Epilepsie et permis de conduire au Mali : connaissances, attitudes et pratiques des moniteurs d’auto-école et des candidats au permis de conduire

Introduction: L’un des sujets les plus controversés dans le domaine de l’épilepsie est la problématique de la conduite chez l’épileptique.Objectif: Nous avons initié une étude, en collaboration avec l’Agence Nationale de la Sécurité Routière au Mali (ANASER), ayant pour but de faire l’état des lieux sur les connaissances, attitudes et pratiques des conducteurs, moniteurs et inspecteurs d’auto-écoles en matière d’épilepsie.Methode: Il s’agissait d’une étude longitudinale, prospective, descriptive et analytique qui s’est déroulée de juin 2009 à juin 2010. Elle a porté sur 31 auto-écoles du district de Bamako. 568 personnes ont été interrogées (488 candidats au permis de conduire, 70 moniteurs d’auto-école et 10 inspecteurs).Resultats: Près de 60 % des personnes interrogées accordaient une origine surnaturelle à l’épilepsie ; plus de 85 % indiquaient que l’épilepsie était incompatible avec la conduite automobile. Plus de la moitié ignorait l’existence d’une réglementation. Près de 70 % pensaient que l’épilepsie était pourvoyeuse d’accident de la voie publique.Conclusion: A l’instar de nos précédentes études communautaires au Mali, ce travail a permis de mettre l’accent, d’une part, sur l’importance des connaissances erronées sur l’épilepsie et, d’autre part, sur la nécessité d’actualiser la réglementation en matière de conduite de véhicules motorisés pour ces patients.Mots clés: Attitudes, Épilepsie, Mali, Permis de conduire, Conduite automobileEnglish Title: Epilepsy and driving licence in Mali : knowledge, attitudes and practices of driving schools monitors and the candidates for the licenceEnglish AbstractBackground: One of the most controversial topics in the field of epilepsy remains the issue of driving license for epileptic patients.Purpose: We initiated a study in collaboration with ANASER (National Agency for Road Safety in Mali) with the goal, on one hand, of assessing the knowledge, attitudes and practices of drivers and driving school authorities on epilepsy and, on the other hand, to analyze the current regulations on issuance of license to epileptic patients.Methods: Il s’agissait d’une étude longitudinale, prospective, descriptive et analytique qui s’est déroulée de juin 2009 à juin 2010. We interviewed 568 sujects, including 488 candidates for driver’s license, 70 driving school monitors and 10 inspectors.Results: About 60% gave a supernatural origin of the disease, and more than 85% believed that epilepsy was incompatible with driving. More than half were unaware of regulations. Approximately, 70% of respondents believed that epilepsy was a contributory factor to road accident.Conclusion: As in our previous community studies in Mali, this study emphasizes the importance of misconceptions about epilepsy, and has shown the need to update the regulations regarding the driving of motorized vehicles for these patients.Keywords: Epilepsy, Attitudes, Driving , Driving License, Mal

Differential infectivity of gametocytes after artemisinin-based combination therapy of uncomplicated falciparum malaria

Background: Most malaria-endemic countries use artemisinin-based combination therapy (ACT) as their first-line treatment. ACTs are known to be highly effective on asexual stages of the malaria parasite. Malaria transmission and the spread of resistant parasites depend on the infectivity of gametocytes. The effect of the current ACT regimens on gametocyte infectivity is unclear. Objectives: This study aimed to determine the infectivity of gametocytes to Anopheles gambiae following ACT treatment in the field. Methods: During a randomised controlled trial in Bougoula-Hameau, Mali, conducted from July 2005 to July 2007, volunteers with uncomplicated malaria were randomised to receive artemether-lumefantrine, artesunate-amodiaquine, or artesunate-sulfadoxine/pyrimethamine. Volunteers were followed for 28 days, and gametocyte carriage was assessed. Direct skin feeding assays were performed on gametocyte carriers before and after ACT administration. Results: Following artemether-lumefantrine treatment, gametocyte carriage decreased steadily from Day 0 to Day 21 post-treatment initiation. In contrast, for the artesunate-amodiaquine and artesunate-sulfadoxine/pyrimethamine arms, gametocyte carriage increased on Day 3 and remained constant until Day 7 before decreasing afterward. Mosquito feeding assays showed that artemether-lumefantrine and artesunate-amodiaquine significantly increased gametocyte infectivity to Anopheles gambiae sensu lato (s.l.) (p < 10−4), whereas artesunate-sulfadoxine/pyrimethamine decreased gametocyte infectivity in this setting (p = 0.03). Conclusion: Different ACT regimens could lead to gametocyte populations with different capacity to infect the Anopheles vector. Frequent assessment of the effect of antimalarials on gametocytogenesis and gametocyte infectivity may be required for the full assessment of treatment efficacy, the potential for spread of drug resistance and malaria transmission in the field

Repeated Artemisinin-Based Combination Therapies in a Malaria Hyperendemic Area of Mali: Efficacy, Safety, and Public Health Impact

