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Hybridization of infectious agents is a major emerging public and veterinary health concern at the interface of evolution, epidemiology, and control. Whilst evidence of the extent of hybridization amongst parasites is increasing, their impact on morbidity remains largely unknown. This may be predicted to be particularly pertinent where parasites of animals with contrasting pathogenicity viably hybridize with human parasites. Recent research has revealed that viable zoonotic hybrids between human urogenital Schistosoma haematobium with intestinal Schistosoma species of livestock, notably Schistosoma bovis, can be highly prevalent across Africa and beyond. Examining human populations in Senegal, we found increased hepatic but decreased urogenital morbidity, and reduced improvement following treatment with praziquantel, in those infected with zoonotic hybrids compared to non-hybrids. Our results have implications for effective monitoring and evaluation of control programmes, and demonstrate for the first time the potential impact of parasite hybridizations on host morbidity.

Introduction. Trichomoniasis is nowadays the most prevalent non-viral sexually transmitted infection in the world. In Senegal, the epidemiology of trichomoniasis is not well known. The current study aimed at assessing the prevalence and factors associated withT. vaginalisinfection among women with vaginal discharge.Methods. A retrospective analysis of laboratory records from patients referred at the Fann Teaching Hospital in Dakar, Senegal, for vaginal discharge was carried out. The study covered the period from 2006 to 2011. For each participating woman, a vaginal swab was collected and a wet mount smear performed immediately. Optic microscopic examination with 40x magnification was done to detectT. vaginalisand assess biological modifications such as presence of epithelial cells, white blood cells, and red blood cells. A gram stained smear was also performed and examined under oil immersion (100x magnification) to assess the vaginal flora.Results. Overall, 3893 women were enrolled with a mean age at 31.2 ± 10 years. The prevalence of Trichomoniasis represented 4.8%, 95%CI(3.1-5.7) and it was lower among women less than 30 years (4.1%), while divorced women more likely to be infected compared to married and single women (aOR:2.1, 95%CI (1.2-3.7)). Trichomoniasis was associated with abnormal vaginal flora such as type III (aOR:2.6, 95%CI(1.5-4.4)) and type IV (aOR:3.3, 95%CI(2.1-5.3)). In addition, patients with erythrocytes excretion were more likely to be infected byT. vaginalis(aOR:2.8, 95%CI(1.9-3.9).Conclusion.Trichomonas vaginalisremains prevalent among sexually active women. Strategies aiming at improving disease awareness in these high-risk groups are needed to improve trichomoniasis prevention but extensive epidemiological data are still needed for a better understanding of the disease transmission dynamic.

IntroductionAlternative drugs and diagnostics are needed for the treatment and control of schistosomiasis. The exclusive use of praziquantel (PZQ) in mass drug administration programmes may result in the emergence of drug resistance. PZQ has little activity againstSchistosomalarvae, thus reinfection remains a problem in high-risk communities. Furthermore, the insufficient sensitivity of conventional microscopy hinders therapeutic response assessment. Evaluation of artesunate-mefloquine (AM) as a Novel Alternative Treatment for Schistosomiasis in African Children (SchistoSAM) aims to evaluate the safety and efficacy of the antimalarial combination artesunate-mefloquine, re-purposed for the treatment of schistosomiasis, and to assess the performance of highly sensitive novel antigen-based and DNA-based assays as tools for monitoring treatment response.Methods and analysisThe SchistoSAM study is an open-label, two-arm, individually randomised controlled non-inferiority trial, with a follow-up of 48 weeks. Primary school-aged children from the Richard Toll district in northern Senegal, an area endemic forSchistosoma mansoniandSchistosoma haematobium, are allocated to the AM intervention arm (3-day courses at 6-week intervals) or the PZQ control arm (single dose of 40 mg/kg). The trial’s primary endpoints are the efficacy (cure rate (CR), assessed by microscopy) and safety (frequency and pattern of drug-related adverse events) of one AM course versus PZQ at 4 weeks after treatment. Secondary endpoints include (1) cumulative CR, egg reduction rate and safety after each additional course of AM, and at weeks 24 and 48, (2) prevalence and severity of schistosomiasis-related morbidity and (3) malaria prevalence, incidence and morbidity, both after 24 and 48 weeks. CRs and intensity reduction rates are also assessed by antigen-based and DNA-based diagnostic assays, for which performance for treatment monitoring is evaluated.Ethics and disseminationEthics approval was obtained both in Belgium and Senegal. Oral assent from the children and signed informed consent from their legal representatives was obtained, prior to enrolment. The results will be disseminated in peer-reviewed journals and at international conferences.Trial registration numberNCT03893097; pre-results.

Summary Background Schistosomiasis is a neglected tropical disease of global medical and veterinary importance. As efforts to eliminate schistosomiasis as a public health problem and interrupt transmission gather momentum, the potential zoonotic risk posed by livestock Schistosoma species via viable hybridisation in sub-Saharan Africa have been largely overlooked. We aimed to investigate the prevalence, distribution, and multi-host, multiparasite transmission cycle of Haematobium group schistosomiasis in Senegal, West Africa. Methods In this epidemiological study, we carried out systematic surveys in definitive hosts (humans, cattle, sheep, and goats) and snail intermediate hosts, in 2016–18, in two areas of Northern Senegal: Richard Toll and Lac de Guiers, where transmission is perennial; and Barkedji and Linguere, where transmission is seasonal. The occurrence and distribution of Schistosoma species and hybrids were assessed by molecular analyses of parasitological specimens obtained from the different hosts. Children in the study villages aged 5–17 years and enrolled in school were selected from school registers. Adults (aged 18–78 years) were self-selecting volunteers. Livestock from the study villages in both areas were also randomly sampled, as were post-mortem samples from local abattoirs. Additionally, five malacological surveys of snail intermediate hosts were carried out at each site in open water sources used by the communities and their animals. Findings In May to August, 2016, we surveyed 375 children and 20 adults from Richard Toll and Lac de Guiers, and 201 children and 107 adults from Barkedji and Linguere; in October, 2017, to January, 2018, we surveyed 386 children and 88 adults from Richard Toll and Lac de Guiers, and 323 children and 85 adults from Barkedji and Linguere. In Richard Toll and Lac de Guiers the prevalence of urogenital schistosomiasis in children was estimated to be 87% (95% CI 80–95) in 2016 and 88% (82–95) in 2017–18. An estimated 63% (in 2016) and 72% (in 2017–18) of infected children were shedding Schistosoma haematobium–Schistosoma bovis hybrids. In adults in Richard Toll and Lac de Guiers, the prevalence of urogenital schistosomiasis was estimated to be 79% (52–97) in 2016 and 41% (30–54) in 2017–18, with 88% of infected samples containing S haematobium–S bovis hybrids. In Barkedji and Linguere the prevalence of urogenital schistosomiasis in children was estimated to be 30% (23–38) in 2016 and 42% (35–49) in 2017–18, with the proportion of infected children found to be shedding S haematobium–S bovis hybrid miracidia much lower than in Richard Toll and Lac de Guiers (11% in 2016 and 9% in 2017–18). In adults in Barkedji and Linguere, the prevalence of urogenital schistosomiasis was estimated to be 26% (17–36) in 2016 and 47% (34–60) in 2017–18, with 10% of infected samples containing S haematobium–S bovis hybrids. The prevalence of S bovis in the sympatric cattle population of Richard Toll and the Lac de Guiers was 92% (80–99), with S bovis also found in sheep (estimated prevalence 14% [5–31]) and goats (15% [5–33]). In Barkedji and Linguere the main schistosome species in livestock was Schistosoma curassoni, with an estimated prevalence of 73% (48–93) in sheep, 84% (61–98) in goats and 8% (2–24) in cattle. S haematobium–S bovis hybrids were not found in livestock. In Richard Toll and Lac de Guiers 35% of infected Bulinus spp snail intermediate hosts were found to be shedding S haematobium–S bovis hybrids (68% shedding S haematobium; 17% shedding S bovis); however, no snails were found to be shedding S haematobium hybrids in Barkedji and Linguere (29% shedding S haematobium; 71% shedding S curassoni). Interpretation Our findings suggest that hybrids originate in humans via zoonotic spillover from livestock populations, where schistosomiasis is co-endemic. Introgressive hybridisation, evolving host ranges, and wider ecosystem contexts could affect the transmission dynamics of schistosomiasis and other pathogens, demonstrating the need to consider control measures within a One Health framework. Funding Zoonoses and Emerging Livestock Systems programme (UK Biotechnology and Biological Sciences Research Council, UK Department for International Development, UK Economic and Social Research Council, UK Medical Research Council, UK Natural Environment Research Council, and UK Defence Science and Technology Laboratory).

