Factors associated with coverage of praziquantel for schistosomiasis control in the community-direct intervention (CDI) approach in Mali (West Africa)

BACKGROUND: Despite the progress made in the control of Neglected Tropical Diseases (NTD), schistosome and soil-transmitted helminth infections are far from being effectively managed in many parts of the world. Chemotherapy, the key element of all control strategies, is faced with some difficulties in terms of access to treatment. Our study aims to describe the factors involved in the success or failure of the community-directed intervention (CDI) approach through control programmes, which aims to achieve consistent high coverage at affordable and sustainable costs in endemic areas. METHODS: The CDI approach was carried out from December 2007 to October 2008 in ten villages of the district of Diéma, Mali. At inclusion, each child part of the study’s sample was interviewed and submitted for a physical examination. The study focused on: data collection, treatment of the eligible population, evaluation of the treatment coverage, performance of community drug distributors (CDDs), and the involvement and perception of populations. RESULTS: A total of 8,022 eligible people were studied with a mean coverage rate of 76.7%. Using multiple regression, it was determined that receiving praziquantel as treatment was associated with five factors: belonging to the Fulani or Moorish ethnic minority versus the Bambara/Soninke, use of the central versus the house-to-house drug distribution mode, the ratio of the population to the number of CDDs, the lack of supervision and belonging to the age group of 15 years or above (p<0.05). As well as that, it was found that the presence of parallel community-based programmes (HIV, tuberculosis) that provide financial incentives for community members discouraged many CDDs (who in most cases are volunteers) to participate in the CDI approach due to a lack of incentives. CONCLUSIONS: The findings indicate that the success of the CDI approach depends on, amongst other things, the personal characteristics of the respondents, as well as on community factors

Leishmaniases in West Africa: Past and Current

Leishmaniases are vector-borne diseases. Cutaneous leishmaniasis (CL) is endemic in West Africa. Sporadic and anecdotal cases of visceral leishmaniasis (VL) have been reported in the past. Recent data showed the changing of epidemiology of leishmaniases in West Africa, with the occurrence of outbreak of CL due to Leishmania major in urban and rural areas. CL is transmitted by Phlebotomus duboscqi. The role of Sergentomyia (Spelaeomyia) darlingi as vector in rural areas has been evoked but not confirmed. Cases of VL due to Leishmania spp. have been described in West Africa; however, parasites species were not identified and dogs were suspected to be the reservoir. No humans’ case of symptomatic VL due to L. infantum has been described in West Africa. Recent data in rural areas of Senegal confirmed dog as reservoir of L. infantum. In the same study in Senegal, Sergentomyia sandflies were found infected with L. infantum, indicating a possible role in leishmaniasis transmission. Coinfection leishmaniases-HIV is reported but rare. In this chapter, we included most recent publications and propose an updated landscape of CL and VL epidemiology in West Africa

Use of insecticide-treated nets (ITNs) following a malaria education intervention in Piron, Mali: a control trial with systematic allocation of households

BACKGROUND: Insecticide-treated nets (ITNs) reduce malaria morbidity and mortality, but use is limited. A barrier to ITN use may be lack of knowledge regarding malaria transmission and prevention. This study is a controlled trial comparing ITN use and malaria knowledge levels between households in Piron, Mali, undertaken in 2003. METHODS: Households received net impregnation services either with or without antecedent education. The main outcome measure was ITN use, defined as impregnation of at least one of the household's existing bednets with insecticide during the study. Knowledge about malaria and prevention practices was assessed pre- and post- educational intervention. Results were analysed by household and by individual. RESULTS: Forty-nine percent (34/70) of households who received the educational component impregnated their nets in comparison to 35% (22/62) of households who did not (OR = 1.6 CI = 0.8–3.3, P = 0.19). In individual analysis, ITN use was significantly greater in participants who had received the educational intervention (48%) vs. individuals who did not (33%, OR = 1.9, P = 0.012). Knowledge levels about malaria significantly increased for each individual pre- versus post- educational intervention (average change score = 2.13, standard deviation = 1.97, t = -17.78, P < 0.001), although there was no difference found between educational (change score = 2.14) and control groups (change score = 2.12). CONCLUSION: It is possible to educate individuals about malaria and to implement net impregnation services with limited resources. Greater accessibility to net-impregnation services is necessary but not sufficient to increase ITN use

Malaria Transmission-Blocking Vaccines: Present Status and Future Perspectives

Transmission-blocking vaccines (TBVs) utilize Plasmodium sexual stage proteins to induce antibodies that prevent parasites from infecting blood-fed mosquitoes. This type of vaccine, which can be considered a “vaccine of solidarity,” reduces Plasmodium infections within communities without conferring direct protective immunity to the vaccine recipients. The leading TBV candidates have advanced to field clinical trials, where vaccine-induced antibody function has been demonstrated in mosquito-feeding assays. However, the duration of functional antibody responses has been short-lived; hence current development has focused on improved adjuvant and vaccine delivery systems to generate long-lasting immune responses. For the future implementation of TBVs, community perceptions and understandings should be considered, and education should be provided on the concept and its value. Implementation will need to be undertaken in harmony with current malaria control policies

Natural polymorphism in the thrombospondin-related adhesive protein of Plasmodium falciparum

