Avaliação do cumprimento das atividades de monitoramento do tratamento e de verificação de cura da malária / Evaluación del cumplimiento de las actividades de seguimiento del tratamiento de la malaria y verificación de la curación / Assessment of compliance with malaria treatment monitoring and cure verification activities

RESUMO Objetivo: Avaliar o cumprimento das atividades de monitoramento do tratamento e verificação de cura pelos profissionais do Programa de Controle da Malária. Método: Trata-se de pesquisa avaliativa, realizada por meio de observação sistemática, com auxílio de formulário com escala Likert, adotando escore numérico para avaliar o cumprimento das atividades. A coleta dos dados foi realizada no município amazônico de Cruzeiro do Sul no estado do Acre. Os dados foram analisados por meio de estatística descritiva. Resultados: Foram observados 15 agentes de controle de endemias, 5 enfermeiros e 5 microscopistas, no desempenho de suas funções no programa. As atividades de monitoramento do tratamento e verificação de cura obtiveram os respectivos percentuais totais de cumprimento: 72,0% e 12,1%. Os microscopistas, avaliados em 9 atividades, obtiveram maior percentual de cumprimento de atividades, enquanto que enfermeiros e agentes de controle de endemias tiveram índice de cumprimento parcial ou não realizam determinadas atividades. Conclusão: O Programa de Controle da Malária apresenta desempenho abaixo do preconizado, não atendendo ao padrão ouro estabelecido, podendo significar a manutenção ou a elevação dos casos de malária.

RESUMEN Objetivo: Evaluar el cumplimiento de las actividades de seguimiento del tratamiento y verificación de curación por parte de los profesionales del Programa de Control de la Malaria. Método: Se trata de una investigación evaluativa, realizada a través de la observación sistemática, con la ayuda de una forma de escala Likert, adoptando una puntuación numérica para evaluar el cumplimiento de las actividades. La recolección de datos se realizó en el municipio amazónico de Cruzeiro do Sul en el estado de Acre. Los datos se analizaron mediante estadística descriptiva. Resultados: Se observaron 15 agentes de control endémico, 5 enfermeros y 5 microscopistas en el desempeño de sus funciones en el programa. Las actividades de seguimiento del tratamiento y verificación de curación obtuvieron los respectivos porcentajes totales de cumplimiento: 72,0% y 12,1%. Los microscopistas, evaluados en 9 actividades, obtuvieron un mayor porcentaje de cumplimiento de las actividades, mientras que las enfermeras y agentes de control endémico tuvieron una tasa de cumplimiento parcial o no realizaron determinadas actividades. Conclusión: El Programa de Control de la Malaria se desempeña por debajo del nivel recomendado, sin cumplir con el estándar de oro establecido, lo que puede significar mantener o aumentar los casos de malária.

ABSTRACT Objective: To assess compliance with treatment monitoring and cure verification activities by Malaria Control Program professionals. Method: This is an evaluation research carried out through systematic observation, with the aid of a Likert-type scale form, adopting a numerical score to assess the fulfillment of activities. Data collection was carried out in the Amazonian municipality of Cruzeiro do Sul in Acre State. Data were analyzed using descriptive statistics. Results: Fifteen endemic disease control agents, five nurses and five microscopists were observed in the performance of their functions in the program. Treatment monitoring and cure verification activities obtained the respective total compliance percentages of 72.0% and 12.1%. Microscopists, assessed in 9 activities, obtained a higher percentage of compliance with activities, while nurses and endemic disease control agents had a partial compliance rate or did not perform certain activities. Conclusion: Malaria Control Program performs below the recommended level, not meeting the established gold standard, which may mean maintaining or increasing malaria cases.

Effect of health education on long lasting insecticidal nets utilization among mothers of under five children in Yamaltu Deba Lga, Gombe State, Nigeria

