Tolérance et efficacité de la ligature des varices œsophagiennes au Centre Hospitalier Universitaire Andrainjato, Fianarantsoa, Madagascar / Tolerance and efficacy of esophageal varices ligation at the Andrainjato teaching hospital, Fianarantsoa, Madagascar

Introduction: La ligature des varices œsophagiennes constitue un des piliers de la prise en charge de l'hémorragie digestive par rupture des varices œsophagiennes. Cette étude a pour objectif d'analyser la tolérance et l'efficacité de la ligature des varices œsophagiennes dans un échantillon de patients au Centre Hospitalier Universitaire Andrainjato Fianarantsoa, Madagascar. Méthodes: Une étude prospective, observationnelle longitudinale sur une période de 21 mois (mois de janvier 2018 au mois d'août 2019) a été réalisée. Le test de Khi carré a été utilisé pour déterminer les corrélations (SPSS® v22). Résultats : Trente-et-un patients à prédominance masculine (sex ratio 1,5), âgés de 43,0 ± 9,0 ans, ont été retenus et 67 séances de ligatures de varices œsophagiennes ont été effectuées. La prophylaxie secondaire était l'indication de la ligature dans 96,8 % (n = 30) des cas. Les varices œsophagiennes étaient de grade III dans 64,4 % (n = 20) des cas. Toutes les ligatures ont été réalisées sous anesthésie générale. Le nombre de bandes élastiques utilisées était de 3,4 ± 1,1. La bonne tolérance de la ligature élastique était de 97,0 % (n = 65) lors de la procédure et de 58,0 % (n = 39) en post-procédure. La douleur thoracique post-procédure était observée dans 65,7 % (n = 44) des cas. L'éradication était obtenue après 3 séances dans 6,45 % (n = 2) des cas et 58,1 % (n = 18) étaient en cours d'éradication après 1,7 ± 0,9 séances. Conclusion : Cette étude a pu déterminer que la ligature des varices œsophagiennes est une technique bien tolérée et efficace dans la prévention de l'hémorragie digestive par rupture des varices œsophagiennes malgré certains inconvénients postopératoires

Factors associated with community engagement in areas with high and low incidence of local malaria cases in Zanzibar

Introduction: the prevalence of asymptomatic infection in the general population in Zanzibar has declined from above 25% in 2005 to less than 1% in 2010. Despite these achievements, in 2021, the number of malaria cases increased by two folds. This study aimed at understanding the levels of community engagement towards malaria elimination and factors associated with them to provide recommendations that can be used to reinforce community engagement. Methods: a descriptive cross-sectional survey was conducted using structured questionnaires to 431 randomly selected households. The interviewees were the heads of households or representative adults above 18 years. Univariate and multivariate analysis was done to determine the association between social demographic characteristics, malaria knowledge, practicing malaria prevention interventions and status of community engagement. Statistical significance test was declared at P- value <0.05. Results: of all respondents, 261 (60.6%) were not engaged in either planning or implementation of malaria interventions, of which 120 (45.9%) participants were in the high malaria transmission and 141 (54.0%) from the low malaria transmission (P=0.018). Factors significantly associated with increased odds of community engagement were the level of knowledge on malaria (P= 0.002) and factors independently associated with reduced odds of community engagement was the level of malaria burden (P= 0.01). Conclusion: level of malaria knowledge and malaria burden were associated with community engagement. There is a need to increase malaria knowledge in the community based on the existing gaps as this study suggests that having high malaria knowledge can significantly contribute to increased opportunity for community engagement.

