Epidemiological, clinical and therapeutic profile of uterine fibroids at the Befelatanana University hospital centre of obstetric gynecology of Antananarivo, Madagascar

Background: Leiomyomas or fibromyomas more commonly referred as uterine fibroids are the most common tumors of the female genital tract. They affect 20 to 25% of women in genital activity. The objective of present study is to describe the epidemiological and therapeutic profile of uterine fibroids at the UHCOBG.Methods: Retrospective and descriptive cross-sectional study of patients with uterine fibroids hospitalized in the department of gynecology of the UHCOBG between January 2015 and December 2016.Results: In total, 101 cases of uterine fibroids have been identified with a prevalence of 3.92%. The average age is 42.75±3.6 years old. The most affected age group varies from 35 to 45 years old. Thirty-eight-point six percent of the patients were pauciparous. The medical history of irregular menstrual cycle disorders was present in 17.8% of the cases. The symptomatology was dominated by menometrorrhagia (78.2%) and in 67.3% of the cases, patients had anemia. The majority of patients (64.4%) had poly-myomatous uterus which fibroid location was predominantly corporeal (92.1%), isthmic (21.8%), and three quarters of the mapping was interstitial. Complications were dominated by aseptic necrobiosis (7.9%) and conservative treatment in 68.3% of the cases. Laparotomy is the pillar of a surgical treatment. The duration of hospitalization was short in 77.2% of the cases, 91.1% had a good progress and no death was noticed during 2 years.Conclusions: This is the first operative indication of all gynecological pathologies in present UHC and proves to be a real public health problem. The development of operative laparoscopy is necessary to reduce the morbidity associated with treatment

Evaluation of the therapeutic efficacy of praziquantel against schistosomes in seven countries with ongoing large-scale deworming programs

The World Health Organization (WHO) recommends periodic assessment of the therapeutic efficacy of praziquantel (PZQ) to detect reduced efficacy that may arise from drug resistance in schistosomes. In this multi-country study (2014), we assessed the therapeutic efficacy of a single oral dose of PZQ (40 mg/kg) against Schistosoma mansoni (Brazil, Cameroon, Ethiopia, Mali, Madagascar and Tanzania), S. haematobium (Cameroon, Ethiopia, Mali, Tanzania and Zanzibar) and S. japonicum (the Philippines) infections in school-aged children, across a total of 12 different trials. Each trial was performed according to the standardized methodology for evaluating PZQ efficacy as described by the WHO. Overall, therapeutic efficacy, measured as the reduction in arithmetic mean of schistosome egg counts following drug administration (egg reduction rate; ERR), was high for all three schistosome species (S. mansoni: 93.4% (95%CI: 88.8-96.8); S. haematobium: 97.7% (95%CI: 96.5-98.7) and S. japonicum: 90.0% (95%CI: 68.4-99.3). At the trial level, therapeutic efficacy was satisfactory (point estimate ERR >= 90%) for all three Schistosoma species with the exception of S. mansoni in Cameroon where the ERR was 88.5% (95%CI: 79.0-95.1). Furthermore, we observed that in some trials individual drug response could vary significantly (wide 95%CI) and that few non-responsive individuals could significantly impact ERR point estimates. In conclusion, these results do not suggest any established reduced efficacy of the standard PZQ treatment to any of the three schistosome species within these countries. Nevertheless, the substantial degree of variation in individual responses to treatment in some countries underpins the need for future monitoring. The reported ERR values serve as reference values to compare with outcomes of future PZQ efficacy studies to ensure early detection of reduced efficacies that could occur as drug pressure continues increase. Finally, this study highlights that 95%CI should be considered in WHO guidelines to classify the therapeutic efficacy of PZQ

Evaluation of the Therapeutic Efficacy of Praziquantel Against Schistosomes in Seven Countries with Ongoing Large-Scale Deworming Programs