Background: Malaria remains a major global public health challenge. It is the leading cause of death among children below the age of five years and constitutes 10% of the continent's disease burden. The objective of this study was to determine effect of health education on utilization of long lasting insecticidal nets (LLINs) among mothers of under five children in Yamaltu Deba LGA of Gombe state: Objective: This study was aimed at determining the effect of health education on LLINs utilization among mothers of under five children in Yamaltu Deba LGA of Gombe State. Method: The study was a community-based quasi-experimental intervention where 240 mothers of under five children were selected from two communities using a multi stage sampling technique. Health education was given in the study community and withheld in the control community. Data was collected from both communities before and after the intervention using an interviewer administered structured questionnaire. Data was analyzed using EPI-INFO 3.7.1 and Micro soft Excel software. Result obtained was presented using proportion, Chi-square test was used to assess the relationship between categorical variables and decision taken at p<0.05. Results: The mean ages of respondents in study and control communities were 28.9±6.2 and 27.9±6.7 years respectively. At pre-intervention, LLIN ownership was found to be 86.6% and 76.3% while its utilization was 45.4% and 38.1% in both communities. After health education intervention, (LLINs) improved significantly in study community from 42.9% to 89.9% compared with control community which increased from 33.9% to 60.9% and the difference was statistically significant(P=0.0001). Conclusion: This study concludes that health education significantly improved utilization. We recommended continuous health education on LLINs utilization in communities especially among mothers of under five children

From Charcot's descriptions to the current understanding of neuropsychiatric symptoms in multiple sclerosis / Das descrições de Charcot à compreensão atual dos sintomas neuropsiquiátricos na esclerose múltipla

ABSTRACT Neuropsychiatric disorders in multiple sclerosis have been known since the original clinicopathological description by Charcot in the late nineteenth century. Charcot, in the last decades of his life, became involved in the field of neuropsychiatry. This produced a battle between rival schools in the era that still echoes to this day. Charcot's intuition, including the line of thought of Babinski, one of his most famous disciples, was that there was a connection between mood disorders and many of the diseases of the nervous system. Medicine's concern with establishing a relationship between mood disorders and disease stems from the ancient and middle ages with references found in the Hippocratic doctrine. However, it was only in the second half of the nineteenth and early twentieth century, with Charcot's discoveries, that this discussion was established in a structured way, laying the foundations of neuropsychiatry.

RESUMO Os distúrbios neuropsiquiátricos na esclerose múltipla são conhecidos desde a descrição clínico-patológica original de Charcot no final do século XIX. Charcot nas últimas décadas de sua vida se envolveu no campo da neuropsiquiatria. Isso produziu uma batalha de escolas rivais na época que ainda ecoa até hoje. A intuição de Charcot, incluindo a linha de pensamento de Babinski, um de seus discípulos mais famosos, foi a teoria correta da conexão entre os transtornos do humor e muitas das doenças do sistema nervoso. A preocupação da Medicina em estabelecer uma relação entre transtornos do humor e doenças vem das idades antiga e média, com referências encontradas na doutrina hipocrática. No entanto, foi apenas na segunda metade do século XIX e início do século XX que, com as descobertas de Charcot essa discussão foi realizada de maneira estruturada, estabelecendo os fundamentos da neuropsiquiatria.

Adherence to antimalarial drug policy among doctors in Delta State, Nigeria: implications for malaria control

Background: Malaria is a public health problem compounded with a widespread emergence of drug-resistant Plasmodium falciparum which necessitated the formulation of a new antimalarial drug policy (AMP).Objective: This study was designed to assess adherence to the policy among physicians in health facilities in Delta state, Nigeria. Design: Cross-sectional, analytic study. Data were collected with a semi-structured questionnaire.Setting: Two secondary and one tertiary health facilities in Delta State, Nigeria Participants: Physicians selected with a simple random technique from the facilities Main outcome measures: Prescribing pattern of antimalarial drugs and adherence to WHO treatment guideline among doctors. Results: Majority (90.8%) of respondents believed the antimalarial policy (AMP) should be strictly adhered to, although three-fifth (61.0%) of them rated its performance as poor. The level of adherence to the national antimalarial drug policy was high (78.5%) as most doctors prescribed Arthemeter-Lumefantrine, AL for uncomplicated malaria however barely two-fifth (35.4%) adhered to prescribing injectable Artesunate for complicated malaria. AL, (71.9%) was the most prescribed antimalarial drug for uncomplicated malaria The most prescribed antimalarial drugs for complicated malaria was artesunate (40.0%) followed by quinine (27.6%) and artemether (26.7%); although, chloroquine was also prescribed.Conclusion: The level of adherence to AMP among doctors was sub-optimal. Continuous education of doctors on the new AMP is needed to achieve malarial control

Factors affecting treatment practices of patent medicine vendors for malaria in under-five children: implications for malaria control in Nigeria