A Novel three drug rigemen (moxifloxacin ­ omeprazole - nitazoxanide) in comparison to traditional triple therapy for treatment and eradication of naïve and resistant H. pylori infection in dyspeptic patients

Background: Helicobacter pylori is one of the most common, medically prominent infection worldwide and one of the major causative factor of peptic ulcer disease. So, eradication of H. pylori is effective in healing ulcers, reducing the ulcer recurrence and eliminating the need for maintenance therapy.Objective: The aim of the work was to compare between the efficacy of traditional triple therapy and Moxifloxacin-based triple therapy in treatment of H. pylori infection and to evaluate the efficacy of moxifloxacin-based regimens as a rescue regimen for H. pylori eradication in resistant patients. Patients and methods: This study was carried out on 100 Helicobacter pylori (H. pylori)-infected patients (within the period between septemper, 2018 to May, 2019) who were enrolled from Hepatology, Gastroenterology & Tropical Medicine Department, Al Azhar University Hospitals (El-Hussein and BAB El-Shaarea). Results: Helicobacter pylori eradication results in group III as evaluated by monoclonal H. Pylori stool Ag, 6 weeks post therapeutic regimens reported that eradication rate was 76.9% (20 patients). Regarding post treatment clinical data in group III, 42.3% of patients remained having symptoms and 57.7% had acheived symptomatic improvement. Also, the best results were recorded for H.pylori eradication (90%) in group II who received moxifloxacin based triple therapy compared to group I (with eradication rate 62.9%) who received traditional triple therapy regimen. Thus the better results (76.9%) were achieved in group III (resistant patients from group I). Conclusion: The present results could state that moxifloxacin can overcome traditional triple therapy resistance

Etude de la prise en charge de l'infection à Helicobacter Pylori dans les villes de Pointe-Noire et de Brazzaville en 2015

Introduction : L'infection à Helicobacter Pylori affecte environ 50% de la population mondiale. Sa prévalence est plus élevée dans les pays en développement. Elle est à l'origine de pathologies gastroduodénales et son éradication est de ce fait recommandée.Nous avons réalisé une étude dont l'objectif a été d'évaluer les possibilités diagnostiques, thérapeutiques et la séroprévalence de l'infection à Helicobacter pylori dans les villes de Pointe-Noire et Brazzaville.Méthodes: Etude transversale descriptive et analytique menée de mars à septembre 2015.Résultats : Sur (7) sept tests existants et validés dans le monde; seuls (4) quatre tests étaient disponibles. La non disponibilité du test respiratoire à l'urée marquée au carbone 13 était à l'origine du non contrôle de l'éradication après traitement. Les protocoles d'éradication étaient la quadrithérapie séquentielle ou continue sur 10 jours sans sel de bismuth, non disponible au Congo-Brazzaville.Au total 130 patients ont été inclus; 54(41,5%) hommes et 76 (58,5%) femmes dont 121 (93,1%) patients étaient testés positifs à l'helicobacter pylori, avec une prédominance féminine. Le reflux gastro-oesophagien était la pathologie la plus représentée chez les patients testés positifs mais sans différence significative (P=0,287).Conclusion: L'insuffisance des tests diagnostiques de l'infection à Helicobacter pylori notamment du test respiratoire à l'urée marquée au carbone 13 au Congo-Brazzaville ne permettait pas aux praticiens de contrôler l'éradication. La quadrithérapie bismuthée n'était non plus disponible alors que la séroprévalence hospitalière reste élevée. Ainsi nous faisons le plaidoyer pour l'acquisition du test respiratoire à l'urée marquée au carbone 13 et la mise sur le marché des sels de Bismuth au Congo-Brazzaville

Stigmate immunologique de la circulation des Orthopoxvirus chez des sujets nés après l'éradication de la variole en Côte d'ivoire Afrique de l'ouest