Introduction : Les parasitoses intestinales constituent un probleme majeur de sante dans le monde particulierement dans les pays en voie de developpement. Afin de reduire l’ampleur de ces affections, le Ministere de la Sante du Senegal a introduit en 2005 le deparasitage de masse systematique des enfants conformement aux recommandations de l’Organisation Mondiale pour la Sante (OMS). L’objectif de ce travail etait de determiner la prevalence des parasitoses intestinales et leur impact sur l’anemie et la nutrition quelques annees apres l’instauration de la chimiotherapie preventive. Materiels et methodes : Etude transversale du 1er septembre 2017 au 28 fevrier 2018 au niveau du service de pediatrie du Centre Hospitalier Roi Baudouin de Guediawaye. Un effectif de 375 enfants avait participe a l’etude, avec un âge moyen 44 mois et une predominance masculine (54,1%). Pour chaque enfant recu, un examen direct de selles et apres une concentration par technique de Ritchie etaient effectues. L’etat nutritionnel a ete apprecies et les parametres hematologiques evalues. Resultats : Au total, 103 enfants etaient porteurs de parasites soit une prevalence globale de 27,5%. Les helminthes etaient beaucoup plus representatifs que les protozoaires et les especes parasitaires les plus frequentes etaient Ascaris lumbricoides (18,14%), Trichocephales (3,74%), et Entamoeba coli (2,67%). L’etat nutritionnel etait normal chez 265 enfants tandis que 18,9% et 10,5% avaient respectivement une malnutrition aigue moderee (MAM) et une malnutrition aigue severe (MAS). Nous avons note une association significative entre la parasitose intestinale et la malnutrition (p=0,035 et OR=1,66). L’anemie etait severe chez 4,8% des enfants et moderee chez 68,6%. Une correlation entre les parasitoses intestinales et la survenue d’une anemie a ete demontree (p=0,001 et OR=2,6). Conclusion : La prevalence des parasitoses intestinales reste elevee en banlieue dakaroise malgre le deparasitage de masse. L’amelioration des conditions de vie et l’elargissement du deparasitage aux enfants de plus de 5 ans pourraient rendre plus efficiente cette strategie. Introduction: Intestinal parasitosis is a major health problem in the world, particularly in developing countries. In order to reduce the scale of these diseases, the Ministry of Health of Senegal introduced, in 2005, the systematic mass deworming of children in accordance with the recommendations of the World Health Organisation (WHO). This paper focuses on determining the prevalence of intestinal parasites and their impact on anemia and nutrition a few years after the initiation of preventive chemotherapy. Materials and methods: A cross-sectional study was conducted from 1st September 2017 to 28th February 2018 at the pediatric ward of the hospital center Roi Baudouin in Guediawaye, Senegal. A total of 375 children participated in the study, with a mean age of 44 months and a male predominance (54.1%). Each child received a direct stool examination after a concentration using Ritchie techniques was obtained. The nutritional status was assessed and the hematological parameters evaluated. Results: A total of 103 children had parasites, with an overall prevalence of 27.5%. Helminths were much more representative than the protozoa, and the most common parasitic species were Ascaris lumbricoides (18.14%), whipworms (3.74%), and Entamoeba coli (2.67%). Nutritional status was normal in 265 children, while 18.9% and 10.5% respectively had moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). A significant association between intestinal parasitosis and malnutrition was found (p = 0.035 and OR = 1.66). Anemia was severe in 4.8% of children and moderate in 68.6%. There was a link between intestinal parasitosis and the occurrence of anemia (p = 0.001 and OR = 2.6). Conclusion: The prevalence of intestinal parasitosis remains high in the suburbs of Dakar despite mass deworming. Improving living conditions and expanding deworming to children over 5 years of age could make this strategy more efficient.

To eliminate soil-transmitted helminth (STH) infections as a public health problem, the administration of benzimidazole (BZ) drugs to children has recently intensified. But, as drug pressure increases, the development of anthelmintic drug resistance (AR) becomes a major concern. Currently, there is no global surveillance system to monitor drug efficacy and the emergence of AR. Consequently, it is unclear what the current efficacy of the used drugs is and whether AR is already present. The aim of this study is to pilot a global surveillance system to assess anthelmintic drug efficacy and the emergence of AR in STH control programs. For this, we will incorporate drug efficacy trials into national STH control programs of eight countries (Bangladesh, Cambodia, Lao PDR, Vietnam, Ghana, Rwanda, Senegal and a yet to be defined country in the Americas). In each country, one trial will be performed in one program implementation unit to assess the efficacy of BZ drugs against STHs in school-aged children by faecal egg count reduction test. Stool samples will be collected before and after treatment with BZs for Kato-Katz analysis and preserved to purify parasite DNA. The presence and frequency of known single nucleotide polymorphisms (SNPs) in the β-tubulin genes of the different STHs will subsequently be assessed. This study will provide a global pattern of drug efficacy and emergence of AR in STH control programs. The results will provide complementary insights on the validity of known SNPs in the ß-tubulin gene as a marker for AR in human STHs as well as information on the technical and financial resources required to set up a surveillance system. Finally, the collected stool samples will be an important resource to validate different molecular technologies for the detection of AR markers or to identify novel potential molecular markers associated with AR in STH.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common worldwide enzymopathy with approximately 400 million individuals affected. This inherited disease is sex-linked recessive inheritance. The high prevalence of certain variants of G6PD in different populations and ethnic groups increases the likelihood of finding associations with other pathologies. Sickle cell disease and thalassemia are the most common pathologies associated with G6PD deficiency. The aim of this study was firstly to study the prevalence of glucose-6-phosphate dehydrogenase deficiency (A-376/202) by molecular analysis in homozygous sickle cell patients, and secondly to study the influence of this association on the clinical severity of the disease. In a cross-sectional study, 100 patients aged 15 years with homozygous sickle cell disease in the stationary phase regularly monitored in a National Center for Blood Transfusion were included over a six-month period stretching from September 2015 to February 2016. An EDTA sampling tube was taken from each patient for the study of hematological parameters and a molecular study for the detection of mutations 376 and 202. Clinical, epidemiological and biological variables were collected using a questionnaire. Data was analyzed using Epi-info 7.2. The results of the study showed that the variant A- characterized by a double mutation (376/202) was found with a frequency of 13% (13/100) with a clear male predominance (p E‚ 0.006). Variant A- was statistically significantly associated with cholelithiasis (pE‚0.031). This study is of therapeutic interest since the recognition of G6PD-deficient sickle cell disease would make it possible to take adequate preventive measures with respect to the taking of oxidizing drugs. Key words: Glucose-6-phosphate dehydrogenase (G6PD) deficiency, sickle cell disease, stationary phase, Senegal.

Introduction: In Senegal, surveys have revealed areas of high endemicity of Schistosomiasis including the town of Richard Toll. We undertook this study to determine the echocardiocardiographic characteristics of school-agechildren in endemic bilharziasis. Methodology: We performed a descriptive cross-sectional study in Richard Toll and Dakar in school-age children. Results: A total of 250 children were included. There was male predominance, age between 4 and 16 (10 years old ± 2.77). Hematuria was reported in 69.6% of cases in endemic areas. Positive testing for Schistoma haematobium was found exclusively in Richard-Toll at 33.5%. The diastolic, systolic, basal and median left ventricle dimensions were larger in Richard Toll’s population compared to Dakar. It was the same for the right chambers dimensions. The average pulmonary systolic arterial pressure was greater in Richard-Toll: 26.38 ± 3.16 mmHg versus 21.82 ± 1.73 mmHg in Dakar (p Conclusion: The heart of the school-aged child in endemic area is characterized by larger cavitary dimensions.

Summary Adding low-dose primaquine to malaria treatment reduced gametocyte carriage by 73%. Patients who received primaquine had more frequent hemoglobinuria and there was a greater reduction in haemoglobin concentration in G6PD-deficient patients. One patient who received primaquine developed moderately severe anemia., Introduction More information is needed about the safety of low-dose primaquine in populations where G6PD deficiency is common. Methods Adults with Plasmodium falciparum malaria were randomized to receive 1 of 3 artemisinin combination therapies (ACTs) with or without primaquine (0.25 mg/kg). Glucose-6-phosphate dehydrogenase (G6PD) status was determined using a rapid test. Patients were followed for 28 days to record hemoglobin concentration, adverse events, and gametocyte carriage. The primary end point was the change in Hb at day 7. Results In sum, 274 patients were randomized, 139 received an ACT alone, and 135 received an ACT + primaquine. The mean reduction in Hb at day 7 was similar in each group, a difference in the ACT + PQ versus the ACT alone group of −0.04 g/dL (95% confidence interval [CI] −0.23, 0.31), but the effect of primaquine differed according to G6PD status. In G6PD-deficient patients the drop in Hb was 0.63 g/dL (95% CI 0.03, 1.24) greater in those who received primaquine than in those who received an ACT alone. In G6PD-normal patients, the reduction in Hb was 0.22 g/dL (95% CI −0.08, 0.52) less in those who received primaquine (interaction P = .01). One G6PD normal patient who received primaquine developed moderately severe anaemia (Hb < 8 g/dL). Dark urine was more frequent in patients who received primaquine. Primaquine was associated with a 73% (95% CI 24–90) reduction in gametocyte carriage (P = .013). Conclusion Primaquine substantially reduced gametocyte carriage. However, the fall in Hb concentration at day 7 was greater in G6PD-deficient patients who received primaquine than in those who did not and one patient who received primaquine developed moderately severe anemia. Clinical Trial registration PACTR201411000937373 (www.pactr.org)

Aim Dental surgeons must be aware of the most appropriate endodontic treatments and how to properly conduct them. The aim of this study was to evaluate the knowledge of dental surgeons in Burkina Faso in terms of endodontic treatment procedures. Materials and methods This descriptive, cross-sectional study was performed during the regular annual conference of the National Board of Dental Surgeons of Burkina Faso, held on February 27 and 28, 2015 in Ouagadougou, through a questionnaire. Results A total of 33 practitioners took part (52.4% of the dental surgeons of Burkina Faso) in the study. The majority of them (90.9%) used sodium hypochlorite as their preferred irrigation solution. Nearly half of the dental surgeons (48.5%) did not know how to use a permeabilization file, and most did not make use of nickel–titanium (NiTi) mechanized instruments (78.8%) or rubber dams (93.9%). Approximately two-thirds of participants did not perform file-in-place radiography (66.7%) or control radiography of the canal obturation (63.6%). The adjusted single-cone technique was the most commonly used (87.9%). Conclusion This study highlights that the majority of dental surgeons in Burkina Faso are not using the currently recommended endodontic procedures to perform obturations. Clinical significance Dental surgeons in Burkina Faso must commit to regularly upgrading their knowledge and techniques. How to cite this article Kaboré WAD, Chevalier V, Gnagne- Koffi Y, Ouédraogo CDW, Ndiaye D, Faye B. A Survey of Endodontic Practices among Dentists in Burkina Faso. J Contemp Dent Pract 2017;18(8):641-646.

