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Rajaonarifara E, Roche B, Chesnais CB, Rabenantoandro H, Evans M, Garchitorena A. Heterogeneity in elimination efforts could increase the risk of resurgence of lymphatic filariasis in Madagascar. Infect Genet Evol 2024; 120:105589. [PMID: 38548211 DOI: 10.1016/j.meegid.2024.105589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Progress in lymphatic filariasis (LF) elimination is spatially heterogeneous in many endemic countries, which may lead to resurgence in areas that have achieved elimination. Understanding the drivers and consequences of such heterogeneity could help inform strategies to reach global LF elimination goals by 2030. This study assesses whether differences in age-specific compliance with mass drug administration (MDA) could explain LF prevalence patterns in southeastern Madagascar and explores how spatial heterogeneity in prevalence and age-specific MDA compliance may affect the risk of LF resurgence after transmission interruption. METHODOLOGY We used LYMFASIM model with parameters in line with the context of southeastern Madagascar and explored a wide range of scenarios with different MDA compliance for adults and children (40-100%) to estimate the proportion of elimination, non-elimination and resurgence events associated with each scenario. Finally, we evaluated the risk of resurgence associated with different levels of migration (2-6%) from surrounding districts combined with varying levels of LF microfilaria (mf) prevalence (0-24%) during that same study period. RESULTS Differences in MDA compliance between adults and children better explained the observed heterogeneity in LF prevalence for these age groups than differences in exposure alone. The risk of resurgence associated with differences in MDA compliance scenarios ranged from 0 to 19% and was highest when compliance was high for children (e.g. 90%) and low for adults (e.g. 50%). The risk of resurgence associated with migration was generally higher, exceeding 60% risk for all the migration levels explored (2-6% per year) when mf prevalence in the source districts was between 9% and 20%. CONCLUSION Gaps in the implementation of LF elimination programme can increase the risk of resurgence and undermine elimination efforts. In Madagascar, districts that have not attained elimination pose a significant risk for those that have achieved it. More research is needed to help guide LF elimination programme on the optimal strategies for surveillance and control that maximize the chances to sustain elimination and avoid resurgence.
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Affiliation(s)
- Elinambinina Rajaonarifara
- UMR 224 MIVEGEC, Univ. Montpellier, IRD, CNRS, Montpellier, France; NGO Pivot, Ifanadiana, Madagascar; Sciences & Ingénierie, Sorbonne Université, Paris, France.
| | - Benjamin Roche
- UMR 224 MIVEGEC, Univ. Montpellier, IRD, CNRS, Montpellier, France
| | | | - Holivololona Rabenantoandro
- Service de Lutte contre les Maladies Epidémiques et Négligées - Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Michelle Evans
- NGO Pivot, Ifanadiana, Madagascar; Departement of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA
| | - Andres Garchitorena
- UMR 224 MIVEGEC, Univ. Montpellier, IRD, CNRS, Montpellier, France; NGO Pivot, Ifanadiana, Madagascar
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Gebreegziabher E, Raoliarison A, Ramananjato A, Fanomezana A, Rafaliarisoa M, Ralisata S, Razafindrakoto J, Smith JL, Ahmed J, Smith Gueye C. Identifying and characterizing high-risk populations in pilot malaria elimination districts in Madagascar: a mixed-methods study. Malar J 2024; 23:121. [PMID: 38664837 PMCID: PMC11046788 DOI: 10.1186/s12936-024-04927-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND In Madagascar, the districts of Antsirabe II, Faratsiho and Antsiranana I have relatively low malaria incidence rates and have been selected by the National Malaria Control Programme for pilot elimination strategies. The districts have residual transmission despite increasing coverage and quality of malaria services. This study sought to identify priority subpopulations at highest risk for malaria and collect information on intervention preferences and methods that will inform subnational tailoring of malaria service delivery. METHODS This mixed methods study employed (i) a quantitative malaria risk factor assessment in Antsirabe II and Faratsiho comprising a test-negative frequency matched case-control study and a qualitative risk factor assessment in Antsiranana I; and (ii) a qualitative formative assessment in all three districts. For the case-control study, a mixed effects logistic regression was used with age, sex and district included as fixed effects and health facility included as a random effect. The qualitative risk factor assessment used semi-structured interview guides and key informant interviews. For the qualitative formative assessment in the three districts, a summary report was generated following semi-structured interviews and focus group discussions with high-risk populations (HRPs) and stakeholders. RESULTS In Antsirabe II and Faratsiho districts, rice agriculture workers, outdoor/manual workers, particularly miners, and those with jobs that required travel or overnight stays, especially itinerant vendors, had higher odds of malaria infection compared to other (non-rice) agricultural workers. In Antsiranana I, respondents identified non-rice farmers, mobile vendors, and students as HRPs. Risk factors among these groups included overnight stays and travel patterns combined with a lack of malaria prevention tools. HRPs reported treatment cost and distance to the health facility as barriers to care and expressed interest in presumptive treatment and involvement of gatekeepers or people who have influence over intervention access or participation. CONCLUSIONS The study results illustrate the value of in-depth assessments of risk behaviours, access to services and prevention tools, surveillance and prevention strategies, and the involvement of gatekeepers in shaping subnational tailoring to reach previously unreached populations and address residual transmission in elimination settings.
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Affiliation(s)
- Elisabeth Gebreegziabher
- Malaria Elimination Initiative, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Andry Raoliarison
- US President's Malaria Initiative (PMI), PMI Impact Malaria, Antananarivo, Madagascar
| | | | | | - Martin Rafaliarisoa
- US President's Malaria Initiative (PMI), PMI Impact Malaria, Antananarivo, Madagascar
| | - Sandy Ralisata
- US President's Malaria Initiative (PMI), PMI Impact Malaria, Antananarivo, Madagascar
| | | | - Jennifer L Smith
- Malaria Elimination Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Jehan Ahmed
- U.S. President's Malaria Initiative (PMI), PMI Impact Malaria, Washington, DC, USA
| | - Cara Smith Gueye
- Malaria Elimination Initiative, University of California San Francisco, San Francisco, CA, USA.
- U.S. President's Malaria Initiative (PMI), PMI Impact Malaria, Washington, DC, USA.
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Rakotomanana F, Dreyfus A, Randrianarisoa MM, Raberahona M, Chevallier E, Andriamasy HE, Bernardson BA, Ranaivomanana P, Ralaitsilanihasy F, Rasoamaharo M, Randrianirisoa SAN, Razafindranaivo TA, Rakotobe L, Ratefiharimanana A, Randriamanana DA, Rakotondrazanany H, Cauchoix B, Baril L, Rakotosamimanana N, Randremanana RV. Prevalence of pulmonary tuberculosis and HIV infections and risk factors associated to tuberculosis in detained persons in Antananarivo, Madagascar. Sci Rep 2024; 14:8640. [PMID: 38622161 PMCID: PMC11018834 DOI: 10.1038/s41598-024-58309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
The incidence rate of tuberculosis in prisons is estimated to be 8 times greater than that in the general population in Madagascar. Our objectives were to estimate the prevalence of pulmonary tuberculosis and HIV infection among prisoners and to identify risk factors associated with tuberculosis. We conducted a cross-sectional study at the central prison of Antananarivo from March to July 2021. Individual male and female inmates aged ≥ 13 years who had lived in the prison for at least three months prior to the study period were included as participants. Acid-fast bacilli detection by microscopy and/or culture, an intradermal tuberculin test, a chest X-ray, and a rapid diagnostic orientation test for HIV were performed. Among 748 participants, 4 (0.5%) were confirmed to have pulmonary tuberculosis. Overall, 14 (1.9%) patients had "confirmed" or "probable" tuberculosis [0.90-2.84, 95% CI]. The proportion of participants with latent tuberculosis infection was 69.6% (517/743) based on a positive tuberculin test without clinical symptoms or radiography images indicating tuberculosis. Out of 745 HIV screening tests, three showed reactive results (0.4%). Age (OR = 4.4, 95% CI [1.4-14.0]) and prior tuberculosis treatment (or episodes) were found to be associated with confirmed and probable tuberculosis.
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Affiliation(s)
- Fanjasoa Rakotomanana
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar.
| | - Anou Dreyfus
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Winterthurestrasse 270, 8057, Zürich, Switzerland
| | - Mirella M Randrianarisoa
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
| | - Mihaja Raberahona
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Joseph Raseta Befelatanana, 101, Antananarivo, Madagascar
| | - Elodie Chevallier
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
| | - Harizaka E Andriamasy
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
| | - Barivola A Bernardson
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
| | - Paulo Ranaivomanana
- Unité des Mycobactéries, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
| | | | - Miangaly Rasoamaharo
- Imagerie Médicale, Hôpital Joseph Ravoahangy Andrianavalona, 101, Antananarivo, Madagascar
| | | | | | - Liva Rakotobe
- Programme National de Lutte Contre L'IST SIDA, 101, Antananarivo, Madagascar
| | | | | | | | | | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
- Medical Department for Infectious Diseases, French National Agency for Medicines and Health Products Safety (ANSM), 93200, Saint Denis, France
| | | | - Rindra V Randremanana
- Epidemiology and Clinical Research Unit, Institut Pasteur Madagascar, 101, Antananarivo, Madagascar
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Andrianarimanana-Köcher D, Rakotoarivelo RA, Randria MJDD, Raberahona M, Ratefiharimanana A, Andriamasy EH, Vallès X, Benski AC, Emmrich JV, Walsh A, Robinson K, Muller N. Call for action: addressing the alarming surge of HIV in Madagascar. BMJ Glob Health 2024; 9:e015484. [PMID: 38569660 PMCID: PMC11002381 DOI: 10.1136/bmjgh-2024-015484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
| | - Rivo Andry Rakotoarivelo
- Faculté de Médecine, Université de Fianarantsoa, Fianarantsoa, Madagascar
- Centre Hospitalier Universitaire Tambohobe, Fianarantsoa, Madagascar
| | - Mamy Jean de Dieu Randria
- Faculté de Médecine, Université d'Antananarivo, Antananarivo, Analamanga, Madagascar
- Centre Hospitalier Universitaire Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Mihaja Raberahona
- Faculté de Médecine, Université d'Antananarivo, Antananarivo, Analamanga, Madagascar
- Centre Hospitalier Universitaire Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Andosoa Ratefiharimanana
- Institut Supérieur des Technologies Régional d'Alaotra Mangoro, Université de Toamasina, Toamasina, Madagascar
| | | | - Xavier Vallès
- International Health Program from the Catalan Institute for Health, Barcelona, Spain
- Foundation Institute of Research in Health Sciences Germans Trias i Pujol, Badalona, Spain
| | - Anne-Caroline Benski
- Département de la Femme, de l'Enfant et de l'Adolescent, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Julius Valentin Emmrich
- Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Andrew Walsh
- Department of Anthropology, University of Western Ontario, London, Ontario, Canada
| | | | - Nadine Muller
- Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
- Speciality Network: Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Randrianasolo RO, Randrianantoandro NR, Tohaina D, Rasamimanana G, Tehindrazanarivelo AD. Survival within 12months after stroke in Madagascar. J Med Vasc 2024; 49:98-102. [PMID: 38697716 DOI: 10.1016/j.jdmv.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/19/2024] [Indexed: 05/05/2024]
Abstract
The data on the long-term prognosis of stroke are scarce in Madagascar. Our objective was to determine survival within 12months after a stroke event. A longitudinal study was carried out on a hospital cohort of subjects with stroke in Mahajanga in western Madagascar. We included in the study all subjects admitted to adult emergencies at Mahajanga University Hospitals during the year 2019 and diagnosed with stroke. A follow-up by telephone call or by descent at the home of the patients was carried out after at least 12months from the onset of the disease. We analyzed in-hospital mortality and survival within 12months after the stroke. At the end of the study period, 144 stroke cases were retained. Strokes accounted for 5.07% of emergency admission causes. Male gender accounted for 51.4% of the population. The average age of the subjects was 60.7years. In-hospital mortality was 32.6%. Survival at 1month was 50%, at 3months 48.4%, and at 12months 43%. High blood pressure was found as a risk factor for stroke in 79.9% of patients, 76.5% of whom were undertreated. Stroke mortality was high in our population. Most of the deaths occurred during the first month. Improved prevention and care are needed in Madagascar.
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Affiliation(s)
| | | | - Dolly Tohaina
- Faculty of Medicine, University of Mahajanga, Mahajanga, Madagascar
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Rakotozandrindrainy R, Rakotoarivelo RA, Kislaya I, Marchese V, Rasamoelina T, Solonirina J, Ratiaharison EF, Razafindrakoto R, Razafindralava NM, Rakotozandrindrainy N, Radomanana M, Andrianarivelo MR, Klein P, Lorenz E, Jaeger A, Hoekstra PT, Corstjens PLAM, Schwarz NG, van Dam GJ, May J, Fusco D. Schistosome infection among pregnant women in the rural highlands of Madagascar: A cross-sectional study calling for public health interventions in vulnerable populations. PLoS Negl Trop Dis 2024; 18:e0011766. [PMID: 38626192 PMCID: PMC11051649 DOI: 10.1371/journal.pntd.0011766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/26/2024] [Accepted: 03/26/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Schistosomiasis is a parasitic infection highly prevalent in sub-Saharan Africa (SSA) with Madagascar being among the countries with highest burden of the disease worldwide. Despite WHO recommendations, suggesting treatment of pregnant women after the first trimester, this group is still excluded from Mass Drug Administration programs. Our study, had the objective to measure the prevalence of schistosome infection among pregnant women in Madagascar in order to inform public health policies for treatment in this vulnerable population. METHODS Women were recruited for this cross-sectional study between April 2019 and February 2020 when attending Antenatal Care Services (ANCs) at one of 42 included Primary Health Care Centers. The urine-based upconverting reporter particle, lateral flow (UCP-LF) test detecting circulating anodic antigen was used for the detection of schistosome infections. To identify factors associated with the prevalence of schistosome infection crude and adjusted prevalence ratios and 95% CIs were estimated using mixed-effect Poisson regression. RESULTS Among 4,448 participating women aged between 16 and 47 years, the majority (70.4%, 38 n = 3,133) resided in rural settings. Overall, the prevalence of schistosome infection was 55.9% (n = 2486, CI 95%: 53.3-58.5). A statistically significant association was found with age group (increased prevalence in 31-47 years old, compared to 16-20 years old (aPR = 1.15, CI 95%: 1.02-1.29) and with uptake of antimalaria preventive treatment (decreased prevalence, aPR = 0.85, CI 95%: 0.77-0.95). No other associations of any personal characteristics or contextual factors with schistosome infection were found in our multivariate regression analysis. DISCUSSION AND CONCLUSION The high prevalence of schistosome infection in pregnant women supports the consideration of preventive schistosomiasis treatment in ANCs of the Malagasy highlands. We strongly advocate for adapting schistosomiasis programs in highly endemic contexts. This, would contribute to both the WHO and SDGs agendas overall to improving the well-being of women and consequently breaking the vicious cycle of poverty perpetuated by schistosomiasis.
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Affiliation(s)
| | | | - Irina Kislaya
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Valentina Marchese
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | | | | | | | | | | | | | - Mickael Radomanana
- Infectious diseases service, University Hospital Tambohobe, Fianarantsoa, Madagascar
| | | | - Philipp Klein
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Eva Lorenz
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Anna Jaeger
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | | | | | - Norbert Georg Schwarz
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | | | - Jürgen May
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Daniela Fusco
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
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Leblanc C, Kassié D, Ranaivoharimina M, Rakotomanana EFN, Mangahasimbola RT, Randrianarijaona A, Ramiandrasoa R, Nely AJ, Razafindraibe NP, Andriamandimby SF, Ranoaritiana DB, Rajaonarivony V, Randrianasolo L, Baril L, Mattern C, Ratovoson R, Guis H. Mixed methods to evaluate knowledge, attitudes and practices (KAP) towards rabies in central and remote communities of Moramanga district, Madagascar. PLoS Negl Trop Dis 2024; 18:e0012064. [PMID: 38551968 PMCID: PMC11006160 DOI: 10.1371/journal.pntd.0012064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/10/2024] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
Control of dog-mediated rabies relies on raising awareness, access to post-exposure prophylaxis (PEP) and mass dog vaccination. To assess rabies awareness in Moramanga district, Madagascar, where rabies is endemic, two complementary quantitative and qualitative approaches were carried out in 2018. In the quantitative approach, a standardized questionnaire was administered to 334 randomized participants living in 170 households located less than 5 km from the anti-rabies treatment center (ARTC) located in Moramanga city (thereafter called the central area), and in 164 households located more than 15 km away from the ARTC in two rural communes (thereafter called the remote area). Logistic regression models were fitted to identify factors influencing knowledge and practice scores. The qualitative approach consisted in semi-structured interviews conducted with 28 bite victims who had consulted the ARTC, three owners of biting dogs, three ARTC staff and two local authorities. Overall, 15.6% (52/334) of households owned at least one dog. The dog-to-human ratio was 1:17.6. The central area had a significantly higher dog bite incidence (0.53 per 100 person-years, 95% CI: 0.31-0.85) compared to the remote area (0.22 per 100 person-years, 95% CI: 0.09-0.43) (p = 0.03). The care pathway following a bite depended on wound severity, how the dog was perceived and its owner's willingness to cover costs. Rabies vaccination coverage in dogs in the remote area was extremely low (2.4%). Respondents knew that vaccination prevented animal rabies but owners considered that their own dogs were harmless and cited access and cost of vaccine as main barriers. Most respondents were not aware of the existence of the ARTC (85.3%), did not know the importance of timely access to PEP (92.2%) or that biting dogs should be isolated (89.5%) and monitored. Good knowledge scores were significantly associated with having a higher socio-economic status (OR = 2.08, CI = 1.33-3.26) and living in central area (OR = 1.91, CI = 1.22-3.00). Good practice scores were significantly associated with living in central area (OR = 4.78, CI = 2.98-7.77) and being aware of the ARTC's existence (OR = 2.29, CI = 1.14-4.80). In Madagascar, knowledge on rabies was disparate with important gaps on PEP and animal management. Awareness campaigns should inform communities (i) on the importance of seeking PEP as soon as possible after an exposure, whatever the severity of the wound and the type of biting dog who caused it, and (ii) on the existence and location of ARTCs where free-of-charge PEP is available. They should also encourage owners to isolate and monitor the health of biting dogs. Above all, awareness and dog vaccination campaigns should be designed so as to reach the more vulnerable remote rural populations as knowledge, good practices and vaccination coverage were lower in these areas. They should also target households with a lower socio-economic status. If awareness campaigns are likely to succeed in improving access to ARTCs in Madagascar, their impact on prompting dog owners to vaccinate their own dogs seems more uncertain given the financial and access barriers. Therefore, to reach the 70% dog vaccination coverage goal targeted in rabies elimination programs, awareness campaigns must be combined with free-of-charge mass dog vaccination.
