En 2005, 16 % des enfants de CM2 ont un surpoids modere et 3,7 % sont obeses. La proportion d'enfants en surcharge ponderale est restee stable entre 2002 et 2005.
We report two 28-day in-vivo antimalarial efficacy studies carried out in the urban centres of Bongor and Koumra, southern Chad. We assess chloroquine (CQ), sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) to treat Plasmodium falciparum uncomplicated malaria. Methods and outcome classification complied with latest WHO guidelines. Out of the 301 and 318 children aged 6-59 months included in Bongor and Koumra, respectively, 246 (81.7%) and 257 (80.8%) were eligible for analysis. In Bongor and Koumra, the 28-day PCR-adjusted failure rates for CQ were 23.7% (95% CI 14.7-34.8%) and 32.9% (95% CI 22.1-45.1%), respectively, and those for SP were 16.3% (95% CI 9.4-25.5%) and 4.3% (95% CI 1.2-10.5%). AQ failure rates were 6.4% (95% CI 2.1-14.3%) and 2.2% (95% CI 0.3-7.6%). The current use of CQ in Bongor and Koumra is questionable, and a more efficacious treatment is needed. Considering the reduced efficacy of SP in Bongor, AQ seems to be the best option for the time being. Following WHO recommendations that prioritize the use of artemisinin-based combinations, artesunate plus amodiaquine could be a potential first-line treatment. Nevertheless, the efficacy of this combination should be evaluated and the change carefully prepared, implemented and monitored.
Summary Objective To assess the efficacy of chloroquine in the treatment of Plasmodium vivax malaria in in Dawei District, southern Myanmar. Methods Enrolled patients at Sonsinphya clinic >6 months of age were assessed clinically and parasitologically every week for 28 days. To differentiate new infections from recrudescence, we genotyped pre‐ and post‐treatment parasitaemia. Blood chloroquine was measured to confirm resistant strains. Results Between December 2002 and April 2003, 2661 patients were screened, of whom 252 were included and 235 analysed. Thirty‐four per cent (95% CI: 28.1–40.6) of patients had recurrent parasitaemia and were considered treatment failures. 59.4% of these recurrences were with a different parasite strain. Two (0.8%) patients with recurrences on day 14 had chloroquine concentrations above the threshold of 100 ng/ml and were considered infected with chloroquine resistant parasites. 21% of failures occurred during the first 3 weeks of follow‐up: early recurrence and median levels of blood chloroquine comparable to those of controls suggested P. vivax resistance. Conclusions Plasmodium vivax resistance to chloroquine seems to be emerging in Dawei, near the Thai‐Burmese border. While chloroquine remains the first‐line drug for P. vivax infections in this area of Myanmar, regular monitoring is needed to detect further development of parasite resistance.
In 2003, artesunate-amodiaquine (AS+AQ) was introduced as the new first-line treatment for uncomplicated malaria in Burundi. After confirmed diagnosis, treatment was delivered at subsidized prices in public health centres. Nine months after its implementation a study was carried out to assess whether children below five years of age with uncomplicated malaria were actually receiving AS+AQ. A community-based study was conducted in Makamba province. Randomly selected households containing one or more children under five with reported fever onset within fourteen days before the study date were eligible. Case-management information was collected based on caregiver recall. A case definition of symptomatic malaria from observations of children presenting a confirmed malaria episode on the day of the survey was developed. Based on this definition, those children who had probable malaria among those with fever onset in the 14 days prior to the study were identified retrospectively. Treatment coverage with AS+AQ was then estimated among these probable malaria cases. Out of 195 children with fever on the day of the study, 92 were confirmed as true malaria cases and 103 tested negative. The combination of 'loss of appetite', 'sweating', 'shivering' and 'intermittent fever' yielded the highest possible positive predictive value, and was chosen as the case definition of malaria. Out of 526 children who had had fever 14 days prior to the survey, 165 (31.4%) were defined as probable malaria cases using this definition. Among them, 20 (14.1%) had been treated with AS+AQ, 10 with quinine (5%), 68 (41%) received non-malaria treatments, and 67 got traditional treatment or nothing (39.9%). Most people sought treatment from public health centres (23/99) followed by private clinics (15/99, 14.1%). The median price paid for AS+AQ was 0.5 US$. AS+AQ was the most common treatment for patients with probable malaria at public health centres, but coverage was low due to low health centre utilisation and apparently inappropriate prescribing. In addition, AS+AQ was given to patients at a price ten times higher than the subsidized price. The availability and proper use of ACTs should be monitored and maximized after their introduction in order to have a significant impact on the burden of malaria.
Dans les années 1990 et face à l’absence de données, Médecins sans frontières (MSF) a mis en place des études cliniques afin de mesurer l’efficacité des antipaludéens et d’adapter les traitements au sein de ses missions. Entre 1996 et 2004, plus de 12 000 patients furent inclus dans 43 études réalisées dans 18 pays d’Asie et d’Afrique. Ces études ont été conduites dans des zones d’accès difficile et d’insécurité, en général dans des pays d’Afrique subsaharienne. Elles ont permis d’améliorer la qualité des traitements dans les missions de MSF, de contribuer à adapter les protocoles nationaux dans certains pays et d’influencer les changements des recommandations au niveau international. Le nombre important de publications scientifiques issues des missions de MSF montre qu’une recherche clinique de qualité peut être conduite malgré les nombreuses difficultés rencontrées sur le terrain. Ces études nécessitent une rigueur suffisante pour que les résultats soient valides scientifiquement, mais elles doivent aussi pouvoir bénéficier de la souplesse requise compte tenu des conditions de terrain particulières. Bien que ce travail démontre le rôle potentiel des ONG (organisations non gouvernementales) médicales dans la collecte de données scientifiques, la responsabilité première dans le lancement de telles études devrait revenir aux ministères de la santé, à l’OMS (Organisation mondiale de la santé) et à d’autres organismes internationaux en charge de la lutte contre les maladies endémiques.
Since 2011 public concerns about Human Papillomavirus (HPV) vaccination safety and efficacy arose in France. We explored the relevance of using vaccines reimbursement data to assess the impact of those public concerns on vaccination coverage.We used the Permanent Sample of Beneficiaries which was, at the time of the study, a representative sample of 1/97(th) health insurance beneficiaries of the main Social Security scheme, the General Health Insurance Scheme, covering approximately 77 % of the French resident population. We estimated HPV vaccination coverage among girls born between 1995 and 1999 at their 15(th), 16(th) and 17(th) birthday.The coverage for complete vaccination among 16 years old girls decreased from 26.5 % in the first semester of 2011 to 18.6 % in the first semester of 2014.HPV vaccination coverage was already low in 2011 and continued to decrease thereafter. Vaccines reimbursement data allowed us to reactively monitor the impact of the controversy on vaccination coverage and design counteracting measures.
L'enquete du cycle triennal menee aupres des enfants en derniere annee de maternelle lors de l'annee scolaire 2005-2006 recueille des informations sur l'etat de sante et le recours aux soins ou a la prevention des enfants âges de cinq a six ans.
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