RESUMO
A rising number of diphtheria cases were recorded in Europe in 2022, including in Belgium, within the newly arriving young migrant population. In October 2022, Médecins Sans Frontières (MSF) opened a temporary roadside container-clinic offering free medical consultations. Over 3 months of activity, the temporary clinic detected 147 suspected cases of cutaneous diphtheria with 8 laboratory-confirmed cases growing toxigenic Corynebacterium diphtheriae. This was followed by a mobile vaccination campaign, during which 433 individuals living rough in squats and informal shelters were vaccinated. This intervention has shown how even in Europe's capital, access to preventive and curative medical services remains difficult for those who need it the most. Appropriate access to health services, including routine vaccination, are crucial to improve the health status among migrants.
Un nombre croissant de cas de diphtérie a été enregistré en Europe en 2022, y compris en Belgique, au sein de la population de jeunes migrants nouvellement arrivés. En octobre 2022, Médecins Sans Frontières (MSF) a ouvert un conteneur-clinique temporaire en bord de route offrant des consultations médicales gratuites. En 3 mois d'activité, la clinique temporaire a détecté 147 cas suspects de diphtérie cutanée et 8 cas confirmés en laboratoire de Corynebacterium diphtheriae toxigène. Cette opération a été suivie d'une campagne de vaccination mobile, au cours de laquelle 433 personnes vivant dans la rue, dans des squats et des abris informels, ont été vaccinées. Cette intervention a montré que même dans la capitale de l'Europe, l'accès aux services médicaux préventifs et curatifs reste difficile pour ceux qui en ont le plus besoin. Un accès adéquat aux services de santé, y compris une vaccination de routine, est primordial pour améliorer l'état de santé des migrants.
RESUMO
BACKGROUND: Nowadays, parasite-based diagnosis by microscopy or malaria rapid diagnostic tests (RDT) is universally promoted before malaria treatment. However, studies on adherence of primary caregivers to malaria test results have provided conflicting results. METHODS: The antimalarial and antibiotic prescription rates in patients with suspected malaria at Provincial Hospital of Tete, Mozambique, and the features associated with antibiotic prescription in non-severely ill parasite-negative patients were assessed. RESULTS: In March and April 2010, Plasmodium falciparum malaria was diagnosed by microscopy or RDT in 728 (27.2%) of 2672 patients tested. Almost all malaria patients were prescribed antimalarials and 20% were also given antibiotics. Of 1944 parasite-negative patients, 126 (6.5%) were prescribed antimalarials and 1213 (62.4%) antibiotics. Among non-severely ill parasite-negative patients with complete information (n = 1607), the antibiotic prescription rate was 68.8% and was more frequent with respiratory symptoms and leukocyte counts >10 000/µL (adjusted OR = 1.62, 95% CI 1.18-2.23 and adjusted OR = 2.12, 95% CI 1.66-2.71, respectively). CONCLUSIONS: Adherence to malaria test results was good in this reference setting, but antibiotic prescription was relatively frequent in clinically stable non-malaria patients. Optimal management of parasite-negative patients must be further defined along with programmatic deployment of the parasite-based strategy.
