Evaluation de la prescription et de la dispensation des médicaments essentiels au Mali

Objectif : La politique pharmaceutique du Mali repose sur le concept des médicaments essentiels génériques. L’adoption des médicaments génériques dans un programme s’accompagne souvent d’un usage irrationnel de ces médicaments à cause même de la disponibilité de ces médicaments. C’est ainsi que cette étude a été initiée pour évaluer la qualité de la prescription et de la dispensation des médicaments au Mali. Méthodes : Il s’agit d’une étude transversale descriptive qui a été conduite de 2004 à 2013. L’enquête a été faite dans 20 centres de santé primaires et 20 pharmacies privées dans trois régions du pays. Dans chacune de ces structures, 30 ordonnances exécutées au moment de l’enquête ont été collectées. Résultats : Le nombre moyen de médicaments par ordonnance était de 3,0±1,3 et 2,4±1,2, respectivement dans les secteurs public et privé. La prescription des médicaments sous dénomination commune internationale était de 91,6% dans le secteur public et 37,2% dans le secteur privé. Le secteur public prescrivait 33,7% d’injectables contre 16,2% dans le privé (p<0,001). Le coût moyen de l’ordonnance prescrite était plus bas dans le secteur public (3415,3FCFA soit 5,21 euros ) que dans le secteur privé (7111,2 FCFA soit10,85euros). Conclusion : Les médicaments génériques sont couramment utilisés dans le public mais beaucoup moins dans le privé. Les guides thérapeutiques étant déjà disponibles, il conviendrait d’instaurer une information interactive des praticiens, par biais de visites et supervisions intensives par des cadres plus expérimentés de la hiérarchie, cela serait de nature à optimiser la qualité des prescriptions des praticiens

Supplémentation en farine fortifiée « Misola » chez les personnes vivant avec le VIH sous traitement ARV au Mali.

Position du problème: Tester l’apport d’une supplémentation en farine fortifiée chez les personnes vivant avec le VIH sous traitement antirétroviral au Mali. Méthodes : Nous avons réalisé une étude prospective longitudinale chez 52 patients infectés par le VIH en ambulatoire sous traitement antirétroviral. A l'introduction de la farine ‘Misola', les paramètres de suivi à 3 mois ont été : (poids/taille), le taux de CD4 et la numération formule sanguine. Résultats : La majorité de nos patients était des femmes (69%). L'âge moyen était de 38 ans avec des extrêmes de 20 à 58 ans. La normalisation de l'indice de masse corporel de J15 à J60 était de 100%. L'augmentation de la reprise pondérale était significative (p=0,0001). Les paramètres biologiques étudiés étaient également augmentés à J60. Conclusion : La supplémentation en farine Misola semble être un facteur de gain pondéral rapide chez les PVIH sous ARV. Nous recommandons une étude randomisée sur un grand échantillon pour confirmer ces résultat

Uvéite antérieure tuberculeuse chez un enfant au Centre de Santé de Référence de la Commune V du District de Bamako

Introduction : La sphère oculaire est une localisation rare de la tuberculose. Nous rapportons un cas de cette infection à localisation oculaire chez une jeune fille malienne. Décrire les lésions oculaires au cours d’une infection tuberculeuse. Observation :Il s’agit d’une étude de cas clinique descriptive concernant une fillette de 13 ans, reçue en consultation dans notre service pour rougeur et baisse de l’acuité à l’œil droit évoluant progressivement depuis quelques mois. Malgré les multiples consultations et traitements reçus, les symptômes persistaient et s’aggravaient insidieusement. Dans ses antécédents, nous n’avons pas trouvé de notion de traumatisme oculaire, ni de contage tuberculeux. L’examen ophtalmologique révèle une uvéite antérieure granulomatose avec baisse importante de l’acuité visuelle. L’examen des crachats est négatif, en revanche, l’IDR à la tuberculine est phlycténulaire avec un diamètre d’induration > 35mm. Le traitement anti tuberculeux selon le protocole du Programme Nationale de Lutte contre la Tuberculose (PNLT) a permis une amélioration clinique et fonctionnelle rapide, puis la guérison de la patiente. Conclusion : Le diagnostic de la tuberculose oculaire est difficile dans les pays en voie de développement. Il nécessite la mise à disposition de nouveaux outils diagnostics et une collaboration multidisciplinair

