ABSTRACT
OBJECTIVE: The main objective of the MACOMBA (Maternity and Control of Malaria-HIV co-infection in Bangui) trial was to show that cotrimoxazole (CTX) is more effective than sulphadoxine-pyremethamine-IPTp (IPTp-SP) to prevent placental malaria infection (primary end point) among HIV-positive pregnant women with a CD4+ count ≥350 cells/mm3 in Bangui, CAR. METHODS: MACOMBA is a multicentre, open-label randomised trial conducted in four maternity hospitals in Bangui. Between 2013 and 2017, 193 women were randomised and 112 (59 and 53 in CTX and IPTp-SP arms, respectively) were assessed for placental infection defined by microscopic parasitaemia or PCR. RESULTS: Thirteen women had a placental infection: five in the CTX arm (one by microscopic placental parasitaemia and four by PCR) and eight by PCR in the SP-IPTp (8.5% vs. 15.1%, p = 0.28). The percentage of newborns with low birthweight (<2500 g) did not differ statistically between the two arms. Self-reported compliance to CTX prophylaxis was good. There was a low overall rate of adverse events in both arms. CONCLUSION: Although our results do not allow us to conclude that CTX is more effective, drug safety and good compliance among women with this treatment favour its widespread use among HIV-infected pregnant women, as currently recommended by WHO.
Subject(s)
HIV Infections/complications , Malaria/prevention & control , Pregnancy Complications, Parasitic/drug therapy , Pyrimethamine/pharmacology , Sulfadoxine/pharmacology , Trimethoprim, Sulfamethoxazole Drug Combination/pharmacology , Adult , Antimalarials/administration & dosage , Antimalarials/therapeutic use , Central African Republic/epidemiology , Drug Combinations , Female , HIV Infections/epidemiology , Humans , Malaria/epidemiology , Pregnancy , Young AdultABSTRACT
Hepatitis delta virus (HDV) increases morbidity in Hepatitis B virus (HBV)-infected patients. In the mid-eighties, an outbreak of HDV fulminant hepatitis (FH) in the Central African Republic (CAR) killed 88% of patients hospitalized in Bangui. We evaluated infections with HBV and HDV among students and pregnant women, 25 years after the fulminant hepatitis (FH) outbreak to determine (i) the prevalence of HBV and HDV infection in this population, (ii) the clinical risk factors for HBV and/or HDV infections, and (iii) to characterize and compare the strains from the FH outbreak in the 1980s to the 2010 HBV-HDV strains. We performed a cross sectional study with historical comparison on FH-stored samples (n = 179) from 159 patients and dried blood-spots from volunteer students and pregnant women groups (n = 2172). We analyzed risk factors potentially associated with HBV and HDV. Previous HBV infection (presence of anti-HBc) occurred in 345/1290 students (26.7%) and 186/870 pregnant women (21.4%)(p = 0.005), including 110 students (8.8%) and 71 pregnant women (8.2%), who were also HBsAg-positive (p = 0.824). HDV infection occurred more frequently in pregnant women (n = 13; 18.8%) than students (n = 6; 5.4%) (p = 0.010). Infection in childhood was probably the main HBV risk factor. The risk factors for HDV infection were age (p = 0.040), transfusion (p = 0.039), and a tendency for tattooing (p = 0.055) and absence of condom use (p = 0.049). HBV-E and HDV-1 were highly prevalent during both the FH outbreak and the 2010 screening project. For historical samples, due to storage conditions and despite several attempts, we could only obtain partial HDV amplification representing 25% of the full-length genome. The HDV-1 mid-eighties FH-strains did not form a specific clade and were affiliated to two different HDV-1 African subgenotypes, one of which also includes the 2010 HDV-1 strains. In the Central African Republic, these findings indicate a high prevalence of previous and current HBV-E and HDV-1 infections both in the mid-eighties fulminant hepatitis outbreak and among asymptomatic young adults in 2010, and reinforce the need for universal HBV vaccination and the prevention of HDV transmission among HBsAg-positive patients through blood or sexual routes.
