Knowledge, attitudes, practices of teenagers on sexual health in the district of Ambohidratrimo

Background: Talking about sex, sexuality, sexual health in many countries, including Madagascar, is very difficult because of the sacred and taboos that surround these questions but especially because of certain puritanism. The objective of this study was to assess the knowledge, attitudes and practices of adolescents in matters of sexual health.Methods: A retrospective, descriptive cross-sectional study was carried out in adolescents aged 10 to 19 seen in Ambohidratrimo district. The data were collected during the month of June and July 2019 and relate to data for the twelve months before the survey.Results: A total of 210 adolescents were recruited whose average age was 15.82±2.75 years and the sex ratio was 1:04. Eighty-six percent of the adolescents surveyed had heard of sexual health. Nine out of 10 adolescents would go to a health worker if they contract an STI. Almost a quarter or 23.8% of respondents declared having already had sexual intercourse.Conclusions: At the end of this study on the knowledge, attitudes and practices of adolescents on sexual health, they certainly have knowledge but considered average. Therefore, there is a need for sexuality education, for improving knowledge and understanding of sexual development, human procreation, healthy and adapted sexual behavior and different means of contraception, on the part of adolescents, but also with the aim of improving communications between adolescents and their parent

Epidemiological, clinical and therapeutic profile of uterine fibroids at the Befelatanana University hospital centre of obstetric gynecology of Antananarivo, Madagascar

Background: Leiomyomas or fibromyomas more commonly referred as uterine fibroids are the most common tumors of the female genital tract. They affect 20 to 25% of women in genital activity. The objective of present study is to describe the epidemiological and therapeutic profile of uterine fibroids at the UHCOBG.Methods: Retrospective and descriptive cross-sectional study of patients with uterine fibroids hospitalized in the department of gynecology of the UHCOBG between January 2015 and December 2016.Results: In total, 101 cases of uterine fibroids have been identified with a prevalence of 3.92%. The average age is 42.75±3.6 years old. The most affected age group varies from 35 to 45 years old. Thirty-eight-point six percent of the patients were pauciparous. The medical history of irregular menstrual cycle disorders was present in 17.8% of the cases. The symptomatology was dominated by menometrorrhagia (78.2%) and in 67.3% of the cases, patients had anemia. The majority of patients (64.4%) had poly-myomatous uterus which fibroid location was predominantly corporeal (92.1%), isthmic (21.8%), and three quarters of the mapping was interstitial. Complications were dominated by aseptic necrobiosis (7.9%) and conservative treatment in 68.3% of the cases. Laparotomy is the pillar of a surgical treatment. The duration of hospitalization was short in 77.2% of the cases, 91.1% had a good progress and no death was noticed during 2 years.Conclusions: This is the first operative indication of all gynecological pathologies in present UHC and proves to be a real public health problem. The development of operative laparoscopy is necessary to reduce the morbidity associated with treatment

Grass Diversity and Pasture Quality Baseline Assessement in Central Madagascar

Poaceae family contributes to Madagascar’s biodiversity hotspot with 217 of 541 grass species endemic to the island, although their forage value is unknown, at least in the scientific literature. Our research aims 1) to describe the diversity of native and endemic grasses thereby recognising the role of grass species diversity in forage and ecosystem management and 2) to provide new knowledge about pasture management based on the relationship between grazing capacity and productivity within experimental pastureland plots under different fire and grazing treatments. Our study seeks to provide information to inform improvements in livestock nutrition via grazing management of natural pastures in central Madagascar, specifically around the Ankafobe, Ibity and Itremo Protected Areas. Sampling in different grassy habitats was undertaken to develop a grass checklist and overview of grass diversity across the project sites. Further, in the communal and experimental pastures standardised grass surveys were carried out to compare grazing capacity and biomass productivity in the experimental pastures. Our regional survey recorded 123 Poaceae species during the first year: including 90% native species (of which 34% were endemic) and 10% introduced species. Thirty species, all C4 and belonging to PACMAD clade, are found within established pasture grasslands. Across communal pastures the most frequently recorded species and thus most frequently grazed are Loudetia simplex, Aristida rufescens, Panicum luridum, Schizachyrium sanguineum, Hyparrhenia rufa and Aristida tenuissima – these species are predominantly associated with fire. The grazing capacity baseline, at about 0.7 to 0.8 ha/zebu/year, is similar across all experimental sites that are also characterised by having a similar climate, acidic soils with low nitrogen and phosphorus, and., Annual biomass production appears to be driven by fire frequency: at both Itremo and Ankafobe, where fire is an annual occurrence, biomass yield is 2.4-2.9t/ha whereas at Ibity, where fire frequency is fire every 3-4 years, biomass productivity is 6.9t/ha. However, it is unclear how these productivity estimates relate to forage quality; the relationship will be the subject of future work