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Affiliation(s)
- Claire Leblanc
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- General Paediatrics and Paediatric Infectious Disease Unit, Nantes University Hospital, Nantes, France
| | - Daouda Kassié
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- CIRAD, UMR ASTRE, Antananarivo, Madagascar
- ASTRE, Univ Montpellier, CIRAD, INRAE, Montpellier, France
| | - Mendrika Ranaivoharimina
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | | | - Anjasoa Randrianarijaona
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Ravo Ramiandrasoa
- Vaccination Center, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Alphonse José Nely
- Service for the Fight against Plague, Emerging and Re-emerging Diseases and Neglected Tropical Endemo-Epidemic Diseases, Ministry of Public Health, Antananarivo, Madagascar
- WHO Madagascar, Antananarivo 101, Madagascar
| | | | - Soa Fy Andriamandimby
- National Laboratory of Rabies, Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Dany Bakoly Ranoaritiana
- Direction of Health Monitoring, Epidemiological Surveillance and Response (DVSSER), Ministry of Public Health, Antananarivo, Madagascar
| | - Virginie Rajaonarivony
- Service for the Fight against Plague, Emerging and Re-emerging Diseases and Neglected Tropical Endemo-Epidemic Diseases, Ministry of Public Health, Antananarivo, Madagascar
| | - Laurence Randrianasolo
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Chiarella Mattern
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Ceped (Institut de Recherche pour le Développement, Université de Paris, INSERM), Paris, France
| | - Rila Ratovoson
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Hélène Guis
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- CIRAD, UMR ASTRE, Antananarivo, Madagascar
- ASTRE, Univ Montpellier, CIRAD, INRAE, Montpellier, France
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
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Miarinjara A, Raveloson AO, Mugel SG, An N, Andriamiadanarivo A, Rajerison ME, Randremanana RV, Girod R, Gillespie TR. Socio-ecological risk factors associated with human flea infestations of rural household in plague-endemic areas of Madagascar. PLoS Negl Trop Dis 2024; 18:e0012036. [PMID: 38452122 PMCID: PMC10950221 DOI: 10.1371/journal.pntd.0012036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/19/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024] Open
Abstract
Plague is a flea-borne fatal disease caused by the bacterium Yersinia pestis, which persists in rural Madagascar. Although fleas parasitizing rats are considered the primary vectors of Y. pestis, the human flea, Pulex irritans, is abundant in human habitations in Madagascar, and has been found naturally infected by the plague bacterium during outbreaks. While P. irritans may therefore play a role in plague transmission if present in plague endemic areas, the factors associated with infestation and human exposure within such regions are little explored. To determine the socio-ecological risk factors associated with P. irritans infestation in rural households in plague-endemic areas of Madagascar, we used a mixed-methods approach, integrating results from P. irritans sampling, a household survey instrument, and an observational checklist. Using previously published vectorial capacity data, the minimal P. irritans index required for interhuman bubonic plague transmission was modeled to determine whether household infestations were enough to pose a plague transmission risk. Socio-ecological risk factors associated with a high P. irritans index were then identified for enrolled households using generalized linear models. Household flea abundance was also modeled using the same set of predictors. A high P. irritans index occurred in approximately one third of households and was primarily associated with having a traditional dirt floor covered with a plant fiber mat. Interventions targeting home improvement and livestock housing management may alleviate flea abundance and plague risk in rural villages experiencing high P. irritans infestation. As plague-control resources are limited in developing countries such as Madagascar, identifying the household parameters and human behaviors favoring flea abundance, such as those identified in this study, are key to developing preventive measures that can be implemented at the community level.
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Affiliation(s)
- Adélaïde Miarinjara
- Departments of Environmental Sciences and Environmental Health, Emory University and Rollins School of Public Health, Atlanta, United States of America
| | - Annick Onimalala Raveloson
- Medical Entomology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Ecole Doctorale Science de la Vie et de l’Environnement, Université d’Antananarivo, Antananarivo, Madagascar
| | - Stephen Gilbert Mugel
- Departments of Environmental Sciences and Environmental Health, Emory University and Rollins School of Public Health, Atlanta, United States of America
| | - Nick An
- Departments of Environmental Sciences and Environmental Health, Emory University and Rollins School of Public Health, Atlanta, United States of America
| | | | | | | | - Romain Girod
- Medical Entomology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Thomas Robert Gillespie
- Departments of Environmental Sciences and Environmental Health, Emory University and Rollins School of Public Health, Atlanta, United States of America
- Centre Valbio, Ranomafana, Madagascar
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9
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Armah-Ansah EK, Budu E, Wilson EA, Oteng KF, Gyawu NO, Ahinkorah BO, Ameyaw EK. What predicts health facility delivery among women? analysis from the 2021 Madagascar Demographic and Health Survey. BMC Pregnancy Childbirth 2024; 24:116. [PMID: 38326785 PMCID: PMC10848540 DOI: 10.1186/s12884-024-06252-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND One of the pivotal determinants of maternal and neonatal health outcomes hinges on the choice of place of delivery. However, the decision to give birth within the confines of a health facility is shaped by a complex interplay of sociodemographic, economic, cultural, and healthcare system-related factors. This study examined the predictors of health facility delivery among women in Madagascar. METHODS We used data from the 2021 Madagascar Demographic and Health Survey. A total of 9,315 women who had a health facility delivery or delivered elsewhere for the most recent live birth preceding the survey were considered in this analysis. Descriptive analysis, and multilevel regression were carried out to determine the prevalence and factors associated with health facility delivery. The results were presented as frequencies, percentages, crude odds ratios and adjusted odds ratios (aORs) with corresponding 95% confidence intervals (CIs), and a p-value < 0.05 was used to declare statistical significance. RESULTS The prevalence of health facility delivery was 41.2% [95% CI: 38.9-43.5%]. In the multilevel analysis, women aged 45-49 [aOR = 2.14, 95% CI = 1.34-3.43], those with secondary/higher education [aOR = 1.62, 95% CI = 1.30-2.01], widowed [aOR = 2.25, 95% CI = 1.43-3.58], and those exposed to mass media [aOR = 1.18, 95% CI = 1.00-1.39] had higher odds of delivering in health facilities compared to those aged 15-49, those with no formal education, women who had never been in union and not exposed to mass media respectively. Women with at least an antenatal care visit [aOR = 6.95, 95% CI = 4.95-9.77], those in the richest wealth index [aOR = 2.74, 95% CI = 1.99-3.77], and women who considered distance to health facility as not a big problem [aOR = 1.28, 95% CI = 1.09-1.50] were more likely to deliver in health facilities compared to those who had no antenatal care visit. Women who lived in communities with high literacy levels [aOR = 1.54, 95% CI = 1.15-2.08], and women who lived in communities with high socioeconomic status [aOR = 1.72, 95% CI = 1.28-2.31] had increased odds of health facility delivery compared to those with low literacy levels and in communities with low socioeconomic status respectively. CONCLUSION The prevalence of health facility delivery among women in Madagascar is low in this study. The findings of this study call on stakeholders and the government to strengthen the healthcare system of Madagascar using the framework for universal health coverage. There is also the need to implement programmes and interventions geared towards increasing health facility delivery among adolescent girls and young women, women with no formal education, and those not exposed to media. Also, consideration should be made to provide free maternal health care and a health insurance scheme that can be accessed by women in the poorest wealth index. Health facilities should be provided at places where women have challenges with distance to other health facilities. Education on the importance of antenatal care visits should also be encouraged, especially among women with low literacy levels and in communities with low socioeconomic status.
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Affiliation(s)
- Ebenezer Kwesi Armah-Ansah
- Department of Population and Development, National Research University - Higher School of Economics, Moscow, Russia.
- Population Dynamics Sexual and Reproductive Health Unit, African Population and Health Research Center, Nairobi, Kenya.
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
| | - Eugene Budu
- Korle Bu Teaching Hospital, P. O. Box, 77, Accra, Ghana
| | - Elvis Ato Wilson
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Kenneth Fosu Oteng
- Ashanti Regional Health Directorate, Ghana Health Service, Kumasi, Ghana
| | - Nhyira Owusuaa Gyawu
- Quality management Unit, Korle Bu Teaching Hospital, P. O. Box, 77, Accra, Ghana
| | | | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
- L & E Research Consult Ltd, Upper West Region, Wa, Ghana
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10
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Franke MA, Emmrich JV, Ranjaharinony F, Ravololohanitra OG, Andriamasy HE, Knauss S, Muller N. A cross-sectional analysis of the effectiveness of a nutritional support programme for people with tuberculosis in Southern Madagascar using secondary data from a non-governmental organisation. Infect Dis Poverty 2024; 13:13. [PMID: 38303047 PMCID: PMC10835822 DOI: 10.1186/s40249-024-01182-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND There is a strong, bi-directional link between tuberculosis (TB) and undernutrition: TB often causes undernutrition, and undernourished people are more likely to contract TB and experience worse outcomes. Globally, several TB nutritional support programmes exist; however, evidence on their effectiveness is limited and contested. This study evaluates the effect of a nutritional support programme implemented for people with TB in the Atsimo-Andrefana region, Madagascar in 2022. Within this programme, undernourished people with TB [with a body mass index (BMI) of < 18.5 kg/m2] receive 0.6 L of vegetable oil and 6.0 kg of a soy-wheat blend per month throughout their TB treatment. METHODS We analysed secondary non-governmental organisation data collected between January and November 2022 in the Atsimo-Andrefana region, Southern Madagascar, including information on an individual's medical conditions (e.g., type of TB, treatment outcomes) and nutritional status measured prior to, during, and after completion of treatment (e.g., height, weight, mid-upper arm circumference). We conducted descriptive analyses of patient baseline characteristics and outcomes to assess the impact of the provided nutritional support on the BMI of people with TB. RESULTS A total of 1310 people with TB were included in the study [9.9% (130) children under the age of 5, 32.1% (420) children between 5 and 18 years, 58.0% (760) adults]. 55.4% of children under 5, 28.1% of children between ages 5 and 18, and 81.3% of adults were undernourished at treatment initiation. 42.3% (55/130) of children under 5 experienced severe acute malnutrition at treatment uptake. While the average BMI of adults with TB receiving food support increased over time, from 17.1 kg/m2 (interquartile range: 15.8-18.3, range: 10.3-22.5) to 17.9 kg/m2 (interquartile range: 16.6-19.1, range: 11.9-24.1), most adults remained undernourished even after completing TB treatment. CONCLUSIONS The current TB nutritional support programme falls short of sufficiently increasing the BMI of people with TB to overcome malnutrition. There is an urgent need to revise the nutritional support available for people with TB, particularly for children under 5.
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Affiliation(s)
- Mara Anna Franke
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- London School of Hygiene and Tropical Medicine, London, UK.
- Ärzte Für Madagaskar E.V., Leipzig, Germany.
| | - Julius Valentin Emmrich
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte Für Madagaskar E.V., Leipzig, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Harizaka Emmanuel Andriamasy
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Doctors for Madagascar, Antananarivo, Madagascar
| | - Samuel Knauss
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte Für Madagaskar E.V., Leipzig, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nadine Muller
- Global Digital Health Lab at Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Ärzte Für Madagaskar E.V., Leipzig, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Speciality Network: Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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11
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Andrianaivoarimanana V, Savin C, Birdsell DN, Vogler AJ, Le Guern AS, Rahajandraibe S, Brémont S, Rahelinirina S, Sahl JW, Ramasindrazana B, Rakotonanahary RJL, Rakotomanana F, Randremanana R, Maheriniaina V, Razafimbia V, Kwasiborski A, Balière C, Ratsitorahina M, Baril L, Keim P, Caro V, Rasolofo V, Spiegel A, Pizarro-Cerda J, Wagner DM, Rajerison M. Multiple Introductions of Yersinia pestis during Urban Pneumonic Plague Epidemic, Madagascar, 2017. Emerg Infect Dis 2024; 30:289-298. [PMID: 38270131 PMCID: PMC10826772 DOI: 10.3201/eid3002.230759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Pneumonic plague (PP) is characterized by high infection rate, person-to-person transmission, and rapid progression to severe disease. In 2017, a PP epidemic occurred in 2 Madagascar urban areas, Antananarivo and Toamasina. We used epidemiologic data and Yersinia pestis genomic characterization to determine the sources of this epidemic. Human plague emerged independently from environmental reservoirs in rural endemic foci >20 times during August-November 2017. Confirmed cases from 5 emergences, including 4 PP cases, were documented in urban areas. Epidemiologic and genetic analyses of cases associated with the first emergence event to reach urban areas confirmed that transmission started in August; spread to Antananarivo, Toamasina, and other locations; and persisted in Antananarivo until at least mid-November. Two other Y. pestis lineages may have caused persistent PP transmission chains in Antananarivo. Multiple Y. pestis lineages were independently introduced to urban areas from several rural foci via travel of infected persons during the epidemic.
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Affiliation(s)
| | | | | | - Amy J. Vogler
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Anne-Sophie Le Guern
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Soloandry Rahajandraibe
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Sylvie Brémont
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Soanandrasana Rahelinirina
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Jason W. Sahl
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Beza Ramasindrazana
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Rado Jean Luc Rakotonanahary
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Fanjasoa Rakotomanana
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Rindra Randremanana
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Viviane Maheriniaina
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Vaoary Razafimbia
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Aurelia Kwasiborski
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Charlotte Balière
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Maherisoa Ratsitorahina
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Laurence Baril
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Paul Keim
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Valérie Caro
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - Voahangy Rasolofo
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
| | - André Spiegel
- Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison)
- Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda)
- Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner)
- Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
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Rafetrarivony LF, Rabenandrasana MAN, Hariniaina ER, Randrianirina F, Smith AM, Crucitti T. Antimicrobial susceptibility profile of Neisseria gonorrhoeae from patients attending a medical laboratory, Institut Pasteur de Madagascar between 2014 and 2020: phenotypical and genomic characterisation in a subset of Neisseria gonorrhoeae isolates. Sex Transm Infect 2024; 100:25-30. [PMID: 37945345 PMCID: PMC10850657 DOI: 10.1136/sextrans-2023-055878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/08/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES Antimicrobial-resistant Neisseria gonorrhoeae (NG) is a concern. Little is known about antimicrobial susceptibility profiles and associated genetic resistance mechanisms of NG in Madagascar. We report susceptibility data of NG isolates obtained by the medical laboratory (CBC) of the Institut Pasteur de Madagascar, Antananarivo, Madagascar, during 2014-2020. We present antimicrobial resistance mechanisms data and phenotype profiles of a subset of isolates. METHODS We retrieved retrospective data (N=395) from patients with NG isolated during 2014-2020 by the CBC. We retested 46 viable isolates including 6 found ceftriaxone and 2 azithromycin resistant, as well as 33 isolated from 2020. We determined minimal inhibitory concentrations for ceftriaxone, ciprofloxacin, azithromycin, penicillin, tetracycline and spectinomycin using Etest. We obtained whole-genome sequences and identified the gene determinants associated with antimicrobial resistance and the sequence types (STs). RESULTS Over the study period, ceftriaxone-resistant isolates exceeded the threshold of 5% in 2017 (7.4% (4 of 54)) and 2020 (7.1% (3 of 42)). All retested isolates were found susceptible to ceftriaxone, azithromycin and spectinomycin, and resistant to ciprofloxacin. The majority were resistant to penicillin (83% (38 of 46)) and tetracycline (87% (40 of 46)). We detected chromosomal mutations associated with antibiotic resistance in gyrA, parC, penA, ponA, porB and mtrR genes. None of the retested isolates carried the mosaic penA gene. The high rate of resistance to penicillin and tetracycline is explained by the presence of bla TEM (94.7% (36 of 38)) and tetM (97.5% (39 of 40)). We found a high number of circulating multilocus STs. Almost half of them were new types, and one new type was among the four most predominant. CONCLUSIONS Our report provides a detailed dataset obtained through phenotypical and genotypical methods which will serve as a baseline for future surveillance of NG. We could not confirm the occurrence of ceftriaxone-resistant isolates. Our results highlight the importance of implementing quality-assured gonococcal antimicrobial resistance surveillance in Madagascar.
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Affiliation(s)
| | | | | | | | - Anthony Marius Smith
- Centre for Enteric Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Tania Crucitti
- Experimental Bacteriology, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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13
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Raberahona M, Rakotomalala R, Andriananja V, Andriamamonjisoa J, Rakotomijoro E, Andrianasolo RL, Rakotoarivelo RA, Randria MJDD. A retrospective cohort analysis of people living with HIV/AIDS enrolled in HIV care at a reference center in Antananarivo, Madagascar. Front Public Health 2024; 11:1329194. [PMID: 38288430 PMCID: PMC10822960 DOI: 10.3389/fpubh.2023.1329194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/22/2023] [Indexed: 01/31/2024] Open
Abstract
Background The impact of the "Treat all" policy on the individual and in terms of public health is closely related to early diagnosis and retention in care. Patient-level data are scarce in Madagascar. In this study, we aimed to describe the profile of a cohort of newly diagnosed people living with HIV/AIDS (PLHIV), identify their outcomes, and assess factors associated with attrition from care and advanced HIV disease (AHD) at presentation. Methods We conducted a retrospective cohort study of PLHIV aged ≥15 years newly diagnosed at the University Hospital Joseph Raseta Befelatanana Antananarivo from 1 January 2010 to 31 December 2016. Results A total of 490 PLHIV were included in the cohort analysis. In total, 67.1% were male. The median age (interquartile range) at enrollment in care was 29 years (24-38). Overall, 36.1% of PLHIV were diagnosed with AHD at baseline. The proportion of patients with WHO stage IV at baseline increased significantly from 3.3% in 2010 to 31% in 2016 (p = 0.001 for trend). The probability of retention in care after the diagnosis at 12 months, 24 months, and 36 months was 71.8%, 65.5%, and 61.3%, respectively. Age ≥ 40 years (aHR: 1.55; 95% CI: 1.05-2.29; p = 0.026), low level of education (aHR:1.62; 95% CI: 1.11-2.36; p = 0,013), unspecified level of education (aHR:2.18; 95% CI: 1.37-3.47; p = 0.001) and unemployment (aHR:1.52; 95% CI: 1.07-2.16; p = 0.019) were independently associated with attrition from care. Factors associated with AHD at baseline were age ≥ 40 (aOR: 2.77; 95% CI: 1.38-5.57, p = 0.004), unspecified level of education (aOR: 3.80; 95% CI: 1.58-9.16, p = 0.003) and presence of clinical symptoms at baseline (aOR: 23.81; 95% CI: 10.7-52.98; p < 0.001). Sex workers were independently less likely to have an AHD at presentation (aOR: 0.23; 95% CI: 0.05-0.96, p = 0.044). Conclusion Sociodemographic determinants influenced retention in care more than clinical factors. The presence of clinical symptoms and sociodemographic determinants were the main factors associated with AHD at baseline.
