Caractéristiques cliniques, biologiques et évolution des cas de paludisme de l'adulte hospitalisés en médécine interne à l'hôpital de zone de Come

Objectif: Décrire les signes et l'évolution du paludisme en médecine interne.Patients et méthodes : Etude transversale, descriptive sur 2 ans (1er janvier 2012 au 31 décembre 2013) en médecine interne de l'hôpital de Zone de Comè (Bénin). Etaient inclus, les patients chez qui le paludisme a été diagnostiqué en cours d'hospitalisation. Les données ont été analysées avec SPSS 18.0.Résultats : 45 cas de paludisme ont été diagnostiqués parmi les 317 cas de fièvre enregistrés pen-dant la période d'étude, soit 14,2%. La sex-ratio était de 0,88 et l'âge moyen de 36,69±13,76 ans. Les autres symptômes les plus fréquents étaient l'asthénie (55,6%), les vomissements (22,2%) et les cé-phalées (20,0%). 25 patients (55,6%) avaient au moins un critère de gravité ; 4,4% étaient décédés et 6,6% ont été transféré vers un niveau supérieur. Conclusion : Le paludisme est fréquent en Médecine. Promptement pris en charge, l'évolution est souvent favorable

Influence des facteurs climatiques sur la morbidité palustre à Tillabéry au Niger

Problématique : La transmission du paludisme dans les pays du Sahel est tributaire des facteurs climatiques. Au Niger, il y a un gradient de transmission qui est décroissant du Sud au Nord. L'objectif de l'étude est de décrire les relations entre les facteurs climatiques et le paludisme afin de mettre au point des stratégies de contrôle. Patients et méthodes : Il s'agit d'une étude analytique et rétrospective, utilisant les données de 2004 à 2013 (10 ans) de la commune urbaine de Tillabéry. Les données sanitaires sur le paludisme sont issues du Système National d'Information Sanitaire (SNIS) du Niger. Les données climatologiques étaient celles de la Direction de la Météorologie Nationale (DMN). La méthode statistique utilisée est le coefficient de corrélation "r" entre les variables climatiques et morbi-mortalité palustre.Résultats : L'analyse univariée montre que le nombre de cas de paludisme le plus élevé était observé au mois de septembre et l'humidité relative minimale la plus élevée au mois d'aout. L'analyse multivariée fait ressortir une corrélation forte et positive entre l'humidité relative minimale et la mortalité (r = 0,719), puis la morbidité (r = 0,674). Par contre la température était négativement corrélée à la mortalité (r = -0,386) et à la morbidité palustre (r = -0,363).Conclusion : Il ressort de cette étude que l'humidité relative minimale et la pluviométrie ont un réel impact sur les pics de morbidité et de mortalité palustre, par opposition à la température. Le pic de morbi-mortalité intervient en septembre, un mois après les fortes pluviométries et humidités relatives minimales du mois d'aout. Ces observations serviront à la planification de la lutte anti larvaire, anti-vectorielle, de la chimio-prévention et de la prise en charge par les programmes nationaux de lutte contre le paludisme

Efficacy of Artesunate + Sulphadoxine-Pyrimethamine (AS + SP) and Amodiaquine + Sulphadoxine-Pyrimethamine (AQ+ SP) for Uncomplicated falciparum Malaria in Equatorial Guinea (Central Africa)

The objectives of the study were (i) to evaluate the efficacy of combination drugs; such as artesunate + sulphadoxinepyrimethamine (AS + SP) and amodiaquine + sulphadoxine-pyripethamine (AQ+ SP) in treatment of uncomplicated falciparum malaria (ii) to differentiate recrudescence from reinfection by analysing msp-1 and msp-2 genes of Plasmodium falciparum in treatment failure cases. Methods. We carried out an in vivo study in the year 2005 in 206 children between 6 to 59 months age groups. Of the 206; 120 received AQ+ SP; and 86 received AS + SP. A clinical and parasitological followup during 14 days was undertaken. Finger-prick blood sample from each patient was taken onWhatman filter paper (no. 3) on days 0; 7; 14 and also the day when the parasite and symptoms reappeared for PCR analysis. Results. Late treatment failure was observed in 3.5(4/114) with AQ+ SP; and 2.5(2/79) with AS + SP. The success rate was 96.5with AQ+ SP and 97.5with AS + SP. No deaths and severe reactions were recorded. Out of the 6 treatment failure cases; one was reinfection as observed by PCR analysis of msp-1 and msp-2 genes on day 14. Discussion. Both the combinations found to be efficacious and safe and could be used as a first-line treatment for uncomplicated falciparum malaria in Equatorial Guinea