Background: Patent medicine vendors (PMVs) are the most common source of antimalarial drugs and treatment for majority of Nigerians. The quality of their practice could have implications for malaria control. This study sought to explore the factors influencing the malaria treatment practices of PMVs for under-five children in Akwa Ibom State. Methods: A cross-sectional survey using an interviewer-administered questionnaire was conducted among 176 PMVs selected by simple random sampling from two local government areas (LGAs). In addition, four focus group discussions (FGD) were conducted to generate qualitative data. Quantitative data was analysed using SPSS version 20 while content analysis was done on the qualitative data. Results: Artemisinin Combination Therapy (ACT) was the most frequently recommended antimalarial treatment by PMVs (75.6%) for children as against chloroquine (17%) and Sulphadoxine/Pyrimethamine (2.8%). However, only 39.2% of PMVs recommended the appropriate antimalarial treatment (ACTs at the right dose for age), while 71% recommended referral for severe malaria. Factors found to be associated with appropriate management of malaria from quantitative analysis included Educational qualification, attending malaria training and their knowledge of malaria. The FGDs showed that severity of child's illness, parents/caregivers drug request and perceived ability of the parents/caregiver to afford the drugs influenced PMVs malaria treatment practices. Conclusion: Knowledge of malaria, severity of child's illness and parents' drug request influenced the treatment practices of PMVs. Training PMVs on appropriate malaria management and community health education/sensitization to leverage on the influence of client-demand on ACT use is recommended to improve PMVs treatment practice

Recidiva de Malária: relato de caso / Malaria recurrence: case report

A malária caracteriza-se pela invasão de parasitas do gênero Plasmodium, considerada a principal parasitose tropical e uma das mais frequentes no mundo. Este relato tem como objetivo descrever um caso de malária, encontrado numa zona não endêmica, onde o paciente apresentou recidiva para P. vivax. Relato de caso: V.C.B, masculino, 63 anos. Apresentou sintomas de febre, dores de cabeça, tremores e sudorese, dez meses após uma viagem à Amazônia. O paciente foi encaminhado para exames, sendo diagnosticado com recidiva para o Plasmodium vivax. Considerações finais: É de extrema importância que profissionais e estudantes da saúde saibam diagnosticar corretamente a malária, assim como a possível presença de recidivas, a fim de minimizar erros de diagnóstico e uma correta profilaxia para o paciente.

Assessment of adverse drug reactions in the home management of malaria cases of children under 5 years using artemisinin-based combination therapy in Mfou health district, Center region of Cameroon

health concerns in Cameroon. Its treatment is frequently initiated at home, most often with street drugs. The home management of malaria cases entails the prescription of Artemisinin-based combination (ACTs) as first-line therapy for treatment of uncomplicated malaria after having confirmed the malaria case using rapid diagnostic tests. But induced adverse reactions of this therapy are not well known in Cameroon. Thus, a prospective, observational, cohort study of adverse events associated with ACTs was conducted from January 2013 to November 2013 in the health district of Mfou. Children under 5 years receiving ACTs for malaria treatment at home were enrolled. Suspected ADRs and other clinical events were recorded. Data were managed and analysed using Epi Info version 3.5.3 and Statistical Package for Social Sciences, statistical software version 20. Of the 479 children investigated, 56.8% (n=272/479) were males, the age group 25-59 months (49.5%; n=237/479) was most represented, 27.1% (n=130/479) had experienced one form of ADRs, male children (56.2%; n=73/130) and the age group 25-59 months (50.8%; n=66/130) were most affected. No significant association was found between age, sex and incidence of adverse ACTs reactions. The main experienced ACTs reactions were tiredness (43.1%; n=56/130) followed by lack of appetite (24.6%; n=32/130). The incidence ACTs ARDs was found to be relatively low and tolerable. Home management of malaria cases using ACTs should be encouraged and community members should be trained to improve the recognizing and reporting of adverse effects

Factors associated with timely treatment of malaria in the Brazilian Amazon: a 10-year population-based study / Factores asociados con el tratamiento oportuno de la malaria en la Amazonia brasileña: estudio de 10 años basado en la población / Fatores associados ao tratamento precoce da malária na Amazônia brasileira: um estudo populacional de 10 anos