Background Therapeutic efficacy studies in uncomplicated Plasmodium falciparum malaria are confounded by new infections, which constitute competing risk events since they can potentially preclude/pre-empt the detection of subsequent recrudescence of persistent, sub-microscopic primary infections. Methods Antimalarial studies typically report the risk of recrudescence derived using the Kaplan–Meier (K–M) method, which considers new infections acquired during the follow-up period as censored. Cumulative Incidence Function (CIF) provides an alternative approach for handling new infections, which accounts for them as a competing risk event. The complement of the estimate derived using the K–M method (1 minus K–M), and the CIF were used to derive the risk of recrudescence at the end of the follow-up period using data from studies collated in the WorldWide Antimalarial Resistance Network data repository. Absolute differences in the failure estimates derived using these two methods were quantified. In comparative studies, the equality of two K–M curves was assessed using the log-rank test, and the equality of CIFs using Gray’s k-sample test (both at 5% level of significance). Two different regression modelling strategies for recrudescence were considered: cause-specific Cox model and Fine and Gray’s sub-distributional hazard model. Results Data were available from 92 studies (233 treatment arms, 31,379 patients) conducted between 1996 and 2014. At the end of follow-up, the median absolute overestimation in the estimated risk of cumulative recrudescence by using 1 minus K–M approach was 0.04% (interquartile range (IQR): 0.00–0.27%, Range: 0.00–3.60%). The overestimation was correlated positively with the proportion of patients with recrudescence [Pearson’s correlation coefficient (ρ): 0.38, 95% Confidence Interval (CI) 0.30–0.46] or new infection [ρ: 0.43; 95% CI 0.35–0.54]. In three study arms, the point estimates of failure were greater than 10% (the WHO threshold for withdrawing antimalarials) when the K–M method was used, but remained below 10% when using the CIF approach, but the 95% confidence interval included this threshold. Conclusions The 1 minus K–M method resulted in a marginal overestimation of recrudescence that became increasingly pronounced as antimalarial efficacy declined, particularly when the observed proportion of new infection was high. The CIF approach provides an alternative approach for derivation of failure estimates in antimalarial trials, particularly in high transmission settings. Electronic supplementary material The online version of this article (10.1186/s12936-019-2837-4) contains supplementary material, which is available to authorized users.

Resume Justificatif Les donnees relatives a la pneumonie a Pneumocystis en Afrique sub-saharienne ne sont pas bien connues. La faiblesse du plateau technique et l’utilisation d’outils de diagnostic biologique peu sensibles sont parmi les raisons evoquees. L’objectif de cette etude est de reactualiser les donnees de l’affection au centre hospitalier universitaire de Fann a Dakar et d’evaluer les methodes de diagnostic biologique utilisees. Materiel et methodes Une etude prospective descriptive est realisee du 5 janvier 2009 au 31 octobre 2011 au service de parasitologie-mycologie du centre hospitalier universitaire de Fann a Dakar. Les prelevements du liquide de lavage broncho-alveolaire recus au laboratoire sont examines au microscope par immunofluorescence indirecte ou apres coloration au Giemsa ou au bleu de toluidine O pour la mise en evidence de Pneumocystis jirovecii. Resultats Cent quatre-vingt-trois prelevements de liquide de lavage broncho-alveolaire provenant de 183 patients sont recus au laboratoire. Seize sont positifs pour la recherche de P. jirovecii , soit une frequence de 9 %. Quatre parmi eux sont infectes par le VIH. L’immunofluorescence indirecte a permis de retrouver P. jirovecii chez les 16 patients alors que la coloration au Giemsa n’a detecte P. jirovecii que chez un seul patient. Aucun cas n’est diagnostique par le bleu de toluidine O. Conclusion La pneumonie a Pneumocystis au laboratoire de parasitologie-mycologie du centre hospitalier universitaire de Fann a Dakar est majoritairement diagnostiquee chez des patients infectes par le VIH.

BACKGROUND Since 2006, artemisinin-based combination therapies (ACT) have been used to treat uncomplicated Plasmodium falciparum malaria in Senegal, as recommended by WHO. Recently, decreased parasite clearance with artemisinin derivatives has been reported in Cambodia and Thailand. The effectiveness of artemisinin derivatives in Africa must be monitored. This study was conducted to evaluate the efficacy and the tolerability of three ACT widely used in Senegal. METHODS From October 2010 to February 2011, a descriptive and analytical sequential study was conducted in adults and children to evaluate these three combinations: artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ), and dihydroartemisinin-piperaquine (DHAPQ). The study took place at the health posts of Deggo and Pikine and the health center of Guediawaye, in the suburbs of Dakar. The primary endpoint was the PCR-corrected adequate clinical and parasitological response (ACPR) at day 28 (D28); the secondary endpoints included ACPR at D42, clearance times for parasites, fever, and gametocytes, and the incidence of adverse events. RESULTS The study included 393 patients: 139 in the AL group, 130 in the ASAQ group, and 124 in the DHAPQ group. In the intent-to-treat population, PCR-corrected ACPR at day 28 was 92.8% in the AL, 89.2% in the ASAQ, and 91.1% in the DHAPQ (p = 0.58) groups, and in the per-protocol population, 98.4%, 98.3%, and 100% respectively (p = 0.39). At D42, ACPR was 99.2% in the AL, and 99.1% in each of the ASAQ and DHAPQ arms (p = 1). No early therapeutic failure (ETF) was observed. The combinations were well tolerated, with no serious adverse events reported during the follow-up period. CONCLUSION These combinations are still effective and well-tolerated. Continued monitoring is nonetheless essential to detect early artemisinin resistance in Africa.

International audience; Mycetoma is a neglected tropical disease caused by various actinomycetes or fungi. The disease is characterized by the formation of tumor like-swellings and grains. Senegal is an endemic country where mycetoma cases are under-or misdiagnosed due to the lack of capacities and knowledge among health workers and the community; and where the management of eumycetoma, burdened by a high amputation rate, is currently inadequate. This study aimed to update data on the epidemiology of mycetoma cases diagnosed in three hospital centres in Senegal over a 10 years-period. A total of 193 patients, diagnosed from 2008 to 2018, were included in the study. The most frequent presentation was eumycetoma (47.2%); followed by actinomycetoma (36.8%); it remained undetermined in 16.1% of the patients. The mean age was 38.3 years (68.4% of the patients were between 15 and 45 years-old); the male: female ratio was a 2.94; and most were farmers. One hundred fifty-six (80.8%) patients had used phytotherapy before attending the hospital. Mycetoma was mainly located to the lower limbs (91.2%). Grains were observed in 85% of the patients; including white (25.6%) and yellow (4.3%) grains. The etiological diagnosis was complex, resulting in negative direct microscopy, culture and/or histopathology findings, which explains that 16.1% remained uncharacterized. In most of cases, actinomycetoma were treated with a combination of cotrimoxazole, amoxicillin/clavulanic acid, and streptomycin; whereas eumy-cetoma cases were treated with terbinafine. The surgery was done in 100 (51.8%) of the patients including 9 in actinomycetoma, 78 in eumycetoma and 13 in undetermined form. The high number of uncharacterized mycetoma in this study, the delay in attending a qualified health-care facility, and the lack of available adequate antifungal drug, point out the need to strengthen mycetoma management capacities in Senegal.

Primaquine is a drug widely used for Plasmodium vivax malaria treatment. It is known to be active on Plasmodium falciparum mature gametocytes which are responsible for the transmission of the parasite from humans to mosquitoes. In 2018, Senegal initiated the large-scale use of a single low dose of primaquine associated with artemisinin-based combination therapy for malaria elimination. This study aimed to assess the therapeutic adherence of the implementation of primaquine in the Saint-Louis region. To measure therapeutic adherence, questionnaires were developed and made it possible to collect information from treated malaria patients, health workers, the investigating team and health authorities. Out of 1087 malaria patients, 585 received primaquine. Children under the age of 5 could not receive it due to the lack of the pediatric formulation. The involvement of private health facilities has shown its effectiveness in the implementation of the strategy. However, efforts must be made to improve the documentation of cases in the national surveillance system and to acquire logistical means facilitating the supply of the drug in remote locations. The authorities must become more involved in finding a solution for the availability and sufficient supply of primaquine to formulations adapted to the population.

Introduction: Intestinal parasitic infection (IPI) remains major public health problem in worldwide, being most prevalent in developing countries. Mass drug administration with Mebendazole is an effective strategy for the control of these diseases in pre-school and schoolchildren. The aim of this study was to assess the prevalence of intestinal parasitic infections and established associated risk factors among pre-school and schoolchildren living in rural area in Senegal. Materials and method: A cross sectional survey was carried out between Novembers to December 2014. Children less than 10 years were randomly selected using a systematic random sampling method. Stool samples were examined by light microscopy for the detection of parasite using direct examination, Modified Ritchie Method and the modified Ziehl Neelsen staining method. Results: Among 392 children selected in the study, 137 were found with at least one intestinal parasite representing an overall prevalence of 34.95% [CI 95% (29.3–41.3)]. Protozoan infection was more frequent than helminthic infection (93.4% versus 2.2% respectively). Association between helminths and protozoa was 4.4%. Intestinal parasites identified were Giardia intestinales (72.48%), Entamoeba coli (13.76%), Blastocystis hominis (3.67%) and Hymenolepis nana (1.83%). Prevalence was higher among children aged over 5 years old (48.4%) (aOR= 5.39; 95% IC (2.06–13.9); p=0.001). Children living in family with more than 10 individuals and those drinking unsafe water were found most infected respectively 37.5%) (aOR= 1.24; 95% CI (0.65–2.38); p=0.51) and (42.3%) (aOR=1.45; 95% CI (0.83–2.52); p=0.18). Prevalence was higher in children with underweight 36.3% [aOR= 1.53; 95% IC (0.88–2.67); p=0.13). No correlation was found between sex and intestinal parasitic infection. Conclusion: This study showed that intestinal parasites remain prevalent in pre-school and schoolchildren with a changing of the epidemiological profile. Protozoan infection was more frequent than helminthic infection. Preventive measures including mass drug administration with Albendazole and water supply could reduce the prevalence of these diseases.