Accuracy of an Immunochromatographic Diagnostic Test (ICT Malaria Combo Cassette Test) Compared to Microscopy among under Five-Year-Old Children when Diagnosing Malaria in Equatorial Guinea

Conventional malaria diagnosis based on microscopy raises serious difficulties in weak health systems. Cost-effective and sensitive rapid diagnostic tests have been recently proposed as alternatives to microscopy. In Equatorial Guinea; a study was conducted to assess the reliability of a rapid diagnostic test compared to microscopy. The study was designed in accordance with the directives of the Standards for Reporting Diagnostic Accuracy Initiative (STARD). Peripheral thick and thin films for the microscopy diagnosis and a rapid immunochromatographic test (ICT Malaria Combo Cassette Test) were performed on under five-year-old children with malaria suspicion. The ICT test detected Plasmodium spp. infection with a sensitivity of 81.5and a specificity of 81.9while P. falciparum diagnosis occurred with a sensitivity of 69.7and a specificity of 73.7. The sensitivity of the ICT test increased with higher parasitemias. The general results showed little concordance between the ICT test and microscopy (kappa = 0.28; se: 0.04). In Equatorial Guinea; the ICT Malaria Combo Cassette Test has proven to be an acceptable test to detect high P. falciparum parasitemias. However; the decrease of sensitivity at medium and low parasitemias hampers that ICT can replace properly performed microscopy at present in the diagnosis of malaria in children

Caregivers' Knowledge about Childhood Malaria in Gilgel Gibe Field Research Center; Southwest Ethiopia

Background: Malaria morbidity and mortality reduction in children greatly depends on caregivers' knowledge about childhood malaria. Objective: The objective of the study was to assess caregivers' knowledge about malaria in Gilgel Gibe Field Research Center; Southwest Ethiopia. Methods: A cross-sectional study was conducted from November to December 2005. A Sample of 588 households having children between the ages of 2-59 months were randomly selected from urban; semi-urban and rural strata proportional to their size. Caregivers of the children were interviewed using a structured questionnaire. Findings: Of 572 interviewed caregivers; most of them (70.1) spontaneously mentioned mosquitoes as the cause of malaria in children while half of them (51.9) had non-biomedical perceptions as causes of the disease. Among the symptoms of malaria in children; fever was mentioned spontaneously by most (86.2) of the caregivers. The three most commonly perceived preventive measures of malaria for children were cleaning the surrounding (43.7); keeping personal hygiene (35.7); and mosquito net usage (35). Urban or semi-urban residence; lower income and having formal education were found to be associated with good knowledge about childhood malaria. Conclusion: This study identified misperceptions regarding the cause and low level of awareness about childhood malaria among caregivers. These issues need to be addressed through tailored health promotion activities to prevent and control childhood malaria

Malaria specific mortality in lowlands and highlands of Muheza district; north-eastern Tanzania

Vital registration of causes of death in Tanzania is incomplete and many deaths occur outside health care settings. Verbal autopsies (VA) are used to determine the underlying cause of death, and the probable diagnosis helps to estimate reasonably cause-specific mortality. In this paper, we report findings of a verbal autopsy survey which involved eight villages in both low and highlands of Muheza district, north-eastern Tanzania. The survey was conducted following.a rapid census, which was done to identify households that had lost one or more members within a period of two years from the date of census. Trained research assistants administered VA questionnaires to parents/close relatives. Two physicians reviewed each report independently and a third opinion was sought where there was discordant report between the two. A total of 9,872 households were surveyed and 134 deaths were recorded. A total of 96 (71.6%) deaths were from lowland villages representing high malaria transmission. Majority (72.4%) of the reported deaths occurred at home whilst 32.1% occurred at heath facility settings. Overall, severe malaria was the leading cause accounting for 34.3% of all deaths. Infants were most affected and accounted for 43.5% of the total deaths. Pulmonary tuberculosis ranked second (8.2%) cause of deaths and was exclusively confined to individuals ≥15 years. Probable cause of death could not be determined in 13.4% of deaths. In conclusion, majority of deaths in rural north-eastern Tanzania occur at home and the immediate causes are usually unknown or not documented. These findings indicate that the verbal autopsy is a useful tool for detecting leading causes of death at community level in the absence of health facility-based data