ABSTRACT Objective To identify factors associated with timely treatment of malaria in the Brazilian Amazon. Malaria, despite being treatable, has proven difficult to control and continues to be an important public health problem globally. Brazil accounted for almost half of the 427 000 new malaria cases notified in the Americas in 2013. Methods This was a cross-sectional study using secondary data on all notified malaria cases for the period from 2004 - 2013. Timely treatment was considered to be all treatment started within 24 hours of symptoms onset. Multivariate logistic regression was used to identify independent factors associated with timely treatment. Results The proportion of cases starting treatment on a timely basis was 41.1%, tending to increase in more recent years (OR = 1.40; 95%CI: 1.37 - 1.42 in 2013). Furthermore, people starting within < 24 hours were more likely to: reside in the states of Rondônia (OR = 1.50; 95%CI: 1.49 - 1.51) or Acre (OR = 1.53; 95%CI: 1.55 - 1.57); be 0 - 5 years of age (OR = 1.39; 95%CI: 1.34 - 1.44) or 6 - 14 years of age (OR = 1.34; 95%CI: 1.32 - 1.36); be indigenous (OR = 1.41; 95%CI: 1.37 - 1.45); have a low level of schooling (OR = 1.20; 95%CI: 1.19 - 1.22); and be diagnosed by active detection (OR = 1.39; 95%CI: 1.38 - 1.39). Conclusion In the Brazilian Amazon area, individuals were more likely to have timely treatment of malaria if they were young, residing in Acre or Rondônia states, have little schooling, and be identified through active detection. Identifying groups vulnerable to late treatment is important for preventing severe cases and malaria deaths.

RESUMEN Objetivo Determinar los factores asociados con el tratamiento oportuno de la malaria en la Amazonia brasileña. La malaria, a pesar de que es tratable, ha resultado difícil de controlar y sigue siendo un problema importante de salud pública mundial. En Brasil se notificaron casi la mitad de los 427 000 nuevos casos de malaria en la Región de las Américas en el 2013. Métodos Se realizó un estudio transversal que utilizó datos secundarios de todos los casos notificados de malaria en el período 2004-2013. Se entendió como tratamiento oportuno todo tratamiento iniciado en las 24 horas posteriores a la aparición de los síntomas. Para determinar los factores independientes asociados con el tratamiento oportuno, se usó el método de regresión logística multifactorial. Resultados La proporción de casos en los que se inició el tratamiento oportunamente fue de 41,1%, con una tendencia ascendente en los últimos años (razón de posibilidades [OR] = 1,40; IC 95%: 1,37 - 1,42 en el 2013). Además, en las personas que comenzaron el tratamiento menos de 24 horas después de la aparición de los síntomas era mayor la probabilidad de que residieran en los estados de Rondônia (OR = 1,50; IC 95%: 1,49 - 1,51) o Acre (OR = 1,53; IC 95%: 1,55 - 1,57); también era mayor la probabilidad de que tuvieran entre 0 y 5 años (OR = 1,39; IC 95%: 1,34 - 1,44) o entre 6 y 14 años (OR = 1,34; IC 95%: 1,32 - 1,36); fueran indígenas (OR = 1,41; IC 95%: 1,37 - 1,45); tuvieran un nivel bajo de escolarización (OR = 1,20; IC 95%: 1,19 - 1,22) y hubieran sido diagnosticadas por detección activa (OR = 1,39; IC 95%: 1,38 - 1,39). Conclusiones En la zona de la Amazonia brasileña, era más probable que las personas que iniciaban oportunamente el tratamiento contra la malaria fueran jóvenes, residieran en los estados de Acre o Rondônia, tuvieran un nivel bajo de escolarización y fueran detectadas mediante la detección activa. La identificación de los grupos vulnerables al tratamiento tardío es importante para prevenir los casos graves y las muertes por malaria.