Subject(s)
Hepatitis B virus/isolation & purification , Hepatitis B/virology , Hepatitis D/virology , Hepatitis Delta Virus/isolation & purification , Adolescent , Adult , Central African Republic/epidemiology , Cross-Sectional Studies , Disease Outbreaks/history , Female , Genotype , Hepatitis B/epidemiology , Hepatitis B/history , Hepatitis B/transmission , Hepatitis B virus/classification , Hepatitis B virus/genetics , Hepatitis B virus/physiology , Hepatitis D/epidemiology , Hepatitis D/history , Hepatitis D/transmission , Hepatitis Delta Virus/classification , Hepatitis Delta Virus/genetics , Hepatitis Delta Virus/physiology , History, 20th Century , History, 21st Century , Humans , Male , Phylogeny , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/virology , Young AdultABSTRACT
Malaria in pregnancy is a serious public health problem in tropical areas. Frequently, the placenta is infected by accumulation of Plasmodium falciparum-infected erythrocytes in the intervillous space. Falciparum malaria acts during pregnancy by a range of mechanisms, and chronic or repeated infection and co-infections have insidious effects. The susceptibility of pregnant women to malaria is due to both immunological and humoral changes. Until a malaria vaccine becomes available, the deleterious effects of malaria in pregnancy can be avoided by protection against infection and prompt treatment with safe, effective antimalarial agents; however, concurrent infections such as with HIV and helminths during pregnancy are jeopardizing malaria control in sub-Saharan Africa.
ABSTRACT
Malaria in pregnancy is a serious public health problem in tropical areas. Frequently, the placenta is infected by accumulation of Plasmodium falciparum-infected erythrocytes in the intervillous space. Falciparum malaria acts during pregnancy by a range of mechanisms, and chronic or repeated infection and co-infections have insidious effects. The susceptibility of pregnant women to malaria is due to both immunological and humoral changes. Until a malaria vaccine becomes available, the deleterious effects of malaria in pregnancy can be avoided by protection against infection and prompt treatment with safe, effective antimalarial agents; however, concurrent infections such as with HIV and helminths during pregnancy are jeopardizing malaria control in sub-Saharan Africa
Subject(s)
Coinfection , HIV Infections , Helminths , Malaria, Falciparum , Placenta , PregnancyABSTRACT
Developing countries face numerous barriers to conducting effective and efficient ethics reviews of international collaborative research. In addition to potentially overlooking important scientific and ethical considerations, inadequate or insufficiently trained ethics committees may insist on unwarranted changes to protocols that can impair a study's scientific or ethical validity. Moreover, poorly functioning review systems can impose substantial delays on the commencement of research, which needlessly undermine the development of new interventions for urgent medical needs. In response to these concerns, the Drugs for Neglected Diseases Initiative (DNDi), an independent nonprofit organization founded by a coalition of public sector and international organizations, developed a mechanism to facilitate more effective and efficient host country ethics review for a study of the use of fexinidazole for the treatment of late stage African Trypanosomiasis (HAT). The project involved the implementation of a novel 'pre-review' process of ethical oversight, conducted by an ad hoc committee of ethics committee representatives from African and European countries, in collaboration with internationally recognized scientific experts. This article examines the process and outcomes of this collaborative process.