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Affiliation(s)
- Mihaja Raberahona
- Department of Infectious Diseases, University Hospital Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | - Rado Rakotomalala
- Department of Infectious Diseases, University Hospital Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - Volatiana Andriananja
- Department of Infectious Diseases, University Hospital Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - Johary Andriamamonjisoa
- Department of Infectious Diseases, University Hospital Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - Etienne Rakotomijoro
- Department of Infectious Diseases, University Hospital Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | | | - Rivonirina Andry Rakotoarivelo
- Department of Infectious Diseases, Faculty of Medicine, University Hospital Tambohobe Fianarantsoa, University of Fianarantsoa, Fianarantsoa, Madagascar
| | - Mamy Jean de Dieu Randria
- Department of Infectious Diseases, University Hospital Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
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14
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Tejiokem MC, Barry A, Ratovoson R, Yambiyo B, Hamidou Lazoumar R, Herrant M, Madaha E, Richard V. African countries from the Pasteur Network reexamine their syndromic sentinel surveillance system associated with household contact within the AFROSCREEN program. Front Public Health 2024; 11:1292435. [PMID: 38249384 PMCID: PMC10796548 DOI: 10.3389/fpubh.2023.1292435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Surveillance to better detect and respond to new pathogens remains a major challenge for global public health. The Pasteur Network recently held a brainstorming workshop located in Cameroon attended by Pasteur epidemiological teams from Niger, Central African Republic (CAR), Cameroon, Senegal, and Madagascar to discuss how the Pasteur Network in Africa could use the lessons of COVID-19 to set-up a pilot sentinel surveillance scheme given its expertise and involvement during the pandemic. The possibility of coupling sentinel syndromic and biological surveillance already implemented for influenza surveillance with the recent sequencing capacity put in place by the AFROSCREEN program prompted us to consider strengthening surveillance tools to target "Pathogen X" detection in Africa. The perspective project provided by the Pasteur Network teams and shared with other partners of the AFROSCREEN program will target strengthening of the diagnosis of severe acute respiratory infections (IRAS) and the surveillance of IRAS, the evaluation of the impact of SARS-CoV-2 on the epidemiology of IRAS, and the addition of the detection of new pathogens, called "Pathogen X," based on sequencing capacity and epidemiological criteria from One Health approaches.
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Affiliation(s)
| | | | - Rila Ratovoson
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Brice Yambiyo
- Institut Pasteur de Bangui, Bangui, Central African Republic
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15
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Garchitorena A, Rasoloharimanana LT, Rakotonanahary RJ, Evans MV, Miller AC, Finnegan KE, Cordier LF, Cowley G, Razafinjato B, Randriamanambintsoa M, Andrianambinina S, Popper SJ, Hotahiene R, Bonds MH, Schoenhals M. Morbidity and mortality burden of COVID-19 in rural Madagascar: results from a longitudinal cohort and nested seroprevalence study. Int J Epidemiol 2023; 52:1745-1755. [PMID: 37793001 DOI: 10.1093/ije/dyad135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Three years into the pandemic, there remains significant uncertainty about the true infection and mortality burden of COVID-19 in the World Health Organization Africa region. High quality, population-representative studies in Africa are rare and tend to be conducted in national capitals or large cities, leaving a substantial gap in our understanding of the impact of COVID-19 in rural, low-resource settings. Here, we estimated the spatio-temporal morbidity and mortality burden associated with COVID-19 in a rural health district of Madagascar until the first half of 2021. METHODS We integrated a nested seroprevalence study within a pre-existing longitudinal cohort conducted in a representative sample of 1600 households in Ifanadiana District, Madagascar. Socio-demographic and health information was collected in combination with dried blood spots for about 6500 individuals of all ages, which were analysed to detect IgG and IgM antibodies against four specific proteins of SARS-CoV-2 in a bead-based multiplex immunoassay. We evaluated spatio-temporal patterns in COVID-19 infection history and its associations with several geographic, socio-economic and demographic factors via logistic regressions. RESULTS Eighteen percent of people had been infected by April-June 2021, with seroprevalence increasing with individuals' age. COVID-19 primarily spread along the only paved road and in major towns during the first epidemic wave, subsequently spreading along secondary roads during the second wave to more remote areas. Wealthier individuals and those with occupations such as commerce and formal employment were at higher risk of being infected in the first wave. Adult mortality increased in 2020, particularly for older men for whom it nearly doubled up to nearly 40 deaths per 1000. Less than 10% of mortality in this period would be directly attributed to COVID-19 deaths if known infection fatality ratios are applied to observed seroprevalence in the district. CONCLUSION Our study provides a very granular understanding on COVID-19 transmission and mortality in a rural population of sub-Saharan Africa and suggests that the disease burden in these areas may have been substantially underestimated.
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Affiliation(s)
- Andres Garchitorena
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
- NGO Pivot, Ifanadiana, Madagascar
| | | | - Rado Jl Rakotonanahary
- NGO Pivot, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Michelle V Evans
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Karen E Finnegan
- NGO Pivot, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Marius Randriamanambintsoa
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Samuel Andrianambinina
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Stephen J Popper
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - Raphaël Hotahiene
- Direction de lutte contre les maladies transmissibles, Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Matthew H Bonds
- NGO Pivot, Ifanadiana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Randrianarisoa RMF, Refeno V, Andrianandrasana NOTF, Ralison F, Vololontiana HMD, Rafaramino F. Description of multiple myeloma cases and assessment of survival and mortality factors in Madagascar. Hematology 2023; 28:2261803. [PMID: 37746751 DOI: 10.1080/16078454.2023.2261803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION In Madagascar, the epidemiologic, therapeutic, and evolutionary aspects of multiple myeloma remain poorly understood. Our objectives were to describe the cases, report factors associated with mortality, and estimate patient survival. PATIENTS AND METHOD This was a retrospective descriptive and analytical study conducted in five teaching hospitals in Madagascar: HJRA and CENHOSOA (Antananarivo), CHUPZAGA (Mahajanga), CHUAT (Toamasina) and CHUT (Fianarantsoa). The study included patients diagnosed with multiple myeloma between January 1, 2010 and December 31, 2021. RESULTS Of the 11,374 cancer patients, 75 (0.66%) had multiple myeloma. The mean age of the patients was 59.9 years (±8.9) and the sex ratio was 1.5. Arterial hypertension was observed in 32% of the patients. The most common symptom of myeloma was bone pain (n = 48; 64%). Forty-six patients (61%) were diagnosed with stage III myeloma and 28 patients (37.3%) with stage IIIA myeloma according to the Durie-Salmon classification. Anemia, renal failure, hypercalcemia and fractures were present in 53%, 37%, 21% and 28% of cases, respectively. Fifty-four patients received specific treatment. The combination of melphalan-prednisone-thalidomide was used in 79.63% of cases, and one patient had received autologous stem cell transplantation. Eleven patients (14.67%) died. Chronic kidney disease (p = 0.009), smoking (p = 0.028) and two associated comorbidities (p = 0.035) were associated with mortality. The median overall survival was 45.5 months. CONCLUSION Patient survival is shorter than reported in the literature. The high mortality rate is due to comorbidities and limited access to recommended therapies.
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Affiliation(s)
| | - Valéry Refeno
- Oncology Department, Professeur Zafisaona Gabriel Hospital, Mahajanga, Madagascar
| | | | - Fidiarivony Ralison
- Department of Internal Medicine, Mahavoky Atsimo Hospital, Mahajanga, Madagascar
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LaFleur M, Rasoanaivo HA, Andrianarivo TH, Andrianomanana FR, McKernan S, Raherison MS, Andrianantenaina R, Miller M, Ratsimbazafy J, Lapierre SG, Ranaivomanana P, Rakotosamimanana N. Tuberculosis in Lemurs and a Fossa at National Zoo, Madagascar, 2022. Emerg Infect Dis 2023; 29:2587-2589. [PMID: 37987598 PMCID: PMC10683818 DOI: 10.3201/eid2912.231159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
We diagnosed Mycobacterium tuberculosis in captive lemurs and a fossa in Antananarivo, Madagascar. We noted clinical signs in the animals and found characteristic lesions during necropsy. The source of infection remains unknown. Our results illustrate the potential for reverse zoonotic infections and intraspecies transmission of tuberculosis in captive wildlife.
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18
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Rakotomalala FA, Bouillin J, Randriarimanana SD, Thaurignac G, Maharavo L, Raberahona M, Razafindrakoto L, Rasoanarivo J, Rakoto-Andrianarivelo M, Rakoto DAD, Babin FX, Rasamoelina T, Delaporte E, Samison LH, Peeters M, Nerrienet E, Ayouba A. High Seroprevalence of IgG Antibodies to Multiple Arboviruses in People Living with HIV (PLWHIV) in Madagascar. Viruses 2023; 15:2258. [PMID: 38005934 PMCID: PMC10674502 DOI: 10.3390/v15112258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
To estimate the prevalence of IgG antibodies against six arboviruses in people living with HIV-1 (PLWHIV) in Madagascar, we tested samples collected between January 2018 and June 2021. We used a Luminex-based serological assay to detect IgG antibodies against antigens from Dengue virus serotypes 1-4 (DENV1-4), Zika virus (ZIKV), West Nile virus (WNV), Usutu virus (USUV), Chikungunya virus (CHIKV), and O'nyong nyong virus (ONNV). Of the 1036 samples tested, IgG antibody prevalence was highest for ONNV (28.4%), CHIKV (26.7%), WNV-NS1 (27.1%), DENV1 (12.4%), USUV (9.9%), and DENV3 (8.9%). ZIKV (4.9%), DENV2 (4.6%), WNV-D3 (5.1%), and DENV4 (1.4%) were lower. These rates varied by province of origin, with the highest rates observed in Toamasina, on the eastern coast (50.5% and 56.8%, for CHIKV and ONNV, respectively). The seroprevalence increased with age for DENV1 and 3 (p = 0.006 and 0.038, respectively) and WNV DIII (p = 0.041). The prevalence of IgG antibodies against any given arborvirus varied over the year and significantly correlated with rainfalls in the different areas (r = 0.61, p = 0.036). Finally, we found a significant correlation between the seroprevalence of antibodies against CHIKV and ONNV and the HIV-1 RNA plasma viral load. Thus, PLWHIV in Madagascar are highly exposed to various arboviruses. Further studies are needed to explain some of our findings.
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Affiliation(s)
- Fetra Angelot Rakotomalala
- Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo 101, Madagascar; (F.A.R.); (S.D.R.); (L.M.); (M.R.-A.); (T.R.); (L.H.S.)
- TransVIHMI, University of Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), 34394 Montpellier, France; (J.B.); (G.T.); (E.D.); (M.P.)
- Ecole Doctorale Sciences de la Vie et de l’Environnement, Université d’Antananarivo, Antananarivo 101, Madagascar;
| | - Julie Bouillin
- TransVIHMI, University of Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), 34394 Montpellier, France; (J.B.); (G.T.); (E.D.); (M.P.)
| | - Santatriniaina Dauphin Randriarimanana
- Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo 101, Madagascar; (F.A.R.); (S.D.R.); (L.M.); (M.R.-A.); (T.R.); (L.H.S.)
| | - Guillaume Thaurignac
- TransVIHMI, University of Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), 34394 Montpellier, France; (J.B.); (G.T.); (E.D.); (M.P.)
| | - Luca Maharavo
- Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo 101, Madagascar; (F.A.R.); (S.D.R.); (L.M.); (M.R.-A.); (T.R.); (L.H.S.)
- Ecole Doctorale Sciences de la Vie et de l’Environnement, Université d’Antananarivo, Antananarivo 101, Madagascar;
| | - Mihaja Raberahona
- Service des Maladies Infectieuses, Centre Hôspitalier Universitaire Joseph Raseta de Befelatanana, Antananarivo 101, Madagascar;
| | - Lucien Razafindrakoto
- Service de Pneumo-Phtisiologie, Centre Hospitalier Universitaire Analakininina, Toamasina 501, Madagascar;
| | - Jasmina Rasoanarivo
- Secrétariat Exécutif du Comité National de la Lutte Contre le SIDA, Antananarivo 101, Madagascar;
| | - Mala Rakoto-Andrianarivelo
- Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo 101, Madagascar; (F.A.R.); (S.D.R.); (L.M.); (M.R.-A.); (T.R.); (L.H.S.)
| | - Danielle Aurore Doll Rakoto
- Ecole Doctorale Sciences de la Vie et de l’Environnement, Université d’Antananarivo, Antananarivo 101, Madagascar;
| | | | - Tahinamandranto Rasamoelina
- Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo 101, Madagascar; (F.A.R.); (S.D.R.); (L.M.); (M.R.-A.); (T.R.); (L.H.S.)
| | - Eric Delaporte
- TransVIHMI, University of Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), 34394 Montpellier, France; (J.B.); (G.T.); (E.D.); (M.P.)
| | - Luc Hervé Samison
- Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo 101, Madagascar; (F.A.R.); (S.D.R.); (L.M.); (M.R.-A.); (T.R.); (L.H.S.)
| | - Martine Peeters
- TransVIHMI, University of Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), 34394 Montpellier, France; (J.B.); (G.T.); (E.D.); (M.P.)
| | | | - Ahidjo Ayouba
- TransVIHMI, University of Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), 34394 Montpellier, France; (J.B.); (G.T.); (E.D.); (M.P.)
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Rakotosamimanana S, Mangahasimbola RT, Ratovoson R, Randremanana RV. Determinants of COVID-19-related knowledge and disrupted habits during epidemic waves among women of childbearing age in urban and rural areas of the Malagasy Middle East. BMC Public Health 2023; 23:1990. [PMID: 37828477 PMCID: PMC10571364 DOI: 10.1186/s12889-023-16931-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/07/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND With regard to the coronavirus disease (COVID-19) pandemic in Madagascar, little is known about the knowledge, the perceptions and the impacts of this disease on women of childbearing age. People's knowledge of COVID-19 can have an impact on their attitudes towards seeking care. The aim of the current study is to determine the knowledge of COVID-19 and associated determinants among women of childbearing age in Moramanga. METHODS A cross-sectional study based on questionnaire administration was used among women of childbearing age. Data collection was conducted from August to October 2021. A scoring method was applied to evaluate their knowledge level and perceptions about COVID-19 and its impacts on their lives. A binary stepwise logistic regression was performed to determine the sociodemographic determinants of their knowledge level about COVID-19. RESULTS A total of 885 women of childbearing age from urban and rural Moramanga areas were interviewed. Approximately 49.8% (441/885) lived in urban areas, and 50.2% (444/885) lived in rural areas. Approximately 35.3% (322/885) of the participants had a good level of knowledge of COVID-19. Multivariate analysis showed that the probability of having a good level of knowledge of COVID-19 had a significant statistical association (p value < 0.05) with living in an urban area [AOR: 2.89; 95% CI (1.89-4.42)], telephone ownership [AOR: 1.71; 95% CI (1.16-2.53)], radio ownership [AOR 2.2; 95% CI (1.43-3.38)], watching TV [AOR = 1.95; 95% CI (1.34-2.83)] and reading journal papers [AOR = 3.74 95% CI (1.69-8.27)]. CONCLUSIONS Almost a third of the sampled women of childbearing age had a good level of knowledge of COVID-19. Access to information through telecommunications technologies increases the chances of being better informed about the disease. To avoid the negative repercussions of infectious disease epidemics, it is necessary to improve the awareness of childbearing women about these diseases by taking demographic features of the population into account.
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Affiliation(s)
| | | | - Rila Ratovoson
- Institut Pasteur de Madagascar, Antananarivo 101, Madagascar
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20
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Devred I, Rambliere L, Herindrainy P, Andriamarohasina L, Harimanana A, Randrianirina F, Ratsima EH, Hivernaud D, Kermorvant-Duchemin E, Andrianirina ZZ, Abdou AY, Delarocque-Astagneau E, Guillemot D, Crucitti T, Collard JM, Huynh BT. Incidence and risk factors of neonatal bacterial infections: a community-based cohort from Madagascar (2018-2021). BMC Infect Dis 2023; 23:658. [PMID: 37798644 PMCID: PMC10552278 DOI: 10.1186/s12879-023-08642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Few studies on neonatal severe bacterial infection are available in LMICs. Data are needed in these countries to prioritize interventions and decrease neonatal infections which are a primary cause of neonatal mortality. The BIRDY project (Bacterial Infections and Antimicrobial Drug Resistant among Young Children) was initially conducted in Madagascar, Senegal and Cambodia (BIRDY 1, 2012-2018), and continued in Madagascar only (BIRDY 2, 2018-2021). We present here the BIRDY 2 project whose objectives were (1) to estimate the incidence of neonatal severe bacterial infections and compare these findings with those obtained in BIRDY 1, (2) to identify determinants associated with severe bacterial infection and (3) to specify the antibiotic resistance pattern of bacteria in newborns. METHODS The BIRDY 2 study was a prospective community-based mother and child cohort, both in urban and semi-rural areas. All pregnant women in the study areas were identified and enrolled. Their newborns were actively and passively followed-up from birth to 3 months. Data on clinical symptoms developed by the children and laboratory results of all clinical samples investigated were collected. A Cox proportional hazards model was performed to identify risk factors associated with possible severe bacterial infection. FINDINGS A total of 53 possible severe bacterial infection and 6 confirmed severe bacterial infection episodes were identified among the 511 neonates followed-up, with more than half occurring in the first 3 days. For the first month period, the incidence of confirmed severe bacterial infection was 11.7 per 1,000 live births indicating a 1.3 -fold decrease compared to BIRDY 1 in Madagascar (p = 0.50) and the incidence of possible severe bacterial infection was 76.3, indicating a 2.6-fold decrease compared to BIRDY 1 in Madagascar (p < 0.001). The 6 severe bacterial infection confirmed by blood culture included 5 Enterobacterales and one Enterococcus faecium. The 5 Enterobacterales were extended-spectrum β-lactamases (ESBL) producers and were resistant to quinolones and gentamicin. Enterococcus faecium was sensitive to vancomycin but resistant to amoxicillin and to gentamicin. These pathogns were classified as multidrug-resistant bacteria and were resistant to antibiotics recommended in WHO guidelines for neonatal sepsis. However, they remained susceptible to carbapenem. Fetid amniotic fluid, need for resuscitation at birth and low birth weight were associated with early onset possible severe bacterial infection. CONCLUSION Our results suggest that the incidence of severe bacterial infection is still high in the community of Madagascar, even if it seems lower when compared to BIRDY 1 estimates, and that existing neonatal sepsis treatment guidelines may no longer be appropriate in Madagascar. These results motivate to further strengthen actions for the prevention, early diagnosis and case management during the first 3 days of life.
