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Biomedical subjects

R Migliani

Publications and source records attributed to R Migliani.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Recrudescence and geographic extension of the plague in Madagascar from 1980 to 1999].

Plague was introduced to Madagascar in 1898, and it has been characterized by a predominant distribution to the central highlands in the following decades. An increase of plague cases has been observed in the past 20 years, in particular in the capital, Antananarivo, and in the coastal town, Mahajanga, after long periods of silence in 28 and 63 years, respectively. A total of 2,982 confirmed or presumptive cases were reviewed in order to describe the changes in the epidemiological pattern of the disease from 1980 through 1999. The mean annual number of plague cases has increased from 33 during the 1980-1984 period to 298 during the 1995-1999 period. A similar trend of distribution has been observed from the first period to the second by an increase of endemic districts above 800 m altitude from 17 to 37. However, the lethality rate has in the same 20 years observation period decreased from 41.6% to 20.7%, probably due to re-enforcing measures as part of the national control program.

Altitude↗
PubMed2001

[The plague at the Tsenabe Isotry market in Antananarivo: a complex epidemiologic situation].

The transmission of Yersinia pestis is intense among rats in the wholesale market Tsenabe Isotry in the capital Antananarivo (anti-F1 sero-prevalence 80%, flea index 8.4 for a cut-off risk index of > 1). However, the number of plague-suspected (not laboratory confirmed) human cases has only been 3 in this district during a four years period from 1995 to 1999. A seroepidemiological survey among the market vendors was undertaken in June 1999 to test the hypothesis that the low incidence of human plague is due to acquired immunity. In addition, surveillance of the rat and the flea populations in the market was carried out. Only 3 (3.2%) of 95 screened vendors were anti-F1 IgG positive, whereas the markers of plague transmission among rodents and fleas were still high. This result suggests that the low incidence of human plague was not due to acquired immunity but to other factors such as the limited contact between humans and the rat fleas because of the abundance of rats, the absence of epizootic due to the resistance of rats in the capital and a particular behaviour of the predominant rat Rattus norvegicus.

Adolescent↗
PubMed2001

[Identification of communities endemic for urinary bilharziosis by the "Lot Quality Assurance Sampling" method in Madagascar].

Reduction of morbidity is the main component in the National Schistosomiasis Control Program in Madagascar. The lot quality assurance sampling (LQAS) method has previously been shown as a useful tool in assessment of immunization coverage. A study was carried in the western part of Madagascar aiming to evaluate the applicability of the method in measuring the level of Schistosoma haematobium endemic level in different communities. Parasitological examination of urine samples from 1,124 children aged 5 to 19 years from 12 different schools by use of filtration technique constituted the reference in determining the prevalence. Three schools were found hyper-endemic (prevalence more than 60%), 5 schools were intermediate-endemic (prevalence between 30 to 59%), and 4 were hypo-endemic (prevalence less than 30%). Those figures indicate a heterogeneous distribution of S. haematobium in the study area. A sampling plan (16.6) was then tested in the same area while other sampling plans were simulated in the laboratory. School teachers randomized under supervision the children to participate in this study and collected urine samples. All sampling plans (16.6), (14.5), (12.4), (10.3), (8.2), (6.1) et (4.0) allowed correct identification of hyper-endemic and hypo-endemic areas. Misclassifications occurred frequently for intermediate-endemic areas. The study confirms that the LQAS method by use of a (16.6) sampling plan constitute a valuable tool for large scale screening of hyper-endemic areas for therapeutic intervention as part of the control program. The study has also shown that school teachers may offer a potential source of manpower locally in such screening operations.

Adolescent↗
PubMed2001

[Geographic Information Systems and health: application to Antananarivo city].

The general health status of the population in the capital, Antananarivo, is determined by a number of different socio-economical and environmental factors. A study was undertaken in 1998 by which the Geographic Information System (GIS) was implemented in order to describe characteristics in town areas (fokontany) suffering from a high disease burden. It was observed that there was a heterogeneous distribution of health care supporting facilities in comparison to population density in the different areas of the capitol. A risk-score system by use of an image-technique was elaborated. The most important problem encountered in the study was the reduced availability of standardized collected data. The results suggest that GIS constitutes a useful tool in assessment of urban health problems in order to identify fokontany in particular need of additional health care support.

Data Collection↗
PubMed2000

[Seroprevalence of viral hepatitis B in the city of Mahajanga, Madagascar in 1999].

