Pratique du myélogramme en 10 ans au laboratoire d'Hématologie du Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona (CHUJRA) Antananarivo, Madagascar

Une étude rétrospective descriptive a été menée sur 2338 myélogrammes effectués au laboratoire d'hé-matologie du centre hospitalier universitaire Joseph Ravoahangy Andrianavalona Antananarivo de janvier 2008 à décembre 2017. L'objectif principal était de décrire les résultats des myélogrammes pendant cette période.L'étude a montré que la fréquence moyenne de demande de myélogramme est de 234 par an. L'âge moyen des patients était de 33,30 ans avec des extrêmes de 29 jours à 82 ans. Une prédominance masculine a été notée avec un sex ratio H/F de 1,2.Les anomalies de l'hémogramme ont constitué le motif principal de prescription des myélogrammes (58,08%). La pancytopénie était la plus fréquente.Les diagnostics révélés par les analyses des myélogrammes étaient le plus fréquemment des hémopathies malignes (58,1%), dont 32,97% de leucémies aigues.Parmi les myélogrammes analysés, 10% étaient nor-maux. La confrontation clinico-biologique est de mise pour une bonne pratique du myélogramme

Prevalence of HIV-tuberculosis coinfection at the University Hospital of Tulear, Madagascar.

Screening for HIV is recommended for all TB patients but it has not yet been initiated in some regions of Madagascar. In this study, our main objective was to determine the seroprevalence of HIV infection in TB patients and secondarily to determine the risk factors favoring TB infection in these patients. This prospective cross-sectional study took place in the pneumology department of the University Hospital of Tulear from January to April, 2017. We diagnosed 75 patients with tuberculosis, 96.05% of them new cases. The sex-ratio was 1.81. Patients' mean age was 35 years. Two patients (2.66%) were coinfected with HIV. Among the new cases diagnosed, 62.66% had pulmonary tuberculosis with positive microscopy (TPM +). Two patients reported a person with tuberculosis among their family or close friends. Living with someone in poor hygiene conditions was reported by 82.66% of the cases. Overall, 24% were unemployed. These patients had quite varied ethnic origins. The prevalence of HIV infection in TB patients was higher than in the general population. Low income and low educational levels were the main risk factors for TB infection in Madagascar.

Medical selection effectiveness inassessing the risk of HIV transmission in blood transfusion in Antananarivo Madagascar

Un défi auquel fait face un centre de transfusion en Afrique consiste à assurer une sécurité transfusionnelle optimale. Il est estimé que 25% des dons de sang collectés en Afrique sub-saharienne francophone sont infectés par des agents viraux (HIV, HBV, HCV), parasitaires (Plasmodium spp., microfilaires) et bactériennes. Méthode : Il s'agit d'une étude rétrospective descriptive effectuée au CRTS Analamanga. L'étude concerne tous les dons enregistrés au CRTS Analamanga durant l'année 2013 et l'année 2014. La prévalence du VIH chez les donneurs de sang durant ces deux périodes a été comparée à celle rapportée dans la population générale. Nous avons comparé la prévalence du VIH au niveau du CRTS en utilisant le test de l'écart-réduit avec les données du SE/CNLS 2013 pour l'année 2013 et les données du SE/CNLS 2014 pour l'année 2014. Résultats: Le nombre de total de dons pour l'année 2013 était de 14316. La prévalence du VIH était de 0,78% (112/14316) (ℇ = 5,46). Pour l'année 2014, le nombre total de dons était de 16551 donnant une prévalence du VIH de 0,28% (472/16551) (ℇ = 0,31) Conclusion : La sélection médicale est le seul moyen le plus efficace pour la réduction des IT par le sang en transfusion en Afrique et à Madagascar. La sélection médicale du donneur avec le questionnaire actuel est inefficace pour diminuer le risque de la transmission du VIH par la transfusion sanguine. Une élaboration d'un nouveau questionnaire est urgente. L'adoption des stratégies adaptées aux réalités locales est bénéfique pour le pays

Description of 48 cases of multiple myeloma seen in the hematology laboratory of the CHU-Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar.