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Affiliation(s)
- Ines Devred
- CESP, Anti-infective evasion and pharmacoepidemiology team, Université Paris-Saclay, UVSQ, Inserm, Montigny-Le-Bretonneux, F- 78180, France
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, F-75015, France
| | - Lison Rambliere
- CESP, Anti-infective evasion and pharmacoepidemiology team, Université Paris-Saclay, UVSQ, Inserm, Montigny-Le-Bretonneux, F- 78180, France
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, F-75015, France
| | | | | | - Aina Harimanana
- Epidemiology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | | | - Delphine Hivernaud
- Hôpital Necker-Enfants malades, Department of Neonatal medicine, AP-HP, Université Paris Cité, Paris, France
| | - Elsa Kermorvant-Duchemin
- Hôpital Necker-Enfants malades, Department of Neonatal medicine, AP-HP, Université Paris Cité, Paris, France
| | | | - Armya Youssouf Abdou
- CESP, Anti-infective evasion and pharmacoepidemiology team, Université Paris-Saclay, UVSQ, Inserm, Montigny-Le-Bretonneux, F- 78180, France
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, F-75015, France
| | - Elisabeth Delarocque-Astagneau
- CESP, Anti-infective evasion and pharmacoepidemiology team, Université Paris-Saclay, UVSQ, Inserm, Montigny-Le-Bretonneux, F- 78180, France
- Medical Information, AP-HP. Paris Saclay, Public Health, Clinical research, Le Kremlin-Bicêtre, F-94276, France
| | - Didier Guillemot
- CESP, Anti-infective evasion and pharmacoepidemiology team, Université Paris-Saclay, UVSQ, Inserm, Montigny-Le-Bretonneux, F- 78180, France
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, F-75015, France
- Medical Information, AP-HP. Paris Saclay, Public Health, Clinical research, Le Kremlin-Bicêtre, F-94276, France
| | - Tania Crucitti
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Jean-Marc Collard
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Bich-Tram Huynh
- CESP, Anti-infective evasion and pharmacoepidemiology team, Université Paris-Saclay, UVSQ, Inserm, Montigny-Le-Bretonneux, F- 78180, France.
- Institut Pasteur, Université Paris Cité, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, F-75015, France.
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Kutz JM, Rausche P, Rasamoelina T, Ratefiarisoa S, Razafindrakoto R, Klein P, Jaeger A, Rakotomalala RS, Rakotomalala Z, Randrianasolo BS, McKay-Chopin S, May J, Rakotozandrindrainy R, Puradiredja DI, Sicuri E, Hampl M, Lorenz E, Gheit T, Rakotoarivelo RA, Fusco D. Female genital schistosomiasis, human papilloma virus infection, and cervical cancer in rural Madagascar: a cross sectional study. Infect Dis Poverty 2023; 12:89. [PMID: 37749705 PMCID: PMC10518971 DOI: 10.1186/s40249-023-01139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Women's health in resource-limited settings can benefit from the integrated management of high-burden diseases, such as female genital schistosomiasis (FGS) and human papilloma virus (HPV)-related cervical cancer. In schistosomiasis-endemic countries such as Madagascar, data on FGS and HPV prevalence are lacking as well as preventive measures for both conditions. This study aims to estimate the prevalence of FGS and HPV in rural Madagascar, and to examine associated risk factors to identify opportunities for improving women's health. METHODS After initial community outreach activities, interested women aged 18-49 years were recruited consecutively in 2021 at three primary health care centers in the district of Marovoay. FGS was detected by colposcopy. Colposcopy images were double-blind reviewed by two independent specialists. A Luminex bead-based assay was performed on cervical vaginal lavage specimens for HPV typing. Crude (CPR) and adjusted prevalence ratios (APR) of associations between selected factors and FGS and HPV positivity were estimated using univariable and multivariable binary Poisson regression with 95% confidence intervals (CIs). RESULTS Among 500 women enrolled, 302 had complete information on FGS and HPV diagnosis, and were thus eligible for analysis. Within the sample, 189 (62.6%, 95% CI: 56.9-68.1) cases of FGS were detected. A total of 129 women (42.7%, 95% CI: 37.1-48.5) tested positive for HPV. In total, 80 women (26.5%, 95% CI: 21.6-31.8]) tested positive for both conditions. No association was observed between FGS and HPV positivity, while previous pregnancy (APR = 0.65, 95% CI: 0.43-0.78) and older age (APR = 0.59, 95% CI: 0.42-0.81) are showing a negative association with HPV infection compared to no previous pregnancy and younger age groups. CONCLUSIONS The results of the study show that FGS and HPV are highly prevalent in rural Madagascar. The concurrent prevalence of these two conditions requires urgent adaptations of public health strategies to improve women's health, such as integrated services at primary level of care.
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Affiliation(s)
- Jean-Marc Kutz
- Department of Infectious Disease Epidemiology, Bernhard-Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Pia Rausche
- Department of Infectious Disease Epidemiology, Bernhard-Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | | | | | | | - Philipp Klein
- Department of Infectious Disease Epidemiology, Bernhard-Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Anna Jaeger
- Department of Infectious Disease Epidemiology, Bernhard-Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | | | - Zoly Rakotomalala
- Centre Hospitalier Universitaire (CHU) Androva, Mahajanga, Madagascar
| | | | | | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard-Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Dewi Ismajani Puradiredja
- Department of Infectious Disease Epidemiology, Bernhard-Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Elisa Sicuri
- Barcelona Institute for Global Health (IS Global), Barcelona, Spain
| | | | - Eva Lorenz
- Department of Infectious Disease Epidemiology, Bernhard-Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Tarik Gheit
- International Agency for Research on Cancer (IARC), Lyon, France
| | | | - Daniela Fusco
- Department of Infectious Disease Epidemiology, Bernhard-Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany.
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22
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Rakotosamimanana S, Taglioni F, Ravaoarimanga M, Rajerison ME, Rakotomanana F. Socioenvironmental determinants as indicators of plague risk in the central highlands of Madagascar: Experience of Ambositra and Tsiroanomandidy districts. PLoS Negl Trop Dis 2023; 17:e0011538. [PMID: 37672517 PMCID: PMC10506711 DOI: 10.1371/journal.pntd.0011538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/18/2023] [Accepted: 07/19/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Human plague cases are reported annually in the central highland regions of Madagascar, where the disease is endemic. The socioenvironmental characteristics and lifestyles of the populations of the central highland localities could be linked to this endemicity. The aim of this study was to determine socioenvironmental determinants that may be associated with plague risk and explain this variation in epidemiological contexts. METHODS The current study was based on the distribution of plague cases between 2006 and 2015 that occurred in localities of districts positioned in the central highlands. Household surveys were performed from June to August 2017 using a questionnaire and direct observations on the socioenvironmental aspects of households in selected localities. Bivariate and multivariate analyses were performed to highlight the socioenvironmental parameters associated with plague risk in both districts. RESULTS A total of 503 households were surveyed, of which 54.9% (276/503) were in Ambositra and 45.1% (227/503) were in Tsiroanomandidy. Multivariate analyses showed that thatched roofs [adjusted odds ratio (AOR): 2.63; 95% confidence interval (95% CI): 1.78-3.88] and ground floor houses [AOR: 2.11; 95% CI: 1.3-3.45-] were significantly associated with the vulnerability of a household to plague risk (p value<0.05). CONCLUSIONS Plague risk in two districts of the Malagasy central highlands is associated with human socioenvironmental characteristics. Socioenvironmental characteristics are parameters expressing spatial heterogeneity through the difference in epidemiological expression of the plague in Ambositra and Tsiroanomandidy. These characteristics could be used as indicators of vulnerability to plague risk in plague-endemic areas.
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23
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Pando C, Hazel A, Tsang LY, Razafindrina K, Andriamiadanarivo A, Rabetombosoa RM, Ambinintsoa I, Sadananda G, Small PM, Knoblauch AM, Rakotosamimanana N, Grandjean Lapierre S. A social network analysis model approach to understand tuberculosis transmission in remote rural Madagascar. BMC Public Health 2023; 23:1511. [PMID: 37558982 PMCID: PMC10410943 DOI: 10.1186/s12889-023-16425-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Quality surveillance data used to build tuberculosis (TB) transmission models are frequently unavailable and may overlook community intrinsic dynamics that impact TB transmission. Social network analysis (SNA) generates data on hyperlocal social-demographic structures that contribute to disease transmission. METHODS We collected social contact data in five villages and built SNA-informed village-specific stochastic TB transmission models in remote Madagascar. A name-generator approach was used to elicit individual contact networks. Recruitment included confirmed TB patients, followed by snowball sampling of named contacts. Egocentric network data were aggregated into village-level networks. Network- and individual-level characteristics determining contact formation and structure were identified by fitting an exponential random graph model (ERGM), which formed the basis of the contact structure and model dynamics. Models were calibrated and used to evaluate WHO-recommended interventions and community resiliency to foreign TB introduction. RESULTS Inter- and intra-village SNA showed variable degrees of interconnectivity, with transitivity (individual clustering) values of 0.16, 0.29, and 0.43. Active case finding and treatment yielded 67%-79% reduction in active TB disease prevalence and a 75% reduction in TB mortality in all village networks. Following hypothetical TB elimination and without specific interventions, networks A and B showed resilience to both active and latent TB reintroduction, while Network C, the village network with the highest transitivity, lacked resiliency to reintroduction and generated a TB prevalence of 2% and a TB mortality rate of 7.3% after introduction of one new contagious infection post hypothetical elimination. CONCLUSION In remote Madagascar, SNA-informed models suggest that WHO-recommended interventions reduce TB disease (active TB) prevalence and mortality while TB infection (latent TB) burden remains high. Communities' resiliency to TB introduction decreases as their interconnectivity increases. "Top down" population level TB models would most likely miss this difference between small communities. SNA bridges large-scale population-based and hyper focused community-level TB modeling.
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Affiliation(s)
- Christine Pando
- Stony Brook University, 101 Nicolls Road, Stony Brook, NY, 11794-8343, USA
| | - Ashley Hazel
- Francis I. Proctor Foundation, University of California, San Francisco, 490 Illinois Street, 2nd Floor, San Francisco, CA, 94110, USA
| | - Lai Yu Tsang
- Stony Brook University, 101 Nicolls Road, Stony Brook, NY, 11794-8343, USA
| | | | | | - Roger Mario Rabetombosoa
- Centre ValBio Research Station, BP 33 Ranomafana, Ifanadiana, Madagascar
- Institut Pasteur de Madagascar, 101, Ambohitrakely, Antananarivo, Madagascar
| | - Ideal Ambinintsoa
- Centre ValBio Research Station, BP 33 Ranomafana, Ifanadiana, Madagascar
| | - Gouri Sadananda
- Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106, USA
| | - Peter M Small
- Stony Brook University, 101 Nicolls Road, Stony Brook, NY, 11794-8343, USA
| | - Astrid M Knoblauch
- Institut Pasteur de Madagascar, 101, Ambohitrakely, Antananarivo, Madagascar
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Simon Grandjean Lapierre
- Institut Pasteur de Madagascar, 101, Ambohitrakely, Antananarivo, Madagascar.
- Centre de Recherche du Centre Hospitalier de L, Université de Montréal, 900 Saint-Denis, Montréal, H2X 3H8, Canada.
- Université de Montréal, 2900 Edouard Montpetit, Montreal, H3T 1J4, Canada.
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Broban A, Olive MM, Tantely ML, Dorsemans AC, Rakotomanana F, Ravalohery JP, Rogier C, Heraud JM, Andriamandimby SF. Seroprevalence of IgG Antibodies Directed against Dengue, Chikungunya and West Nile Viruses and Associated Risk Factors in Madagascar, 2011 to 2013. Viruses 2023; 15:1707. [PMID: 37632049 PMCID: PMC10458928 DOI: 10.3390/v15081707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Arboviruses have been shown to circulate in Madagascar, including West Nile, dengue, and chikungunya viruses, though the extent of their circulation remains poorly documented. We estimated the seroprevalence of these three arboviruses in Madagascar and determined risk factors associated with seropositivity. Serum samples obtained from 1680 individuals surrounding the Sentinel Health Centers network in all regions of the country were analyzed using ELISA and hemagglutination inhibition assays for dengue, chikungunya, and West Nile viruses IgG antibodies, and multivariate logistic regression models were run. Overall, 6.5% [IC 95% 3.2-9.9] were seropositive for dengue virus, predominantly of Dengue serotype 1, 13.7% [IC 95% 6.5-20.9] for chikungunya virus, and 12.7% [IC 95% 9.0-16.5] for West Nile virus. There was no association with age, showing that dengue and chikungunya viruses were likely recently introduced. Eastern and Northern parts were more affected by dengue and chikungunya viruses, while West Nile virus seemed to circulate in all parts of the country. Dengue and chikungunya seropositivity were notably associated with high levels of vegetation, as well as frequent work in the forest, and West Nile seropositivity with the presence of cultivated areas, as well as standard of living. This analysis gives a new insight into arboviruses circulation and transmission patterns in Madagascar.
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Affiliation(s)
- Anaïs Broban
- Virology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (A.B.); (M.-M.O.); (A.-C.D.); (J.-P.R.); (S.F.A.)
- Epicentre, 75017 Paris, France
| | - Marie-Marie Olive
- Virology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (A.B.); (M.-M.O.); (A.-C.D.); (J.-P.R.); (S.F.A.)
| | | | - Anne-Claire Dorsemans
- Virology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (A.B.); (M.-M.O.); (A.-C.D.); (J.-P.R.); (S.F.A.)
| | - Fanjasoa Rakotomanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar;
| | - Jean-Pierre Ravalohery
- Virology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (A.B.); (M.-M.O.); (A.-C.D.); (J.-P.R.); (S.F.A.)
| | - Christophe Rogier
- Directorate, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar;
- Primum Vitare ! D’abord Prévenir !, 75015 Paris, France
| | - Jean-Michel Heraud
- Virology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (A.B.); (M.-M.O.); (A.-C.D.); (J.-P.R.); (S.F.A.)
| | - Soa Fy Andriamandimby
- Virology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (A.B.); (M.-M.O.); (A.-C.D.); (J.-P.R.); (S.F.A.)
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25
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Mananjara DEA, Rakotoarinoro M, Rakotoarison VC, Raliniaina M, Razafindraibe NP, Ravonirina C, Randriamparany T, Rasamoelina-Andriamanivo H, Rakotozandrindrainy R, Cardinale E, Lightowlers MW, Donadeu M, Mwape KE. Confirmation by necropsy of a high prevalence of porcine cysticercosis in a rural district of Madagascar. Parasitology 2023; 150:852-857. [PMID: 37496390 PMCID: PMC10478050 DOI: 10.1017/s0031182023000653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023]
Abstract
Neurocysticercosis is recognized as an important health issue in the Malagasy population. To date, investigations into prevalence of infection with the causative agent, Taenia solium, in the parasite's natural animal intermediate hosts, have relied on serological methods which have been found to be non-specific. We determined the prevalence of porcine cysticercosis among pigs from a contiguous area of the Betafo and Mandoto administrative districts, Vakinankaratra Region, Madagascar. One hundred and four slaughter-weight pigs were examined by detailed necropsy examination including slicing of the heart, tongue, masseter muscles, diaphragm and carcase musculature. Thirty-seven animals (35.6%) were found infected with T. solium, representing one of the highest rates of infection ever reported, worldwide. These findings highlight the importance of T. solium in Madagascar and support the need for increased efforts to prevent the parasite's transmission to reduce its burden on the health of the Malagasy population.
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Affiliation(s)
- Diana Edithe Andria Mananjara
- National Center for Applied Research on Rural Development (FOFIFA), BP04 Rue Farafaty Ampandrianomby, Antsirabe, Antananarivo 101, Madagascar
| | - Mihajamanana Rakotoarinoro
- National Center for Applied Research on Rural Development (FOFIFA), BP04 Rue Farafaty Ampandrianomby, Antsirabe, Antananarivo 101, Madagascar
| | - Valisoa C. Rakotoarison
- National Center for Applied Research on Rural Development (FOFIFA), BP04 Rue Farafaty Ampandrianomby, Antsirabe, Antananarivo 101, Madagascar
| | - Modestine Raliniaina
- National Center for Applied Research on Rural Development (FOFIFA), BP04 Rue Farafaty Ampandrianomby, Antsirabe, Antananarivo 101, Madagascar
| | | | - Claudia Ravonirina
- Regional Directorate of Agriculture and Livestock Vakinankaratra, Madagascar
| | - Tantely Randriamparany
- National Veterinary Diagnostic Laboratory, Anosimasina Itaosy, Antananarivo 102, Madagascar
| | | | | | | | - Marshall W. Lightowlers
- Department of Biosciences, Melbourne Veterinary School, 250 Princes Highway, Werribee, Victoria 3030, Australia
| | - Meritxell Donadeu
- Department of Biosciences, Melbourne Veterinary School, 250 Princes Highway, Werribee, Victoria 3030, Australia
- Initiative for Neglected Animal Diseases (INAND), Constantia Park, Pretoria, South Africa
| | - Kabemba E. Mwape
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia
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Rasoamanamihaja CF, Rakotoarivelo RA, Edosoa G, Rasamoelina T, Montresor A, Marchese V, Fusco D. Schistosomiasis elimination in Madagascar: challenges and opportunities for implementing the new WHO guidelines. BMJ Glob Health 2023; 8:e012598. [PMID: 37580102 PMCID: PMC10432657 DOI: 10.1136/bmjgh-2023-012598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/01/2023] [Indexed: 08/16/2023] Open
Abstract
Madagascar is one of the countries with the highest burden of schistosomiasis worldwide. The release from the WHO of the new 2021-2030 neglected tropical disease (NTD) roadmap alongside with the schistosomiasis guidelines sets the ambitious goal of eliminating schistosomiasis as a public health problem worldwide. In Madagascar, implementation barriers exist. This paper has the objective of identifying strengths, weaknesses, opportunities and threats in order to build on their basis practices and policies that can help the country to align with the international global health agenda and reach the ambitious goal set by the WHO.
