Anti-malarial prescriptions in three health care facilities after the emergence of chloroquine resistance in Niakhar, Senegal (1992–2004)

<p>Abstract</p> <p>Background</p> <p>In the rural zone of Niakhar in Senegal, the first therapeutic failures for chloroquine (CQ) were observed in 1992. In 2003, the national policy regarding first-line treatment of uncomplicated malaria was modified, replacing CQ by a transitory bi-therapy amodiaquine/sulphadoxine-pyrimethamine (AQ/SP), before the implementation of artemisinin-based combination therapy (ACT) in 2006.</p> <p>The aims of the study were to assess the evolution of anti-malarial prescriptions in three health care facilities between 1992 and 2004, in parallel with increasing CQ resistance in the region.</p> <p>Methods</p> <p>The study was conducted in the area of Niakhar, a demographic surveillance site located in a sahelo-sudanese region of Senegal, with mesoendemic and seasonal malaria transmission. Health records of two public health centres and a private catholic dispensary were collected retrospectively to cover the period 1992–2004.</p> <p>Results</p> <p>Records included 110,093 consultations and 292,965 prescribed treatments. Twenty-five percent of treatments were anti-malarials, prescribed to 49% of patients. They were delivered all year long, but especially during the rainy season, and 20% of patients with no clinical malaria diagnosis received anti-malarials. Chloroquine and quinine represented respectively 55.7% and 34.6% of prescribed anti-malarials. Overall, chloroquine prescriptions rose from 1992 to 2000, in parallel with clinical malaria; then the CQ prescription rate decreased from 2000 and was concomitant with the rise of SP and the persistence of quinine use. AQ and SP were mainly used as bi-therapy after 2003, at the time of national treatment policy change.</p> <p>Conclusion</p> <p>The results show the overall level of anti-malarial prescription in the study area for a considerable number of patients over a large period of time. Even though resistance to CQ rapidly increased from 1992 to 2001, no change in CQ prescription was observed until the early 2000s, possibly due to the absence of an obvious decrease in CQ effectiveness, a lack of therapeutic options or a blind follow-up of national guidelines.</p

Reduction in the proportion of fevers associated with Plasmodium falciparum parasitaemia in Africa: a systematic review

BACKGROUND: Malaria is almost invariably ranked as the leading cause of morbidity and mortality in Africa. There is growing evidence of a decline in malaria transmission, morbidity and mortality over the last decades, especially so in East Africa. However, there is still doubt whether this decline is reflected in a reduction of the proportion of malaria among fevers. The objective of this systematic review was to estimate the change in the Proportion of Fevers associated with Plasmodium falciparum parasitaemia (PFPf) over the past 20 years in sub-Saharan Africa. METHODS: Search strategy. In December 2009, publications from the National Library of Medicine database were searched using the combination of 16 MeSH terms.Selection criteria. Inclusion criteria: studies 1) conducted in sub-Saharan Africa, 2) patients presenting with a syndrome of 'presumptive malaria', 3) numerators (number of parasitologically confirmed cases) and denominators (total number of presumptive malaria cases) available, 4) good quality microscopy.Data collection and analysis. The following variables were extracted: parasite presence/absence, total number of patients, age group, year, season, country and setting, clinical inclusion criteria. To assess the dynamic of PFPf over time, the median PFPf was compared between studies published in the years ≤2000 and &gt; 2000. RESULTS: 39 studies conducted between 1986 and 2007 in 16 different African countries were included in the final analysis. When comparing data up to year 2000 (24 studies) with those afterwards (15 studies), there was a clear reduction in the median PFPf from 44% (IQR 31-58%; range 7-81%) to 22% (IQR 13-33%; range 2-77%). This dramatic decline is likely to reflect a true change since stratified analyses including explanatory variables were performed and median PFPfs were always lower after 2000 compared to before. CONCLUSIONS: There was a considerable reduction of the proportion of malaria among fevers over time in Africa. This decline provides evidence for the policy change from presumptive anti-malarial treatment of all children with fever to laboratory diagnosis and treatment upon result. This should insure appropriate care of non-malaria fevers and rationale use of anti-malarials

Laboratory demonstration of a prozone-like effect in HRP2-detecting malaria rapid diagnostic tests: implications for clinical management

