Etude de la gestion des ASACO : contribution à l'amélioration du fonctionnement de l'Association de Santé Communautaire de Konobougou, Mali

Au Mali, le fonctionnement des centres de santé communautaire (CSCOM) est assuré par l'association de santé communautaire (ASACO).L'objectif de l'étude était d'évaluer l'ASACO de Konobougou sur le principe de gestion du CSCOM universitaire, afin d'améliorer les connaissances,aptitudes et pratiques sur la gestion communautaire.Méthodologie : Il s'agissait d'une étude de rechercheaction participative au centre de santé communautaire et universitaire de Konobougou dans la Région de Ségou en 2017 allant de juillet à octobre. Ont participé à cette étude 219 personnes réparties comme suit :200 usagers du centre de santé, 5 agents de santé, 11 membres de l'ASACO et 3 élus communaux.Résultat : Les organes de gestion de l'ASACOexistaient et fonctionnaient. Par contre le comité de surveillance n'était pas fonctionnel, il l'est devenu après le plan d'action. La connaissance de la population sur l'existence de la carte de membre était 32% à l'évaluation initiale contre 82% après le plan d'actions à l'évaluation secondaire. Les membres de l'ASACOqui ne connaissaient pas l'organe de contrôle interne et externe étaient respectivement 37,5% et 25% avant le plan d'action contre 0% à l'évaluation finale.Conclusion : L'ASACO possède des outils sur le principe de gestion des CSCOM. La formation continue permettrait de renforcer sa capacité sur le bon fonctionnement des CSCOM

Requiem for Nigro or is anal squamous carcinoma still a surgical problem: abdominoperineal excision rather than a defunctioning stoma?

Background: Combined multimodal treatment (CMT) is the preferred treatment for anal squamous carcinoma with radical surgery reserved for treatment failure. Some patients require a defunctioning stoma prior to CMT. Successful closure of such a stoma is unlikely. Abdominoperineal excision (APE) may be suitable as primary treatment in these patients.Objectives: To evaluate organ preservation in the treatment of anal squamous cancer and the closure rate of pre-treatment, temporary diverting colostomy, thereby assessing whether APE could be offered as primary treatment in those requiring a pre-treatment colostomy.Methods: A retrospective review of all patients with anal squamous carcinoma was undertaken. Patients who required defunctioning colostomies prior to CMT were analysed for potential resectability of tumour prior to CMT and rate of permanent stoma.Results: One hundred and twenty-five patients were included of which 58 were males. The mean age was 56 years. 107 were treated with curative intent. Six received primary APE and 12 salvage APE. Thirty (22 males) required pre-treatment diverting colostomies. Three (10%) stomas were successfully reversed. Forty-eight (38%) of the 125 completed treatment with a permanent colostomy. Six patients who needed a stoma prior to CMT were deemed resectable.Conclusion: Organ preservation was not possible in about a third of patients. Defunctioning stomas prior to CMT were likely to be permanent. We propose that APE could be considered as an alternative in selective cases where the tumour is resectable with low morbidity and a stoma is indicated

Hypertension

Approximately one in four adults has hypertension; a prevalence that increases with age and may reach to two out of three adults older than 70 years of age. In the Framingham Heart Study 65-75 of hypertension in the elderly is of the isolated systolic hypertension variety. Hypertension causes a two- to threefold increased risk of atherosclerotic cardiovascular events. Hypertension clusters with dyslipidaemia; insulin resistance; glucose intolerance and obesity in more than 80 of cases.1 The great majority of hypertensives thus have additional cardiovascular risk factors. The global cardiovascular risk; of which hypertension is but one component; is best appreciated by the use of risk charts such as the Framingham Risk Score

Health workers perceptions on chloroquine and sulfadoxine/sulfalene-pyrimethamine monotherapies: implications for the change to combination therapy of artemether/lumefantrine in Tanzania

Objective: To describe; from health workers (HWs) perspectives; the potential and actual barriers to the implementation of the first change of policy from chloroquine (CQ) to Sulfadoxine / Sulfalane - Pyrimewthamine (SP) in preparation for the second change of policy to Artemisinin based Combination Therapies (ACTs). Methods: A descriptive cross-sectional survey of HWs using questionnaire interviews was carried out in public and private health facilities in Songea Urban district. The interview concerned awareness and knowledge on the commonly used antimalarial drugs as given in the new policy; focusing on SP use and the associated side effects as well as perceptions on the potency and safety of SP versus CQ and the perceived alternative antimalarial drugs to non-response or reaction to SP. Results: Awareness on the new policy was very high; 91.4 of HWs were aware that SP was the new drug. Although the majority of HWs (81.9) reported using the new policy as soon as it was out; a significant percentage (76.2) reported continued use of SP (P-value 0.001). SP was perceived to have a low potency in that it was slow in fever clearance. A significant percentage (65.7) of HWs reported a history of problems with SP use namely headaches and skin reactions. Quinine (QN) was significantly frequently mentioned as the perceived alternative drug to CQ (61.1) and non-response (56.6) or reaction (54.1) to SP. Conclusion: Findings show that SP was generally not preferred by HWs; and they continued to use CQ despite the evidence that it was no longer effective indicating that. HWs tend to maintain perceptions based on their experiences with drugs currently in use. Pertinent information; education and behaviour change communication strategies related to the change from SP to ACT should focus on the fact that the previous drug is no longer effective so as to induce consistent use of the new drug

Traitement du paludisme de l'enfant en Afrique : les ACT en question

Les Artemisinin-based Combination Therapies (ACT) representent la majorite des alternatives aux antipaludiques de reference et sont sur le point d'etre deployees largement en Afrique. Elles sont particulierement attractives pour traiter les enfants. Les vertus annoncees de ces associations sont multiples : puissance accrue; rapidite d'action; stabilisation de la chimioresistance et reduction de la transmission. L'abondante litterature consacree aux ACT depuis quelques annees permet de faire le point sur ces divers aspects; en insistant sur la question du confort des enfants malades

Comparative efficacy of dihydroartemisinin, chloroquine and combination of dihydroartemisinin and chloroquine or mefloquine in mice infected with Plasmodium berghei

Comparative efficacy of dihydroartemisinin alone, chloroquine alone, combination of dihydroartemisinin plus mefloquine and combination of dihydroartemisinin plus chloroquine was evaluated in mice. Parasite clearance time was very short in mice treated with dihydroartemisinin alone mean ± SD PCT was (1.64- ± 0.50 days). This was followed by combination of dihydroartemisinin with mefloquine (2.73 ± 0.47), Then combination of dihydroartemisinin with chloroquine (2.84 ± 0.50). The mice that were treated with chloroquine alone had PCT of 4.0 ± 2.32. There was significant difference between the dihydroartemisinin group and the chloroquine group (P<0.0002). There was also significant difference between the dihydroartemisinin group and combination of dihydroartemisinin plus mefloquine and also combination of dihydroartemisinin plus chloroquine (P<0.005). The combination therapy was more effective than when chloroquine was administered alone

Therapeutic value of partial excision of lesions combined with administration of an autogenous vaccine during an episode of cutaneous papillomatosis in cattle of Uganda

The therapeutic value of partial excision of lesions combined with administration of an autogenous vaccine in calves during an episode of cutaneous papillomatosis was evaluated. Of 10 Holstein calves naturally infected with cutaneous papillomatosis; 5 were given 20 ml of autogenous vaccine in addition to undergoing partial excision of the lesions; the other 5 calves were not given vaccine. Results indicate that partial excision combined with administration of autogenous vaccine has some therapeutic value in calves with small pedunculated papillomas; but not in calves with large confluent lesions