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Background The prevalence of epilepsy is 7.7‰ in Laos and 5.8‰ in Cambodia, and the treatment gap exceeds 90% in both countries. Objective Our research program aims to measure the effectiveness of two community-based health care approaches using two different types of Domestic Health Visitors (DHV) trained to screen and follow patients with epilepsy (PWE): (1) in Laos, DHV were chosen from health center staff (2) in Cambodia, DHV were health volunteers residing in the villages. Patients and Methods / Material and Methods Between 2015 and 2017, these two quasi-experimental studies were conducted in rural districts over a 12- months period comparing an intervention area and a control area. Our intervention included an Information, Education and Communication campaign, specific training of the DHV staff, and regular monitoring. In Laos, the treatment gap was reduced by 5.5% (20 to 43 cases under treatment of the 418 expected) in the intervention area versus 0.5% (21 to 25 cases under treatment of the 788 expected) in the control area (p

International audience; Background: More than 70 million people suffer epilepsy worldwide. Low availability of anti-epileptic drugs, side-effects and drug-resistant epilepsy affect the quality of life of persons with epilepsy (PWE) in low and middle income countries. In Peru, a country with a high prevalence of epilepsy (16.6/1000) and Laos, a country with a high treatment gap (97.0%), herbal medicine (HM) was frequently used for this neurological condition. Objectives: The aim of this study was to assess and compare the use of HM in Peru and Laos. Specific objectives were to determine therapeutic strategies of PWE, to assess knowledge, attitudes and practices of healthcare actors and to identify HM used to treat epilepsy.Methodology: We estimated the percentage of plants used among PWE in a study conducted in rural communities of Peru between February and June 2015 and in rural and urban communities of Laos between February and June 2017. Inclusion criteria were patients older than 2 years who had lived in the area for at least 3 months and a diagnosis of epilepsy confirmed by a neurologist. Information was collected thanks to structured interviews with a survey questionnaire. Botanical species mentioned were collected and identified by a botanist.Results: In Peru, of 228 PWE included, 60.0% had used HM prescribed by a traditional healer. A Traditional healer was consulted as first intention in 45.2% of PWE. Valeriana officinalis was the HM most prescribed as 25.0% of Traditional healers recommended its use. In Laos, preliminary results show that HM were known by 20.0% of market plant sellers. Most mentioned etiologies in Laos were contamination by rests of animal’s food and brain malformations. Conclusion: This study is the first one to identify a pattern of HM use for epilepsy in Peru and Laos and will allow understanding determinants of the care pathway for PWE.

International audience

International audience

International audience

Background Cervical cancer is the first female cancer in Lao PDR, a low-income country with no national screening and prevention programs for this human papillomavirus (HPV) associated pathology. HIV-infected women have a higher risk of persistent oncogenic HPV infection. The purpose of this study was to determine the knowledge, awareness and attitudes about cervical cancer among Lao women attending or not an HIV treatment center, in order to understand if this attendance had offered an opportunity for information and prevention. Methods A cross-sectional case–control survey was conducted in three provinces of Lao PDR, Vientiane, Luang Prabang and Savannakhet. Cases were 320 women aged 25 to 65, living with HIV and followed in an HIV treatment center. Controls were 320 women matched for age and place of residence, not attending an HIV treatment center. Results Cases had a greater number of sexual partners and used condoms more often than controls. Only 36.6% of women had consulted a gynecologist (47.5% among cases and 25.6% among controls, p < 0.001) and 3.9% had benefited from at least one Pap smear screening (5.6% cases and 2.2% controls, p = 0.02). The average knowledge score was 3.5 on a 0 to 13 scale, significantly higher in cases than in controls (p < 0.0001). Despite having a lower education level and economic status, the women living with HIV had a better knowledge about cervical cancer and were more aware than the controls of the risk of developing such a cancer (35.9% vs. 8.4%, p = 0.0001). The main source of information was healthcare professionals. The main reasons for not undergoing Pap smear were the absence of symptoms and the default of medical injunction for cases, the lack of information and ignorance of screening usefulness for controls. Conclusion In Lao PDR, routine consultation in HIV treatment centers is not enough harnessed to inform women of their high risk of developing cervical cancer, and to perform screening testing and treatment of precancerous lesions. Implementing this cost-effective strategy could be the first step toward a national prevention program for cervical cancer.

