Seasonal malaria chemoprevention coverage in Burkina Faso in 2018: Descriptive analysis of mothers' knowledge and attitude during cross sectional survey

Seasonal malaria chemoprevention (SMC) is effective to prevent malaria in children 3 to 59 months in the Sahel region. Mother's seasonal malaria chemoprevention related knowledge and attitudes and the coverage of the strategy among targeted children were assessed. A cross-sectional survey was conducted in 1828 children aged 3 to 59 months from November 7 to 18, 2018 in eight health regions of Burkina Faso where SMC was implemented with Malaria Consortium supported fund. Data were collected using structured questionnaire and direct inspection of SMC card. MAGPI software was used for data collection and STATA 12.0 was used for the analysis. A total of 1828 children 3 to 59 months were enrolled and 951 mothers interviewed on different aspects of SMC. Overall, the SMC coverage was high for single cycle or for cumulative coverage basis. Single cycle coverage increased over rounds, from mother and tutor's interview (from 87.09% (1592/1828) to 91.19% (1667/1828); p=0.001). Over 91.18% (869/951) knew that SMC objective was to prevent malaria. Overall SMC was well tolerated and most 95.2% (296/320) of mothers and tutors surveyed owned treated bed nets. Despite combining high coverage and treated bed-net use, at least 16.19% remained rapid diagnosis test positives during the survey. SMS coverage was high in the current survey and most mothers knew the relevance of SMC administration with high bed-net coverage.

Features of malaria among patients HIV infected in a Department of Infectious Diseases in Bamako

Introduction. We studied malaria in HIV infected subjects hospitalized in the department of infectious diseases at Point G Teaching Hospital in Mali, with the objective to have current data on malaria in patients infected by HIV. Materials and methods. We conducted a prospective study from October, 1st 2016 to September 30th 2018 in patients seropositive for HIV having positive thick smear for Plasmodium and hospitalized in the department of infectious diseases at Point G Teaching Hospital. We collected sociodemographic, clinical and lab data form those patients. Data have been entered and analyzed using SPSS20.0 software. Results. Hospital frequency of malaria among People living with HIV was 24.4% (151/618). This population has a mean-age of 44.1±12.4 y/o and a sex ratio (M/F) of 0.86. Majority of patients were at WHO stage IV of HIV infection (63.4%). Symptoms were by decreasing frequency: fever (98.3%); headache (86.4%); anorexia (72.9%); asthenia (61.0%) and vomiting (42.4%). the mean parasitemia was 172.9±352.1 trophozoite/mm3 . Mean hemoglobin level was 9.1±3.2 g/dl and the mean CD4 count was 9±3 cell/mm3 . Severe malaria was independent from WHO HIV stage and from immunologic deficiency. The malaria treatment when correctly followed conduct to good improvement of the anemia (p = 0.03) and the negativity of the parasitemia (p = 0.00). Death in our HIV patient is linked to association with severe malaria (p = 0,012). Conclusion. Malaria is relatively common and severe among PLWHA in Mali. Prompt treatment is still effective and must be implemented to ensure a good prognosis. Despite cotrimoxazole chemoprophylaxis, a certain number of PLHIV suffer from malaria, raising the hypothesis of plasmodium resistance to antifolates.

Isoniazid preventative therapy uptake for child household contacts of tuberculosis index cases, Kisumu County, Kenya, 2014-2015

Isoniazid Preventative Therapy (IPT) is recommended for children aged less than 5 years that have been in contact with an open case of TB, and screen negative for TB, to prevent the risk of TB progression. We examined IPT uptake among child household contacts of TB index cases, within a TB case detection study, in a high TB burden region. A cross-sectional study involving all IPT-eligible children drawn from a TB case detection study was done in Kisumu County, Kenya between 2014 and 2015. By linking a subset of the study database to the TB program IPT register, we described Child contacts as initiated on IPT and TB index cases as having child contacts initiated on IPT based on whether their names or their child contacts names respectively, were found in the IPT register. Logistic regression analysis was used to describe index and contact characteristics associated with IPT initiation. Of 555 TB index cases recruited into the study, 243 (44%) had a total of 337 IPT-eligible child contacts. Forty-seven (19%) index cases that had child contacts initiated on IPT; they were more likely to have been diagnosed with smear positive TB compared to those who were diagnosed with smear negative TB (OR 5.1, 95%CI 1.1-23.2; P=0.03) and to reside in rural Kisumu compared to those in urban Kisumu (OR 3.3, 95% CI 1.6-6.8; P<0.01). The 51 (15%) child contacts that were initiated on IPT were more likely to be were first degree relatives of the index case compared to those who were not (OR 2.6, 95% CI 1.2-5.5; P=0.02) and to reside in rural Kisumu compared to those in urban Kisumu (OR 2.6, 95% CI 1.2-5.1; P<0.01). IPT initiation, which is influenced by index and contact characteristics, is suboptimal. The TB program should provide health worker training, avail appropriate pediatric TB diagnostic tools, job aids and monitoring tools, and ensure continuous supply of medication, and to facilitate IPT implementation. Additionally, targeted health education interventions should be formulated to reach those who are unlikely to accept IPT