RESUMO Objetivo Identificar os fatores associados ao tratamento precoce da malária na Amazônia brasileira. Embora seja tratável, a malária tem sido difícil de controlar e continua a representar um importante problema de saúde pública em escala mundial. Em 2013, o Brasil registrou quase a metade dos 427.000 novos casos de malária notificados nas Américas. Métodos Este foi um estudo transversal que utilizou dados secundários sobre todos os casos de malária notificados no período de 2004 a 2013. O tratamento precoce foi definido como todo tratamento iniciado nas primeiras 24 horas desde o surgimento dos sintomas. Utilizamos a regressão logística multivariada para identificar fatores independentes associados ao tratamento precoce. Resultados A proporção de casos que iniciaram tratamento precoce foi de 41,1%, tendendo a aumentar em anos mais recentes (odds ratio [OR] = 1,40; IC 95%: 1,37 - 1,42 em 2013). Além disso, as pessoas que iniciaram o tratamento em menos de 24 horas tiveram maior probabilidade de: residir nos estados de Rondônia (OR = 1,50; IC 95%: 1,49 - 1,51) ou Acre (OR = 1,53; IC 95%: 1,55 - 1,57); ter entre 0 e 5 anos de idade (OR = 1,39; IC 95%: 1,34 - 1,44) ou entre 6 e 14 anos de idade (OR = 1,34; IC 95%: 1,32 - 1,36); ser indígena (OR = 1,41; IC 95%: 1,37 - 1,45); ter um baixo nível de escolaridade (OR = 1,20; IC 95%: 1,19 - 1,22); e ser diagnosticado por meio da detecção ativa (OR = 1,39; IC 95%: 1,38 - 1,39). Conclusão Na região da Amazônia brasileira, as pessoas têm uma maior probabilidade de receber tratamento precoce para a malária se forem jovens, residirem nos estados do Acre ou de Rondônia, tiverem um baixo nível de escolaridade e forem identificadas através da detecção ativa. A identificação de grupos vulneráveis ao tratamento tardio é importante para prevenir os casos graves e as mortes decorrentes da malária.

Post-malaria myasthenia gravis

We report a nine-year-old girl who presented with complete drooping of the left eyelid and restriction of medial gaze following an attack of febrile illness. The child was admitted into a rural hospital where she was misdiagnosed and managed as a case of meningitis. She was referred to a tertiary children hospital when her condition was not improving and where she developed the eye signs. She was diagnosed as a case of severe malaria which responded well to quinine therapy. In our neurophysiology clinic, examination revealed partial unilateral left eye ptosis, weak frontalis, neck flexors, fingers extensors & knee flexors. Her investigations revealed positive neostigmine test, decremental response to repetitive nerve stimulation(-15.6%,nasalis), increased jitter in single-fibre electromyography (left frontalis & extensor-digitorum communis) and negative serology for myasthenia gravis antibodies. She showed remarkable improvement after pyridostigmine therapy which continued for three months. Regular follow-up showed no recurrence of her symptoms

Efficacité et tolérance de Malacur® (dihydroartémisinine-pipéraquine) dans le traitement du paludisme simple à Plasmodium falciparum chez les sujets âgés de plus de 14 ans au Cameroun

Introduction: Les combinaisons thérapeutiques à base d'artémisinine sont depuis quelques années le traitement antipaludique de première intention dans une grande partie des pays endémiques. Des souches résistantes à différentes combinaisons ont été décelées en Asie du sud-est, ce qui oblige à une surveillance continuelle dans le monde entier. Matériels et méthode : Pour cela, à Yaoundé (Cameroun), a été réalisée une étude prospective,ouverte, non-randomisée pour évaluer l'efficacité clinique et parasitologique de l'association dihydroar- témisinine-pipéraquine (DHA-PQ) dans le traitement du paludisme simple à P. falciparum, chez les sujets âgés de plus de 14 ans. Résultats : Les résultats ont montré que 100% des 47 patients inclus dans cette analyse ont été libres de parasitémie dès le premier jour après la fin du traitement et les résultats se sont maintenus jusqu'à la fin du suivi, le 28ème jour. De la même manière 78,7% des patients ont été apyrétiques le jour après la première prise et 100% après les 3 jours de traitement. Aucun patient n'a montré d'évènement indésirable grave ni n'a abandonné le traitement pour cette raison. Conclusion : Les résultats confirment l'efficacité de l'association DHA-PQ comme traitement de première intention dans le traitement du paludisme non-compliqué à Plasmodium falciparum

Management of malaria in pregnancy by Traditional Birth Attendants in Ogun State, Nigeria

