La peste à Madagascar : spatialisation, connaissances par la population et perception de l'accessibilité aux soins

The plague is a pathogen complex with three main actors: the pathogen, the flea and the rodent. It is a major threat in the history of humanity. While in some parts of the world it has disappeared, in Madagascar it is endemic and a public health problem. This zoonosis, in its human form, affects about 400 individuals every year, particularly in areas located at an altitude of more than 800 meters above sea level, known as the central highlands. Even within the central highlands, the expression of the disease is not the same. This geography thesis aims to identify the different factors that can explain the endimicity, persistence and differences in the epidemiological expression of the disease, as well as the appearance of human cases of the plague on the island. Biological and ecological factors alone cannot explain the dynamics and circulation of the plague in Madagascar. Since health has both a social and biological aspect, the socio-spatial, behavioral and environmental factors that promote the appearance of human cases and the circulation of the disease have been explored in this thesis.La peste est un complexe pathogène regroupant trois acteurs principaux : l’agent pathogène, la puce et le rongeur. C’est un fléau majeur dans l’histoire de l’humanité. Si dans certaines régions du monde elle a disparue, à Madagascar elle sévit d’une manière endémo-épidémique et est un problème de santé publique. Cette zoonose, sous sa forme humaine, touche chaque année environ 400 individus notamment dans les zones situées à plus de 800 mètres d’altitude dites des Hautes Terres Centrales. Au sein même des Hautes Terres Centrales, l’expression de la maladie n’est pas la même. Cette thèse de géographie vise à identifier les différents facteurs pouvant expliquer à la fois l’endémicité, la persistance, les différences d’expressions épidémiologiques de la maladie mais aussi l’apparition des cas humains de la peste sur la grande île. Les facteurs biologiques et écologiques ne pouvant pas expliquer, à eux seuls, la dynamique et la circulation de la peste à Madagascar. La santé revêtant à la fois un aspect social et biologique, les déterminants socio-spatiaux, comportementaux et environnementaux liés à l’apparition des cas humains et la circulation de la maladie ont été explorées dans le cadre de cette thèse

Plague in Madagascar : spatialization, knowledge by the population and perception of access to health care

La peste est un complexe pathogène regroupant trois acteurs principaux : l’agent pathogène, la puce et le rongeur. C’est un fléau majeur dans l’histoire de l’humanité. Si dans certaines régions du monde elle a disparue, à Madagascar elle sévit d’une manière endémo-épidémique et est un problème de santé publique. Cette zoonose, sous sa forme humaine, touche chaque année environ 400 individus notamment dans les zones situées à plus de 800 mètres d’altitude dites des Hautes Terres Centrales. Au sein même des Hautes Terres Centrales, l’expression de la maladie n’est pas la même. Cette thèse de géographie vise à identifier les différents facteurs pouvant expliquer à la fois l’endémicité, la persistance, les différences d’expressions épidémiologiques de la maladie mais aussi l’apparition des cas humains de la peste sur la grande île. Les facteurs biologiques et écologiques ne pouvant pas expliquer, à eux seuls, la dynamique et la circulation de la peste à Madagascar. La santé revêtant à la fois un aspect social et biologique, les déterminants socio-spatiaux, comportementaux et environnementaux liés à l’apparition des cas humains et la circulation de la maladie ont été explorées dans le cadre de cette thèse.The plague is a pathogen complex with three main actors: the pathogen, the flea and the rodent. It is a major threat in the history of humanity. While in some parts of the world it has disappeared, in Madagascar it is endemic and a public health problem. This zoonosis, in its human form, affects about 400 individuals every year, particularly in areas located at an altitude of more than 800 meters above sea level, known as the central highlands. Even within the central highlands, the expression of the disease is not the same. This geography thesis aims to identify the different factors that can explain the endimicity, persistence and differences in the epidemiological expression of the disease, as well as the appearance of human cases of the plague on the island. Biological and ecological factors alone cannot explain the dynamics and circulation of the plague in Madagascar. Since health has both a social and biological aspect, the socio-spatial, behavioral and environmental factors that promote the appearance of human cases and the circulation of the disease have been explored in this thesis

Determinants of COVID-19-related knowledge and disrupted habits during epidemic waves among women of childbearing age in urban and rural areas of the Malagasy Middle East