Long-term prognostic significance of right bundle-branch morphology ventricular ectopy induced during stress test in patients with intermediate to high probability of coronary artery disease

Aims: Stress-induced right bundle-branch block morphology ventricular ectopy (SI-RBVE) may be caused by left ventricular myocardial anomalies. While frequent ventricular ectopy (FVE) has been linked to poor outcomes, the prognostic value of SI-RBVE has not been established. The study aims to determine whether SI-RBVE is associated with increased mortality. Methods and results: Three hundred forty-three patients with an intermediate to high probability of coronary artery disease were prospectively included. Patients were referred for a single-photon emission computed tomography and underwent a stress test according to standard protocols. Stress-induced right bundle-branch block morphology ventricular ectopy (VE) was defined as one or more induced premature beats with positive predominance in V1. Frequent VE was defined as the presence of seven or more ventricular premature beats per minute or any organized ventricular arrhythmia. During a mean follow-up of 4.5 ± 1.3 years, 59 deaths occurred. The death rate was higher in the SI-RBVE group (23.4% vs. 14.0%, P = 0.021). Age [odds ratio (OR) = 1.09 (95% CI: 1.06-1.13), P < 0.001] and peripheral artery disease [OR = 2.47 (95% CI: 1.35-4.50) P = 0.003] were independent factors of mortality, but single-photon emission computed tomography findings were not. There was an interaction between SI-RBVE and left ventricular ejection fraction (LVEF). In patients with LVEF > 50%, SI-RBVE was an incremental risk factor for mortality [OR = 2.83 (95% CI: 1.40-5.74), P = 0.004]. Stress-induced right bundle-branch block morphology VE patients also presented higher rates of known coronary artery disease, ischaemia, scar, and ST-segment changes. Frequent VE was not related to mortality. Conclusion: Stress-induced right bundle-branch block morphology VE is associated with an increased mortality in patients with preserved LVEF

Comparative field performance and adherence to test results of four malaria rapid diagnostic tests among febrile patients more than five years of age in Blantyre, Malawi

<p>Abstract</p> <p>Background</p> <p>Malaria rapid diagnostics tests (RDTs) can increase availability of laboratory-based diagnosis and improve the overall management of febrile patients in malaria endemic areas. In preparation to scale-up RDTs in health facilities in Malawi, an evaluation of four RDTs to help guide national-level decision-making was conducted.</p> <p>Methods</p> <p>A cross sectional study of four histidine rich-protein-type-2- (HRP2) based RDTs at four health centres in Blantyre, Malawi, was undertaken to evaluate the sensitivity and specificity of RDTs, assess prescriber adherence to RDT test results and explore operational issues regarding RDT implementation. Three RDTs were evaluated in only one health centre each and one RDT was evaluated in two health centres. Light microscopy in a reference laboratory was used as the gold standard.</p> <p>Results</p> <p>A total of 2,576 patients were included in the analysis. All of the RDTs tested had relatively high sensitivity for detecting any parasitaemia [Bioline SD (97%), First response malaria (92%), Paracheck (91%), ICT diagnostics (90%)], but low specificity [Bioline SD (39%), First response malaria (42%), Paracheck (68%), ICT diagnostics (54%)]. Specificity was significantly lower in patients who self-treated with an anti-malarial in the previous two weeks (odds ratio (OR) 0.5; p-value < 0.001), patients 5-15 years old versus patients > 15 years old (OR 0.4, p-value < 0.001) and when the RDT was performed by a community health worker versus a laboratory technician (OR 0.4; p-value < 0.001). Health workers correctly prescribed anti-malarials for patients with positive RDT results, but ignored negative RDT results with 58% of patients with a negative RDT result treated with an anti-malarial.</p> <p>Conclusions</p> <p>The results of this evaluation, combined with other published data and global recommendations, have been used to select RDTs for national scale-up. In addition, the study identified some key issues that need to be further delineated: the low field specificity of RDTs, variable RDT performance by different cadres of health workers and the need for a robust quality assurance system. Close monitoring of RDT scale-up will be needed to ensure that RDTs truly improve malaria case management.</p

Challenges in Diagnosing Paediatric Malaria in Dar es Salaam, Tanzania.

