Anti-malarial prescriptions in three health care facilities after the emergence of chloroquine resistance in Niakhar, Senegal (1992–2004)

<p>Abstract</p> <p>Background</p> <p>In the rural zone of Niakhar in Senegal, the first therapeutic failures for chloroquine (CQ) were observed in 1992. In 2003, the national policy regarding first-line treatment of uncomplicated malaria was modified, replacing CQ by a transitory bi-therapy amodiaquine/sulphadoxine-pyrimethamine (AQ/SP), before the implementation of artemisinin-based combination therapy (ACT) in 2006.</p> <p>The aims of the study were to assess the evolution of anti-malarial prescriptions in three health care facilities between 1992 and 2004, in parallel with increasing CQ resistance in the region.</p> <p>Methods</p> <p>The study was conducted in the area of Niakhar, a demographic surveillance site located in a sahelo-sudanese region of Senegal, with mesoendemic and seasonal malaria transmission. Health records of two public health centres and a private catholic dispensary were collected retrospectively to cover the period 1992–2004.</p> <p>Results</p> <p>Records included 110,093 consultations and 292,965 prescribed treatments. Twenty-five percent of treatments were anti-malarials, prescribed to 49% of patients. They were delivered all year long, but especially during the rainy season, and 20% of patients with no clinical malaria diagnosis received anti-malarials. Chloroquine and quinine represented respectively 55.7% and 34.6% of prescribed anti-malarials. Overall, chloroquine prescriptions rose from 1992 to 2000, in parallel with clinical malaria; then the CQ prescription rate decreased from 2000 and was concomitant with the rise of SP and the persistence of quinine use. AQ and SP were mainly used as bi-therapy after 2003, at the time of national treatment policy change.</p> <p>Conclusion</p> <p>The results show the overall level of anti-malarial prescription in the study area for a considerable number of patients over a large period of time. Even though resistance to CQ rapidly increased from 1992 to 2001, no change in CQ prescription was observed until the early 2000s, possibly due to the absence of an obvious decrease in CQ effectiveness, a lack of therapeutic options or a blind follow-up of national guidelines.</p

Evolution of malaria mortality and morbidity after the emergence of chloroquine resistance in Niakhar, Senegal

Background: Recently, it has been assumed that resistance of Plasmodium to chloroquine increased malaria mortality. The study aimed to assess the impact of chemoresistance on mortality attributable to malaria in a rural area of Senegal, since the emergence of resistance in 1992, whilst chloroquine was used as first-line treatment of malaria, until the change in national anti-malarial policy in 2003. Methods: The retrospective study took place in the demographic surveillance site (DSS) of Niakhar. Data about malaria morbidity were obtained from health records of three health care facilities, where diagnosis of malaria was based on clinical signs. Source of data concerning malaria mortality were verbal autopsies performed by trained fieldworkers and examined by physicians who identified the probable cause of death. Results: From 1992 to 2004, clinical malaria morbidity represented 39% of total morbidity in health centres. Mean malaria mortality was 2.4 parts per thousand and 10.4 parts per thousand among total population and children younger than five years, respectively, and was highest in the 1992-1995 period. It tended to decline from 1992 to 2003 (Trend test, total population p = 0.03, children 0-4 years p = 0.12 - children 1-4 years p = 0.04 - children 5-9 years p = 0.01). Conclusion: Contrary to what has been observed until 1995, mortality attributable to malaria did not continue to increase dramatically in spite of the growing resistance to chloroquine and its use as first-line treatment until 2003. Malaria morbidity and mortality followed parallel trends and rather fluctuated accordingly to rainfall

L'enquêteur enquêté. De la « connaissance par corps » dans l'entretien sociologique