International audience; Gastrointestinal parasite infections represent one of the biggest public health problems in the world. Therefore, appropriate innovative tools are needed for assessing interventions to control these infections. This study aims to compare the performance of real-time polymerase chain reaction (PCR) assays to microscopic examination for detection of intestinal parasites. A direct microscopic examination and stool concentration was performed on 98 stool samples from patients attending Senegalese hospitals. Negative microscopic control samples were also collected in Nice and Marseille (France). Species-specific primers/probes were used to detect 20commongastrointestinal protozoans and helminths. Positive frequency and the sensitivity of each real-time PCR assay were compared with conventional microscopic examination. Real-time PCR was positive in 72 of 98 samples (73.5%), whereas microscopic examination was positive in 37 (37.7%) samples (P < 0.001). The real-time PCR assays were more sensitive than microscopy, with 57.4% (31/54) versus 18.5% (10/54), respectively, in the detection of parasites in asymptomatic patients (P < 0.05). In terms of polyparasitism, there were more coinfections detected by real-time PCR assays compared with microscopic methods (25.5% versus 3.06%). In comparison to parasite prevalence on individual samples, the results showed a perfect agreement (100%) between the two techniques for seven species, whereas discrepancies were observed for the others (agreement percentage varying from 64.2% to 98.9%). Real-time PCR appeared to be superior to microscopic examination for the detection of parasites in stool samples. This assay will be useful in diagnostic laboratories and in the field for evaluating the efficacy of mass drug administration programs.

International audience

OBJECTIVE Onychomycosis are a mycose of nail due to fungi. According to published data, they stands for half of all nail abnormalities. This survey was carried out to determine the frequency and the fungi involved in onychomycosis in Dakar. MATERIAL AND METHODS This study was carried out at the laboratory of parasitology and mycology at Le Dantec Hospital, in Senegal from January 2008 to December 2012 and includes 507 patients. RESULTS Onychomycosis were mycologically proved in 58.78% (298/507) of patients. Patient's age varies between 02 years to 82 years with a mean of 34.24 years. Women were more infected than men (sex-ratio was 2.38). Onychomycosis due to dermatophyte represented 37.92% (113/298) of patients and were essentially located on toes (60.71%). Distal and lateral subungual onychomycosis was the most frequent clinical form. Trichophyton rubrum and Trichophyton interdigitale were isolated respectively in 53.6% and 26.1% on toes. Yeasts represented 59.06% (176/298) of onychomycosis and were essentially located on fingernails (80.11%). Candida albicans represented 90.86% of isolated yeasts. Molds were isolated in nine cases (3.02%) and predominated in toenails. CONCLUSION Among 507 patients with onychopathy, this study identified 298 cases of onychomycosis. T. rubrum was the main dermatophytes and was isolated on toenails whereas on fingernails C. albicans was more often observed.

Dans les zones d’endemie palustre comme le Senegal, le traitement preventif intermittent (TPI) a ete adopte pour prevenir le paludisme chez la femme enceinte. Cependant, l‘impact du TPI sur le developpement de l‘immunite n‘est pas encore bien documente. Nous avons mene une etude prospective sur 100 femmes enceintes sous TPI venues en consultation prenatale a la maternite de l’hopital RoiBaudouin de Guediawaye au Senegal de septembre a decembre 2008. Un prelevement de sang a ete realise a l‘inclusion et a l’accouchement pour determiner la prevalence palustre et la production des cytokines IL10, IL12, TNFα et IFNγ par ELISA. Parmi les 100 femmes incluses, 17 % etaient positives au TDR a l’inclusion, dont une seule confirmee par microscopie. A l’inclusion, la production moyenne d’IL10 etait legerement plus elevee chez les femmes negatives (8 UA) comparee aux femmes positives par TDR (7 UA) p=0,069. Cependant, a l’accouchement, la tendance s’est inversee avec une moyenne de production d’IL10 plus elevee chez les femmes positives (6,8 UA) comparee aux femmes negatives (5 UA) (p=0,014). D’une maniere generale le taux des cytokines inflammatoires; IL12; IFNγ et TNFα a augmente entre l’inclusion et l’accouchement. A l’inclusion une faible production d’IL12 etait notee aussi bien chez les femmes avec TDR positif (0,42 UA) que chez les femmes avec TDR negatif (0,15 UA). Une diminution de la production d’IFNγ et du TNFα a ete entre l‘inclusion et l‘accouchement aussi bien chez les femmes positives que chez les negatives. Les cytokines IL12 et IFNγ sembleraient etre impliquees dans le developpement de l‘immunite antipalustre pendant la grossesse.

Aim The aim of the present study was to assess knowledge of, and management attitude of dentists regarding Dentin hypersensitivity. Materials and methods The study involved all the dentists from private and public sectors, exerting in Senegal. The following data were requested from the surveyed dentists using an anonymous questionnaire; sociodemographics (i.e. age, gender, area of activity, etc.) and knowledge on triggering factor, type of pain, diagnosis, preventive and curative procedures. Results Out of the 238 dentists who received the questionnaire, 68.9% returned properly filled forms. They were 116 males and 48 females with a mean age of 41.99 ± 8.50 years. Eighty three percent of the participants had a good understanding of the characteristics of pain related to DH and 92% recogni-zed chemical and thermal stimuli as triggering factor while mechanical stimulus was not evoked. Many responders (90.9%) did not have any idea of the mechanism for pain transmission across the dentin. Regarding diagnosis technique, 68% use mechanical stimuli to elicit DH pain. Regarding management procedure, the use of desensitizing tooth paste is the mostly chosen option followed by professional topical application of fluoride. More than 1/3rd of the surveyed dentists confess resorting to root canal to manage DH. Conclusion We recommend incorporation of basic science knowledge on orofacial pain and competencies to manage painful conditions like dentin hypersensitivity. Also, Health regulatory institutions should make continuing dental education a requirement to preserve the dental licensure. How to cite this article Benoist FL, Ndiaye FG, Faye B, Bane K, Ngom PI, Ndong PMK. Knowledge of and Management Attitude regarding Dentin Hypersensitivity among Dentists from a West African Country. J Contemp Dent Pract 2014;15(1):86-91.

Onychomycosis is a fungal nails infection often caused by yeasts, dermatophytes and molds. It is an important public health concern due to its high prevalence, the problem of diagnostics, and the poor response to treatments. The objective of this study was to evaluate the epidemiological and microbiological profile of onychomycosis diagnosed at the Laboratory of Parasitology-Mycology of the National University Hospital of Fann in Dakar, Senegal, from 2012 to 2016. A retrospective and descriptive study was performed from January 2012 to December 2016 in a patient attending the laboratory of Parasitology-Mycology at the Fann teaching hospital. Socio-demographic, clinical and biological data were collected from the bench registers. Samples from the lesions were tested using direct microscopy and cultured on a Sabouraud-Chloramphenicol and Sabouraud-Chloramphenicol-Actidione medium. A descriptive analysis was done using Stata IC 12 software. The significance level of different tests was set at 5% two-side. A total of 469 patients were included in this study. The mean age of the study population was 33.2 &plusmn, 15.2 years, and the sex ratio was 0.52. The prevalence of onychomycosis was 48.4% (227/469). The main clinical presentations were disto-lateral subungual onychomycosis (37.9%) and onyxis (46.5%). Identified fungal species were Candida albicans (42.7%), Candida spp (39.5%), Trichophyton soudanense (10.1%), Fusarium spp (5.3%), and Candida tropicalis (2.6%). Candida albicans was more frequent in subjects over 15 years of age (43.6%) and women (45%). However, Trichophyton soudanense was higher in patients under 15 years old (17.4%) as well as in male subjects (18.8%). In conclusion, onychomycosis is a common cause of consultation in health facilities. Candida albicans and Trichophyton Soudanense are the main fungal species causing onychomycosis. A better understanding of the epidemiology of onychomycosis as well as the spectrum of the pathogen could contribute to improve the management of the infection.

The objective of this study was to describe demographics of patients who had benefited from a cervical cancer screening by an HPV viral test; to specify the protocol used to establish diagnosis using the test results; and to describe treatment and follow-up methods on positively tested patients. This was an descriptive prospective cohort study conducted at the Nabil Choucair health center and the Military Hospital of Ouakam from May 1st 2017 to January 30th 2018. The study involved 144 patients who had benefited from an HPV ABBOOT m2000 viral test. The studied parameters included socio-demographic characteristics, clinical aspects, test results, diagnosis, treatment and follow-up. The data was collected on a form and the statistical analysis was performed using Epi-info 7. In this study we collected 144 women. The mean age of the patients was 39.9 years. Patients were predominantly married (84%) and mostly housewives (48.1%), with slightly more than half (55.6%) of them who attended school. More than half of the patients 61.8% were under contraception. Almost all patients (92.4%) were of child bearing age. The average gravidity was 3.4 with an average parity of 2.7. The average age at marriage was 22.6 years mostly in a monogamous household (56.8%). The average age at first intercourse was 22.1. The average age at first pregnancy was 23.9. More than ¾ of women (78.3%) had one partner; however, note that 21.7% of the patients had 2 or more partners. The viral test was positive in 17 patients (11.8%). Papillomaviruses 16 and 18 were the most encountered (56%). Colposcopy was normal and satisfactory in 9 patients (53%), 2 patients had abnormal minor changes (11.7%) and 2 cases had major changes (11.7%). Cervical biopsy was performed in 2 patients (11.7%), histology showed CIN3 and micro invasive carcinoma. For those patients a conization was performed. The postoperative course was simple. The HPV viral test for primary cervical cancer screening offers opportunities and is possible in developing countries such as Senegal despite its limited means.

