56 research outputs found

    Distribution Ă©pidĂ©miologique de l’infection Ă  VIH chez les femmes enceintes dans les dix rĂ©gions du Cameroun et implications stratĂ©giques pour les programmes de prĂ©vention

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    Introduction: le Cameroun se situe dans un contexte d'Ă©pidĂ©mie  gĂ©nĂ©ralisĂ©e du VIH. La sous-population des femmes enceintes, facilementaccessible au sein de la population gĂ©nĂ©rale, reprĂ©sente une cible  robante pour mener la surveillance du VIH et estimer l'Ă©volution Ă©pidĂ©miologique. L'objectif de notre Ă©tude Ă©tait d'Ă©valuer la distribution Ă©pidĂ©miologique du VIH chez les femmes enceintes.MĂ©thodes: Ă©tude transversale menĂ©e en 2012 chez 6521 femmes  enceintes (49,3% ĂągĂ©es de 15-24 ans) en premiĂšre consultation prĂ©natale (CPN1) dans 60 sites des 10 rĂ©gions Camerounaises. L'algorithme en sĂ©rie a Ă©tĂ© utilisĂ© pour le sĂ©rodiagnostic du VIH.RĂ©sultats: la prĂ©valence du VIH Ă©tait de 7,8% (508/6521), avec une  diffĂ©rence non significative (p=0,297) entre milieu rural (7,4%) et milieu urbain (8,1%). En zone rurale, cette prĂ©valence variait de 0,7% à  l'ExtrĂȘme-Nord Ă  11,8% au Sud. Cependant, en zone urbaine elle variait de 4% Ă  l'Ouest Ă  11,1% au Sud-Ouest. Suivant l'Ăąge, la prĂ©valence Ă©tait plus Ă©levĂ©e (11,3%) chez les femmes de 35-39 ans. Suivant le niveau de scolarisation, la prĂ©valence du VIH Ă©tait plus faible (4,4%) chez celles non-scolarisĂ©es, et plus Ă©levĂ©e (9,3%) chez celles ayant un niveau  primaire. Selon la profession, l'infection Ă©tait plus Ă©levĂ©e chez les  coiffeuses (15,5%), secrĂ©taires (14,8%), commerçantes (12,9%) et  institutrices/enseignantes (10,8%). Conclusion: la prĂ©valence du VIH reste Ă©levĂ©e chez les femmes enceintes au Cameroun, sans distinction entre milieux rural et urbain. Les stratĂ©gies de prĂ©vention devraient s'orienter prĂ©fĂ©rentiellement chez les femmes enceintes ĂągĂ©es, celles du niveau d'instruction primaire, et celles du  secteur des petites et moyennes entreprises

    "Slash and Clear", a Community-Based Vector Control Method to Reduce Onchocerciasis Transmission by Simulium sirbanum in Maridi, South Sudan: A Prospective Study

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    Background: High ongoing Onchocerca volvulus transmission was recently documented in Maridi County, South Sudan. To complement community-directed treatment with ivermectin (CDTI) as the main onchocerciasis control strategy, we initiated a community-based vector control method “slash and clear” at the Maridi dam, a Simulium damnosum s.l. breeding site, to reduce O. volvulus transmission. Methods: Simulium damnosum s.l. biting rates were collected before and during the twenty months following the “slash and clear” intervention using the human landing catches. Black flies were dissected to measure parity rates before and twelve months after the intervention. Larvae and pupae of S. damnosum s.l. were collected from the dam for morphological and chromosomal characterization to identify the cytospecies involved. Results: Biting rates of S. damnosum s.l. close to the Maridi dam spillway decreased by >90% post-“slash and clear” for more than six months. Twelve months after the “slash and clear” intervention, the reduction in biting rates was still at <50% (p = 0.0007). Parity rates reduced from 13% pre-“slash and clear” (November 2019) to 5.6% post-“slash and clear” (November 2020). Larvae collected from the dam were identified as Simulium sirbanum. Conclusion: The “slash and clear” method was found to be an effective and cheap community-based method to reduce black fly biting rates caused by S. sirbanum. When repeated at least annually together with a high CDTI coverage, this intervention has the potential to considerably accelerate onchocerciasis elimination