Monoclonal gammopathies are common abnormalities and their incidence increases with age. They are detected in roughly 3 % of people older over 50 years and up to 7 % of those over 70 years. Multiple myeloma (MM) is characterized by the proliferation of plasma cells within the bone marrow and excess secretion of monoclonal immunoglobulins. In Madagascar, late performance of biological examinations such as serum protein electrophoresis overestimates MM rates. We studied 54 patient records between March 2009 and January 2015 in the biology laboratory of the Joseph Ravoahangy Andrianavalona university hospital in Antananarivo (Madagascar). Monoclonal gammopathy was associated with multiple myeloma in most cases (88.9 %). Patients' median age was 64.2 years. Men were slightly more affected than women. It is discovered most frequently due to bone symptoms (83.3 %), and anemia is always present. Monoclonal gammopathy is mostly IgG. The bone marrow study showed medullary plasmacytosis. This disease appears most often in the elderly and has a slight male predominance. Bone marrow cytology is mandatory for diagnosis.

Trichomonas vaginalis among women raped in Antananarivo, 2005-2011.

Rape is a forensic emergency due to the possibility of sexually transmitted infections, including HIV/AIDS. Moreover, an upsurge is currently underway. The objective of this study was to determine the incidence of Trichomonas vaginalis in women undergoing tests at the Microbiology Unit of the Joseph Ravoahangy Andrianavalona Antananarivo Hospital after being raped. This retrospective descriptive study covers the 7-year period from 2005 to 2011 and reports the results of direct examination of the vaginal discharge after vulvar smears from rape patients. We studied the age of patients and the results of these direct smear examinations that tested for T. vaginalis. In our study, the number of women with T. vaginalis increased markedly with age. The mean age of the patients was 13.7 years (range: 2 to 41 years). Among the 232 rape victims tested, only 26 were positive for it (11.20%); trichomoniasis was thus rare among these women. T. vaginalis is a common cause of vaginitis in women and one of the most common infections transmitted by sexual assault. In children, the presence of T. vaginalis in vaginal sample is a strong indicator of sexual abuse. Other sexually transmitted infections can be transmitted during sexual abuse.

Profile and antimicrobial resistance to newly available drugs of urinary tract pathogens among Malagasy pregnant women.

Urinary tract infections are caused by growth of microorganisms anywhere in the urinary tract and pregnant women are particularly susceptible to it. Collection of baseline information regarding urinary tract bacterial profile and their antimicrobial susceptibility in pregnant women are important for treatment purposes. In order to determine the distribution of community-acquired urinary tract pathogens and estimate their susceptibility patterns to antimicrobial agents currently available in Antananarivo (Madagascar), we conducted a cross sectional preliminary survey (four months) on bacteria isolated from urine of pregnant women attending antenatal care clinic, Ambohimiandra Hospital Center. Fifty pathogens were isolated of which 21 (42%) were Gram-negative bacilli and 29 (58%) Gram-positive cocci. The most commonly isolated pathogen was Coagulase Negative Staphylococci (13 strains) for Gram-positive cocci and Escherichia coli (6 strains) for Gram-negative bacilli. Thirty three percent of Gram-negative bacilli were resistant to 3GC. One Klebsiella pneumoniae strain was found to be resistant to imipenem and one Group B Streptococci strain was vancomycin resistant. This development of resistance to newly available antimicrobial and the increase proportion of Gram-positive cocci strains imply that a drastic antimicrobial resistance surveillance need to be carried out to ensure appropriate empirical treatment.

Enquête épidémiologique des souches fongiques responsables des infections au niveau de la peau, des phanères et de la muqueuse au sein du laboratoire de parasitologie CHU/HJRA Madagascar

Objectif : Déterminer les souches fongiques responsables des infections au niveau de la peau, des phanères et des muqueuses buccale et vaginale au sein du laboratoire de parasitologie du Centre Hospitalier Joseph Ravoahangy Andrianavalona Tananarive Madagascar.Matériel et méthodes : Nous avons effectué une étude rétrospective descriptive. Les dossiers de prélèvements inclus entre le mois d'octobre 2008 à l'octobre 2014 ont été consultés.Résultats : Nous avons colligés 617 prélèvements pendant cette période dont 349 était positifs à l'examen direct et ou à la culture. Les principales souches isolées étaient par ordre de fréquence Candida albicans, Candida non albicans, Malassezia sp, Microsporum langeroni et Trichophyton mentagrophytes. Conclusion : Cette étude a permis d'identifier les principaux agents pathogènes incriminés dans la mycose superficielle, et de déterminer l'aspect épidémiologique de ses agents au sein du laboratoire de parasitologie