We have developed a typing system using natural sequence variation in the thrombospondin-related adhesive protein (TRAP) gene of Plasmodium falciparum. This method permits a haplotype to be assigned to any particular TRAP gene. We have applied this method to a hospital-based, case control-study in Mali. Previous sequence variation and conservation in TRAP has been confirmed. Particular TRAP haplotypes can be used as geographic hallmarks. Because of the high level of conflict between characters, we have examined the phylogenetic relationships between parasites using a network approach. Having received patient samples from urban and periurban areas of Bamako, the majority of haplotypes were closely related and distinct from TRAP sequences present in other continents. This suggests that the structure of TRAP can only tolerate a limited number of sequence variations to preserve its function but that this is sufficient to allow the parasite to evade the host's immune system until a long-lived immune response can be maintained. It may also reflect host genetics in that certain variants may escape the host immune response more efficiently than others. For vaccine design, sequences from the major regional variants may need to be considered in the production of effective subunit vaccines

Use of a pLDH-based dipstick in the diagnostic and therapeutic follow-up of malaria patients in Mali

<p>Abstract</p> <p>Background</p> <p>Malaria is a major public health problem in Mali and diagnosis is typically based on microscopy. Microscopy requires a well trained technician, a reliable power source, a functioning microscope and adequate supplies. The scarcity of resources of community health centres (CHC) does not allow for such a significant investment in only one aspect of malaria control. In this context, Rapid Diagnostic Tests (RDTs) may improve case management particularly in remote areas.</p> <p>Methods</p> <p>This multicentre study included 725 patients simultaneously screened with OptiMal-IT test and thick smears for malaria parasite detection. While evaluating the therapeutic efficacy of choroquine in 2 study sites, we compared the diagnostic values of thick smear microscopy to OptiMal-IT test applying the WHO 14 days follow-up scheme using samples collected from 344 patients.</p> <p>Results</p> <p>The sensitivity and the specificity of OptiMal-IT compared to thick smear was 97.2% and 95.4%, whereas the positive and negative predictive values were 96.7 and 96.1%, respectively. The percent agreement between the two diagnostic tests was 0.93. The two tests were comparable in detecting malaria at day 0, day 3 and day 14. The only difference was observed at day 7 due to high gametocytemia. Subjectively, health care providers found OptiMal-IT easier to use and store under field conditions.</p> <p>Conclusion</p> <p>OptiMal-IT test revealed similar results when compared to microscopy which is considered the gold standard for malaria diagnostics. The test was found to have a short processing time and was easier to use. These advantages may improve malaria case management by providing a diagnostic and drug efficacy follow-up tool to peripheral health centres with limited resources.</p

Ethical Data Release in Genome-Wide Association Studies in Developing Countries

Michael Parker and colleagues discuss the ethical issues associated with data release from genome-wide association studies in developing countries

SPODT: An R Package to Perform Spatial Partitioning

International audienceSpatial cluster detection is a classical question in epidemiology: Are cases located near other cases? In order to classify a study area into zones of different risks and determine their boundaries, we have developed a spatial partitioning method based on oblique decision trees, which is called spatial oblique decision tree (SpODT). This non-parametric method is based on the classification and regression tree (CART) approach introduced by Leo Breiman. Applied to epidemiological spatial data, the algorithm recursively searches among the coordinates for a threshold or a boundary between zones, so that the risks estimated in these zones are as different as possible. While the CART algorithm leads to rectangular zones, providing perpendicular splits of longitudes and latitudes, the SpODT algorithm provides oblique splitting of the study area, which is more appropriate and accurate for spatial epidemiology. Oblique decision trees can be considered as non-parametric regression models. Beyond the basic function, we have developed a set of functions that enable extended analyses of spatial data, providing: inference, graphical representations, spatio-temporal analysis, adjustments on covariates, spatial weighted partition, and the gathering of similar adjacent final classes. In this paper, we propose a new R package, SPODT, which provides an extensible set of functions for partitioning spatial and spatio-temporal data. The implementation and extensions of the algorithm are described. Function usage examples are proposed, looking for clustering malaria episodes in Bandiagara, Mali, and samples showing three different cluster shapes

Access and use of interventions to prevent and treat malaria among pregnant women in Kenya and Mali: a qualitative study.

BACKGROUND: Coverage of malaria in pregnancy interventions in sub-Saharan Africa is suboptimal. We undertook a systematic examination of the operational, socio-economic and cultural constraints to pregnant women's access to intermittent preventive treatment (IPTp), long-lasting insecticide-treated nets (LLINs) and case management in Kenya and Mali to provide empirical evidence for strategies to improve coverage. METHODS: Focus group discussions (FGDs) were held as part of a programme of research to explore the delivery, access and use of interventions to control malaria in pregnancy. FGDs were held with four sub-groups: non-pregnant women of child bearing age (aged 15-49 years), pregnant women or mothers of children aged <1 year, adolescent women, and men. Content analysis was used to develop themes and sub-themes from the data. RESULTS: Women and men's perceptions of the benefits of antenatal care were generally positive; motivation among women consisted of maintaining a healthy pregnancy, disease prevention in mother and foetus, checking the position of the baby in preparation for delivery, and ensuring admission to a facility in case of complications. Barriers to accessing care related to the quality of the health provider-client interaction, perceived health provider skills and malpractice, drug availability, and cost of services. Pregnant women perceived themselves and their babies at particular risk from malaria, and valued diagnosis and treatment from a health professional, but cost of treatment at health facilities drove women to use herbal remedies or drugs bought from shops. Women lacked information on the safety, efficacy and side effects of antimalarial use in pregnancy. CONCLUSION: Women in these settings appreciated the benefits of antenatal care and yet health services in both countries are losing women to follow-up due to factors that can be improved with greater political will. Antenatal services need to be patient-centred, free-of-charge or highly affordable and accountable to the women they serve