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PubMedDate not supplied

[In vivo study of chloroquine resistance of Plasmodium falciparum malaria in Mayotte].

According to the existence of Plasmodium falciparum chloroquine-resisting cases in Madagascar and, someone, in the Comoro Archipelago, a study using in vivo W.H.O. test was conducted in Mayotte Island. Between the end of 1985 and 1987, despite the great difficulties for ambulatory blood collection in a rural population, 24% of malaria cases had been followed up during 28 days, using a dose of 25 mg/Kg in 3 days. During 1986 and 1987, 5 cases showed positive serology of thin blood films. Either the possibility of reinfection cannot be excluded, these cases may be notified as R I and R II resistant type according to the W.H.O. standard test. In vitro W.H.O. test is necessary to confirm this fact but is not possible in local laboratory conditions. Thus, the surveillance of chemosensitivity of Plasmodium falciparum local strains is a priority. Nevertheless, chloroquine remains efficient for prophylactic (new travelers only) or curative purpose in the main cases.

Animals↗
PubMed1989

[Imported falciparum malaria in Marseilles hospitals in 1987. Apropos of 104 cases].

Patients were composed of 85 adults and 19 children; 70 were European, 23 Comorian; malaria was contracted by 9 patients in French Guyana, 60 in Africa, 23 in Comoro Islands; prophylaxis was correct for 45 patients (nearly all of the cases with chloroquine) when the first symptoms occurred. Every case of malaria appeared during the month following their return from an endemic area. Fever was often moderate or intermittent, altered by prophylaxis and previous treatments. Some patients had a clinical profile of "visceral evolutive malaria" and 3 a cerebral malaria. The most frequent biologic alteration was thrombopenia (40 times under 100,000/microliters). No relation between parasites density and clinical profile has been identified. The sensitivity of the strains for antimalarial drugs has been studied 35 times: 28 strains were chloroquine resistant, 3 have a decreased sensitivity for quinine. Most of the resistant strains came from Central Africa. Two patients died.

Adolescent↗
PubMedDate not supplied

[Imported malaria in the hospitals of Marseilles from 1973 to 1976: epidemiological characteristics].

Between 1973 and 1976, 96 confirmed hospital cases of imported malaria occurred in Marseille. The collected epidemiological data indicate the recent increase of the annual incidence and an equal number of cases in immigrants and in people returning from the tropics. Among them, tourists, servicemen and merchant seamen are the groups most at risk. A high proportion of infections are with P. falciparum, mainly from Africa, Malagasy and Comoros. The diagnosis is only confirmed on an average of 6 days after the first medical advice and 2 patients died from falciparum infections. Travellers to tropical countries are often careless about taking prophylactic drugs and the danger of imported malaria should be emphasized.

Adult↗
PubMed1996

Transmission of Plasmodium falciparum by allogeneic bone marrow transplantation.

We describe a case of Plasmodium falciparum infection in a Comorian patient undergoing BMT. The patient's last visit to an endemic area was 1 year prior to BMT. The donor left the Comoro Islands 2 months before marrow harvesting. They had both had previous episodes of malaria and were seropositive for Plasmodium falciparum. At the time of BMT, blood smears were negative in both the donor and recipient. On day 12 post-BMT the patient was asymptomatic but a blood smear revealed 12.5% parasitemia. We consider that donors and recipients at risk pre-BMT should routinely be given specific treatment before marrow harvesting and conditioning, independent of the appearance of blood smears.

Adult↗
PubMed1996

Expanded programme on immunization (EPI). Immunization schedules in the WHO African region, 1995.