Utilisation des facteurs climatiques pour la surveillance de la fréquence des occurrences de méningite/ paludisme à Bamako

Objectif : Notre travail consiste à : Déterminer les périodes de risque pour la méningite et le paludisme à Bamako; Etablir une corrélation entre : - d’une part les paramètres météorologiques (température de l’air, humidité relative de l’air, pluviométrie, insolation et vitesse du vent) et la fréquence des occurrences de paludisme ; - d’autre part les mêmes paramètres pour la méningite. Méthode : Nous avons fait une étude rétrospective de l’évolution du paludisme et de la méningite en fonction de la variation des paramètres météorologiques (température de l’air, humidité relative de l’air, pluviométrie, insolation et vitesse du vent) à Bamako. Résultats : Le paludisme, rare au 1er et 2èm trimestres, est très fréquent au 3è trimestre et au 4è trimestre. Quant à la méningite elle est fréquente au premier semestre et rare pendant le reste de l’année. La fréquence du paludisme est liée à la température moyenne de l’air, à la grande humidité de l’air, à la pluviométrie abondante, à la faible insolation et à la faible vitesse du vent. La fréquente de la méningite est liée à la haute température de l’air, à la faible humidité de l’air, à la faible pluviométrie, à la forte insolation et à la grande vitesse du vent. Conclusion : La fréquence du paludisme est liée à la grande humidité, et à la faible insolation. Quant à la méningite, sa fréquence est liée à la haute température, à la grande vitesse du vent et à la forte insolation

Efficacy and safety of a fixed dose artesunate-sulphamethoxypyrazine-pyrimethamine compared to artemether-lumefantrine for the treatment of uncomplicated falciparum malaria across Africa: a randomized multi-centre trial

<p>Abstract</p> <p>Background</p> <p>The efficacy of artemisinin-based combination therapy has already been demonstrated in a number of studies all over the world, and some of them can be regarded as comparably effective. Ease of administration of anti-malarial treatments with shorter courses and fewer tablets may be key determinant of compliance.</p> <p>Methods</p> <p>Patients with uncomplicated falciparum malaria and over six months of age were recruited in Cameroon, Mali, Rwanda and Sudan. 1,384 patients were randomly assigned to receive artesunate-sulphamethoxypyrazine-pyrimethamine (AS-SMP) three-day (once daily for 3 days) regimen (N = 476) or AS-SMP 24-hour (0 h, 12 h, 24 h) regimen (N = 458) or artemether-lumefantrine (AL), the regular 6 doses regimen (N = 450). The primary objective was to demonstrate non-inferiority (using a margin of -6%) of AS-SMP 24 hours or AS-SMP three days versus AL on the PCR-corrected 28-day cure rate.</p> <p>Results</p> <p>The PCR corrected 28-day cure rate on the intention to treat (ITT) analysis population were: 96.0%(457/476) in the AS-SMP three-day group, 93.7%(429/458) in the AS-SMP 24-hour group and 92.0%(414/450) in the AL group. Likewise, the cure rates on the PP analysis population were high: 99.3%(432/437) in the AS-SMP three-day group, 99.5%(416/419) in the AS-SMP 24-hour group and 99.7(391/394)% in the AL group. Most common drug-related adverse events were gastrointestinal symptoms (such as vomiting and diarrhea) which were slightly higher in the AS-SMP 24-hour group.</p> <p>Conclusion</p> <p>AS-SMP three days or AS-SMP 24 hours are safe, are as efficacious as AL, and are well tolerated.</p> <p>Trial registration</p> <p>NCT00484900 <url>http://www.clinicaltrials.gov</url>.</p

Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis.

