Efficacy and safety of praziquantel in preschool-aged children in an area co-endemic for Schistosoma mansoni and S. haematobium

BACKGROUND: In sub-Saharan Africa the recommended strategy to control schistosomiasis is preventive chemotherapy. Emphasis is placed on school-aged children, but in high endemicity areas, preschool-aged children are also at risk, and hence might need treatment with praziquantel. Since a pediatric formulation (e.g., syrup) is not available outside of Egypt, crushed praziquantel tablets are used, but the efficacy and safety of this treatment regimen is insufficiently studied.METHODOLOGY: We assessed the efficacy and safety of crushed praziquantel tablets among preschool-aged children (>6 years) in the Azaguié district, south Côte d'Ivoire, where Schistosoma mansoni and S. haematobium coexist. Using a cross-sectional design, children provided two stool and two urine samples before and 3 weeks after treatment. Crushed praziquantel tablets, mixed with water, were administered at a dose of 40 mg/kg. Adverse events were assessed and graded 4 and 24 hours posttreatment by interviewing mothers/guardians.PRINCIPAL FINDINGS: Overall, 160 preschool-aged children had at least one stool and one urine sample examined with duplicate Kato-Katz thick smears and a point-of-care circulating cathodic antigen (POC-CCA) cassette for S. mansoni, and urine filtration for S. haematobium diagnosis before and 3 weeks after praziquantel administration. According to the Kato-Katz and urine filtration results, we found high efficacy against S. mansoni (cure rate (CR), 88.6%; egg reduction rate (ERR), 96.7%) and S. haematobium (CR, 88.9%; ERR, 98.0%). POC-CCA revealed considerably lower efficacy against S. mansoni (CR, 53.8%). Treatment was generally well tolerated, but moderately severe adverse events (i.e., body and face inflammation), were observed in four Schistosoma egg-negative children. CONCLUSIONS/SIGNIFICANCE: Crushed praziquantel administered to preschool-aged children at a dose of 40 mg/kg is efficacious against S. mansoni and S. haematobium in a co-endemic setting of Côte d'Ivoire. Further research is required with highly sensitive diagnostic tools and safety must be investigated in more depth.TRIAL REGISTRATION: Controlled-Trials.com ISRCTN53172722

Strong gametocytocidal effect of methylene blue-based combination therapy against falciparum malaria

With the availability of new preventive and curative interventions, global malaria control has been strengthened significantly in recent years. Drugs effective in reducing malaria gametocytaemia might contribute to local elimination and possible long-term eradication. We here report on the effects of methylene blue (MB)-based malaria combination therapy on gametocytaemia during a randomised-controlled trial in Burkina Faso. An open-label randomised controlled phase II study in 180 children aged 6-10 years with uncomplicated falciparum malaria was conducted in Nouna, north-western Burkina Faso. Children were randomised to MB-artesunate (AS), MB-amodiaquine (AQ), and AS-AQ (local standard of care). Overall follow-up was for 28 days, follow-up for gametocytaemia was for 14 days. The treatment groups were similar in baseline characteristics and there was only one loss to follow-up. Compared to AS-AQ, both MB-containing regimens were associated with significantly reduced gametocyte carrier rates during follow-up days 3, 7, and 14. This effect was seen both in patients with and without P. falciparum gametocytaemia at baseline. MB reveals pronounced gametocytocidal activity which appears to act against both existing and developing P. falciparum gametocytes. MB-based combination therapy thus has the potential to reduce transmission of P. falciparum malaria in endemic regions, which has important implications for future elimination and eradication strategies

Etude contributive à la connaissance des populations de simulies dans la commune de Bouaflé, Centre-Ouest de la Côte d’Ivoire

Après l’arrêt des activités du programme de lutte contre l’onchocercose en Afrique de l’Ouest (OCP) en 2002, la Côte d’Ivoire n’a pu conduire régulièrement les activités de lutte du fait de la crise socio-politique qui a démarré en 2002. La recolonisation abondante des cours d’eau par les simulies et son corollaire la nuisance simulidienne le long de certains bassins versants, est due au fait que de vastes régions plus ou moins forestières n’ont jamais été traitées régulièrement par les insecticides contre les populations larvaires de simulies vectrices. L’objectif général du travail est de contribuer à la connaissance de la dynamique des populations de simulies et de la transmission de l’onchocercose en Côte d’Ivoire et particulièrement aux alentours du fleuve Marahoué dans la commune de Bouaflé. La technique de capture des simulies sur appât humain a été utilisée. Les résultats indiquent une forte nuisance simulidienne (117 piqûres / Homme / Jour) avec un pic l’après-midi. Les simulies capturées sont essentiellement (99,1%) des espèces savanicoles ; elles présentent une grande longévité (64.44%). Du point de vue transmission, aucune simulie femelle infectée ou infectieuse n’a été décelée pendant la durée de l’étude.Mots clés : Onchocercose, espèces savanicoles, dynamique de populations, nuisance simulidienne, transmission

Premiers Resultats Sur L'intensification Ecologique Et Demarche Participative En Zone Cotonniere A L'ouest Du Burkina Faso