Abstract Background With regard to the coronavirus disease (COVID-19) pandemic in Madagascar, little is known about the knowledge, the perceptions and the impacts of this disease on women of childbearing age. People’s knowledge of COVID-19 can have an impact on their attitudes towards seeking care. The aim of the current study is to determine the knowledge of COVID-19 and associated determinants among women of childbearing age in Moramanga. Methods A cross-sectional study based on questionnaire administration was used among women of childbearing age. Data collection was conducted from August to October 2021. A scoring method was applied to evaluate their knowledge level and perceptions about COVID-19 and its impacts on their lives. A binary stepwise logistic regression was performed to determine the sociodemographic determinants of their knowledge level about COVID-19. Results A total of 885 women of childbearing age from urban and rural Moramanga areas were interviewed. Approximately 49.8% (441/885) lived in urban areas, and 50.2% (444/885) lived in rural areas. Approximately 35.3% (322/885) of the participants had a good level of knowledge of COVID-19. Multivariate analysis showed that the probability of having a good level of knowledge of COVID-19 had a significant statistical association (p value < 0.05) with living in an urban area [AOR: 2.89; 95% CI (1.89–4.42)], telephone ownership [AOR: 1.71; 95% CI (1.16–2.53)], radio ownership [AOR 2.2; 95% CI (1.43–3.38)], watching TV [AOR = 1.95; 95% CI (1.34–2.83)] and reading journal papers [AOR = 3.74 95% CI (1.69–8.27)]. Conclusions Almost a third of the sampled women of childbearing age had a good level of knowledge of COVID-19. Access to information through telecommunications technologies increases the chances of being better informed about the disease. To avoid the negative repercussions of infectious disease epidemics, it is necessary to improve the awareness of childbearing women about these diseases by taking demographic features of the population into account

Socio-environmental features associated with plague risk in rural plague foci in the Central Highlands of Madagascar: experience of the Ambositra and Tsiroanomandidy districts.

International audienc

Socioenvironmental determinants as indicators of plague risk in the central highlands of Madagascar: Experience of Ambositra and Tsiroanomandidy districts

Background Human plague cases are reported annually in the central highland regions of Madagascar, where the disease is endemic. The socioenvironmental characteristics and lifestyles of the populations of the central highland localities could be linked to this endemicity. The aim of this study was to determine socioenvironmental determinants that may be associated with plague risk and explain this variation in epidemiological contexts.Methods The current study was based on the distribution of plague cases between 2006 and 2015 that occurred in localities of districts positioned in the central highlands. Household surveys were performed from June to August 2017 using a questionnaire and direct observations on the socioenvironmental aspects of households in selected localities. Bivariate and multivariate analyses were performed to highlight the socioenvironmental parameters associated with plague risk in both districts.Results A total of 503 households were surveyed, of which 54.9% (276/503) were in Ambositra and 45.1% (227/503) were in Tsiroanomandidy. Multivariate analyses showed that thatched roofs [adjusted odds ratio (AOR): 2.63; 95% confidence interval (95% CI): 1.78–3.88] and ground floor houses [AOR: 2.11; 95% CI: 1.3–3.45-] were significantly associated with the vulnerability of a household to plague risk (p value<0 . 05 ).Conclusions Plague risk in two districts of the Malagasy central highlands is associated with human socioenvironmental characteristics. Socioenvironmental characteristics are parameters expressing spatial heterogeneity through the difference in epidemiological expression of the plague in Ambositra and Tsiroanomandidy. These characteristics could be used as indicators of vulnerability to plague risk in plague-endemic areas

