Clinical picture of pulmonary plague observed in the paediatric wards of antananarivo

Introduction: In Madagascar, plague is a highly contagious acute endemic infectious disease. The diagnosis of the most severe form of pneumonic plague remains difficult in children, hence the objectives of the present study; which is to identify the clinical signs of this clinical form in children and to describe its epidemiological and evolutionary profile. Methods: A retrospective case-control study was conducted in four pediatric wards in Antananarivo during the urban pneumonic plague outbreak from September 2017 to January 2018. Those cases were defined as children aged 0-15 years old suspected of having plague with positive RDT and PCR, and they were defined as children aged 0-15 years old with negative RDT and PCR. Results: Fifty-two cases of pneumonic plague were identified, half of which (50%) were under 24 months of age. A male predominance was noted with a sex ratio of 1.23 and 86.54% of the patients were from urban areas. Several clinical signs were found but none was specific for pneumonic plague: cough (59.62% p: 0.5), dyspnea (3.85% p: 0.16), chest pain (3.85% p: 0.26%), hemoptysis (7.69% p: 0.17), vomiting (9.62% p: 0.14), diarrhea (11.54% p: 0.45), altered general condition (38.46% p: 0.24%). Two deaths were noted (3.8%). Conclusion: No specific clinical warning signs have been identified in childhood pneumonic plague. In the event of an epidemic of urban pneumonic plague, any bacterial pneumonia should at least initially include active treatment against Yersinia pestis

Etude évaluative de la rémanence des initiatives en faveur de la prévention primaire et secondaire pour l'épilepsie et la santé mentale à Madagascar

International audienceA Madagascar, des initiatives pour la prise en charge de l’épilepsie et de la santé mentale (campagnes de sensibilisation, formations, etc.) ont été réalisées entre 2013 et 2018 dans 5 des 22 régions. Notre objectif principal était d’évaluer l’efficacité de ces initiatives à moyen terme (2 à 5 ans plus tard)

Availability cost of antiepileptic and psychotropic drugs after community-based interventions in madagascar

International audienceBackground: In Madagascar, prevalence of epilepsy is 27.3/1000 and the lifetime prevalence of mental disorders 34.0. From 2013 to 2018, interventions were carried out by the MoH to train GPs on these diseases and raise awareness among the population.Objectives: The objective was to compare the availability and cost of drugs between intervention and control areas in 8 regions of Madagascar.Methods: Data were collected from all types of points of sale (POS) for medicines (public and private). All psychotropic and antiepileptic drugs were included. The study received ethical approval from the Madagascar MoH.Results: 218 POS (82.5%) agreed to be investigated. Regarding the overall availability of AEDs, there was no significant difference between intervention and control areas (95.9% vs 94.4% of POS stocking at least one AED). There were however differences for carbamazepine (79.7% vs 53.4%) and sodium valproate (27.0% vs 11.8%) with these being available in a greater number of POS in the intervention areas (p <0.05). Phenobarbital was the most commonly stocked AED in both areas (90.5% and 88.9% p=0.7). Phenytoin was not available in any supply chain. Among psychotropic drugs, anxiolytics (89.0%) were the most frequently available overall, followed by neuroleptics (21.6%) and tricyclic antidepressants (15.6%). There were significantly more outlets in the intervention areas having tricyclic antidepressants (27.0%) and mood stabilizers (4.1%). The price of AEDs and psychotropic drugs were lower in the intervention areas, except for injectable neuroleptics.Conclusions: These results suggest greater availability and lower prices for antiepileptic and psychotropic drugs in the intervention areas. As both availability and cost of drugs can affect access to treatment, this provides a relevant focus for the national epilepsy and mental health st

L’épilepsie à Madagascar : quelle rémanence des initiatives passées ?

