[Infection Prevention and Control during the 11th Outbreak of Ebola Virus Disease in Equateur Province, Democratic Republic of the Congo]. / La prévention et le contrôle des infections lors de la 11e épidémie de maladie à virus Ebola dans la province de l'Équateur, République démocratique du Congo.

The province of Equateur in the north-west of the Democratic Republic of the Congo (DRC) experienced a new Ebola outbreak in 2020. Among the responses, the actions of prevention and control of the infections were essential, particularly in health facilities. They need to be developed from a long-term perspective and not as a one-off emergency response.

La province de l'Équateur dans le nord-ouest de la RDC a subi en 2020 une nouvelle épidémie de maladie à virus Ebola. Parmi les réponses à y apporter, les activités de prévention et de contrôle des infections ont été essentielles, en particulier dans les structures de santé. Elles sont à développer dans une optique de long terme et non pas de réponse ponctuelle en urgence.

[Diagnosis of Children's Fever Attacks in Health Facilities in the City of Cabinda (Angola)]. / Diagnostic des accès fébriles chez des enfants de la ville de Cabinda (Angola).

According to WHO recommendations, antimalarial drugs should be used only after a biological confirmation of a malaria attack. In order to better understand the diagnosis decision-making and the use of the malaria tests (immunochromatographic test RDT and direct microscope observation), a survey was carried out in two health facilities in the city of Cabinda, Angola in 2014. Diagnosis and drug prescriptions by the health staff were observed in 787 febrile children. It clearly appeared that there was a lack of trust of the health professionals in the test results, especially in the RDT. They tended to take into account test results irregularly, giving a diagnosis of malaria for half the febrile children despite only 16% of positive RDT. Acute febrile illness and malaria attacks seemed thus frequently confused. Alternative causes for fever were rarely sought out. Antimalarial drugs were hence overprescribed. Better training for staff and of their supervision by experimented practitioners are one of the means envisaged for triggering real change in the providers' practice.

Selon les recommandations de l'OMS, les traitements antipaludiques ne doivent être prescrits qu'en cas de confirmation biologique des accès palustres. Afin de mieux connaître la démarche diagnostique des accès fébriles chez les enfants ainsi que la prescription de médicaments antipaludiques, une enquête a été réalisée dans deux centres de santé de la ville de Cabinda (Angola) en 2014. Les diagnostics établis par les soignants et leurs prescriptions ont été analysés en fonction des résultats des tests rapides (TDR) et des examens sanguins microscopiques réalisés chez 787 enfants consultant ces centres pour fièvre. Le diagnostic de paludisme, seul ou associé à d'autres maladies, est établi chez la moitié des enfants bien qu'un TDR ne soit positif que chez 16 % d'entre eux. Les soignants n'ont pas confiance dans le résultat des tests, en particulier en cas de négativité d'un TDR. Accès fébriles et accès palustres paraissent être souvent confondus en une même entité. Les autres causes de fièvre sont peu recherchées et les médicaments antipaludiques sont sur-prescrits. La formation des soignants et leur supervision par des médecins expérimentés sont nécessaires pour un bon usage des médicaments antipaludiques.

Antimalarial drugs available in the city Cabinda (Angola) in 2016.

Antimalarial drug offerings in the city of Cabinda (Angola) were assessed during the fourth quarter of 2016. Combinations of artemisinin with other effective antimalarial drugs were available free of charge in public health centres, theoretically after a biological validation of the diagnosis of a malaria attack. Private pharmacies offered many products without medical prescription, most of them being ACT (Artemisinin Combined Therapy) but some being Artemisia derivatives alone. The cost of treatment for a presumptive attack varied from 14 to 44 €. The diversity of antimalarial drugs and of their dosages makes it difficult for sellers to provide appropriate recommendations for their use. In the informal sector, sellers offered the same products at similar prices as the formal sector but with the option of purchasing only a part of the treatment. Analgesics and herbal medicine not validated as antimalarial drugs were also available.

Risk factors of cholera transmission in rural areas in Haiti.

Cholera, present in Haiti since October 2010, persisted in early 2014 in several places, each with its own particular epidemiological characteristics. The scarcity of fresh water probably contributed to the spread of the disease in some rural areas. Population gatherings in places without an access to either safe water or sanitation infrastructure were another factor. Outreach activities of hygiene promotion and improving access to chlorinated water had positive results. The disappearance of choléra in areas where effective preventive actions were conducted supports the conclusion that its transmission is predominantly interhuman, without the sustainable installation of the pathogenic Vibrio in the Haitian environment. These actions must be modulated according to the various areas.