    Elimination of onchocerciasis in Africa by 2025: an ambitious target requires ambitious interventions

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    To achieve the elimination of onchocerciasis transmission in all African countries will entail enormous challenges, as has been highlighted by the active discussion around onchocerciasis intervention strategies and evaluation procedures in this journal.Serological thresholds for onchocerciasis elimination, adapted for the African setting, need to be established. The Onchocerciasis Technical Advisory Subgroup of the World Health Organization is currently developing improved guidelines to allow country elimination commi

    Epilepsy-related stigma and cost in two onchocerciasis-endemic areas in South Sudan: a pilot descriptive study

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    INTRODUCTION:Epilepsy is a major public health concern in sub-Saharan Africa, particularly in resource-limited rural villages where persons with epilepsy (PWE) are often confronted with a wide treatment gap, frequent stigma and high cost of epilepsy care. We investigated stigma and economic cost related to epilepsy in the states of Maridi and Amadi in South Sudan, two onchocerciasis endemic areas with high epilepsy prevalence. METHODS:Between November 2019 and February 2020, community-based surveys were conducted in eight villages of Maridi and Amadi States. Consenting PWE were identified via a door-to-door approach, and perceived stigma was assessed using the validated Kilifi stigma scale. Additional data about household income, as well as epilepsy-related direct and indirect costs were collected. RESULTS:239 PWE were recruited (95 from Maridi, 144 from Amadi). Stigma scores were higher in Maridi compared to Amadi (mean scores: 13.9 vs 6.5, p&#x2009;&lt;&#x2009;0.001). Mean weighted epilepsy costs per month in Maridi (38.4 USD) were double those observed in Amadi (17.6 USD). The main epilepsy-related expenditure was the purchase of anti-epileptic drugs (AED). Stigma scores correlated with epilepsy cost (Spearman-rho&#x2009;=&#x2009;0.24, p&#x2009;&lt;&#x2009;0.001) and were positively associated with traditional medicine use (regression estimate&#x2009;=&#x2009;1.9; p&#x2009;=&#x2009;0.027). CONCLUSION:In rural South Sudan, PWE and their families often experienced stigma from the community. Higher perceived stigma was associated with traditional medicine use, which increased the overall cost of epilepsy management. Demystifying epilepsy and making AED more accessible would improve the quality of life of PWE and their families, and reduce the economic burden of epilepsy

    From river blindness to river epilepsy: Implications for onchocerciasis elimination programmes

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    Current onchocerciasis elimination programmes do not include identification and management of onchocerciasis-associated epilepsy (OAE) in their strategies. Creating awareness about OAE will increase community-directed treatment with ivermectin (CDTI) adherence, particularly in areas of high prevalence, while motivating funders and stakeholders not to relent their efforts in the fight against onchocerciasis. Strengthening onchocerciasis elimination efforts should be prioritised wherever epilepsy prevalence is high in order to reduce OAE-related morbidity and mortality. In such areas, alternative treatment strategies including biannual CDTI, ground larviciding of blackfly breeding sites, and/or treatment with moxidectin should be considered. Addressing the OAE disease burden in these generally remote onchocerciasis-endemic regions confronted with poverty, weak healthcare infrastructures, and insecurity goes beyond current onchocerciasis elimination plans. New strategies with appropriate budgets are required. A morbidity management and disease prevention (MMDP) strategy, fully integrated into the health system, must be developed by multidisciplinary working groups involving neglected tropical disease (NTD) and epilepsy specialists, advocacy experts, and persons from affected communities. ‘River epilepsy’ needs to be urgently recognised and placed in the international development and NTD agendas
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