ABSTRACT
Malaria is a major public health problem in Niger. The Global Fund to fight AIDS, Tuberculosis, and Malaria launched, in 2011, an initiative entitled "Affordable Medicines Facility - Malaria" or AMFm which aims to make artemisinin-based combination therapies (ACT) more available, more accessible and to eliminate the development of artemisinin resistance. It is in this context that we have conducted a randomized comparative double open-arm study of the efficacy and safety of artemether-lumefantrine (AL) and artesunate-amodiaquine (AM) in Gaya.The objective of the study is to evaluate and then to compare the efficiency and tolerance to these two combinations. The study was modeled with the WHO 2003, 28 days protocol.370 febrile patients were examined. 159 patients were included, where 79 (49.4%) were put in the AL arm and 81 (50.6%) were placed in the AM arm. The adequate clinical and parasitological response was 94.8% and 97.1% respectively for AL and AM. There was no statistical significant difference in efficiency between the two therapies (P=0.4). This difference in adverse effects was not statistically significant (P=0.18). Artemether-lumefantrine and artesunate-amodiaquine are two combinations with comparable efficacies and safety.
Le paludisme est un problème majeur de santé publique au Niger. Le Fonds Mondial de la lutte contre le sida, la tuberculose et le paludisme a lancé en 2011 une initiative appelée « Affordable Medecines Facility - Malaria" ou AMFm qui vise à rendre les combinaisons thérapeutiques à base d'artémisinine (CTA) plus disponibles, plus accessibles et de lutter contre la résistance à l'artémisinine. C'est dans ce contexte que nous avons mené une étude comparative, randomisée, à deux bras ouverts de l'efficacité thérapeutique des associations artémether-luméfantrine (AL) et artésunate-amodiaquine (AM) au niveau du site sentinelle de Gaya.L'objectif de l'étude est d'évaluer puis de comparer l'efficacité et la tolérance de ces deux CTA. La méthode utilisée est le protocole OMS/2003 avec le suivi de 28 jours.370 patients fébriles ont été examinés. 159 patients ont été inclus dont 79 (49.4%) pour le bras AL et 80 (50.3%) pour le bras AM. La réponse clinique et parasitologique adéquate est respectivement de 94.8% pour AL et 97.1% AM. Il n'y a pas de différence statistiquement significative d'efficacité entre les deux molécules (P=0.4). Il n'y a pas aussi de différence statistiquement significative d'effet secondaire entre les deux molécules (P=0.18). AL et AM sont d'efficacité et de tolérance comparables.
ABSTRACT
Although long-lasting insecticide-treated bednets (LLINs) have been widely used for malaria control, little is known about how the condition of LLINs affects the risk of malaria infection. The objective of this cross-sectional study was to examine the association between the use of LLINs with holes and caregiver-reported malaria diagnosed in children under five years of age (U5). Data were collected in Boboye health district, Niger, in 2010. Surveyors conducted interviews and bednet inspections in 1,034 households. If a household had a U5 child, the surveyor asked the caregiver whether the child had experienced a fever episode in the past two weeks that entailed standard treatment for uncomplicated malaria at a healthcare facility. The authors analyzed the association between the use of LLINs with holes and caregiver-reported malaria episodes in U5 children using logistic regression, adjusted for possible confounders. Of the 1,165 children included in the analysis, approximately half (53.3%) used an intact LLIN while far fewer (10.6%) used a LLIN with holes. Compared to children using an intact LLIN, children using a LLIN with holes were significantly more likely to have a caregiver-reported malaria episode (8.7% vs. 17.1%; odds ratio: 2.23; 95% confidence interval: 1.24–4.01). In this study site, LLINs with holes were less protective than intact LLINs.
ABSTRACT
Although long-lasting insecticide-treated bednets (LLINs) have been widely used for malaria control, little is known about how the condition of LLINs affects the risk of malaria infection. The objective of this cross-sectional study was to examine the association between the use of LLINs with holes and caregiver-reported malaria diagnosed in children under five years of age (U5). Data were collected in Boboye health district, Niger, in 2010. Surveyors conducted interviews and bednet inspections in 1,034 households. If a household had a U5 child, the surveyor asked the caregiver whether the child had experienced a fever episode in the past two weeks that entailed standard treatment for uncomplicated malaria at a healthcare facility. The authors analyzed the association between the use of LLINs with holes and caregiver-reported malaria episodes in U5 children using logistic regression, adjusted for possible confounders. Of the 1,165 children included in the analysis, approximately half (53.3%) used an intact LLIN while far fewer (10.6%) used a LLIN with holes. Compared to children using an intact LLIN, children using a LLIN with holes were significantly more likely to have a caregiver-reported malaria episode (8.7% vs. 17.1%; odds ratio: 2.23; 95% confidence interval: 1.24–4.01). In this study site, LLINs with holes were less protective than intact LLINs.
ABSTRACT
In Niger, insecticide-treated bed nets (ITNs) have been distributed to the target group of households with young children and/or pregnant women at healthcare facilities in the course of antenatal/immunization clinics. With the aim of universal coverage, ITNs were additionally distributed to households through strengthened community health committees in 2009. This study assessed the impact of the community-based net distribution strategy involving community health committees in the ITN coverage in Boboye Health District, Niger. A cross-sectional survey was carried out on 1,034 households drawn from the intervention area (the co-existence of the community-based system together with the facility-based system) and the control area (the facility-based system alone). In the intervention area, 55.8% of households owned ITNs delivered through the community-based system, and 29.6% of households exclusively owned ITNs obtained through the community-based system. The community-based system not only reached households within the target group (54.6% ownership) but also those without (59.1% ownership). Overall, household ITN ownership was significantly higher in the intervention area than in the control area (82.5% vs. 60.7%). In combination, the community-based system and the facility-based system achieved a high ITN coverage. The community-based system contributed to reducing leakage in the facility-based system.