Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites.

BACKGROUND: Malaria continues to be a major cause of infectious disease mortality in tropical regions. However, deaths from malaria are most often not individually documented, and as a result overall understanding of malaria epidemiology is inadequate. INDEPTH Network members maintain population surveillance in Health and Demographic Surveillance System sites across Africa and Asia, in which individual deaths are followed up with verbal autopsies. OBJECTIVE: To present patterns of malaria mortality determined by verbal autopsy from INDEPTH sites across Africa and Asia, comparing these findings with other relevant information on malaria in the same regions. DESIGN: From a database covering 111,910 deaths over 12,204,043 person-years in 22 sites, in which verbal autopsy data were handled according to the WHO 2012 standard and processed using the InterVA-4 model, over 6,000 deaths were attributed to malaria. The overall period covered was 1992-2012, but two-thirds of the observations related to 2006-2012. These deaths were analysed by site, time period, age group and sex to investigate epidemiological differences in malaria mortality. RESULTS: Rates of malaria mortality varied by 1:10,000 across the sites, with generally low rates in Asia (one site recording no malaria deaths over 0.5 million person-years) and some of the highest rates in West Africa (Nouna, Burkina Faso: 2.47 per 1,000 person-years). Childhood malaria mortality rates were strongly correlated with Malaria Atlas Project estimates of Plasmodium falciparum parasite rates for the same locations. Adult malaria mortality rates, while lower than corresponding childhood rates, were strongly correlated with childhood rates at the site level. CONCLUSIONS: The wide variations observed in malaria mortality, which were nevertheless consistent with various other estimates, suggest that population-based registration of deaths using verbal autopsy is a useful approach to understanding the details of malaria epidemiology

Arthropathies Microcristallines : à Propos de 150 Cas au Sénégal

Objectif : Déterminer le profil épidémiologique des cas d’arthropathies microcristallines dans le service de rhumatologie du CHU Aristide Le Dantec. Matériel et méthodes : Il s’agit d’une étude rétrospective menée entre janvier 2002 et décembre 2015 dans le service de rhumatologie du CHU Aristide Le Dantec de Dakar. Nous avions inclus tous les dossiers des patients diagnostiqués pour arthropathies microcristallines selon les critères en vigueur. Résultats : Nous avons colligées 150 cas d’arthropathies microcristallines : 106 cas de gouttes, 37 cas de CCA et 7 cas de rhumatisme apatitique. Les cas de goutte étaient observés chez 92 hommes (86,79%) et 14 femmes (13,21%), d’âge moyen de 55,72 ans (extrême entre 31 et 91 ans). Le délai diagnostique était en moyenne de 11,17 ans (extrême entre 3 jours et 40 ans). L’hyperuricémie était constante et était associé à des facteurs de risque métabolique. Les cas de chondrocalcinose articulaire étaient observés chez 31 femmes (83,8%) et 6 hommes (16,2%) d’âge moyen de 69,05 ans (extrême entre 59 et 91 ans). Le délai diagnostic était de 10,46 ans (extrême entre 1 et 26 ans). Les cas de rhumatisme apatitique étaient constitués uniquement de femme jeune dont l’âge moyen était de 32 ans (extrême entre 29 et 34 ans). Conclusion: L’incidence de cette affection semble être en augmentation dans notre étude où elle est dominée, comme en Occident par la goutte. Le diagnostic des arthropathies microcristallines était tardif et sa présentation clinique et radiologique sévère. Cette sévérité est attribuable en partie au retard diagnostic ce qui est similaire aux formes rapportées chez le noir africain.   Objective: Determine the epidemiological profile of microcrystalline arthropathies in the rheumatology department of the University Hospital of Dakar. Material and methods: This is a retrospective study conducted between January 2002 and December 2015 in the rheumatology department of Aristide Le Dantec University Hospital of Dakar. Microcrystalline arthropathies were diagnosed according to current criteria. Results: We collected 150 cases of microcrystalline arthropathy: 106 cases of gout, 37 cases of CCA and 7 cases of apatitic rheumatism. Cases of gout were observed in 92 men (86.79%) and 14 women (13.21%), with a mean age of 55.72 years (extreme between 31 and 91 years). The diagnostic delay was on average 11.17 years (extreme between 3 days and 40 years). Hyperuricemia was constant and was associated with metabolic risk factors. The cases of articular chondrocalcinosis were observed in 31 women (83.8%) and 6 men (16.2%) with a mean age of 69.05 years (extreme between 59 and 91 years). The diagnostic delay was 10.46 years (extreme between 1 and 26 years). The cases of apatitic rheumatism consisted only of young women whose average age was 32 years (extreme between 29 and 34 years). Conclusion: The incidence of this condition seems to be increasing in our study where it is dominated, as in the West, by gout. The diagnosis of microcrystalline arthropathies was late and its clinical and radiological presentation severe. This severity is partly attributable to the delayed diagnosis, which is similar to the forms reported in black Africans

Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites.

BACKGROUND: Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. OBJECTIVE: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15-64 years) and older (65+ years) NCD mortality. DESIGN: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. RESULTS: A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15-64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. CONCLUSIONS: These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work

Arthropathies Microcristallines : à Propos de 150 Cas au Sénégal

Objectif : Déterminer le profil épidémiologique des cas d’arthropathies microcristallines dans le service de rhumatologie du CHU Aristide Le Dantec. Matériel et méthodes : Il s’agit d’une étude rétrospective menée entre janvier 2002 et décembre 2015 dans le service de rhumatologie du CHU Aristide Le Dantec de Dakar. Nous avions inclus tous les dossiers des patients diagnostiqués pour arthropathies microcristallines selon les critères en vigueur. Résultats : Nous avons colligées 150 cas d’arthropathies microcristallines : 106 cas de gouttes, 37 cas de CCA et 7 cas de rhumatisme apatitique. Les cas de goutte étaient observés chez 92 hommes (86,79%) et 14 femmes (13,21%), d’âge moyen de 55,72 ans (extrême entre 31 et 91 ans). Le délai diagnostique était en moyenne de 11,17 ans (extrême entre 3 jours et 40 ans). L’hyperuricémie était constante et était associé à des facteurs de risque métabolique. Les cas de chondrocalcinose articulaire étaient observés chez 31 femmes (83,8%) et 6 hommes (16,2%) d’âge moyen de 69,05 ans (extrême entre 59 et 91 ans). Le délai diagnostic était de 10,46 ans (extrême entre 1 et 26 ans). Les cas de rhumatisme apatitique étaient constitués uniquement de femme jeune dont l’âge moyen était de 32 ans (extrême entre 29 et 34 ans). Conclusion: L’incidence de cette affection semble être en augmentation dans notre étude où elle est dominée, comme en Occident par la goutte. Le diagnostic des arthropathies microcristallines était tardif et sa présentation clinique et radiologique sévère. Cette sévérité est attribuable en partie au retard diagnostic ce qui est similaire aux formes rapportées chez le noir africain.   Objective: Determine the epidemiological profile of microcrystalline arthropathies in the rheumatology department of the University Hospital of Dakar. Material and methods: This is a retrospective study conducted between January 2002 and December 2015 in the rheumatology department of Aristide Le Dantec University Hospital of Dakar. Microcrystalline arthropathies were diagnosed according to current criteria. Results: We collected 150 cases of microcrystalline arthropathy: 106 cases of gout, 37 cases of CCA and 7 cases of apatitic rheumatism. Cases of gout were observed in 92 men (86.79%) and 14 women (13.21%), with a mean age of 55.72 years (extreme between 31 and 91 years). The diagnostic delay was on average 11.17 years (extreme between 3 days and 40 years). Hyperuricemia was constant and was associated with metabolic risk factors. The cases of articular chondrocalcinosis were observed in 31 women (83.8%) and 6 men (16.2%) with a mean age of 69.05 years (extreme between 59 and 91 years). The diagnostic delay was 10.46 years (extreme between 1 and 26 years). The cases of apatitic rheumatism consisted only of young women whose average age was 32 years (extreme between 29 and 34 years). Conclusion: The incidence of this condition seems to be increasing in our study where it is dominated, as in the West, by gout. The diagnosis of microcrystalline arthropathies was late and its clinical and radiological presentation severe. This severity is partly attributable to the delayed diagnosis, which is similar to the forms reported in black Africans

