Histoire du foyer de la trypanosomose humaine africaine de nola en republique centrafricaine, de 1971 à 2004

La trypanosomiase humaine africaine (THA) ou maladie du sommeil, affection redoutable qui fit jadis beaucoup de ravages au sein des populations dans différentes régions d’Afrique dont celle de Nola enRépublique Centrafricaine (RCA), reste un problème de santé publique en Afrique sub-saharienne. La cinquante sixième assemblée mondiale de la santé, tenue le 26/03/2003, reconnaissait que les douleurs,les souffrances et la mortalité dues à la trypanosomiase menacent quotidiennement plus de 60 millions d’habitants dans plus de 37 pays d’Afrique sub-saharienne dont 22 comptent parmi les moins avancés.Nous rapportons ici, l’histoire du foyer de THA de Nola en RCA, de 1971 à 2004. Sur le plan méthodologique, il s’agit d’une étude rétrospective couvrant la période de 1971 à 2004. Sur des fichesd’enquête établies, nous avons collecté des données à Nola à partir des registres des trypanosomés et à Bangui la capitale, à partir des rapports des missions de prospection de dépistage actif. L’analyse desdonnées a été faite à l’aide du logiciel EPI INFO 6 version 2000. De 1971 à 2004, 3348 patients ont été recensés parmi lesquels 1814 anciens malades et 1534 nouveaux cas. Les femmes étaient plus atteintes (54%) que les hommes avec un sex-ratio de 1,2. La tranche d’âge la plus touchée est celle de 20 à 29 ans (67,0%). L’indice de morbidité nouvelle (IMN) est passé de 0,01% en 1971 à 1,7% en 1991 et à 0,05% en 2004. L’indice de contamination totale (ICT) est passé de 0,05% en 1971 à 2,3% en 1989 et à 0,05% en 2004. Les cas de rechutes et de réinfections représentaient 54,2% entre 1992 et 2004. La majorité des malades dépistés étaient en 2ème phase (64%). La lutte anti-vectorielle avec pose de pièges coniques imprégnés d’insecticides a été primordiale dans la maîtrise de l’épidémie dans cette région

The African Vaccine-Preventable Diseases Network: a vaccine advocacy initiative

Achieving high and equitable childhood immunisation coverage in Africa will not only protect children from disability and premature death, it will also boost productivity, reduce poverty and support the economic growth of the continent. Thus, Africa needs innovative and sustainable vaccine advocacy initiatives. One such initiative is the African Vaccine-Preventable Diseases Network, formed in 2009. This association of immunisation practitioners, vaccinologists, paediatricians, and infectious disease experts provides a platform to advocate for the introduction of newly available vaccines (e.g. 10-valent and 13-valent pneumococcal conjugate and rotavirus vaccines) into the Expanded Programme on Immunisation (EPI) as well as increased and equitable coverage for established EPI vaccines.Key words: Vaccine preventable diseases, vaccine, network, Africa, awareness, child healt

Episodic Therapy for Genital Herpes in Sub-Saharan Africa: A Pooled Analysis from Three Randomized Controlled Trials

