Prévalences des Parasites Intestinaux Humains Chez les Patients du Service de Parasitologie de l’INRSP Bamako de 2010 à 2015

Introduction: L’invasion de l’appareil digestif humain par les parasites est le motif de consultation de plusieurs patients à l’Institut National de Recherche en Santé Publique (INRSP). Objectifs : Il s’agissait de déterminer la prévalence des parasites intestinaux humains chez les patients reçus au laboratoire de parasitologie de l’INRSP pendant la période de 2010 à 2015. Ce qui permettra de mesurer l’impact de l’amélioration de la situation sanitaire sur la transmission des parasites intestinaux au sein de la population humaine de la ville de Bamako. Méthodologie : C’était une étude rétrospective basée sur les résultats portés dans les registres de laboratoire. Résultats : Au total, 1833 individus sur 3815 patients étaient positifs aux infections intestinales parasitaires. Une prévalence de 44% a été obtenue chez les sujets féminins contre 42,2% chez les patients masculins. Les tranches d’âges de 1 à 10 ans et ceux de 11 à 20 ans étaient plus infectés avec 46,5%. L’ethnie Bambara avait le plus élevé taux d’infection (46%) et les Tamasheks avaient le plus bas taux (30%), alors que les élèves et étudiants avec 46,5% étaient la couche socio-professionnelle la plus infectée. Les douleurs abdominales étaient les plus fréquents signes cliniques. Entamoeba histolytica, 72% et Giardia intestinalis, 15,4% étaient les espèces parasitaires les plus fréquentes. Conclusion : Une diminution progressive de la proportion des sujets infectés allant de 52,2% en 2010 à 29,0% en 2015 a été constatée. Cela démontre un effet positif des efforts déployés par le gouvernement pour l’amélioration des conditions sanitaires à Bamako. Introduction: The invasion of the human digestive tract by parasites is the reason of several patients’ visits at the National Institute for Research in Public Health (INRSP). Objectives: The aim was to determine the prevalence of human intestinal parasites in patients admitted to the INRSP parasitology laboratory during the period from 2010 to 2015. That can enable to measure the impact of health situation improvement on the transmission of intestinal parasites in the human population in Bamako. Methodology: This was a retrospective study based on the information reported in the laboratory note books records. Results: A total of 1,833 individuals out of 3815 patients were detected positive. A prevalence of 44% was obtained in female subjects and 42.2% in male patients. The age groups 1-10 and 11-20 were more infected with 46.5%. Bambara ethnic group had the highest infection rate (46%) and the Tamasheks had the lowest rate (30%), while school kids and students were the most infected socio-professional group with 46.5%. Abdominal pain was the most common clinical signs. Entamoeba histolytica, 72% and Giardia intestinalis, 15.4% were the most common parasite species. Conclusion: A gradual decrease in the proportion of infected people ranging from 52.2% in 2010 to 29.0% in 2015 was found. This demonstrates a positive effect of the efforts made by the government to improve health conditions in Bamako

Mapping the Probability of Schistosomiasis and Associated Uncertainty, West Africa

We aimed to map the probability of Schistosoma haematobium infection being >50%, a threshold for annual mass praziquantel distribution. Parasitologic surveys were conducted in Burkina Faso, Mali, and Niger, 2004–2006, and predictions were made by using Bayesian geostatistical models. Clusters with >50% probability of having >50% prevalence were delineated in each country

Organomegaly in Mali before and after praziquantel treatment. A possible association with Schistosoma haematobium.

Continuous exposure to schistosome-infested water results in acute and chronic morbidity in all ages. We analysed occurence of organomegaly via ultrasonography and investigated a possible additive effect of dual-dose drug administration in 401 Schistosoma haematobium infected individuals from a highly endemic area in Mali. Mean intensity of infection at baseline (22.0 eggs per 10 ml) was reduced to 0.22 eggs per 10 ml 9 weeks after treatment (both treatments combined). Odds of persistent infection among those given dual-dose treatment was 41% of that in people given single dose (b = 0.41; p = 0.05; 95% CI 0.17-1.00), but after two years, 70.7% of the 157 participants, who completed the survey, were re-infected with no significant difference in prevalence and intensity of infection between treatment groups. Resolution of organomegaly occurred in all age groups after treatment. A novel association between Schistosoma haematobium infection and moderate portal vein enlargement was found in 35% (n: 55). Severe portal vein diameter enlargement was found in 3.2%. After two years, moderate hepatomegaly was present in 50.6%, moderate splenomegaly in 45.6% and moderate portal vein diameter enlargement in 19%. A subsequent dose of PZQ did not provide any additional long-term advantages

Prevalence of Giardia intestinalis Infection in Schistosomiasis-Endemic Areas in South-Central Mali

