Safety and Efficacy of Adding a Single Low Dose of Primaquine to the Treatment of Adult Patients With Plasmodium falciparum Malaria in Senegal, to Reduce Gametocyte Carriage: A Randomized Controlled Trial.

Introduction: More information is needed about the safety of low-dose primaquine in populations where G6PD deficiency is common. Methods: Adults with Plasmodium falciparum malaria were randomized to receive 1 of 3 artemisinin combination therapies (ACTs) with or without primaquine (0.25 mg/kg). Glucose-6-phosphate dehydrogenase (G6PD) status was determined using a rapid test. Patients were followed for 28 days to record hemoglobin concentration, adverse events, and gametocyte carriage. The primary end point was the change in Hb at day 7. Results: In sum, 274 patients were randomized, 139 received an ACT alone, and 135 received an ACT + primaquine. The mean reduction in Hb at day 7 was similar in each group, a difference in the ACT + PQ versus the ACT alone group of -0.04 g/dL (95% confidence interval [CI] -0.23, 0.31), but the effect of primaquine differed according to G6PD status. In G6PD-deficient patients the drop in Hb was 0.63 g/dL (95% CI 0.03, 1.24) greater in those who received primaquine than in those who received an ACT alone. In G6PD-normal patients, the reduction in Hb was 0.22 g/dL (95% CI -0.08, 0.52) less in those who received primaquine (interaction P = .01). One G6PD normal patient who received primaquine developed moderately severe anaemia (Hb < 8 g/dL). Dark urine was more frequent in patients who received primaquine. Primaquine was associated with a 73% (95% CI 24-90) reduction in gametocyte carriage (P = .013). Conclusion: Primaquine substantially reduced gametocyte carriage. However, the fall in Hb concentration at day 7 was greater in G6PD-deficient patients who received primaquine than in those who did not and one patient who received primaquine developed moderately severe anemia. Clinical Trial registration: PACTR201411000937373 (www.pactr.org)

Efficacy and tolerability of a new formulation of artesunate-mefloquine for the treatment of uncomplicated malaria in adult in Senegal: open randomized trial

BACKGROUND: Prompt treatment of malaria attacks with arteminisin-based combination therapy (ACT) is an essential tool for malaria control. A new co-blister tablet of artesunate-mefloquine (AM) with 25 mg/kg mefloquine has been developed for the management of uncomplicated malaria attacks. This non-inferiority randomized trial, was conducted to evaluate the efficacy and safety of the new formulation of AM in comparison to artemether-lumefantrine (AL) for the treatment of acute uncomplicated Plasmodium falciparum malaria in adults in Senegal. METHODS: The study was carried out from September to December 2010 in two health centres in Senegal. The study end points included (i) PCR corrected adequate clinical and parasitological response (ACPR) at day 28, (ii) ACPR at days 42 and 63, (iii) parasites and fever clearance time, (iv) incidence of adverse events and patients biological profile at day 7 using the WHO 2003 protocol for anti-malarial drug evaluation. RESULTS: Overall, 310 patients were randomized to receive either AM (n = 157) or AL (n = 153). PCR corrected ACPR at day 28 was at 95.5% in the AM arm while that in the AL arm was at 96.7% (p = 0.83). Therapeutic efficacy was at 98.5% in the AM arm versus 98.2% in the AL group at day 42 (p = 1). At day 63, ACPR in the AM and AL arms was at 98.2% and 97.7%, respectively (p = 0.32). The two treatments were well tolerated with similar biological profile at day 7. However, dizziness was more frequent in the AM arm. CONCLUSION: Artesunate-mefloquine (25 mg/Kg mefloquine) is efficacious and well-tolerated for the treatment of uncomplicated P. falciparum malaria in adult patients

Evaluation De La Denutrition Chez Les Enfants Ages De 2 A 60 Mois Hospitalises Aux Services De Pediatrie Des Hopitaux De Ziguinchor (Senegal)