INTRODUCTION: HIV-associated cryptococcal, TB and pneumococcal meningitis are the leading causes of adult meningitis in sub-Saharan Africa (SSA). We performed a systematic review and meta-analysis with the primary aim of estimating mortality from major causes of adult meningitis in routine care settings, and to contrast this with outcomes from clinical trial settings. METHODS: We searched PubMed, EMBASE and the Cochrane Library for published clinical trials (defined as randomized-controlled trials (RCTs) or investigator-managed prospective cohorts) and observational studies that evaluated outcomes of adult meningitis in SSA from 1 January 1990 through 15 September 2019. We performed random effects modelling to estimate pooled mortality, both in clinical trial and routine care settings. Outcomes were stratified as short-term (in-hospital or two weeks), medium-term (up to 10 weeks) and long-term (up to six months). RESULTS AND DISCUSSION: Seventy-nine studies met inclusion criteria. In routine care settings, pooled short-term mortality from cryptococcal meningitis was 44% (95% confidence interval (95% CI):39% to 49%, 40 studies), which did not differ between amphotericin (either alone or with fluconazole) and fluconazole-based induction regimens, and was twofold higher than pooled mortality in clinical trials using amphotericin based treatment (21% (95% CI:17% to 25%), 17 studies). Pooled short-term mortality of TB meningitis was 46% (95% CI: 33% to 59%, 11 studies, all routine care). For pneumococcal meningitis, pooled short-term mortality was 54% in routine care settings (95% CI:44% to 64%, nine studies), with similar mortality reported in two included randomized-controlled trials. Few studies evaluated long-term outcomes. CONCLUSIONS: Mortality rates from HIV-associated meningitis in SSA are very high under routine care conditions. Better strategies are needed to reduce mortality from HIV-associated meningitis in the region

Artemisinin-based combinations versus amodiaquine plus sulphadoxine-pyrimethamine for the treatment of uncomplicated malaria in Faladje, Mali

<p>Abstract</p> <p>Background</p> <p>Because of the emergence of chloroquine resistance in Mali, artemether-lumefantrine (AL) or artesunate-amodiaquine (AS+AQ) are recommended as first-line therapy for uncomplicated malaria, but have not been available in Mali until recently because of high costs.</p> <p>Methods</p> <p>From July 2005 to January 2006, a randomized open-label trial of three oral antimalarial combinations, namely AS+AQ, artesunate plus sulphadoxine-pyrimethamine (AS+SP), and amodiaquine plus sulphadoxine-pyrimethamine (AQ+SP), was conducted in Faladje, Mali. Parasite genotyping by polymerase chain reaction (PCR) was used to distinguish new from recrudescent <it>Plasmodium falciparum </it>infections.</p> <p>Results</p> <p>397 children 6 to 59 months of age with uncomplicated <it>Plasmodium falciparum </it>malaria were enrolled, and followed for 28 days to assess treatment efficacy. Baseline characteristics were similar in all three treatment groups. The uncorrected rates of adequate clinical and parasitologic response (ACPR) were 55.7%, 90.8%, and 97.7% in AS+AQ, AS+SP, and AQ+SP respectively (p < 0.001); after PCR correction ACPR rates were similar among treatment groups: 95.4%, 96.9%, and 99.2% respectively (p = 0.17). Mean haemoglobin concentration increased across all treatment groups from Day 0 (9.82 ± 1.68 g/dL) to Day 28 (10.78 ± 1.49 g/dL) (p < 0.001), with the greatest improvement occurring in children treated with AQ+SP. On Day 2, the prevalence of parasitaemia was significantly greater among children treated with AQ+SP (50.8%) than in children treated with AS+AQ (10.5%) or AS+SP (10.8%) (p < 0.001). No significant difference in gametocyte carriage was found between groups during the follow-up period.</p> <p>Conclusion</p> <p>The combination of AQ+SP provides a potentially low cost alternative for treatment of uncomplicated <it>P. falciparum </it>infection in Mali and appears to have the added value of longer protective effect against new infection.</p

Comparative study of the efficacy and tolerability of dihydroartemisinin - piperaquine - trimethoprim versus artemether - lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Cameroon, Ivory Coast and Senegal