Background: Malaria in pregnancy is a major public health issue in sub-Saharan Africa. Most deliveries in this region are attended by the Traditional Birth Attendants (TBAs).Objective: To assess the knowledge and practice of prevention and treatment of malaria in pregnancy amongst TBAs in Ogun State, south-west Nigeria.Methods: This descriptive, cross-sectional study used systematic random sampling to select 200 registered TBAs within the state. Pre-tested, semi-structured interviewer-based questionnaires were used to obtain relevant data.Results: The mean age of respondents was 37.7 ± 2.2 years. Most of the respondents had secondary school education (82.0%) and were females (89.0%). The majority (68.0%) had good knowledge of malaria during pregnancy; 83.0% used blood test for the diagnosis of malaria while 62.2% of these used Malaria Rapid Diagnostic Test kits. A third of the respondents (33.0%) used Artemisinin-Combination Therapy for treatment while 13.0% used Chloroquine. The majority (85.5%) of the respondents did not practice directly observed therapy in intermittent preventive treatment for malaria using Sulphadoxine-Pyrimethamine (SP). The age of the respondents was significantly associated with their level of knowledge (p = 0.019).Conclusion: The TBAs had high level of knowledge and good practice of the management of malaria in pregnancy. However, some still treated malaria with Chloroquine and were not conversant with the use of SP for the prevention of malaria. It is recommended that capacity building sessions for the TBAs be instituted to improve the quality of care they provide

Analysis of Artemether and Dihydroartemisinin by high performance high liquid chromatography in biological fluids-issues and solutions

Artemether-Lumefantrine is the most widely recommended antimalarial combination used to treat millions of patients suffering from malaria. Artemether undergoes rapid metabolism and gets converted to its active metabolite dihydroartemisisn. Drug analysis is a vital aspect to evaluate drugs in research. There are a number of methods available for the determination of artemether in biological fluids. These methods include HPLC based UV detection, GS-MS, HPLC-ECD and HPLC-MS/MS. This article reviews different methods for the determination of artemether in the biological fluids. Among the available methods HPLC-MS/MS proves to be the most accurate and reliable one for analysis. This has the advantage of improved sensitivity and selectivity with smaller sample volume

Avaliação da completude e da oportunidade das notificações de malária na Amazônia Brasileira, 2003-2012 / Evaluación de la integridad y reporte oportuno de las notificaciones de malaria en la Amazonia brasileña en el período de 2003 a 2012 / Evaluation of the completeness and timeliness of malaria reporting in the Brazilian Amazon, 2003-2012

OBJETIVO: avaliar a completude e oportunidade das notificações, do diagnóstico e do tratamento da malária na Amazônia Legal Brasileira. MÉTODOS: estudo descritivo, com dados de 23 campos das fichas de notificação registradas no Sistema de Informação de Vigilância Epidemiológica da Malária (Sivep-Malária) no período de 2003 a 2012. RESULTADOS: em 86,0% dos campos da ficha de notificação, a completude foi boa (≥90,0% de preenchimento); nas Secretarias Municipais de Saúde, 40,6% das notificações tiveram registro oportuno (0-7 dias após a notificação), e no Ministério da Saúde, 75,6% (0-30 dias após a notificação); o diagnóstico e o tratamento oportunos ocorreram em 44,6% e 45,4% dos pacientes, respectivamente. CONCLUSÃO: a maioria das notificações apresentou boa completude; a oportunidade no registro das notificações ficou aquém dos padrões internacionais; e a oportunidade no diagnóstico e no tratamento revelou-se abaixo das recomendações do Ministério da Saúde.

OBJETIVO: evaluar la integridad de los datos y reporte oportuno de las notificaciones, de diagnóstico y tratamiento de malaria en la Amazonía brasileña. MÉTODOS: estudio descriptivo, con datos de 23 ítems de las fichas de notificación registradas en el Sistema de Información de Malaria (Sivep-Malária), en el periodo 2003-2012. RESULTADOS: el 86,0% de los ítems de la ficha de notificación fueron completados adecuadamente (≥90,0% completado); en las secretarias municipales de salud, 40,6% de las notificaciones tuvieron registro oportuno (0-7 días después de la notificación) y en el Ministerio de Salud, 75,6% (0-30 días después de la notificación); el diagnóstico y tratamiento oportunos ocurrieron en 44,6% y 45,4% de los pacientes, respectivamente. CONCLUSIÓN: la mayoría de las notificaciones mostró una buena integridad; la tasa de registro oportuno de las notificaciones fue inferior a los estándares internacionales y el diagnóstico y tratamiento oportuno fue inferior a lorecomendado por el Ministerio de Salud.