Introduction: Malnutrition is a public health problem in developing countries. The prevalence of malnutrition at the national level hardly reflects the reality in hospitals. It is in this context that we assessed the nutritional status of children from 2 months to 5 years hospitalized in the pediatric ward of the regional hospital and the Ziguinchor Peace Hospital. Materials and methods: This was a prospective study from June 1 to October 30, 2016. Children aged 2 to 60 months, hospitalized in one of the two services, were included. Children with esdato-ascetic syndrome were not included. Epidemiological, anthropometric data, and associated diagnosis were studied. Results: We included 114 children (70 boys and 44 girls). The average age was 21.9 months [4-59]. Forty-two point one percent (42.1%) of infants &lt;6 months were breastfed exclusively with breast milk. The weaning of children was done early in 55.3%. The mean age of mothers was 26.6 years [17-38]. The socioeconomic level was low in 62.3% of cases. The prevalence of malnutrition averaged 35.5% for underweight; 32.9% for wasting and 32.0% for stunting. Acute respiratory infections (ARI) and acute gastroenteritis were the most common associated conditions. Mean hospital stay was 8 days ± 009 [3-28]. About two thirds of the patients (n = 72) had a hospital stay of more than 7 days. Malnutrition was significantly associated with multiparity, low socioeconomic status, hospital stay of more than 7 days and infectious diseases. Conclusion: Infections and a hospital stay longer than a week are factors favoring malnutrition in children from 2 months to 5 years

Diversité et Occurrence des Ravageurs dans les Agroécosystèmes Maraîchers en Basse Casamance, Sénégal

Les arthropodes ravageurs des cultures constituent une menace permanente pour la production horticole. La plupart des familles d’arthropode sont très mal connues dans la zone agroécologique de la Casamance car peu de travaux de recherches ont été effectués. Une meilleure connaissance des ravageurs facilite le choix des stratégies de lutte. L’objectif de cette étude est de déterminer l’occurrence et la diversité spécifique des ravageurs associés aux cultures maraîchères. Une étude a été menée sur 144 parcelles situées dans trois localités de la zone agroécologique de la Casamance. L’inventaire des arthropodes ravageurs des cultures a été effectué dans les périmètres maraîchers. Des indices écologiques sont calculés pour évaluer diversité des ravageurs. Un nombre de 4882 spécimens de ravageurs dont 65 espèces réparties dans sept ordres et 28 familles sont collectés sur 17 plantes hôtes. Quatre ordres de ravageurs attaquent la moitié des plantes hôtes échantillonnées. Un total de 51 espèces a une présence de 100%. La diversité des ravageurs est plus élevée à Oussouye alors que l’abondance est plus élevée à Ziguinchor. La connaissance de la diversité et de la distribution des ravageurs facilitent la mise en place de stratégies alternatives de lutte en vue de préserver la filière maraîchère. Arthropod pests of crops are a permanent threat to horticultural production. Most arthropod families are poorly known in the Casamance agroecological zone because little research has been done. A better knowledge of the pests facilitates the choice of control strategies. The objective of this study is to determine the occurrence and specific diversity of pests associated with crops. A study was conducted on 144 plots located in three localities of the Casamance agroecological zone. The inventory of crop pests were carried out in the market gardens. Ecological indices were calculated to assess pest diversity. A total of 4882 pest specimens including 65 species in seven orders and 28 families were collected from 17 host plants. Four orders of pests attacked half of the sampled host plants. A total of 51 species have a 100% occurrence. Pest diversity is higher in Oussouye, while abundance is higher in Ziguinchor. Knowledge of the diversity and distribution of pests facilitates the development of alternative control strategies to preserve the market gardening sector

Étude in vitro de l’effet antifalcémiant des globules rouges et de l’activité antioxydante d’extraits de la poudre de racines de Maytenus senegalensis Lam (Celestraceae)

La drépanocytose est une hémoglobinopathie largement répandue chez les populations africaines noires. Actuellement, très peu de traitements conventionnels existent sur le marché, d’où le recours à la médecine traditionnelle. Maytenus senegalensis est une plante prescrite par les tradipraticiens dans la prise en charge de la drépanocytose. L’activité antifalcémiante des extraits de la poudre de racines de Maytenus senegalensis a été étudiée dans ce travail. Après obtention de l’extrait hexanique par extraction à l’aide d’un Soxhlet, le marc est macéré dans de l’acétate d’éthyle puis dans du méthanol pour donner les extraits correspondants. L’activité des fractions a été évaluée sur des drépanocytes de type SS. Les activités antifalcémiantes les plus importantes ont été observées pour les fractions polaires du méthanol et de l’acétate d’éthyle avec des taux d’inversion de la falciformation respectivement de 77% et de 65% à 10 mg/mL. Les activités antioxydantes de M. senegalensis (CI50 = 0,195 ± 0,004 mg/mL) et de l’acide ascorbique (CI50 = 0,078 ± 0,002 mg/mL) ont été déterminées. Les pouvoirs antioxydants (PA) montrent que l’activité antiradicalaire de l’acide ascorbique (PA = 12,85) est 2,5 fois meilleure que celle de M. senegalensis (PA = 5,14). Les résultats de l’étude justifient l’utilisation traditionnelle des racines de Maytenus senegalensis dans la prise en charge de la drépanocytose.Mots clés : Hémoglobine, drépanocytose, Maytenus senegalensis, activité antifalcémiante, stress oxydant, radicaux libres, activité antioxydante

