47 results on '"Rakotoarivelo RA"'
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2. Helicobacter pylori: what eradication regimen in a tropical area after the failure of two separate lines of eradication including metronidazole and clarithromycin?
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Razafimahefa, SH., additional, Rakotoarivelo, RA., additional, Andriamampionona, TF., additional, Rabenjanahary, TH., additional, and Ramanampamonjy, RM., additional
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- 2013
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3. Infection à Helicobacter pylori : revue de la littérature et réalités à Madagascar
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Razafimahefa, SH, primary, Rabenjanahary, TH, additional, Rakotoarivelo, RA, additional, Rakotozafindrabe, RAL, additional, Zerbib, F, additional, Ramanampamonjy, RM, additional, and Rajaona, RH, additional
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- 2012
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4. Réactions paradoxales sous antituberculeux chez des patients non infectés par le VIH : une difficulté diagnostique et thérapeutique
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Rakotoarivelo, RA., primary, Labourré, G., additional, Wille, H., additional, Michaux, C., additional, Vandenhende, MA., additional, Lacoste, D., additional, Bernard, N., additional, Morlat, P., additional, and Bonnet, F., additional
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- 2011
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5. Tuberculose chez les patients hémodialysés chroniques: à propos de quatre observations
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Randriamanantsoa, LN, primary, Rakotoarivelo, RA, additional, Raharivelina, CA, additional, and Rabenantoandro, R, additional
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- 2011
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6. Large uncomplicated hydropneumopericardium
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Razafimahefa Sh, A.D. Johnson, P. Ramanalimanana, Rakotoarivelo Ra, D. Ranoharison, and S Rakotoarimanana
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,lcsh:R895-920 ,medicine.medical_treatment ,medicine.disease ,Hemothorax ,Pericardial effusion ,Inferior vena cava ,Surgery ,Pericarditis ,medicine.vein ,Pneumothorax ,Pericardiocentesis ,Cardiac tamponade ,medicine ,Radiology, Nuclear Medicine and imaging ,Subcutaneous port ,business - Abstract
A 45-year-old Malagasy man, with a 2-month medical history of chronic pericarditis, presented to the Department of Cardiology at Joseph Raseta Hospital with cardiac tamponade. Pericardiocentesis was performed, with improvement in the patient’s clinical condition, following aspiration of 400 cc of serofibrinous fluid. The control chest X-ray revealed a hydropneumopericardium (Figs 1a and 1b). Following evaluation of the fluid, tuberculosis treatment was started with an adjunctive corticosteroid regimen and resultant complete resolution of all cardiac symptoms. The diagnosis of hydropneumopericardium requires the application of Shackelford criteria which include (i) high-pitched tympanic percussion note, (ii) loud metallic splashing sound synchronous with heart sounds, and (iii) characteristic chest X-ray with an air-fluid level in the pericardial cavity. 1 Traumatic origins of hydropneumopericardium are more common than non-traumatic causes. Non-traumatic causes of hydropneumopericardium include asthma, gastro-pericardic fistula complicating gastric pathology, and infectious disease from illnesses such as pericarditis and pneumonia. Traumatic causes are many and varied, including chest trauma (11%) and iatrogenic causes (74%), particularly those arising after mechanical ventilation, cardiac surgery, and pace-maker implantation. 2
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- 2010
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7. Drivers of COVID-19 vaccine uptake among rural populations in Madagascar: a cross-sectional study.
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Kislaya I, Andrianarimanana DK, Marchese V, Hosay L, Rivomalala R, Holinirina R, Rasamoelina T, Zafinimampera AOT, Ratefiarisoa S, Totofotsy O, Rakotomalala R, Rausche P, Doumbia CO, Guth A, Pavoncello V, Veilleux S, Randriamanantany ZA, May J, Puradiredja DI, Rakotoarivelo RA, and Fusco D
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- Humans, Madagascar, Cross-Sectional Studies, Adult, Male, Female, Middle Aged, Young Adult, Adolescent, Aged, Vaccination Hesitancy statistics & numerical data, Vaccination Hesitancy psychology, SARS-CoV-2, COVID-19 Vaccines administration & dosage, COVID-19 prevention & control, Rural Population statistics & numerical data
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Background: The WHO set the global immunisation threshold for COVID-19 at 70% to achieve worldwide protection against the disease. To date, global COVID-19 vaccine coverage is still below this threshold, in particular in several sub-Saharan African (SSA) countries, such as Madagascar. While factors influencing COVID-19 vaccine hesitancy have been widely explored in the past few years, research on drivers of COVID-19 vaccine uptake remains scarce. This study aimed at investigating drivers associated with COVID-19 vaccine uptake in the Boeny region of Madagascar., Methods: The study used a cross-sectional survey design to collect data on drivers of vaccine uptake from a sample of adults recruited from 12 healthcare facilities between November 2022 and February 2023. Relative and absolute frequencies were used to summarize participants' characteristics. Prevalence ratios were estimated by Poisson regression to identify and compare sociodemographic and motivational drivers of vaccine uptake among those who were willing to get vaccinated against COVID-19 with those who had already been vaccinated., Results: A total of 928 participants aged between 18 and 76 years were included in the study. Among those recruited, 44.9% (n = 417) had already been vaccinated and 55.1% (n = 511) were willing to receive their first dose of COVID-19 vaccine on the day of the interview. The proportions of those respondents who live in urban areas (56.5% vs. 43.8%) and who have high school or university education (46.6% vs. 35.8%) were higher for the uptake group, whereas the proportion of employed respondents (66.3% vs. 56.5%) was higher among those willing to get vaccinated. Vaccine being free of charge (aPR = 1.77 [CI 95%: 1.45-2.17]) and being able to travel again (aPR = 1.61 [CI 95%: 1.30-1.98]) were the drivers most strongly associated with higher vaccine uptake after adjustment for sociodemographic factors., Conclusions: This study shows that actual COVID-19 vaccine uptake is influenced by a different set of factors than willingness to get vaccinated. Taking this difference in drivers into account can inform more tailored vaccination strategies to increase worldwide coverage., (© 2024. The Author(s).)
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- 2024
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8. Prevalence of Strongyloides stercoralis and other helminths in four districts of Madagascar.
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Scarso S, Rakotoarivelo RA, Hey JC, Rasamoelina T, Razafindrakoto AR, Rasolojaona ZT, Razafindralava NM, Remkes A, Rakotozandrindrainy N, Rasoamanamihaja CF, Schwarz NG, May J, Rakotozandrindrainy R, Marchese V, Formenti F, Perandin F, Tamarozzi F, Mazzi C, Fusco D, and Buonfrate D
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Background: Estimation of prevalence of Strongyloides stercoralis infection is required in endemic areas, in order to identify areas in need of control programmes. Data on prevalence of strongyloidiasis in Madagascar are scant. Aim of this work was to estimate prevalence of S. stercoralis in four districts of Madagascar., Methods: Fecal and serum samples collected in the context of a previous study on schistosomiasis were tested with S. stercoralis real-time PCR and serology, respectively. A multiplex real-time PCR for Ascaris lumbricoides, Ancylostoma duodenalis, Necator americanus, and Trichuris trichiura was done on fecal samples collected in the areas demonstrating higher prevalence of strongyloidiasis. Comparisons between proportions were made using Fisher exact test, with false discovery rate correction used for post-hoc comparisons. A multivariable Firth logistic regression model was used to assess potential risk factors for S. stercoralis infection., Results: Overall, 1775 serum samples were tested, of which 102 of 487 (20.9%) and 104 of 296 (35.2%) were serological-positive in Marovoay and in Vatomandry districts (both coastal areas), respectively, compared to 28 of 496 (5.6%) and 30 of 496 (6.1%) in Tsiroanomandidy and in Ambositra districts (both highlands), respectively (adj. p < 0.001). PCR for S. stercoralis was positive in 15 of 210 (7.1%) and in 11 of 296 (3.7%) samples from Marovoay from Vatomandry, respectively, while was negative for all samples tested in the other two districts. High prevalence of A. lumbricoides (45.9%), hookworm (44.6%) and T. trichiura (32.1%) was found in Vatomandry. In the multivariable analysis, strongyloidiasis was associated with hookworm infection. Hookworm infection was also associated with male sex and lower education level., Conclusions: S. stercoralis prevalence proved higher in coastal areas compared to highlands. Different climatic conditions may explain this distribution, along with previous rounds of anthelminthics distributed in the country, which may have reduced the parasite load in the population. The high prevalence of the other soil-transmitted helminths (STH) in Vatomandry was unexpected, given the good coverage with benzimidazole in control campaigns. Further studies are needed to explore the risk factors for STH and S. stercoralis infections in Madagascar, in order to align with the WHO recommendations., (© 2024. The Author(s).)
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- 2024
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9. Schistosome infection among pregnant women in the rural highlands of Madagascar: A cross-sectional study calling for public health interventions in vulnerable populations.