L'intensification écologique (IE) constitue une voie intéressante pour accroitre durablement la production agricole en substituant à des facteurs de productions industriels, des processus biologiques. La littérature nous enseigne que les légumineuses jouent un rôle important dans l'amélioration des systèmes de culture. Toutefois, leur intégration semble insuffisamment assurée dans les systèmes de culture à base de coton et céréales, à l'Ouest du Burkina Faso. La présente étude vise à comparer les performances agronomiques et économiques des systèmes intégrant des légumineuses annuelles en culture pure et en culture associée, dans le cadre d'une démarche d'expérimentation chez et par les paysans (ECPP). Au cours d'une campagne agricole (2011), nous avons utilisé les indicateurs économiques (temps de travaux, productivité de la terre et du travail) et agronomiques (rendement, valorisation fourragère, valorisation de l'espace) pour établir cette comparaison. Les résultats obtenus indiquent que les agriculteurs préfèrent le système de culture à base de niébé (24 paysans) par rapport à celui à base de mucuna (13 paysans). Les résultats montrent que la teneur en azote de la biomasse de mucuna en culture pure est la plus élevée. Cette légumineuse est suivie par l'association maïs-légumineuse, qui n'a pas occasionné de travail supplémentaire, par contre l'association a permis d'économiser près de 30 % de l'espace, et de diversifier les produits agricoles. L'étude a permis en outre de conclure que les cultures associées présentent un réel intérêt pour les agriculteurs engagés dans l'intensification agricole. Elles offrent l'opportunité de produire plus de biomasse par unité de surface, avec une qualité meilleure qu'en système de culture conventionnel.Mots clés: Intensification écologique, système à base de coton et céréales, indicateurs économiques, économie d'espace, Burkina FasoThe ecological intensification (EI) represents an interesting way to increase durably the agricultural production by replacing the industrial factors of production by biological processes. Literature teaches us that the legumes play a significant role in the improvement of cropping systems. However, their insertion is inadequate in cropping systems based on cotton and cereals in Western Burkina Faso. This study aims to compare the agronomic and economic performances of cropping systems integrating annual legumes in pure culture or mixed cropping in a process of experimentation to the and by farmers (ETBF). During a crop year (2011), we used economic indicators (work time, productivity of land and labor) and agronomic data (yield, forage enhancement, development of space) for this comparison. The results indicate that farmers preferred the cropping system based on cowpea (24 farmers) compared to that based on mucuna (13 farmers). Observations show that content of biomass in nitrogen of mucuna in pure culture is highest. Mucuna is followed by corn/legumes associations which do not cause additional work but can save nearly 30 % of the space, and diversify agricultural products. This study makes it possible to conclude that the associated cultures have a real interest for the farmers engaged in the intensification of their exploitation. They offer the opportunity to produce more biomass per unit of area, with a better quality than in conventional cropping system

Effets de la culture permanente coton-maïs sur l’évolution d’indicateurs de fertilité des sols de l’Ouest du Burkina Faso

Face à la problématique de baisse de fertilité des sols et de rendements agricoles, des innovations agropastorales sont conçues et expérimentées par les producteurs dans le cadre du projet Fertipartenaires (FOOD/2007 /144-075) dans 7 villages de la province du Tuy (Burkina Faso). Le présent travail avait pour objectifs (i) de faire un diagnostic organo-minéral des sols, et (ii) de déterminer les impacts de la baisse de fertilité du sol sur les performances du maïs et des légumineuses. Les analyses chimiques (carbone, phosphore, pH) ont été réalisées sur les sols cultivés de soixante et trois (63) parcelles des producteurs et sur les sols non cultivés de sept (7) zones de référence. Les rendements du maïs ont été déterminés sur trente et quatre (34) parcelles et ceux des légumineuses sur vingt et neuf (29) parcelles. Les résultats indiquent que l’exploitation continue des terres (l’âge moyen de mise en culture des terres par village se situant entre 11 et 31 années) entraîne une baisse du pH, des teneurs en carbone et une augmentation en phosphore assimilable. Cette baisse de fertilité organique des sols entraîne une baisse de la production du niébé et du mucuna, mais celle de la production du maïs est moins claire. Ce diagnostic suggère que les innovations intègrent le rehaussement du taux de la matière organique.Mots clés: Zone cotonnière, exploitation continue, diagnostic organo-minéral, fertilité, maïs, légumineuse

Valorisation de substrats organiques divers dans l'agriculture péri-urbaine de Ouagadougou (Burkina Faso) pour l'amendement et la fertilisation des sols : acteurs et pratiques