[Response to the cholera epidemic at Port au Prince (Haiti) in December 2010]. / Les réponses a l'epidémie de choléra a Port-au-Prince (Haïti) en décembre 2010.

Cholera, that had been present in rural areas north of Port-au-Prince, Haiti since October 2010, reached the urban area in November. Due to the novelty of the disease in this region, to the lack of health care, clean water, and waste disposal facilities, and to the extensive damage caused by the earthquake on January 12, 2010, that left a large victim population living in camps, a large-scale health disaster was feared. However, after two months, the disease appeared to be relatively well-controlled and treated with a fatality rate of less than 1% in the urban area. Actions implemented by the Ministry of Health long with its efforts to coordinate the intervention of the many humanitarian partners played a role in this outcome.

[Observations during basic care after the earthquake in Port-au-Prince, Haiti on January 12, 2010]. / Soins de base après le tremblement de terre de Port-au-Prince du 12 janvier 2010.

Provision of basic health care to earthquake victims in camps in Haiti indicated that the population was in relatively good health. It also allowed early detection of possible epidemic outbreak.

[Management of HIV/AIDS patients in Kompong Cham, Cambodia]. / Prise en charge des patients souffrant de VIH/SIDA a Kompong Cham, Cambodge.

In 2003 the NGO Médecins sans Frontières started an anti-viral drug treatment program for HIV/AIDS patients in the regional hospital of Kompong Cham, Cambodia. In 2005 a total of 1100 adults and 149 children were on the active list. Sixty percent of new patients were at WHO stages 3 or 4. Compliance with HAART was high after 24 months. Access to second-line regimens is discussed.

[Popular nosology of infantile diseases in West Côte-d'Ivoire and consequences for malaria care management]. / Nosologie populaire des maladies infantiles dans l'Ouest de la Côte-d'Ivoire. Implications pour le paludisme.

In a rural area of intense and permanent malaria transmission in Southwest Côte-d'lvoire, traditional midwifes of the Yacouba ethnic group, with also an important function for the children health and care, were interviewed in 2002 about their knowledge of the infantile pathologies. Their nosology is greatly based on symptoms and etiologic explanations of the disorder of secretions. The accumulation of a viscous liquid in different parts of the body, especially in the chest, the throat or the head, explains numerous febrile or afebrile diseases, including malnutrition. Some pathologies, particularly convulsions, are described by analogy with animals behaviour Relations between these entities and the biomedical ones are difficult to establish. The traditional care and treatments result from these concepts. A vomiting child or a child suffering from diarrhoea is subject to devices to evacuate his excess of liquid. Yellow brews are used against jaundice. Furthermore, an important mistrust remains towards medical treatments particularly for all parenteral therapies. Health facilities are only used as a the last resort. Their bad reputation is confirmed by the high rate of mortality of patients coming often too late. To improve malaria care management, health-care workers have to take into consideration these concepts and also prove their abilities to ensure good medical practices.

[Female prostitutes in Phnom Penh, Cambodia: changes in knowledge, attitudes and practices between 2000 and 2004]. / Femmes prostituées à Phnom Penh (Cambodge): évolution des connaissances, attitudes et pratiques entre 2000 et 2004.

A survey was carried out to evaluate the knowledge, attitudes and practice of female prostitutes In Phnom Penh (Cambodia) in 2000 and 2004. A total of 131 women were included both years. The population was 75% Cambodian and 25% Vietnamese. Average age was 22.9 years in 2000 and 25.5 years in 2004. Sixty-seven percent of the women surveyed stated that prostitution was a "voluntary" choice. The awareness rate for sexual transmitted diseases (STD) including AIDS and its main clinical signs and of the protective value of condoms was 90% in 2000 and 96% in 2004. However 30% reported unprotected sexual relations with at least one of their last 10 clients. Twenty-five percent performed oral sex usually without precaution. Drug use was limited to methamphetamines. Monthly income ranged from 15 dollars to 22.5 dollars (mean, 66 dollars). This amount is higher than the salary of a factory worker. Despite good knowledge of STD and prevention measures, prostitutes in Phnom Penh appear to have unsafe sexual practices.