La co-infection tuberculose-VIH chez l'enfant au Sénégal

Objectifs : Décrire les aspects épidémiologique, diagnostique, thérapeutique et évolutif de la co-infection tuberculose-VIH au Centre National d'Enfants Albert Royer (CHNEAR) de Dakar. Patients et méthode : Etude rétrospective, analytique et descriptive menée du 1er janvier 2000 au 31 décembre 2014. Tous les enfants âgés de 0 à 15 ans co-infectés par le VIH et tuberculose étaient inclus au CHNEAR. Les antécédents, les facteurs de risque, les données cliniques, bactériologiques et évolutives ont été recueillis et analysés grâce au logiciel SPSS version 16 (test du Chi2 : p < 0,05 était considérée comme statistiquement significative).Résultats : Un total de 99 cas de co-infection tuberculose-VIH ont été colligés parmi les 705 enfants infectés par le VIH au CHNEAR (soit une de fréquence de 14%). L'âge moyen des enfants était de 6,8 ans. Le sex-ratio de 1.3 était en faveur des garçons. La majorité (60,2%) des enfants étaient orphelins d'au moins un parent. Un contage tuberculeux était retrouvé chez 26 enfants. Les principaux terrains retrouvés étaient la malnutrition dans 48 cas, la dermatose dans 32 cas, la candidose dans 18 cas, l'otite dans 13 cas, la gastro-entérite aiguë dans 6 cas, la pneumonie dans 4 cas et la drépanocytose A/S dans 3 cas. La localisation pulmonaire était la plus fréquente dans 67 cas, suivie des atteintes ganglionnaires dans 28 cas et abdominales dans 11 cas et des formes multifocales dans 9 cas. La recherche de bacille acido-alcoolo-résistant était positive dans 15,5%. Tous les patients avaient bénéficié d'un traitement (antituberculeux, antirétroviraux (ARV), prophylaxie au cotrimoxazole). La létalité était de 16,2%. Les principaux facteurs de risque de décès retrouvés étaient l'âge (p = 0,0278), le sexe (p = 0.0018), et la localisation de la tuberculose (p = 0,0170). Conclusion : La co-infection tuberculose-VIH est très fréquente chez l'enfant au Sénégal, ceci malgré un accès gratuit aux ARV. Nous recommandons une vulgarisation de la chimioprophylaxie à l'isoniazide chez les enfants infectés par le VIH

Evaluation de la chloroquino-resistance apres deux annees d'arret de la chimioprophylaxie chez les enfants de 0-9 ans dans un village d'endemie palustre au Mali

This study was carried out in the village of Faladie; Mali located in the malaria-endemic Kati region; two years after routine use of chloroquine prophylaxis was discontinued in children 0 to 9 years old. The main purpose of this study was to assess changes in chloroquine resistance. Two cross-sectional surveys in association with WHO in vivo chloroquine sensitivity testing were conducted; i.e.; one in September 2000 and one in December 2002. Findings in 2000 showed that 77.5of m o t h e rs administered ch l o roquine prophylaxis to their ch i l d ren in compliance with physician ord e rs. The plasmodic index was 62. The ove rall level of para s i t o l ogic resistance (based on the 1996 WHO in vivo tests) was 80. The ove rall therapeutic fa il ure rate was 17.5. Findings in 2002 demonstrated a plasmodic index of 28; an ove rall para s i t o l ogic resistance rate of 45(based on WHO in vivo tests); and an overall therapeutic failure rate of 15. The diminution of resistance in 2002 may be due to the decrease of drugs pre s s u re and to low ex p o s u re of individuals to mosquitoes at the end of transmission season. Althougt these data indicate a 44drop in hloroquine resistance (P=0.0001); no increase in the clinical effi c a cy of chloroquine was observed (P= 0.05). In view of these results we propose more emphasis on information campaigns to increase public awareness of the need for chemoprophylaxis only for pregnant women; on the promotion of the use of bednets and insecticide-impregnated materials; and on environmental management

Incidence de l'anemie en saison de forte transmission du paludisme a Doneguebougou a propos de volontaires de 6 mois a 6 ans traites par du fer puis soumis a une chimioprophylaxie antipaludique