Interviewing Interviewers. On "bodily Knowledge" in sociological Interviews. Interviewers are traditionally advised to control their personal reactions during surveys. We might wonder, on the contrary, under which conditions the prejudices of the interviewer with regard to the subject of the survey might be of interest in themselves? Is there any point in taking the interviewer's unfor- mulated thoughts as a source of information? ; A set of recent studies on sociological interviews, which we have listed here, have tended to shift the attention of the analyst from the content of the interview to its form and everything surrounding it, in brief, from the text to the context and the paratext as additional signifiers. as well as from what is explicit to what is latent. In this article, we are proposing to move forward in a more systematic, scientific way along this newly-opened path, by transposing to sociological interviews (while taking a number of precautions) the use of the notion of "counter-transfer" and the debates to which it has given rise among theoreticians of psychoanalysis. The idea of subjecting the interviewer to questions about his/her feelings during the survey and about the survey topic proved to be highly heuristic for the interviewer when applied to a recent survey on ultra-precarious populations as well as stimulating anyone interested. in: the bodily dimension of social domination; i.e. for anyone who. in choosing a contextual framework and . under the constraints of the field, partly turns1 away from the spoken word to look at other signifiers in addition to strictly linguistic ones.■ Dominique Memmi: L'enquêteur enquêté. De la «connaissance par corps» dans l'entretien sociologique Un conseil classique donné aux enquêteurs consiste à contrôler leurs réactions personnelles au cours de l 'enquête. À quelles conditions, peut-on, au contraire. . se demander: les préjugés de l'enquêteur .- sur l'objet de son enquête deviennent-ils intéressants ? Quel intérêt y a-t-il à prendre comme source d'information les impensés de l'enquêteur sur son objet? Une série de travaux récents sur l'entretien en sociologie, dont on propose ici l'inventaire, ont tendu à déplacer le regard de l'analyste du contenu de l'entretien vers sa forme et tout ce qui . l'entoure, ou. pour le dire vite, du texte vers le contexte et le paratexte. comme autres signifiants, mais aussi à déplacer le regard de l'explicite vers le latent. Il est proposé ici d'aller plus avant et de façon plus systématique, scientifiquement plus armée, sur cette piste entrouverte, en transposant, moyennant un certain nombre de précautions, à l'exploitation des entretiens sociologiques la notion de «contre-transfert», et les débats auxquels elle a donné lieu chez les théoriciens de la psychanalyse. Soumettre l'enquêteur à la question sur. les affects qui furent les siens au cours de l'enquête, et à propos de l'objet de l'enquête: appliquée à une enquête récente sur des populations très précari- sées. une telle approche se révèle heuristique pour ce dernier et de surcroît sti-mulante pour qui se penche sur la dimension corporelle de la domination ; sociale, c'est-à-dire pour celui qui. par choix problématique et par contrainte de terrain, se détourne en partie de la . parole pour s'intéresser à d'autres signifiants que le signifiant linguistique. .Memmi Dominique, Arduin Pascal. L'enquêteur enquêté. De la « connaissance par corps » dans l'entretien sociologique. In: Genèses, 35, 1999. L'Europe vue d'ailleurs, sous la direction de Jean Leroy. pp. 131-145

Population et santé à Mlomp : département d'Oussouye, région de Ziguinchor, Sénégal

Présentation illustrée du travail de suivi démographique effectué par l'Observatoire démographique de Mlomp (Sénégal)

La restitution des résultats dans les systèmes de surveillance démographique : une étude dans 3 sites africains

International audienc

Changement de protocole dans la méthode d’autopsie verbale et mesure de la mortalité palustre en milieu rural sénégalais

Trois populations rurales du Sénégal sont suivies depuis plusieurs décennies, ce qui permet de retracer l’évolution de la mortalité palustre. Cependant, des limites sont associées à la méthode de l’autopsie verbale (AV) utilisée pour déterminer les causes de décès et notamment le paludisme. Un changement de protocole a eu lieu dans les années récentes, dans deux des trois sites, avec la lecture des AV effectuée parallèlement par deux médecins; l’étude cherche à vérifier si ce changement a entraîné des modifications dans la mesure de la mortalité palustre. Cinq cent quinze AV, réalisées suite aux décès d’enfants de moins de cinq ans survenus de 2000 à 2005, ont été analysées. L’élaboration d’un modèle de régression logistique multinomiale permet d’identifier les facteurs qui jouent sur la détermination d’un décès palustre parmi les caractéristiques de l’enfant, du décès, des symptômes et de la méthodologie. Les caractéristiques liées à la méthode ne jouent pas sur le diagnostic palustre. Ce résultat nous assure d’une relative continuité des séries statistiques de la mortalité palustre depuis 2000 dans les deux sites où la méthode a changé sur la période. Cependant, l’intervention de deux médecins (au lieu d’un seul) dans la détermination des causes de décès a diminué fortement la possibilité d’aboutir à une cause mal définie ou inconnue. En l’absence de statistiques sanitaires, les données fournies par le biais de la méthode d’AV mise en place dans les sites de suivi démographique (SSD) permettent de disposer d’informations assez précises dans le domaine épidémiologique, y compris celles concernant le paludisme

Evolution of malaria mortality and morbidity after the emergence of chloroquine resistance in Niakhar, Senegal

Abstract Background Recently, it has been assumed that resistance of Plasmodium to chloroquine increased malaria mortality. The study aimed to assess the impact of chemoresistance on mortality attributable to malaria in a rural area of Senegal, since the emergence of resistance in 1992, whilst chloroquine was used as first-line treatment of malaria, until the change in national anti-malarial policy in 2003. Methods The retrospective study took place in the demographic surveillance site (DSS) of Niakhar. Data about malaria morbidity were obtained from health records of three health care facilities, where diagnosis of malaria was based on clinical signs. Source of data concerning malaria mortality were verbal autopsies performed by trained fieldworkers and examined by physicians who identified the probable cause of death. Results From 1992 to 2004, clinical malaria morbidity represented 39% of total morbidity in health centres. Mean malaria mortality was 2.4‰ and 10.4‰ among total population and children younger than five years, respectively, and was highest in the 1992-1995 period. It tended to decline from 1992 to 2003 (Trend test, total population p = 0.03, children 0-4 years p = 0.12 - children 1-4 years p = 0.04- children 5-9 years p = 0.01). Conclusion Contrary to what has been observed until 1995, mortality attributable to malaria did not continue to increase dramatically in spite of the growing resistance to chloroquine and its use as first-line treatment until 2003. Malaria morbidity and mortality followed parallel trends and rather fluctuated accordingly to rainfall.</p