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Affiliation(s)
| | | | - Glenn Edosoa
- World Health Organization, Antananarivo, Madagascar
| | | | | | - Valentina Marchese
- Infectious Diseases Epidemiology, Bernhard-Nocht-Institut fur Tropenmedizin, Hamburg, Germany
- German Center for Infection Research Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
| | - Daniela Fusco
- Infectious Diseases Epidemiology, Bernhard-Nocht-Institut fur Tropenmedizin, Hamburg, Germany
- German Center for Infection Research Hamburg-Lübeck-Borstel-Riems Site, Hamburg, Germany
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Sendrasoa FA, Ratovonjanahary VT, Ranaivo IM, Rasamoelina T, Rakotoarisaona MF, Andrianarison M, Ramarozatovo LS, Rabenja FR. Epidemiological and clinical aspects of sporotrichosis in patients seen at a reference hospital in Madagascar. PLoS Negl Trop Dis 2023; 17:e0011478. [PMID: 37494410 PMCID: PMC10406185 DOI: 10.1371/journal.pntd.0011478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 08/07/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION Sporotrichosis is a subacute to chronic fungal infection of skin and subcutaneous tissues, caused by dimorphic fungi belonging to the genus Sporothrix, commonly seen in tropical and subtropical regions like Madagascar. This study describes the epidemiological, clinical, and the treatment outcomes with itraconazole for sporotrichosis. METHODS A descriptive retrospective study on patients suffering from sporotrichosis, from March 2013 to January 2019, was conducted, in the reference center for endemic mycoses. Patients with sporotrichosis who received itraconazole for at least 3 months were included in the study. Patients received itraconazole 200 mg daily for 3 to 6 months. Therapeutic responses were evaluated at months 3 and 6 after treatment. Outcomes were classified as minor response, major response, cure, and failure. RESULTS Forty-three cases of sporotrichosis were included. The median age of patients was 40 years. Most of them (62.8%) were rural workers. Men were more frequently infected (72%). At the end of 6th month of treatment, 20 patients (46.5%) were cured and a major response to itraconazole was observed in 8 patients (18.6%). The cure rate was higher in 12 patients (27.9%) who had disease durations of less than to one year than in those who had more time of disease (18.6%) (p = 0.01). Thirteen patients (30.2%) were lost to follow up. The rate of lost to follow-up was also higher (39.5%) in patients who had sporotrichosis of less than to one year than in those who had more time of disease. CONCLUSION The cure rate found in this study was inferior to that reported in the literature. However, it was higher in patients with early symptomatology.
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Affiliation(s)
| | | | - Irina Mamisoa Ranaivo
- Department of dermatology, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | | | | | | | - Lala Soavina Ramarozatovo
- Department of dermatology, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
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Gruninger SK, Rasamoelina T, Rakotoarivelo RA, Razafindrakoto AR, Rasolojaona ZT, Rakotozafy RM, Soloniaina PR, Rakotozandrindrainy N, Rausche P, Doumbia CO, Jaeger A, Zerbo A, von Thien H, Klein P, van Dam G, Tannich E, Schwarz NG, Lorenz E, May J, Rakotozandrindrainy R, Fusco D. Prevalence and risk distribution of schistosomiasis among adults in Madagascar: a cross-sectional study. Infect Dis Poverty 2023; 12:44. [PMID: 37098581 PMCID: PMC10127445 DOI: 10.1186/s40249-023-01094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/09/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for sustainable development goals, including universal health coverage (UHC). Current control strategies focus on school-aged children, systematically neglecting adults. We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC. METHODS In a cross-sectional study performed between March 2020 and January 2021 at three primary health care centers in Andina, Tsiroanomandidy and Ankazomborona in Madagascar, we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1482 adult participants. Univariable and multivariable logistic regression were performed to evaluate odd ratios. RESULTS The highest prevalence of S. mansoni, S. haematobium and co-infection of both species was 59.5%, 61.3% and 3.3%, in Andina and Ankazomborona respectively. Higher prevalence was observed among males (52.4%) and main contributors to the family income (68.1%). Not working as a farmer and higher age were found to be protective factors for infection. CONCLUSIONS Our findings provide evidence that adults are a high-risk group for schistosomiasis. Our data suggests that, for ensuring basic health as a human right, current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific, holistic and integrated approaches.
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Affiliation(s)
- Sarah Katharina Gruninger
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | | | - Rivo Andry Rakotoarivelo
- Department of Infectious Diseases, University of Fianarantsoa Andrainjato, 301, Fianarantsoa, Madagascar
| | | | | | - Rodson Morin Rakotozafy
- Department of Microbiology and Parasitology, University of Antananarivo, 101, Antananarivo, Madagascar
| | | | - Njary Rakotozandrindrainy
- Department of Microbiology and Parasitology, University of Antananarivo, 101, Antananarivo, Madagascar
| | - Pia Rausche
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Cheick Oumar Doumbia
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- University Clinical Research Centre (UCRC), University of Sciences Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Anna Jaeger
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Alexandre Zerbo
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Heidrun von Thien
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Philipp Klein
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Govert van Dam
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Egbert Tannich
- National Reference Centre for Tropical Pathogens (NRC), Hamburg, Germany
| | - Norbert Georg Schwarz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Eva Lorenz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Department of Tropical Medicine I, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Daniela Fusco
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany.
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Razanajatovo NH, Randriambolamanantsoa TH, Rabarison JH, Randrianasolo L, Ankasitrahana MF, Ratsimbazafy A, Raherinandrasana AH, Razafimanjato H, Raharinosy V, Andriamandimby SF, Heraud JM, Dussart P, Lacoste V. Epidemiological Patterns of Seasonal Respiratory Viruses during the COVID-19 Pandemic in Madagascar, March 2020-May 2022. Viruses 2022; 15:12. [PMID: 36680053 PMCID: PMC9864023 DOI: 10.3390/v15010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Three epidemic waves of coronavirus disease-19 (COVID-19) occurred in Madagascar from March 2020 to May 2022, with a positivity rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of 21% to 33%. Our study aimed to identify the impact of COVID-19 on the epidemiology of seasonal respiratory viruses (RVs) in Madagascar. We used two different specimen sources (SpS). First, 2987 nasopharyngeal (NP) specimens were randomly selected from symptomatic patients between March 2020 and May 2022 who tested negative for SARS-CoV-2 and were tested for 14 RVs by multiplex real-time PCR. Second, 6297 NP specimens were collected between March 2020 and May 2022 from patients visiting our sentinel sites of the influenza sentinel network. The samples were tested for influenza, respiratory syncytial virus (RSV), and SARS-CoV-2. From SpS-1, 19% (569/2987) of samples tested positive for at least one RV. Rhinovirus (6.3%, 187/2987) was the most frequently detected virus during the first two waves, whereas influenza predominated during the third. From SpS-2, influenza, SARS-CoV-2, and RSV accounted for 5.4%, 24.5%, and 39.4% of the detected viruses, respectively. During the study period, we observed three different RV circulation profiles. Certain viruses circulated sporadically, with increased activity in between waves of SARS-CoV-2. Other viruses continued to circulate regardless of the COVID-19 situation. Certain viruses were severely disrupted by the spread of SARS-CoV-2. Our findings underline the importance and necessity of maintaining an integrated disease surveillance system for the surveillance and monitoring of RVs of public health interest.
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Affiliation(s)
| | | | | | - Laurence Randrianasolo
- Epidemiology and Clinical Research Unit, Institut Pasteur of Madagascar, Antananarivo 101, Madagascar
| | - Miamina Fidy Ankasitrahana
- Direction de la Veille Sanitaire, de la Surveillance Epidémiologique et Ripostes, Ministry of Public Health, Antananarivo 101, Madagascar
| | - Arvé Ratsimbazafy
- National Influenza Center, Virology Unit, Institut Pasteur of Madagascar, Antananarivo 101, Madagascar
| | - Antso Hasina Raherinandrasana
- Direction de la Veille Sanitaire, de la Surveillance Epidémiologique et Ripostes, Ministry of Public Health, Antananarivo 101, Madagascar
| | - Helisoa Razafimanjato
- National Influenza Center, Virology Unit, Institut Pasteur of Madagascar, Antananarivo 101, Madagascar
| | - Vololoniaina Raharinosy
- National Influenza Center, Virology Unit, Institut Pasteur of Madagascar, Antananarivo 101, Madagascar
| | - Soa Fy Andriamandimby
- National Influenza Center, Virology Unit, Institut Pasteur of Madagascar, Antananarivo 101, Madagascar
| | | | - Philippe Dussart
- National Influenza Center, Virology Unit, Institut Pasteur of Madagascar, Antananarivo 101, Madagascar
| | - Vincent Lacoste
- National Influenza Center, Virology Unit, Institut Pasteur of Madagascar, Antananarivo 101, Madagascar
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Schuster A, Randrianasolo BS, Rabozakandraina OO, Ramarokoto CE, Brønnum D, Feldmeier H. Knowledge, experiences, and practices of women affected by female genital schistosomiasis in rural Madagascar: A qualitative study on disease perception, health impairment and social impact. PLoS Negl Trop Dis 2022; 16:e0010901. [PMID: 36342912 PMCID: PMC9639808 DOI: 10.1371/journal.pntd.0010901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Background Female genital schistosomiasis (FGS) is a neglected manifestation of urogenital schistosomiasis caused by S. haematobium. The disease presents with symptoms such as pelvic pain, vaginal discharge and bleeding and menstruation disorders, and might lead to infertility and pregnancy complications. The perspectives of women with FGS have not been studied systematically. The aim of the study was to understand knowledge, experiences, and practices of women with FGS. Methods We performed a qualitative study with seventy-six women diagnosed of having FGS, in the Ambanja district in Northwest Madagascar. Data collection was either through focus group discussion (N = 60) or in an individual semi-structured interview (N = 16). FGS was diagnosed by colposcopy. The data was analysed using Mayring´s qualitative content analysis. Results Knowledge on how the disease is acquired varied and ideas on prevention remained vague. Patients suffered from vaginal discharge and pelvic complaints. Some women expressed unbearable pain during sexual intercourse and compared their pain to an open wound being touched. FGS considerably impaired women´s daily activities and their quality of life. Infertility led to resignation and despair, conflicts with the partner and to social exclusion from the community. Women fearing to sexually transmit FGS refrained from partnership and sexual relations. Many women with FGS reported stigmatisation. A coping strategy was to share strain with other women having similar complaints. However, concealing FGS was a common behaviour which led to social isolation and delayed health care seeking. Conclusions Our study underlines that FGS has an important impact on the sexual health of women and on their social life in the community. Our results highlight the importance of providing adequate health education and structural interventions, such as the supply of water and the provision of sanitation measures. Further, correct diagnosis and treatment of FGS in adolescent girls and women should be available in all S. haematobium-endemic areas. Trial registration The qualitative study was embedded in a randomised controlled trial (RCT) in which two doses of praziquantel were compared (https://clinicaltrials.gov/ct2/show/NCT04115072). Female genital schistosomiasis is a parasitic disease, acquired by humans when exposed to infested water. Patients can develop severe gynaecologic symptoms and face psychological and social problems. Although urogenital schistosomiasis is very common in many communities in Sub-Sahara Africa, knowledge on FGS among community members and health care workers is poor. Knowledge and experiences of women affected by FGS have never been explored but need to be understood to provide effective health care and to promote adequate interventions. In this study, waterborne and sexual transmission were the most recurrently mentioned pathways for FGS acquisition. Most women perceived the risk for FGS as immutable and related to the precarious living conditions. The women were able to differentiate between urinary and female genital schistosomiasis. FGS caused partnership conflicts and affected women’s position in the community. Stigma within the community and mistrust in health care resulted in delayed seeking health care. In view of these results, we propose including health education and structural interventions to improve living conditions, in order to reduce the burden of FGS. Further, improved access to correct diagnosis and treatment should be provided.
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Affiliation(s)
- Angela Schuster
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of General Practice, Berlin, Germany
- * E-mail:
| | | | | | | | - Dorthe Brønnum
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Hermann Feldmeier
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
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Rakotonirinarisoa V, Rakotoarinoro NA, Ramiandrisoa RL, Ramiandrisoa FA, Randriamiarana H, Rakotoson JL, Andrianasolo RL, Rabearivony N. [Characteristics of chest pain in acute coronary syndromes seen in the cardiology department of Befelatanana (Madagascar)]. Ann Cardiol Angeiol (Paris) 2022; 71:290-293. [PMID: 35940965 DOI: 10.1016/j.ancard.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Chest pain is one of the different elements of orientation for the diagnosis of acute coronary syndrome. Sometimes its clinical presentation is misleading. The objective of this study was to describe the characteristics of chest pain during an acute coronary syndrome in the cardiology department of the Joseph Raseta Befelatanana University Hospital Center, Antananarivo, Madagascar. METHODS We carried out a cross-sectional, descriptive study of 10 months from January 2019 to October 2019. All patients diagnosed with acute coronary syndrome during this period were included. RESULTS Sixty-five cases were included. A "typical chest pain" was only encountered in 7.7% of cases. Advanced age (p = 0.04) and sedentary lifestyle (p = 0.03) were associated with the occurrence of silent myocardial ischemia, and. hypertension with a prolonged duration (≥15 minutes) of chest pain (p = 0.03). Dyslipidemia was associated with atypical irradiation of chest pain (p = 0.003). Alcoholism had an impact on pain triggered by effort (p = 0.01) and relieved by rest (p = 0.04). CONCLUSION The current symptomatology of acute coronary syndrome is increasingly atypical. Knowledge of the factors that can influence the different characteristics of chest pain could serve as a benchmark in clinical practice in our population.
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Affiliation(s)
- Valinjaka Rakotonirinarisoa
- Service de Cardiologie, CHU Befelatanana, Antananarivo, Madagascar; Service de Cardiologie, CH de la Côte d'Argent, Dax, France; Service d'Endocrinologie, CHU Befelatanana, Antananarivo, Madagascar; Service de Pneumologie, CHU Befelatanana, Antananarivo, Madagascar.
| | | | | | - Fy Aria Ramiandrisoa
- Service de Cardiologie, CH de la Côte d'Argent, Dax, France; Service d'Endocrinologie, CHU Befelatanana, Antananarivo, Madagascar; Service de Pneumologie, CHU Befelatanana, Antananarivo, Madagascar
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Muller N, Ranjaharinony F, Etrahagnane M, Frühauf A, Razafindranaivo T, Ramasimanana H, Emmrich JV. Crossing the Last Mile of TB Care in Rural Southern Madagascar: A Multistakeholder Initiative. Glob Health Sci Pract 2022; 10:e2200101. [PMID: 36316148 PMCID: PMC9622284 DOI: 10.9745/ghsp-d-22-00101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
Despite a free TB care policy, access to TB care in rural Madagascar is limited due to a markedly underfunded health care system. The World Health Organization estimated the yearly TB incidence in Madagascar at 238 cases per 100,000 people in 2020; only half of the patients with TB are being notified and treated. We describe the development, implementation, and lessons learned of an intervention to improve TB care services in a remote, rural district in southern Madagascar. We involved national, regional, and local stakeholders in assessing the multifaceted challenges in a remote, rural area and codesigning activities to address them. The overarching principles of the intervention were to (1) promote national TB guidelines, (2) build on best practices, and (3) prioritize low-cost activities to enable scale-up. An in-depth assessment of challenges in accessing and delivering TB care resulted in the following prioritization of activities: (1) fostering community engagement, (2) decentralizing service provision, (3) improving quality of care, (4) providing nutritional support, and (5) ensuring staff support and supervision. The intervention was launched in September 2019 and is ongoing as of October 2022. During mobile TB clinics conducted between September 2019 and December 2020, 4,982 presumptive patients were screened and 1,706 (34.2%) have been diagnosed with TB. Based on 2010-2020 official TB notification data, we calculated trend-adjusted additional TB notifications during the intervention, resulting in a 2.6-fold increase in cases in 2019-2020. The intervention district's TB notification rate increased from 178 cases per 100,000 people in 2018 to 424 cases per 100,000 people in 2020. Involving stakeholders from all levels of care was perceived as a key to success. The unexpected increase in the number of patients with TB in the intervention district overburdened the current paper-based TB notification system and emphasized the need for expanded diagnostics and social support services.
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Affiliation(s)
- Nadine Muller
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Charité Global Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Anna Frühauf
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Charité Global Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Julius Valentin Emmrich
- Charité Global Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
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Riedmann J, Solonavalona AF, Rakotozafy AR, Ralamboson S, Endres M, Siegerink B, Siebert E, Knauss S, Emmrich JV. Proportion of stroke types in Madagascar: A tertiary-level hospital-based case series. PLoS One 2022; 17:e0276199. [PMID: 36240194 PMCID: PMC9565373 DOI: 10.1371/journal.pone.0276199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Like other countries in sub-Saharan Africa, Madagascar has a high burden of stroke. The Malagasy population is unique in sharing both African and Asian ancestry. The proportion of ischemic and hemorrhagic stroke types is unknown for this population. AIM Our aim was to establish the proportion of stroke types and known risk factors for the Malagasy population. METHODS We conducted a single-center, tertiary-level hospital-based case series. We included all patients with a CT-imaging confirmed stroke who presented at the emergency ward of the study hospital between January 1, 2017, and November 20, 2018. RESULTS Of 223 patients with CT-confirmed stroke, 57.4% (128/223, 95% CI: 51-64%) had an ischemic stroke and 42.6% (95/223, 95% CI: 36-49%) had an intracranial hemorrhage. The majority (89.5%; 85/95, 95% CI: 83-96%) of intracranial hemorrhages were intracerebral; 4.2% (4/95, 95% CI: 0-8%) had a subdural hematoma, 5.3% (5/95, 95% CI: 1-10%) had a subarachnoid hemorrhage, there was one isolated intraventricular hemorrhage (1.1%; 1/95, 95% CI: -1-3%). The prevalence of hypertension among stroke patients was high (86.6%; 187/216, 95% CI: 82-91%). CONCLUSIONS Our study is the first to report the proportion of stroke types and known risk factors in Madagascar. We find that the proportion of hemorrhagic strokes was unexpectedly higher than that reported from other countries in sub-Saharan Africa. Our findings highlight the need for a country-specific approach to stroke prevention, treatment, and rehabilitation and provide guidance on public health resource allocation in Madagascar.