BACKGROUND: A randomized controlled trial in South Africa found a beneficial effect of acyclovir on genital ulcer healing, but no effect was seen in trials in Ghana, Central African Republic and Malawi. The aim of this paper is to assess whether the variation in impact of acyclovir on ulcer healing in these trials can be explained by differences in the characteristics of the study populations. METHODOLOGY/PRINCIPAL FINDINGS: Pooled data were analysed to estimate the impact of acyclovir on the proportion of ulcers healed seven days after randomisation by HIV/CD4 status, ulcer aetiology, size and duration before presentation; and impact on lesional HIV-1. Risk ratios (RR) were estimated using Poisson regression with robust standard errors. Of 1478 patients with genital ulcer, most (63%) had herpetic ulcers (16% first episode HSV-2 ulcers), and a further 3% chancroid, 2% syphilis, 0.7% lymphogranuloma venereum and 31% undetermined aetiology. Over half (58%) of patients were HIV-1 seropositive. The median duration of symptoms before presentation was 6 days. Patients on acyclovir were more likely to have a healed ulcer on day 7 (63% vs 57%, RR = 1.08, 95% CI 0.98-1.18), shorter time to healing (p = 0.04) and less lesional HIV-1 RNA (p = 0.03). Small ulcers (<50 mm(2)), HSV-2 ulcers, first episode HSV-2 ulcers, and ulcers in HIV-1 seropositive individuals responded best but the better effectiveness in South Africa was not explained by differences in these factors. CONCLUSIONS/SIGNIFICANCE: There may be slight benefit in adding acyclovir to syndromic management in settings where most ulcers are genital herpes. The stronger effect among HIV-1 infected individuals suggests that acyclovir may be beneficial for GUD/HIV-1 co-infected patients. The high prevalence in this population highlights that genital ulceration in patients with unknown HIV status provides a potential entry point for provider-initiated HIV testing

Intravaginal and Menstrual Practices among Women Working in Food and Recreational Facilities in Mwanza, Tanzania: Implications for Microbicide Trials

Intravaginal and menstrual practices may potentially influence results of trials of microbicides for HIV prevention through effects on the vaginal environment and on adherence to microbicide and placebo products. As part of the feasibility study for the Microbicides Development Programme Phase 3 trial of a vaginal microbicide in Mwanza, a variety of quantitative and qualitative methods were used to describe these practices, associations with behaviour and underlying social norms among women working in food and recreational facilities. Intravaginal cleansing by inserting fingers and either water alone or soap and water was thought necessary to remove “uchafu” (dirt), referring to vaginal secretions, including menstrual blood and post-coital discharge. Vaginal cleansing was carried out within 2 hours after 45% of sex acts. Sexual enhancement practices were less common. Intravaginal and menstrual practices and associated behaviours and demographic factors should be measured and monitored throughout microbicide trials to enable analyses of their impacts on microbicide effectiveness

Caractéristiques socio-démographiques et pratiques sexuelles à risques chez les hommes qui ont des relations sexuelles avec des hommes à Bangui, République Centreafricaine

info:eu-repo/semantics/publishe

Aetiology of urethral discharge in Bangui, Central African Republic

Objectives: To determine the aetiology of urethritis in Bangui, Central African Republic. Methods: 410 men presenting with urethral discharge and 100 asymptomatic controls were enrolled. Urethral swabs were obtained and processed by gonococcal culture and polymerase chain reaction for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, and Ureaplasma urealyticum. Results: In multivariate analyses, M genitalium and C trachomatis were significantly associated with urethral discharge when comparing cases of non-gonococcal urethritis (NGU) with controls. T vaginalis was also more common in cases than in controls, but this reached statistical significance only among cases in whom N gonorrhoeae was also detected. U urealyticum was not associated with urethritis. The gonococcus was found in 69% of cases of urethral discharge. M genitalium was the predominant pathogen in patients with NGU, being found in 42% (53/127) of such patients while C trachomatis was found in only 17% (22/127). T vaginalis was found in 18% (23/127) of patients with NGU, but also in 15% (43/283) of patients with gonococcal urethritis, and two thirds of patients with T vaginalis also had the gonococcus. Multiple infections were common. M genitalium caused a syndrome similar to chlamydial urethritis, with a less severe inflammation than in gonococcal infection. No behavioural or clinical characteristic could discriminate between the various aetiological agents. Conclusions: M genitalium is more prevalent than C trachomatis and is the most common cause of NGU in Bangui. It causes a syndrome similar to chlamydial urethritis. T vaginalis is weakly associated with urethritis, and is often found along with other pathogens. Key Words: urethritis; Central African Republic; Mycoplasma genitaliu

Early archives of genetically-restricted proviral DNA in the female genital tract after heterosexual transmission of HIV-1

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