Definition and characterization of localised meningitis epidemics in Burkina Faso: a longitudinal retrospective study

<p>Abstract</p> <p>Background</p> <p>The epidemiology of meningococcal meningitis in the African meningitis belt is characterised by seasonality, localised epidemics and epidemic waves. To facilitate research and surveillance, we aimed to develop a definition for localised epidemics to be used in real-time surveillance based on weekly case reports at the health centre level.</p> <p>Methods</p> <p>We used national routine surveillance data on suspected meningitis from January 2004 to December 2008 in six health districts in western and central Burkina Faso. We evaluated eight thresholds composed of weekly incidence rates at health centre level for their performance in predicting annual incidences of 0.4%and 0.8% in health centre areas. The eventually chosen definition was used to describe the spatiotemporal epidemiology and size of localised meningitis epidemics during the included district years.</p> <p>Results</p> <p>Among eight weekly thresholds evaluated, a weekly incidence rate of 75 cases per 100,000 inhabitants during at least two consecutive weeks with at least 5 cases per week had 100% sensitivity and 98% specificity for predicting an annual incidence of at least 0.8% in health centres. Using this definition, localised epidemics were identified in all but one years during 2004-2008, concerned less than 10% of the districts' population and often were geographically dispersed. Where sufficient laboratory data were available, localised epidemics were exclusively due to meningococci.</p> <p>Conclusions</p> <p>This definition of localised epidemics a the health centre level will be useful for risk factor and modelling studies to understand the meningitis belt phenomenon and help documenting vaccine impact against epidemic meningitis where no widespread laboratory surveillance exists for quantifying disease reduction after vaccination.</p

Healthcare access in Benin: poverty and community aid networks

info:eu-repo/semantics/publishe

Statistical methodology for modelling the relation between effectiveness of anti-bullying interventions and time

info:eu-repo/semantics/publishedCommunication oral

Increased osteoclast-like cells formation in long-term bone marrow cultures from patients with a spinal cord injury

Patients with a spinal cord section loose a significant amount of bone. After paraplegia, bone loss occurs below the lesional level and is the more dramatic in iliac bones and in the metaphyseal area of long bones. A peak of urinary calcium and hydroxyprolinuria is observed approximately 6 weeks after their lesion. To further understand the mechanisms underlying the bone damage, we used long-term bone marrow cultures to compare osteoclast-like (OCL-like) cell formation above and below the lesional level. Seven paraplegic, one quadriparetic, one quadriplegic patients and five normal subjects were investigated. Six weeks after their spinal cord section, the number of OCL-like cells formed in iliac bone marrow cultures was significantly greater than those formed in sternal bone marrow cultures for all paraplegic patients tested. No significant differences were seen between iliac and sternal bone marrow cultures for the quadriparetic, the quadriplegic patient, or for the five normal subjects. Conditioned media (CM) from iliac marrow of paraplegic patients increased OCL-like cell formation in normal bone marrow cultures. IL-1, TNF-alpha, IL-6, and PGE2 were measured in the CM after 3 weeks of culture. IL-6 was found to be significantly higher in iliac CM compared with sternal CM in six out of seven paraplegic patients. In two patients, addition of an anti-IL-6 monoclonal antibody to the marrow cultures significantly decreased the number of OCL-like cells formed at 3 weeks. We conclude that paraplegia caused by a cord section locally induces an increase in the capacity of progenitors to form OCL-like cells in long-term bone marrow cultures. A locally increased IL-6 production in the marrow below the lesional level could be partly responsible for this observation.Journal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

How to improve women’s and partner’s participation to prenatal HIV counseling in rural and urban areas in Kivu, democratic republic of Congo ?

info:eu-repo/semantics/nonPublishe

Definition and characterization of localized meningitis epidemics in Burkina Faso: a longitudinal retrospective study.

info:eu-repo/semantics/publishe

Effet Du Traitement Pr�Ventif Intermittent (Tpi) De La Femme Enceinte à La Sulfadoxine-Pyrim�Thamine (Sp) Sur Le Poids De Naissance Des Enfants Dans Un Milieu à R�Sistance éLev�E Du Plasmodium Falciparum à La Sp à L’Est De La R�Publique D�Mocratique Du Congo (Rdc)

Objective: to assess the effect of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) on birth weight in a region of DRC with a high level of drug resistance. Methods: data collected in 1998-99 and 2007 (after increase of SP resistance) from infants and mothers under IPTp-SP and those collected in 1998-99 from infants and mothers receiving chloroquine were retrospectively analyzed by multiple and logistic regression models including the different groups of treatment and potential confounding factors. Results: the mean weight of infants born from mother under IPTp-SP was higher than that in infants whose mothers had received chloroquine as well in 1998-99 as in 2007. Adjusted mean birth weight differences were respectively +70.2g (SE=21.2; P=0.003) and +53.9 g (SE=26.1; P=0.027). Lower risk of low birth weight were also observed in the IPTp-SP groups [adjusted OR: 0.75 (IC95%:0.55 - 1.02) and 0.58 (0.38 – 0.88)] in 1998-99 and at 2007 respectively. Conclusion: considering that no alternatives are currently available, even when the level of SP resistance is as high as 60% as observed in Rutshuru, its use for the IPT in pregnant woman remains effective when compared to the prophylaxis with chloroquine used in the same region at the end of nineties.Objectif : Evaluer l’effet du TPI à la SP sur le poids de naissance des nouveau-nés dans une région de la RDC avec une proportion élevée d’échecs thérapeutiques à la SP. Méthodes : une analyse rétrospective comparant le poids de naissance d’enfants nés de mères sous TPI à la SP en 2007 (après mise en évidence d’une résistance importante à la SP) et ceux sous le même traitement en 1998 et 1999 à celui des enfants nés de mères sous prophylaxie à la chloroquine en 1998 et 1999 a été réalisée à l’aide de modèles de régression multiple et logistique incluant les différents groupes de traitement ainsi que les confondants potentiels. Résultats : Le poids moyen des enfants de mères sous SP (en 1998 – 1999 et en 2007) était supérieur à celui des enfants des mères sous chloroquine et après régression multiple, on observe un gain pondéral moyen respectivement de 70,2g (ES=21,2 ; P=0,003) et 53,9 g (ES=26,1 ; P=0,027) en 1998 – 1999 et 2007 par rapport aux enfants des mères sous chloroquine. Après ajustement, on observe une réduction du risque de PPN dans les groupes sous SP, en 2007 0,58 (0,38 - 0,88) et en 1998 – 1999 0,75 (0.55 - 1.02) par rapport au groupe sous chloroquine. Conclusion : En l’absence d’une alternative fiable, même dans les régions à résistance élevée à la SP comme RUTSHURU (Echec thérapeutique à 60,6%), son utilisation pour le TPI de la femme enceinte reste efficace si on le compare à la prophylaxie par la chloroquine dans cette région à la fin des années 90