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Affiliation(s)
- Julia Riedmann
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Solofo Ralamboson
- Soavinandriana Military Hospital (CENHOSOA), Antananarivo, Madagascar
| | - Matthias Endres
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Göttingen, Germany
- ExcellenceCluster NeuroCure, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Bob Siegerink
- Center for Stroke Research, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Samuel Knauss
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Julius Valentin Emmrich
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- * E-mail:
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Harimanana A, Rakotondrasoa A, Rivoarilala LO, Criscuolo A, Opatowski L, Rakotomanana EFN, Herindrainy P, Collard JM, Crucitti T, Huynh BT. Neonatal acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the community of a low-income country (NeoLIC): protocol for a household cohort study in Moramanga, Madagascar. BMJ Open 2022; 12:e061463. [PMID: 36153019 PMCID: PMC9511544 DOI: 10.1136/bmjopen-2022-061463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Data regarding the acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in neonates at the community level are scarce in low-income and middle-income countries (LMICs), where the burden of neonatal sepsis is high.Our study aims at identifying and quantifying the role of the different routes of ESBL-PE transmission for neonates, which are still undefined in the community in LMICs. METHODS AND ANALYSIS In a semirural community in Madagascar, 60 mothers and their neonates will be recruited at delivery, during which a maternal stool sample and meconium of the newborn will be collected. Home visits will be planned the day of the delivery and next at days 3, 7, 14, 21 and 28. Stool samples from the newborn, the mother and every other household member will be collected at each visit, as well as samples from the environment in contact with the newborn (food, surfaces and objects). Sociodemographic data and factors which might drive ESBL-PE acquisition will also be collected.We will analyse the isolated ESBL-PE using DNA sequencing methods to characterise clones, resistance genes and plasmids of ESBL-PE. To analyse these data globally, we will develop novel analytical approaches combining mathematical modelling and statistics. Finally, mathematical simulations will be performed to test different strategies of control of ESBL-PE transmission to neonates.In complement, we will conduct an anthropological investigation to understand local environments and practices that would contribute to neonatal ESBL-PE acquisition. In-depth interviews with members of 16 households will be conducted and 4 mother-newborn pairs will be followed by a participants' observations methodology. ETHICS AND DISSEMINATION The study was approved by the ethical committee in Madagascar and by the institutional review board of Institut Pasteur, Paris, France.Findings will be reported to participating families, collaborators and local government; presented at national and international conferences and disseminated by peer-review publications.
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Affiliation(s)
| | | | | | - Alexis Criscuolo
- Institut Pasteur, Paris, Île-de-France, France
- Université de Paris, Paris, Île-de-France, France
| | - Lulla Opatowski
- Institut Pasteur, Paris, Île-de-France, France
- Institut National de la Santé et de la Recherche Médicale, Université de Versailles Saint-Quentin-en-Yvelines and Université Paris-Saclay, Montigny-Le-Bretonneux, Île-de-France, France
| | | | - Perlinot Herindrainy
- Infectious Disease Detection and Surveillance, ICF International, Antananarivo, Madagascar
| | - Jean-Marc Collard
- Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Tania Crucitti
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Bich-Tram Huynh
- Institut Pasteur, Paris, Île-de-France, France
- Institut National de la Santé et de la Recherche Médicale, Université de Versailles Saint-Quentin-en-Yvelines and Université Paris-Saclay, Montigny-Le-Bretonneux, Île-de-France, France
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ten Bosch Q, Andrianaivoarimanana V, Ramasindrazana B, Mikaty G, Rakotonanahary RJL, Nikolay B, Rahajandraibe S, Feher M, Grassin Q, Paireau J, Rahelinirina S, Randremanana R, Rakotoarimanana F, Melocco M, Rasolofo V, Pizarro-Cerdá J, Le Guern AS, Bertherat E, Ratsitorahina M, Spiegel A, Baril L, Rajerison M, Cauchemez S. Analytical framework to evaluate and optimize the use of imperfect diagnostics to inform outbreak response: Application to the 2017 plague epidemic in Madagascar. PLoS Biol 2022; 20:e3001736. [PMID: 35969599 PMCID: PMC9410560 DOI: 10.1371/journal.pbio.3001736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 08/25/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
During outbreaks, the lack of diagnostic “gold standard” can mask the true burden of infection in the population and hamper the allocation of resources required for control. Here, we present an analytical framework to evaluate and optimize the use of diagnostics when multiple yet imperfect diagnostic tests are available. We apply it to laboratory results of 2,136 samples, analyzed with 3 diagnostic tests (based on up to 7 diagnostic outcomes), collected during the 2017 pneumonic (PP) and bubonic plague (BP) outbreak in Madagascar, which was unprecedented both in the number of notified cases, clinical presentation, and spatial distribution. The extent of these outbreaks has however remained unclear due to nonoptimal assays. Using latent class methods, we estimate that 7% to 15% of notified cases were Yersinia pestis-infected. Overreporting was highest during the peak of the outbreak and lowest in the rural settings endemic to Y. pestis. Molecular biology methods offered the best compromise between sensitivity and specificity. The specificity of the rapid diagnostic test was relatively low (PP: 82%, BP: 85%), particularly for use in contexts with large quantities of misclassified cases. Comparison with data from a subsequent seasonal Y. pestis outbreak in 2018 reveal better test performance (BP: specificity 99%, sensitivity: 91%), indicating that factors related to the response to a large, explosive outbreak may well have affected test performance. We used our framework to optimize the case classification and derive consolidated epidemic trends. Our approach may help reduce uncertainties in other outbreaks where diagnostics are imperfect. The response to the 2017 plague outbreak in Madagascar was complicated by the lack of a perfect or "gold standard" diagnostic. This study shows how multiple, imperfect diagnostic tests can be used to improve the response to an outbreak.
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Affiliation(s)
- Quirine ten Bosch
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR2000, F-75015 Paris, France
- Quantitative Veterinary Epidemiology, Department of Animal Sciences, Wageningen University and Research, Wageningen, the Netherlands
- * E-mail:
| | | | | | - Guillain Mikaty
- Environment and Infectious Risks Research Unit, Laboratory for Urgent Response to Biological Threats (ERI-CIBU), Institut Pasteur, Paris, France
| | | | - Birgit Nikolay
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR2000, F-75015 Paris, France
| | | | - Maxence Feher
- Environment and Infectious Risks Research Unit, Laboratory for Urgent Response to Biological Threats (ERI-CIBU), Institut Pasteur, Paris, France
| | - Quentin Grassin
- Environment and Infectious Risks Research Unit, Laboratory for Urgent Response to Biological Threats (ERI-CIBU), Institut Pasteur, Paris, France
| | - Juliette Paireau
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR2000, F-75015 Paris, France
| | | | - Rindra Randremanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo Madagascar
| | - Feno Rakotoarimanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo Madagascar
| | - Marie Melocco
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo Madagascar
| | | | - Javier Pizarro-Cerdá
- Yersinia Research Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 6047, F-75015 Paris, France
- National Reference Laboratory for Plague and other Yersiniosis, Institut Pasteur, F-75015 Paris, France
- World Health Organization Collaborating Center for Plague FRA-140, Institut Pasteur, F-75015 Paris, France
| | - Anne-Sophie Le Guern
- Yersinia Research Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 6047, F-75015 Paris, France
- National Reference Laboratory for Plague and other Yersiniosis, Institut Pasteur, F-75015 Paris, France
- World Health Organization Collaborating Center for Plague FRA-140, Institut Pasteur, F-75015 Paris, France
| | - Eric Bertherat
- World Health Organization, Health Emergency Programme, Department of Infectious Hazard Management, Geneva, Switzerland
| | - Maherisoa Ratsitorahina
- Direction, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Directorate of Health and Epidemiological Surveillance, Ministry of Public Health, Antananarivo, Madagascar
| | - André Spiegel
- Direction, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Laurence Baril
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo Madagascar
| | | | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR2000, F-75015 Paris, France
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Andrianiaina MMA, Raherison RE, Razanamparany T, Raharinavalona SA, Rakotomalala ADP, Andrianasolo RL. [Epidemiologic-clinical, biological and radiological features of pulmonary tuberculosis in patients with diabetes in Antananarivo, Madagascar]. Pan Afr Med J 2022; 42:49. [PMID: 35949462 PMCID: PMC9338721 DOI: 10.11604/pamj.2022.42.49.29199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/08/2022] [Indexed: 11/11/2022] Open
Abstract
Pulmonary tuberculosis is frequently associated with diabetes mellitus and, sometimes, it may present with atypical signs. The purpose of this study is to identify the epidemiological, clinical, biological and radiological features of pulmonary tuberculosis in patients with diabetes versus patients without diabetes in order to improve treatment. We conducted a retrospective, cross-sectional descriptive and analytical study in the Department of Endocrinology and Pneumology at the Joseph Raseta Befelatanana University Hospital Center and in the Department of Respiratory Diseases at the Soavinandriana Hospital Center in Antananarivo, Madagascar. It involved patients diagnosed with pulmonary tuberculosis who presented a positive bacilloscopy exam from January 2018 to January 2020 (25 months). In our study, the overall prevalence of diabetes among TB patients was 20.31 %. Older age, insidious clinical course, severe biologic inflammatory syndrome, fewer caves but more systematized opacities and diffuse radiological lesions in the basal zone (more commonly unilateral right lesions) were mainly detected in patients with diabetes compared to patients without diabetes. Knowledge of signs of pulmonary TB in patients with diabetes can help health care workers to make a diagnosis, even in patients with atypical signs. Moreover, as the majority of pulmonary tuberculosis occur in patients with unstable diabetes, a good glycemic balance can certainly reduce its incidence.
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Affiliation(s)
| | - Rija Eric Raherison
- Service d´Endocrinologie du Centre Hospitalier Universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
| | - Thierry Razanamparany
- Service de Médecine du Centre Hospitalier Régional de Référence de Vakinakaratra Antsirabe, Vakinakaratra Antsirabe, Madagascar
| | - Sitraka Angelo Raharinavalona
- Service de Médecine Interne et des Maladies Cardiovasculaires du Centre Hospitalier de Soavinandriana, Soavinandriana, Madagascar
| | | | - Radonirina Lazasoa Andrianasolo
- Service d´Endocrinologie du Centre Hospitalier Universitaire Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar
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Collard JM, Andrianonimiadana L, Habib A, Rakotondrainipiana M, Andriantsalama P, Randriamparany R, Rabenandrasana MAN, Weill FX, Sauvonnet N, Randremanana RV, Guillemot V, Vonaesch P, Sansonetti PJ. High prevalence of small intestine bacteria overgrowth and asymptomatic carriage of enteric pathogens in stunted children in Antananarivo, Madagascar. PLoS Negl Trop Dis 2022; 16:e0009849. [PMID: 35533199 PMCID: PMC9119516 DOI: 10.1371/journal.pntd.0009849] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 05/19/2022] [Accepted: 04/01/2022] [Indexed: 11/26/2022] Open
Abstract
Environmental Enteric Dysfunction (EED) refers to an incompletely defined syndrome of inflammation, reduced absorptive capacity, and reduced barrier function in the small intestine. It is widespread among children and adults in low- and middle-income countries and is also associated with poor sanitation and certain gut infections possibly resulting in an abnormal gut microbiota, small intestinal bacterial overgrowth (SIBO) and stunting. We investigated bacterial pathogen exposure in stunted and non-stunted children in Antananarivo, Madagascar by collecting fecal samples from 464 children (96 severely stunted, 104 moderately stunted and 264 non-stunted) and the prevalence of SIBO in 109 duodenal aspirates from stunted children (61 from severely stunted and 48 from moderately stunted children). SIBO assessed by both aerobic and anaerobic plating techniques was very high: 85.3% when selecting a threshold of ≥105 CFU/ml of bacteria in the upper intestinal aspirates. Moreover, 58.7% of the children showed more than 106 bacteria/ml in these aspirates. The most prevalent cultivated genera recovered were Streptococcus, Neisseria, Staphylococcus, Rothia, Haemophilus, Pantoea and Branhamella. Feces screening by qPCR showed a high prevalence of bacterial enteropathogens, especially those categorized as being enteroinvasive or causing mucosal disruption, such as Shigella spp., enterotoxigenic Escherichia coli, enteropathogenic E. coli and enteroaggregative E. coli. These pathogens were detected at a similar rate in stunted children and controls, all showing no sign of severe diarrhea the day of inclusion but both living in a highly contaminated environment (slum-dwelling). Interestingly Shigella spp. was the most prevalent enteropathogen found in this study (83.3%) without overrepresentation in stunted children. About 2 million children under the age of 5 suffer from stunted growth in Madagascar. Although deficient diet is the major cause of undernutrition, impaired absorption or assimilation caused by Environmental Enteric dysfunction (EED) has been proposed to play an important role in stunting. EED is widespread among children and adults in low- and middle-income countries (LMIC) and is also associated with undernutrition, poor sanitation, certain gut infections resulting in an abnormal gut microbiota and small intestinal bacterial overgrowth (SIBO) although the role of SIBO in EED remains unclear. The current study highlights the presence at high concentrations of bacterial taxa usually found in the oro-pharyngeal sphere in a high number of duodenal fluids of stunted children. This uncommon presence suggests a decompartmentalization of the gastrointestinal tract and a possible pro-inflammatory effect due to the ectopic presence of some of these bacteria in the duodenum. The study also points to a high prevalence of enteropathogens (especially Shigella spp.) in the feces of both stunted and control children, hence preventing from proposing a direct association with stunting. This suggests that, beside combatting poverty and improving diet, environmental sanitation, quality of water sources, hygiene promotion and health education are key points to mitigate stunting and restore nutritional benefits.
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Affiliation(s)
- Jean-Marc Collard
- Unité de Bactériologie Expérimentale, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- * E-mail:
| | - Lova Andrianonimiadana
- Unité de Bactériologie Expérimentale, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Azimdine Habib
- Unité de Bactériologie Expérimentale, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Prisca Andriantsalama
- Unité d’Epidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Ravaka Randriamparany
- Unité d’Epidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - M. A. N. Rabenandrasana
- Unité de Bactériologie Expérimentale, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - François-Xavier Weill
- Centre National de Référence des Escherichia coli, Shigella et Salmonella, Unité des Bactéries Pathogènes Entériques, Institut Pasteur, Paris, France
| | - Nathalie Sauvonnet
- Unité de Pathogénie Microbienne Moléculaire, Institut Pasteur, Paris, France
| | | | - Vincent Guillemot
- Hub of Bioinformatics and Biostatistics, Institut Pasteur, Paris, France
| | - Pascale Vonaesch
- Unité de Pathogénie Microbienne Moléculaire, Institut Pasteur, Paris, France
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Rahantamalala A, Rakotoarison RL, Rakotomalala E, Rakotondrazaka M, Kiernan J, Castle PM, Hakami L, Choi K, Rafalimanantsoa AS, Harimanana A, Wright P, Grandjean Lapierre S, Schoenhals M, Small PM, Marcos LA, Vigan-Womas I. Prevalence and factors associated with human Taenia solium taeniosis and cysticercosis in twelve remote villages of Ranomafana rainforest, Madagascar. PLoS Negl Trop Dis 2022; 16:e0010265. [PMID: 35404983 PMCID: PMC9064101 DOI: 10.1371/journal.pntd.0010265] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/03/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Infections with the tapeworm Taenia solium (taeniosis and cysticercosis) are Neglected Tropical Diseases (NTD) highly endemic in Madagascar. These infections are however underdiagnosed, underreported and their burden at the community level remains unknown especially in rural remote settings. This study aims at assessing the prevalence of T. solium infections and associated risk factors in twelve remote villages surrounding Ranomafana National Park (RNP), Ifanadiana District, Madagascar. Methodology A community based cross-sectional survey was conducted in June 2016. Stool and serum samples were collected from participants. Tapeworm carriers were identified by stool examination. Taenia species and T. solium genotypes were characterised by PCR and sequencing of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene. Detection of specific anti-cysticercal antibodies (IgG) or circulating cysticercal antigens was performed by ELISA or EITB/Western blot assays. Principal findings Of the 459 participants with paired stool and blood samples included ten participants from seven distinct villages harbored Taenia spp. eggs in their stools samples DNA sequencing of the cox1 gene revealed a majority of T. solium Asian genotype (9/10) carriage. The overall seroprevalences of anti-cysticercal IgGs detected by ELISA and EITB were quite similar (27.5% and 29.8% respectively). A prevalence rate of 12.4% of circulating cysticercal antigens was observed reflecting cysticercosis with viable cysts. Open defecation (Odds Ratio, OR = 1.5, 95% CI: 1.0–2.3) and promiscuity with households of more than 4 people (OR = 1.9, 95% CI: 1.1–3.1) seem to be the main risk factors associated with anticysticercal antibodies detection. Being over 15 years of age would be a risk factor associated with an active cysticercosis (OR = 1.6, 95% CI: 1.0–2.7). Females (OR = 0.5, 95% CI: 0.3–0.9) and use of river as house water source (OR = 0.3, 95% CI: 0.1–1.5) were less likely to have cysticercosis with viable cysts. Conclusions/Significance This study indicates a high exposure of the investigated population to T. solium infections with a high prevalence of cysticercosis with viable cysts. These data can be useful to strengthen public health interventions in these remote settings. Taenia solium infections in humans (taeniosis and neurocysticercosis) and in pigs (cysticercosis) are endemic in Madagascar presenting a significant public health burden. Neurocysticercosis with localization of the parasite in the Central Nervous System is the most severe and frequent form of parasitic brain diseases in humans and responsible of thousands of worldwide deaths per year. Madagascar is a T. solium endemic country where poor sanitation, free roaming pigs and outdoor defecation are common, and maintain the parasite transmission cycle. Little information is available regarding taeniosis/cysticercosis epidemiology in Madagascar. We carried out a community-based study to investigate the prevalence of human taeniosis/cysticercosis and associated risk factors in 12 rural remote villages of Ranomafana and Kelilalina townships (Ifanadiana district, Madagascar). Our results reveal that in 7/12 villages investigated, a high number of participants had teaniosis. Moreover, a high number of active cysticercosis cases were detected. Open defecation and promiscuity were seemed to be the main risk factors associated to T. solium infections. The results of this study will be useful to guide interventions in these remote settings surrounding the Ranomafana National Park.
