Epidemiological and bacteriological profile of neonatal bacterial infections seen in hospital pediatric in Antananarivo

Background: Neonatal bacterial infection is one of the leading causes of new-born morbidity and mortality. Bacterial ecology is not known in our unit, no study has been devoted to this subject. This work aimed to determine the germs responsible for neonatal bacterial infections and their level of sensitivity to the usual antibiotics.Methods: This is a retrospective descriptive study conducted in the Neonatology Department from January 1, 2018 to April 30, 2019 (16 months) including all newborns under 29 days hospitalized during the study period and possessing positive bacteriological results regardless of the site of collection (blood, urine, cerebrospinal fluid).Results: The diagnosis of neonatal infection was confirmed in 47 cases, i.e. 26.1% of suspicions of neonatal bacterial infection hospitalized during the study period. The female predominance was found with a sex ratio of 0.81. The most frequently isolated germs are, in order of frequency, coagulase-negative staphylococci (10 cases), Escherichia coli (7 cases), Enterobacter cloacae (5 cases), Klebsiella pneumoniae (5 cases) and Enterobacter aerogenes (5 cases). Of the 47 cases studied, 16 cases were multidrug-resistant infections including 7 cases i.e. 14.9% of nosocomial infections. The majority of Enterobacteria are strains producing broad spectrum beta lactamases (12 cases to 22). The molecules that remained effective were mainly Imipenem and Amikacin.Conclusions: Neonatal infection remains a real public health problem. The emergence of multi-resistant bacteria complicates the management. The knowledge of bacterial ecology on a wider population is an important asset in its prevention and management

Knowledge, attitude, and practice of care providers about congenital rubella syndrome

Background: Behaviour of healthcare providers when facing an illness is an important part of their struggle. The aim of this study was to assess the level of knowledge, the attitude and the practice of health care providers regarding to the Congenital Rubella Syndrome.Methods: Authors did a descriptive study on the knowledge, the attitude and the practice of healthcare providers about Congenital Rubella Syndrome with 161 healthcare providers working in 8 hospitals in Madagascar. A self-introduced survey was used to collect the data.Results: There were 87% of all healthcare providers included in the study, who said that rubella in the first trimester of pregnancy was the cause of this syndrome for child, 87% knew at least 2 of the 3 major signs of Congenital Rubella Syndrome and more than 80% had a good knowledge of the criteria for diagnosing cases (suspected, clinically confirmed, laboratory confirmed). The referral to a hospital or to a specialist was the most proposed for the management of the case of Congenital Rubella Syndrome. The prescription of an IgG avidity for rubella and advising abortion were the main propositions for mothers having a positive test at the first trimester of pregnancy.Conclusions: A fairly satisfactory level of knowledge of healthcare providers was noted

Epidemio-clinical aspects of congenital rubella syndrome in Madagascar

Background: Congenital rubella syndrome is the first congenital defect preventable by vaccination. The purpose of this study was to provide basic information on the extent and epidemiology of congenital rubella syndrome in Madagascar.Methods: A retrospective and descriptive study from January 2013 to May 2019 was conducted in 8 hospitals in 2 provinces of Madagascar, Antananarivo and Toliara. The study included children who attended the services selected during the study period and who had the following conditions: children aged of 0 to 59 months, regardless of vaccination status, meeting the World Health Organization clinical criteria for congenital rubella syndrome with or without biological confirmation.Results: Of the 152,304 cases of children of all ages who visited or were hospitalized during the study period, 112 clinically confirmed cases of congenital rubella syndrome were identified. The age group 0 to 11 months involved 60 children (53.6%). Congenital heart disease was found in 83.0% of cases, mental backwardness in 43.7% and microcephaly in 26.8%. Twenty-three among (20.5%) them died. The death was due to cardiac diseases in 16 children.Conclusions: Findings confirm that the diagnosis of congenital rubella syndrome is underestimated in current pediatric practice in Madagascar. The introduction of the rubella vaccine in the Expanded Program on Immunization and the implementation of an effective and sustainable surveillance system for congenital rubella syndrome in the country is a proved effective tool for the prevention of this disease

Nature's contributions to human well-being under climate change: Evidence from Central and Eastern Madagascar

Anthropogenic climate change has an unprecedented impact on ecosystems and their services, with severe consequences for human well-being, particularly for the marginalised and vulnerable members of society in the Global South. The well-being of communities relies not only on material and regulating services ecosystems provide but also on non-material services. In this paper, we unravel the diverse ways that climate change impacts affect Nature's Contributions to People (NCP) and the well-being of rural populations in four sites in Madagascar—a biodiversity hotspot but one of the economically poorest countries in the world. We conducted participatory community workshops, mapping and semi-structured interviews with local residents across social subgroups to understand the mechanisms of climate-related degradation and the resulting impacts on different dimensions of human well-being through an NCP lens. We found that non-material services are generally more often associated with well-being effects. Climate change degrades material and non-material services through sea level rise, biodiversity loss, drought, precipitation and temperature variability, with consequences for materials, companionship and labour, food and feed, and physical and psychological experiences. Loss of land and forests is expressed through ecological grief. The outcome of our research provides evidence-based information to local policymakers, conservation practitioners, and climate change agencies. This information can help improve government efforts toward holistic conservation and climate change adaptation by addressing the impacts on the physical and mental well-being of the most vulnerable communities. Read the free Plain Language Summary for this article on the Journal blog