There are 48 countries/areas in this Region (Tables 1-3). No data are available from Reunion and Saint Helena. BCG is given at birth in 46 countries. Diphtheria-pertussis-tetanus (DPT) vaccine is used as a primary series of 3 doses in 46 countries. In 35 countries, DPT is given from 6 weeks of age; in 6 countries at 2 months of age (Angola, Botswana, Burkina Faso, Congo, Gambia and Zambia); and in 5 countries at 3 months of age (Algeria, Mauritius, Seychelles, Swaziland and Zimbabwe). Eight countries give 4 doses of DPT (Benin, Burundi, Congo, Equatorial Guinea, Rwanda, Seychelles, South Africa and Zambia) while 2 countries give 5 doses of DPT (Algeria and Togo). Diphtheria-tetanus (DT) is given in 3 countries: in Botswana at 6 years, in Mauritius at 2 and 5 years and in South Africa at 5 years of age. No Td* is given in any of the countries in this Region. Oral poliovirus vaccine (OPV) is used in a primary series of 3 doses simultaneously with DPT vaccine in all countries. Eighteen countries give OPV at birth. Measles vaccine is given at 9 months of age in 45 countries. Seychelles gives measles vaccine at 15 months of age. None of these countries give a combined measles-mumps-rubella (MMR) vaccine. Rubella vaccine alone is also not given in any of the countries in the Region. Hepatitis B vaccine is used in 7 countries (Botswana, Gabon, Gambia, Nigeria, South Africa, Uganda and Zimbabwe). It is given in 2 doses in 2 countries (Gambia and Nigeria) and at birth in 4 countries (Botswana, Gabon, Gambia and Nigeria). Thirty-one countries are at risk for yellow fever. However, yellow fever vaccine is given only in 10 countries (Central African Republic, Chad, Côte d'Ivoire, Gabon, Gambia, Ghana, Niger, Sao Tome and Principe, Senegal and Togo). Six countries give yellow fever vaccine at 9 months, Chad gives it at 6 months, Gabon and Sao Tome and Principe at 1 year of age and Togo at 10 months. Tetanus toxoid (TT) is used for pregnant women or non-pregnant women of childbearing age. The schedules include 2 to 5 doses. Forty-two countries use a 5-dose schedule. TT is given to schoolchildren in 5 countries (Botswana, Comoros, Guinea, Lesotho and Madagascar).

Africa↗
PubMedDate not supplied

[The epidemiology of trench fever: a pilot study in homeless people in Marseilles].

Trench fever, cause by Bartonella quintana, disappeared decades ago. Between 1992 and 1994 about 20 cases were reported in industrialized countries [6, 7]. Some of these cases were associated with HIV infection [5], but most affected the homeless. The epidemiology of B. quintana is unknown in Europe, but infection and transmission are favoured by poor housing and hygiene. This paper describes the results of a seroprevalence survey among the homeless living in Marseille. The eight major non-profit organizations caring for the homeless in the city participated for the four winter months. Four of these organizations also provide health care. Each subject who came to be housed for more than one day were asked to complete a questionnaire and give a small blood sample by micropuncture. They were clearly informed about the aims of the research and were allowed to refuse participation freely. All blood samples were tested by the WHO collaborative center for ricketssiae using a previously tested and validated immunofluorescence technique. The subjects were scored positive if the IgG titer was above 1/100. Two hundred and twenty one subjects agreed to participate in the study. Most were of French origin (51.4%) and 40% under 40 years old. The seroprevalence was 1.8% (IC 95%: 0.05-3.55). None of the four positive subjects presented symptoms and clinical examination was normal. All four were over 40 years old; two were of French origin, 1 from Algeria and 1 from the Comoro Islands. One had an IgG titer above 1/3, 200, possibly reflecting recent contamination and/or severe infection. Statistical analysis revealed no significant association between seropositivity and housing or hygiene conditions. No socio-demographic data are available about the homeless in Marseille and indeed, there is no list of such individuals. It is therefore not possible to estimate the representativity of our sample. Nevertheless, we show that the homeless include infected individuals. Physicians who care for such subjects should prescribe B. quintana serological investigations, and organizations that take in these people should implement preventive action and health education programs. Any such policy must be designed so as to be acceptable to homeless people. This work should also encourage public health professionals to investigate more extensively infectious diseases among the homeless.

Adolescent↗
PubMedDate not supplied

[The development of public health education: the Mauritius experience].