Pattern of cause-specific childhood mortality in a malaria endemic area of Burkina Faso

Background: Reliable mortality data are a prerequisite for planning health interventions; yet such data are often not available in developing countries; particularly in sub-Saharan Africa (SSA). Demographic surveillance systems (DSS) implementing the verbal autopsy (VA) method are the only possibility to observe cause-specific mortality of a population on a longitudinal basis in many countries. Methods: This paper reports all-cause and cause-specific mortality rates in children under the age of five years from 1999 until 2003 in a malaria holoendemic area of north-western Burkina Faso. The DSS of the Nouna Health Research Centre; which VA data were analysed; covers a rural population of about 30;000 (41 villages) and an urban population of about 25;000 (Nouna town). Results: A total of 1.544 deaths were analysed (...)

Le paludisme: 1ere cause de mortalite en Afrique (1ere partie)

Le paludisme est un des rares fleaux de sante publique qui ait traverse les siecles sans jamais perdre de son activite (Pr. P. Aubry). Pire; la maladie progresse en Afrique. Selon les statistiques nationales (BP); le paludisme a represente en 2003; 54;53des motifs de consultation et 43;87des causes de deces (tout age confondu). Chez les enfants de moins de 5 ans; le paludisme represente 62;76des hospitalisations et 54;64des causes de deces. Cette maladie est la 1ere cause de mortalite dans la plupart des pays d'Afrique du sud du Sahara. A defaut de pouvoir l'eradiquer; l'application rigoureuse des methodes simples de protection et un recours precoce a un centre de sante peuvent contribuer efficacement a diminuer la mortalite

Roll Back malaria (RBM): What; Why and How?

Malaria continues to be the leading public health problem in Africa. There is evidence of a worsening global malaria situation. Mortality rates in Africa are rising. The malaria prasite is increasingly resistant to the commonly used antimalarial drugs. New epidemics are reported - some of them in countries that have; until recently; been free of the disease. In many countries; resources for malaria control programmes are stretched to the limit. Malaria contributes to widespread human suffering; particularly among the poorest. It is a major constraint to economic and social development that has a negative impact on Africa's growth. Background to RBM movement: In 1997 the total of malaria was US$ 2;000 million and was projected to reach US$ 3;600 million per year by 2000 in Africa. This observation prompted the OAU Heads of States to adopt a Declaration in 1997; requiring member states to intensfy the fight against malaria. WHO; established the Roll Back Malaria (RBM) movement in July 1998. RBM in Africa builds on earlier initiatives to control malaria; namely: The Regional Strategy for Malaria Control (1991); The Accelerated Implementation of Malaria Control (1995); The African Initiative for Malaria (AIM) Control in the 21sth Century (April 1998). The RBM movement in Africa was given another boost by the abuja Declaration (April 2000). What is Roll Back Malaria (RBM) and how does it work? the RBM partnership is not a project or a programme. it is a social movement that is part of a broader societal action for health and human development and is characterised by the various actors working in harmony. The RBM movement emphasises and depends on up-to-date technical systems and expertise for malaria control; for surveillance; for controlling mosquito vectors; for promoting the use of effective medicines for integrated management of childhood diseases and for encouraging the development of new diagnostic; treatment and preventive measures. It also depends on building partnerships at various levels: regional; national; district and community. The RBM strategy builds on past experience; is evidence-based; and focuses on outcomes. Its implementation is multisectoral; involving governments; civil society; development agencies; NGO's the private sector; researchers; the media and other interested parties including local communities. The RBM movement tries to get the best possible results with existing malaria control tools; through better functioning health services as well as focussing on intense action against malaria at community level; with high level political backing; the attention on strengthening the health systems. The interests of the people; particularly people in poor communities - and especially children and women - are at the centre of the RBM movement. It supports the development and adaptation of new tools: These are needed to ensure that gains are sustained. RBM in Africa: The mission is to control malaria in Africa as a contribution to Africa's health and overall socio-economic development. Target of RBM: The RBM partners have set a 10-year target to reduce by 50the world's malaria burden by 2010 and by 75by 2015; of the figure for 2000. To achieve this: . 60of people with malaria should get correct treatment within 24 hours of recognition by 2005; . 60of people at risk should be using effective preventive measures by 2005; . 60of pregnant women should be getting intermittent presumptive treatment (IPT) by 2005; etc. All these will be achieved through creating a social movement that enables countries to take effective and sustainable action against the diseases