OBJECTIVE: to evaluate the completeness and timeliness of malaria case reporting, diagnosis and treatment in the Brazilian Amazon. METHODS: this is a descriptive study using data from 23 fields of notification forms recorded on the Malaria Epidemiological Surveillance Information System (Sivep-Malaria) between 2003 and 2012. RESULTS: data completeness was good in 86,0% of fields (≥90,0% filled in); there was timely recording of 40,6% of notifications at the Municipal Health Departments (0-7 days following notification) and 75,6% at the Ministry of Health (0-30 days following notification); timely diagnosis and timely treatment occurred in 44,6% and 45,4% of patients, respectively. CONCLUSION: most notification forms had good completeness; timeliness in recording notifications was below international standards; timeliness of diagnosis and treatment was below the Ministry of Health recommendations.

Methods Employed in the Prevention and Treatment of Malaria among Pregnant Women in a Riverine Community in Bayelsa State; Nigeria

Background: Malaria remains a major public health problem in Nigeria and is the most common cause of hospital attendance in all age groups of which children and pregnant women are the major risk groups; therefore this study was designed to explore various methods of prevention and treatment of malaria among pregnant women in riverine community in Bayelsa State.Method: A descriptive survey with a sample size of 120 respondents. Data were collected using questionnaire and SPSS version 20 was used for data analysis.Results: The finding of the study revealed that majority of the respondents were within 16-25; with a minimum age of 16; maximum age of 45 and a mean of 30. More than half of the respondents agreed that malaria can be transmitted to the fetus and can lead to intrauterine fetal death. Majority uses insecticide treated nets (ITNs); snapper; insecticide spray; window and door net in preventing malaria; while a good number of the respondent claimed to use drug when they have malaria; most of which were prescribed.Conclusion: Majority of the respondents employed good practices in the prevention and treatment of malaria. However; some of the respondents still use crude methods that are detrimental to health. Therefore; it was recommended that community awareness and enlightenment programmes should be put in place in order to eradicate the crude methods that are harmful; as well as promote the good methods used in the prevention and treatment of malaria

Traitement preventif intermittent du nourrisson par la Sulfadoxine-Pyrimethamine en Republique Democratique du Congo : etude de faisabilite au niveau des sites sentinelles de Kinshasa et du Bas-Congo.(Protocole de recherche)

Introduction : La paludisme est responsable d'une importante morbidite en milieu tropical principalement chez le jeune enfant. Le TPI administre au nourrisson dans le cadre du programme elargi de vaccination reduit l'incidence du paludisme maladie et le taux de mortalite infantile. Cependant; le succes du traitement preventif intermittent du nourrisson (TPI) a la Sulfadoxine-pyrimethamine (SP); outre l'efficacite de la molecule utilisee; repose aussi sur la perception de la chimio prevention par la communaute. L'objectif principal de l'etude est d'evaluer la faisabilite du TPI du nourrisson a la SP en RDC. Methodologie: Notre etude sera transversale analytique avec un volet quantitatif et un volet qualitatif. L'etude sera menee du 01 Novembre au 31 Decembre 2014 dans les sites sentinelles de Kingasani et Kimpese respectivement dans les provinces de Kinshasa et du Bas-Congo incluant respectivement 311 et 309 nourrissons de 2 a 11 mois. Resultats : Les donnees principales a recueillir sont; pour la partie quantitative; la prevalence de la fievre et la prevalence parasitaire; et la couverture vaccinale ainsi que leur determinants y compris la prevalence des les mutations C59 R pfdhfr et 540 E pfdhps. Pour la partie qualitative; on explorera l'adhesion ou non au TPI ainsi que les raisons d'une non adhesion eventuelle. Discussion: A travers cette etude; nous esperons obtenir les donnees sur les conditions d'application du TPIn a la SP dans le contexte de la RDC afin de mettre a jour la politique de lutte pour elargir le pannel d'outils capables de reduire la morbidite et la mortalite palustre en RDC

Identifying beneficiaries for user fee waivers: ethical challenges in public health.

Shortages in the public budget for government health services led to the adoption of a system of user fees for healthcare in many developing countries. The Government of India introduced user charges in public health services on a pilot basis as a part of its health sector reforms in the late 1990s and early 2000. A major criticism of user charges relates to 'equity'. Full waiver of the fees has been recommended for the poor to ensure equitable access to services. Waiver is a right conferred on an individual that entitles him/her to obtain health services in certain health facilities at no direct charge or at a reduced price.