Justification : Depuis l'éradication du virus de la variole, on note une émergence des autres Orthopoxvirus surtout le Monkeypoxvirus en Afrique centrale. A ce jour aucun cas d'infection humaine à Orthopoxvirus n'a été notifié en Côte d'Ivoire. Cependant, l'activité humaine en milieu rural, la présence des réservoirs potentiels et le climat sont des facteurs favorables à la circulation de ce groupe de virus. Objectif : Mettre en évidence la circulation des Orthopoxvirus en Côte d'Ivoire en situation post éradication de la variole dans la population non vaccinée contre cette maladie. Matériel et méthode : 385 sérums de sujets non vaccinés contre la variole, choisis parmi 1353 sérums collectés lors d'une surveillance nationale de la fièvre jaune, ont été analysés. La méthode ELISA a été utilisée pour rechercher les IgG anti Orthopoxvirus. Résultats : l'âge moyen des patients était de 11 ans et le sex-ratio était de 1,97. Les IgG anti-Orthopoxvirus ont été détectées dans 4,95% des sérums ; seuls 0,78% de ces sérums avaient un titre ≥ 400. La majorité des sérums contenant ces IgG (84,16%) provenaient d'individus habitant la moitié sud de la Côte d'Ivoire. Conclusion : le niveau d'exposition aux Orhopoxvirus reste faible chez les sujets non vaccinés contre la variole. Cependant, vu le nombre croissant de sujets susceptibles à ces virus, il est nécessaire de mettre en place des sites sentinelles de surveillance, particulièrement du Monkeypoxvirus

From malaria control to elimination in South Africa: the researchers' perspectives

Background: Global decline in malaria episodes over the past decade gave rise to a debate to target malaria elimination in eligible countries. However; investigation regarding researchers' perspectives on barriers and facilitating factors to effective implementation of a malaria elimination policy in South Africa (SA) is lacking. Aim: The aim of this study was to investigate the malaria researchers' knowledge, understandings, perceived roles, and their perspectives on the factors influencing implementation of a malaria elimination policy in SA. Setting: Participants were drawn from the researchers who fulfilled the eligibility criteria as per the protocol, and the criteria were not setting-specific. Methods: The study was a descriptive cross-sectional survey conducted through an emailed self-administered semi-structured questionnaire amongst malaria researchers who met the set selection criteria and signed informed consent. Results: Most (92.3%) participants knew about SA's malaria elimination policy; but only 45.8% had fully read it. The majority held a strong view that SA's 2018 elimination target was not realistic; citing that the policy had neither been properly adapted to the country's operational setting nor sufficiently disseminated to all relevant healthcare workers. Key concerns raised were lack of new tools; resources; and capacity to fight malaria; poor cross-border collaborations; overreliance on partners to implement; poor community involvement; and poor surveillance.Conclusion: Malaria elimination is a noble idea; with sharp divisions. However; there is a general agreement that elimination requires: (a) strong cross-border initiatives; (b) deployment of adequate resources; (c) sustainable multistakeholder support and collaboration; (d) good surveillance systems; and (e) availability and use of all effective intervention tools

Polio Eradication in the African Region: Progress and Way Forward

In 2012 the declaration of global polio eradication as a programmatic emergency for public health targets resulted in the setting of objectives and a schedule for eradication. Innovative approaches were taken to address the polio situation in the African Region. Supplementary immunization activities; planning; monitoring and surveillance have all been stepped up; and technological advances such as GPS and the use of polio dashboards to monitor key performance data have been employed. Key priority countries (Angola; Chad; Democratic Republic of the Congo; Nigeria) and communities (including nomadic groups) have been targeted.Great progress has been documented; for example routine immunization has risen from less than10 in 1980 to 77 in 2013. However; there are still some challenges to overcome; notably wild poliovirus outbreaks and three remaining foci of transmission - Nigeria; the Central Africa subregion and the Horn of Africa. This article charts the steps taken and the continuing action needed to realise the aim of polio eradication

Measles Elimination in the WHO African Region: Progress and Challenges

In 2001; countries in the African Region adopted the measles mortality reduction strategies recommended by the WHO and UNICEF. Following the significant reduction in measles cases and deaths with the implementation of the strategies; in 2011; the African Region adopted a measles elimination goal for 2020. To assess progress; performance was reviewed using estimates of the first dose of measles vaccine in routine immunization (MCV1); the reported coverage for measles supplementary immunization activities (SIAs); as well as surveillance data. During 2011-2013; regional MCV1 coverage was stagnant at around 74; while approximately 215 million children were reached in measles SIAs in 43 countries. Regional measles vaccination coverage has not increased and measles incidence has remained high in the past three years. Intensive efforts are required to ensure that routine immunization and SIAs provide high population immunity; and to increase the sensitivity of measles surveillance