Profile and antimicrobial resistance to newly available drugs of urinary tract pathogens among Malagasy pregnant women

Urinary tract infections are caused by growth of microorganisms anywhere in the urinary tract and pregnant women are particularly susceptible to it. Collection of baseline information regarding urinary tract bacterial profile and their antimicrobial susceptibility in pregnant women are important for treatment purposes. In order to determine the distribution of community-acquired urinary tract pathogens and estimate their susceptibility patterns to antimicrobial agents currently available in Antananarivo (Madagascar), we conducted a cross sectional preliminary survey (four months) on bacteria isolated from urine of pregnant women attending antenatal care clinic, Ambohimiandra Hospital Center. Fifty pathogens were isolated of which 21 (42%) were Gram-negative bacilli and 29 (58%) Gram-positive cocci. The most commonly isolated pathogen was Coagulase Negative Staphylococci (13 strains) for Gram-positive cocci and Escherichia coli (6 strains) for Gram-negative bacilli. Thirty three percent of Gram-negative bacilli were resistant to 3GC. One Klebsiella pneumoniae strain was found to be resistant to imipenem and one Group B Streptococci strain was vancomycin resistant. This development of resistance to newly available antimicrobial and the increase proportion of Gram-positive cocci strains imply that a drastic antimicrobial resistance surveillance need to be carried out to ensure appropriate empirical treatment.

Changing profile and increasing antimicrobial resistance of uropathogenic bacteria in Madagascar.

OBJECTIVES: We wanted to update the distribution of community-acquired uropathogens and to estimate their susceptibility profile to newly available antibiotics in Antananarivo (Madagascar). MATERIALS AND METHODS: We conducted a 3-year preliminary study (2011-2013) on bacteria isolated from the urine of patients at the Laboratory of Training and Research in Medical Biology (Antananarivo). RESULTS: Three hundred and fifty-seven pathogens were isolated: 234 (65.55%) Gram-negative bacilli and 123 (34.45%) Gram-positive cocci. The most commonly isolated bacteria were Escherichia coli (89 strains) followed by Staphylococcus aureus (48 strains). Thirty-three percent of Gram-negative bacilli were resistant to 3 CG. Forty percent of Klebsiella pneumoniae strains were significantly resistant to imipenem (P = 0.01). CONCLUSIONS: The increased resistance to newly available antibiotics and the increased rate of Gram-positive cocci strains require a drastic surveillance of antibiotic resistance to ensure appropriate empirical treatment.

Prevalence of hepatitis B virus serologic markers in pregnant patients in Antananarivo, Madagascar.

BACKGROUND AND OBJECTIVES: Hepatitis B virus (HBV) infection is a major public health problem in Madagascar. Its severity is related to the risk of chronicity, especially in case of neonatal contamination. Our objectives were to investigate the prevalence of HBV infection among pregnant patients at the Befelatanana obstetrics and gynecology teaching hospital department (BOGTH) by detecting HBsAg and to evaluate the risk of HBV mother to child transmission by screening for HBeAg. METHODS: We conducted a 6-month prospective study in the BTHOGD from February 2012 to July 2012. All pregnant patients consulting for antenatal care were screened for HBV serologic markers. RESULTS: The prevalence of HBsAg was 1.9% (20 out 1050 screened patients). The average age was 26.51 years (25-30 years). Most patients tested were unaware of their hepatitis B status and only 0.38% had been vaccinated before pregnancy. Only 1 (5%) of the 20 patients with HBsAg was positive for HBeAg. CONCLUSION: Hepatitis B is very frequent in pregnant patients in Madagascar and it is recommended that all pregnant patients be routinely screened for HBsAg. This screening of maternal infection would allow applying prophylactic measures to neonates to decrease the risk of disease chronicity.

Phenotypic and allelic profile of ABO and Rhésus D blood group system among blood donor in Antananarivo.