Epidemiological and bacteriological profile of neonatal bacterial infections seen in hospital pediatric in Antananarivo

Background: Neonatal bacterial infection is one of the leading causes of new-born morbidity and mortality. Bacterial ecology is not known in our unit, no study has been devoted to this subject. This work aimed to determine the germs responsible for neonatal bacterial infections and their level of sensitivity to the usual antibiotics.Methods: This is a retrospective descriptive study conducted in the Neonatology Department from January 1, 2018 to April 30, 2019 (16 months) including all newborns under 29 days hospitalized during the study period and possessing positive bacteriological results regardless of the site of collection (blood, urine, cerebrospinal fluid).Results: The diagnosis of neonatal infection was confirmed in 47 cases, i.e. 26.1% of suspicions of neonatal bacterial infection hospitalized during the study period. The female predominance was found with a sex ratio of 0.81. The most frequently isolated germs are, in order of frequency, coagulase-negative staphylococci (10 cases), Escherichia coli (7 cases), Enterobacter cloacae (5 cases), Klebsiella pneumoniae (5 cases) and Enterobacter aerogenes (5 cases). Of the 47 cases studied, 16 cases were multidrug-resistant infections including 7 cases i.e. 14.9% of nosocomial infections. The majority of Enterobacteria are strains producing broad spectrum beta lactamases (12 cases to 22). The molecules that remained effective were mainly Imipenem and Amikacin.Conclusions: Neonatal infection remains a real public health problem. The emergence of multi-resistant bacteria complicates the management. The knowledge of bacterial ecology on a wider population is an important asset in its prevention and management.</jats:p

Knowledge, attitude, and practice of care providers about congenital rubella syndrome

Background: Behaviour of healthcare providers when facing an illness is an important part of their struggle. The aim of this study was to assess the level of knowledge, the attitude and the practice of health care providers regarding to the Congenital Rubella Syndrome.Methods: Authors did a descriptive study on the knowledge, the attitude and the practice of healthcare providers about Congenital Rubella Syndrome with 161 healthcare providers working in 8 hospitals in Madagascar. A self-introduced survey was used to collect the data.Results: There were 87% of all healthcare providers included in the study, who said that rubella in the first trimester of pregnancy was the cause of this syndrome for child, 87% knew at least 2 of the 3 major signs of Congenital Rubella Syndrome and more than 80% had a good knowledge of the criteria for diagnosing cases (suspected, clinically confirmed, laboratory confirmed). The referral to a hospital or to a specialist was the most proposed for the management of the case of Congenital Rubella Syndrome. The prescription of an IgG avidity for rubella and advising abortion were the main propositions for mothers having a positive test at the first trimester of pregnancy.Conclusions: A fairly satisfactory level of knowledge of healthcare providers was noted.</jats:p

Epidemio-clinical aspects of congenital rubella syndrome in Madagascar

Background: Congenital rubella syndrome is the first congenital defect preventable by vaccination. The purpose of this study was to provide basic information on the extent and epidemiology of congenital rubella syndrome in Madagascar.Methods: A retrospective and descriptive study from January 2013 to May 2019 was conducted in 8 hospitals in 2 provinces of Madagascar, Antananarivo and Toliara. The study included children who attended the services selected during the study period and who had the following conditions: children aged of 0 to 59 months, regardless of vaccination status, meeting the World Health Organization clinical criteria for congenital rubella syndrome with or without biological confirmation.Results: Of the 152,304 cases of children of all ages who visited or were hospitalized during the study period, 112 clinically confirmed cases of congenital rubella syndrome were identified. The age group 0 to 11 months involved 60 children (53.6%). Congenital heart disease was found in 83.0% of cases, mental backwardness in 43.7% and microcephaly in 26.8%. Twenty-three among (20.5%) them died. The death was due to cardiac diseases in 16 children.Conclusions: Findings confirm that the diagnosis of congenital rubella syndrome is underestimated in current pediatric practice in Madagascar. The introduction of the rubella vaccine in the Expanded Program on Immunization and the implementation of an effective and sustainable surveillance system for congenital rubella syndrome in the country is a proved effective tool for the prevention of this disease.</jats:p

Randomized clinical trial of artemisinin versus non-artemisinin combination therapy for uncomplicated falciparum malaria in Madagascar

<p>Abstract</p> <p>Background</p> <p>Data concerning antimalarial combination treatment for uncomplicated malaria in Madagascar are largely lacking. Randomized clinical trial was designed to assess therapeutic efficacies of chloroquine (CQ), amodiaquine (AQ), sulphadoxine-pyrimethamine (SP), amodiaquine plus sulphadoxine-pyrimethamine combination (AQ+SP) and artesunate plus amodiaquine combination (AQ+AS).</p> <p>Methods</p> <p>287 children between 6 months and 15 years of age, with uncomplicated falciparum malaria, were enrolled in the study. Primary endpoints were the day-14 and day-28 risks of parasitological failure, either unadjusted or adjusted by genotyping.</p> <p>Results</p> <p>All treatment regimens, except for CQ treatment, gave clinical cure rates above 97% by day-14 and 92% by day-28 (PCR-corrected). AQ+SP was as effective as AQ+AS. The risk of new infection within the month after therapy was generally higher for AQ+AS than AQ+SP.</p> <p>Conclusion</p> <p>These findings show that the inexpensive and widely available combination AQ+SP may be valuable in for the treatment of uncomplicated malaria in Madagascar and could have an important role in this country, where much of the drugs administered go to patients who do not have malaria.</p