Fixed-Dose Artesunate-Amodiaquine Combination vs Chloroquine for Treatment of Uncomplicated Blood Stage P. vivax Infection in the Brazilian Amazon: An Open-Label Randomized, Controlled Trial

BACKGROUND: Despite increasing evidence of the development of Plasmodium vivax chloroquine (CQ) resistance, there have been no trials comparing its efficacy with that of artemisinin-based combination therapies (ACTs) in Latin America. METHODS: This randomized controlled trial compared the antischizontocidal efficacy and safety of a 3-day supervised treatment of the fixed-dose combination artesunate-amodiaquine Winthrop(R) (ASAQ) versus CQ for treatment of uncomplicated P. vivax infection in Manaus, Brazil. Patients were followed for 42 days. Primary endpoints were adequate clinical and parasitological responses (ACPR) rates at day 28. Genotype-adjustment was performed. RESULTS: From 2012 to 2013, 380 patients were enrolled. In the per-protocol (PP) analysis, adjusted-ACPR was achieved in 100% (165/165) and 93.6% (161/172) of patients in the ASAQ and CQ arm (difference 6.4%, 95% CI 2.7%; 10.1%) at day 28 and in 97.4% (151/155) and 77.7% (129/166), respectively (difference 19.7%, 95% CI 12.9%; 26.5%), at day 42. Apart from ITT D28 assessment, superiority of ASAQ on ACPR was demonstrated. ASAQ presented faster clearance of parasitaemia and fever. Based on CQ blood level measurements, CQ resistance prevalence was estimated at 11.5% (95% CI: 7.5-17.3) up to day 42. At least one emergent adverse event (AE) was recorded for 79/190 (41x6%) in the ASAQ group and for 85/190 (44x7%) in the CQ group. Both treatments had similar safety profiles. CONCLUSIONS: ASAQ exhibited high efficacy against CQ resistant P. vivax and is an adequate alternative in the study area. Studies with an efficacious comparator, longer follow-up and genotype-adjustment can improve CQR characterization

Acceptability and efficacy of intra-rectal quinine alkaloids as a pre-transfer treatment of non-per os malaria in peripheral health care facilities in Mopti, Mali

<p>Abstract</p> <p>Background</p> <p>The acceptability and efficacy of a new kit with a new formulation of quinine alkaloids designed for the intra-rectal administration in the treatment of non-per os malaria was assessed in the peripheral health care system of Mopti, Mali.</p> <p>Methods</p> <p>A single-arm trial was conducted from August 2003 to January 2004. An initial dose of diluted quinine alkaloids (20 mg/kg Quinimax^®) was administered by the intra-rectal route to children with presumptive non per-os malaria at six peripheral heath care centres. The children were then referred to two referral hospitals where standard inpatient care including intravenous route were routinely provided. A malaria thick smear was done at inclusion and a second malaria thick smear after arrival at the referral facility, where a more complete clinical examination and laboratory testing was done to confirm diagnosis. Confirmed cases of severe malaria or others diseases were treated according to national treatment guidelines. Cases of non per-os malaria received a second dose of intra rectal quinine alkaloids. Primary outcome was acceptability of the intra rectal route by children and their parents as well as the ease to handle the kit by health care workers.</p> <p>Results</p> <p>The study included 134 children with a median age of 33 months and 53.7% were male. Most of the children (67%) and 92% of parents or guardians readily accepted the intra-rectal route; 84% of health care workers found the kit easy to use. At the peripheral health care centres, 32% of children had a coma score ≤ 3 and this was reduced to 10% at the referral hospital, following one dose of intra-rectal quinine alkaloids (IRQA). The mean time to availability of oral route treatment was 1.8 ± 1.1 days. Overall, 73% of cases were confirmed severe malaria and for those the case fatality rate was 7.2%.</p> <p>Conclusion</p> <p>IRQA was well accepted by children, their parents/guardians and by the health workers at peripheral health facilities in Mopti, Mali. There was also a quick recovery from deep coma and a reduced case fatality rate in severe malaria.</p

Connaissances, attitudes et pratiques des professionnels de santé en santé mentale dans les pays en développement

International audienc

Knowledge, attitudes and practices in mental health of health professionals at the end of their curriculum in Burkina Faso: A pilot study

International audienceAim: To study the knowledge, attitudes and practices regarding mental health amongst health professionals at the end of their curriculum in Burkina Faso.Design: A descriptive and cross-sectional study was adopted.Methods: A simple random sampling was used to select 420 health students in Burkina Faso. Self-administered questionnaires on sociodemographic profile, knowledge, attitudes and practices about mental health were distributed.Results: The response rate to the questionnaires was 93%. Our study sample included 391 students amongst whom 35% (138/391) were nurse students, 32% (125/391) medical students, 26% (100/391) midwife students and 7% (28/391) were pharmacy students. A quarter of our sample had completed an internship in psychiatry.Medical students’ average knowledge, attitudes and practices in mental health were significantly higher than that of other students. Medical students had more time dedicated to mental health lectures and more opportunities for a mental health internship, unlike nurse students

Associations of mental disorders and neurotropic parasitic diseases: a meta-analysis in developing and emerging countries