A seroepidemiological study was carried out to assess the prevalence of hepatitis B virus (HBV) in the city of Mahajanga, Madagascar in July 1999. A total of 654 serum samples were collected from randomly selected subjects over the age of 2 years. The ELISA technique was used to detect serum markers of HBV infection. Prevalence rates were 14.2 p. 100 for HBs, 1.4 p. 100 for HBe antigens, and 49.5 p. 100 for HBV infection as defined by the presence of at least one serum markers. HBs antigens were detected in 20.8 p. 100 of children between the ages of 2 and 4 years and 15.3 p. 100 of women of childbearing age. In the latter age group, 5.6 p. 100 demonstrated HBe antigens, which are considered as a replication marker. The findings of this study are in agreement with those of a previous study in Madagascar and indicate that an expanded program of immunization against hepatitis B virus is warranted.

Adolescent↗
PubMed2000

[Plague in the port of Mahajanga: 6 inhabitants out of 1000 carry the anti-F1 antibody in 1999].

The authors report the results of a randomized epidemiological survey aiming to assess the sero-prevalence of plague in the general population > or = 2-year-old in Mahajanga. In 656 sera tested (by ELISA), the prevalence of anti-F1 antibodies was found to be 6.1%@1000 inhabitants, close to the expected prevalence in the area, where plague reappeared in 1991 after 62 years of absence. The study also demonstrated that the shrew, Suncus murinus, is an important reservoir in the plague transmission in Mahajanga.

Adolescent↗
PubMed2000

[Cysticercosis in the port of Mahajanga: more frequent than we thought!].

A seroepidemiological survey was carried out in July 1999 to assess the prevalence of cysticercosis in general population in the Mahajanga City (West of Madagascar). Blood specimens were collected from a randomised sample including 626 individuals more than 2 years old. ELISA and confirmative immunoblot techniques (EITB) were used to measure Cysticercus cellulosae antibodies. The overall prevalence by ELISA test was 19% (15.8-22.7% CI95%). Among positive cases, 87% were also positive by EITB. Cysticercosis is considered as major health problem in Madagascar. A national control programme implementation is imperative.

Adolescent↗
PubMed2000

[Hepatitis B virus infection: a public health problem in Madagascar].

In this article, the authors summarize studies on hepatitis B virus infection in Madagascar. Estimated prevalence rate for acute or chronic HBs antigen infection is 23% among general population which classify the country in high endemicity area. Vertical and horizontal transmissions for the childhood are high with an estimated prevalence rate for HBs antigen infection of 10 to 35% among children under less than 5-year-old according to areas. This situation indicates that an expanded program of immunization against hepatitis B virus is warranted.

Acute Disease↗
PubMed1999

[Evidence of risk factors for condom breakage among French military personnel stationed overseas].

The French Army Medical Service has been distributing free condoms to overseas personnel since 1989. An epidemiologic study conducted in Cambodia showed that the rate of condom failure during protected sex was 16.3 p. 100. In view this high failure rate, a study to evaluate safety guidelines for condom use was deemed necessary. This report describes the results of an inquiry designed to identify risk factors for condom breakage. The study population included 124 servicemen stationed overseas who consulted an army physician following condom failure. An anonymous questionnaire was completed by the physician with the informed consent of the patient. Data was analyzed by multiple correspondence analysis. Anogenital intercourse and alcohol abuse were the main risk factors for condom failure. Oral sex before penetration, carrying the condom in the pocket, and improper application by the sex partner were also risk factors for failure. The major finding of this study was that 64 of the 124 (51.6 p. 100) denied any sexual activity or improper handling that might have led to condom breakage. Although condoms are still indispensable for prevention sexually transmitted diseases, the results of this study show that they do not provide absolute protection. Health care officials should inform the public as to the risk factors for breakage of latex condoms.

Africa↗
PubMed1997

[Epidemiologic surveillance in the Army and Public Health: as exemplified by rubella].

Since 1993, several outbreaks of rubella are annually reported from the French military. This trend reveals a transfer of the reservoir of wild virus towards a non-immune population of male adolescents and young adults, as a result of the rubella control programmes. This paradoxical phenomenon should disappear within the next decade, when the new vaccinal schedule including a combined measles, mumps and rubella vaccine for the children of both sexes 11 to 13 years old will have been implemented. Meanwhile, the military system of weekly epidemiological report will be usable as a national observatory for the rubella. Moreover, providing specific data in real time, it will be able to support a strategy of intervention for an early neutralization of epidemics.

Adolescent↗
PubMed1995

[Burundi: humanitarian mission (January-April 1994)].