Malaria situation in Uganda and treatment of Un-complicated malaria

Malaria is the leading cause of illness and death in Uganda. In 1992 it accounted for 25of the total out patient morbidity; 20of the admissions to health facilties and 15of all in-patient deaths (MOH; Planning Unit 1993). The 1994 atributable to malria. However; in the last quarter of 1997 and the first quarter of 1998; there was an upsurge of malaria cases throughout the country. The increase was attributed to the El Nino climate anormalies. The proportional illness attributable to malaria in 1997 ranged from 30-35

Pharmacology of absorption and distribution: optimal use of antimalarial drugs in the treatment of severe falciparum malaria in Kenya

Since 1989; a project at the KEMRI CRC Unit at Kilifi has focused on the design of appropriate and praticable regimens for the treatment of severe falciparum malaria. Initially; there was no data describing the absorption; distribution and elimination of quinine in Kenyan children; who constitute the great majority of patients. Pharmacokinetic studies were conducted to define these variables; which formed the basis for the design of appropriate and praticable treatment regimens. Even with optimal clinical management; the majority is high in cases of severe malaria treated with quinine at Kilifi. Alternative drugs have been studied in a search for a therapeutic regimen which will further reduce mortality

Epidemiology of malaria in Kenya

Over four million cases of malaria are reported every year in Kenya. A mortality rate of 5.1 per cent has been observed among those patients admitted with severe malaria. The high prevalence of malaria; increasing incidence of treatment and control activities make malaria a major public health problem. All the four species of malaria exist in Kenya

L'analyse de la situation du paludisme au Togo

Malgre les efforts deployes depuis des annees; le paludisme reste et demeure l'une des principales causes de morbidite et de mortalite au Togo. Les enfants de moins de 5 ans constituent la tranche d'age la plus vulnerable. Un effort reste a faire au niveau des institutions sanitaires afin que toutes les donnees statistiques permettant de bien cerner la situation; soient disponibles

Epidemiologie du paludisme sur les hautes terres malgaches depuis 1878

Le paludisme est decrit sur les cotes malgaches depuis le XVIe siecle; mais la premiere epidemie liee a l'introduction de plasmodium falciparum n'est survenue sur les hautes terres qu'en 1878. La deuxieme epidemie; de 1896; a permis l'installation d'une transmission endemique jusqu'a la compagne d'eridication des annees 1950. L'arret progressif des activites antipaludiques dans les annees 1970 a permis une reinfestation progressive des hautes terres et la survenue d'une epidemie meurtriere de 1986 a 1988 qui redevient endemique depuis 1989. Ces trois epidemies ont en commun une repartition geographique heterogene; un mode de transmission instable et une tres forte morbidite-mortalite

Le paludisme : une dimension de notre misere

Le paludisme qui represente le tiers des hospitalisations pediatriques au Zaire est l'une des principales causes de mortalite chez l'enfant de moins d'un an. L'elaboration d'une strategie de lutte efficace contre le paludisme s'avere donc necessaire; elle devrait tenir compte de la promotion intellectuelle et socio-economique des populations a proteger

Paediatric anaemia at Kamuzu Central Hospital

This retrospective study assessed the outcome of children admitted during a six week period to KCH with anaemia. 19 percent of admissions had a primary discharge diagnosis of anaemia and there was a 12 percent mortality. et2 percent had a diagnosis that included both malaria and anaemia; but malaria was only documentated in 36 percent. Malaria may be over-diagnosed. More data is required to determine whether delays in obtaining blood for transfusion influence mortality

Morbidite et letalite palustres dans un service de pediatrie en Afrique de l'Ouest

Le paludisme est a l'origine de 30 pour cent des hospitalisations dans le service de pediatrie de l'hopital de Bobo-Dioulasso au Burkina Faso; avec une grande variation de frequence au cours de l'annee soit 11 pour cent des hospitalisations en saison seche et 43 pour cent en periode de transmission palustre. Avec un taux de letalite de 7 pour cent; le paludisme est directement responsable de 15 pour cent des deces des enfants hospitalises