Arthropathies Microcristallines: à Propos de 150 cas a Sénégal

Objectif : Les arthropathies microcristallines sont classiquement considérées comme rares en Afrique sub-saharienne où la majorité des études porte sur la goutte. L’objectif de notre étude était de déterminer le profil épidémiologique des cas d’arthropathies microcristallines dans le service de rhumatologie du CHU Aristide Le Dantec. Matériel et méthodes : Il s’agit d’une étude rétrospective menée entre janvier 2002 et décembre 2016 dans le service de rhumatologie du CHU Aristide Le Dantec de Dakar. Nous avions inclus tous les dossiers des patients diagnostiqués pour arthropathies microcristallines selon les critères en vigueur. Résultats : Nous avons colligées 150 cas d’arthropathies microcristallines : 106 cas de gouttes, 37 cas de chondrocalcinose articulaire et 7 cas de rhumatisme apatitique. L’âge moyen des patients était de 58,12 ± 14,12 ans avec des extrêmes entre 31 et 91 ans. Quatre-vingt-douze (86,79%) patients atteints de goutte étaient des hommes et trente et un patients (83,8%) atteints de CCA étaient des femmes. Le délai diagnostique moyen des patients atteints d’arthropathies microcristallines était de 10,71±8,07 ans. La présentation clinique des arthropathies microcristallines était polyarticulaire (63 ; 42%), oligoarticulaire (48 ; 32%) et monoarticulaire (35 ; 23,3%) des cas. Les genoux et les chevilles étaient les articulations les plus touchées avec respectivement 40,7 et 20,7% des cas. L’hyperuricémie était constante et était associée à des facteurs de risque métabolique tel que l’obésité et la dyslipidémie avec respectivement 39,62 et 37,74 % des cas.  Conclusion : L’incidence de cette affection semble être en augmentation dans notre étude où elle est dominée, comme en Occident par la goutte. Le diagnostic des arthropathies microcristallines était tardif et sa présentation clinique et radiologique sévère. Cette sévérité est attribuable en partie au retard diagnostic ce qui est similaire aux formes rapportées chez le noir africain.   Objective: Microcrystalline arthropathies are classically considered rare in sub-Saharan Africa where the majority of studies focus on gout. The objective of our study was to determine the epidemiological profile of cases of microcrystalline arthropathy in the rheumatology department of the University Hospital of Dakar. Material and methods: This is a retrospective study conducted between January 2002 and December 2016 in the rheumatology department of Aristide Le Dantec University Hospital of Dakar. Microcrystalline arthropathies were diagnosed according to current criteria. Results: We collected 150 cases of microcrystalline arthropathies: 106 cases of gout, 37 cases of articular chondrocalcinosis and 7 cases of apatitic rheumatism. The average age of patients was 58.12 ± 14.12 years with extremes between 31 and 91 years. Ninety-two (86.79%) patients with gout were male and thirty-one (83.8%) patients with CCA were female. The average diagnostic delay of patients with microcrystalline arthropathies was 10.71 ± 8.07 years. The clinical presentation of microcrystalline arthropathies was polyarticular (63; 42%), oligoarticular (48; 32%) and monoarticular (35; 23.3%) of the cases. The knees and ankles were the most affected joints with respectively 40.7 and 20.7% of cases. Hyperuricemia was constant and was associated with metabolic risk factors such as obesity and dyslipidemia with respectively 39.62 and 37.74% of cases. Conclusion: The incidence of this condition seems to be increasing in our study where it is dominated, as in the West, by gout. The diagnosis of microcrystalline arthropathies was late and its clinical and radiological presentation severe. This severity is partly attributable to the delayed diagnosis, which is similar to the forms reported in black Africans

Prevalence et facteurs associes a l’halitose buccale : Etude dans une population generale senegalaise