Background: Malaria rapid diagnostic tests (RDTs) are now widely used for prompt on-site diagnosis in remote endemic areas where reliable microscopy is absent. Aberrant results, whereby negative test results occur at high parasite densities, have been variously reported for over a decade and have led to questions regarding the reliability of the tests in clinical use. Methods. In the first trial, serial dilutions of recombinant HRP2 antigen were tested on an HRP2-detectiing RDT. In a second trial, serial dilutions of culture-derived Plasmodium falciparum parasites were tested against three HRP2-detecting RDTs. Results: A prozone-like effect occurred in RDTs at a high concentration of the target antigen, histidine-rich protein-2 (above 15,000 ng/ml), a level that corresponds to more than 312000 parasites per L. Similar results were noted on three RDT products using dilutions of cultured parasites up to a parasite density of 25%. While reduced line intensity was observed, no false negative results occurred. Conclusions: These results suggest that false-negative malaria RDT results will rarely occur due to a prozone-like effect in high-density infections, and other causes are more likely. However, RDT line intensity is poorly indicative of parasite density in high-density infections and RDTs should, therefore, not be considered quantitative. Immediate management of suspected severe malaria should rely on clinical assessment or microscopy. Evaluation against high concentrations of antigen should be considered in malaria RDT product development and lot-release testing, to ensure that very weak or false negative results will not occur at antigen concentrations that might be seen clinically

Aspects diagnostiques et thérapeutiques des cancers du rectum à l’Institut du Cancer de Dakar au Sénégal.

Le but de ce travail &#233;tait de d&#233;crire le profil &#233;pid&#233;miologique, les aspects diagnostiques et &#233;valuer la prise en charge th&#233;rapeutique des cancers du rectum. Il s&#8217;agissait d&#8217;une &#233;tude r&#233;trospective, descriptive et analytique r&#233;alis&#233;e &#224; l&#8217;Institut du Cancer de Dakar, ayant collig&#233; 89 patients pr&#233;sentant un cancer du rectum. Nous avons exclu decette &#233;tude les cancers du canal anal &#233;tendus au rectum. Les param&#232;tres &#233;pid&#233;miologiques, diagnostiques et th&#233;rapeutiques ont &#233;t&#233; d&#233;crits. La survie a &#233;t&#233; &#233;valu&#233;e par la m&#233;thode de Kaplan Meier. L&#8217;&#226;ge moyen des malades &#233;tait de 50 ans, le sex ratio de 1,2. L&#8217;examen clinique montrait que la tumeur si&#233;geait au bas rectum dans 76,6%. L&#8217;ad&#233;nocarcinome Lieberk&#252;hnien repr&#233;sentait 97% des cas. La classification selon Dukes montrait : 4 stades B, 13 stades C et 8 stades D. La radiochimioth&#233;rapie concomitante n&#233;o-adjuvante a &#233;t&#233; faite chez 40 malades et a permis un traitement chirurgical le plus souvent, dont 11 r&#233;sections ant&#233;rieures et 9 amputations abdomino-p&#233;rin&#233;ales. Nous avons observ&#233; 6 r&#233;cidives. La survie &#224; 5 ans &#233;tait de 15%. Le cancer du rectum reste une affection rare dans nos pays. Son pronostic est tr&#232;s p&#233;joratif du fait du diagnostic tardif et de l&#8217;inaccessibilit&#233; &#224; la radioth&#233;rapie et &#224; la chimioth&#233;rapie.Mots cl&#233;s : cancer du rectum, r&#233;section chirurgicale, radiochimioth&#233;rapie

Screening of Cardiovascular Risk Factors among Workers of a Construction Company in a Developing Country, Senegal

Objectives: This study aimed to evaluate the prevalence of cardiovascular risk factors in workplace and the global risk among workers of a Construction Company in a developing country.Methods: It was a retrospective and descriptive survey over two years in a construction company in Dakar, Senegal.Results: We collected 64 workers with a male predominance. The average age of workers was 44.9 years. Evaluation and analysis of cardiovascular risk reflected four levels: low in 78.12%, moderate in 15.62%, high in 4.69% and very high in 1.57%. Sedentary was strongly associated with moderate or high cardiovascular risk. Metabolic syndrome was strongly associated with moderate or elevated cardiovascular risk.Conclusion: Our study reveals a high prevalence of cardiovascularrisk factors in Senegalese workers. It would be important to include a screening program and correct assessment of overall cardiovascular risk in this population.Keys-words: Cardiovascular risk factor; Cardiovascular disease; Prevention; Workplace; Construction compan