International audienceBackground: Although they are declining worldwide, neurotropic parasitic diseases are still common in developingand emerging countries. The aim of this study was to estimate the pooled prevalence and pooled associationmeasures of comorbidities between mental disorders (anxiety, depression, bipolar disorder, and schizophrenia) andneurotropic parasitic diseases (malaria, cysticercosis, toxoplasmosis, human African trypanosomiasis, Chagas disease,and human toxocariasis) in developing and emerging countries.Methods: As the first meta-analysis on this topic, this study was performed in accordance with PRISMA guidelines.The protocol was registered in PROSPERO (N°CRD42017056521). The Medline, Embase, Lilacs, and Institute ofEpidemiology and Tropical Neurology databases were used to search for articles without any restriction in languageor date. We evaluated the quality of studies independently by two investigators using the Downs and Blackassessment grid and pooled estimates using the random-effects method from CMA (Comprehensive Meta Analysis)Version 3.0.Results: In total, 18 studies published between 1997 and 2016 met our inclusion criteria. We found that theprevalence of anxiety and depression in people suffering from Chagas disease and/or neurocysticercosis was 44.9%(95% CI, 34.4–55.9). In 16 pooled studies that included 1782 people with mental disorders and 1776 controls,toxoplasmosis and/or toxocariasis were associated with increased risk of schizophrenia and/or bipolar disorders(odds ratio = 2.3; 95% CI, 1.7–3.2). Finally, toxocariasis and/or toxoplasmosis were associated with an increased risk ofthe onset of schizophrenia (odds ratio = 2.4; 95% CI, 1.7–3.4).Conclusion: Our pooled estimates show that the associations between diseases studied are relatively high indeveloping and emerging countries. This meta-analysis supports the hypothesis that toxoplasmosis could be thecause of schizophrenia. These findings could prove useful to researchers who want to further explore andunderstand the associations studied

Co-morbidities of mental disorders and chronic physical diseases in developing and emerging countries: a meta-analysis

International audienceBACKGROUND:As the data on the association of mental disorders and chronic physical diseases in developing and emerging countries is heterogeneous, this study aims to produce the first meta-analysis of these comorbidities.METHODOLOGY:The meta-analysis protocol was registered in PROSPERO (N°CRD42017056521) and was performed in accordance with PRISMA guidelines. Initially, an article search was conducted on Medline, Embase, Lilacs and the Institut d'Epidémiologie et de Neurologie Tropicale database [Institute of Epidemiology and Tropical Neurology], as well as manually, with no restriction on language or date focusing on mental disorders, chronic diseases and neurotropic diseases. Two independent investigators assessed the quality of the studies which met the inclusion criteria using the Downs and Black assessment grid. The pooled estimates were calculated out using a random-effects method with CMA software Version 3.0. A meta-regression was then performed, and the significance level was set at 0.05.RESULTS:Of the 2604 articles identified, 40 articles involving 21,747 subjects met the inclusion criteria for co-morbidities between mental disorders and chronic physical diseases. Thirty-one articles were included in the meta-analysis of prevalence studies and 9 articles in that of the analytical studies. The pooled prevalence of mental disorders in patients with chronic physical diseases was 36.6% (95% CI, 31.4-42.1) and the pooled odds ratio was 3.1 (95% CI, 1.7-5.2). There was heterogeneity in all the estimates and in some cases, this was explained by the quality of the studies.CONCLUSION:Some estimates regarding the prevalence of mental disorders in people with chronic physical diseases living in developing and emerging countries were similar to those in developed countries. Mental disorders are a burden in these countries. In order to respond effectively and efficiently to the morbidity and mortality associated with them, mental health care could be integrated with physical care

Efficacy and Safety of Fixed-Dose Artesunate-Amodiaquine vs. Artemether-Lumefantrine for Repeated Treatment of Uncomplicated Malaria in Ugandan Children

<div><p></p><p>The safety and efficacy of the two most widely used fixed-dose artemisinin-based combination therapies (ACT), artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) are well established for single episodes of uncomplicated <i>Plasmodium falciparum</i> malaria, but the effects of repeated, long-term use are not well documented. We conducted a 2-year randomized, open-label, longitudinal, phase IV clinical trial comparing the efficacy and safety of fixed-dose ASAQ and AL for repeated treatment of uncomplicated malaria in children under 5 years at Nagongera Health Centre, Uganda. Participants were randomized to ASAQ or AL and all subsequent malaria episodes were treated with the same regimen. 413 children were enrolled and experienced a total of 6027 malaria episodes (mean 15; range, 1–26). For the first malaria episode, the PCR-corrected-cure rate for ASAQ (97.5%) was non-inferior to that for AL (97.0%; 95% CI [−0.028; 0.037]). PCR-corrected cure rates for subsequent malaria episodes that had over 100 cases (episodes 2–18), ranged from 88.1% to 98.9% per episode, with no clear difference between the treatment arms. Parasites were completely cleared by day 3 for all malaria episodes and gametocyte carriage was less than 1% by day 21. Fever clearance was faster in the ASAQ group for the first episode. Treatment compliance for subsequent episodes (only first dose administration observed) was close to 100%. Adverse events though common were similar between treatment arms and mostly related to the disease. Serious adverse events were uncommon, comparable between treatment arms and resolved spontaneously. Anemia and neutropenia occurred in <0.5% of cases per episode, abnormal liver function tests occurred in 0.3% to 1.4% of cases. Both regimens were safe and effective for repeated treatment of malaria.</p><p>Trial Registration</p><p>Current Controlled Trials <a href="http://www.controlled-trials.com/mrct/trial/452497/NCT00699920" target="_blank">NCT00699920</a></p></div

Estimates of comparative efficacy of ASAQ and AL for treatment of the first episode of malaria: Per protocol (PP) population.

<p>Values are for all subjects completing the first episode of the study according to protocol (PP population).</p>a<p>ASAQ was considered non-inferior to AL if the lower limit of the one-sided 95% confidence interval was>−5%.</p>b<p>P-value was determined by Fisher's exact test.</p>c<p>P-value was determined by Wilcoxon's signed-rank test.</p>d<p>P-value was determined by Chi-squared test.</p><p>Estimates of comparative efficacy of ASAQ and AL for treatment of the first episode of malaria: Per protocol (PP) population.</p