Intestinal parasitic infections causes significant morbidity in worldwide. In Senegal, since 2005 mass deworming campaign has been introduced as a preventive strategy. The main objective of this study was to evaluate the prevalence of intestinal parasitic infection among children living in Koranic teaching Schools in Senegal. A cross-sectional study was conducted from January to May 2018. Koranic schools were selected using simple random sampling and data on socio-demographic characteristicsand prevalence were collected. Stool samples were collected and treated accordingly. Descriptive analysis was performed using Stata software. Significance level was set at 5%. A total of 463 children were recruited in this study. The mean age of study population was 10.93 ± 2.4. The overall prevalence of intestinal parasites was 22.68%. Poly-parasitism was detected in 20% of students. Students infected with single, double and triple parasites were 80%, 19.05% and 0.95%, respectively. The most common parasites were Entomoba coli cyst (33.33%), followed by Ascaris lumbricoides (32.38%), Giardia cyst (9.52%), Trichirus Trichiura (3.81%) and Schistosoma mansoni 0.95%. Intestinal parasites were more common in peri-urban areas (66.31%). Intestinal parasitic infection has been found to be very common in Koranic school children. Therefore, health education, improvement of learning and living conditions, and student deworming are essential.

L’objectif de cette etude etait de determiner la prevalence des helminthoses digestives, diagnostiquees dans un hopital universitaire de Dakar, Senegal. Sur 1 526 examens parasitologiques de selles, chez des patients avec symptomatologie evocatrice, un examen direct et des techniques de Ritchie et de Baerman ont ete realises entre 2004 et 2009 au laboratoire de parasitologie-mycologie de l’hopital A. Le Dantec de Dakar, 310 mettaient en evidence des helminthoses parasitologiques, soit une prevalence de 20,3 %. Les helminthes les plus frequemment retrouves etaient : Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis, Taenia saginata ou Taenia solium. Les hommes sont plus touches que les femmes avec respectivement 58 % et 42 %, soit un sex-ratio de 1,38. Les enfants âges de 10 a 15 ans etaient les plus touches, avec une prevalence de 34,5 %. Ces resultats confirment que les helminthoses intestinales sont endemiques a Dakar, d’ou la necessite de la mise en place de campagnes de deparasitage et d’education pour la sante, ainsi que d’une amelioration de l’environnement.

Background Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ), given each month during the transmission season, is recommended for children living in areas of the Sahel where malaria transmission is highly seasonal. The recommendation for SMC is currently limited to children under five years of age, but, in many areas of seasonal transmission, the burden in older children may justify extending this age limit. This study was done to determine the effectiveness of SMC in Senegalese children up to ten years of age. Methods and Findings SMC was introduced into three districts over three years in central Senegal using a stepped-wedge cluster-randomised design. A census of the population was undertaken and a surveillance system was established to record all deaths and to record all cases of malaria seen at health facilities. A pharmacovigilance system was put in place to detect adverse drug reactions. Fifty-four health posts were randomised. Nine started implementation of SMC in 2008, 18 in 2009, and a further 18 in 2010, with 9 remaining as controls. In the first year of implementation, SMC was delivered to children aged 3–59 months; the age range was then extended for the latter two years of the study to include children up to 10 years of age. Cluster sample surveys at the end of each transmission season were done to measure coverage of SMC and the prevalence of parasitaemia and anaemia, to monitor molecular markers of drug resistance, and to measure insecticide-treated net (ITN) use. Entomological monitoring and assessment of costs of delivery in each health post and of community attitudes to SMC were also undertaken. About 780,000 treatments were administered over three years. Coverage exceeded 80% each month. Mortality, the primary endpoint, was similar in SMC and control areas (4.6 and 4.5 per 1000 respectively in children under 5 years and 1.3 and 1.2 per 1000 in children 5-9 years of age; the overall mortality rate ratio [SMC: no SMC] was 0.90, 95% CI 0.68–1.2, p = 0.496). A reduction of 60% (95% CI 54%–64%, p < 0.001) in the incidence of malaria cases confirmed by a rapid diagnostic test (RDT) and a reduction of 69% (95% CI 65%–72%, p < 0.001) in the number of treatments for malaria (confirmed and unconfirmed) was observed in children. In areas where SMC was implemented, incidence of confirmed malaria in adults and in children too old to receive SMC was reduced by 26% (95% CI 18%–33%, p < 0.001) and the total number of treatments for malaria (confirmed and unconfirmed) in these older age groups was reduced by 29% (95% CI 21%–35%, p < 0.001). One hundred and twenty-three children were admitted to hospital with a diagnosis of severe malaria, with 64 in control areas and 59 in SMC areas, showing a reduction in the incidence rate of severe disease of 45% (95% CI 5%–68%, p = 0.031). Estimates of the reduction in the prevalence of parasitaemia at the end of the transmission season in SMC areas were 68% (95% CI 35%–85%) p = 0.002 in 2008, 84% (95% CI 58%–94%, p < 0.001) in 2009, and 30% (95% CI -130%–79%, p = 0.56) in 2010. SMC was well tolerated with no serious adverse reactions attributable to SMC drugs. Vomiting was the most commonly reported mild adverse event but was reported in less than 1% of treatments. The average cost of delivery was US$0.50 per child per month, but varied widely depending on the size of the health post. Limitations included the low rate of mortality, which limited our ability to detect an effect on this endpoint. Conclusions SMC substantially reduced the incidence of outpatient cases of malaria and of severe malaria in children, but no difference in all-cause mortality was observed. Introduction of SMC was associated with an overall reduction in malaria incidence in untreated age groups. In many areas of Africa with seasonal malaria, there is a substantial burden in older children that could be prevented by SMC. SMC in older children is well tolerated and effective and can contribute to reducing malaria transmission. Trial Registration ClinicalTrials.gov NCT00712374, In a stepped-wedge cluster-randomized trial, Paul J. Milligan and colleagues determine the effectiveness of SMC in Senegalese children up to ten years of age., Author Summary Why was this study done? SMC was originally intended for children under five years of age. In many areas of the sub-Sahel, there is a substantial burden of malaria in older children; this may justify extending the age range of SMC. This study was done in central Senegal to evaluate the effectiveness of SMC when given to children up to ten years of age. What did the researchers do and find? SMC was introduced into the area served by 54 health posts by district health teams over three years using a randomised stepped-wedge design. Malaria cases were detected at outpatient clinics and in hospitals, and deaths were recorded through a demographic surveillance system. SMC reduced the incidence of malaria in children up to ten years of age by 60%. No reduction in all-cause child deaths was observed, but the incidence of severe malaria was reduced by 45%. SMC administered to children up to ten years of age led to a reduction in malaria incidence in older age groups by 26%. What do these findings mean? SMC given to children up to ten years of age is highly effective in preventing malaria in children and can contribute to reducing overall malaria transmission. SMC programmes have started in 11 countries. In many of these countries, there is a substantial burden of malaria in older children. The findings of this study indicate that a much greater impact could be achieved by extending the age range of SMC.

Background:Dihydroartemisinin-piperaquine (DP) is increasingly recommended for antimalarial treatment in many endemic countries; however, concerns have been raised over its potential under dosing in young children. We investigated the influence of different dosing schedules on DP's clinical efficacy.Methods and Findings:A systematic search of the literature was conducted to identify all studies published between 1960 and February 2013, in which patients were enrolled and treated with DP. Principal investigators were approached and invited to share individual patient data with the WorldWide Antimalarial Resistance Network (WWARN). Data were pooled using a standardised methodology. Univariable and multivariable risk factors for parasite recrudescence were identified using a Cox's regression model with shared frailty across the study sites. Twenty-four published and two unpublished studies (n = 7,072 patients) were included in the analysis. After correcting for reinfection by parasite genotyping, Kaplan-Meier survival estimates were 97.7% (95% CI 97.3%-98.1%) at day 42 and 97.2% (95% CI 96.7%-97.7%) at day 63. Overall 28.6% (979/3,429) of children aged 1 to 5 years received a total dose of piperaquine below 48 mg/kg (the lower limit recommended by WHO); this risk was 2.3-2.9-fold greater compared to that in the other age groups and was associated with reduced efficacy at day 63 (94.4% [95% CI 92.6%-96.2%], p

Background It is recommended that children aged 3 months to five years of age living in areas of seasonal transmission in the sub-Sahel should receive Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) during the malaria transmission season. The purpose of this study was to evaluate the safety of SMC with SPAQ in children when delivered by community health workers in three districts in Senegal where SMC was introduced over three years, in children from 3 months of age to five years of age in the first year, then in children up to 10 years of age. Methods A surveillance system was established to record all deaths and all malaria cases diagnosed at health facilities and a pharmacovigilance system was established to detect adverse drug reactions. Health posts were randomized to introduce SMC in a stepped wedge design. SMC with SPAQ was administered once per month from September to November, by nine health-posts in 2008, by 27 in 2009 and by 45 in 2010. Results After three years, 780,000 documented courses of SMC had been administered. High coverage was achieved. No serious adverse events attributable to the intervention were detected, despite a high level of surveillance. Conclusions SMC is being implemented in countries of the sub-Sahel for children under 5 years of age, but in some areas the age distribution of cases of malaria may justify extending this age limit, as has been done in Senegal. Our results show that SMC is well tolerated in children under five and in older children. However, pharmacovigilance should be maintained where SMC is implemented and provision for strengthening national pharmacovigilance systems should be included in plans for SMC implementation. Trial Registration ClinicalTrials.gov NCT 00712374

