Knowledge and acceptability of the rectal treatment route in Laos and its application for pre-referral emergency malaria treatment

<p>Abstract</p> <p>Background</p> <p>Rectal artesunate has been shown to reduce death and disability from severe malaria caused by delays in reaching facilities capable of providing appropriate treatment.</p> <p>Acceptability of this mode of drug delivery in Laos is not known. In 2009 the acceptability of rectal treatments was evaluated among the general Lao population and Lao doctors in a national survey.</p> <p>Methods</p> <p>A cross sectional survey was performed of 985 households selected through a multi-stage random sampling process from 85 villages in 12/18 provinces and of 315 health staff randomly selected at each administrative level.</p> <p>Results</p> <p>Out of 985 families, 9% had used the rectal route to treat children (the main indication was seizures or constipation). The population considered it less effective than other routes. Other concerns raised included pain (28%), discomfort for children (40%) and the possibility of other side effects (20%). Of 300 health staff surveyed (nurses 44%, doctors 66%), only 51% had already used the rectal route with a suppository, mostly to treat fever (76%). Health staff working in provincial hospitals had more experience of using the rectal route than those in urban areas. The majority (92%) were keen to use the rectal route to treat malaria although oral and intramuscular routes were preferred and considered to be more efficacious.</p> <p>Discussion and conclusion</p> <p>Use of rectal treatments is uncommon in Laos and generally not considered to be very effective. This view is shared by the population and health care workers. More information and training are needed to convince the population and health staff of the efficacy and advantages of the rectal route for malaria treatment.</p

Can we eradicate Cysticercosis?

International audiencepas de résum

Malaria risk assessment through Remote Sensing and MultiCriteria Evaluation in Madagascar

ObjectiveMadagascar is one of the low-income countries with limited resources. In order to minimize the cost of the fight against malaria, the main objective of this study is to identify the priority zone for Indoor Residual Spraying (IRS).IntroductionMalaria remains a major public health problem in Madagascar. Indoor Residual Spraying (IRS) is the adopted strategy for malaria control in the CHs and Fringe regions of Madagascar. Remotely sensed data analysis combined with Multi-Criteria Evaluation become crucial to target priority areas for intervention.MethodsSatellite images were used to update land cover information using object based image analysis method, NOAA and MODIS for temperature and rainfall data. Multi-Criteria Evaluation was performed by weighted linear combination to obtain the gradient of malaria transmission risk. Factor weights were determined by pair-wise comparison based on literature review and expert knowledge. Fuzzy set theory was used to perform the factors weighting. To estimate a best fit risk magnitude probability per commune, we used per pixel values for inhabited locations, and chose an adjusted mean. The Jenks Natural Breaks algorithm was used to classify the obtained malaria risk gradient. All the process was compiled in a semi-automatic plugin working in an open source software. Comparison of risk magnitude between two consecutive years was performed to assess the environmental change.ResultsThree models of malaria risk are available for 2014, 2015 and 2016. The updated land cover map showed suitable breeding sites for mosquito responsible of malaria transmission in CHs with an accuracy of 84%. A change of 64.4% and 35.6% unchanged were obtained concerning change detection of malaria risk between 2014 and 2015. Between the years 2015 and 2016, 11.2% of the area of interest remains unchanged while 88.8% changed. Respectively 26.9% decreased and 61.9% increased.ConclusionsIt is crucial to focus the indoor residual spraying efforts according to the risk gradient. This allows to increase the effectiveness of the intervention targeting areas with the most need, as well as to optimize financial and logistical resource management.References1. Rakotomanana, F, Randremanana R, Rabarijaona L, et al. Determining areas that require indoor insecticide spraying using Multi Criteria Evaluation, a decision-support tool for malaria vector control programmes in the Central Highlands of Madagascar. International Journal of Health Geographics, 2007, 6:2. 10.1186/1476-072X-6-22. Saaty TL: A scaling method for priorities in hierarchical structures . Journal of Mathematical Psychology. 1977, 15: 234-281. 10.1016/0022-2496(77)90033-5

Prevalence and genetic variants of G6PD deficiency among two Malagasy populations living in Plasmodium vivax-endemic areas

Abstract Background The prevalence and variants of G6PD deficiency in the Plasmodium vivax-endemic zones of Madagascar remain unknown. The admixed African-Austronesian origins of the Malagasy population make it probable that a heterogeneous mix of genetic variants with a spectrum of clinical severity will be circulating. This would have implications for the widespread use of P. vivax radical cure therapy. Two study populations in the P. vivax-endemic western foothills region of Madagascar were selected for G6PD screening. Both the qualitative fluorescent spot test and G6PD genotyping were used to screen all participants. Results A total of 365 unrelated male volunteers from the Tsiroanomandidy, Mandoto, and Miandrivazo districts of Madagascar were screened and 12.9% were found to be phenotypically G6PD deficient. Full gene sequencing of 95 samples identified 16 single nucleotide polymorphisms, which were integrated into a genotyping assay. Genotyping (n = 291) found one individual diagnosed with the severe G6PD Mediterranean C563T mutation, while the remaining G6PD deficient samples had mutations of African origin, G6PD A- and G6PD A. Conclusions Deployment of P. vivax radical cure in Madagascar must be considerate of the risks presented by the observed prevalence of G6PDd prevalence. The potential morbidity associated with cumulative episodes of P. vivax clinical relapses requires a strategy for increasing access to safe radical cure. The observed dominance of African G6PDd haplotypes is surprising given the known mixed African-Austronesian origins of the Malagasy population; more widespread surveying of G6PDd epidemiology across the island would be required to characterize the distribution of G6PD haplotypes across Madagascar

MOESM4 of Contemporary epidemiological overview of malaria in Madagascar: operational utility of reported routine case data for malaria control planning

Additional file 4. Additional plots of the trends of reported malaria case data in Madagascar (2010–2015). This file provides additional analysis of the temporal trends in the reported malaria data. Data are adjusted for reporting and diagnostic shortages, and trends are examined using autocorrelation plots, generalized additive models and linear regression models

MOESM1 of Contemporary epidemiological overview of malaria in Madagascar: operational utility of reported routine case data for malaria control planning

Additional file 1. Summary of data sources consulted. The table provides details of the data sources used for each figure in the paper

Remote sensing and multi-criteria evaluation for malaria risk mapping to support indoor residual spraying prioritization in the central highlands of Madagascar

International audienceThe National Malaria Control Program (NMCP) in Madagascar classifies Malagasy districts into two malaria situations: districts in the pre-elimination phase and districts in the control phase. Indoor residual spraying (IRS) is identified as the main intervention means to control malaria in the Central Highlands. However, it involves an important logistical mobilization and thus necessitates prioritization of interventions according to the magnitude of malaria risks. Our objectives were to map the malaria transmission risk and to develop a tool to support the Malagasy Ministry of Public Health (MoH) for selective IRS implementation. For the 2014-2016 period, different sources of remotely sensed data were used to update land cover information and substitute in situ climatic data. Spatial modeling was performed based on multi-criteria evaluation (MCE) to assess malaria risk. Models were mainly based on environment and climate. Three annual malaria risk maps were obtained for 2014, 2015, and 2016. Annual parasite incidence data were used to validate the results. In 2016, the validation of the model using a receiver operating characteristic (ROC) curve showed an accuracy of 0.736; 95% CI [0.669-0.803]. A free plugin for QGIS software was made available for NMCP decision makers to prioritize areas for IRS. An annual update of the model provides the basic information for decision making before each IRS campaign. In Madagascar and beyond, the availability of the free plugin for open-source software facilitates the transfer to the MoH and allows further application to other problems and contexts