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Rakotozandrindrainy R, Rakotoarivelo RA, Kislaya I, Marchese V, Rasamoelina T, Solonirina J, Ratiaharison EF, Razafindrakoto R, Razafindralava NM, Rakotozandrindrainy N, Radomanana M, Andrianarivelo MR, Klein P, Lorenz E, Jaeger A, Hoekstra PT, Corstjens PLAM, Schwarz NG, van Dam GJ, May J, and Fusco D
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- Humans, Female, Madagascar epidemiology, Pregnancy, Cross-Sectional Studies, Adult, Young Adult, Adolescent, Middle Aged, Prevalence, Public Health, Prenatal Care, Rural Population, Schistosomiasis epidemiology, Schistosomiasis drug therapy, Schistosomiasis prevention & control, Vulnerable Populations, Pregnancy Complications, Parasitic epidemiology, Pregnancy Complications, Parasitic prevention & control, Pregnancy Complications, Parasitic drug therapy
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Introduction: Schistosomiasis is a parasitic infection highly prevalent in sub-Saharan Africa (SSA) with Madagascar being among the countries with highest burden of the disease worldwide. Despite WHO recommendations, suggesting treatment of pregnant women after the first trimester, this group is still excluded from Mass Drug Administration programs. Our study, had the objective to measure the prevalence of schistosome infection among pregnant women in Madagascar in order to inform public health policies for treatment in this vulnerable population., Methods: Women were recruited for this cross-sectional study between April 2019 and February 2020 when attending Antenatal Care Services (ANCs) at one of 42 included Primary Health Care Centers. The urine-based upconverting reporter particle, lateral flow (UCP-LF) test detecting circulating anodic antigen was used for the detection of schistosome infections. To identify factors associated with the prevalence of schistosome infection crude and adjusted prevalence ratios and 95% CIs were estimated using mixed-effect Poisson regression., Results: Among 4,448 participating women aged between 16 and 47 years, the majority (70.4%, 38 n = 3,133) resided in rural settings. Overall, the prevalence of schistosome infection was 55.9% (n = 2486, CI 95%: 53.3-58.5). A statistically significant association was found with age group (increased prevalence in 31-47 years old, compared to 16-20 years old (aPR = 1.15, CI 95%: 1.02-1.29) and with uptake of antimalaria preventive treatment (decreased prevalence, aPR = 0.85, CI 95%: 0.77-0.95). No other associations of any personal characteristics or contextual factors with schistosome infection were found in our multivariate regression analysis., Discussion and Conclusion: The high prevalence of schistosome infection in pregnant women supports the consideration of preventive schistosomiasis treatment in ANCs of the Malagasy highlands. We strongly advocate for adapting schistosomiasis programs in highly endemic contexts. This, would contribute to both the WHO and SDGs agendas overall to improving the well-being of women and consequently breaking the vicious cycle of poverty perpetuated by schistosomiasis., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Rakotozandrindrainy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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10. Call for action: addressing the alarming surge of HIV in Madagascar.
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Andrianarimanana-Köcher D, Rakotoarivelo RA, Randria MJD, Raberahona M, Ratefiharimanana A, Andriamasy EH, Vallès X, Benski AC, Emmrich JV, Walsh A, Robinson K, and Muller N
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- Humans, Madagascar epidemiology, Risk Factors, HIV Infections epidemiology, HIV Infections prevention & control
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Competing Interests: Competing interests: None declared.
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- 2024
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11. A retrospective cohort analysis of people living with HIV/AIDS enrolled in HIV care at a reference center in Antananarivo, Madagascar.
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Raberahona M, Rakotomalala R, Andriananja V, Andriamamonjisoa J, Rakotomijoro E, Andrianasolo RL, Rakotoarivelo RA, and Randria MJD
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- Humans, Male, Adult, Female, Retrospective Studies, Madagascar epidemiology, CD4 Lymphocyte Count, Cohort Studies, Acquired Immunodeficiency Syndrome, HIV Infections drug therapy
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Background: The impact of the "Treat all" policy on the individual and in terms of public health is closely related to early diagnosis and retention in care. Patient-level data are scarce in Madagascar. In this study, we aimed to describe the profile of a cohort of newly diagnosed people living with HIV/AIDS (PLHIV), identify their outcomes, and assess factors associated with attrition from care and advanced HIV disease (AHD) at presentation., Methods: We conducted a retrospective cohort study of PLHIV aged ≥15 years newly diagnosed at the University Hospital Joseph Raseta Befelatanana Antananarivo from 1 January 2010 to 31 December 2016., Results: A total of 490 PLHIV were included in the cohort analysis. In total, 67.1% were male. The median age (interquartile range) at enrollment in care was 29 years (24-38). Overall, 36.1% of PLHIV were diagnosed with AHD at baseline. The proportion of patients with WHO stage IV at baseline increased significantly from 3.3% in 2010 to 31% in 2016 ( p = 0.001 for trend). The probability of retention in care after the diagnosis at 12 months, 24 months, and 36 months was 71.8%, 65.5%, and 61.3%, respectively. Age ≥ 40 years (aHR: 1.55; 95% CI: 1.05-2.29; p = 0.026), low level of education (aHR:1.62; 95% CI: 1.11-2.36; p = 0,013), unspecified level of education (aHR:2.18; 95% CI: 1.37-3.47; p = 0.001) and unemployment (aHR:1.52; 95% CI: 1.07-2.16; p = 0.019) were independently associated with attrition from care. Factors associated with AHD at baseline were age ≥ 40 (aOR: 2.77; 95% CI: 1.38-5.57, p = 0.004), unspecified level of education (aOR: 3.80; 95% CI: 1.58-9.16, p = 0.003) and presence of clinical symptoms at baseline (aOR: 23.81; 95% CI: 10.7-52.98; p < 0.001). Sex workers were independently less likely to have an AHD at presentation (aOR: 0.23; 95% CI: 0.05-0.96, p = 0.044)., Conclusion: Sociodemographic determinants influenced retention in care more than clinical factors. The presence of clinical symptoms and sociodemographic determinants were the main factors associated with AHD at baseline., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Raberahona, Rakotomalala, Andriananja, Andriamamonjisoa, Rakotomijoro, Andrianasolo, Rakotoarivelo and Randria.)
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- 2024
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12. An extensive arterial thrombosis with lower limb ischemia in a COVID-19 patient: A case report.
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Andriamizanaka JA, Rakotomijoro E, Andriananja V, Raberahona M, Andrianasolo RL, Rakotoarivelo RA, and de Dieu Randria Mamy J
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The coronavirus disease 2019 (COVID-19) pandemic is responsible for huge morbidity and mortality throughout the world. Several serious complications of this disease have been reported. It can cause hypercoagulability, which may lead to venous and arterial thromboembolic diseases. This hypercoagulability state is also associated with high morbidity and mortality. Arterial thrombosis in COVID-19 is poorly described compared to venous thrombosis and pulmonary embolism. We report a case of an extensive arterial thrombosis leading to a limb ischemia with extremely high D-dimer in a COVID-19 patient. A 69-year-old man was hospitalized for febrile dyspnea. He is a hypertensive and diabetic patient. On admission, pulse oxygen saturation was 72% on room air. He had cyanosis of the left foot up to the mid-thigh. The left pedal, posterior tibial, popliteal and femoral pulses were abolished. Chest CT scan was in favor of COVID-19. He has a high D-dimer level of 257,344 ng/mL. Arterial Echo-Doppler found an extensive intraluminal thrombus along the arterial axes of the left lower limb, completely obstructing them, starting from the primitive iliac artery just after its bifurcation with the aorta, and extending distally (external iliac; common femoral; superficial femoral; popliteal; anterior tibial; posterior tibial; fibular and pedal). The patient was diagnosed with COVID-19 critical form, associated with ischemia of the left lower limb secondary to an extensive arterial thrombosis. He was receiving anticoagulation, and underwent surgical amputation of the ischemic limb. The patient survived the event; however, he was on long-term oxygen therapy at home. Arterial thrombosis may occur during COVID-19 and may be responsible for peripheral or central ischemia aggravating morbidity and mortality. The occurrence of these events is related to the D-dimer value. Anticoagulation is an important part of the management of COVID-19, especially in severe forms in order to limit the occurrence of these thromboembolic diseases., Competing Interests: None of the authors declare any conflict of interest., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)
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- 2023
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13. Awareness and knowledge of female genital schistosomiasis in a population with high endemicity: a cross-sectional study in Madagascar.