Introduction: Halitosis is a common complain among dental patients, chronic among 50% of the adult population, and of oral origin in 90% of the cases. The objective of this study was to evaluate the prevalence and related factors of oral halitosis among a senegalese population. Material and method: This was a transversal descriptive study of 396 Senegalese adults using a 24-point self-assessment questionnaire on halitosis. All subjects were examined to estimate the organoleptic means and to measure the Sulfur Volatile Compounds (SVC), using a halimeter. Halitosis was diagnosed when the level of sulfur volatile Compound was ≥125 ppb and the organoleptic score ≥ 2. Data were statistically analyzed using the chi2 test. Results: The global prevalence of halitosis was 32.3 %. The difference was not statistically significant between male and female. Among the 396 patients suffering from bad breath, 128 had a permanent halitosis and 52 had a physiological halitosis. The means of the organoleptic scores were 3.12 and that of the (SVC) were 273.9 ppb. Conclusion: The results of the study showed a relation between the organoleptic tests and the level of sulfur volatile compounds (SVC). Keywords: Halitosis, organoleptic tests, sulfur volatile compound, epidemiology, and self-assessment

Prostate cancer outcome in Burkina Faso

<p>Abstract</p> <p>Introduction</p> <p>African-American black men race is one of non-modifiable risk factors confirmed for prostate cancer. Many studies have been done in USA among African- American population to evaluate prostate cancer disparities. Compared to the USA very few data are available for prostate cancer in Sub-Saharan African countries. The objective of this study was to describe incident prostate cancer (PC) diagnosis characteristics in Burkina Faso (West Africa).</p> <p>Methods</p> <p>We performed a prospective non randomized patient’s cohort study of new prostate cancer cases diagnosed by histological analysis of transrectal prostate biopsies in Burkina Faso. Study participants included 166 patients recruited at the urology division of the university hospital of Ouagadougou. Age of the patients, clinical symptoms, digital rectal examination (DRE) result, serum prostate-specific antigen (PSA) level, histological characteristics and TNM classification were taking in account in this study.</p> <p>Results</p> <p>166 transrectal prostate biopsies (TRPB) were performed based on high PSA level or abnormal DRE. The prostate cancer rate on those TRPB was 63, 8 % (n=106). The mean age of the patients was 71, 5 years (52 to 86). Urinary retention was the first clinical patterns of reference in our institution (55, 7 %, n = 59). Most patients, 56, 6 % (n = 60) had a serum PSA level over than 100 ng/ml. All the patients had adenocarcinoma on histological study of prostate biopsy cores. The majority of cases (54, 7 % n = 58) had Gleason score equal or higher than 7.</p> <p>Conclusion</p> <p>Prostate cancer is diagnosed at later stages in our country. Very high serum PSA level and poorly differentiated tumors are the two major characteristics of PC at the time of diagnosis.</p

Field-based evidence of fast and global increase of Plasmodium falciparum drug-resistance by DNA-microarrays and PCR/RFLP in Niger

<p>Abstract</p> <p>Background</p> <p>Over the last years, significant progress has been made in the comprehension of the molecular mechanism of malaria resistance to drugs. Together with <it>in vivo </it>tests, the molecular monitoring is now part of the survey strategy of the <it>Plasmodium </it>sensitivity. Currently, DNA-microarray analysis allows the simultaneous study of many single nucleotide polymorphisms (SNP) of <it>Plasmodium </it>isolates. In December 2005, the International Federation of the Red Cross distributed two million three hundred thousand long-lasting insecticide nets to pregnant women and mothers of under five years children in the whole Niger. Then, Niger adopted artemisinin-based combination therapy as first-line treatment.</p> <p>Methods</p> <p>Thirty four SNPs of <it>pfcrt, pfdhfr, pfdhps, pfmdr </it>and <it>pfATPase </it>were analysed by DNA-microarray and PCR/RFLP in two villages – Zindarou and Banizoumbou – with different durations of malaria transmission. The main objective of the study was to measure the dynamics <it>of Plasmodium falciparum </it>resistant strains and associated factors.</p> <p>Results</p> <p>This study shows a global and clear increase of the drug-resistance associated molecular markers frequencies during a relatively short-time period of four years. Markers associated with resistance to chloroquine and sulphonamids were more frequently found in the short transmission zone than in the long transmission one. The <it>pfcrt76T </it>mutation is significantly more present at Banizoumbou than Zindarou (38.3% vs 25.2%, p = 0.013).</p> <p>This work allowed the screening of several field strains for five SNPs of <it>PfATPase6 </it>gene. The <it>pfATPase6S769N</it>, candidate mutation of resistance to artemisinin was not found. However the <it>pfATPsaeA623E </it>mutation was found in 4.7% of samples.</p> <p>Conclusion</p> <p>A significant increase of several SNPs frequencies was highlighted over a four-year period. The polymorphism of five <it>PfATPase6 </it>gene SNPs was described. The global, large and fast increase of the molecular resistance is discussed in the context of current changes of health policy and malaria control in Niger.</p