Background and aim Traditional practices are deeply rooted in Lao people’s perceptions and beliefs about health and illness. The objective of the study was to understand the perceptions of healthcare professionals and traditional healers regarding the management of epilepsy in Laos, and their reciprocal views. Experimental procedure An observational study was carried out in two areas of Laos from February to May 2017. Semi directive questionnaires were used to collect quantitative and qualitative data. Semiotic square was carried out to highlight relationships between attitudes of traditional healers and healthcare professionals. For quantitative approach, the proportions were reported, and the test used was Fisher’s test for nominal variables. The mean and standard deviation expressed the continuous variables and the Student’s t-test was used. Results and conclusion Epilepsy was cited by 90.9% of traditional healers as a convulsive disease with saliva or urine, and herbal medicines were predominantly used (86.4%) to treat it. Few healthcare professionals (26.5%) pointed out that they knew remedies to treat epilepsy other than antiepileptic drugs (AEDs), and 76.5% of healthcare professionals mentioned that epilepsy was a disease which only AEDs could treat. On the other hand, 54.5% of traditional healers confirmed a traditional remedy could cure completely epilepsy through long-term use. Ninety percent of traditional healers said the collaboration with healthcare professionals was a good idea and 44.1% of the healthcare professionals group said was complicated. The combination of these medicines for the management of epilepsy needs to be adapted to Lao’s medical context., Graphical abstract Image 1, Highlights of the findings and novelties • Understanding the perceptions and reciprocal views of care providers. • Study the combination of traditional and conventional medicine for epilepsy. • Public health policies: integration of traditional medicine in the care of patients.

Relevance More than 70 million people suffer epilepsy worldwide. Low availability of anti-epileptic drugs, side-effects and drug-resistant epilepsy affect the quality of life of persons with epilepsy in countries with a poorly developed health system. Herbal medicine is frequently used for this neurological condition. Objectives The main objective was to provide a detailed analysis of Herbal Medicine used for neurological conditions related with epilepsy in Asia, Africa and Latin America. More broadly, this study aims to highlight species with assessed efficacy (cross-cultural use, pharmacological effects on models of epileptic seizures) and safety (toxicological data in laboratory) information, in order to point out species of interest for further studies. A critical assessment of models used in pharmacological evaluations was done. Materials and methods The systematic search for Herbal Medicine treatments for epilepsy was performed considering all the articles published until February 2017 through three scientific databases. It was made with MeSH terms and free text defining the epilepsy seizures and plant species. We included studies carried out in Asia, Africa and Latin America. All articles reporting the use of Herbal Medicine to treat epilepsy seizures and/or their pharmacological evaluation were retained for further analysis. Results The search yielded 1886 articles, from 30 countries. Hundred and six articles published between 1982 and 2017 were included, corresponding to a total of 497 use reports for 351 plant species belonging to 106 families. Three hundred and seventy seven use reports corresponding to 264 species in ethnopharmacological surveys and 120 evaluation reports corresponding to 107 species were noted. Twenty-nine reports, for 29 species, combined both ethnopharmacological and pharmacological evaluation. Fifty eight studies originated from Africa, 35 studies from Asia and 18 from Latin America. Highest use report was noted for rhizomes of Acorus calamus L. (12 use report in 1 country) and leaves of Bacopa monnieri (L.) Wettst. (8 use report in 2 countries). Therefore these species display the highest use convergence. Regarding pharmacological evaluation most studied species were: Leonotis leonurus (L.) R.Br. (4 evaluation reports in 1 country), Uncaria rhynchophylla (Miq.) Miq. ex Havil. (3 evaluation reports in 2 countries) and Calotropis gigantea (L.) Dryand. (3 evaluation reports in 1 country). In vivo models of chronic epilepsy were more relevant than in vitro models or chemical models inducing acute seizures for pharmacological assessment. Conclusion Species with the highest use report were not those with pharmacological evaluation. It will be pertinent to assess the pharmacological effects and safety of medicinal plants used mostly by traditional healers on predictive models of seizures.