Malaria is a major cause of paediatric morbidity and mortality. As no clinical features clearly differentiate malaria from other febrile illnesses, and malaria diagnosis is challenged by often lacking laboratory equipment and expertise, overdiagnosis and overtreatment is common. Children admitted with fever at the general paediatric wards at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania from January to June 2009 were recruited consecutively and prospectively. Demographic and clinical features were registered. Routine thick blood smear microscopy at MNH was compared to results of subsequent thin blood smear microscopy, and rapid diagnostics tests (RDTs). Genus-specific PCR of Plasmodium mitochondrial DNA was performed on DNA extracted from whole blood and species-specific PCR was done on positive samples. Among 304 included children, 62.6% had received anti-malarials during the last four weeks prior to admission and 65.1% during the hospital stay. Routine thick blood smears, research blood smears, PCR and RDT detected malaria in 13.2%, 6.6%, 25.0% and 13.5%, respectively. Positive routine microscopy was confirmed in only 43% (17/40), 45% (18/40) and 53% (21/40), by research microscopy, RDTs and PCR, respectively. Eighteen percent (56/304) had positive PCR but negative research microscopy. Reported low parasitaemia on routine microscopy was associated with negative research blood slide and PCR. RDT-positive cases were associated with signs of severe malaria. Palmar pallor, low haemoglobin and low platelet count were significantly associated with positive PCR, research microscopy and RDT. The true morbidity attributable to malaria in the study population remains uncertain due to the discrepancies in results among the diagnostic methods. The current routine microscopy appears to result in overdiagnosis of malaria and, consequently, overuse of anti-malarials. Conversely, children with a false positive malaria diagnosis may die because they do not receive treatment for the true cause of their illness. RDTs appear to have the potential to improve routine diagnostics, but the clinical implication of the many RDT-negative, PCR-positive samples needs to be elucidated.\u

A new world malaria map: Plasmodium falciparum endemicity in 2010

Background: transmission intensity affects almost all aspects of malaria epidemiology and the impact of malaria on human populations. Maps of transmission intensity are necessary to identify populations at different levels of risk and to evaluate objectively options for disease control. To remain relevant operationally, such maps must be updated frequently. Following the first global effort to map Plasmodium falciparum malaria endemicity in 2007, this paper describes the generation of a new world map for the year 2010. This analysis is extended to provide the first global estimates of two other metrics of transmission intensity for P. falciparum that underpin contemporary questions in malaria control: the entomological inoculation rate (PfEIR) and the basic reproductive number (PfR). Methods: annual parasite incidence data for 13,449 administrative units in 43 endemic countries were sourced to define the spatial limits of P. falciparum transmission in 2010 and 22,212 P. falciparum parasite rate (PfPR) surveys were used in a model-based geostatistical (MBG) prediction to create a continuous contemporary surface of malaria endemicity within these limits. A suite of transmission models were developed that link PfPR to PfEIR and PfR and these were fitted to field data. These models were combined with the PfPR map to create new global predictions of PfEIR and PfR. All output maps included measured uncertainty. Results: an estimated 1.13 and 1.44 billion people worldwide were at risk of unstable and stable P. falciparum malaria, respectively. The majority of the endemic world was predicted with a median PfEIR of less than one and a median PfRc of less than two. Values of either metric exceeding 10 were almost exclusive to Africa. The uncertainty described in both PfEIR and PfR was substantial in regions of intense transmission. Conclusions: the year 2010 has a particular significance as an evaluation milestone for malaria global health policy. The maps presented here contribute to a rational basis for control and elimination decisions and can serve as a baseline assessment as the global health community looks ahead to the next series of milestones targeted at 20