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Affiliation(s)
- Anjanirina Rahantamalala
- Institut Pasteur de Madagascar, Immunology of Infectious Diseases Unit, Antananarivo, Madagascar
- * E-mail:
| | | | - Emma Rakotomalala
- Institut Pasteur de Madagascar, Immunology of Infectious Diseases Unit, Antananarivo, Madagascar
| | | | - Jaydon Kiernan
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Paul M. Castle
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Lee Hakami
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Koeun Choi
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | | | - Aina Harimanana
- Institut Pasteur de Madagascar, Epidemiology and Clinical Research Unit, Antananarivo, Madagascar
| | - Patricia Wright
- Centre ValBio, Ranomafana, Ifanadiana, Madagascar
- Department of Anthropology, Stony Brook University, Stony Brook, New York, United States of America
| | - Simon Grandjean Lapierre
- Global Health Institute, Stony Brook University, Stony Brook, New York, United States of America
| | - Matthieu Schoenhals
- Institut Pasteur de Madagascar, Immunology of Infectious Diseases Unit, Antananarivo, Madagascar
| | - Peter M. Small
- Centre ValBio, Ranomafana, Ifanadiana, Madagascar
- Global Health Institute, Stony Brook University, Stony Brook, New York, United States of America
| | - Luis A. Marcos
- Global Health Institute, Stony Brook University, Stony Brook, New York, United States of America
- Division of Infectious Diseases, Department of Medicine, Department of Microbiology and Molecular Genetics, Stony Brook University, Stony Brook, New York, United States of America
| | - Inès Vigan-Womas
- Institut Pasteur de Madagascar, Immunology of Infectious Diseases Unit, Antananarivo, Madagascar
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Rogier E, McCaffery JN, Nace D, Svigel SS, Assefa A, Hwang J, Kariuki S, Samuels AM, Westercamp N, Ratsimbasoa A, Randrianarivelojosia M, Uwimana A, Udhayakumar V, Halsey ES. Plasmodium falciparum pfhrp2 and pfhrp3 Gene Deletions from Persons with Symptomatic Malaria Infection in Ethiopia, Kenya, Madagascar, and Rwanda. Emerg Infect Dis 2022; 28:608-616. [PMID: 35201739 PMCID: PMC8888236 DOI: 10.3201/eid2803.211499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Histidine-rich protein 2 (HRP2)–based rapid diagnostic tests detect Plasmodium falciparum malaria and are used throughout sub-Saharan Africa. However, deletions in the pfhrp2 and related pfhrp3 (pfhrp2/3) genes threaten use of these tests. Therapeutic efficacy studies (TESs) enroll persons with symptomatic P. falciparum infection. We screened TES samples collected during 2016–2018 in Ethiopia, Kenya, Rwanda, and Madagascar for HRP2/3, pan-Plasmodium lactate dehydrogenase, and pan-Plasmodium aldolase antigen levels and selected samples with low levels of HRP2/3 for pfhrp2/3 genotyping. We observed deletion of pfhrp3 in samples from all countries except Kenya. Single-gene deletions in pfhrp2 were observed in 1.4% (95% CI 0.2%–4.8%) of Ethiopia samples and in 0.6% (95% CI 0.2%–1.6%) of Madagascar samples, and dual pfhrp2/3 deletions were noted in 2.0% (95% CI 0.4%–5.9%) of Ethiopia samples. Although this study was not powered for precise prevalence estimates, evaluating TES samples revealed a low prevalence of pfhrp2/3 deletions in most sites.
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Tantely ML, Guis H, Randriananjantenaina I, Raharinirina MR, Velonirina HJ, Cardinale E, Raveloarijaona N, Cêtre-Sossah C, Garros C, Girod R. Mosquito species associated with horses in Madagascar: a review of their vector status with regard to the epidemiology of West Nile fever. Med Vet Entomol 2022; 36:1-13. [PMID: 34427959 DOI: 10.1111/mve.12544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
In Madagascar, the high West Nile virus (WNV) antibody prevalence reported in horse populations suggests a high level of vector-horse contact. This study aims to characterize the mosquito species usually involved in WNV transmission in horse stables in Madagascar. Five horse stables were investigated in October and November 2016 in five distinct inland areas. Mosquitoes were collected using double net traps baited with human, poultry or horse as well as light traps. Blood meal identification from engorged females was performed using host-specific PCRs. A total of 2898 adult mosquitoes were collected with Culex (Culex) antennatus (Becker) (40.7%), and Cx. (Cux.) quinquefasciatus Say (14.9%), being the most abundant species. The mosquito abundance varied between horse stables (P < 10-7 ) and depending on the bait used in the double net traps (P < 0.003). Among the 190 tested blood meals, 119 consisted of single blood meals with 85 from horse, 17 from human, 16 from chicken, one from cattle and 71 consisted of mixed blood meals. The mosquito species collected during this study exhibited a generalist feeding behaviour allowing them to act as bridge vectors between different vertebrate hosts involved in WNV transmission cycle. Their vector status with regard to West Nile fever epidemiology is reviewed.
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Affiliation(s)
- M L Tantely
- Medical Entomology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - H Guis
- UMR ASTRE, CIRAD, Antananarivo, Madagascar
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- UMR ASTRE, CIRAD, Montpellier, France
| | - I Randriananjantenaina
- Medical Entomology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Department of Entomology, Faculty of Sciences, University of Antananarivo, Antananarivo, Madagascar
| | - M R Raharinirina
- Medical Entomology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - H J Velonirina
- Medical Entomology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - E Cardinale
- UMR ASTRE, CIRAD, Montpellier, France
- UMR ASTRE, CIRAD, Sainte-Clotilde, La Réunion, France
| | - N Raveloarijaona
- UMR ASTRE, CIRAD, Antananarivo, Madagascar
- Direction of Veterinary Services, Ministry of Agriculture, Livestock and Fisheries, Antananarivo, Madagascar
- Department of Veterinary Medecine, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | - C Cêtre-Sossah
- UMR ASTRE, CIRAD, Montpellier, France
- UMR ASTRE, CIRAD, Sainte-Clotilde, La Réunion, France
| | - C Garros
- UMR ASTRE, CIRAD, Montpellier, France
- UMR ASTRE, CIRAD, Sainte-Clotilde, La Réunion, France
| | - R Girod
- Medical Entomology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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Ramasindrazana B, Parany MNJ, Rasoamalala F, Rasoanoro M, Rahajandraibe S, Vogler AJ, Sahl JW, Andrianaivoarimanana V, Rajerison M, Wagner DM. Local-scale diversity of Yersinia pestis: A case study from Ambohitromby, Ankazobe District, Madagascar. Zoonoses Public Health 2022; 69:61-70. [PMID: 34480413 DOI: 10.1111/zph.12892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 12/30/2022]
Abstract
Plague is a re-emerging zoonotic disease and a major public health concern in several portions of the world, especially in Madagascar. We report on the presence of different subtypes of Yersinia pestis co-occurring in the same locality. After confirmation of a human plague case in Ambohitromby Commune (Ankazobe District) via isolation of Y. pestis, we undertook small mammal trapping to identify the circulation of Y. pestis amongst rodents in this locality; blood samples were collected from rodents for seroprevalence analysis. Of the 60 individuals of Rattus rattus captured, one yielded an isolate of Y. pestis, 13 others were positive for F1 antigen of Y. pestis using a rapid diagnostic test, and 4 were PCR positive targeting the caf1 and pla genes; 28/60 (46.7%) of the captured R. rattus were seropositive for Y. pestis. Whole-genome SNP analyses revealed that the two isolates obtained from the human case, and the R. rattus belonged to two different subtypes of Y. pestis (s05 and s13, respectively) that were circulating concurrently in Ambohitromby in 2016. Three Y. pestis subtypes (s03, s05 and s13) have now been isolated from Ambohitromby. Subtype s05 had been persisting there for >10 years but one or both of the other subtypes may have been introduced from the Central Highlands region as they were not observed in previous years (s13) or only observed once previously (s03). High seroprevalence against Y. pestis in R. rattus suggests that a portion of the local murine population may have acquired resistance to Y. pestis. Future research should focus on genomically characterizing Y. pestis strains circulating in Ankazobe District and other plague-endemic regions of Madagascar to better understand the overall phylogeography of Y. pestis.
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Affiliation(s)
- Beza Ramasindrazana
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Domaine Sciences et Technologies, Université d'Antananarivo, Antananarivo, Madagascar
| | - Mamionah N J Parany
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Domaine Sciences et Technologies, Université d'Antananarivo, Antananarivo, Madagascar
| | - Fanohinjanaharinirina Rasoamalala
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Domaine Sciences et Technologies, Université d'Antananarivo, Antananarivo, Madagascar
| | - Mercia Rasoanoro
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Domaine Sciences et Technologies, Université d'Antananarivo, Antananarivo, Madagascar
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Razafindratsima Y, Razakandrainy A, Fortin S, Ralison C, Mouquet-Rivier C. Observation of Traditional Caregiver-Infant Feeding Behaviours and Porridge and Energy Intakes during One Meal to Define Key Messages for Promoting Responsive Feeding in the Amparafaravola District, Rural Madagascar. Nutrients 2022; 14:nu14020361. [PMID: 35057542 PMCID: PMC8781864 DOI: 10.3390/nu14020361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Undernutrition is highly prevalent in young children in Madagascar and insufficient intake per meal could be one of the main causes. A cross-sectional survey of infant feeding practices including video-recorded meal observations was carried out with 101 caregiver-infant pairs in the Amparafaravola district, Northeast Madagascar. The objective was to quantify the porridge/energy intake of 9-11-month-old children and assess its association with the caregiver-infant feeding behaviours. Then, key messages for promoting responsive feeding (RF) were developed and tested through focus group discussions. The mean porridge intake was 12.8 ± 7.5 g/kg body weight (BW)/meal, corresponding to hardly one-third of the 300 kcal recommended from complementary foods for 9-11-month-old children. Analysis of meal videos suggested that mothers practiced the five positive feeding behaviours (self-feeding, responsive, active, social, and distraction), and rarely the negative ones. Only 6.9% of mothers used positive RF "very frequently", although it was associated with higher intakes (p < 0.05), with mean intake reaching 21 g/kg BW. In focus groups, caregivers approved the six RF messages and related counselling cards. They suggested some modifications to improve their understanding, and counselling cards were revised accordingly. The long-term impact of RF-promoting card use on the meal intakes and the nutritional status of young children must now be assessed.
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Affiliation(s)
- Yannick Razafindratsima
- Department of Food and Nutrition Science, University of Antananarivo, P.O. Box 175, Antananarivo 101, Madagascar; (Y.R.); (C.R.)
- GRET (Professionnels du Développement Solidaire), BP 1563, Antananarivo 101, Madagascar;
- Qualisud, University of Montpellier, Avignon University, CIRAD, Institut Agro, IRD, Université de la Réunion, 34394 Montpellier, France;
| | | | - Sonia Fortin
- Qualisud, University of Montpellier, Avignon University, CIRAD, Institut Agro, IRD, Université de la Réunion, 34394 Montpellier, France;
| | - Charlotte Ralison
- Department of Food and Nutrition Science, University of Antananarivo, P.O. Box 175, Antananarivo 101, Madagascar; (Y.R.); (C.R.)
| | - Claire Mouquet-Rivier
- Qualisud, University of Montpellier, Avignon University, CIRAD, Institut Agro, IRD, Université de la Réunion, 34394 Montpellier, France;
- Correspondence: ; Tel.: +33-4-67-41-62-95
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Ratovoson R, Razafimahatratra R, Randriamanantsoa L, Raberahona M, Rabarison HJ, Rahaingovahoaka FN, Andriamasy EH, Herindrainy P, Razanajatovo N, Andriamandimby SF, Dussart P, Schoenhals M, Randria MJDD, Heraud JM, Randremanana RV. Household transmission of COVID-19 among the earliest cases in Antananarivo, Madagascar. Influenza Other Respir Viruses 2022; 16:48-55. [PMID: 34378341 PMCID: PMC8447323 DOI: 10.1111/irv.12896] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Households are among the highest risk for the transmission of SARS-CoV-2. In sub-Saharan Africa, very few studies have described household transmission during the COVID-19 pandemic. Our work aimed to describe the epidemiologic parameters and analyze the secondary attack rate (SAR) in Antananarivo, Madagascar, following the introduction of SARS-CoV-2 in the country in March 2020. METHODS A prospective case-ascertained study of all identified close contacts of laboratory-confirmed COVID-19 infections was conducted in Antananarivo from March to June 2020. Cases and household contacts were followed for 21 days. We estimated epidemic parameters of disease transmission by fitting parametric distributions based on infector-infected paired data. We assessed factors influencing transmission risk by analyzing the SAR. FINDINGS Overall, we included 96 index cases and 179 household contacts. Adjusted with the best-fit normal distribution, the incubation period was 4.1 days (95% CI 0.7-7.5]). The serial interval was 6.0 days (95% CI [2.4-9.6]) after adjusting with the best-fit Weibull distribution. On average, each index case infected 1.6 family members (95%CI [0.9-2.3]). The mean SAR among close contacts was 38.8% (95% CI [19.5-58.2]) with the best-fit gamma distribution. Contacts older than 35 years old were more likely to be infected, and the highest SAR was found among them. CONCLUSION The results of our study provide key insights into the epidemiology of the first wave of SARS-CoV-2 in Madagascar. High rates of household transmission were found in Antananarivo, emphasizing the need for preventive measures to reduce community transmission.
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Affiliation(s)
| | - Rado Razafimahatratra
- Centre Hospitalier Universitaire Anosiala‐AlakamisyAmbohidratrimo‐AntananarivoMadagascar
| | | | - Mihaja Raberahona
- Centre Hospitalier Universitaire Joseph Raseta BefelatananaAntananarivoMadagascar
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Kauffman K, Werner CS, Titcomb G, Pender M, Rabezara JY, Herrera JP, Shapiro JT, Solis A, Soarimalala V, Tortosa P, Kramer R, Moody J, Mucha PJ, Nunn C. Comparing transmission potential networks based on social network surveys, close contacts and environmental overlap in rural Madagascar. J R Soc Interface 2022; 19:20210690. [PMID: 35016555 PMCID: PMC8753172 DOI: 10.1098/rsif.2021.0690] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/16/2021] [Indexed: 11/12/2022] Open
Abstract
Social and spatial network analysis is an important approach for investigating infectious disease transmission, especially for pathogens transmitted directly between individuals or via environmental reservoirs. Given the diversity of ways to construct networks, however, it remains unclear how well networks constructed from different data types effectively capture transmission potential. We used empirical networks from a population in rural Madagascar to compare social network survey and spatial data-based networks of the same individuals. Close contact and environmental pathogen transmission pathways were modelled with the spatial data. We found that naming social partners during the surveys predicted higher close-contact rates and the proportion of environmental overlap on the spatial data-based networks. The spatial networks captured many strong and weak connections that were missed using social network surveys alone. Across networks, we found weak correlations among centrality measures (a proxy for superspreading potential). We conclude that social network surveys provide important scaffolding for understanding disease transmission pathways but miss contact-specific heterogeneities revealed by spatial data. Our analyses also highlight that the superspreading potential of individuals may vary across transmission modes. We provide detailed methods to construct networks for close-contact transmission pathogens when not all individuals simultaneously wear GPS trackers.
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Affiliation(s)
- Kayla Kauffman
- Department of Evolutionary Anthropology, Duke University, Durham, NC 27708, USA
- Marine Science Institute, University of California, Santa Barbara, CA 93106, USA
| | - Courtney S. Werner
- Department of Evolutionary Anthropology, Duke University, Durham, NC 27708, USA
| | - Georgia Titcomb
- Marine Science Institute, University of California, Santa Barbara, CA 93106, USA
| | | | - Jean Yves Rabezara
- Science de la Nature et Valorisation des Ressources Naturelles, Centre Universitaire Régional de la SAVA, Antalaha, Madagascar
| | | | - Julie Teresa Shapiro
- Department of Life Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Alma Solis
- Department of Evolutionary Anthropology, Duke University, Durham, NC 27708, USA
- Duke Global Health Institute, Durham, NC 27156, USA
| | | | - Pablo Tortosa
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Université de La Réunion, Ile de La Réunion, France
| | - Randall Kramer
- Nicholas School of the Environment, Duke University, Durham, NC 27708, USA
| | - James Moody
- Department of Sociology, Duke University, Durham, NC 27708, USA
| | - Peter J. Mucha
- Department of Mathematics, Dartmouth College, Hanover, NH 03755, USA
| | - Charles Nunn
- Department of Evolutionary Anthropology, Duke University, Durham, NC 27708, USA
- Duke Global Health Institute, Durham, NC 27156, USA
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Ramiadantsoa T, Metcalf CJE, Raherinandrasana AH, Randrianarisoa S, Rice BL, Wesolowski A, Randriatsarafara FM, Rasambainarivo F. Existing human mobility data sources poorly predicted the spatial spread of SARS-CoV-2 in Madagascar. Epidemics 2021; 38:100534. [PMID: 34915300 PMCID: PMC8641444 DOI: 10.1016/j.epidem.2021.100534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/29/2021] [Accepted: 12/02/2021] [Indexed: 12/24/2022] Open
Abstract
For emerging epidemics such as the COVID-19 pandemic, quantifying travel is a key component of developing accurate predictive models of disease spread to inform public health planning. However, in many LMICs, traditional data sets on travel such as commuting surveys as well as non-traditional sources such as mobile phone data are lacking, or, where available, have only rarely been leveraged by the public health community. Evaluating the accuracy of available data to measure transmission-relevant travel may be further hampered by limited reporting of suspected and laboratory confirmed infections. Here, we leverage case data collected as part of a COVID-19 dashboard collated via daily reports from the Malagasy authorities on reported cases of SARS-CoV-2 across the 22 regions of Madagascar. We compare the order of the timing of when cases were reported with predictions from a SARS-CoV-2 metapopulation model of Madagascar informed using various measures of connectivity including a gravity model based on different measures of distance, Internal Migration Flow data, and mobile phone data. Overall, the models based on mobile phone connectivity and the gravity-based on Euclidean distance best predicted the observed spread. The ranks of the regions most remote from the capital were more difficult to predict but interestingly, regions where the mobile phone connectivity model was more accurate differed from those where the gravity model was most accurate. This suggests that there may be additional features of mobility or connectivity that were consistently underestimated using all approaches but are epidemiologically relevant. This work highlights the importance of data availability and strengthening collaboration among different institutions with access to critical data - models are only as good as the data that they use, so building towards effective data-sharing pipelines is essential.