This study assessed the phenotypic and allelic profiles of ABO and Rhesus D blood group system among first time blood donors at the National Centre of Blood Supply of Antananarivo. We collected through this retrospective study all data registered during 7 years of practice (from 2003 to 2009). Age and sex were analysed with the result of ABO and RhD screening. They were tested both with Beth Vincent and Simonin tests which were performed in a plate, by using commercial monoclonal antibody (Diaclone(®) et Eryclone(®)), and home-made red cells tests. The Rh D was performed with the same commercial kits. The frequencies of alleles were calculated by using Bernstein method. Data about 45,857 donors were obtained. A male predominance (80.46%) was found and most of our donors were aged <40 (74.92%). 98.90% of the donors were Rh D positive. Phenotypic distribution of each ABO antigen was, respectively, 22.61, 29.66, 6.13 and 41.60% for A, B, AB and O antigen. Allelic frequencies of A, B and O were 0.1559, 0.1987 and 0.6454. These results confirmed the fact that Madagascan population had admixed ethnic origin.

Prevalence and trends of hepatitis C virus among blood donors in Antananarivo, from 2003 to 2009.

PURPOSE OF THE STUDY: Due to anemia and maternal, childhood and infancy diseases, blood transfusion is one of the most important medical cares given in sub-Saharan Africa, including Madagascar. World Health Organization encourages worldwide countries to maximize transfusion security. Until now, there was no data within a large population of blood donors. Therefore, the aim of this study was to assess the prevalence and time trends of hepatitis C virus (HCV) among all first-time blood donors coming into the National Centre of Transfusion Supply in Antananarivo. MATERIAL AND METHODS: This retrospective study was conducted at the National Centre of Transfusion Supply in Antananarivo from 2003 to May 2009. We looked up to all recorded results of systematic screening of blood donor candidates and we took data about all first-time blood donors, including age and gender. Forty-seven thousand five hundred and ten of 47,636 first-time blood donors were retained, the others were excluded due to lack of some data. RESULTS: The mean age of our donors was 33.3 years (35.8 for male, and 32.6 for female; P<<0.05). Eighty percent were male (38,225/47,510). HCV prevalence was 0.65% during the period of study and HCV positive donor candidates were older than HCV negative (mean age: 39.1 vs. 33.2; P<<0.05). It was in fact stable from 2003 to 2007, and then decreased. HCV prevalence was higher in women than in men (0.9 vs. 0.6; P<0.05), and it increased by age (P<0.05). CONCLUSION: Our study found a low prevalence of HCV among blood donors compared to many countries in Africa.

[Simplified preparation of test-red blood cells for ABO blood grouping in a laboratory in Madagascar]. / Préparation simplifiée d'hématies-tests pour le groupage sanguin ABO dans un laboratoire malgache.

INTRODUCTION: To ensure self-sufficiency and lower costs associated with reagent red blood cells, some medical laboratories produce their own test-red blood cells for plasma ABO blood grouping. However, given the vital importance of blood goup testing, it is essential to verify the reliability of these cells. The purpose of this study was to assess the quality of laboratory-made ABO test-red blood cells. MATERIAL AND METHODS: This study comparing house made and commercially available test-red blood cells was carried out at the Medical Biology Training and Research Laboratory in Madagascar. This laboratory is attended by people wishing to obtain their blood group card. RESULTS: In this population, no discrepancy was found between the red cell and plasma tests. Comparison of test-red blood cells with commercially available reagent red blood cells showed no difference in reactivity in the first four days of conservation. However a decrease in the reactivity of house made cells appeared on the 5th day. CONCLUSION: House made red blood cells are costless than commercially available reagent red blood cells mainly due to the simplified method of preparation. However, since laboratory-made cells progressivley lose antigenic reactivity quicly, production must be repeated regularly and good internal quality control is necessary to ensure reliability.

Seroprevalence du VIH chez les donneurs de sang au Centre National de Transfusion Sanguine d'Antananarivo de 2003 a 2009

Introduction. La securite transfusionnelle est primordiale pour la prevention des infections transmissibles par l'acte transfusionnel; notamment l'infection par les virus des hepatites B et C; et l'infection a VIH. Peu de donnees sont disponibles concernant l'infection au VIH chez les donneurs de sang a Antananarivo. Notre objectif est d'evaluer la seroprevalence de l'infection au VIH pour les premiers dons au Centre National de Transfusion Sanguine d'Antananarivo sur une periode allant de janvier 2003 a mai 2009. Methode. Il s'agit d'une etude retrospective; et nous avons analyse les donnees medicales enregistrees dans le cahier de registre du centre. Le test du VIH a ete realise durant cette periode avec le kit Determine HIV1-2 (Abbott Laboratories; Japan). Resultats. Parmi les 47 635 premiers dons inclus; la seroprevalence du VIH augmentait de facon progressive; allant de 0;08en 2003; a 1;06en 2009. Il n'y a pas eu de difference du genre. Aucun sujet seropositif n'a ete retrouve chez les donneurs ages de plus de 60 ans. Conclusion. Malgre cette tendance a l'augmentation; la seroprevalence du VIH est parmi les plus basses retrouvees en Afrique subsaharienne. Toutefois; il est urgent de reviser le questionnaire pour renforcer la puissance de cette premiere etape. L'amelioration de la technique de depistage est indispensable en ne restant pas seulement sur le test rapide du VIH