Resume Introduction Les mycetomes sont des pseudotumeurs inflammatoires des tissus mous sous-cutanes et eventuellement osseux. Ils sont le plus souvent polyfistulises et evoluent sur un mode chronique. Patients et methodes Cette etude a interesse 113 patients recenses au laboratoire de parasitologie et mycologie de l’hopital Aristide Le Dantec, de Dakar, au Senegal durant la periode allant de juin 2008 a juillet 2010. Resultats Les patients, provenant de differentes regions du Senegal et de la sous region, sont referes au niveau du laboratoire apres suspicion de mycetome. Parmi 250 patients, 113 se sont reveles positifs a l’examen direct et apres culture soit un indice d’infestation de 45,2 %. L’âge moyen des patients varie de 13 ans a 73 ans avec une moyenne d’âge de 33,9 ans. La tranche d’âge comprise entre 20–39 ans est la plus touchee (27,34 %), suivie de celle entre 40–59 ans (25,2 %), 60 ans et plus (4,5 %), 30–39 ans (16,64 %), 13–19 ans (7,2 %). Les hommes sont plus atteints que les femmes avec respectivement 79,6 % et 20,4 %. Les cultivateurs sont les plus representes avec 48,7 %, suivis des eleveurs (42,5 %). Les atteintes du pied sont les plus retrouvees (72,5 %), suivies de la jambe (12,3 %), du genou (7,1 %), du cuir chevelu (2,7 %), de la main (1,8 %). Les autres localisations sont retrouvees avec moins de 1 %, dos, cuisse, poitrine et ganglion inguinal. Les mycetomes fongiques sont plus retrouves que les mycetomes actinomycosiques avec respectivement 70 % et 30 % ; les especes les plus retrouvees sont : Madurella mycetomatis (53,1 %), Actinomadura pelletieri (23 %), Leptosphaeria senegalensis (9,7 %), Streptomyces somaliensis (2,6 %), Actinomadura madurae (2,6 %), Pseudallescheria boydii (1,8 %), Nocardia spp. (1,8 %), Scedosporium apiospermum (0,9 %), Fusarium solani (0,9 %). Nous avons retrouves des agents de dermatophytes : Microsporum langeronii (1,8 %), et Trichophyton mentagrophytes (0,9 %). Conclusion Cette etude montre que les mycetomes sont des affections endemiques au Senegal, handicapant a la longue, et touchent particulierement les personnes vivant en zone rurale.

L’impact du traitement presomptif intermittent (TPI) sur l’immunite de la femme enceinte au Senegal n’est pas tres bien connu. L’objectif de cette etude etait d’evaluer la production des immunoglobulines (IgG) dirigees contre les proteines MSP1, GLURP et DBL5 entre l’inclusion et l’accouchement chez des femmes enceintes sous TPI. Nous avons mene une etude prospective au niveau de la maternite Roi-Baudouin de Guediawaye (RBG) [Senegal]. Les femmes incluses dans cette etude ont subi des prelevements sanguins a l’inclusion et a l’accouchement. Les echantillons de sang collectes ont ete analyses apres centrifugation pour la detection des IgG, par technique Elisa a partir des serums. Un consentement libre et eclaire etait obtenu prealablement a l’inclusion des femmes. Au total, 101 femmes âgees de 18 a 44 ans etaient incluses dans l’etude. Les femmes multigestes representaient 70,3 % de la population d’etude, tandis que les primigestes representaient 29,7 %. Le dosage des IgG a revele de faibles variations entre l’inclusion et l’accouchement des femmes pour ce qui est des IgG anti-MSP1 (83,1 contre 79,5; p = 0,52), de meme que pour les IgG anti-GLURP-R2 (84,1 contre 75,9; p = 0,16). Apres ajustement sur la gestite, on note une baisse significative de la production d’anticorps anti-VAR2CSA entre l’inclusion et l’accouchement des femmes de l’etude (p < 0,05). En diminuant l’incidence du paludisme pendant la grossesse, le TPI reduit l’acquisition des anticorps antiparasites placentaires, ce qui retarderait l’installation d’une immunite antipalustre protectrice. L’application du TPI chez la femme enceinte serait de ce fait plus indiquee en zone hypoendemique ou l’exposition au paludisme est plus faible.

Introduction : L’adhesion aux tissus dentaires est un sujet en permanente evolution tant pour le choix des materiaux que des protocoles proposes au praticien, rendant ainsi difficile sa realisation en clinique. Il l’est d’autant plus pour les lesions cervicales non carieuses du fait de leur localisation et de la qualite du substrat.Objectif : Le but de ce travail etait d’evaluer a six mois l’efficacite clinique d’un adhesif auto-mordancant dans le traitement de 150 lesions cervicales non carieuses.Methode : Un total de 150 restaurations (76 avec mordancage et 74 sans mordancage) a ete place par un meme operateur chez 31 patients âges de 24 a 73 ans. L’adhesif etait applique selon les recommandations du fabricant suivi de l’application du composite Herculite® XRV Ultra (Kerr Hawe, USA). Les restaurations ont ete evaluees a trois et six mois en utilisant les criteres USPHS modifies. Les donnees ont ete statistiquement analysees en utilisant le logiciel SPSS 10.0.Resultats : Huit restaurations ont ete perdues a six mois pour celles realisees avec mordancage et onze pour celles effectuees sans mordancage. Neuf restaurations ont presente une perte clinique de l’integrite marginale. Une legere coloration marginale a ete observee sur quatre restaurations (deux avec et deux sans mordancage). Il n’y pas de difference statistiquement significative. Conclusion : Selon le protocole clinique utilise dans cette etude, les restaurations des lesions cervicales non carieuses realisees avec ou sans mordancage ont un comportement clinique acceptable a six mois.

Resume Introduction Les teignes du cuir chevelu sont des affections dues a des dermatophytes qui sont des champignons filamenteux septes adaptes a la keratine humaine et animale colonisant et parasitant la peau et les phaneres de l’homme. Materiels et methodes Cette etude a concerne 607 cas de teignes du cuir chevelu diagnostiques au laboratoire de parasitologie et mycologie de l’hopital Aristide-Le-Dantec, a Dakar, au Senegal durant la periode allant de juin 2005 a juin 2007. Resultats Les patients au nombre de 1309 sont enregistres au niveau du laboratoire apres suspicion de teigne du cuir chevelu a la consultation. Parmi ces patients, 607 se sont reveles positifs a l’examen direct et a la culture soit un indice d’infestation de 45,84 %. L’âge des patients varie entre trois mois a 69 ans avec une moyenne d’âge de 25 ans. La tranche d’âge comprise entre dix a 19 ans est la plus infestee (27,34 %), suivie de celle entre 20 a 29 ans (26,20 %), zero a neuf ans (22,57 %), 30 a 39 ans (16,64 %), 40 a 49 ans (5,43 %), 50 a 59 ans (1,81 %) et 60 a 69 ans (0,16 %). Nous avons trouve une prevalence des teignes plus elevee chez les sujets de sexe masculin avec 57,56 % contre 41,84 % chez le sexe feminin. Six especes ont ete isolees : Trichophyton soudanense qui est l’espece la plus retrouvee avec 55,19 %, suivie de Microsporum langeroni 28,84 %, Trichophyton rubrum (14,82 %), Microsporum canis (0,67 %), Trichophyton mentagrophytes (0,32 %) et Trichophyton violaceum (0,16 %). Conclusion Cette etude montre que les teignes du cuir chevelu sont des affections endemiques au Senegal et touchent particulierement les enfants entre dix et 19 ans.

Diabetes is the most common metabolic disorder worldwide and is a major public health problem. Its frequency increases every day in all countries. However, in developing African countries, few people have access to drugs. In addition, in Africa, traditional beliefs induce people to use medicinal plants whenever they have health problems. Thus, many people in these developing countries use plants for the treatment of diabetes. Yet, few studies are focused on the knowledge and attitudes of the users on medicinal plants in Africa in general and in Senegal in particular. Hence we undertook this survey on the use of medicinal plants for the treatment of diabetes in Senegal in order to make recommendations which could contribute to the increase of the value of herbal medicines in developing countries. We did a cross-sectional survey by direct interview at a university teaching hospital, in Dakar with a representative sample of 220 patients. Forty-one plants were used by the patients and the two most frequently cited were Moringa oleifera Lam (65.90%) and Sclerocarya birrea (A. Rich) Hochst (43.20%). Patients gave several reasons for using medicinal plants (traditional treatment: 40%, efficacy: 32%, low cost: 20%). The principal suppliers of plants were tradesmen in the market (66.8%) and traditional therapists (5%). Sixty-five per cent of patients think that medicinal plants are efficient for the treatment of diabetes and 20% have reported adverse effects which could be caused by medicinal plants. In conclusion, many people in our study think that medicinal plants are efficient for the treatment of diabetes, which requires research work by scientists in developing countries in this field in order to prove their efficacy and innocuousness.

BACKGROUND: Home-based management of malaria (HMM) may improve access to diagnostic testing and treatment with artemisinin combination therapy (ACT). In the Sahel region, seasonal malaria chemoprevention (SMC) is now recommended for the prevention of malaria in children. It is likely that combinations of antimalarial interventions can reduce the malaria burden. This study assessed the feasibility, effectiveness and safety of combining SMC and HMM delivered by community health workers (CHWs). METHODS: A cluster-randomised trial was carried out during two transmission seasons in eight villages located in the south-eastern part of Senegal. Intervention communities received HMM+SMC while control communities received HMM. Primary end point was the incidence of malaria attacks during the follow up period. Secondary end points included: malaria diagnostic accuracy; access to ACT treatment; SMC coverage; safety and drug tolerability. RESULTS: The adjusted rate ratio for incidence of malaria attacks in intervention and control communities was 0.15, indicating a protective effect of HMM+SMC of 85% (95% CI: 39.9-96.3%, p=0.01). Access to ACT treatment was 96.4% while SMC coverage represented 97.3% (95% CI: 91.3-100%) in 2010, and 88.8% (95% CI: 84.2-93.6%) in 2011. No serious adverse events were recorded. CONCLUSION: It seems feasible and safe to combine SMC with HMM intervention, while achieving high coverage and effectiveness of both SMC and HMM. TRIAL REGISTRATION: (www.pactr.org) PACTR201305000551876.