A public course has been initiated in 1990 in Mauritius for covering the national growing needs of public health specialists. This training course was organized jointly by the Ministry of Health, the University of Bordeaux II and the French Cooperation. After 3 sessions dedicated specifically to the Mauritian physicians, the course has been re-designed for the needs of the other countries of the region. A feasibility study performed in 1994 in the countries of the Indian ocean region showed that during the past decade, the district level had become the focus point to integrate the health programs. This process has progressively transferred a wider and stronger part of the responsibilities from the central level to the district level and the survey showed that most of the health district managers were physicians that did not have the proper background for carrying such responsibilities. According to these results, a course curriculum was created by the Mauritian Ministry of Health and the University of Bordeaux II and submitted to various organisms supporting health program development in the region. This proposal was strongly supported by several agencies (the french Cooperation, Unicef, WHO, World Bank...) who agreed to sponsor candidates for that training course. The first session was organized in 1995, a second one in 1996. This training course is targeted to the medical doctors who are in charge of the management of health services at the district level. It is divided in two parts: A six-weeks intensive training course performed in Mauritius that include formal teaching and practical exercises in small groups for a total of 210 hours. The curriculum is mainly targeted on the various aspects of management as the management of health information (biostatistics epidemiology and computing), the management of human resources, financial resources and material resources. In addition to these main topics, there is an introduction to pedagogy, communication skills and applied research methodology. Following this six-weeks, training the students come back to work in their country and have 8 months to perform a thesis supervised by a local public health specialist. The subject of the thesis has to be closely related with one of the topic taught and should provide an obvious improvement for the public health situation in the district where this physician is acting. In 1995, 22 candidates attend to the course (13 from Madagascar, 4 from Mauritius, 3 from Comoros, 1 from Angola, 1 from Equatorial Guinea and 1 from Tchad), 19 had successively completed all the modules and got the diploma of public health delivered by the University of Bordeaux II. This diploma has been recognized as an equivalent to a master in public health in Mauritius. The evaluation of the courses-performed by the students, the teachers and the financial agencies gave a very positive results although the workload was considered as too important for a six-weeks training course. The recommendations of the 1995 session were included in the 1996 programs which is still on going for 23 candidates. The 97 session will probably extend the number of students up to 40, divided in 4 subgroups for practical exercises. In parallel to the course, a quarterly bulletin will be created and sent to the present and past candidates of this course in order to support a continuous medical education training program targeted to the district physicians.

Communication↗
PubMed1997

[Natural history of chromoblastomycosis in Madagascar and the Indian Ocean] [Natural history of chromoblastomycosis in Madagascar and the [Natural history of chromoblastomycosis in Madagascar and the Indian Ocean].

The natural history of chromoblastomycosis was studied in Madagascar by analysing the characteristics of 1323 confirmed cases observed since 1955, including 45 patients receiving a new antifungic drug (terbinafine) during a multicentric study organized in 1995. The surveys data, conserved by the histopathology laboratory in the Institut Pasteur of Madagascar during 40 years, permit this retrospective analysis. The description of two ecosystems, one in the North with Fonsecaea pedrosoi evolving in the tropical rainforest and one in the South with Cladophialophora carrionii (41% of the whole sample) isolated in the spiny desert, demonstrates that the deforestation, in order to product charcoal and to build houses, is the primary factor associated with this disease. The epidemiologic (87% of patients are male and 96% are more than 16 years old, with more than 74% of the lesions located on feet and legs), mycologic (62% of the isolated strains belong to the F. pedrosoi species) and therapeutic (low efficiency of thiabendazole in long-term lesions, high efficiency of terbinafine especially on recent lesions and on Cladophialophora-infected patients) aspects of the natural history of chromomycosis confirmed that Madagascar is the most important focus in the world (global prevalence of about 1 for 8500 inhabitants), with few sporadic cases in the other islands of the Indian Ocean (La Reunion, Comoro islands and Mayotte). In the difficult context of Madagascar, the need for a non-specialized laboratory-applicable diagnostic technique that provides infection and species identification led the Institut Pasteur de Madagascar to develop an ELISA-based technique. A large-scale control throughout the country, with the assessment of effective oral chemotherapy with terbinafine, is seen as possible by the authors with the help of the manufacturer.

Antifungal Agents↗
PubMed1998

[Dengue, arbovirus and migrations in the Indian Ocean].

