Search

Global access to deworming treatment is one of the public health success stories of low-income countries in the 21st Century. Parasitic worm infections are among the most ubiquitous chronic infections of humans, and early success with mass treatment programmes for these infections was the key catalyst for the Neglected Tropical Disease (NTD) agenda. Since the launch of the “London Declaration” in 2012, school-based deworming programmes have become the world’s largest public health interventions. WHO estimates that by 2020, some 3.3 billion school-based drug treatments had been delivered. The success of this approach was brought to a dramatic halt in April 2020 when schools were closed worldwide to minimize COVID-19 pandemic transmission. These closures immediately excluded 1.5 billion children not only from access to education but also from all school-based health services, including deworming. WHO PULSE surveys in 2021 identified NTD treatment as among the most negatively affected health interventions worldwide, second only to mental health interventions. In reaction, governments created a global Coalition with the twin aims of reopening schools and of rebuilding more resilient school-based health systems. Today, some 75 countries, comprising more than half the world’s population, are delivering on this response, and school-based coverage of some key school-based programmes exceeds 2020 levels. This paper explores how science, and a combination of new policy and epidemiological perspectives, led to the exceptional growth in school-based NTD programmes after 2012, and are again driving new momentum in response to the COVID-19 pandemic.

Cet article étudie la manière dont les femmes ou les couples gèrent les grossesses non prévues dans les capitales du Maroc et du Sénégal (Rabat et Dakar), deux pays soumis à des règles strictes en matière de sexualité des célibataires. Nous analysons les logiques sociales et individuelles qui prévalent à l'annonce d'une grossesse inattendue et la manière dont se prennent les décisions qui vont aboutir à la poursuite de cette grossesse ou à son interruption. Nous nous basons sur des données qualitatives tirées d'un programme financé par l'Union Européenne entre 2005 et 2009, sur l'usage de la contraception d'urgence dans les villes africaines. Nos résultats montrent qu'en dépit de programmes de planification familiale plus performants dans leur pays, les femmes de Rabat vivent leur entrée en sexualité dans des conditions difficiles. Si à Dakar la chasteté avant le mariage est prônée, le non-respect de cette règle entraîne des sanctions beaucoup moins sévères qu'au Maroc. Le choix de l'avortement en cas de grossesse non prévue évolue avec le cycle de vie des individus et selon le stade de la relation. Une pratique envisageable à un moment donné, ne l'est plus forcément à d'autres moments de la relation. Enfin, dans les deux villes, nos données révèlent une forte implication des familles dans la gestion de la formation des couples et de leur fécondité. Cette tendance apparaît cependant plus exacerbée au Maroc où les familles se mobilisent parfois âprement pour obliger ou interdire un avortement.

This paper examines how women or couples manage unplanned pregnancies in the capital cities of Morocco and Senegal (Rabat and Dakar), both subject to strict rules in terms of sexuality among single people. We analyze the social and individual logics prevailing when an unexpected pregnancy is announced and how decisions are made as to whether to continue or terminate the pregnancy. We analyse qualitative data from a program funded by the European Union between 2005 and 2009 on the use of emergency contraception in African cities. Our results show that despite the existence of effective family planning programs in Rabat, circumstances of sexual debut among women are difficult. In Dakar, although chastity before marriage is promoted, non-compliance with this rule is not as severely condemned than in Morocco. Choosing abortion when faced with unplanned pregnancy depends on people's life cycle and on the stage of their relationship. One practice contemplated at a given time in the relationship may no longer be feasible at another time. Finally, in both cities, our data highlight the strong involvement of families in managing couple relationships and their fertility. This influence seems further exacerbated in Morocco where families sometimes fiercely require or forbid abortion.

The definitive version is available at www3.interscience.wiley.com, OBJECTIVE: To determine the relationship between human lymphatic filariasis, caused by Wuchereria bancrofti, and falciparum malaria, which are co-endemic throughout West Africa. METHODS: We used geographical information systems and spatial statistics to examine the prevalence of lymphatic filariasis in relation to malaria prevalence, mosquito species distributions, vegetation and climate. RESULTS: A negative spatial association between W. bancrofti and falciparum malaria prevalence exists. Interspecies competition between parasites, seasonality, differences in the distribution and vector competence of Anopheles vectors, agricultural practices and insecticide resistance may be factors driving current (and potentially future) spatial distributions. CONCLUSION: Further investigating these factors will become crucial as large-scale lymphatic filariasis and malaria control programmes are implemented in West Africa that may influence the epidemiology of both diseases.

OBJECTIVES: The impact of large-dose vitamin A supplementation given at intervals of 4 months on child mortality and morbidity was examined according to the time interval since dosing, number of doses received previously, and time of year. METHODS: Two double-blind, randomized, placebo-controlled trials of large doses of vitamin A administered at intervals of 4 months were conducted in adjacent populations in northern Ghana. RESULTS: While vitamin A supplementation significantly reduced the overall incidence of severe illnesses (especially diarrhea with dehydration), clinic attendances, hospital admissions, and mortality, there was no evidence that the impact of each dose of vitamin A was related to the number of doses the child had received previously. There was no evidence that the effectiveness of the supplement waned over the 3 to 5 months between doses. The impact on mortality did not differ significantly by the month in which the supplement had been given. CONCLUSIONS: In the study population, there was no evidence that an interval between doses of less than 4 months would have had a greater impact on severe morbidity or mortality, and the effectiveness of supplementation did not vary by time of year.