International audience; Wet markets are a critical part of South-East Asian culture and economy. However, their role in circulation and transmission of both endemic and emerging disease is a source of concern in a region considered a hotspot of disease emergence. In the Lao People's Democratic Republic (Lao PDR, Laos), live and dead wild animals are fre- quently found in wet markets, despite legislation against the bushmeat trade. This is generally considered to increase the risk of disease transmission and emergence, al- though whether or not wildlife vendors themselves have indeed increased incidence of zoonotic disease has rarely been assessed. In preparation for a future longitudi- nal study of market vendors investigating vendors’ exposure to zoonotic pathogens, we conducted a pilot survey of Lao market vendors of wildlife meat, livestock meat and vegetables, to identify demographic characteristics and potential control groups within markets. We also investigated baseline risk perception for infectious diseases among market vendors and assessed the association between risk perception and risk mitigation behaviours. The surveys conducted with 177 vendors revealed simi- lar age, sex, ethnic background and geographical origin between vendor types, but differences in professional background and work history for livestock meat vendors. The perception of disease risk was very low across all vendors, as was the reported use of personal protective equipment, and the two appeared unrelated. Personal risk discounting and assumptions about transmission routes may explain this lack of association. This information will help inform the development of future research, risk communication and risk mitigation policy, especially in the light of the COVID-19 pandemic.

Epilepsy is the most common neurological disorder encountered in primary care in Southeast Asia. People with epilepsy require long-term therapy management. Nonadherence to antiepileptic drugs (AEDs) has been identified as a major factor in suboptimal control of epilepsy. Pharmacies offer patients a first-line point of contact with the healthcare system. Many pharmacies operate with limited or nonqualified human resources that can lead to insufficient knowledge, inappropriate supply of medicines, and insufficient counseling.The aim of this study was to evaluate the qualification and knowledge concerning epilepsy and AEDs among pharmacy-dispensing workers who sell drugs to people with epilepsy.A cross-sectional qualitative study was conducted in public and private pharmacies, in both urban and rural areas of Cambodia and Lao People's Democratic Republic (Lao PDR). The knowledge was collected through a questionnaire.A total of 180 respondents from 123 outlets in the two countries were included in this study. A proportion of 40.8% (31) of respondents in Cambodia and 38.5% (40) in Lao PDR were pharmacists, followed by sellers who did not received any healthcare training with a proportion of 18.4% (14) in Cambodia compared to 20.2% (21) in Lao PDR. Head trauma was cited as the main cause of epilepsy by 72.4% (55) in Cambodia and 27.2% (28) in Lao PDR (p 0.001). Epilepsy was considered as a contagious disease by 6.6% (5) of respondents in Cambodia compared to 18.4% (19) in Lao PDR (p = 0.03). Eighty-seven percent (66) of respondents in Cambodia knew at least one long-term AED versus 67.3% (70) in Lao PDR (p = 0.003). Phenobarbital was mentioned in more than 90.0% of cases in both countries. In overall, 15.4% (21) thought that if seizures are controlled for some months, people with epilepsy could stop taking their AEDs. Only one respondent from Lao PDR was aware of drug-drug interaction between AEDs and oral contraception.An educational intervention should be implemented to improve the knowledge of epilepsy and AEDs for pharmacy-dispensing workers. This could include advice for all pharmacy-dispensing workers in order to improve AED management and follow-up of therapeutic adherence.