Update on Elimination of Epidemic Meningitis in the African Region

At the demand of the African ministries of health; a new conjugate vaccine was developed by Serum Institute of India Limited (SIIL) against meningococcal A meningitis; the germ responsible for more than 95 of the meningitis epidemics in Africa; through a partnership between WHO and PATH and; with the financial support from the Bill et Melinda Gates Foundation. The vaccine is being introduced in all the 26 countries of the meningitis belt between 2010 and 2016. So far; 153 million people have been vaccinated in 12 countries. The vaccine is efficacious; no case of meningococcal meningitis A has been identified among vaccinated individuals and in post-campaign carriage studies. The overall number of meningitis cases dropped sharply during epidemic seasons in the countries of the belt. The vaccine will be introduced via routine immunization by the end of 2015

Community-Based Surveillance on Polio Eradication in the Horn of Africa

Community-based surveillance complements the existing surveillance systems in the mission to control and eradicate polioviruses. It is a cost effective method and has a number of benefits. It was introduced in Ethiopia in 2003 and in the South Sudan CORE Group Polio Project areas in 2010. As well as the results obtained from this initiative; the report looks at the challenges; lessons learned and suggests some ways to strengthen the programme

Cross-Border Initiative on Polio Eradication in the Horn of Africa

Community-based surveillance complements the existing surveillance systems in the mission to control and eradicate polioviruses. It is a cost effective method and has a number of benefits. It was introduced in Ethiopia in 2003 and in the South Sudan CORE Group Polio Project areas in 2010. As well as the results obtained from this initiative; the report looks at the challenges; lessons learned and suggests some ways to strengthen the programme

All-Age Group Polio Supplementary Immunization Activities; Garissa County; Kenya

The Polio Eradication Initiative (PEI) has made significant progress towards attaining the poliomyelitis targets in the African Region and research; among other activities; has played a critical role. An overview of the contribution of a select few operational research (OR) activities undertaken is given in this article. These mainly concern social research targeted at understanding and changing behaviour to enhance effective intervention uptake. Lessons learned from this research for the planning and implementation of interventions are also discussed

Role of Operational Research in Accelerating Progress towards Attainment of Poliomyelitis Targets in the African Region

The Polio Eradication Initiative (PEI) has made significant progress towards attaining the poliomyelitis targets in the African Region and research; among other activities; has played a critical role. An overview of the contribution of a select few operational research (OR) activities undertaken is given in this article. These mainly concern social research targeted at understanding and changing behaviour to enhance effective intervention uptake. Lessons learned from this research for the planning and implementation of interventions are also discussed

Tetanus nearly Eliminated after 40 Years of Vaccination in Rural Sengerema District; Tanzania

Objective: To study the incidence of tetanus during the last 50 years in Sengerema; Tanzania. Design: Analysing the annual reports in the only district hospital; focusing on the number of admissions and mortality for tetanus and malaria. Setting: Sengerema Hospital; Sengerema district; Tanzania. Subject: Number of admissions and mortality in Sengerema Hospital due to tetanus. Interventions: In the seventies and eighties a vaccination campaign was started end organised in order to cover the whole district and to provide immunity for tetanus. Main outcome measures: From 1962 to 2012; we analysed the incidence and fatality rate of tetanus. Result: One hundred and fifteen admissions in the sixties; increasing to 183 in the seventies; dropping to 30 in the nineties. For the last ten years 18 patients with tetanus were seen in the only district hospital. Then last year no admissions for tetanus were registered. The number of deaths due to tetanus decreased simultaneously; during the last decade a single fatality case was reported. Conclusion: During the last decades; we have witnessed the disappearing of tetanus in Sengerema Hospital. The incidence of tetanus can be reduced significantly or eliminated by an effective immunisation programme; even in rural Tanzania

Polio Eradication Initiative (PEI) Emergency Plan: A Panacea for Polio Eradication in Nigeria