The World Health Organization (WHO) recommends periodic assessment of the therapeutic efficacy of praziquantel (PZQ) to detect reduced efficacy that may arise from drug resistance in schistosomes. In this multi-country study (2014), we assessed the therapeutic efficacy of a single oral dose of PZQ (40 mg/kg) against Schistosoma mansoni (Brazil, Cameroon, Ethiopia, Mali, Madagascar and Tanzania), S. haematobium (Cameroon, Ethiopia, Mali, Tanzania and Zanzibar) and S. japonicum (the Philippines) infections in school-aged children, across a total of 12 different trials. Each trial was performed according to the standardized methodology for evaluating PZQ efficacy as described by the WHO. Overall, therapeutic efficacy, measured as the reduction in arithmetic mean of schistosome egg counts following drug administration (egg reduction rate; ERR), was high for all three schistosome species (S. mansoni: 93.4% (95%CI: 88.8-96.8); S. haematobium: 97.7% (95%CI: 96.5-98.7) and S. japonicum: 90.0% (95%CI: 68.4-99.3). At the trial level, therapeutic efficacy was satisfactory (point estimate ERR ≥90%) for all three Schistosoma species with the exception of S. mansoni in Cameroon where the ERR was 88.5% (95%CI: 79.0-95.1). Furthermore, we observed that in some trials individual drug response could vary significantly (wide 95%CI) and that few non-responsive individuals could significantly impact ERR point estimates. In conclusion, these results do not suggest any established reduced efficacy of the standard PZQ treatment to any of the three schistosome species within these countries. Nevertheless, the substantial degree of variation in individual responses to treatment in some countries underpins the need for future monitoring. The reported ERR values serve as reference values to compare with outcomes of future PZQ efficacy studies to ensure early detection of reduced efficacies that could occur as drug pressure continues increase. Finally, this study highlights that 95%CI should be considered in WHO guidelines to classify the therapeutic efficacy of PZQ

Fragility Assessment of Traditional Wooden Houses in Madagascar Subjected to Extreme Wind Loads

Cyclones are a common hazard in Madagascar, each year causing fatalities and damage to the physical and socioeconomic infrastructure. Residential infrastructures are a critical sector within the built environment and studying their performance under natural hazards is a significant step for assessing the risk and resilience of a community. In the coastal regions of Madagascar, more than 80% of houses are self-built, non-engineered traditional wooden houses constructed based on heritage practices and using low or no-cost materials collected in nearby areas or forests. These traditional wooden houses are particularly vulnerable to cyclonic winds and, in this paper, a novel approach is used to evaluate their structural performance and to predict their likelihood of failure under extreme wind conditions. The structural systems and their damage due to extreme winds were first evaluated based on field surveys and collected information such as post-disaster reports. A range of field tests was then carried out at two coastal sites to evaluate the strength of the members and connections identified as commonly used for constructing traditional wooden houses in Madagascar. Damage fragility curves were subsequently developed based on the performance of the connections of roof coverings, wall claddings, the roof structural system, and the performance of columns embedded into the ground and combined to predict the structure's performance. The experimental methods and results presented in this study can be exploited to improve the existing Malagasy guidelines for cyclone resistance of traditional wooden houses published in 2016. The developed fragility curves can also be used to represent traditional wooden houses within a community for risk or resilience assessment under cyclonic wind conditions

Insights from practitioners in Madagascar to inform more effective international conservation funding

Peer reviewe

Temperature affects predation of schistosome-competent snails by a novel invader, the marbled crayfish Procambarus virginalis.

The human burden of environmentally transmitted infectious diseases can depend strongly on ecological factors, including the presence or absence of natural enemies. The marbled crayfish (Procambarus virginalis) is a novel invasive species that can tolerate a wide range of ecological conditions and colonize diverse habitats. Marbled crayfish first appeared in Madagascar in 2005 and quickly spread across the country, overlapping with the distribution of freshwater snails that serve as the intermediate host of schistosomiasis-a parasitic disease of poverty with human prevalence ranging up to 94% in Madagascar. It has been hypothesized that the marbled crayfish may serve as a predator of schistosome-competent snails in areas where native predators cannot and yet no systematic study to date has been conducted to estimate its predation rate on snails. Here, we experimentally assessed marbled crayfish consumption of uninfected and infected schistosome-competent snails (Biomphalaria glabrata and Bulinus truncatus) across a range of temperatures, reflective of the habitat range of the marbled crayfish in Madagascar. We found that the relationship between crayfish consumption and temperature is unimodal with a peak at ~27.5°C. Per-capita consumption increased with body size and was not affected either by snail species or their infectious status. We detected a possible satiation effect, i.e., a small but significant reduction in per-capita consumption rate over the 72-hour duration of the predation experiment. Our results suggest that ecological parameters, such as temperature and crayfish weight, influence rates of consumption and, in turn, the potential impact of the marbled crayfish invasion on snail host populations