Rectal Carriage of Extended-Spectrum Beta-Lactamase-Producing Gram-Negative Bacilli in Community Settings in Madagascar

BACKGROUND: Extended-spectrum ß-lactamase-producing Enterobacteria (ESBL-PE) emerged at the end of the 1980s, causing nosocomial outbreaks and/or hyperendemic situations in hospitals and long-term care facilities. In recent years, community-acquired infections due to ESBL-PE have spread worldwide, especially across developing countries including Madagascar. OBJECTIVES: This study aimed to determine the prevalence and risk factors of intestinal carriage of ESBL-PE in the community of Antananarivo. METHODS: Non-hospitalized patients were recruited in three health centers in different socio economic settings. Fresh stool collected were immediately plated on Drigalski agar containing 3 mg/liter of ceftriaxone. Gram-negative bacilli species were identified and ESBL production was tested by a double disk diffusion (cefotaxime and ceftazidime +/- clavulanate) assay. Characterization of ESBLs were perfomed by PCR and direct sequencing . Molecular epidemiology was analysed by Rep-PCR and ERIC-PCR. RESULTS: 484 patients were screened (sex ratio  = 1.03, median age 28 years). 53 ESBL-PE were isolated from 49 patients (carrier rate 10.1%). The isolates included Escherichia coli (31), Klebsiella pneumoniae (14), Enterobacter cloacae (3), Citrobacter freundii (3), Kluyvera spp. (1) and Pantoae sp.(1). In multivariate analysis, only the socioeconomic status of the head of household was independently associated with ESBL-PE carriage, poverty being the predominant risk factor. CONCLUSIONS: The prevalence of carriage of ESBL in the community of Antananarivo is one of the highest reported worldwide. This alarming spread of resistance genes should be stopped urgently by improving hygiene and streamlining the distribution and consumption of antibiotics

Recourir à l'avortement médicamenteux à Madagascar : une pratique banalisée ? = Using medial abortion in Madagascar : a trivialized practice ? [poster]

Régulations, Marchés, Santé : interroger les enjeux actuels du médicament en Afrique, Ouidah, BEN, 26-/03/2018 - 29/03/201

Recourir à l'avortement médicamenteux à Madagascar : une pratique banalisée ? = Using medical abortion in Madagascar : a trivialized practice ? [résumé]

Régulations, Marchés, Santé : interroger les enjeux actuels du médicament en Afrique, Ouidah, BEN, 26-/03/2018 - 29/03/201

Recourir à l'avortement médicamenteux à Madagascar : une pratique banalisée ? = Using medial abortion in Madagascar : a trivialized practice ? [poster]

Régulations, Marchés, Santé : interroger les enjeux actuels du médicament en Afrique, Ouidah, BEN, 26-/03/2018 - 29/03/201

Projet "création de vergers à graines forestières." Rapport annuel 1996

Ce document présente les activités menées par le programme de recherche sur les espèces feuillus du Département des Recherches Forestière et Piscicoles du FOFIFA mené en collaboration avec le CIRAD-Forêt "Programme Plantations Forestières." Les travaux décrits dans ce document concernent la mise en place des essais pour l'année 1996. Ils sont pour la plupart réalisés dans le cadre du projet "Création de vergers à graines forestières." Les dispositifs ont été installés, pour cette année, sur six stations couvrant la plupart des régions bio-climatiques de Madagasca

Monitoring for outbreak associated excess mortality in an African city: Detection limits in Antananarivo, Madagascar

Objectives Quantitative estimates of the impact of infectious disease outbreaks are required to develop measured policy responses. In many low- and middle-income countries, inadequate surveillance and incompleteness of death registration are important barriers. Design Here, we characterize how large an impact on mortality would have to be to be detectable using the uniquely detailed mortality notification data from the city of Antananarivo, Madagascar, with application to a recent measles outbreak. Results The weekly mortality rate of children during the 2018–2019 measles outbreak was 161% above the expected value at its peak, and the signal can be detected earlier in children than in the general population. This approach to detecting anomalies from expected baseline mortality allows us to delineate the prevalence of COVID-19 at which excess mortality would be detectable with the existing death notification system in Antananarivo. Conclusions Given current age-specific estimates of the COVID-19 fatality ratio and the age structure of the population in Antananarivo, we estimate that as few as 11 deaths per week in the 60–70 years age group (corresponding to an infection rate of approximately 1%) would detectably exceed the baseline. Data from 2020 will undergo necessary processing and quality control in the coming months. Our results provide a baseline for interpreting this information