In Senegal, a significant decrease of malaria transmission intensity has been noted the last years. Parasitaemia has become lower and, therefore, more difficult to detect by microscopy. In the context of submicroscopic parasitaemia, it has become relevant to rely on relevant malaria surveillance tools to better document malaria epidemiology in such settings. Serological markers have been proposed as an essential tool for malaria surveillance. This study aimed to evaluate the sero-epidemiological situation of Plasmodium falciparum malaria in two sentinel sites in Senegal. Cross-sectional surveys were carried out in Velingara (south Senegal) and Keur Soce (central Senegal) between September and October 2010. Children under 10 years old, living in these areas, were enrolled using two-level, random sampling methods. P. falciparum infection was diagnosed using microscopy. P. falciparum antibodies against circumsporozoite protein (CSP), apical membrane protein (AMA1) and merozoite surface protein 1_42 (MSP1_42) were measured by ELISA method. A stepwise logistic regression analysis was done to assess factors associated with P. falciparum antibodies carriage. A total of 1,865 children under 10 years old were enrolled. The overall falciparum malaria prevalence was 4.99% with high prevalence in Velingara of 10.03% compared to Keur Soce of 0.3%. Symptomatic malaria cases (fever associated with parasitaemia) represented 17.37%. Seroprevalence of anti-AMA1, anti-MSP1_42 and anti-CSP antibody was 38.12, 41.55 and 40.38%, respectively. The seroprevalence was more important in Velingara and increased with age, active malaria infection and area of residence. The use of serological markers can contribute to improved malaria surveillance in areas with declining malaria transmission. This study provided useful baseline information about the sero-epidemiological situation of malaria in Senegal and can contribute to the identification of malaria hot spots in order to concentrate intervention efforts. Trial registration number: PACTR201305000551876 ( http://www.pactr.org ).

Background Artesunate-amodiaquine (AS-AQ) is one of the most widely used artemisinin-based combination therapies (ACTs) to treat uncomplicated Plasmodium falciparum malaria in Africa. We investigated the impact of different dosing strategies on the efficacy of this combination for the treatment of falciparum malaria. Methods Individual patient data from AS-AQ clinical trials were pooled using the WorldWide Antimalarial Resistance Network (WWARN) standardised methodology. Risk factors for treatment failure were identified using a Cox regression model with shared frailty across study sites. Results Forty-three studies representing 9,106 treatments from 1999-2012 were included in the analysis; 4,138 (45.4%) treatments were with a fixed dose combination with an AQ target dose of 30 mg/kg (FDC), 1,293 (14.2%) with a non-fixed dose combination with an AQ target dose of 25 mg/kg (loose NFDC-25), 2,418 (26.6%) with a non-fixed dose combination with an AQ target dose of 30 mg/kg (loose NFDC-30), and the remaining 1,257 (13.8%) with a co-blistered non-fixed dose combination with an AQ target dose of 30 mg/kg (co-blistered NFDC). The median dose of AQ administered was 32.1 mg/kg [IQR: 25.9-38.2], the highest dose being administered to patients treated with co-blistered NFDC (median = 35.3 mg/kg [IQR: 30.6-43.7]) and the lowest to those treated with loose NFDC-25 (median = 25.0 mg/kg [IQR: 22.7-25.0]). Patients treated with FDC received a median dose of 32.4 mg/kg [IQR: 27-39.0]. After adjusting for reinfections, the corrected antimalarial efficacy on day 28 after treatment was similar for co-blistered NFDC (97.9% [95% confidence interval (CI): 97.0-98.8%]) and FDC (98.1% [95% CI: 97.6%-98.5%]; P = 0.799), but significantly lower for the loose NFDC-25 (93.4% [95% CI: 91.9%-94.9%]), and loose NFDC-30 (95.0% [95% CI: 94.1%-95.9%]) (P

Benzodiazepines are relatively well-tolerated medicines but can induce serious problems of addiction and that is why their use is regulated. However, in developing countries like Senegal, these products are used without clear indications on their prescription, their dispensation or their use. This work focuses on the prescription of these medicines with a view to make recommendations for their rational use. Benzodiazepine prescription was studied with psychiatrists or neurologists and generalists in 2003. Specialist doctors work in two Dakar university hospitals and generalists in the 11 health centres in Dakar. We did a survey by direct interview with 29 of 35 specialists and 23 of 25 generalists. All doctors were interviewed in their office. The questionnaire focused on benzodiazepine indications, their pharmacological properties, benzodiazepines prescribed in first intention against a given disease and the level of training in benzodiazepines by doctors. Comparisons between specialists and generalists were made by chi-square test. Benzodiazepines were essentially used for anxiety, insomnia and epilepsy. With these diseases, the most benzodiazepines prescribed are prazepam against anxiety and insomnia and diazepam against epilepsy. About 10% of doctors do not know that there is a limitation for the period of benzodiazepine use. The principal reasons of drugs choice are knowledge of the drugs, habit and low side effects of drugs. All generalists (100%) said that their training on benzodiazepines is poor vs. 62.1% of specialists, and doctors suggest seminars, journals adhesions and conferences to complete their training in this field. There are not many differences between specialists and generalists except the fact that specialists prefer prazepam in first intention in the insomnia treatment where generalists choose bromazepam. In addition, our survey showed that specialists' training in benzodiazepines is better than that of generalists. Overall, benzodiazepine prescription poses problems particularly in training, and national authorities must take urgent measures for rational use of these drugs.

Prescription and use of benzodiazepins were evaluated with a patients survey. Direct interview were conducted with 150 patients in ten pharmacies in the city of Saint-Louis, Senegal from January to June 2002. Ten of the 15 retail pharmacies in this city agreed to participate in the survey. All patients gave their agreement to participate to the study; the questionnaire contained essentially closed questions. Writers of prescriptions were general practitioners (38.67%), specialists (34.67%), nurses (18%) and midwifes (8.66%). The most prescribed benzodiazepins were prazepam, dipotassic clorazepate, lorazepam and diazepam. Use of these drugs during night is most recommended. Nevertheless, 26.67% of the prescriptions indicated the drug should be use during the day. The period of use was between one and three Months for 33.99% of patients and three Months or more in 42%. Benzodiazepins were used by 66.67% for insomnia, alone or associated with another condition, for anxiety by 14.6% and for epilepsy by 10%. Prescriptions were for benzodiazepins alone in 47.37% of the patients and in combination with other psychotropic drugs for 19.33%. Somnolence and dependence were the most reported side effects.

Identification of fungal clinical isolates is essential for therapeutic management. In resource-limited settings, identification mostly relies on biochemical tests whose sensitivity and specificity are known to be insufficient for identification of closely related or newly described species. MALDI-TOF has been shown in favored countries to be a reliable and powerful tool for microorganism identification, including yeasts. The aim of this study was to compare MALDI-TOF with routine identification procedures in a resource-poor context. A total of 734 clinical specimens (502 vaginal swabs, 147 oral swabs, 61 bronchoalveolar lavage fluids and 24 stool samples) have been tested in the mycology unit of Fann Hospital, Dakar, Senegal. Strains isolated from culture were identified by both conventional phenotypic methods (germ tube formation and biochemical panels) and MALDI-TOF Saramis/VITEK MS, bioMerieux, France. In addition to comparing the final identification, we determined the time of obtaining the results and the cost for both approaches. Overall, 218 (29.7 %) samples were positive for Candida. MALDI-TOF MS enabled the identification of 214 of the 218 strains isolated (98.1 %) at species level. Phenotypic approach yielded identification for 208 strains (95.4 %). Congruence between the tests was observed for 203 isolates. A discrepancy was observed for one isolate identified as Candida krusei with the phenotypic approach and Candida tropicalis with the MALDI-TOF. In addition, ten isolates identified at genus level by phenotypic methods were identified as C. glabrata (n = 8), C. tropicalis (n = 1) and C. parapsilosis (n = 1) by MALDI-TOF. The turnaround time for identification was

Background Malaria is major public health problem in Senegal. In some parts of the country, it occurs almost permanently with a seasonal increase during the rainy season. There is evidence to suggest that the prevalence of malaria in Senegal has decreased considerably during the past few years. Recent data from the Senegalese National Malaria Control Programme (NMCP) indicates that the number of malaria cases decrease from 1,500,000 in 2006 to 174,339 in 2010. With the decline of malaria morbidity in Senegal, the characterization of the new epidemiological profile of this disease is crucial for public health decision makers. Methods SaTScan™ software using the Kulldorf method of retrospective space-time permutation and the Bernoulli purely spatial model was used to identify malaria clusters using confirmed malaria cases in 74 villages. ArcMAp was used to map malaria hotspots. Logistic regression was used to investigate risk factors for malaria hotspots in Keur Soce health and demographic surveillance site. Results A total of 1,614 individuals in 440 randomly selected households were enrolled. The overall malaria prevalence was 12%. The malaria prevalence during the study period varied from less than 2% to more than 25% from one village to another. The results showed also that rooms located between 50 m to 100 m away from livestock holding place [adjusted O.R = 0.7, P = 0.044, 95% C.I (1.02 - 7.42)], bed net use [adjusted O.R = 1.2, P = 0.024, 95% C.I (1.02 –1.48)], are good predictors for malaria hotspots in the Keur Soce health and demographic surveillance site. The socio economic status of the household also predicted on hotspots patterns. The less poor household are 30% less likely to be classified as malaria hotspots area compared to the poorest household [adjusted O.R = 0.7, P = 0.014, 95% C.I (0.47 – 0.91)]. Conclusion The study investigated risk factors for malaria hotspots in small communities in the Keur Soce site. The result showed considerable variation of malaria prevalence between villages which cannot be detected in aggregated data. The data presented in this paper are the first step to understanding malaria in the Keur Soce site from a micro-geographic perspective.