Monitoring the efficacy and safety of three artemisinin based-combinations therapies in Senegal: results from two years surveillance

BACKGROUND: Malaria remains a major public health problem in developing countries. Then in these countries prompt access to effective antimalarial treatment such as Artemisinin based-Combination Therapies (ACT) proves to be an essential tool for controlling the disease. In Senegal, since 2006 a nationwide scaling up program of ACT is being implemented. In this context it has become relevant to monitor ACT efficacy and provide recommendations for the Senegalese national malaria control program. METHODS: An open randomized trial was conducted during two malaria transmission seasons (2011 and 2012) to assess the efficacy and safety of three combinations: dihydro-artemisinin-piperaquine (DHAPQ), artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ). The primary end point of the study was represented by a PCR adjusted adequate clinical and parasitological response (ACPR) at day 28. Secondary end points included: (i) a ACPR at days 35 and 42, (ii) a parasite and fever clearance time, (iii) ACTs safety and tolerability. The 2003 WHO’s protocol for antimalarial drug evaluation was used to assess each outcome. RESULTS: Overall, 534 patients were randomized selected to receive, either ASAQ (n = 180), AL (n = 178) or DHAPQ (n = 176). The PCR adjusted ACPR at day 28 was 99.41% for the group ASAQ, while that was 100% in the AL and DHAPQ groups (p = 0.37). The therapeutic efficacy was evaluated at 99.37% in the ASAQ arm versus 100% in AL and DHAPQ arm at day 35 (p = 0.37). At day 42, the ACPR was 99.27% in the ASAQ group versus 100% for both AL and DHAPQ groups, (p = 0.36). No serious adverse event was noted during the study period. Also a similar safety profile was noted in the 3 study groups. CONCLUSION: In the context of scaling up of ACTs in Senegal, ASAQ, AL and DHAPQ are highly effective and safe antimalarial drugs. However, it’s remains important to continue to monitor their efficacy. TRIAL REGISTRATION: PACTR 201305000552290

The association between malaria parasitaemia, erythrocyte polymorphisms, malnutrition and anaemia in children less than 10 years in Senegal:a case control study

BACKGROUND: Malaria and anaemia (Haemoglobin <11 g/dl) remain frequent in tropical regions and are closely associated. Although anaemia aetiologies are known to be multi-factorial, most studies in malaria endemic areas have been confined to analysis of possible associations between anaemia and individual factors such as malaria. A case control study involving children aged from 1 to 10 years was conducted to assess some assumed contributors to anaemia in the area of Bonconto Health post in Senegal. METHODS: Study participants were randomly selected from a list of children who participated in a survey in December 2010. Children aged from 1 to 10 years with haemoglobin level below 11 g/dl represented cases (anaemic children). Control participants were eligible if of same age group and their haemoglobin level was >= 11 g/dl. For each participant, a physical examination was done and anthropometric data collected prior to a biological assessment which included: malaria parasitaemia infection, intestinal worm carriage, G6PD deficiency, sickle cell disorders, and alpha-talassaemia. RESULTS: Three hundred and fifty two children < 10 years of age were enrolled (176 case and 176 controls). In a logistic regression analysis, anaemia was significantly associated with malaria parasitaemia (aOR=5.23, 95%CI[1.1-28.48]), sickle cell disorders (aOR=2.89, 95%CI[1,32-6.34]), alpha-thalassemia (aOR=1.82, 95%CI[1.2-3.35]), stunting (aOR=3.37, 95%CI[1.93-5.88], age ranged from 2 to 4 years (aOR=0.13, 95%CI[0.05-0.31]) and age > 5 years (aOR=0.03, 95%CI[0.01-0.08]). Stratified by age group, anaemia was significantly associated with stunting in children less than 5 years (aOR=3.1 95%CI[1.4 – 6.8]), with, sickle cell disorders (aOR=3.5 95%CI [1.4 – 9.0]), alpha-thalassemia (or=2.4 95%CI[1.1–5.3]) and stunting (aOR=3.6 95%CI [1.6–8.2]) for children above 5 years. No association was found between G6PD deficiency, intestinal worm carriage and children’s gender. CONCLUSION: Malaria parasitaemia, stunting and haemoglobin genetic disorders represented the major causes of anaemia among study participants. Anaemia control in this area could be achieved by developing integrated interventions targeting both malaria and malnutrition