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Rausche P, Rakotoarivelo RA, Rakotozandrindrainy R, Rakotomalala RS, Ratefiarisoa S, Rasamoelina T, Kutz JM, Jaeger A, Hoeppner Y, Lorenz E, May J, Puradiredja DI, and Fusco D
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Introduction: Female genital schistosomiasis (FGS) is a neglected disease with long-term physical and psychosocial consequences, affecting approximately 50 million women worldwide and generally representing an unmet medical need on a global scale. FGS is the chronic manifestation of a persistent infection with Schistosoma haematobium . FGS services are not routinely offered in endemic settings with a small percentage of women at risk receiving adequate care. Madagascar has over 60% prevalence of FGS and no guidelines for the management of the disease. This study aimed to determine FGS knowledge among women and health care workers (HCWs) in a highly endemic area of Madagascar., Methods: A convenience sampling strategy was used for this cross-sectional study. Descriptive statistics including proportions and 95% confidence intervals (CI) were calculated, reporting socio-demographic characteristics of the population. Knowledge sources were evaluated descriptively. Binary Poisson regression with robust standard errors was performed; crude (CPR) and adjusted prevalence ratio (APR) with 95% CIs were calculated., Results: A total of 783 participants were included in the study. Among women, 11.3% ( n = 78) were aware of FGS while among the HCWs 53.8% ( n = 50) were aware of FGS. The highest level of knowledge was observed among women in an urban setting [24%, ( n = 31)] and among those with a university education/vocational training [23% ( n = 13)]. A lower APR of FGS knowledge was observed in peri-urban [APR 0.25 (95% CI: 0.15; 0.45)] and rural [APR 0.37 (95% CI 0.22; 0.63)] settings in comparison to the urban setting. Most HCWs reported other HCWs [40% ( n = 20)] while women mainly reported their family [32% ( n = 25)] as being their main source of information in the 6 months prior to the survey., Discussion and Conclusions: Our study shows limited awareness and knowledge of FGS among population groups in the highly endemic Boeny region of Madagascar. With this study we contribute to identifying an important health gap in Madagascar, which relates to a disease that can silently affect millions of women worldwide. In alignment with the targets of the NTD roadmap, addressing schistosomiasis requires a paradigm shift for its control and management including a greater focus on chronic forms of the disease., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Rausche, Rakotoarivelo, Rakotozandrindrainy, Rakotomalala, Ratefiarisoa, Rasamoelina, Kutz, Jaeger, Hoeppner, Lorenz, May, Puradiredja and Fusco.)
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- 2023
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14. Female genital schistosomiasis, human papilloma virus infection, and cervical cancer in rural Madagascar: a cross sectional study.
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Kutz JM, Rausche P, Rasamoelina T, Ratefiarisoa S, Razafindrakoto R, Klein P, Jaeger A, Rakotomalala RS, Rakotomalala Z, Randrianasolo BS, McKay-Chopin S, May J, Rakotozandrindrainy R, Puradiredja DI, Sicuri E, Hampl M, Lorenz E, Gheit T, Rakotoarivelo RA, and Fusco D
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- Pregnancy, Humans, Female, Cross-Sectional Studies, Human Papillomavirus Viruses, Madagascar epidemiology, Genitalia, Female, Uterine Cervical Neoplasms epidemiology, Papillomavirus Infections epidemiology
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Background: Women's health in resource-limited settings can benefit from the integrated management of high-burden diseases, such as female genital schistosomiasis (FGS) and human papilloma virus (HPV)-related cervical cancer. In schistosomiasis-endemic countries such as Madagascar, data on FGS and HPV prevalence are lacking as well as preventive measures for both conditions. This study aims to estimate the prevalence of FGS and HPV in rural Madagascar, and to examine associated risk factors to identify opportunities for improving women's health., Methods: After initial community outreach activities, interested women aged 18-49 years were recruited consecutively in 2021 at three primary health care centers in the district of Marovoay. FGS was detected by colposcopy. Colposcopy images were double-blind reviewed by two independent specialists. A Luminex bead-based assay was performed on cervical vaginal lavage specimens for HPV typing. Crude (CPR) and adjusted prevalence ratios (APR) of associations between selected factors and FGS and HPV positivity were estimated using univariable and multivariable binary Poisson regression with 95% confidence intervals (CIs)., Results: Among 500 women enrolled, 302 had complete information on FGS and HPV diagnosis, and were thus eligible for analysis. Within the sample, 189 (62.6%, 95% CI: 56.9-68.1) cases of FGS were detected. A total of 129 women (42.7%, 95% CI: 37.1-48.5) tested positive for HPV. In total, 80 women (26.5%, 95% CI: 21.6-31.8]) tested positive for both conditions. No association was observed between FGS and HPV positivity, while previous pregnancy (APR = 0.65, 95% CI: 0.43-0.78) and older age (APR = 0.59, 95% CI: 0.42-0.81) are showing a negative association with HPV infection compared to no previous pregnancy and younger age groups., Conclusions: The results of the study show that FGS and HPV are highly prevalent in rural Madagascar. The concurrent prevalence of these two conditions requires urgent adaptations of public health strategies to improve women's health, such as integrated services at primary level of care., (© 2023. National Institute of Parasitic Diseases.)
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- 2023
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15. Schistosomiasis elimination in Madagascar: challenges and opportunities for implementing the new WHO guidelines.
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Rasoamanamihaja CF, Rakotoarivelo RA, Edosoa G, Rasamoelina T, Montresor A, Marchese V, and Fusco D
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- Humans, Madagascar epidemiology, Public Health, Global Health, World Health Organization, Schistosomiasis epidemiology, Schistosomiasis prevention & control
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Madagascar is one of the countries with the highest burden of schistosomiasis worldwide. The release from the WHO of the new 2021-2030 neglected tropical disease (NTD) roadmap alongside with the schistosomiasis guidelines sets the ambitious goal of eliminating schistosomiasis as a public health problem worldwide. In Madagascar, implementation barriers exist. This paper has the objective of identifying strengths, weaknesses, opportunities and threats in order to build on their basis practices and policies that can help the country to align with the international global health agenda and reach the ambitious goal set by the WHO., Competing Interests: Competing interests: None declared., (© World Health Organization 2023. Licensee BMJ.)
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- 2023
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16. Prevalence and risk distribution of schistosomiasis among adults in Madagascar: a cross-sectional study.
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Gruninger SK, Rasamoelina T, Rakotoarivelo RA, Razafindrakoto AR, Rasolojaona ZT, Rakotozafy RM, Soloniaina PR, Rakotozandrindrainy N, Rausche P, Doumbia CO, Jaeger A, Zerbo A, von Thien H, Klein P, van Dam G, Tannich E, Schwarz NG, Lorenz E, May J, Rakotozandrindrainy R, and Fusco D
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- Adult, Animals, Humans, Male, Cross-Sectional Studies, Madagascar epidemiology, Prevalence, Schistosoma haematobium, Schistosoma mansoni, Risk Factors, Young Adult, Middle Aged, Sex Factors, Agriculture statistics & numerical data, Coinfection epidemiology, Coinfection parasitology, Schistosomiasis haematobia complications, Schistosomiasis haematobia epidemiology, Schistosomiasis haematobia prevention & control, Schistosomiasis mansoni complications, Schistosomiasis mansoni epidemiology, Schistosomiasis mansoni prevention & control
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Background: The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for sustainable development goals, including universal health coverage (UHC). Current control strategies focus on school-aged children, systematically neglecting adults. We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC., Methods: In a cross-sectional study performed between March 2020 and January 2021 at three primary health care centers in Andina, Tsiroanomandidy and Ankazomborona in Madagascar, we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1482 adult participants. Univariable and multivariable logistic regression were performed to evaluate odd ratios., Results: The highest prevalence of S. mansoni, S. haematobium and co-infection of both species was 59.5%, 61.3% and 3.3%, in Andina and Ankazomborona respectively. Higher prevalence was observed among males (52.4%) and main contributors to the family income (68.1%). Not working as a farmer and higher age were found to be protective factors for infection., Conclusions: Our findings provide evidence that adults are a high-risk group for schistosomiasis. Our data suggests that, for ensuring basic health as a human right, current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific, holistic and integrated approaches., (© 2023. The Author(s).)
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- 2023
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17. Intensified tuberculosis treatment to reduce the mortality of HIV-infected and uninfected patients with tuberculosis meningitis (INTENSE-TBM): study protocol for a phase III randomized controlled trial.
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Maitre T, Bonnet M, Calmy A, Raberahona M, Rakotoarivelo RA, Rakotosamimanana N, Ambrosioni J, Miró JM, Debeaudrap P, Muzoora C, Davis A, Meintjes G, Wasserman S, Wilkinson R, Eholié S, Nogbou FE, Calvo-Cortes MC, Chazallon C, Machault V, Anglaret X, and Bonnet F
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- Adult, Adolescent, Humans, Rifampin, Aspirin therapeutic use, South Africa epidemiology, Antitubercular Agents adverse effects, Randomized Controlled Trials as Topic, Multicenter Studies as Topic, Clinical Trials, Phase III as Topic, Tuberculosis, Meningeal diagnosis, Tuberculosis, Meningeal drug therapy, HIV Infections complications, HIV Infections diagnosis, HIV Infections drug therapy
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Background: Tuberculous meningitis (TBM) is the most lethal and disabling form of tuberculosis (TB), particularly in sub-Saharan Africa. Current anti-TB treatment is poorly effective since TBM mortality reaches 40% in HIV-negative patients and up to 70% in HIV-co-infected patients. To reduce TBM-induced morbidity and mortality, the INTENSE-TBM trial evaluates two interventions in both HIV-infected and uninfected patients: an anti-TB treatment intensification using oral high-dose rifampicin (35 mg/kg daily) and linezolid (1200 mg daily and then 600 mg daily) during the first 8 weeks of the anti-TB treatment and the use of adjunctive aspirin (200 mg daily)., Methods: This is a randomized controlled, phase III, multicenter, 2 × 2 factorial plan superiority trial. The trial has four arms, combining the two experimental treatments (intensified TBM regimen and aspirin) with the two reference treatments (WHO standard TB treatment and placebo), and is open-label for anti-TB treatment and double-blind placebo-controlled for aspirin treatment. This trial is conducted in adults or adolescents of age ≥15 years with TBM defined as "definite," "probable," or "possible" using Tuberculosis Meningitis International Research Consortium criteria, in four African countries: Ivory Coast, Madagascar, Uganda, and South Africa. The primary outcome is all-cause death between inclusion and week 40., Discussion: The INTENSE-TBM trial represents a key opportunity to enhance TBM treatment with widely available existing drugs notably in high-incidence settings of both TB and HIV. The trial design is pragmatic and the results will permit early and effective applications in TBM patient care, in both HIV and TB high-incidence countries., Trial Registration: ClinicalTrials.gov NCT04145258. Registered on October 30, 2019., (© 2022. The Author(s).)