A decade of plague in Madagascar: a description of two hotspot districts

International audienceBackground: Human plague cases, mainly in the bubonic form, occur annually in endemic regions of the central highlands of Madagascar. The aim of this study was to compare the dynamics of the epidemiological features of the human plague in two districts of the central highlands region. Methods: In Madagascar, all clinically suspected plague cases that meet clinical and epidemiological criteria specified in the World Health Organization (WHO) standard case definition are reported to the national surveillance system. Data on plague cases reported between 2006 and 2015 in the districts of Ambositra and Tsiroanomandidy were analysed. Statistical comparisons between the epidemiological characteristics of the two districts were conducted. Results: A total of 840 cases of plague were reported over the studied period, including 563 (67%) probable and confirmed cases (P + C). Out of these P + C cases, nearly 86% (488/563) were cases of bubonic plague. Reported clinical forms of plague were significantly different between the districts from 2006 to 2015 (p = 0.001). Plague cases occurred annually in a period of 10 years in the Tsiroanomandidy district. During the same period, the Ambositra district was characterized by a one-year absence of cases. Conclusion: The differences in the epidemiological situation with respect to the plague from 2006 to 2015 in the two central highlands districts may suggest that several factors other than biogeographical factors determine the representation of the plague and its dynamics in this region. Considering the epidemiological situations according to the specific contexts of the districts could improve the results in the fight against the plague in Madagascar

Spatial analysis of pulmonary tuberculosis in Antananarivo Madagascar: tuberculosis-related knowledge, attitude and practice.

Tuberculosis infection may remain latent, but the disease is nevertheless a serious public health issue. Various epidemiological studies on pulmonary tuberculosis have considered the spatial component and taken it into account, revealing the tendency of this disease to cluster in particular locations. The aim was to assess the contribution of Knowledge Attitude and Practice (KAP) to the distribution of tuberculosis and to provide information for the improvement of the National Tuberculosis Program.We investigated the role of KAP to distribution patterns of pulmonary tuberculosis in Antananarivo. First, we performed spatial scanning of tuberculosis aggregation among permanent cases resident in Antananarivo Urban Township using the Kulldorff method, and then we carried out a quantitative study on KAP, involving TB patients. The KAP study in the population was based on qualitative methods with focus groups.The disease still clusters in the same districts identified in the previous study. The principal cluster covered 22 neighborhoods. Most of them are part of the first district. A secondary cluster was found, involving 18 neighborhoods in the sixth district and two neighborhoods in the fifth. The relative risk was respectively 1.7 (p<10-6) in the principal cluster and 1.6 (p<10-3) in the secondary cluster. Our study showed that more was known about TB symptoms than about the duration of the disease or free treatment. Knowledge about TB was limited to that acquired at school or from relatives with TB. The attitude and practices of patients and the population in general indicated that there is still a stigma attached to tuberculosis.This type of survey can be conducted in remote zones where the tuberculosis-related KAP of the TB patients and the general population is less known or not documented; the findings could be used to adapt control measures to the local particularities

Influence of Epidemiological Context on Knowledge, Attitudes and Practices Related to Plague in Population Living in Endemic Areas in the Central Highlands, Madagascar.

International audienc

Influence of Socio-Spatial Determinants on Knowledge, Attitudes and Practices Related to the Plague in Populations Living in Endemic Areas in the Central Highlands of Madagascar

International audienceBackground: Plague is endemic to the central highlands of Madagascar. Sporadic human cases or outbreaks can occur annually in these areas. In Madagascar, the association between endemicity and the knowledge, attitudes and practices (KAP) of populations with regard to this disease remain poorly documented. The aim of this study was to assess KAP related to the plague of populations living in the central highlands. Methods: A cross sectional survey was conducted among the general population from June to August 2017. Based on the reported cases of plague between 2006 and 2015 in two central highland districts, a KAP questionnaire was administered to the population. Based on the proportion of correct answers provided by respondents, KAP scores were classified into three KAP categories: low ( Mean + SD). Multivariate analyses were performed to determine the associations between population KAP scores related to plague with socio-demographic and epidemiological factors. In addition, individual interviews and focus groups with health professionals were conducted to assess plague perception. Results: A total of 597 individuals participated in the survey. Around 20% (n=119) had a good KAP score, 62% (n=370) an average KAP score and 18% (n=108) a low KAP score. Among the 119 respondents with a good KAP score, 80% (n=95) of them resided in Ambositra district and 20% (n=24) resided in Tsiroanomandidy district. According to the health professionals in the two districts, populations in endemic areas are well aware of the plague. A significant association with a lower KAP score was found in populations without mobile phone, having no contact with a former plague case and living in Tsiroanomandidy district (p<0.05). Conclusion: The results of the study showed the need to adapt plague control interventions to the local context to allow a better allocation of human and financial resources. This will minimize delays in patient management care and increase community resilience to plague epidemics