International audienceIntroduction Des initiatives pour la prise en charge del’épilepsie (campagnes de sensibilisation, formations, etc.) ontété menées dans 5 des 22 régions de Madagascar entre 2013 et2018. Notre objectif principal était d’évaluer l’efficacité à longterme de ces initiatives (soit 2 à 5 ans plus tard). Les objec-tifs spécifiques étaient (i) d’évaluer les effets et les bénéficesdes interventions auprès de la population générale et des per-sonnes souffrant d’épilepsie, et (ii) d’évaluer les bénéfices desinterventions auprès des prestataires de soins.Méthodes Il s’agit d’une étude quasi expérimentale (zonesd’intervention vs zones contrôle) composée de 5 enquêtes(i) Connaissances–Attitudes–Pratiques (CAP) populationgénérale, (ii) outils pour les scolaires, (iii) médecins général-istes CAP, (iv) diagnostics et conformité des prescriptions, et(v) les consultations à différents niveaux du système de santé.Résultats Les scores CAP de la population générale et dupersonnel soignant étaient significativement plus élevés dansla zone d’intervention. La bande dessinée était un outiltrès efficace et didactique pour sensibiliser et informer lesenfants. Les consultations étaient plus fréquentes dans leszones d’intervention notamment dans les centres de santéde base. La conformité des diagnostics et des prescriptions(avec les recommandations OMS) était plus élevée dans la zoned’intervention, mais tout de même classé comme « moyenne »après audit par des spécialistes. Une différence significative aété retrouvée avec une meilleure concordance en zone con-trôle (80 %) par rapport en zone d’intervention (56 %).Conclusion Les connaissances sur l’épilepsie en populationgénérale étaient insuffisantes, et l’éducation du public estainsi recommandée pour corriger des idées fausses. La bandedessinée destinée aux écoliers a été efficace pour améliorer lesCAP des élèves d’écoles publiques. La formation des médecinsgénéralistes a été efficace à court terme, mais à long terme,les CAP sont de nouveau très insuffisantes. Les interventionsdoivent être soutenues et continues jusqu’à ce que le diagnos-tic et la prise en charge des épileptiques soient acqui

Effects of an educational comic book on epilepsy-related knowledge, attitudes and practices among schoolchildren in Madagascar

International audienceIntroduction: Epilepsy is a chronic disease of the brain that affects approximately 50 million people globally, with over 80 % of them living in low- and middle-income countries (LMICs). In Madagascar, as in most LMICs, one of the main obstacles to treatment is the stigma and discrimination experienced by patients. Beliefs and prejudices regarding this disease are common, especially among children. "Ao Tsara" is an educational comic book regarding epilepsy, which has been translated in Malagasy from a French version, and which objective is to raise awareness and fight epilepsy related stigma and discrimination. Comic books have indeed been used successfully to raise awareness and change behaviors in several areas of public health. Methods: We conducted a study to evaluate the effect of a single reading of this comic book on epilepsy related knowledge, attitudes and practices (KAP) in schoolchildren in Madagascar. This quasi-experimental study compared data collected before and immediately after reading "Ao Tsara". It was conducted both in a school in an urban area and in a school in a rural area. Results: We recruited 244 children with a mean age of 11.4 (±1.5) in this study. We noted a significant improvement in the global KAP score after reading the comic book, overall as well as both in the urban school and the rural school. Out of a maximum score of twenty, the global KAP score increased from 9.4 to 11.2 (p < 0.001). Although the increase in knowledge was reasonable (10.2-12.9, p < 0.001) and the corresponding subscore after reading the comic book was at a satisfactory level, that was not the case for attitudes & practices, where the sub-score despite a significant increase remained low (8.7-9.5 out of a maximum score of twenty, p < 0.001). The comic book was much appreciated by the children with more than 50.0 % giving it the top rating, and 66.4 % stating they had learned a lot from it. Conclusion: A single reading of the comic book has demonstrated a positive effect on the knowledge, attitudes and practices of primary school children in Madagascar. This educational tool, which was much enjoyed by the children, could be of great value to raise awareness about epilepsy in Madagascar. By targeting a slightly older age group and adjusting the reading approach, the outcomes could be optimized especially in terms of attitudes and practices

Productive disruption: opportunities and challenges for innovation in infectious disease surveillance

Infectious diseases place an unacceptable and disproportionate social and economic burden on low-income countries. National disease control programmes have the difficult task of allocating limited budgets for interventions across regions of their countries, based on often disparate datasets of varying quality from a range of sources including clinics, hospitals, village health workers, the private sector and non-governmental organisations (NGOs). Every stage of the data collection and analysis pipeline for surveillance systems may be affected by a lack of capacity as well as by biases and misaligned incentives for reporting and managing data. Addressing these issues will be essential for effective reduction in the burden of endemic infectious diseases globally as well as to preparing for emerging epidemic threats