Les populations a risque d'anemie en zone subsaharienne sont les nourrissons; les jeunes enfants et les femmes enceintes. Les deux principales etiologies reconnues a ces anemies sont la carence martiale et le paludisme. L'importance relative de chacune de ces etiologies est cependant difficile a mesurer; car elles sont souvent en association ou; intriquees a d'autres etiologies notamment infectieuses. Notre etude se proposait d'explorer l'hypothese d'un impact favorable d'une supplementation martiale a dose curative chez des sujets anemies de 6 mois a 6 ans; sur l'incidence de l'anemie et de l'anemie grave associees au paludisme a Plasmodium falciparum dans cette population en periode de forte transmission du paludisme. Nous avons evalue et suivi les parametres hemoglobine; prevalence et incidence de l'anemie; IP et acces de paludisme dans une population d'enfants ages de 6 mois a 6 ans durant 5 mois de transmission du paludisme dans un village rural du Mali. Les sujets inclus dans l'etude ont recu un traitement martial de 45 jours par du Fumarate ferreux quand ils etaient anemies. Tous ont recu un traitement curatif antipaludique par la chloroquine avant d'etre randomises entre deux groupes de suivi dont l'un etait assigne a une chimioprophylaxie antipaludique a base de chloroquine et de proguanil et l'autre a un suivi sans chimioprophylaxie antipaludique. Parmi 227 sujets inclus; 217 ont ete suivis durant les 5 mois de suivi. Le traitement martial de 45 jours a ete institue chez 160 sujets pour anemie dont 157 ont ete revus au bout du traite- ment et en fin de suivi de cohorte. Le nombre de sujets ayant corrige leur anemie a la fin du traitement martial etait de 87 soit 55;4. Au cours du suivi; 5 cas d'anemie severe ont ete diagnostiques ; aucun de ces cas n'etait releve dans le groupe d'enfants initialement traites par du fer. Nous n'avons pas trouve de risque plus grand de faire un palu- disme lorsque les sujets avaient recu prealablement du fer pour anemie; mais nous notions plus significativement d'acces de paludisme chez les sujets gueris de leur anemie que chez ceux qui n'avaient pas corrige leur anemie au bout des 45 jours de traitement martial. Nous concluons que la carence martiale est une cause importante d'anemie dans la population de nourrissons et d'enfants de 6 mois a 6 ans et que le traitement martial presomptif de l'anemie en debut de forte transmission du paludisme; a un effet benefique; pour cette population pendant la saison de forte transmission du paludisme en zone subsaharienne

Prevention and Control of Tuberculosis

Tuberculosis is again becoming a major public health problem. In order to control this complex disease; case-management; chemoprophylaxis and vaccination are used. The aim of case-management is to virtually stop transmission of tuberculosis infection by multidrug chemotherapy. This is; however; hampered by poor drug compliance and the high cost of the most effective drugs. Bacilli-Calmette-Guerin (BCG) vaccination has been used for a long time but with contentious efficacy. Though recent studies put the efficacy at 50; its cost-effectiveness has yet to be established. Isoniazid preventive therapy (1PT) for control of tuberculosis is also rapidly gaining acceptance. In patients who adhere to 80of medication taken; the efficacy is usually high. As for the control of tuberculosis among health care workers; engineering; administrative and personal respiratory measures have been introduced. Following the introduction of these measures in USA; dramatic decline in the risk of tuberculosis among these workers has occurred

Malaria chemoprophylaxis among European tourists in tropical Africa : use; adverse reactions; and efficacy

In order to determine knowledge, attitudes and practices towards malaria prophylaxis, as well as its side-effects and efficacy, a self-administered questionnaire was distributed to European travellers on return flights from tropical Africa to Europe. Between 1985 and 1988 the questionnaire was completed by 44,472 passengers (80.1% of those on board) on 242 flights. A follow-up questionnaire was completed by 42,202 (94.9%) of the same travellers 3 months later. Almost all knew about the risk of malaria, but 10% relied solely on advice from nonmedical sources. While 55.6% had taken at least one measure against mosquito bites, only 4.5% adopted three such measures (used repellents and insecticides and wore long clothing after dusk). Compliance with chemoprophylaxis use was reported by 57.0% of travellers who spent less than 3 months in Africa, compared with 29.2% who stayed 3-12 months. Depending on the antimalaria regimen taken, 11-44% of the travellers experienced adverse effects, while four deaths were attributed to the chemoprophylaxis. The incidence of malaria per month of exposure for travellers who took no chemoprophylaxis was 15.2 per 1000 in East Africa and 24.2 per 1000 in West Africa. In East Africa, the prophylactic efficacy of the currently recommended antimalaria regimens (relative to that of no chemoprophylaxis) was zero for a chloroquine dosage of 300 mg base per week (4 malaria fatalities), 64.1% for a chloroquine dosage of 600 mg base per week (P = 0.03), and 94.0% for mefloquine (P = 0.003)