Trade of bushmeat and other wildlife for human consumption presents a unique set of challenges to policy-makers who are confronted with multiple trade-offs between conservation, food security, food safety, culture and tradition. In the face of these complex issues, risk assessments supported by quantitative information would facilitate evidence-based decision making. We propose a conceptual model for disease transmission risk analysis, inclusive of these multiple other facets. To quantify several processes included in this conceptual model we conducted questionnaire surveys with wildlife consumers and vendors in semi-urban centers in Lao People's Democratic Republic (Lao PDR, Laos) and direct observations of consumer behaviors. Direct observation of market stalls indicated an estimated average of 10 kg bushmeat biomass per stall per hour. The socio-demographic data suggested that consumption of bushmeat in urban areas was not for subsistence but rather driven by dietary preference and tradition. Consumer behavioral observations indicated that each animal receives an average of 7 contacts per hour. We provide other key parameters to estimate the risk of disease transmission from bushmeat consumption and illustrate their use in assessing the total public health and socio-economic impact of bushmeat consumption. Pursuing integrative approaches to the study of bushmeat consumption is essential to develop effective and balanced policies that support conservation, public health, and rural development goals., Graphical abstract Unlabelled Image, Highlights • Bushmeat trade in Lao PDR is considerable and likely exceeds sustainable levels. • Bushmeat consumption in urban centers is not a necessity but a preference. • High contact rates between consumers and bushmeat add to the transmission risk. • Integrated assessment of conservation, food security and food safety risks needed

Relevance A low level of knowledge about epilepsy among health workers, a context of stigmatizing sociocultural beliefs, and a low availability of antiepileptic drugs in Lao People's Democratic Republic (PDR) are major gaps in the medical management of people with epilepsy in this country. Objectives The principal objective of the study was to identify the associated factors of adherence to community healthcare structures in Lao PDR. Specific objectives were to evaluate patients' adherence status, practices and knowledge about epilepsy and its care, and factors influencing decision-making on therapeutic interventions. Materials and methods The study was an observational cross-sectional survey about knowledge, attitudes, and practices, handled from February to May 2016. Eighty-seven people with epilepsy were identified in two areas in the periphery of Vientiane Capital through an active screening in villages and homes. Semidirective questionnaires were conducted to collect quantitative and qualitative data. Quantitative analysis included a comparison of adherent vs. nonadherent people with epilepsy, using Chi-square or Fisher's test. Advanced qualitative lexical analysis was carried out on the open-ended questions. Results Sixty-two people with epilepsy were included and the adherence rate to community care was 67.7%. The only sociodemographic variable that differed significantly between adherent and nonadherent members was the income level (p = 0.015): the wealthiest class of people with epilepsy did not adhere to community healthcare. Eleven percent of people with epilepsy thought that epilepsy was contagious, 80.6% that medication may reduce epilepsy seizure rates, and 33.9% that it was possible to cure epilepsy permanently. Physicians informed about the disease in 69.0% of adherent people with epilepsy and in 40.0% of nonadherent ones (p = 0.029), whereas villagers were involved in 29.0% and 50.0% of cases, respectively. There was a significant difference between the two groups for the prescribed antiepileptic drugs (p = 0.012): phenobarbital covered 73.8% of adherent people with epilepsy but only 40% of nonadherent ones. Half of nonadherent people with epilepsy went regularly to a central hospital in the Vientiane Capital, 15.0% went to Thailand, and 10.0% practiced self-medication in occasional mobilities. Conclusion A wider range of antiepileptic drugs at a reduced cost and the promotion of adherence to community healthcare would allow a better management of people with epilepsy in Lao PDR.

International audience

International audience; Purpose:The prevalence of epilepsy is 7.7& in Laos and 5.8 & in Cambodia, the treatment gap exceeds 95% in both countries. Our researchprogram aims to measure the effectiveness of two new community-based health care approaches using two different types of Domestic HealthVisitors (DHV) trained to screen and follow patients with epilepsy (PWE): (1) in Laos DHV chosen from health center staff (2) an identicalstrategy in Cambodia where DHV duty was carried out by health volunteers residing in the villages.Method:Between 2015 and 2017, these two quasi-experimental studies were conducted in rural districts over a 12-months period comparing anintervention area and a control area. Our intervention included an Information, Education and Communication campaign, training of the DHVstaff, a number of surveys on general population about Knowledge, attitudes and practices (KAP) and regular monitoring.Results:In Laos after a 12-month intervention period, the treatment gap was reduced by 5.5% (20 to 43 cases under treatment of the 418expected) in the intervention vs. 0.5% (21 to 25 cases under treatment of the 788 expected) in the control area (p