The 1993 assassination of the President of the Republic of Burundi led to a bloodbath resulting in the killing of 700 000 people and 300 000 refugees in camps scattered throughout the country. After the emergency surgery phase, the French cooperation which was in charge of health care in the Gitega sector requested a humanitary mission. Two public health physicians, a polyvalent clinical physician, and two field nurses were sent. All were armed service personnel. From January to April 1994, after a preliminary assessment of the situation, this mission took charge of health services as well as administrative services for the population of the region including some 10 000 refugees. Epidemiologic surveillance was carefully organized. During the first quarter of the year, there were 2451 declared cases of bacterial dysentery, 6738 cases of malaria-like fever including 25% confirmed by paristological findings on a study of 60 consultants, 87 cases of measles, and 1306 cases of conjunctivitis. There were no cases of cholerea or meningoccoal meningitis. A food support program was started when it was noted that the overall rate of acute malnutrition among refugee children under the age of 5 years was 25% (weight/height ratio less than minus 2 standard deviations or observation of edema). At the present time the situation in the sector is back to normal and the health care system is operating satisfactorally. However the situation in neighboring Rwanda could have adverse effects on the political stability of Burundi.

Burundi↗
PubMed1994

Cameroon: an African model for final stages of guinea worm eradication.

The Cameroon Guinea worm eradication program initiated case containment activities in 1991 in the Mayo-Sava Division, the only endemic region in the country. These activities differed from the Pakistan program, the only other operational model for dracunculiasis case containment, in two important ways. In Cameroon, next-level supervisors received reports of new cases from village health workers during routine weekly visits to endemic villages. The Pakistan program established a faster case reporting scheme that allowed higher level personnel (sector supervisors and regional managers) to confirm cases within one week of worm emergence. Second, in Cameroon case containment activities were extended only to villages reporting five or more cases the previous transmission season and villages with recent confirmed cases. In Pakistan, all villages reporting cases during the previous year were included in the program. A village-by-village case search one year after initiation of case containment in the Mayo-Sava indicated decreases of 60% in the number of cases and 51% in the number of villages reporting cases. Based on the apparent success of the efforts in Cameroon, we propose a two-stage scheme for implementation of case containment. Both stages are based on rapid detection and containment of cases, within 24 hr of worm emergence, by village-based health workers. In stage 1, cases are reported and confirmed during routine weekly visits to the endemic villages by next-level supervisors. Weekly reporting should be extended to all villages with recent confirmed cases and to as many villages reporting cases during the previous transmission season as logistically possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Cameroon↗
PubMed1994

[Malaria in children at the Sihanoukville Hospital (Cambodia)].

The authors have studied 68 children admitted with malaria in Sihanoukville Hospital (Cambodia) from December 1992 to April 1993. Sihanoukville is located on coast of the country, in a hypoendemic area with seasonal transmission occurring during this study. The patients lived in urban (1/3) or in rural areas (2/3). Plasmodium (P.) vivax alone was found in 15 cases. Among them, two patients presented with severe malaria, but chloroquine was efficient in all cases. P. falciparum with or without P. vivax, was predominant (53 cases). Most of these cases were severe, according to WHO criteria (n = 43), from which 11 deaths occurred (25%). There were 26 cases of cerebral malaria, with a death rate of 34.6%. A severe course was observed with the following criteria: prostration or coma (p = 0.029), severe anaemia (p = 0.037) and hyperparasitaemia (p = 0.00078). A significant longer delay for treatment and admission was noted among rural patients (p = 0.023 and p = 0.011 respectively). In those children, hyperparasitaemia, poor clinical status on admission and lethality were more frequent. The clinical course was not clearly improved with the addition of erythromycin in the quinine regimen. No quinine resistance was observed in this data.

Cambodia↗
PubMed1993

[Management of sexually transmissible diseases in an urban environment in Cameroon in 1992].

During the progress, in 1989, of a programme of social marketing of condoms in Cameroon, it was obvious that this approach should be supplemented by a similar programme for the management of STD's. Nine surveys were carried out in 1992 in Yaounde and Douala in the sexually most active male population (in the general community, at the workplace and in the leisure environment) in order to collect the basic data necessary for its implementation. Treatment essentially consists of mono-chemotherapy with drugs which are generally inefficient against the two principal etiologies of urethritis: Neisseria gonorrhoeae and Chlamydia trachomatis. The cost of treatment is considered excessive and leads to poor follow-up of the complete prescription. Simultaneous treatment of partners should be developed. All these data have been taken into account for the elaboration of a pilot programme which should be implemented in 1993.

Adolescent↗
PubMed1993

[Epidemiological features of retroviral infection by HTLV-1 in central Africa].

Subsaharian Africa is the most important reservoir of HTLV1 virus but its epidemiology is not well-known. The authors have studied from 1987 to 1990 the situation in 6 countries in Central Africa. The already described routes of transmission are present: through blood transfusions (but it's not such a common practice), heterosexual transmission (but it doesn't seem to be as important as in other continents), and mother to child transmission through breast feeding. Nevertheless, environmental factors--which have to investigated--could play a role for transmission, among them one could think to vectors and parasites.

Adolescent↗