Senegal, West Africa].

Surveys were carried out in four savannah areas of Senegal. The studied zones had different climatic, economic and demographic characteristics. Two types of studies were performed: on the one hand, a retrospective survey carried out in health centres and, on the other, household surveys in the corresponding areas; all households were questioned in Niakhar, but only selected households in other areas following WHO method of cluster survey for vaccine coverage. Questions involved the circumstances of the bite, symptoms and treatment. The retrospective survey reported very few cases of snakebites over the prospected period. In addition, two zones of surveys were population study areas under observation since more than 20 years and, it has been possible to check certain information in the data base. In the first zone, Thies, a sub-urban area (population density higher than 150 inhabitants per km2), primarily occupied by fruit plantations (mangos, oranges, lemons) and gardens, the annual incidence of snakebites (i.e. all snakebites including those without any symptoms) reached 43 bites per 100,000 and mortality was 1.8 deaths per 100,000. In the study zone of Niakhar, located in the groundnut culture area of Senegal which is also highly populated (130 inhabitants per km2), the incidence of snakebites was 23 bites per 100,000 and mortality was close to 1.8 deaths per 100,000 a year. The area of Nioro du Rip is a mixed agricultural area (food producing and revenue agriculture) and less populated (100 inhabitants per km2). The annual incidence was roughly of 304 per 100,000 and the mortality 3.6 per 100,000. Finally, the fourth area, Bandafassi in the extreme South-East of Senegal is a mountainous zone exclusively occupied by bush and food producing agriculture, and sparsely populated (20 inhabitants per km2). The incidence was 915 per 100,000 and the mortality 11 deaths per 100,000. The population at risk involved males from 15 to 45 years. Pastoral work (agriculture and breeding) was at the origin of the majority of the accidents. The recourse to traditional practitioners was systematic, which explained why the data from the health centers were not relevant enough to evaluate the importance of the envenoming.

Adult↗
PubMed2005

Round table of November 20th, 2004: recommendations for improving the management of envenomations.

The round table underlines the necessity to follow the epidemiological and clinical surveys in order to precise the incidence and severity of snakebites and inform the health authorities that could thus arrange to take in charge envenomation accidents. Simple therapeutic protocols adapted to epidemiological and clinical data will be elaborated according to each level of health pyramid. They will be included in the health staff training and integrate traditional practitioners whose role must be clearly defined. An experimental and clinical validation must confirm its appropriateness with countries and victims needs. Some microeconomic surveys are necessary to identify adapted funding and thus improve their accessibility

Africa↗
PubMed2004

Structure of the microfilarial reservoir of Loa loa in the human host and its implications for monitoring the progr,ammes of Community-Directed Treatment with Ivermectin carried out in Africa.

This paper describes the structure of the microfilarial reservoir of Loa loa in an endemic population of central Cameroon. The possible effects of age and sex on the prevalence and intensity of microfilaraemia have been explored. Logistic analysis showed that the prevalence of microfilaraemia increased significantly with age, reaching 60 % in the oldest males. This result suggests that the figure commonly reported, according to which only one third of the infected individuals were microfilaraemic, should be reconsidered; in addition, as part of surveys of loiasis, crude microfilaraemia prevalence values should be replaced by adjusted ones. The intensity of infection did not show any age-specific change. As a result, even if the oldest members of the male population are clearly the most at risk of developing post-ivermectin serious adverse reactions, especially Loa-encephalopathy, the other members of the population are not risk-free. Therefore, in those areas where the African Programme for Onchocerciasis Control is undertaking regular mass distributions of ivermectin for onchocerciasis control, and where loiasis is co-endemic, no subpopulation should be excluded from surveillance and monitoring during community directed treatments with ivermectin.

Adolescent↗
PubMed2004

[Long-term impact of a mass treatment by praziquantel on morbidity due to Schistosoma haematobium in two hyperendemic villages of Niger].