Background Community case management of malaria (CCMm) and seasonal malaria chemoprevention (SMC) are anti-malarial interventions that can lead to substantial reduction in malaria burden acting in synergy. However, little is known about the social acceptability of these interventions. A study was undertaken to assess whether combining the interventions would be an acceptable approach to malaria control for community health workers (CHWs). Methods Sixty-one interviews and six focus group discussions were conducted nested in a cluster-randomized trial assessing the impact of combining CCMm and SMC in a rural area of Senegal. Participants consisted of: (i) members of village associations, (ii) members of families who had access to the interventions as well as members of families who did not access the interventions, (iii) CHWs, and (iv) community leaders, e g, religious guides and village chiefs. Results The interventions were acceptable to the local population and perceived as good strategy to make health care services available to community members and thus, to reduce the delays in access to anti-malarial treatment as well as expenses related to patients’ transfer to the health post. The use of malaria rapid diagnostic test (RDT) contributed to improving CHWs diagnostic capacity as well as malaria treatment practices. Study participants notified RDT and drugs stock-out as the major risk for sustainability of the intervention at community level. Conclusion Combining CCMm and SMC is a well accepted, community-based approach that can contribute to control malaria in areas where malaria transmission is seasonal.

BACKGROUND: In sub-Saharan Africa, malaria is the leading cause of morbidity and mortality especially in children. In Senegal, seasonal malaria chemoprevention (SMC) previously referred to as intermittent preventive treatment in children (IPTc) is a new strategy for malaria control in areas of high seasonal transmission. An effectiveness study of SMC, using sulphadoxine-pyrimethamine (SP) plus amodiaquine (AQ), was conducted in central Senegal from 2008 to 2010 to obtain information about safety, feasibility of delivery, and cost effectiveness of SMC. Here are report the effect of SMC delivery on the prevalence of markers of resistance to SP and AQ. METHODS: This study was conducted in three health districts in Senegal with 54 health posts with a gradual introduction of SMC. Three administrations of the combination AQ + SP were made during the months of September, October and November of each year in children aged less than 10 years living in the area. Children were surveyed in December of each year and samples (filter paper and thick films) were made in 2008, 2009 and 2010. The prevalence of mutations in the pfdhfr, pfdhps, pfmdr1 and pfcrt genes was investigated by sequencing and RTPCR in samples positive by microscopy for Plasmodium falciparum. RESULTS: Mutations at codon 540 of pfdhps and codon 164 of pfdhfr were not detected in the study. Among children with parasitaemia at the end of the transmission seasons, the CVIET haplotypes of pfcrt and the 86Y polymorphism of pfmdr1 were more common among those that had received SMC, but the number of infections detected was very low and confidence intervals were wide. The overall prevalence of these mutations was lower in SMC areas than in control areas, reflecting the lower prevalence of parasitaemia in areas where SMC was delivered. CONCLUSION: The sensitivity of P. falciparum to SMC drugs should be regularly monitored in areas deploying this intervention. Overall the prevalence of genotypes associated with resistance to either SP or AQ was lower in SMC areas due to the reduced number of parasitaemia individuals.

Cryptococcal meningitis is one of the most important opportunistic infection and a major contributor to early mortality. In sub-Saharan Africa, particularly in Senegal, prevalence of cryptococcal meningitis remains high. This study aimed to describe the epidemiology, laboratory profile, therapeutic and outcome of cases diagnosed in Dakar.We analyzed the cryptococcosis cases diagnosed at the department of parasitology-mycology in Fann Teaching Hospital in Dakar from 2004 to 2011. The diagnosis was confirmed by culture on Sabouraud's dextrose agar and/or by India ink preparation and/or by cryptococcal antigen detection. The diagnosis methods were assessed by using culture as reference.A total of 106 cases of cryptococcal meningitis were diagnosed. The prevalence of cryptococcal meningitis was 7.8 %. The mean age of the patients was 40.17 ± 9.89 years. There were slightly more male (53.8 %) than female (46.2 %) patients; 89.6 % were found to be infected with HIV, and the median CD4+ count was 27/mm(3). Approximately 79.5 % of the patients had100 CD4+ lymphocytes/mm(3). India ink staining presented sensitivity at 94.11 % and specificity at 100 %. Sensitivity and specificity of cryptococcal antigen detection in cerebrospinal fluid were, respectively, 96.96 and 15.78 %. The most frequently used antifungal drug was fluconazole (86.7 %), and the mortality rate was 62.2 % (66 deaths).Early diagnosis is essential to control cryptococcosis, and countries should prioritize widespread and reliable access to rapid diagnostic cryptococcus antigen assays. But it is important to make available conventional methods (India ink and culture) in the maximum of laboratory in regional health facilities.

Although malaria is declining in many countries in Africa, malaria and anaemia remain frequent in children. This study was conducted to assess the relationship between malaria parasitaemia, intestinal worms, and anaemia, in children

Background HIV infection is a concern in the army troupes because of the risk behaviour of the military population. In order to allow regular access to CD4+ T cell enumeration of military personnel as well as their dependents and civilians living with HIV, the Senegalese Army AIDS program is implementing PIMATM Alere technology in urban and semi-urban military medical centres. Validation such device is therefore required prior their wide implementation. The purpose of this study was to compare CD4+ T cell count measurements between the PIMATM Alere to the BD FACSCountTM. Methodology We selected a total of 200 subjects including 50 patients with CD4+ T-cells below 200/mm3, 50 between 200 and 350/mm3, 50 between 351 and 500/mm3, and 50 above 500/mm3. CD4+ T-cell count was performed on venous blood using the BD FASCountTM as reference method and the PIMATM Point of Care technology. The mean biases and limits of agreement between the PIMATM Alere and BD FACSCountTM were assessed with the Bland-Altman analysis, the linear regression performed using the Passing-Bablok regression analysis, and the percent similarity calculated using the Scott method. Results Our data have shown a mean difference of 22.3 cells/mm3 [95%CI:9.1-35.5] between the BD FACSCountTM and PIMATM Alere CD4 measurements. However, the mean differences of the two methods was not significantly different to zero when CD4+ T-cell count was below 350/mm3 (P = 0.76). The Passing-Bablok regression in categorized CD4 counts has also showed concordance correlation coefficient of 0.89 for CD4+ T cell counts below 350/mm3 whilst it was 0.5 when CD4 was above 350/mm3. Conclusion Overall, our data have shown that for low CD4 counts, the results from the PIMATM Alere provided accurate CD4+ T cell counts with a good agreement compared to the FACSCountTM.

Background Prompt treatment of malaria attacks with arteminisin-based combination therapy (ACT) is an essential tool for malaria control. A new co-blister tablet of artesunate-mefloquine (AM) with 25 mg/kg mefloquine has been developed for the management of uncomplicated malaria attacks. This non-inferiority randomized trial, was conducted to evaluate the efficacy and safety of the new formulation of AM in comparison to artemether-lumefantrine (AL) for the treatment of acute uncomplicated Plasmodium falciparum malaria in adults in Senegal. Methods The study was carried out from September to December 2010 in two health centres in Senegal. The study end points included (i) PCR corrected adequate clinical and parasitological response (ACPR) at day 28, (ii) ACPR at days 42 and 63, (iii) parasites and fever clearance time, (iv) incidence of adverse events and patients biological profile at day 7 using the WHO 2003 protocol for anti-malarial drug evaluation. Results Overall, 310 patients were randomized to receive either AM (n = 157) or AL (n = 153). PCR corrected ACPR at day 28 was at 95.5% in the AM arm while that in the AL arm was at 96.7% (p = 0.83). Therapeutic efficacy was at 98.5% in the AM arm versus 98.2% in the AL group at day 42 (p = 1). At day 63, ACPR in the AM and AL arms was at 98.2% and 97.7%, respectively (p = 0.32). The two treatments were well tolerated with similar biological profile at day 7. However, dizziness was more frequent in the AM arm. Conclusion Artesunate-mefloquine (25 mg/Kg mefloquine) is efficacious and well-tolerated for the treatment of uncomplicated P. falciparum malaria in adult patients.

Background: The National Malaria Control Programme in Senegal, introduced since 2006, artemisinin-based combination therapy (ACT administration) for the treatment of uncomplicated malaria cases. In this framework, an anti-malarial pharmacovigilance plan was developed and implemented in all public health services. This study investigated the occurrence of Adverse Drug Events (ADEs) after ACT. Methods: The study was conducted between January 2007 and December 2009. It was based on spontaneous reports of ADEs in public health facilities. Data on patient demographic characteristics, dispensing facility, adverse signs and symptoms and causality were collected from a total of 123 patients. Results: The age range of these patients was six months to 93 years with a mean of 25.9 years. Of the reported symptoms, 46.7% were related to the abdomen and the digestive system. Symptoms related to the nervous system, skin and subcutaneous tissue, circulatory and respiratory systems and general symptoms and signs were 7%, 9.7%, 3.5% and 31.3%, respectively. Causality results linked 14.3% of symptoms to Falcimon W (Artesunate-Amodiaquine) with certainty. Effects were classified as mild and severe in 69.1% and 7.3% of cases respectively while 23.6% were serious. All patients with serious ADEs were hospitalized. One death was reported in a patient who had taken 24 pills at once. Conclusion: These results confirm the need to develop and implement pharmacovigilance systems in malaria endemic countries in order to monitor the safety of anti-malarial treatments.