Prevalence of and risk factors for sexually-transmitted infections in hidden female sex workers.

OBJECTIVES: We wanted to determine the age-specific prevalence of selected sexually transmitted infections while assessing the risk factors among hidden female sex workers (HFSW). METHODS: One hundred HFSW over 15 years of age were recruited in an impoverished area of Antananarivo, Madagascar. After oral informed consent, blood and endocervical swabs were tested for specific antigens, antibodies, and pathogens using molecular, serologic, and microscopic examinations. A risk factor analysis was conducted with odds ratios and 95% confidence intervals. RESULTS: Thirty-two percent, 27, 12, and 7% of HFSW were infected respectively with Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis. Specific antibodies against, syphilis were detected in 11%. None were HIV-positive. The main factors associated with STI were: young age, being married, lower education level, early age for first intercourse, and a history of genital infection.

Temporal trends in sexually transmitted infection prevalence and condom use following introduction of the female condom to Madagascar sex workers.

We followed 1000 sex workers in Madagascar for 18 months to assess whether adding female condoms to male condom distribution led to increased protection levels and decreased sexually transmitted infections (STIs). For months 1-6, participants had access to male condoms only; in the final 12 months, they had access to male and female condoms. We interviewed participants about condom use every two months and tested for chlamydia, gonorrhoea and trichomoniasis every six months. Following six months of male condom distribution, participants used protection in 78% of sex acts with clients. Following female condom introduction, protection at months 12 and 18 rose to 83% and 88%, respectively. Aggregate STI prevalence declined from 52% at baseline to 50% at month 6. With the female condom added, STI prevalence dropped to 41% and 40% at months 12 and 18, respectively. We conclude female condom introduction is associated with increased use of protection to levels that reduce STI risk.

Results of a randomised trial of male condom promotion among Madagascar sex workers.

OBJECTIVES: To test the effect of supplementing peer promotion of male condom use with clinic based counselling, measured in terms of STI prevalence and reported male condom use. METHODS: 1000 female sex workers in Madagascar were randomised to two study arms: peer education supplemented by individual risk reduction counselling by a clinician (peer + clinic) versus condom promotion by peer educators only (peer only). STI testing was conducted at baseline and 6 months. Behavioural interviews were administered at baseline, 2, 4, and 6 months. RESULTS: At baseline, women in the peer only arm had prevalences of 16.0%, 23.6%, and 12.1% for chlamydia, gonorrhoea, and trichomoniasis respectively, with an aggregate prevalence of 38.2%. Baseline STI prevalences for the peer + clinic arm were slightly lower and 34.1% in aggregate. At 6 months, aggregate STI prevalence increased in the peer only arm to 41.4%, whereas the aggregate prevalence diminished slightly to 32.1% in the peer + clinic arm. In logistic regression analyses, the estimated odds ratios (ORs) for chlamydia, gonorrhoea, trichomoniasis, and aggregate STI were 0.7 (95% confidence interval 0.4 to 1.0), 0.7 (0.5 to 1.0), 0.8 (0.6 to 1.2), and 0.7 (0.5 to 0.9) respectively, comparing the peer + clinic arm with the peer only arm. The logistic regression OR for reported condom use with clients in the past 30 days increased from 1.1 at 2 months to 1.8 at 6 months, comparing the peer + clinic arm with the peer only arm, and was 1.4 overall (1.1 to 1.8). Adjustment for baseline factors changed the regression results little. CONCLUSIONS: The impact of male condom promotion on behaviour can be heightened through more concentrated counselling on risk reduction. Persistently high STI prevalence despite increases in reported condom use by sex workers supports the need for multidimensional control programmes.