Intestinal parasite infections are frequent causes of diarrhea and malnutrition among children in the tropics. Transmission of helminths and intestinal protozoa is intimately connected with conditions of poverty, including inadequate sanitation and hygiene. Concurrent infections with several intestinal pathogens may lead to excess morbidity. Yet, there is a paucity of epidemiological data from Mali. In this study, stool samples from 56 individuals, aged 2–63 years, from Bamako and Niono, south-central Mali were examined for intestinal parasites using stool microscopy. Additionally, stool samples were subjected to a rapid diagnostic test (RDT) and polymerase chain reaction (PCR) for the detection of Cryptosporidium spp. and Giardia intestinalis. The predominant pathogens were Schistosoma mansoni and G. intestinalis with prevalences of 41% and 38%, respectively. Hymenolepis nana was detected in 4% of the participants, while no eggs of soil-transmitted helminths were found. Concurrent infections with G. intestinalis and S. mansoni were diagnosed in 16% of the participants. For the detection of G. intestinalis, PCR was more sensitive (100%) than RDT (62%) and microscopy (48%). As helminth-protozoa coinfections might have important implications for morbidity control programs, future studies should employ diagnostic tools beyond stool microscopy to accurately assess the co-endemicity of giardiasis and schistosomiasis

Impact of a malaria intervention package in schools on Plasmodium infection, anaemia and cognitive function in schoolchildren in Mali: a pragmatic cluster-randomised trial.

BACKGROUND: School-aged children are rarely targeted by malaria control programmes, yet the prevalence of Plasmodium infection in primary school children often exceeds that seen in younger children and could affect haemoglobin concentration and school performance. METHODS: A cluster-randomised trial was carried out in 80 primary schools in southern Mali to evaluate the impact of a school-based malaria intervention package. Intervention schools received two interventions sequentially: (1) teacher-led participatory malaria prevention education, combined with distribution of long-lasting insecticidal nets (LLINs), followed 7 months later at the end of the transmission season by (2) mass delivery of artesunate and sulfadoxine-pyrimethamine administered by teachers, termed intermittent parasite clearance in schools (IPCs). Control schools received LLINs as part of the national universal net distribution programme. The impact of the interventions on malaria and anaemia was evaluated over 20 months using cross-sectional surveys in a random subset of 38 schools(all classes), with a range of cognitive measures (sustained attention, visual search, numeracy, vocabulary and writing) assessed in a longitudinal cohort of children aged 9-12 years in all 80 schools. RESULTS: Delivery of a single round of IPCs was associated with dramatic reductions in malaria parasitaemia (OR 0.005, 95% CI 0.002 to 0.011, p<0.001) and gametocyte carriage (OR 0.02, 95% CI 0.00 to 0.17, p<0.001) in intervention compared with control schools. This effect was sustained for 6 months until the beginning of the next transmission season. IPCs was also associated with a significant decrease in anaemia (OR 0.56, 95% CI 0.40 to 0.78, p=0.001), and increase in sustained attention (difference +0.23, 95% CI 0.10 to 0.36, p<0.001). There was no evidence of impact on other cognitive measures. CONCLUSION: The combination of malaria prevention education, LLINs and IPCs can reduce anaemia and improve sustained attention of school children in areas of highly seasonal transmission. These findings highlight the impact of asymptomatic malaria infection on cognitive performance in schoolchildren and the benefit of IPCs in reducing this burden. Additionally, malaria control in schools can help diminish the infectious reservoir that sustains Plasmodium transmission

The impact of food assistance on food insecure populations during conflict: Evidence from a quasi-experiment in Mali

Mali, a vast landlocked country at the heart of West Africa in the Sahel region, is one of the least developed and most food insecure countries in the world. Mali suffered from a series of political, constitutional and military crises since January 2012, including the loss of government control of northern territories from April 2012 until January 2013. A range of humanitarian aid interventions were scaled up in response to these complex crises. In this study, we exploit data from a unique pre-crisis baseline to evaluate the impact of humanitarian aid on the food security of rural populations. We design a quasi-experimental study based on two survey rounds, five years apart, in the Mopti region in Northern Mali. Data was collected from 66 communities randomly selected from within food-insecure districts. Study outcomes include household expenditures and food consumption and a proxy for child nutritional status (height measurements). We estimate program impact by combining propensity score matching and difference-in-difference. Food assistance was found to increase household non-food and food expenditures and micro-nutrient availability. Disaggregating by degree of conflict exposure showed that the effects on children's height and caloric and micro-nutrient consumption were mostly concentrated in areas not in the immediate vicinity of the conflict, unlike the increase in food expenditures that were driven by households located in close proximity to armed groups. The effects were also concentrated on households receiving at least two forms of food assistance. In villages where armed groups were present, food assistance improved household zinc consumption and also appeared to support food expenditures. Food transfers are thus found to exert a protective effect among food insecure population in conflict context

Closing the praziquantel treatment gap: new steps in epidemiological monitoring and control of schistosomiasis in African infants and preschool-aged children