International audience

Melioidosis, a severe infection with the environmental bacterium Burkholderia pseudomallei, is being recognised increasingly frequently. What determines its uneven distribution within endemic areas is poorly understood. We cultured soil from a rice field in Laos for B. pseudomallei at different depths on 4 occasions over a 13-month period. We also measured physical and chemical parameters in order to identify associated characteristics. Overall, 195 of 653 samples (29.7%) yielded B. pseudomallei. A higher prevalence of B. pseudomallei was found at soil depths greater than the 30 cm currently recommended for B. pseudomallei environmental sampling. B. pseudomallei was associated with a high soil water content and low total nitrogen, carbon and organic matter content. Our results suggested that a sampling grid of 25 five metre square quadrats (i.e. 25 × 25 m) should be sufficient to detect B. pseudomallei at a given location if samples are taken at a soil depth of at least 60 cm. However, culture of B. pseudomallei in environmental samples is difficult and liable to variation. Future studies should both rely on molecular approaches and address the micro-heterogeneity of soil when investigating physico-chemical associations with the presence of B. pseudomallei.

Background The global burden of diarrhea is a leading cause of morbidity and mortality worldwide. In montane areas of South-East Asia such as northern Laos, recent changes in land use have induced increased runoff, soil erosion and in-stream suspended sediment loads, and potential pathogen dissemination. To our knowledge, few studies have related diarrhea incidences to catchment scale hydrological factors such as river discharge, and loads of suspended sediment and of Fecal Indicator Bacteria (FIB) such as Escherichia coli, together with sociological factors such as hygiene practices. We hypothesized that climate factors combined with human behavior control diarrhea incidence, either because higher rainfall, leading to higher stream discharges, suspended sediment loads and FIB counts, are associated with higher numbers of reported diarrhea cases during the rainy season, or because water shortage leads to the use of less safe water sources during the dry season. Using E. coli as a FIB, the objectives of this study were thus (1) to characterize the epidemiological dynamics of diarrhea in Northern Laos, and (2) to identify which hydro-meteorological and sociological risk factors were associated with diarrhea epidemics. Methods Considering two unconnected river catchments of 22 and 7,448 km2, respectively, we conducted a retrospective time series analysis of meteorological variables (rainfall, air temperature), hydrological variables (discharge, suspended sediments, FIB counts, water temperature), and the number of diarrheal disease cases reported at 6 health centers located in the 5 southern districts of the Luang Prabang Province, Lao PDR. We also examined the socio-demographic factors potentially affecting vulnerability to the effect of the climate factors, such as drinking water sources, hygiene habits, and recreational water exposure. Results Using thus a mixed methods approach, we found E. coli to be present all year long (100–1,000 Most Probable Number or MPN 100 mL-1) indicating that fecal contamination is ubiquitous and constant. We found that populations switch their water supply from wells to surface water during drought periods, the latter of which appear to be at higher risk of bacterial contamination than municipal water fountains. We thus found that water shortage in the Luang Prabang area triggers diarrhea peaks during the dry and hot season and that rainfall and aquifer refill ends the epidemic during the wet season. The temporal trends of reported daily diarrhea cases were generally bimodal with hospital admissions peaking in February-March and later in May-July. Annual incidence rates were higher in more densely populated areas and mostly concerned the 0–4 age group and male patients. Conclusions We found that anthropogenic drivers, such as hygiene practices, were at least as important as environmental drivers in determining the seasonal pattern of a diarrhea epidemic. For diarrheal disease risk monitoring, discharge or groundwater level can be considered as relevant proxies. These variables should be monitored in the framework of an early warning system provided that a tradeoff is found between the size of the monitored catchment and the frequency of the measurement., Author Summary Aiming to identify the most critical drivers of diarrhea epidemics in montane areas of South-East Asia, we conducted a retrospective time series analysis of diarrhea reported cases and of hydro-meteorological variables measured in two contrasted river basins in northern Laos, together with socio-behavioral practices. We found that during drought periods, the population switches its water supply from wells to surface water where we measured numbers of fecal indicator bacteria (E. coli) of 100–1,000 MPN 100 mL-1 (the World Health Organization recommendation is 0 MPN 100 mL-1 in drinking water supply sources). We found that water shortages trigger diarrhea peaks during the dry and hot seasons and that rainfall and subsequent aquifer refill ends the epidemic during the wet season. As E. coli counts in surface water are high all year long, E. coli may not be a relevant indicator of the fecal risk in this area. Conversely, stream discharge and aquifer water level appear to be relevant proxies to predict diarrheal risk. Mitigating both environmental and anthropogenic drivers of fecal bacteria dissemination in developing countries is critical in the context of global change: more intense rainfall combined to the extension of run-off prone land uses (e.g. tree plantation without understorey) may decrease both the aquifer recharge and the contaminant retention ecosystem service, and thus threaten the availability of safe water resource for the population.

