Impact of combining intermittent preventive treatment with home management of malaria in children less than 10 years in a rural area of Senegal: a cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>Current malaria control strategies recommend (i) early case detection using rapid diagnostic tests (RDT) and treatment with artemisinin combination therapy (ACT), (ii) pre-referral rectal artesunate, (iii) intermittent preventive treatment and (iv) impregnated bed nets. However, these individual malaria control interventions provide only partial protection in most epidemiological situations. Therefore, there is a need to investigate the potential benefits of integrating several malaria interventions to reduce malaria prevalence and morbidity.</p> <p>Methods</p> <p>A randomized controlled trial was carried out to assess the impact of combining seasonal intermittent preventive treatment in children (IPTc) with home-based management of malaria (HMM) by community health workers (CHWs) in Senegal. Eight CHWs in eight villages covered by the Bonconto health post, (South Eastern part of Senegal) were trained to diagnose malaria using RDT, provide prompt treatment with artemether-lumefantrine for uncomplicated malaria cases and pre-referral rectal artesunate for complicated malaria occurring in children under 10 years. Four CHWs were randomized to also administer monthly IPTc as single dose of sulphadoxine-pyrimethamine (SP) plus three doses of amodiaquine (AQ) in the malaria transmission season, October and November 2010. Primary end point was incidence of single episode of malaria attacks over 8 weeks of follow up. Secondary end points included prevalence of malaria parasitaemia, and prevalence of anaemia at the end of the transmission season. Primary analysis was by intention to treat. The study protocol was approved by the Senegalese National Ethical Committee (approval 0027/MSP/DS/CNRS, 18/03/2010).</p> <p>Results</p> <p>A total of 1,000 children were enrolled. The incidence of malaria episodes was 7.1/100 child months at risk [95% CI (3.7-13.7)] in communities with IPTc + HMM compared to 35.6/100 child months at risk [95% CI (26.7-47.4)] in communities with only HMM (aOR = 0.20; 95% CI 0.09-0.41; <it>p </it>= 0.04). At the end of the transmission season, malaria parasitaemia prevalence was lower in communities with IPTc + HMM (2.05% versus 4.6% <it>p </it>= 0.03). Adjusted for age groups, sex, <it>Plasmodium falciparum </it>carriage and prevalence of malnutrition, IPTc + HMM showed a significant protective effect against anaemia (aOR = 0.59; 95% CI 0.42-0.82; <it>p </it>= 0.02).</p> <p>Conclusion</p> <p>Combining IPTc and HMM can provide significant additional benefit in preventing clinical episodes of malaria as well as anaemia among children in Senegal.</p

Strengthening psychosocial support and emergency response in Senegal : lessons from a tragic traffic accident: Strengthening Psychosocial Support and Emergency Response in Senegal: Lessons from a Tragic Traffic Accident

International audienceOn January 8, 2023, Senegal experienced a tragic traffic accident that claimed the lives of 42 people and left approximately 100 injured. During such events, the victims, their families, the first responders to arrive on the scene and the frontline personnel must benefit from medical and psychological care. Promptly, the Emergency Health Operations Center (EOC) acted, activating the Kaolack mobile psycho-social intervention and Support Team in addition to deploying mental health professionals in Kaffrine. On-site in Kaffrine, a medical-psychological emergency cell was established. This cell efficiently organized immediate and post-immediate care, offering individual and group counseling sessions tailored to the specific needs of each person affected. Approximately sixty direct or indirect victims received psychological assistance. Beyond the challenges inherent in managing such events and considering their increasing occurrence in our country, a vital lesson emerged-the necessity of formalizing Mobile Intervention and Psychosocial Support Teams in every region for the effective management of medical-psychological emergencies.Cet article rend compte du processus de création d’un dispositif d’urgence innovant au Sénégal, l’Équipe mobile d’intervention et de soutien psychosocial, en rappelant comment au début des années 2000 une tragédie bouleverse le pays et amorce la réflexion sur le suivi psychosocial dans un contexte politique assujetti à l’idiome de la résilience. La création de l’EMIS semble paradoxale, puisqu’elle requiert et valorise des compétences en psychologie et en psychiatrie qui en temps ordinaire sont peu soutenues par les politiques sociales et de santé

A Randomized Trial of Artesunate Mefloquine versus Artemether Lumefantrine for the Treatment of Uncomplicated Plasmodium falciparum Malaria in Senegalese Children

An open randomized clinical trial study was carried out to compare efficacy and tolerability of artesunate mefloquine 25 mg/kg body weight (Artequin paediatric) versus artemether lumefantrine (Coartem) in the treatment of uncomplicated Plasmodium falciparum malaria in children. In each arm, 160 patients were assigned to receive either AS + MQ or AL with 28 days follow-up. The adequate clinical and parasitological response at Day 28 for per protocol analysis was after polymerase chain reaction correction, 100% for AS + MQ and 96.8% for AL. In the intention-to-treat analysis, the respective cure rates were 96.2% for AS + MQ and 93.7% for AL. No serious adverse events (AEs) were reported. The most frequent AE was vomiting, 30% in AS + MQ arm and 36% in AL arm. No biological significant abnormal values related to the study drug have been reported. The new pediatric artesunate mefloquine formulated in granule fixed dose combination is well adapted to children in Africa