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- 2022
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18. High seroprevalence of SARS-CoV-2 in Burkina-Faso, Ghana and Madagascar in 2021: a population-based study.
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Struck NS, Lorenz E, Deschermeier C, Eibach D, Kettenbeil J, Loag W, Brieger SA, Ginsbach AM, Obirikorang C, Maiga-Ascofare O, Sarkodie YA, Boham EEA, Adu EA, Asare G, Amoako-Adusei A, Yawson A, Boakye AO, Deke J, Almoustapha NS, Adu-Amoah L, Duah IK, Ouedraogo TA, Boudo V, Rushton B, Ehmen C, Fusco D, Gunga L, Benke D, Höppner Y, Rasolojaona ZT, Rasamoelina T, Rakotoarivelo RA, Rakotozandrindrainy R, Coulibaly B, Sié A, Awuah AA, Amuasi JH, Souares A, and May J
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- Antibodies, Viral, Bayes Theorem, Burkina Faso epidemiology, Ghana epidemiology, Humans, Madagascar epidemiology, Pandemics, Seroepidemiologic Studies, COVID-19 epidemiology, SARS-CoV-2
- Abstract
Background: The current COVID-19 pandemic affects the entire world population and has serious health, economic and social consequences. Assessing the prevalence of COVID-19 through population-based serological surveys is essential to monitor the progression of the epidemic, especially in African countries where the extent of SARS-CoV-2 spread remains unclear., Methods: A two-stage cluster population-based SARS-CoV-2 seroprevalence survey was conducted in Bobo-Dioulasso and in Ouagadougou, Burkina Faso, Fianarantsoa, Madagascar and Kumasi, Ghana between February and June 2021. IgG seropositivity was determined in 2,163 households with a specificity improved SARS-CoV-2 Enzyme-linked Immunosorbent Assay. Population seroprevalence was evaluated using a Bayesian logistic regression model that accounted for test performance and age, sex and neighbourhood of the participants., Results: Seroprevalence adjusted for test performance and population characteristics were 55.7% [95% Credible Interval (CrI) 49·0; 62·8] in Bobo-Dioulasso, 37·4% [95% CrI 31·3; 43·5] in Ouagadougou, 41·5% [95% CrI 36·5; 47·2] in Fianarantsoa, and 41·2% [95% CrI 34·5; 49·0] in Kumasi. Within the study population, less than 6% of participants performed a test for acute SARS-CoV-2 infection since the onset of the pandemic., Conclusions: High exposure to SARS-CoV-2 was found in the surveyed regions albeit below the herd immunity threshold and with a low rate of previous testing for acute infections. Despite the high seroprevalence in our study population, the duration of protection from naturally acquired immunity remains unclear and new virus variants continue to emerge. This highlights the importance of vaccine deployment and continued preventive measures to protect the population at risk., (© 2022. The Author(s).)
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- 2022
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19. Giant compressive emphysema: a rare complication of COVID-19.
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Rakotoson J, Andriamamonjisoa JA, Andriamihary MNO, Ratsimbazafy SJN, Randrianarimalala RD, Rakotoarivelo RA, and Ralandison S
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- Adult, Humans, Male, Pandemics, SARS-CoV-2, COVID-19, Mediastinal Emphysema, Subcutaneous Emphysema
- Abstract
Background: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a new ribonucleic acid (RNA) beta-coronavirus, responsible for a worldwide pandemic. Very few cases of SARS-COV-2-related emphysema have been described, except among patients with chronic obstructive pulmonary disease. The thoracic CT scan is the key examination for the diagnosis and allows to evaluate the severity of the pulmonary involvement. The prognosis of the patient with giant emphysema (GE) on coronavirus disease 2019 (COVID-19) in critical or severe form remains poor. We report an original case of COVID-19 pneumonia, critical form, complicated by a giant compressive left emphysema of 22.4 cm in a young subject without respiratory comorbidities., Case Presentation: A 34-year-old man was hospitalized for left laterothoracic pain. He had no prior medical history. The physical examination revealed tympany on percussion of the left lung. The CT scan confirmed COVID-19 pneumonia with 95% lung involvement. Also, the presence of a voluminous left sub pleural emphysema of 22.4 cm with compression of the ipsilateral pulmonary parenchyma as well as the mediastinal structures towards the right side. The diagnosis COVID-19 pneumonia, critical form, complicated by a compressive left giant emphysema was made. He was put on oxygen, a dual antibiotic therapy, a corticotherapy, and curative doses of enoxaparin. A thoracic drainage surgery was performed at 24th day of hospitalization, which confirmed the giant emphysema. The patient remains on long-term oxygen therapy., Conclusion: The COVID-19 has polymorphic manifestations, pneumonia is the most important one. There are relatively few reports associating COVID-19 and emphysema; furthermore, reports associating COVID-19 and giant emphysema are extremely scarce. CT scans can confirm the diagnosis and differentiate it from a pneumothorax. The pulmonary prognosis of the association of COVID-19 in its severe or critical form with giant emphysema remains poor., (© 2021. The Author(s).)
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- 2021
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20. A cluster randomized controlled trial for assessing POC-CCA test based praziquantel treatment for schistosomiasis control in pregnant women and their young children: study protocol of the freeBILy clinical trial in Madagascar.
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Fusco D, Rakotozandrindrainy R, Rakotoarivelo RA, Andrianarivelo MR, Rakotozandrindrainy N, Rasamoelina T, Puradiredja DI, Klein P, Stahlberg K, Dechenaud M, Lorenz E, Jaeger A, Kreidenweiss A, Hoekstra PT, Adegnika AA, Sicuri E, Corstjens PLAM, van Dam GJ, May J, and Schwarz NG
- Subjects
- Antigens, Helminth therapeutic use, Child, Preschool, Clinical Trials, Phase III as Topic, Female, Humans, Madagascar, Praziquantel adverse effects, Pregnancy, Pregnant Women, Randomized Controlled Trials as Topic, Anthelmintics adverse effects, Schistosomiasis diagnosis, Schistosomiasis drug therapy
- Abstract
Background: Mass drug administration (MDA) of praziquantel is one of the main control measures against human schistosomiasis. Although there are claims for including pregnant women, infants and children under the age of 5 years in high-endemic regions in MDA campaigns, they are usually not treated without a diagnosis. Diagnostic tools identifying infections at the primary health care centre (PHCC) level could therefore help to integrate these vulnerable groups into control programmes. freeBILy (fast and reliable easy-to-use-diagnostics for eliminating bilharzia in young children and mothers) is an international consortium focused on implementing and evaluating new schistosomiasis diagnostic strategies. In Madagascar, the study aims to determine the effectiveness of a test-based schistosomiasis treatment (TBST) strategy for pregnant women and their infants and children up until the age of 2 years., Methods: A two-armed, cluster-randomized, controlled phase III trial including 5200 women and their offspring assesses the impact of TBST on child growth and maternal haemoglobin in areas of medium to high endemicity of Schistosoma mansoni. The participants are being tested with the point of care-circulating cathodic antigen (POC-CCA) test, a commercially available urine-based non-invasive rapid diagnostic test for schistosomiasis. In the intervention arm, a POC-CCA-TBST strategy is offered to women during pregnancy and 9 months after delivery, for their infants at 9 months of age. In the control arm, study visit procedures are the same, but without the POC-CCA-TBST procedure. All participants are being offered the POC-CCA-TBST 24 months after delivery. This trial is being integrated into the routine maternal and child primary health care programmes at 40 different PHCC in Madagascar's highlands. The purpose of the trial is to assess the effectiveness of the POC-CCA-TBST for controlling schistosomiasis in young children and mothers., Discussion: This trial assesses a strategy to integrate pregnant women and their children under the age of 2 years into schistosomiasis control programmes using rapid diagnostic tests. It includes local capacity building for clinical trials and large-scale intervention research., Trial Registration: Pan-African Clinical Trial Register PACTR201905784271304. Retrospectively registered on 15 May 2019., (© 2021. The Author(s).)
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- 2021
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21. Clinical and epidemiological features discriminating confirmed COVID-19 patients from SARS-CoV-2 negative patients at screening centres in Madagascar.