BACKGROUND.Nigeria has persistently fallen short of the goal to halt and eradicate the transmission of the poliomyelitis virus. The most recent failure of yet again another major polio eradication program under the Global Polio Emergency Initiative 2010-2012 calls for a review of the Nigerian Polio Eradication Initiative Emergency Plan developed under this scheme and time period. This is to determine whether the deployed strategies were optimum to tackle and surmount the intractable problem of sub- optimal vaccine coverage which has remained a critical bottleneck in the successful eradication of the polio virus in Nigeria. It becomes pertinent therefore; to appraise this latest effort to avoid a recurrence of failure in subsequent polio eradication programs.METHODS.A review of related and available literature was conducted on the subject matter using the Google search engine; Google Scholar; and PubMed using the key words polio; eradication; Nigeria; and Global Polio Eradication Initiative.RESULT.Much progress has been made towards achieving the required coverage threshold to completely eradicate polio but the inherent weaknesses and gaps in the Polio Eradication Initiative Emergency Plan plugs eradication efforts back into the vicious cycle of recurrent failure.CONCLUSION. Successful polio eradication efforts through the Polio Eradication Initiative Emergency Plan need to target realistic goals. Current efforts and strategies need to be scaled up and sustained to permanently address the persistent issue of sub optimal coverage of polio immunization

Leprosy elimination: progress and challenges in Nigeria, Kaduna State tb and leprosy control programme as case study

The study aims at describing the achievements and challenges of Leprosy control in Kaduna State using appropriate indicators. The study was a five year (2004-2008) retrospective review of the Leprosy records and annual reports of all the twenty three LGAs in Kaduna State. Various Leprosy indicators were calculated and presented in different graphic presentations. Focus group discussions were organised with the aim of identifying current challenges of Leprosy control in the State. There was a decline in the new Leprosy cases detected annually from 226 cases in 2004 to 140 cases in 2008. The prevalence rate ranged between 0.3-0.4 per 10;000 population within the five year period. The proportion of children among new cases dropped from 12 in 2004 to 5 in 2007 and increased to 9 in 2008. Grade 2 disability among new cases was very high (between 21-27) within the same period. Leprosy elimination target has been achieved in Kaduna State; but new cases with high proportion of children and WHO grade 2 disability were still been reported

Community participation in malaria control in olorunda local government area, osun state, southwestern Nigeria

Malaria is a major health burden in developing countries and needs multiple strategies for its control. Community participation as one of the strategies for malaria control promotes self-awareness and confidence; causes the people to examine the problems and to think positively about the solutions. The study was aimed at assessing the level of community participation in malaria control in Olorunda local government area of Osogbo; Osun state; Nigeria. The study employed a cross-sectional descriptive design. Multi-staged sampling technique was used to choose 550 respondents. An interviewer-administered semi-structured questionnaire was used to elicit information from the respondents. Most of the respondents (65.0) fell between the age ranges 20-39 years; with a mean age of 32.85 + 12 years. Almost all (98.4) respondents had knowledge of malaria with most of them (88.0) correctly aware that mosquito bite could lead to malaria fever. Respondents stated that stagnant pool (92.6) and refuse dump (89.0) could predispose to malaria. About two-thirds (60.6) of the respondents participated in the control of the breeding sites of mosquitoes on specific days for environmental sanitation. The association between community participation in health talk and community participation in malaria control was statistically significant (p

Energy saving bulbs: an emerging threat to public health, from. mercury contamination of the environment

Energy saving bulbs are promoted for their efficiency and capacity to reduce the emission of greenhouse gases; the acknowledged cause of global warming and climate change. They however contain varying quantity of mercury that can easily contaminate the environment. Mercury is a neuro-toxin; but damage has also been reported in the kidney; skin and the cardiovascular system. There is therefore an urgent need to emphasize the safe disposal of the energy-saving bulbs as their use increase in Nigeria. Recycling programme should be institutionalized; with the active participation of the manufacturers and importers of the bulbs; while education programme should be mounted on the handling and safe disposal of broken bulbs