An arbovirus requires a competent haematophagous arthropod for transmission from one vertebrate to another susceptible host. Air transportations allow quick transfers from place to place and the diffusion of potential vectors or infectious hosts. The merchandise transportation by containers allowed the diffusion of Ae. albopictus from Asia through Africa and America. Emerging arbovirusis may occur in zones where they do not exist. Dengue which originally was located in southeastern Asia, is the most important arbovirusis in the world. The occurrence of dengue haemorrhagic fever (DHF) in Asia and America, mostly in urban areas, increased the global concern about dengue. Likewise, cases of DHF are not reported in Africa and in the Indian Ocean southwestern islands. The principal vector of dengue, Aedes aegypti, was present during the dengue 1 outbreak in Comoros, in 1993. In the other islands, only few specimens of Ae. aegypti are observed, and described mostly as none anthropophilic forms. The role of Ae. albopictus as vector of dengue was suspected and reported during outbreaks in Seychelles and Réunion island in 1977-1978. Yellow fever, present in Africa mostly in restricted areas, is absent in Asia. Japanese encephalitis considered as an emerging disease in India could expand through the islands. Rift valley fever, with periodic epizootics in domestic ungulates in Africa, was described as a new disease in Madagascar in 1990-1991. Crimean-Congo haemorrhagic fever is also present in Madagascar. Humans can be infected by vector bite or by handling infectious animal products. The distribution of other viruses (West Nile, Sindbis, Wesselsbron or Chikungunya) is discussed.

Aedes↗
PubMed2006

Feeding behavior of lactating brown lemur females (Eulemur fulvus) in Mayotte: influence of infant age and plant phenology.

Altmann [Baboon Mothers and Infants, University of Chicago Press, 1980] and Dunbar and Dunbar [Animal Behavior 36:970-980, 1988] provided a model that predicts the amount of time spent feeding by lactating baboon females, as related to infant age. Dunbar's model further suggests that food quality affects the amount of time that females devote to feeding activity, and is predictable from rainfall and temperature data. In this study the model was tested with data recorded from births of the Mayotte brown lemur from four maternal dyads (Eulemur fulvus). This study also examines the correlation between female activity budget, quantities of fresh plant matter ingested, and suckling duration using data collected from focal animal samples on the mother-infant dyads. The relationships among rainfall, food supply, and food quality were also tested. It appears that female brown lemurs do not devote more time to feeding during the infant growth period. The data show that female brown lemurs increased their food intake during the early-lactating period when the frequency of suckling is the highest, and before infants begin to eat substantial amounts of solid foods. Thus, the frequency of feeding reflects the cost of lactation better than suckling duration. Furthermore, females did not appear to select foods according to their availability or rainfall levels. I hypothesize that the lack of convergence between lemur data and baboon observations is due to differences between their respective environments and their feeding ecology. These data also indicate that the most significant lactating cost for the brown lemur occurs during the early lactation period.

Aging↗
PubMed2005

Early outcome after Glenn shunt and Fontan palliation and the impact of operation during viral respiratory season: analysis of a 19-year multi-institutional experience.

BACKGROUND: This study was done to investigate the impact of season of operation, age at operation, and surgical era on short-term outcome after single ventricle palliation. One small study suggests that operation during viral respiratory season is associated with prolonged pleural effusion and hospitalization. Single-institution studies also find improved outcomes after the Glenn shunt and Fontan over time, despite operation at a younger age. METHODS: The Pediatric Cardiac Care Consortium (PCCC) database for Fontan (n = 2,713) and Glenn shunt (n = 2,239) performed between 1982 and 2000 was utilized. Death during initial hospitalization and length of stay after each procedure were investigated. Viral respiratory season was defined as the interval of November to March. RESULTS: The mortality rate after Fontan was higher during the viral respiratory season (14 versus 11%, p = 0.03) and in children under age 2 years. Glenn shunt mortality was higher with operation before age of 120 days, but was not affected by operation during viral respiratory season. Age at operation for the Fontan procedure has decreased with declines in hospital mortality (14% to 7%, p < 0.0001) and hospital stay (14 to 11 days, p < 0.0001) comparing 1992 to 1995 with 1996 to 2000. CONCLUSIONS: Fontan procedure performed during viral respiratory season is associated with an increased mortality. Short-term mortality and morbidity after the Glenn and Fontan procedures have improved in the recent era. Operation in the youngest age groups may adversely impact mortality.

Cardiac Surgical Procedures↗
PubMed2003

Local understanding, perceptions and reported practices of mothers/guardians and health workers on childhood malaria in a Tanzanian district--implications for malaria control.

