Hospitalizations in neonatal intensive care unit at Mahajanga: impacts on parents

Background: Experiencing a birth with a pathology imposes on parents a lot of frustration. Objectives of this study were to describe the general profiles of newborns and to describe the hospitalization’s psychosomatic impact on parents; in intensive care unit of the neonatalogy ward at the mother-child complex at the university Hospital Androva Mahajanga Madagascar.Methods: It was prospective descriptive study, by a survey of parents, among 3 months, from 01st May to 31th July.Results: Were included 102 newborns. Mains reasons of admission are low birth weigth (51.9%), prematurity (42.1%) and perinatal asphyxia (23.5%). One hundred mothers and 90 fathers had answered our survey. Sleep distturance (all parents), negative feelings (70% of fathers and 75% of mothers), depressed mood (52.2% of fathers and 78% of mothers) and guilt (25.5% of fathers and 58% of mothers) were the most prominent psycological manifestations among parents; then somatic manifestations as digestive, cardiovascular type; weight loss was objectified on 33% of fathers.Conclusions: Newborns’s hospitalization is a difficult situation for parents. Caregivers have an important role in enabling the family to build up

A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar

Background: Madagascar needs major efforts to achieve the UN Sustainable Development Goals, despite the considerable reduction of child mortality during past years. In this context, implementation of emergency triage assessment and treatment (ETAT) plays an important role. In recent years, ETAT training activities rarely took place in Madagascar. To strengthen ETAT in Madagascar, a pilot training course was conducted in December 2019 at the University Hospital Mahajanga. Objective: This study aims to evaluate if the ETAT+ pilot training content matches clinical needs in Madagascar and whether participants achieved their learning objectives. Methods: In this cross-sectional mixed-methods study, a 41-item questionnaire was used at the end of the ETAT+ training to evaluate their learning experience from the 12 participants (paediatricians, physicians, nurses and midwives). Six weeks after the training, guided interviews were conducted among five participants to describe how training content could be transferred into clinical practice in five health facilities. Results: Results suggest that this pilot project designed to contribute to the re-establishment of ETAT in Madagascar meets participants’ needs and is adapted to clinical realities in terms of transmitted knowledge, skills and competencies. However, results also show that considerable multidisciplinary efforts are needed to advance ETAT+ implementation in Madagascar. Conclusions: Implementation processes of ETAT training programmes need re-evaluation to assure their validity to contribute to quality of care improvements efficiently. Further operational research is required to evaluate sustainable, innovative implementation strategies adapted to contexts in Madagascar

Aberrant Receptor-Mediated Endocytosis of Schistosoma mansoni Glycoproteins on Host Lipoproteins

BACKGROUND: Bilharzia is one of the major parasitic infections affecting the public health and socioeconomic circumstances in (sub) tropical areas. Its causative agents are schistosomes. Since these worms remain in their host for decades, they have developed mechanisms to evade or resist the immune system. Like several other parasites, their surface membranes are coated with a protective layer of glycoproteins that are anchored by a lipid modification. METHODS AND FINDINGS: We studied the release of glycosyl-phosphatidylinositol (GPI)-anchored proteins of S. mansoni and found them in the circulation associated with host lipoprotein particles. Host cells endocytosed schistosomal GPI-anchored proteins via their lipoprotein receptor pathway, resulting in disturbed lysosome morphology. In patients suffering from chronic schistosomiasis, antibodies attacked the parasite GPI-anchored glycoproteins that were associated with the patients' own lipoprotein particles. These immunocomplexes were endocytosed by cells carrying an immunoglobulin-Fc receptor, leading to clearance of lipoproteins by the immune system. As a consequence, neutral lipids accumulated in neutrophils of infected hamsters and in human neutrophils incubated with patient serum, and this accumulation was associated with apoptosis and reduced neutrophil viability. Also, Trypanosoma brucei, the parasite that causes sleeping sickness, released its major GPI-anchored glycoprotein VSG221 on lipoprotein particles, demonstrating that this process is generalizable to other pathogens/parasites. CONCLUSIONS: Transfer of parasite antigens to host cells via host lipoproteins disrupts lipid homeostasis in immune cells, promotes neutrophil apoptosis, may result in aberrant antigen presentation in host cells, and thus cause an inefficient immune response against the pathogen