<p>Abstract</p> <p>Background</p> <p>The ACT recommended by WHO is very effective and well-tolerated. However, these combinations need to be administered for three days, which may limit adherence to treatment.</p> <p>The combination of dihydroartemisinin - piperaquine phosphate - trimethoprim (Artecom^®, Odypharm Ltd), which involves treatment over two days, appears to be a good alternative, particularly in malaria-endemic areas. This study intends to compare the efficacy and tolerability of the combination dihydroartemisinin - piperaquine phosphate - trimethoprim (DPT) versus artemether - lumefantrine (AL) in the treatment of uncomplicated <it>Plasmodium falciparum </it>malaria in Cameroon, Ivory Coast and Senegal.</p> <p>Methods</p> <p>This was a randomized, controlled, open-label clinical trial with a 28-day follow-up period comparing DPT to AL as the reference drug. The study involved patients of at least two years of age, suffering from acute, uncomplicated <it>Plasmodium falciparum </it>malaria with fever. The WHO 2003 protocol was used.</p> <p>Results</p> <p>A total of 418 patients were included in the study and divided into two treatment groups: 212 in the DPT group and 206 in the AL group. The data analysis involved the 403 subjects who correctly followed the protocol (<it>per protocol </it>analysis), i.e. 206 (51.1%) in the DPT group and 197 (48.9%) in the AL group. The recovery rate at D14 was 100% in both treatment groups. The recovery rate at D28 was 99% in the DPT and AL groups before and after PCR results with one-sided 97.5% Confidence Interval of the rates difference > -1.90%. More than 96% of patients who received DPT were apyrexial 48 hours after treatment compared to 83.5% in the AL group (p < 0.001). More than 95% of the people in the DPT group had a parasite clearance time of 48 hours or less compared to approximately 90% in the AL group (p = 0.023). Both drugs were well tolerated. No serious adverse events were reported during the follow-up period. All of the adverse events observed were minor and did not result in the treatment being stopped in either treatment group. The main minor adverse events reported were vomiting, abdominal pain and pruritus.</p> <p>Conclusion</p> <p>The overall efficacy and tolerability of DPT are similar to those of AL. The ease of taking DPT and its short treatment course (two days) may help to improve adherence to treatment. Taken together, these findings make this medicinal product a treatment of choice for the effective management of malaria in Africa.</p

Ecology of Phlebotomine Sand Flies in the Rural Community of Mont Rolland (Thiès Region, Senegal): Area of Transmission of Canine Leishmaniasis

BACKGROUND: Different epidemiological studies previously indicated that canine leishmaniasis is present in the region of Thiès (Senegal). However, the risks to human health, the transmission cycle and particularly the implicated vectors are unknown. METHODOLOGY/PRINCIPAL FINDINGS: To improve our knowledge on the population of phlebotomine sand flies and the potential vectors of canine leishmaniasis, sand flies were collected using sticky traps, light traps and indoor spraying method using pyrethroid insecticides in 16 villages of the rural community of Mont Rolland (Thiès region) between March and July 2005. The 3788 phlebotomine sand flies we collected (2044 males, 1744 females) were distributed among 9 species of which 2 belonged to the genus Phlebotomus: P. duboscqi (vector of cutaneous leishmaniasis in Senegal) and P. rodhaini. The other species belonged to the genus Sergentomyia: S. adleri, S. clydei, S. antennata, S. buxtoni, S. dubia, S. schwetzi and S. magna. The number of individuals and the species composition differed according to the type of trap, suggesting variable, species-related degrees of endophily or exophily. The two species of the genus Phlebotomus were markedly under-represented in comparison to the species of the genus Sergentomyia. This study also shows a heterogeneous spatial distribution within the rural community that could be explained by the different ecosystems and particularly the soil characteristics of this community. Finally, the presence of the S. dubia species appeared to be significantly associated with canine leishmaniasis seroprevalence in dogs. CONCLUSIONS/SIGNIFICANCE: Our data allow us to hypothesize that the species of the genus Sergentomyia and particularly the species S. dubia and S. schwetzi might be capable of transmitting canine leishmaniasis. These results challenge the dogma that leishmaniasis is exclusively transmitted by species of the genus Phlebotomus in the Old World. This hypothesis should be more thoroughly evaluated