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Raberahona M, Rakotomalala R, Rakotomijoro E, Rahaingoalidera T, Andry CE, Mamilaza N, Razafindrabekoto LDE, Rafanomezantsoa E, Andriananja V, Andrianasolo RL, Razafimahefa SH, Rakotoarivelo RA, and Randria MJD
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Early Diagnosis, Female, Humans, Logistic Models, Male, Middle Aged, Young Adult, COVID-19 diagnosis, SARS-CoV-2
- Abstract
Early and fast detection of COVID-19 patients help limit the transmission and wide spread of the virus in the community and will have impact on mortality by reducing the incidence of infection among vulnerable people. Therefore, community-based screening is critical. We aimed to identify clinical signs and symptoms and epidemiological features that could help discriminate confirmed cases of COVID-19 from SARS-CoV-2 negative patients. We found that age (aOR:1.02, 95%CI:1.02-1.03, p < 0.001), symptoms onset between 3 and 14 days (aOR:1.35, 95%CI:1.09)1.68, p = 0.006), fever or history of fever (aOR:1.75, 95%CI:1.42-2.14, p < 0.001), cough (aOR:1.68, 95%CI:1.31-2.04), sore throat (aOR:0.65, 95%CI:0.49-0.85, p = 0.002), ageusia (aOR:2.24, 95%CI:1.42-3.54, p = 0.001), anosmia (aOR:6.04, 95%CI:4.19-8.69, p < 0.001), chest pain (aOR:0.63, 95%CI:0.47-0.85, p = 0.003), myalgia and/or arthralgia (aOR:1.64, 95%CI:1.31-2.04, p < 0.001), household cluster (aOR:1.49, 95%CI:1.17-1.91, p = 0.001) and evidence of confirmed cases in the neighbourhood (aOR:1.92, 95%CI:1.56-2.37, p < 0.001) could help discriminate COVID-19 patients from SARS-CoV-2 negative. A screening score derived from multivariate logistic regression was developed to assess the probability of COVID-19 in patients. We suggest that a patient with a score ≥14 should undergo SARS-CoV-2 PCR testing. A patient with a score ≥30 should be considered at high risk of COVID-19 and should undergo testing but also needs prompt isolation and contact tracing., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2021
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22. Fast and reliable easy-to-use diagnostics for eliminating bilharzia in young children and mothers: An introduction to the freeBILy project.
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Hoekstra PT, Schwarz NG, Adegnika AA, Andrianarivelo MR, Corstjens PLAM, Rakotoarivelo RA, Rakotozandrindrainy R, Sicuri E, Kreidenweiss A, and van Dam GJ
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- Adult, Animals, Antigens, Helminth immunology, Child, Child, Preschool, Female, Humans, Immunologic Tests, Longitudinal Studies, Male, Mothers, Point-of-Care Systems, Pregnancy, Schistosomiasis epidemiology, Sensitivity and Specificity, Anthelmintics therapeutic use, Antigens, Helminth isolation & purification, Praziquantel therapeutic use, Schistosoma isolation & purification, Schistosomiasis drug therapy
- Abstract
Schistosoma antigen detection tests have a large potential for schistosomiasis control programs due to their ability to detect active and ongoing Schistosoma infections, their much higher sensitivity compared to microscopical methods, and the possibility to use non-invasive urine samples. Pregnant women and young children could especially benefit from affordable and easy-to-use antigen tests as inclusion of these vulnerable groups in mass drug administration campaigns will always require higher justification hurdles, especially in low to middle endemic regions with a higher proportion of individuals who are not infected and thus unnecessarily exposed to praziquantel. The overall objective of the 'fast and reliable easy-to-use diagnostics for eliminating bilharzia in young children and mothers' (freeBILy, www.freeBILy.eu) project is to thoroughly evaluate the point-of-care circulating cathodic antigen (POC-CCA) and the up-converting phosphor reporter particle, lateral flow circulating anodic antigen (UCP-LF CAA) urine strip tests to diagnose Schistosoma infections in pregnant women and young children and to assess their potential as a schistosomiasis control tool in test-and-treat strategies. The freeBILy project will generate valuable, evidence-based findings on improved tools and test-and-treat strategies to reduce the burden of schistosomiasis in pregnant women and young children., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2020
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23. Prospective, observational study to assess the performance of CAA measurement as a diagnostic tool for the detection of Schistosoma haematobium infections in pregnant women and their child in Lambaréné, Gabon: study protocol of the freeBILy clinical trial in Gabon.
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Honkpehedji YJ, Adegnika AA, Dejon-Agobe JC, Zinsou JF, Mba RB, Gerstenberg J, Rakotozandrindrainy R, Rakotoarivelo RA, Rasamoelina T, Sicuri E, Schwarz NG, Corstjens PLAM, Hoekstra PT, van Dam GJ, and Kreidenweiss A
- Subjects
- Animals, Anthelmintics therapeutic use, Child, Preschool, Cross-Sectional Studies, Data Accuracy, Female, Follow-Up Studies, Gabon epidemiology, Humans, Infant, Infant, Newborn, Longitudinal Studies, Praziquantel therapeutic use, Pregnancy, Prevalence, Prospective Studies, Real-Time Polymerase Chain Reaction, Schistosoma haematobium genetics, Schistosomiasis haematobia drug therapy, Schistosomiasis haematobia parasitology, Antigens, Helminth analysis, Immunologic Tests methods, Schistosoma haematobium immunology, Schistosomiasis haematobia diagnosis, Schistosomiasis haematobia epidemiology
- Abstract
Background: Schistosoma antigen detection in urine is a valuable diagnostic approach for schistosomiasis control programmes because of the higher sensitivity compared to parasitological methods and preferred sampling of urine over stool. Highly accurate diagnostics are important in low Schistosoma transmission areas. Pregnant women and young children could particularly benefit from antigen testing as praziquantel (PZQ) can be given to only confirmed Schistosoma cases. This prevents the unborn baby from unnecessary exposure to PZQ. We present here the protocol of a diagnostic study that forms part of the freeBILy project. The aim is to evaluate the accuracy of circulating anodic antigen (CAA) detection for diagnosis of Schistosoma haematobium infections in pregnant women and to validate CAA as an endpoint measure for anti-Schistosoma drug efficacy. The study will also investigate Schistosoma infections in infants., Methods: A set of three interlinked prospective, observational studies is conducted in Gabon. The upconverting phosphor lateral flow (UCP-LF) CAA test is the index diagnostic test that will be evaluated. The core trial, sub-study A, comprehensively evaluates the accuracy of the UCP-LF CAA urine test against a set of other Schistosoma diagnostics in a cross-sectional trial design. Women positive for S. haematobium will proceed with sub-study B and will be randomised to receive PZQ treatment immediately or after delivery followed by weekly sample collection. This approach includes comparative monitoring of CAA levels following PZQ intake and will also contribute further data for safety of PZQ administration during pregnancy. Sub-study C is a longitudinal study to determine the incidence of S. haematobium infection as well as the age for first infection in life-time., Discussion: The freeBILy trial in Gabon will generate a comprehensive set of data on the accuracy of the UCP-LF CAA test for the detection of S. haematobium infection in pregnant women and newborn babies and for the use of CAA as a marker to determine PZQ efficacy. Furthermore, incidence of Schistosoma infection in infants will be reported. Using the ultrasensitive diagnostics, this information will be highly relevant for Schistosoma prevalence monitoring by national control programs as well as for the development of medicaments and vaccines., Trial Registration: The registration number of this study is NCT03779347 ( clinicaltrials.gov , date of registration: 19 December 2018).
- Published
- 2020
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24. Epidemiological characteristics of cryptococcal meningoencephalitis associated with Cryptococcus neoformans var. grubii from HIV-infected patients in Madagascar: A cross-sectional study.
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Rakotoarivelo RA, Raberahona M, Rasamoelina T, Rabezanahary A, Rakotomalala FA, Razafinambinintsoa T, Bénet T, Vanhems P, Randria MJD, Romanò L, Cogliati M, Cornet M, and Rakoto Andrianarivelo M
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- Adult, Cross-Sectional Studies, Female, HIV Infections epidemiology, Humans, Madagascar epidemiology, Male, Meningitis, Cryptococcal epidemiology, Middle Aged, Cryptococcus neoformans isolation & purification, HIV Infections complications, Meningitis, Cryptococcal complications, Meningitis, Cryptococcal microbiology
- Abstract
Cryptococcal meningoencephalitis (CM) remains the most prevalent invasive fungal infection worldwide. The main objective of this study was to describe the prevalence of CM and cryptococcal infection in HIV-infected patients in Madagascar. The secondary objectives were to assess the adjusted prevalence of CM according to clinical presentation and patient characteristics, to determine crude 90-day survival according to cryptococcal antigen (CrAg) status and CM, and to identify the genotypes of Cryptococcus clinical isolates. This cross-sectional study was carried out at two urban hospitals in Antananarivo (central highlands) and Toamasina (east coast) between November 2014 and December 2016. Consecutive HIV-infected adults presenting with CD4 cell counts ≤200/μl were enrolled. Lateral flow immunoassays of CrAg were performed on serum for all patients, and on cerebrospinal fluid for patients with CM symptoms. MALDI-ToF MS, ITS sequencing, and determinations of the molecular and mating types of the isolates were performed. Fluconazole is the only drug for CM treatment available in Madagascar. Patients were treated orally, with high doses (1200 mg/day) for 10-12 weeks and then with 200 mg/day. Minimum inhibitory concentrations were determined for amphotericin B, flucytosine, voriconazole and fluconazole in E-tests. Overall prevalence was 13.2% (95% CI 7.9-20.3) for cryptococcal infection and 10.9% (95% CI 6.1-17.5) for CM, among the 129 HIV-infected patients studied. The 90-day mortality rate was 58.8% (10/17) in CrAg-positive patients and 17.9% (20/112) in CrAg-negative patients (p<0.001). The 13 Cryptococcus strains obtained at baseline were all Cryptococcus neoformans var. grubii, genotypes VNI-αA (3 isolates), VNII-αA (4 isolates) or hybrid VNI/VNII-αAAα (6 isolates), suggesting high diversity. Two strains acquired fluconazole resistance after four and five months of exposure, respectively. The prevalence of cryptococcosis is high in Madagascar and this serious condition is life-threatening in HIV-infected patients. These findings will be used to raise the awareness of national authorities to strengthen the national HIV/AIDS control program., Competing Interests: The authors have declared that no competing interests exist.