Although it is established that the treatment by praziquantel reduces the urinary lesions due to Schistosoma haematobium, the frequency of mass treatment necessary to maintain a low morbidity level remains poorly known. The objective of this work was to study the impact over three years of a single praziquantel mass treatment on schistosomiasis morbidity in two different systems of disease transmission in Niger. The study was performed in 2 villages hyperendemic for schistosomiasis in the South-West of Niger presenting respectively 2 different systems of schistosomiasis transmission: Koutoukalé-Zéno (K Zéno), located close to an irrigated area of the Niger River Valley where the transmission is permanent, and Téguey located along a temporary pond where the transmission is seasonal. After the initial evaluation (1994), we carried out a survey 3 years later (1997) except in K. Zéno where an intermediate evaluation was performed 10 months after the initial survey (1995). Approximately 300 randomised people have been examined as follows: macroscopic examination of urine and reagent sticks for macro- and micro-haematuria, filtration and microscopic examination of urine for Schistosoma eggs, and ultrasound scan of the urinary tract for morbidity. The therapeutic coverage has reached 69.9% in K. Zéno and 78.2% in Téguey. The prevalence of infestation decreased from 74.1% to 56.4 % in K. Zéno (p < 0.001) and from 65.3% to 30.4% in Téguey (p < 0.001) at the end of the 3 years. The prevalence of heavy infestation (eggs > or = 50) went in the same time from 9.9% to 12.8% (p = 0.3) in K. Zéno and from 9.1% to 3.3% in Téguey (p = 0.01). Using ultrasound scan, the prevalence of the bladder lesions reached its previous level in both villages. However the prevalence of hydronephrosis decreased from 21.1% to 3.9% in K. éno (p < 0.001) and from 12.6% to 4.2% in Téguey (p < 0.001). Three years after the single mass treatment, the morbidity did not reach the initial level. The effectiveness of the treatment is better in the pond system where the transmission is seasonal. The lesions of the upper tract decreased more slowly than the bladder lesions, but a long time after the treatment. The re-infestation induced the re-appearance of the bladder lesions sooner than the lesions of the upper tract. The periodicity of the treatment should be variable according to the transmission system. It should occur every 2 years in irrigated areas and could be delayed (3 years) in temporary ponds. The control was beneficial in the pond system and induced a significant reduction of the severe lesions.

Adolescent↗
PubMed2004

[Heterogeneity of Schistosoma haematobium transmission in irrigated fields].

Heterogeneity of Schistosoma haematobium transmission in irrigated fields. Although irrigated areas exist since a long time in the Niger Valley the distribution of the urinary schistosomiasis does not appear homogeneous, testifying to the existence of limiting or favourable factors. The identification of these factors could lead to a better definition of the distribution of the schistosomiasis risks and to optimise control programmes. The population of five villages about 1,900 inhabitants living in the same irrigated area (Sébéri) was examined at the end of 1999 before treatment and surveyed two and ten months after treatment by praziquantel in order to investigate re-infections. In parallel, the transmission sites were subject to a semi-monthly malacological follow-up from 1998 to 2001 and the water contacts were quantified in the sites of the main village during 2000. Before treatment, schistosomiasis risks appeared related to the proximity between habitat and lateral canals: the infections concerning youngers were all the more intense that the dwellings were close to the canal. The parasitological indices were the highest in the village lacking of other water sources. The morbidity indices followed a similar distribution with maximum values in the children of the 3 villages located to less than 1 km from the canal; however, morbidity was mainly observed in the adult population, in particular male, of the 2 villages which were the most distant from the canal. After treatment, the incidence of the re-infection between 2 and 10 months was comparable in the 3 villages close to the canal (28%) but was significantly weaker in the 2 villages far from the transmission sites (5%). In the villages bordering the canal, the incidence in the children was all the more high since the habitat was close to the canal. Between 1999 and 2000, the collected number of Bulinus truncatus decreased from 1.4 to 0.6 individuals per survey; moreover, no mollusc harbouring parasites was found, representing the decrease of the parasite burden. The abnormal weakness of re-infection, regarding this type of focus, could be explained by the repeated stop of water supply inducing a complete drying out of the canal for 2 months during the year preceding the study. These repeated drying out also resulted in a reduction of the exposure. Whereas the average frequentation of the sites of the canal remained rather comparable between January (cold dry season) and May (dry hot season), it decreased dramatically in September (rainy season but canals were not irrigated this year) from 99 to 11 daily contacts. The use of the lateral canal when filled represented 80% of the contacts. In the event of drying out, 80% of the contacts were transferred in the ponds but not in the river (5% of the contacts whatever the season). These results confirmed (1) that the presence of canals reduced the use of natural sites and (2) that the drying out of the canals induced a total reduction of the contacts.