[Chemosusceptibility analysis of Plasmodium falciparum imported from Comoros to Marseilles, France in 2001-2003]. / Chimiosensibilité de Plasmodium falciparum importé des Comores à Marseille en 2002-2003.

OBJECTIVES: The aim of this work was to study the chemosensitivity of Plasmodium falciparum strains isolated from patients presenting with malaria after having returned from Comoros Islands in 2002-2003, and hospitalized at the North University Hospital, in Marseilles, France. MATERIALS AND METHODS: In vitro drug susceptibility (for strains maintained in culture) and mutation-specific polymerase chain reaction (PCR) assays (for all strains) were performed. RESULTS: Out of 23 strains kept in culture, 50% were shown to be resistant in vitro to chloroquine, 50% were resistant to pyrimethamine, 40% to cycloguanil, 25% to atovaquone, and 7% to mefloquine. However all these strains were susceptible to quinine, halofantrine, and artemether. Moreover, 48 strains were tested by molecular methods. As a result, 69% were shown to have the Asp108 mutation in the dihydrofolate reductase gene (Pfdhfr), the basic mutation associated with antifolate resistance, and 54% had additional mutations Ile51 plus Arg59, associated with a high level of resistance. Furthermore, 90% of the 20 strains tested in 2003 were shown to have the point mutation Pfcrt76 in the P. falciparum chloroquine resistance transporter (Pfcrt) gene recently proposed as a molecular marker of chloroquine-resistance. CONCLUSION: Obtaining plasmodium strains from Comoros to be tested in Marseilles, where all laboratory facilities are available, is a unique opportunity to establish a surveillance of falciparum drug resistance in the Comoros islands.

[Chagas disease in a rural area of Northeast Brazil]. / La maladie de Chagas dans une zone rurale du Nord-Est du Brésil.

A serological and medical survey on Chagas disease was carried out between December 1997 and June 2000 in four villages of the semi-arid rural Northeast Brazil. The average human serological prevalence rate of 11.8% was strongly linked with age: 1.1% for people under 25, 13.7% for people aged of 26 to 49, 29.5% for people aged of 50+. The clinical form was indeterminate for 57% of the infected population, cardiac for 35%, digestive or mixed for 8%. The infected patients under 55 received at home an etiologic treatment with benznidazol. The survey confirms the drastic reduction of Trypanosoma cruzi transmission during the last decades, especially since 25 years. This situation is the result jointly of the antivectorial activities, improvement of education level and changes in the way of life. However Chagas disease is still a serious problem, especially for numerous middle-aged infected adults. The situation could be improved by increasing the serologic screening in the field as well as the counselling and the treatment of the patients.

[American cutaneous leishmaniasis in the sugar cane-producing area of Pernambuco, North-East Brazil]. / La leishmaniose tégumentaire américaine dans la région sucrière du Pernambouc, Nord-Est du Brésil.

The cases of American cutaneous leishmaniasis reported here were observed between 1995 and 1998 in outpatients at a health clinic in the sugar cane-producing region in the south of Pernambuco State (Brazil), in which the disease is known to be endemic. Two hundred thirty eight cases were reported, equivalent to about ten cases per thousand patients. The disease affected patients of all ages, with a slight male predominance. The lesions were generally single and located on the legs. They were successfully treated with Glucantime. Vectors of the disease, sandflies of the genus Lutzomyia, were captured in and around homes, particularly in stables. This field work demonstrates the extent of a long-standing endemic that can be effectively treated within motivated health structures.

[Intestinal parasite infections and schistosomiasis in a poor urban area, in townships of the sugar cane belt and in villages of the semi-arid area of North-East Brazil]. / Parasitoses intestinales et schistosomose en milieu urbain, en région semi-aride du Nord-Est du Brésil.

We determined the prevalence of intestinal parasite infections between 1993 and 1998 in the populations of a poor quarter of Recife (Pernambuco), in two townships in the sugar cane belt and in three villages of the semi-arid area far from the coast. Intestinal schistosomiasis was present in the sugar-growing area but was not observed in the populations inland that use dams to provide irrigation and fishing. Ascaris was very common in the city and the sugar cane belt and large numbers of hookworms were observed, especially in the sugar-growing area. These nematodes were very rare in the semi-arid area. This distribution probably results from both climatic conditions and human behavior. The high frequency of Amoeba cysts demonstrates that the peasants, farmers and fisherman living in these areas have poor hygiene practices. There are probably many, complex relationships between education, income, lifestyle and intestinal parasite infections.