Organic substrates recycling in the sub-urban agriculture of Ouagadougou (Burkina Faso) for soils fertilization: description of the different actors and their practices. This study aimed to establish an overview of the main actors of the sub-urban agriculture of Ouagadougou, their practices and expectations, and to characterize the used organic substrates (OS). For that, a farm survey was carried out on the most representative sites with 64 persons (cereal farmers, truckers and nurserymen) randomly chosen. OS were sampled with each actor, when available. Thus, 27 samples were taken and characterized through chemical analyses and laboratory incubations to follow organic carbon mineralization. The results highlighted that 35% of cereal farmers, 69% of truckers and 95% of nurserymen were 20 to 40 years old, that a large proportion of cereal farmers and truckers were not sent to school while 70% of nurserymen had at least primary education. Sub-urban agriculture was the only activity for 43% of farmers, 83% of truckers and 91% of nurserymen. Moreover, 71% of cereal farmers and 73% of nurserymen used municipal wastes as source of organic matter against only 17% of truckers, the majority of them using animal manures. The main criterion of choice of OS was their availability without any other consideration. Even if a large majority of the actors think that composts of OS were better than brut OS, a minority of them used currently composts. The best ways for an adoption and utilization of OS composts were to facilitate their accessibility and to promote these composts, composting techniques and their interests through advertising in mass media. Chemical analyses and laboratory incubations showed a great variability of the SUW, both in the same group and actors' groups. However, in case of total organic carbon, total nitrogen and total phosphorous contents, the following tendencies were observed: Contenttruckers > Contentfarmers > Contentnurserymen. For the sum of major elements Ca, K, Mg, Na (SME), it was observed that SMEtruckers ≈ SMEfarmers > SMEnurserymen. In addition, except a few atypical substrates, OS used by nurserymen were largely stabilized compared to those of cereal farmers and truckers

Safety and efficacy of methylene blue combined with artesunate or amodiaquine for uncomplicated falciparum malaria

Besides existing artemisinin-based combination therapies, alternative safe, effective and affordable drug combinations against falciparum malaria are needed. Methylene blue (MB) was the first synthetic antimalarial drug ever used, and recent studies have been promising with regard to its revival in malaria therapy. The objective of this study was to assess the safety and efficacy of two MB-based malaria combination therapies, MB-artesunate (AS) and MB-amodiaquine (AQ), compared to the local standard of care, AS-AQ, in Burkina Faso. Open-label randomised controlled phase II study in 180 children aged 6-10 years with uncomplicated falciparum malaria in Nouna, north-western Burkina Faso. Follow-up was for 28 days and analysis by intention-to-treat. The treatment groups were similar in baseline characteristics and there was only one loss to follow-up. No drug-related serious adverse events and no deaths occurred. MB-containing regimens were associated with mild vomiting and dysuria. No early treatment failures were observed. Parasite clearance time differed significantly among groups and was the shortest with MB-AS. By day 14, the rates of adequate clinical and parasitological response after PCR-based correction for recrudescence were 87% for MB-AS, 100% for MB-AQ (p = 0.004), and 100% for AS-AQ (p = 0.003). By day 28, the respective figure was lowest for MB-AS (62%), intermediate for the standard treatment AS-AQ (82%; p = 0.015), and highest for MB-AQ (95%; p<0.001; p = 0.03). MB-AQ is a promising alternative drug combination against malaria in Africa. Moreover, MB has the potential to further accelerate the rapid parasite clearance of artemisinin-based combination therapies. More than a century after the antimalarial properties of MB had been described, its role in malaria control deserves closer attention. ClinicalTrials.gov NCT00354380

Profils Sociodemographique, Economique Et Alimentaire Chez Des Enfants Malnutris Aigus, Ages De 06 A 59 Mois, Reçus Au Centre Hospitalier Universitaire De Treichville (Abidjan-Cote D’ivoire)

In this descriptive and transversal work, the main objective is to establish the socio-demographic, economic and nutritional profiles of the children, aged between 06 and 59 months, acutely malnourished, consulted and / or hospitalized in pediatric emergency departments and Of the University Hospital of Treichville (UHT). This study is conducted on 290 children, aged between 06 and 59 months. A questioning anthropometric, socio-demographic, economic and food data allows the diagnosis of the nutritional status of each child and the descriptive statistical analysis of the patient. The results show that the prevalence of acute malnutrition is 55.86%, with 35.17 % cases of severe acute malnutrition and 20.68 % of cases of moderate acute malnutrition. The population of acute malnourished children in this study consisted of 84 girls and 78 boys, a sex ratio of 0.928. The children (133) victims of this type of malnutrition come, predominantly and significantly, from the precarious habitats. 126 have out-of-school mothers and 129 have consumed food of diversification or poor quality supplement. In 110 acute malnutrition, the daily family food budget is between 1500 FCFA and 3000 FCFA. At last, the index of food consumption score, also called food consumption, is referred to as a limit in 98. Finally, in this study, the risk factors having a significant impact on nutritional status are the precariousness of the habitat Place of residence), maternal education, complement food quality or diversification, food insecurity, age of complement and current diet

Cryptococcose neuroméningée et tuberculose osseuse chez un immunocompétent: un cas

Les auteurs rapportent un cas de cryptococcose neuroméningée (CNM) chez un patient de 39 ans, non infecté par le VIH suivi pour une tuberculose de hanche. Le tableau clinique était celui d'une méningite subaiguë. Le  diagnostic a été possible grâce à la mise en évidence de cryptocoques dans le LCR. L'évolution a été satisfaisante sous fluconazole