Adolescent↗
PubMed2004

[Abstract envenomation by the African puff adder (Bitis arietans): value of intracompartmental pressure measurement].

The purpose of this report is to describe a case of severe snake bite with envenomation by an African puff adder (Bitis arietans). Presenting symptoms warranted administration of antivenon upon admission. The patient's general condition improved. However bite-related trauma caused extensive phlyctenuar edema of the lower extremity with a high risk of compartimental syndrome due to hardening and compression. Due to the high risk for postoperative infection at our facility, aponevrotomy to relief pressure was not undertaken immediately. Instead management consisted in close surveillance with repeated measurement of peripheral pulses by Doppler ultrasound and of intracompartimental pressure. The outcome was favorable without need for aponevrotomy. This case demonstrates the value of intracompartimental pressure measurement in cases involving this type of envenomation in function of available technical facilities.

Adult↗
PubMed2004

[Pharyngeal carriage of Neisseria meningitidis in a school of Niamey, Niger].

This study of pharyngeal carriage of Neisseria meningitidis in a school in Niamey, Nigeria was carried out to confirm the feasibility of evaluating the impact of conjugate vaccine on the meningococcal carriage. All 90 pupils attending the school were examined during the dry season in February 1998. All children had been vaccinated using polysaccharide A/C in 1996. Samples were collected from the soft palate and immediately seeded on selective medium. After incubation at 37 degrees C for 24 hours, suspicious colonies were re-seeded on Miller-Hinton medium. Identification of N. meningitidis was based on standard biochemical criteria, agglutination grouping and DNA fingerprinting. Seven carriers of N. meningitidis X:NT:P1.5 were found. One of these carriers also presented a strain of N. meningitis A:4:P1.9. The high prevalence of serogroup X strains coincided with an outbreak of meningitis involving the same sub-type and sequence-type in Niamey.

Adolescent↗
PubMed2003

[Limits and weaknesses of intermittent treatment in malaria prevention].

WHO proposal of a new strategy for the control of malaria, intermittent treatment using sulfadoxine-pyrimethamine, encounters various conceptual and logistic problems. First, the treatment is dedicated only to a very small part of the population which is not representative of the population at risk. Secondly, it largely underestimates the risks of this type of drugs. At last, the difficulties of its management should lead to hamper this strategy. It would be preferable to study the real causes of the current strategy failure and to take it into account for a new strategy.

Antimalarials↗
PubMed2003

[Course of urinary schistosomiasis in Niamey, Niger].

A school survey has been carried out in 1998 on a representative sample of 30 schools to assess the effect of the recent urban growth of Niamey on the urban focus of urinary schistosomiasis. A total of 2,024 10-12 years old children were examined and questioned about their water contacts in Niamey and travels in rural areas during the previous year. Generally the prevalence of S. haematobium was low (16%). This can be explained by the lower exposure in urban areas; by the moderate transmission level in the river and by the low incidence of temporary stays in rural areas. A second survey has been carried out in 2000 in 4 schools of a periurban suburb to study the distribution of parasitological risk at the periphery level. A total of 247 10-12 years old children were examined and questioned about their water contacts. Prevalence of S. haematobium was higher in this suburb (74%) but there was a significant decrease of parasitological indices from periphery to the centre. This change seemed related to differences of exposure with an increasing use of water supply and a decreasing use of irrigation canals for swimming and domestic activities.

Child↗