Subject(s)
Antiprotozoal Agents/therapeutic use , Biomedical Research/ethics , Ethical Review , Nitroimidazoles/therapeutic use , Trypanosomiasis, African/drug therapy , Developing Countries , Humans , International CooperationABSTRACT
BACKGROUND: Co-infection with malaria parasite and HIV is an emerging public health problem in tropical areas, particularly in pregnant women, and management of the concurrent effects of these two infections is challenging. Co-trimoxazole is a sulfamide preparation used to prevent opportunistic infections in HIV-infected patients, and many studies have reported that it has significant activity against malaria. As the efficacy of intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) against malaria is decreasing, co-trimoxazole might be an alternative for preventing malaria among HIV-infected populations. The aim of this study is to compare the effectiveness of SP-IPT, which is recommended for the prevention of malaria during pregnancy in the Central African Republic, with that of a daily dose of co-trimoxazole against P. falciparum infections among HIV-infected pregnant women in Bangui, the capital of the Central African Republic. METHODS/DESIGN: The MACOMBA study (MAternity and COntrol of Malaria-HIV co-infection in BAngui) is a multicentre open-label randomized clinical trial conducted at four maternity hospitals in Bangui. All HIV-infected pregnant women presenting for an antenatal clinic visit between the weeks 16 and 28 of amenorrhoea, with a CD4 count of more than 350 cells/mm3, will be eligible. All the women will provide written consent before being enrolled in the study and will then be randomly allocated to either SP-IPT (25 mg of sulfadoxine and 1.25 mg of pyrimethamine) or daily co-trimoxazole doses (960 mg per dose). The primary end-point is the placental malaria parasitaemia rate at delivery. Other main outcome measures include the number of malaria episodes during pregnancy, safety, and treatment compliance. Furthermore, the frequency of molecular resistance markers dhfr and dhps will be measured. DISCUSSION: In this trial, we seek to confirm whether co-trimoxazole is operationally suitable to replace SP-IPT in order to prevent malaria among pregnant women infected with HIV in the Central African Republic. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01746199.
Subject(s)
Antimalarials/administration & dosage , Coinfection , Folic Acid Antagonists/administration & dosage , HIV Infections/complications , Malaria, Falciparum/prevention & control , Pregnancy Complications, Parasitic/prevention & control , Pyrimethamine/administration & dosage , Research Design , Sulfadoxine/administration & dosage , Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage , Antimalarials/adverse effects , Central African Republic , Clinical Protocols , Drug Administration Schedule , Drug Combinations , Female , Folic Acid Antagonists/adverse effects , HIV Infections/diagnosis , Hospitals, Maternity , Humans , Malaria, Falciparum/complications , Malaria, Falciparum/diagnosis , Pregnancy , Pregnancy Complications, Parasitic/diagnosis , Prenatal Care , Pyrimethamine/adverse effects , Sulfadoxine/adverse effects , Time Factors , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/adverse effectsABSTRACT
En RCA, il est globalement ressorti des différents rapports de suivi des indicateurs des OMD que les progrès sont les plus lents en ce qui concerne l'OMD1 (Eradiquer l'extrême pauvreté et la faim), l´OMD 4 (Réduire la mortalité des enfants de moins de 5 ans), l'OMD 5 (Améliorer la santé maternelle) et l'OMD 6 (Combattre le VIH/Sida, le Paludisme et les autres maladies). A l'heure actuelle, dans la plupart des pays à ressources limitées, le cercle vicieux reliant la malnutrition au VIH/SIDA sous tendue par la pauvreté potentialise la mortalité infanto-juvénile. Mondialement, le taux de mortalité des enfants de moins de 5 ans a été réduit de 35 %, passant de 88 en 1990 à 57,2 en 2010 malgré l'accroissement de la population.
Subject(s)
Humans , Acquired Immunodeficiency Syndrome/immunology , HIV , Child Mortality , Malaria/transmissionABSTRACT
Mortalité maternelle est un grave problème de santé publique en RCA avec un taux de 1355 décès pour 100.000 naissances vivantes. Quatre principales difficultés sont à la base de ce problème: a) Difficultés liées à l´accès aux soins. b) Difficultés liées à l´insuffisance et à la répartition inégale du personnel de santé. c) Difficultés liées à la prise en charge des urgences obstétricales et au système de référence. d) Difficultés liées à l´utilisation des services de santé. La réduction de la mortalité maternelle peut utiliser un certain nombre de stratégies efficaces et réalisables en Centrafrique. Cependant, le manque d´un guide clair et explicite limite la mise en oeuvre et la coordination de ces stratégies. Trois options politiques complémentaires ont été définies dans l´objectif de réduire la mortalité maternelle en Centrafrique: 1- Renforcement des capacités nationales en matière de la santé de la reproduction. 2- Renforcement des capacités nationales en matière de la santé de la reproduction. 3- Mobilisation des différentes ressources en faveur de la lutte contre la mortalité maternelle.