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Affiliation(s)
- Tanjona Ramiadantsoa
- Department of Life Science, University of Fianarantsoa, Madagascar; Department of Mathematics, University of Fianarantsoa, Madagascar; Department of Integrative Biology, University of Wisconsin-Madison, WI, USA.
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Princeton School of Public and International Affairs, Princeton University, NJ, USA
| | - Antso Hasina Raherinandrasana
- Surveillance Unit, Ministry of Health of Madagascar, Madagascar; Faculty of Medicine, University of Antananarivo, Madagascar
| | | | - Benjamin L Rice
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Madagascar Health and Environmental Research (MAHERY), Maroantsetra, Madagascar
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Fidisoa Rasambainarivo
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Mahaliana Labs SARL, Antananarivo, Madagascar
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Fenomanana J, Randriatsarafara FM, Ranampy FF, Randriamanantany ZA. A behavioural and HIV serological survey among detainees of Ankazondrano jail in Fianarantsoa, Madagascar. African Journal of AIDS Research 2021; 20:324-328. [PMID: 34905458 DOI: 10.2989/16085906.2021.2008459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Aims: The prevalence of HIV in the general population of Madagascar is 0.3%. Some population groups, especially detainees are vulnerable to this infection. Our study was the first combined HIV survey of the detainees of Ankazondrano jail in Fianarantsoa. The study aims to determine the serological status of the detainees related to HIV infection and their risky behaviours for this infection.Methods: A descriptive cross-sectional survey of the detainees 18 years old and over was carried out in Ankazondrano jail in Fianarantsoa during September 2020.Results: The prevalence of HIV in the sample was zero; 89.43% of the detainees reported to have heard about HIV; only 15.45% had a general knowledge about it; 76.42% of them knew that a condom is a way of protection against HIV infection; however, they had wrong responses about protection against this infection. In fact, 47.97% of the surveyed detainees thought that HIV is transmitted by mosquito bites and 65.04% thought that it is transmitted by shaking hands. Almost one quarter of the detainees reported that there is no risk of HIV contraction in jail.Conclusion: In this study, nevertheless, the prevalence of HIV is zero; detainees of Ankazondrano jail are a vulnerable group to HIV due to their lack of knowledge of this infection and the fact that they undertook risky behaviours.
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Affiliation(s)
- Jocia Fenomanana
- Laboratory Service of CHU at Andrainjato Fianarantsoa Madagascar, Faculty of Medicine, University of Fianarantsoa, Madagascar
| | | | - Fabien Florian Ranampy
- Laboratory Service of CHU at Andrainjato Fianarantsoa Madagascar, Faculty of Medicine, University of Fianarantsoa, Madagascar
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Jeon HJ, Marks F, Sugimoto J, Im J, Kang SS, Haselbeck A, Rakotozandrindrainy R. Surge of Typhoid Intestinal Perforations as Possible Result of COVID-19-Associated Delays in Seeking Care, Madagascar. Emerg Infect Dis 2021; 27:3163-3165. [PMID: 34808080 PMCID: PMC8632171 DOI: 10.3201/eid2712.210516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
During the coronavirus disease pandemic, we observed a 6.4-fold increase in typhoid intestinal perforation incidence in Antananarivo, Madagascar. Thirteen perforations occurred within 6 months (February 2020–July 2020), compared with 13 perforations during the previous 41 months (August 2016–January 2020). The increase may be attributable to delayed healthcare seeking during the pandemic.
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Huynh BT, Kermorvant-Duchemin E, Chheang R, Randrianirina F, Seck A, Hariniaina Ratsima E, Andrianirina ZZ, Diouf JB, Abdou AY, Goyet S, Ngo V, Lach S, Pring L, Sok T, Padget M, Sarr FD, Borand L, Garin B, Collard JM, Herindrainy P, de Lauzanne A, Vray M, Delarocque-Astagneau E, Guillemot D. Severe bacterial neonatal infections in Madagascar, Senegal, and Cambodia: A multicentric community-based cohort study. PLoS Med 2021; 18:e1003681. [PMID: 34582450 PMCID: PMC8478182 DOI: 10.1371/journal.pmed.1003681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/01/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Severe bacterial infections (SBIs) are a leading cause of neonatal deaths in low- and middle-income countries (LMICs). However, most data came from hospitals, which do not include neonates who did not seek care or were treated outside the hospital. Studies from the community are scarce, and few among those available were conducted with high-quality microbiological techniques. The burden of SBI at the community level is therefore largely unknown. We aimed here to describe the incidence, etiology, risk factors, and antibiotic resistance profiles of community-acquired neonatal SBI in 3 LMICs. METHODS AND FINDINGS The BIRDY study is a prospective multicentric community-based mother and child cohort study and was conducted in both urban and rural areas in Madagascar (2012 to 2018), Cambodia (2014 to 2018), and Senegal (2014 to 2018). All pregnant women within a geographically defined population were identified and enrolled. Their neonates were actively followed from birth to 28 days to document all episodes of SBI. A total of 3,858 pregnant women (2,273 (58.9%) in Madagascar, 814 (21.1%) in Cambodia, and 771 (20.0%) in Senegal) were enrolled in the study, and, of these, 31.2% were primigravidae. Women enrolled in the urban sites represented 39.6% (900/2,273), 45.5% (370/814), and 61.9% (477/771), and those enrolled in the rural sites represented 60.4% (1,373/2,273), 54.5% (444/814), and 38.1% (294/771) of the total in Madagascar, Cambodia, and Senegal, respectively. Among the 3,688 recruited newborns, 49.6% were male and 8.7% were low birth weight (LBW). The incidence of possible severe bacterial infection (pSBI; clinical diagnosis based on WHO guidelines of the Integrated Management of Childhood Illness) was 196.3 [95% confidence interval (CI) 176.5 to 218.2], 110.1 [88.3 to 137.3], and 78.3 [59.5 to 103] per 1,000 live births in Madagascar, Cambodia, and Senegal, respectively. The incidence of pSBI differed between urban and rural sites in all study countries. In Madagascar, we estimated an incidence of 161.0 pSBI per 1,000 live births [133.5 to 194] in the urban site and 219.0 [192.6 to 249.1] pSBI per 1,000 live births in the rural site (p = 0.008). In Cambodia, estimated incidences were 141.1 [105.4 to 189.0] and 85.3 [61.0 to 119.4] pSBI per 1,000 live births in urban and rural sites, respectively (p = 0.025), while in Senegal, we estimated 103.6 [76.0 to 141.2] pSBI and 41.5 [23.0 to 75.0] pSBI per 1,000 live births in urban and rural sites, respectively (p = 0.006). The incidences of culture-confirmed SBI were 15.2 [10.6 to 21.8], 6.5 [2.7 to 15.6], and 10.2 [4.8 to 21.3] per 1,000 live births in Madagascar, Cambodia, and Senegal, respectively, with no difference between urban and rural sites in each country. The great majority of early-onset infections occurred during the first 3 days of life (72.7%). The 3 main pathogens isolated were Klebsiella spp. (11/45, 24.4%), Escherichia coli (10/45, 22.2%), and Staphylococcus spp. (11/45, 24.4%). Among the 13 gram-positive isolates, 5 were resistant to gentamicin, and, among the 29 gram-negative isolates, 13 were resistant to gentamicin, with only 1 E. coli out of 10 sensitive to ampicillin. Almost one-third of the isolates were resistant to both first-line drugs recommended for the management of neonatal sepsis (ampicillin and gentamicin). Overall, 38 deaths occurred among neonates with SBI (possible and culture-confirmed SBI together). LBW and foul-smelling amniotic fluid at delivery were common risk factors for early pSBI in all 3 countries. A main limitation of the study was the lack of samples from a significant proportion of infants with pBSI including 35 neonatal deaths. Without these samples, bacterial infection and resistance profiles could not be confirmed. CONCLUSIONS In this study, we observed a high incidence of neonatal SBI, particularly in the first 3 days of life, in the community of 3 LMICs. The current treatment for the management of neonatal infection is hindered by antimicrobial resistance. Our findings suggest that microbiological diagnosis of SBI remains a challenge in these settings and support more research on causes of neonatal death and the implementation of early interventions (e.g., follow-up of at-risk newborns during the first days of life) to decrease the burden of neonatal SBI and associated mortality and help achieve Sustainable Development Goal 3.
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Affiliation(s)
- Bich-Tram Huynh
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, Montigny-Le-Bretonneux, France
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France
- * E-mail:
| | - Elsa Kermorvant-Duchemin
- AP-HP, Hôpital Necker-Enfants Malades, Department of Neonatal Medicine, Université de Paris, Paris, France
| | - Rattanak Chheang
- Medical Biology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Abdoulaye Seck
- Laboratory of Medical Biology, Institut Pasteur de Dakar, Dakar, Senegal
| | | | | | | | - Armya Youssouf Abdou
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, Montigny-Le-Bretonneux, France
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France
| | - Sophie Goyet
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Véronique Ngo
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Siyin Lach
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Long Pring
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Touch Sok
- Ministry of Health, Phnom Penh, Cambodia
| | - Michael Padget
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, Montigny-Le-Bretonneux, France
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France
| | - Fatoumata Diene Sarr
- Epidemiology of Infectious Diseases Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - Laurence Borand
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Benoit Garin
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Jean-Marc Collard
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Agathe de Lauzanne
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Muriel Vray
- Epidemiology of Infectious Diseases Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - Elisabeth Delarocque-Astagneau
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, Montigny-Le-Bretonneux, France
- AP-HP, Paris Saclay, Public Health, Medical Information, Clinical Research, Le Kremlin-Bicêtre, France
| | - Didier Guillemot
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, Montigny-Le-Bretonneux, France
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France
- AP-HP, Paris Saclay, Public Health, Medical Information, Clinical Research, Le Kremlin-Bicêtre, France
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Rakotonanahary RJL, Andriambolamanana H, Razafinjato B, Raza-Fanomezanjanahary EM, Ramanandraitsiory V, Ralaivavikoa F, Tsirinomen'ny Aina A, Rahajatiana L, Rakotonirina L, Haruna J, Cordier LF, Murray MB, Cowley G, Jordan D, Krasnow MA, Wright PC, Gillespie TR, Docherty M, Loyd T, Evans MV, Drake JM, Ngonghala CN, Rich ML, Popper SJ, Miller AC, Ihantamalala FA, Randrianambinina A, Ramiandrisoa B, Rakotozafy E, Rasolofomanana A, Rakotozafy G, Andriamahatana Vololoniaina MC, Andriamihaja B, Garchitorena A, Rakotonirina J, Mayfield A, Finnegan KE, Bonds MH. Integrating Health Systems and Science to Respond to COVID-19 in a Model District of Rural Madagascar. Front Public Health 2021; 9:654299. [PMID: 34368043 PMCID: PMC8333873 DOI: 10.3389/fpubh.2021.654299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022] Open
Abstract
There are many outstanding questions about how to control the global COVID-19 pandemic. The information void has been especially stark in the World Health Organization Africa Region, which has low per capita reported cases, low testing rates, low access to therapeutic drugs, and has the longest wait for vaccines. As with all disease, the central challenge in responding to COVID-19 is that it requires integrating complex health systems that incorporate prevention, testing, front line health care, and reliable data to inform policies and their implementation within a relevant timeframe. It requires that the population can rely on the health system, and decision-makers can rely on the data. To understand the process and challenges of such an integrated response in an under-resourced rural African setting, we present the COVID-19 strategy in Ifanadiana District, where a partnership between Malagasy Ministry of Public Health (MoPH) and non-governmental organizations integrates prevention, diagnosis, surveillance, and treatment, in the context of a model health system. These efforts touch every level of the health system in the district-community, primary care centers, hospital-including the establishment of the only RT-PCR lab for SARS-CoV-2 testing outside of the capital. Starting in March of 2021, a second wave of COVID-19 occurred in Madagascar, but there remain fewer cases in Ifanadiana than for many other diseases (e.g., malaria). At the Ifanadiana District Hospital, there have been two deaths that are officially attributed to COVID-19. Here, we describe the main components and challenges of this integrated response, the broad epidemiological contours of the epidemic, and how complex data sources can be developed to address many questions of COVID-19 science. Because of data limitations, it still remains unclear how this epidemic will affect rural areas of Madagascar and other developing countries where health system utilization is relatively low and there is limited capacity to diagnose and treat COVID-19 patients. Widespread population based seroprevalence studies are being implemented in Ifanadiana to inform the COVID-19 response strategy as health systems must simultaneously manage perennial and endemic disease threats.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Megan B. Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Demetrice Jordan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Mark A. Krasnow
- Centre Valbio, Ranomafana, Madagascar
- Department of Biochemistry, Stanford University, Stanford, CA, United States
| | - Patricia C. Wright
- Centre Valbio, Ranomafana, Madagascar
- Institute for the Conservation of Tropical Environments, Stony Brook University, Stony Brook, NY, United States
- Department of Anthropology, Stony Brook University, Stony Brook, NY, United States
| | - Thomas R. Gillespie
- Centre Valbio, Ranomafana, Madagascar
- Department of Environmental Sciences and Program in Population Biology, Ecology, and Evolutionary Biology, Emory University, Atlanta, GA, United States
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | | | - Michelle V. Evans
- Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, United States
| | - John M. Drake
- Odum School of Ecology and Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, United States
| | - Calistus N. Ngonghala
- Department of Mathematics, University of Florida, Gainesville, FL, United States
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
- Center for African Studies, University of Florida, Gainesville, FL, United States
| | - Michael L. Rich
- PIVOT NGO, Ranomafana, Madagascar
- Brigham and Women's Hospital, Boston, MA, United States
- Partners in Health, Boston, MA, United States
| | - Stephen J. Popper
- PIVOT NGO, Ranomafana, Madagascar
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Ann C. Miller
- PIVOT NGO, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | | | | | | | | | | | | | | | - Andres Garchitorena
- PIVOT NGO, Ranomafana, Madagascar
- MIVEGEC, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - Julio Rakotonirina
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | - Alishya Mayfield
- PIVOT NGO, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
- Brigham and Women's Hospital, Boston, MA, United States
| | - Karen E. Finnegan
- PIVOT NGO, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Matthew H. Bonds
- PIVOT NGO, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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Randremanana RV, Andriamandimby S, Rakotondramanga JM, Razanajatovo NH, Mangahasimbola RT, Randriambolamanantsoa TH, Ranaivoson HC, Rabemananjara HA, Razanajatovo I, Razafindratsimandresy R, Rabarison JH, Brook CE, Rakotomanana F, Rabetombosoa RM, Razafimanjato H, Ahyong V, Raharinosy V, Raharimanga V, Raharinantoanina SJ, Randrianarisoa MM, Bernardson B, Randrianasolo L, Randriamampionona LBN, Tato CM, DeRisi JL, Dussart P, Vololoniaina MC, Randriatsarafara FM, Randriamanantany ZA, Heraud J. The COVID-19 epidemic in Madagascar: clinical description and laboratory results of the first wave, march-september 2020. Influenza Other Respir Viruses 2021; 15:457-468. [PMID: 33586912 PMCID: PMC8013501 DOI: 10.1111/irv.12845] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Following the first detection of SARS-CoV-2 in passengers arriving from Europe on 19 March 2020, Madagascar took several mitigation measures to limit the spread of the virus in the country. METHODS Nasopharyngeal and/or oropharyngeal swabs were collected from travellers to Madagascar, suspected SARS-CoV-2 cases and contact of confirmed cases. Swabs were tested at the national reference laboratory using real-time RT-PCR. Data collected from patients were entered in an electronic database for subsequent statistical analysis. All distribution of laboratory-confirmed cases were mapped, and six genomes of viruses were fully sequenced. RESULTS Overall, 26,415 individuals were tested for SARS-CoV-2 between 18 March and 18 September 2020, of whom 21.0% (5,553/26,145) returned positive. Among laboratory-confirmed SARS-CoV-2-positive patients, the median age was 39 years (IQR: 28-52), and 56.6% (3,311/5,553) were asymptomatic at the time of sampling. The probability of testing positive increased with age with the highest adjusted odds ratio of 2.2 [95% CI: 1.9-2.5] for individuals aged 49 years and more. Viral strains sequenced belong to clades 19A, 20A and 20B indicative of several independent introduction of viruses. CONCLUSIONS Our study describes the first wave of the COVID-19 in Madagascar. Despite early strategies in place Madagascar could not avoid the introduction and spread of the virus. More studies are needed to estimate the true burden of disease and make public health recommendations for a better preparation to another wave.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Fanjasoa Rakotomanana
- Epidemiology and Clinical Research UnitInstitut Pasteur de MadagascarAntananarivoMadagascar
| | | | | | | | | | - Vaomalala Raharimanga
- Epidemiology and Clinical Research UnitInstitut Pasteur de MadagascarAntananarivoMadagascar
| | | | | | - Barivola Bernardson
- Epidemiology and Clinical Research UnitInstitut Pasteur de MadagascarAntananarivoMadagascar
| | - Laurence Randrianasolo
- Epidemiology and Clinical Research UnitInstitut Pasteur de MadagascarAntananarivoMadagascar
| | | | | | | | - Philippe Dussart
- Virology UnitInstitut Pasteur de MadagascarAntananarivoMadagascar
| | | | | | | | - Jean‐Michel Heraud
- Virology UnitInstitut Pasteur de MadagascarAntananarivoMadagascar
- Present address:
Virology DepartmentInstitut Pasteur de DakarDakarSenegal
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