Background Little is known about the efficacy of first and and second-line antiretroviral therapies (ART) for HIV-1 infected children in resource limited Southeast Asian settings. Previous studies have shown that orphans are at a higher risk for virological failure (VF) in Cambodia. Consequently most of them required transfer to second-line ART. We assessed the factors associated with VF among HIV-1 infected children who were either under first-line (mostly 3TC + D4T + NVP) or under second-line (mostly ABC + DDI + LPV) therapies at a referral hospital in Cambodia. Methods A case-control study was conducted from February to July 2013 at the National Pediatric Hospital among HIV-1 infected children (aged 1–15 years) under second-line ART (cases) or first-line (matched controls at a ratio of 1:3) regimens. Children were included if a HIV-1 RNA plasma viral load (VL) result was available for the preceding 12 months. A standardized questionnaire explored family sociodemographics, HIV history, and adherence to ART. Associations between VF (HIV-1 RNA levels ≥1000 copies/ml) and the children’s characteristics were assessed using bivariate and multivariate analyses. Results A total of 232 children, 175 (75.4 %) under first-line and 57 (24.6 %) under second-line ART, for a median of 72.0 (IQR: 68.0–76.0) months, were enrolled. Of them, 94 (40.5 %) were double orphans and 51 (22.0 %) single orphans, and 77 (33.2 %) were living in orphanages. A total of 222 children (95.6 %) were deemed adherent to ART. Overall, 18 (7.7 %; 95 % CI 4.6–11.9) showed a VF, 14 (8.6 %; 95 % CI 4.8–14.0) under first-line and 4 (7.0 %; 95 % CI 1.9–17.0) under second-line ART (p = 0.5). Their median CD4 percentage was 8 % (IQR 2.9–12.9) at ART initiation. Children under second-line ART were older; more often double orphans, and had lower CD4 cell counts at the last control. In the multivariate analysis, having the last CD4 percentage below 15 % was the only factor associated with VF for ART regimen separately or when combined (OR 40.4; 95 % CI 11–134). Conclusions The pattern of risk factors for VF in children is changing in Cambodia. Improved adherence evaluation and intensified monitoring of children with low CD4 counts is needed to decrease the risk of VF. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-1884-y) contains supplementary material, which is available to authorized users.

International audience; BACKGROUND:Road traffic crashes (RTC), that daily kill 3400 people and leave 15,000 with a permanent disability could be prevented through the implementation of safety programs developed in partnership with governments and institutions. The relationship between key stakeholders can be a crucial determinant to the effectiveness of road safety programs. This issue has rarely been addressed. We conducted a detailed organizational analysis of the stakeholders involved in road safety programs in Lao People's Democratic Republic (Lao PDR).METHODS:A case study was performed. The framework used was a snowball effect in which the characterization of all key stakeholders and the links between them, as well as the factors that led to these links, were determined. The effect of the relations between key stakeholders on the prevention of RTC was assessed through an analysis of the transactional, intangible and controlling factors that influence these relationships.RESULTS:The design and implementation of road safety programs in Lao PDR suffer from weak relationships between stakeholders and a poorly functional bicephal leadership between the Ministry of Public Works and Transport and the non-governmental organisation called Handicap International. This poor coordination between key stakeholders is evident, particularly in the area of collective action and is reinforced by a lack of interest from several different stakeholders. Most agencies do not prioritize road safety. Uneven distribution of funding is another contributing factor. Strengthening the leadership is crucial to the success of the program. Some organisations have skills, power the decision making and the allocation of resources in regards to road safety programs. Encouraging participation of these organizations through a more prominent position would thus result in a better collaboration. Non-monetary rewards would further help to strengthen collaborative work.CONCLUSION:The bicephal nature of the leadership of road safety programs proves detrimental, is associated with a weak coalition between stakeholders, and contributes to the declaimed poor effectiveness of the existing programs. The study has identified non-monetary and realistic means of strengthening the collaboration between key stakeholders. Stakeholders need to revise their interpretive schemes, in order to actively support the reinforcement of government leadership of road safety policies.