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- 2020
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25. Needs assessment for a formal emergency medicine residency program in southern Madagascar.
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Mockler G, Rakotoarivelo RA, Ranaivo J, Valenzuela R, Pierson K, Calix D, and Mallon W
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Introduction: World Health Organization data for Madagascar reveal that the nation's under age five mortality rate is 56/1000, and that its maternal mortality rate is 440/100,000. Malaria, leprosy, plague, and tuberculosis remain significant communicable disease threats. Malnutrition rates are improving but continue to impact negatively on the general health of the Malagasy population, especially in the southern region with its 1.9 million inhabitants. There are no emergency medicine (EM) training programs to serve the southern half of Madagascar, which has a large urban population in Fianarantsoa. This study aimed to assess the need for and potential feasibility of an emergency medicine training program in southern Madagascar., Methods: We met with the institutional leadership on site at the university hospital in Fianarantsoa. A needs assessment was performed on multiple domains. Domain 1: existing hospital infrastructure and its physical plant and emergency centre (EC) space allotment. Domain 2: existing clinical and technological resources. Domain 3: educational resources and the existing curriculum for EM. Domain 4: medical student educational program and availability of prospective residency candidates. Domain 5: pre-hospital care and emergency medical services., Results: The size of the EC is adequate for the current census. Clinical resources are typical of many developing countries, with significant need for technological advancement and support, which we delineate in the body of our paper. There is an existing curriculum in Antananarivo and in Majanga, as well as one available through the African Federation for Emergency Medicine. The medical school in the area is relatively new, with graduating classes numbering approximately 30. There is no organised pre-hospital care system, no 9-1-1 equivalent, and no pre-hospital treatment from within metropolitan Fianarantsoa., Conclusions: While the needs assessment indicates substantial need for emergency medicine development in southern Madagascar, the yield (particularly for the metropolitan Fianarantsoa area) would serve the population well., Competing Interests: The authors have no conflicts of interest to declare.
- Published
- 2019
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26. Knowledge, attitudes, perception and practices regarding antiretroviral therapy among HIV-infected adults in Antananarivo, Madagascar: a cross-sectional survey.
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Raberahona M, Lidamahasolo Z, Andriamamonjisoa J, Andriananja V, Andrianasolo RL, Rakotoarivelo RA, and Randria MJD
- Subjects
- Adult, Cross-Sectional Studies, Female, HIV Infections psychology, Humans, Madagascar, Male, Medication Adherence statistics & numerical data, Perception, Sexual Behavior, Social Stigma, Surveys and Questionnaires, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, Health Knowledge, Attitudes, Practice
- Abstract
Background: Adherence to antiretroviral therapy (ART) may be influenced by knowledge, perception and perception regarding ART. The purpose of this study was to assess knowledge, attitude/perception and practice regarding ART among people living with HIV/AIDS (PLHIV)., Methods: We conducted a cross-sectional survey to assess knowledge, attitudes, perception and practices ART in PLHIV. The survey was suggested to all PLHIV of at least 18 years old and who were on ART for at least 1 month. PLHIV who were unable to answer questions correctly and those who did not complete the survey for any reason were excluded., Results: During the study period, 234 PLHIV were included. Participants were mostly men (75.2%). The median age was 33 years (IQR: 27-41). The median time since HIV diagnosis was 25 months (IQR: 9-56) and the median duration of ART was 18 months (IQR: 8-48). 87.6% had an overall good knowledge of ART. However, only 3.2% knew the name of their ART, 31.2% were aware that ART should be taken at a fixed time and 17.1% knew how to take ART in relation to food intake. 75.6% of participants had an overall positive attitude/perception of ART. However, 10.7% were convinced that other methods were more effective than ART for treating HIV and 42.7% thought that taking ART was shameful. The assessment of practices showed that in case of missed dose, 48.3% of participants routinely skipped this dose instead of trying to take it as soon as possible. In multivariate analysis, good knowledge of ART was independently associated with high level of education (aOR: 4.7, IC95%: 1.6-13.7, p = 0.004) and disclosure of HIV status (aOR: 2.7, IC95%: 1.1-6.6, p = 0.029)., Conclusions: This study showed an overall good knowledge and a predominantly positive attitude/perception of ART. However, accurate knowledge of ART intake was insufficient and the stigma associated with taking ART remained very present. Furthermore, very heterogeneous practices may reflect lack of instruction given by the physician regarding ART intake.
- Published
- 2019
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27. Hydrophobia of human rabies.
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Tongavelona JR, Rakotoarivelo RA, and Andriamandimby FS
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Hydrophobia is a clinical sign characteristic of human rabies. This sign occurs following paroxysmal contractions of pharynx responsible for hydrophobic spasms.
- Published
- 2018
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28. Hospitalization of HIV positive patients in a referral tertiary care hospital in Antananarivo Madagascar, 2010-2016: Trends, causes and outcome.
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Raberahona M, Razafinambinintsoa T, Andriananja V, Ravololomanana N, Tongavelona J, Rakotomalala R, Andriamamonjisoa J, Andrianasolo RL, Rakotoarivelo RA, and Randria MJD
- Subjects
- Adult, CD4 Lymphocyte Count, Female, HIV Infections mortality, HIV Infections therapy, Humans, Madagascar epidemiology, Male, Middle Aged, Retrospective Studies, Treatment Outcome, HIV Infections epidemiology, Hospitalization statistics & numerical data, Tertiary Care Centers statistics & numerical data
- Abstract
Background: During the last few years, significant efforts have been made to improve access to antiretroviral therapy which led to dramatic reduction in AIDS-related events and mortality in HIV positive patients at the global level. However, current data in Africa suggested modest impact of widespread antiretroviral therapy scale-up especially regarding HIV-related hospitalization. In this study, we aimed to describe causes of hospitalization and factors associated with AIDS-defining events and inpatient mortality., Materials and Methods: A retrospective study was performed on medical records of HIV positive patients admitted for at least 24 hours in the Infectious Diseases Unit of the University Hospital Joseph Raseta Befelatanana Antananarivo. Cause of hospitalization was considered as the main diagnosis related to the symptoms at admission. Diagnostic criteria were based on criteria described in WHO guidelines. AIDS-defining events were defined as diseases corresponding to WHO stage 4 or category C of CDC classification., Results: From 2010 to 2016, 236 hospital admissions were included. AIDS-defining events were the most frequent cause of hospitalization (61.9%) with an increasing trend during the study period. Tuberculosis (28.4%), pneumocystis pneumonia (11.4%), cerebral toxoplasmosis (7.2%) and cryptococcosis (5.5%) were the most frequent AIDS-defining events. Tuberculosis was also the most frequent cause of overall hospitalization. In multivariate analysis, recent HIV diagnosis (aOR = 2.0, 95% CI: 1.0-3.9), CD4<200 cells/μl (aOR = 4.0, 95%CI: 1.9-8.1), persistent fever (aOR = 4.4, 95%CI: 2.1-9.0), duration of symptoms≥ 6 weeks (aOR = 2.6, 95%CI: 1.2-5.4) were associated with AIDS-defining events. Overall inpatient mortality was 19.5%. Age≥55 years (aOR = 4.9, 95%CI: 1.5-16.6), neurological signs (aOR = 3.2, 95%CI: 1.5-6.9) and AIDS-defining events (aOR = 2.9, 95%CI: 1.2--7.2) were associated with inpatient mortality., Conclusions: AIDS-defining events were the most frequent cause of hospitalization during the study period. Factors associated with AIDS-defining events mostly reflected delay in HIV diagnosis. Factors associated with mortality were advanced age, neurological signs and AIDS-defining events., Competing Interests: The authors have declared that no competing interests exist.
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- 2018
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29. Cytokine Biomarkers Associated with Human Extra-Pulmonary Tuberculosis Clinical Strains and Symptoms.