Major Reduction in Anti-Malarial Drug Consumption in Senegal after Nation-Wide Introduction of Malaria Rapid Diagnostic Tests

BACKGROUND: While WHO recently recommended universal parasitological confirmation of suspected malaria prior to treatment, debate has continued as to whether wide-scale use of rapid diagnostic tests (RDTs) can achieve this goal. Adherence of health service personnel to RDT results has been poor in some settings, with little impact on anti-malarial drug consumption. The Senegal national malaria control programme introduced universal parasite-based diagnosis using malaria RDTs from late 2007 in all public health facilities. This paper assesses the impact of this programme on anti-malarial drug consumption and disease reporting. METHODS AND FINDINGS: Nationally-collated programme data from 2007 to 2009 including malaria diagnostic outcomes, prescription of artemisinin-based combination therapy (ACT) and consumption of RDTs in public health facilities, were reviewed and compared. Against a marked seasonal variation in all-cause out-patient visits, non-malarial fever and confirmed malaria, parasite-based diagnosis increased nationally from 3.9% of reported malaria-like febrile illness to 86.0% over a 3 year period. The prescription of ACT dropped throughout this period from 72.9% of malaria-like febrile illness to 31.5%, reaching close equivalence to confirmed malaria (29.9% of 584,873 suspect fever cases). An estimated 516,576 courses of inappropriate ACT prescription were averted. CONCLUSIONS: The data indicate high adherence of anti-malarial prescribing practice to RDT results after an initial run-in period. The large reduction in ACT consumption enabled by the move from symptom-based to parasite-based diagnosis demonstrates that effective roll-out and use of malaria RDTs is achievable on a national scale through well planned and structured implementation. While more detailed information on management of parasite-negative cases is required at point of care level to assess overall cost-benefits to the health sector, considerable cost-savings were achieved in ACT procurement. Programmes need to be allowed flexibility in management of these funds to address increases in other programmatic costs that may accrue from improved diagnosis of febrile disease

Towards realistic benchmarks for multiple alignments of non-coding sequences

<p><b>Abstract</b></p> <p>Background</p> <p>With the continued development of new computational tools for multiple sequence alignment, it is necessary today to develop benchmarks that aid the selection of the most effective tools. Simulation-based benchmarks have been proposed to meet this necessity, especially for non-coding sequences. However, it is not clear if such benchmarks truly represent real sequence data from any given group of species, in terms of the difficulty of alignment tasks.</p> <p>Results</p> <p>We find that the conventional simulation approach, which relies on empirically estimated values for various parameters such as substitution rate or insertion/deletion rates, is unable to generate synthetic sequences reflecting the broad genomic variation in conservation levels. We tackle this problem with a new method for simulating non-coding sequence evolution, by relying on genome-wide distributions of evolutionary parameters rather than their averages. We then generate synthetic data sets to mimic orthologous sequences from the <it>Drosophila </it>group of species, and show that these data sets truly represent the variability observed in genomic data in terms of the difficulty of the alignment task. This allows us to make significant progress towards estimating the alignment accuracy of current tools in an absolute sense, going beyond only a relative assessment of different tools. We evaluate six widely used multiple alignment tools in the context of <it>Drosophila </it>non-coding sequences, and find the accuracy to be significantly different from previously reported values. Interestingly, the performance of most tools degrades more rapidly when there are more insertions than deletions in the data set, suggesting an asymmetric handling of insertions and deletions, even though none of the evaluated tools explicitly distinguishes these two types of events. We also examine the accuracy of two existing tools for annotating insertions versus deletions, and find their performance to be close to optimal in <it>Drosophila </it>non-coding sequences if provided with the true alignments.</p> <p>Conclusion</p> <p>We have developed a method to generate benchmarks for multiple alignments of <it>Drosophila </it>non-coding sequences, and shown it to be more realistic than traditional benchmarks. Apart from helping to select the most effective tools, these benchmarks will help practitioners of comparative genomics deal with the effects of alignment errors, by providing accurate estimates of the extent of these errors.</p