International audienceArtemisinin-based combination therapies (ACTs) are the first-line treatment of uncomplicated malaria. The public health benefit and safety of repeated administration of a given ACT are poorly studied. We conducted a randomized trial comparing artemether-lumefantrine, artesunate plus amodiaquine (AS+AQ) and artesunate plus sulfadoxine-pyrimethamine (AS+SP) in patients 6 months of age and older with uncomplicated malaria in Mali from July 2005 to July 2007. The patient received the same initial treatment of each subsequent uncomplicated malaria episode except for treatment failures where quinine was used. Overall, 780 patients were included. Patients in the AS+AQ and AS+SP arms had significantly less risk of having malaria episodes; risk ratio (RR) = 0.84 (P = 0.002) and RR = 0.80 (P = 0.001), respectively. The treatment efficacy was similar and above 95% in all arms. Although all drugs were highly efficacious and well tolerated, AS+AQ and AS+SP were associated with less episodes of malaria

Gametocyte clearance dynamics following oral artesunate treatment of uncomplicated falciparum malaria in Malian children

Artemisinin-based combination therapies decrease Plasmodium gametocyte carriage. However, the role of artesunate in monotherapy in vivo, the mechanisms involved, and the utility of gametocyte carriage as a potential tool for the surveillance of antimalarial resistance are poorly understood. In 2010–2011, we conducted an open-label, prospective efficacy study of artesunate as monotherapy in children 1–10 years of age with uncomplicated falciparum malaria in Bougoula-Hameau, Mali. Standard oral doses of artesunate were administered for 7 days and patients were followed up for 28 days. The data were compared to a similar study conducted in 2002–2004. Of 100 children enrolled in the 2010–2011 study, 92 were analyzed and compared to 217 children enrolled in the 2002–2004 study. The proportion of gametocyte carriers was unchanged at the end of treatment (23% at baseline vs. 24% on day 7, p = 1.0) and did not significantly decline until day 21 of follow-up (23% vs. 6%, p = 0.003). The mean gametocyte density at inclusion remained unchanged at the end of treatment (12 gametocytes/μL vs. 16 gametocytes/μL, p = 0.6). Overall, 46% of the 71 initial non-carriers had gametocytes detected by day 7. Similar results were found in the 2002–2004 study. In both studies, although gametocyte carriage significantly decreased by the end of the 28-day follow-up, artesunate did not clear mature gametocytes during treatment and did not prevent the appearance of new stage V gametocytes as assessed by light microscopy. Baseline gametocyte carriage was significantly higher 6 years after the deployment of artemisinin-based combination therapies in this setting

Gametocyte clearance dynamics following oral artesunate treatment of uncomplicated

Artemisinin-based combination therapies decrease Plasmodium gametocyte carriage. However, the role of artesunate in monotherapy in vivo, the mechanisms involved, and the utility of gametocyte carriage as a potential tool for the surveillance of antimalarial resistance are poorly understood. In 2010–2011, we conducted an open-label, prospective efficacy study of artesunate as monotherapy in children 1–10 years of age with uncomplicated falciparum malaria in Bougoula-Hameau, Mali. Standard oral doses of artesunate were administered for 7 days and patients were followed up for 28 days. The data were compared to a similar study conducted in 2002–2004. Of 100 children enrolled in the 2010–2011 study, 92 were analyzed and compared to 217 children enrolled in the 2002–2004 study. The proportion of gametocyte carriers was unchanged at the end of treatment (23% at baseline vs. 24% on day 7, p = 1.0) and did not significantly decline until day 21 of follow-up (23% vs. 6%, p = 0.003). The mean gametocyte density at inclusion remained unchanged at the end of treatment (12 gametocytes/μL vs. 16 gametocytes/μL, p = 0.6). Overall, 46% of the 71 initial non-carriers had gametocytes detected by day 7. Similar results were found in the 2002–2004 study. In both studies, although gametocyte carriage significantly decreased by the end of the 28-day follow-up, artesunate did not clear mature gametocytes during treatment and did not prevent the appearance of new stage V gametocytes as assessed by light microscopy. Baseline gametocyte carriage was significantly higher 6 years after the deployment of artemisinin-based combination therapies in this setting

Revue des outils de suivi agropétérologique et des méthodes utilisés dans le Sahel de l'Afrique de l'Ouest

Agrometeorological monitoring in the Sahelian countries consists of collecting, processing, and analyzing various data and information that can affect the outcome of the agricultural season. It combines observational data from national meteorological, hydrological, agricultural extension, plant protection, and livestock breeding offices, as well as satellite data provided by the AGRHYMET Center. From May until the end of October, multidisciplinary working groups (MWGs) in each country publish dekadal and monthly bulletins. At the regional level in the AGRHYMET Center, data and information coming from the national components are combined with satellite data to elaborate regional syntheses that are published at different time steps. In these publications, the current situation is analyzed and compared with that of the previous period, the previous year, and the average. Forecasts of seasonal rainfall and crop yields, that are refined from month to month, are also given. Color maps illustrates the amounts of rainfall, sowing dates, crop water requirements, satisfaction indices, yield estimates, zones with particular pests, and the advance of the vegetation front. Hard copies and electronic versions of these publications are mailed to subscribers. They are also posted on the Center’s website: www.agrhymet.ne