International audience; BackgroundHIV-related stigma diminishes the quality of life of affected patients. Little is known about perceived and enacted stigma of HIV-infected children in resources-limited settings. We documented the prevalence of perceived stigma and associated factors associated among children on antiretroviral therapy (ART) at a referral hospital in Cambodia.MethodsAfter informed consent, a standardized pre-tested 47-item questionnaire was confidentially administered to consecutive children (7 to 15 years) or their guardians if the child was 18 months to 6 years, during their routine ART visits. The questionnaire explored the sociodemographics of the child and the parents, HIV history, adherence to ART, tolerance of ART and perceived stigma. Associations between perceived stigma and the children¿s characteristics were measured by bivariate and multivariate analyses.ResultsOf 183 children, 101 (55.2%) had lost at least one and 45 (24.6%) both parents; 166 (90.7%) went to school. Of 183 children (female:84, 45.9%, median age 7.0 years, interquartile range: 2.0-9.6), 79 (43.2%) experienced perceived stigma, including rejection by others (26.8%), no invitations to social activities (18.6%) and exclusion from games (14.2%). A total of 43 (23.5 %) children were fearful of their disease and 61 (53.9%) of 113 older than 6 years reported knowledge of their HIV status. Of 136 children over five years and eligible for education, 7 (3.8%) could not go to school due to perceived stigma. Incomplete adherence to ART was reported for 17 (9.2%) children. In multivariate analysis, school attendance (odds ratio [OR]: 3.9; 95% confidence interval [CI]: 2.0-7.9) and income of less than one dollar per person per day (OR: 2.2, 95%CI: 1.1-4.5) were associated with perceived stigma. Conversely, receipt of social support (OR: 0.4, 95% CI 0.2-0.9) was associated with lower risk of perceived stigma.ConclusionPerceived stigma in pediatric ART patients remains a significant issue in Cambodia. Psychological support and interventions should be developed in hospitals, schools, and underprivileged communities to prevent HIV-related stigma for affected children.

International audience; La médecine tropicale est bien enseignée en France, au travers de nombreuses formations délivrantdes diplômes, malheureusement mal ou non reconnus sur le plan international. La disparition desquatre grands Instituts de médecine tropicale français a contribué à cette préjudiciable nonreconnaissance,responsable d'un non-recrutement de tropicalistes francophones compétents, dansles grands organismes internationaux, mais aussi d’un délaissement de nos universités par nosmeilleurs étudiants, au profit d'établissements étrangers.L'absence dans notre pays d'une filière doctorante de santé en zone tropicale en est la principaleexplication. En revanche, elle est disponible dans la plupart des universités européennes. C'est dire,avant qu'il ne soit trop tard, l'impérieuse nécessité de disposer en France d'un doctorat d'université (lePhD des anglo-saxons) de santé publique Tropicale, seul diplôme internationalement reconnu et nondiscuté, même si des thèses d’université portant sur la recherche en médecine tropicale sontsoutenues dans nos universités. L'Académie de médecine, consciente de l'éclatement et de l'absencede dimension internationale de notre dispositif de formation dans cette discipline a vivement appuyé,dans sa séance du 22 octobre 2013, la création d'une telle filière doctorante française.L’Université de Limoges, au sein de laquelle a été créé il y a plus de 30 ans, un Institutd’épidémiologie neurologique et de neurologie tropicale, qui a fait émerger deux masters et une unitéINSERM, possède les infrastructures nécessaires pour l’émergence d’un tel doctorat ; la volontéaffichée par les responsables de cette Université et les textes législatifs en permettent la réalisation.Ce doctorat francophone de santé publique tropicale favorisera le rapprochement au sein des conseilsde direction, de tous les partenaires qu'ils soient gouvernementaux (Universités, Institut Pasteur, IRD,CIRAD...) ou ou non, souhaitant s’engager dans cette démarche d'organisation et de délivrance d’undoctorat national de santé tropicale, complémentaire des actuelles formations diplômantes existantes.