Knowledge on local understanding, perceptions and practices of care providers regarding management of childhood malaria are needed for better malaria control in urban, peri-urban and rural communities. Mothers of under five children attending five purposively selected public health facilities in the Kibaha district, Tanzania, were invited to participate in 10 focus group discussions (FGDs). The health workers of these facilities were included in six other FGDs to elicit their professional views. Analysis was done using interpretative and qualitative approaches. Both health workers and all mothers were clear about the signs and symptoms of homa ya malaria, a description consistent with the biomedical definition of mild malaria. Although most of the mothers related this to mosquito bites, some did not. Mothers also described a severe childhood illness called degedege, consistent with convulsions. Most of the mothers failed to associate this condition with malaria, believing it is caused by evil spirits. Urinating on or fuming the child suffering from degedege with elephant dung were perceived to be effective remedies while injections were considered fatal for such condition. Traditional healers were seen as the primary source of treatment outside homes for this condition and grandmothers and mother in-laws are the key decision makers in the management. Our findings revealed major gaps in managing severe malaria in the study communities. Interventions addressing these gaps and targeting mothers/guardians, mother in-laws, grandmothers and traditional healers are needed.

Adult↗
PubMed2006

[How to live with keratoconus].

BACKGROUND: The article is based on an undergraduate thesis that was written within the framework of investigating problems of rehabilitation in the humanities department of Berlin's Humboldt University. It deals with the issue of whether and, if so, in what spheres of life, people suffering from keratoconus may have to expect changes in lifestyle and what possibilities exist for compensation. The paper is based on the "construct of compensating impairment of sight" according to Nater, a fundamentally resource-oriented approach. Impaired vision has restrictive effects on the quality of life, which can, however, be minimised by appropriate measures of compensation so that, at best, normality can be achieved or felt. MATERIALS AND METHODS: In a Germany-wide written survey by questionnaire. The changes in lifestyle arising from the disease were registered and evaluated (n = 192). RESULTS: Ophthalmologists, optometrists and opticians attending to keratoconus patients generally emphasise the medical or optical care, respectively. The results arrived at in this study extend the medically or optically oriented view and give insights into other spheres of life of those affected, their problems and their strategies of compensation. People suffering from keratoconus occupy an intermediate position between severe dysopia and normality. The most important means of compensation for people with KC is at present the rigid gas permeable contact lens. With its help, most KC patients enjoy normal eyesight, which has a favourable effect on all the results. If keratoconus develops vehemently, restrictions in the quality of life are more severe than in the case of a slow development of the disease. Contrary to the hypothesis proposed in the paper, the existence of a tight social network does not have much of an alleviating effect on the restrictions felt. A sympathetic communication of the diagnosis, however, will have a favourable effect on the patient in accepting the condition and integrating KC into his or her life. CONCLUSIONS: In order to improve the situation of people suffering from KC, the best possible medical/optical care, the interdisciplinarity of all professions involved, and an early, sympathetic and medically well established communication of the diagnosis are essential as well as publicising the disease.

Adaptation, Psychological↗
PubMed1998

Acceptability of voluntary HIV testing with counselling in a rural village in Kagera, Tanzania.

A pilot study on acceptability of voluntary HIV testing with counselling was performed in a rural village in Kagera, Tanzania as a potential intervention against HIV transmission. Village residents were prepared by their leaders and subsequently invited to health education group meetings to volunteer for the test. Consenting individuals were interviewed to determine awareness and acceptance of the offer followed by pre-test counselling and taking of a blood sample for subsequent HIV testing. Two months later, the results of the test were returned with post-test counselling coupled with a short interview of a random sample of adults in the village. Of the 245 adults responding to the call, 137 (55.9%) subsequently volunteered. The main reason for volunteering was to know the HIV status (96%). Among those who were aware of the offer, the main reason for not volunteering was that they felt unlikely to catch AIDS, implying that they had a false perception of being at low risk. In this study a significant proportion were willing to volunteer for the HIV test and to receive the results, indicating a moderate level of acceptability. The results also indicate the need for developing innovative ways of enhancing acceptability of voluntary HIV testing with counselling. However, the relationship between knowledge of HIV status and behavioural change is complex and therefore several potential mechanisms may exist by which HIV testing in combination with counselling can influence behaviour. For this reason, people should be given the choice of knowing their HIV status since it may constitute a potential mechanism for influencing behaviour towards reduction of HIV transmission.

Adolescent↗