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Ranaivomanana P, Raberahona M, Rabarioelina S, Borella Y, Machado A, Randria MJD, Rakotoarivelo RA, Rasolofo V, and Rakotosamimanana N
- Abstract
Background: The primary site of infection for Mycobacterium tuberculosis ( Mtb ) is the alveolar macrophages. However, Mtb can disseminate into other organs and causes extrapulmonary tuberculosis (EPTB). The diagnosis of EPTB is challenging due to relatively inaccessible infectious sites that may be paucibacillary and with clinical symptoms varying by site that are similar to those seen in other diseases. Hence, we sought to identify the expression patterns of a variety of cytokines that may be specific to EPTB from in vitro infections and in the plasma of TB patients. Methods: To define those cytokine secretions associated with EPTB, human THP-1 derived macrophages were first infected with Mtb clinical isolates from pulmonary and EPTB. Infected macrophages supernatants were harvested at different time points and cytokines known to play key roles in TB immune responses including TNF-α, IL-6, IL-10, IFN-γ, and VEGF-A were measured by ELISA. Those cytokines that were in vitro associated to EPTB were also measured in the plasma from patients with PTB, EPTB, non-EPTB-confirmed-like symptoms and healthy controls. Results: While all of the studied cytokine secretions varied after in vitro infection, higher levels of TNF-α and VEGF secretions were observed in vitro in the infected macrophages respectively in the PTB and EPTB infecting clinical isolates. Similar trends were observed from the plasma of patients where patients with PTB showed significantly higher level of TNF-α compared to EPTB and healthy control groups. The patients with EPTB showed higher plasma level of VEGF compared to those patients with the non-EPTB ( p < 0.01) and to healthy controls group ( p < 0.0001). Using Receiver Operating Curves (ROC), we showed that TNF-α and VEGF concentrations could distinguish EPTB from non-confirmed EPTB with high sensitivity and specificity. Conclusion: Pulmonary and extrapulmonary Mtb clinical isolates showed different cytokine induction pattern in human macrophages that is also found in the plasma level of the EPTB patients. Further investigations are needed to define cytokine secretions that can lead to the definition of bio-signatures to differentiate EPTB from other pathologies with confusing symptoms that hampered the diagnosis of TB.
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- 2018
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30. Clinical Features and Outcome in Adult Cases of Tuberculous Meningitis in Tertiary Care Hospital in Antananarivo, Madagascar.
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Raberahona M, Rakotoarivelo RA, Razafinambinintsoa T, Andrianasolo RL, and Randria MJ
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- Adolescent, Adult, Aged, Black People, Female, Humans, Madagascar, Male, Middle Aged, Mycobacterium tuberculosis isolation & purification, Mycobacterium tuberculosis pathogenicity, Retrospective Studies, Risk Factors, Tertiary Care Centers, Tuberculosis, Meningeal cerebrospinal fluid, Tuberculosis, Meningeal microbiology, Delayed Diagnosis, Prognosis, Tuberculosis, Meningeal diagnosis, Tuberculosis, Meningeal epidemiology
- Abstract
Purpose. We aimed to describe and to assess prognosis factors in tuberculous meningitis in adult patients. Methods. We performed a retrospective study of case records of adult patients. Patients classified as definite, probable, or possible tuberculous meningitis according to standardized definition criteria were included and assessed in the study. Results. Seventy-five patients were included in the study. Tuberculous meningitis was classified as definite in 8 (10.7%), probable in 44 (58.7%), and possible in 23 patients (30.6%). HIV was found in 3% of patients. Patients were in advanced stages at admission in 82.7%. Median duration of symptoms prior to admission was 3 weeks (IQR: 2-5). Median time to diagnosis following admission was 5 days (IQR: 3-8). Median CSF WCC was 75 per mm
3 with lymphocytic predominance in 38 cases (52.8%). Median CSF glucose level was 1.48 mmol/L and median CSF protein level was 1 g/L. Mortality rate was 28%. Age ≥ 35 years (aOR: 4.06; 95% CI: 1.16-14.26) and coma (aOR: 12.98; 95% CI: 1.13-149.16) predicted inpatient mortality. Conclusion. Most of the patients experienced more than 3 weeks of diagnostic delay prior to admission. Mortality was high and occurred early after admission. Age and coma were identified as independent prognosis factors.- Published
- 2017
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31. Rapid Fatal Outcome of Cryptococcal Meningoencephalitis in a Non-HIV Immunocompromised Patient with a Low Fluconazole Susceptibility Isolate: A Case Report from Madagascar.
- Author
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Raberahona M, Rakotoarivelo RA, Randriamampionona N, Rakotomalala AF, Razafinambinintsoa T, Bénet T, Vanhems P, Randria MJ, Cornet M, and Rakoto-Andrianarivelo M
- Abstract
Cryptococcal meningoencephalitis is considered rare in HIV-negative individuals. In Madagascar, the epidemiology of cryptococcosis has not yet been well described, neither in immunocompetent nor in immunocompromised patients. We report here the first Malagasy detailed case of cryptococcal meningoencephalitis in a non-HIV immunocompromised adult patient carrying a low fluconazole susceptibility isolate. We emphasize the importance of early and accurate diagnosis to meet the challenges of managing cryptococcosis in developing countries., Competing Interests: The authors have no conflict of interests.
- Published
- 2016
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32. Identification of nasal colonization with β-lactamase-producing Enterobacteriaceae in patients, health care workers and students in Madagascar.
- Author
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Micheel V, Hogan B, Rakotoarivelo RA, Rakotozandrindrainy R, Razafimanatsoa F, Razafindrabe T, Rakotondrainiarivelo JP, Crusius S, Poppert S, Schwarz NG, May J, Frickmann H, and Hagen RM
- Abstract
This study assesses the nasal occurrence of β-lactamase-producing Enterobacteriaceae both in patients in a hospital department of infectious diseases at admission and in healthy Madagascan students and health care workers. Nasal swabs from 681 students, 824 health care workers, and 169 patients were obtained in Antananarivo, Madagascar, and transferred to Germany. Screening for β-lactamase (ESBL, ampC) producing Enterobacteriaceae was performed by cultural and molecular approaches, comprising Brilliance ESBL agar, E-testing, ABCD-testing, and commercial hyplex ESBL and SuperBug ID PCR. Regarding ESBL-positive strains and strains with resistance against at least three out of the four tested bactericidal antibiotic drugs, 0.3% (five out of 1541) of the students and health care workers group showed nasal colonization, whereas colonization was observed in 7.1% (12 out of 169) of the hospitalized patients at admission. No appreciably reduced detection rates after sample storage and intercontinental transport were observed. A considerable proportion of nasal colonization with cephalosporin-resistant Enterobacteriaceae was demonstrated in Madagascan hospital patients at admission, posing a risk of developing future endogenous infections. The nasal colonization of healthy individuals was negligible. Good storage and transport stability of Enterobacteriaceae will allow for future studies even in areas difficult to access.
- Published
- 2015
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33. [Paradoxical reactions induced by antituberculous drugs in non-HIV infected patients: a cases series of four patients and literature review].
- Author
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Rakotoarivelo RA, Vandenhende MA, Michaux C, Morlat P, and Bonnet F
- Subjects
- Adult, Female, Glucocorticoids therapeutic use, Humans, Hypercalcemia chemically induced, Lymphadenitis chemically induced, Lymphopenia chemically induced, Male, Pericardial Effusion chemically induced, Retrospective Studies, Spondylitis chemically induced, Thoracic Vertebrae, Tuberculoma, Intracranial chemically induced, Antitubercular Agents adverse effects
- Abstract
Introduction: The features of paradoxical reactions (PR) that occurred in non-HIV infected patients treated with antituberculous drugs are diverse. We report four new cases of such PR and review the literature., Patients and Methods: Were included all consecutive patients with PR that occurred in non-HIV infected patients who were treated for tuberculosis and followed-up in the department of internal medicine and infectious diseases between January 1st, 2009 and July 31st, 2010., Results: Three of the patients were male. Their median age was 28.5 years. Tuberculous locations were pulmonary (two instances) and extrapulmonary (three instances). Paradoxical reactions occurred after a median of 5.5 weeks after initiation of antituberculous treatment. The PR presented as hypercalcemia (n=1), spondylitis of the 9th thoracic vertebra (n=1), intracerebral tuberculoma (n=1), pericardial effusion (n=1) and adenitis (n=3). Lymphopenia was present in three patients. Three out of the four patients received corticosteroid. Outcome was favorable in three patients., Conclusion: Pardoxical reactions are more common in patients who present with extrapulmonary tuberculosis. Intracerebral tuberculomas and spondylitis may be asymptomatic. Prescription of corticosteroids remains controversial except for intracerebral tuberculoma., (Copyright © 2012 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
34. [Post-malaria neurological syndrome complicating a Plasmodium falciparum malaria in Madagascar].
- Author
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Rakotoarivelo RA, Razafimahefa SH, Andrianasolo R, Fandresena FH, Razanamparany MM, Randria MJ, and Rapelanoro Rabenja F
- Subjects
- Adolescent, Humans, Madagascar, Male, Nervous System Diseases diagnosis, Plasmodium falciparum physiology, Syndrome, Malaria, Cerebral diagnosis, Malaria, Cerebral etiology, Malaria, Falciparum complications, Nervous System Diseases etiology
- Abstract
Post-malaria neurological syndrome is a rare complication of malaria. Typically, it occurs in case of severe malaria. Here we report a case in a Malagasy patient presenting a non-severe Plasmodium falciparum malaria complicated by post-malaria neurological syndrome. The management of such a syndrome is radically different from non-severe malaria. No specific treatment is needed.
- Published
- 2012
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- View/download PDF
35. [Assessment of the management of cases of fever and malaria by general practitioners in the central Highlands of Madagascar, 2009-2010].