Background The treatment gap for epilepsy is considerable in low and middle-income countries. In the Lao PDR it is estimated at over 90%. Health workers play a significant role in bridging the gap between people with epilepsy (PWE) and access to epilepsy care. In a national survey we assessed: 1) the knowledge and practices of health workers in the Lao PDR towards the disease, and, 2) patient attendance at health facilities. Methods We conducted a random three-stage sampling of health workers at the provincial, district and health center levels in 2009. Results Overall, 284 health workers were enrolled in 50 health facilities of 11 provinces: health centers 24.7%; district hospitals 23.2%; and province hospitals 52.1%. Only a minority of these (2.5%) recalled ever having received training or seeking information on epilepsy. Our survey showed a lack of knowledge in diagnosing and prescribing drugs for epilepsy, including phenobarbital, the first-line of treatment. The majority of respondents (59.9%) was unaware of the availability of antiepileptic drugs in health facilities. Only 10 (20%) health facilities, and no health centres, received people with epilepsy. It was estimated that one PWE per month receives medical attention. Traditional beliefs about PWE were common; such as the idea that epilepsy could be transmitted through saliva (63.2%). A higher attendance of PWE was observed in province hospitals where the knowledge of epilepsy care was higher. Global acceptance of people with epilepsy was low. Conclusions The low level of knowledge of epilepsy on the part of health workers may be contributing to the wide treatment gap in the Lao PDR. Improving knowledge of this disease and increasing the availability of antiepileptic drugs will reduce misconceptions about epilepsy, thus encouraging more PWE to seek treatment. Community-based educational programs and extensive advocacy for people with epilepsy only began in 2009.

Man is the only known definitive host of the tapeworm Taenia solium and becomes a carrier by eating undercooked pork contaminated with “Cysticercus cellulosae” (cysticerci). Pigs act as intermediate host and acquire cysticercosis by ingestion of eggs or proglottids from human feces, which develop into cysticerci within tissue mostly without causing clinical symptoms in the host. Cysticercosis occurs in man in a context of “Fecal peril” by ingestion of egg-contaminated soil, water or vegetation or by auto-infestation. In theory separation of swine from humans, good cooking practice and hygiene should lead straightforwardly to the eradication of the disease! However cysticercosis is still a major public health problem in endemic regions with more than 50 million infected people and is now a re-emerging disease in industrialized countries due to human migration. It is also the second cause of seizure in tropical countries. So what are the pitfalls in cysticercosis control and what can we do? Cysticercosis affects free roaming pigs with access to sites contaminated with human feces. Development of good rearing practice guides will be of major impact. Only few tools are available for ante-mortem diagnosis of porcine cysticercosis and tongue palpation remains the most commonly used tool. Therefore, the development of a rapid diagnostic test, usable in villages, to test cattle will be the second weapon. However, this will need recombinant antigens. Diagnostic obstacles also affect human patients presenting with seizures. Scans and biological tests are not readily available leading to the repeated treatment of patients. New target proteins are thus needed to develop these tests. With the sequencing of T. solium genome which will allow identification and production of recombinant protein a new step in the right direction was made. Now a large advocacy to raise funds in order to get this strategy on track is needed. Here we summarize the current state of the disease, practical issues linked to the organization of a feasible control system in developing countries and new data available all over the world and in particular in Madagascar to sustain this advocacy.