Subject(s)
Maternal Mortality , Health Personnel/education , Health Personnel/organization & administration , Reproductive Health Services/organization & administration , Central African RepublicABSTRACT
Imperforate hymen is a malformation that is easy to diagnose, even in countries with limited health care coverage. Unrecognized at birth, it becomes evident at puberty because of the development of a hematocolpos, which requires surgical intervention. This situation can be avoided with a complete examination of the infant at birth. This case report describes four patients whom we saw from 1995 through 2001 at the Bangui (Central African Republic) Pediatric Center and Community Hospital.
Subject(s)
Hematocolpos/surgery , Hymen/abnormalities , Adolescent , Congenital Abnormalities/diagnosis , Emergency Treatment , Female , Hematocolpos/etiology , HumansABSTRACT
Although ectopic pregnancy continues to endanger the life of patients in the Central African Republic, data on this pathology is drastically missing. This study is the result of an observation carried out over a period of 1 year taking all ectopic pregnancy cases into account with a view to identify the risk factors of this pathology and to draw the epidemiological profile of the patients concerned. Controls were used for the identification of the risk factors. The frequency of ectopic pregnancies was of 1 case against 61.8 deliveries. Ectopic pregnancies were more frequent among young women, with a peak in the 20-29 age group. Gonococcus infections and multiple partners were found to be correlated with the occurrence of ectopic pregnancies. If paraclinical tests had helped establish the diagnosis, the presence of clinical symptoms was decisive, thus explaining late diagnosis with tubal rupture followed by an hemorrhage. Those patients who were attended at an advanced stage had to undergo tubal resection, a treatment jeopardizing their obstetrical future. Clearly, African practitioners must imperatively learn to identify the clinical symptoms of this pathology.
Subject(s)
Pregnancy, Ectopic/epidemiology , Adult , Age Distribution , Amenorrhea/etiology , Case-Control Studies , Central African Republic/epidemiology , Delivery, Obstetric/statistics & numerical data , Female , Gonorrhea/complications , Humans , Incidence , Maternal Age , Metrorrhagia/etiology , Pelvic Pain/etiology , Population Surveillance , Pregnancy , Pregnancy Outcome , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/etiology , Pregnancy, Ectopic/therapy , Prevalence , Risk Factors , Rupture, Spontaneous , Sexual Partners , Sterilization, Tubal , Uterine Hemorrhage/etiologyABSTRACT
Uterine rupture is a threat during vaginal deliveries of women with uterine scars from previous caesarean deliveries or other surgery. Special prudence among this group has resulted in a rise of cesarean rates in developed countries but also in Africa. The lack of available data in this domain in our country led us to conduct this preliminary study, with the objectives of: determining the frequency of deliveries among these patients and of the complications associated with them; identifying some of the risk factors and assessing maternal and fetal prognosis. This should facilitate further studies to determine the management attitudes most appropriate to the realities of our health system. We conducted a cross-sectional study during the last six months of 1999 at the central maternity hospital in Bangui. We included in this study only women with previous caesarean scars giving birth again during the study period. We followed them from admission to the labour room until discharge, without intervening in their delivery. Structured questionnaires enabled us to collect data on clinical, social and demographic variables. We recorded 74 births, including one set of twins, among the 73 parturient subjects. Vaginal delivery occurred in 45 cases (60.8%), and caesarean in 29. Women with a single uterine scar gave birth by vaginal delivery significantly more often than they had caesareans. We recorded 7 cases of uterine rupture, most often associated with a birth interval less than 2 years. One uterine rupture led to the mother's death. Perinatal mortality was 10.8%: no newborn survived these uterine ruptures. Vaginal delivery remains possible for women with uterine scars when adequate monitoring of a trial of labor is available and on condition that the pelvis is normal and the birth interval exceeds two years.