Where very young children come into contact with water containing schistosome cercariae, infections occur and schistosomiasis can be found. In high transmission environments, where mothers daily bathe their children with environmentally drawn water, many infants and preschool-aged children have schistosomiasis. This ‘new' burden, inclusive of co-infections with Schistosoma haematobium and Schistosoma mansoni, is being formally explored as infected children are not presently targeted to receive praziquantel (PZQ) within current preventive chemotherapy campaigns. Thus an important PZQ treatment gap exists whereby infected children might wait up to 4-5 years before receiving first treatment in school. International treatment guidelines, set within national treatment platforms, are presently being modified to provide earlier access to medication(s). Although detailed pharmacokinetic studies are needed, to facilitate pragmatic dosing in the field, an extended ‘dose pole' has been devised and epidemiological monitoring has shown that administration of PZQ (40 mg/kg), in either crushed tablet or liquid suspension, is both safe and effective in this younger age-class; drug efficacy, however, against S. mansoni appears to diminish after repeated rounds of treatment. Thus use of PZQ should be combined with appropriate health education/water hygiene improvements for both child and mother to bring forth a more enduring solutio

The scope of coverage under the Rotterdam Rules - Unimodal and multimodal aspects

U radu se proučavaju, raščlanjuju i interpretiraju sve relevantne odredbe o polju primjene Roterdamskih pravila. Analizira se njihovo opće polje primjene, govori se o ugovorima, prijevozima te subjektima prijevoznih poslova na koje se Roterdamska pravila primjenjuju. Proučavaju se i specifične odredbe o posebnim isključenjima. Tumači se u kojem opsegu Roterdamska pravila pokrivaju multimodalni prijevoz te se govori o multimodalnosti kao obilježju suvremenog prijevoza i unifikaciji multimodalnog prijevoza. Pomno se ulazi u sadržaj i doseg odredbi kojima se propisuju uvjeti koji moraju biti ispunjeni da bi odredbe druge međunarodne prijevozne konvencije imale prednost u odnosu na odredbe Roterdamskih pravila. Nastoji se ukazati i na razlike u pogledu njezinog polja primjene i polja primjene međunarodnih konvencija koje su na snazi, a kojima se uređuje prijevoz stvari morem. Odredbe o polju primjene iznimno su važne i zadiru u bit nove konvencije, njezinu koncepciju, temeljna načela i ciljeve novog pravnog uređenja koje Konvencija propisuje. Najvažnije novine polja primjene Roterdamskih pravila u odnosu na međunarodne konvencije koje su na snazi, a koje uređuju prijevoz stvari morem jesu proširenje polja primjene na prijevoze “od vrata do vrata” i novo uređenje prijevoznih isprava. Cilj rada je skrenuti pažnju na polje primjene kao važno pitanje koje utječe na recepciju Roterdamskih pravila i istaknuti ona rješenja koja se najviše kritiziraju i za koja se osnovano može pretpostaviti da predstavljaju zapreku za njihovu recepciju.This paper considers the application of provisions of the United Nations Convention on Contracts for the International Carriage of Goods Wholly or Partly by Sea (the Rotterdam Rules). The scope of coverage issues go to the heart of the new Convention. This article highlights the major topics relating to the scope of coverage. All aspects of this key issue are examined here: the general scope of application; criteria that must be satisfied for the Convention to be applied; types of transactions that the Convention might govern; application to certain parties. Some of these questions have been particularly controversial. Moreover, this paper addresses the circumstances under which the Rotterdam Rules give way to other conventions. The author discusses issues that may arise from the fact that the Convention will cover both the inward and the outward carriage. It further considers specific exclusions from the Convention. Differences between the Rotterdam Rules and the international legislation in force are pointed out. One of the most significant changes introduced by the Rotterdam Rules to the existing law is the expansion of its scope of coverage to include the door-to-door transport. The Convention covers both the inbound and the outbound international shipments to or from a Contracting State. The Convention applies to contracts in both the liner and the non-liner trades, but not to charterparties and other contracts for the use of a ship or of any space thereon. Volume contract, to which the Convention applies, may provide for greater or lesser obligations and liabilities than those imposed by the Rotterdam Rules

Closing the praziquantel treatment gap: new steps in epidemiological monitoring and control of schistosomiasis in African infants and preschool-aged children

Where very young children come into contact with water containing schistosome cercariae, infections occur and schistosomiasis can be found. In high transmission environments, where mothers daily bathe their children with environmentally drawn water, many infants and preschool-aged children have schistosomiasis. This ‘new’ burden, inclusive of co-infections with Schistosoma haematobium and Schistosoma mansoni, is being formally explored as infected children are not presently targeted to receive praziquantel (PZQ) within current preventive chemotherapy campaigns. Thus an important PZQ treatment gap exists whereby infected children might wait up to 4–5 years before receiving first treatment in school. International treatment guidelines, set within national treatment platforms, are presently being modified to provide earlier access to medication(s). Although detailed pharmacokinetic studies are needed, to facilitate pragmatic dosing in the field, an extended ‘dose pole’ has been devised and epidemiological monitoring has shown that administration of PZQ (40 mg/kg), in either crushed tablet or liquid suspension, is both safe and effective in this younger age-class; drug efficacy, however, against S. mansoni appears to diminish after repeated rounds of treatment. Thus use of PZQ should be combined with appropriate health education/water hygiene improvements for both child and mother to bring forth a more enduring solution

Epidemiological Interactions between Urogenital and Intestinal Human Schistosomiasis in the Context of Praziquantel Treatment across Three West African Countries

© 2015 Knowles et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The attached file is the published version of the article