- Author
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Rakotoarivelo RA, Razakarison C, Gottot S, Ravony Harintsoa L, Randrianiriana G, Andriamanjato D, Harilalarisoa H, Ramaniraka I, Rakotondramanga J, Rafaliarivony N, Ranaivoson F, Rakotonirina JF, and Desplats D
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Fever etiology, General Practice, General Practitioners, Humans, Infant, Madagascar, Malaria complications, Male, Middle Aged, Practice Patterns, Physicians', Prospective Studies, Time Factors, Young Adult, Malaria diagnosis, Malaria drug therapy
- Abstract
The aim of this study was to determine the frequency of confirmed malaria among patients with fever in the central Highlands of Madagascar, the clinical utility of treating this fever, and the involvement of community general practitioners in improving malaria management. This descriptive, prospective study took place from July 1, 2009, through June 30, 2010. Patients consulting for fever were classified into 2 groups: the first (G1) included all children younger than 5 years and the second group (G2) children 5 years or older and adults. In G1, 1383 cases of fever included 145 (10.5%) confirmed cases of malaria. The corresponding numbers in G2 were 1172 and 276 (23.5%). The prevalence of malaria was highest between December and May. In G1, the main clinical signs associated with a positive rapid diagnostic test (RDT) were pallor, jaundice, seizures, and failure to eat. In G2, a positive RDT was associated with pallor, coma, and jaundice. Treatment of patients with positive RDTs was based on quinine (51%) or artemisinin-based combination therapy (49%). Malaria remains endemic in the central Highlands of Madagascar. Efforts should be undertaken to improve prescription of antimalarial drugs.
- Published
- 2012
- Full Text
- View/download PDF
36. [Adhesion of physicians to the national malaria policy: situation in Antananarivo (Madagascar), 5 years after the policy revision].
- Author
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Andrianasolo RL, Rakotoson J, Rakotoarivelo RA, Andriamahenina R, Randria Mamy JD, and Rapelanoro Rabenja F
- Subjects
- Adult, Health Policy, Humans, Madagascar, Malaria prevention & control, Middle Aged, Prospective Studies, Surveys and Questionnaires, Time Factors, Guideline Adherence statistics & numerical data, Malaria diagnosis, Malaria drug therapy, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Our goal was to evaluate and analyze physicians' adherence to the national malaria policy in Antananarivo, 5 years after its revision. This prospective descriptive study was conducted in public and private health centers in Antananarivo in 2010, from May 1 to June 30. Adhesion to the new policy included adoption of the rapid diagnostic test for malaria (RDT) and/or microscopy as diagnostic methods and prescription of artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria. A questionnaire was used to collect data from 106 physicians. Their average age was 43.9 years (range: 26 to 59 years). The male-female sex-ratio was 0.59. Physicians trained in using RDTs were confident in this means of diagnosis (p < 10(-4)). Prescription of ACT by physicians was associated with their participation in malaria training (p = 0.02). Only 2/3 of the physicians adhered to the current policy. Adherence increased with trust (p < 10(-4)), availability of RDT (p < 10(-5)), and training about the policy. Physician adhesion, training and confidence are essential to this policy and to changing physician behavior. Improvement of the health system is also needed.
- Published
- 2012
- Full Text
- View/download PDF
37. [Brain abscess with Nocardia asteroides revealing lung adenocarcinoma].
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Rakotoarivelo RA, Raveloson HF, Razafimahefa SH, Farbos S, Gemain MC, and Bonnal F
- Subjects
- Adenocarcinoma complications, Adenocarcinoma of Lung, Brain Abscess diagnosis, Brain Diseases complications, Brain Diseases diagnosis, Diagnosis, Differential, Female, Humans, Incidental Findings, Lung Diseases complications, Lung Neoplasms complications, Middle Aged, Nocardia Infections diagnosis, Nocardia asteroides physiology, Adenocarcinoma diagnosis, Brain Abscess complications, Lung Diseases diagnosis, Lung Neoplasms diagnosis, Nocardia Infections complications, Nocardia asteroides isolation & purification
- Published
- 2011
- Full Text
- View/download PDF
38. [A case of curable encephalomyelitis in a tropical area: pernicious anemia].
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Razafimahefa SH, Razafimahefa J, Rabenjanahary TH, Rakotoarivelo RA, Andriantseheno M, Ramanampamonjy RM, and Rajaona HR
- Subjects
- Anemia, Pernicious drug therapy, Encephalomyelitis pathology, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Tropical Climate, Vitamin B 12 therapeutic use, Vitamins therapeutic use, Anemia, Pernicious diagnosis, Encephalomyelitis etiology
- Abstract
Pernicious anemia is uncommon in Africa. The purpose of this report is to describe a case of pernicious anemia observed in Madagascar. The revealing manifestation was encephalomyelitis with combined medullar sclerosis that responded favorably to vitamin B12 replacement therapy. Clinical symptoms included paresthesia associated with allodynia of all four extremities and with tetrapyramidal syndrome, medullar ataxia and minor cognitive disturbances ongoing for 5 months. Hemogram testing revealed macrocytic anemia. Serum cobalamin level was low. Anti-intrinsic factor antibody was detected. Spinal cord magnetic resonance imaging showed diffuse high-signal intensity along the posterior spinal cord extending from C1 to C4. Vitamin B12 replacement therapy led to full regression of clinical signs after six weeks. Association of central nervous system involvement with macrocytic anemia suggests vitamin B12 deficiency and pernicious anemia should be suspected. This disease can be considered as a curable form of myelitis in Africa and Madagascar.
- Published
- 2011
39. [Severe presentations of Rift Valley Fever in Madagascar].
- Author
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Rakotoarivelo RA, Andrianasolo R, Razafimahefa SH, Randremandranto Razafimbelo NS, and Randria MJ
- Subjects
- Adult, Animal Husbandry, Animals, Antibodies, Viral blood, Cattle virology, Cattle Diseases epidemiology, Cattle Diseases virology, Female, Food Contamination, Hemorrhage mortality, Humans, Insect Vectors virology, Madagascar epidemiology, Male, Meat adverse effects, Meat virology, Middle Aged, Occupational Diseases epidemiology, Occupational Diseases virology, Population Surveillance, RNA, Viral blood, Retinitis etiology, Retinitis mortality, Rift Valley Fever complications, Rift Valley Fever transmission, Rift Valley Fever veterinary, Rift Valley fever virus genetics, Rift Valley fever virus immunology, Rift Valley fever virus isolation & purification, Risk Factors, Travel, Young Adult, Zoonoses, Disease Outbreaks, Hemorrhage etiology, Meningoencephalitis etiology, Rift Valley Fever epidemiology
- Abstract
Objective: The authors describe clinical and epidemiologic characteristics of severe presentations of Rift valley fever (RVF) during the 2008 epidemic in Madagascar., Methodology: The diagnosis was confirmed by RVF virus polymerase chain reaction (PCR), or detection of specifics antibodies by Elisa., Results: Sixteen cases of severe RVF were recorded. The sex-ratio was 7/1 and median age was 32 years (20/59 years). The risk factors of infection were: contact with infected animals or their meat (n=8), and travelling to a risk area (n=2). Hemorrhagic, neurological, and ocular manifestations were observed respectively in 87.5%, 43.8% and 6.3% of cases. All patients who died (n=4) presented with a hemorrhagic form of the disease., Conclusion: The hemorrhagic form was the most frequent presentation of RVF and was responsible for a high level of mortality. Epidemiologic surveillance must be implemented., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
40. [Discrimination of HIV infected persons in medical settings in Madagascar].
- Author
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Andrianasolo RL, Rakotoarivelo RA, Randriarimanana D, Angijiro PG, and Randria MJ
- Subjects
- Adult, Confidentiality, Diagnostic Tests, Routine, Fear, Female, Hospitals, Urban, Humans, Infectious Disease Transmission, Patient-to-Professional prevention & control, Madagascar, Male, Middle Aged, Refusal to Treat statistics & numerical data, Retrospective Studies, Social Stigma, Students, Medical psychology, Allied Health Personnel psychology, Attitude of Health Personnel, HIV Infections psychology, Health Knowledge, Attitudes, Practice, Personnel, Hospital psychology, Prejudice
- Abstract
Objective: The objective of our study was to describe the discrimination profile of healthcare personnel towards people living with HIV/AIDS (PLWHA) in medical settings in Madagascar., Method: A prospective, multicentric, descriptive, and analytic study was made with a questionnaire filled in anonymously, between February and August 2009, in 17 Madagascar hospitals (public and private)., Results: Thirty-six percent of PLWHA reported that they had been confronted with discrimination in the medical field. The age (30-40 years) and the level of education had an impact on discrimination in our study (p<0.05). Paramedics were the most responsible for discrimination (n=8/13) (61.5 %). Discrimination in the medical field was listed as: refusal of the patient to be managed in the hospital (n=5/27) (18.5 %) because of the fear of discrimination (n=4/5) (80 %) and sharing serological status with healthcare providers. Discrimination by the medical staff was listed as the unjustified use of some tools (stethoscope, tensiometer, thermometer) and by the refusal to manage PLWHA (p>0.05). Fifty-three percent of healthcare providers answered the question on HIV transmission mode correctly. Fifteen percent replied that HIV was transmitted by saliva, and 20 % by physical contact., Conclusion: As elsewhere, discrimination of PLWHA in the medical field is present in Madagascar. Fighting discrimination should be included in the strategy against propagation of HIV infection., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
41. [Thyroid cancers in Madagascar].
- Author
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Rakotoarisoa AH, Ralamboson SA, Rakotoarivelo RA, Raharisolo CV, Rakouth A, Ramiandrasoa AL, Andrianjafinala NM, Randrianjafisamindrakotroka NS, and Gizy RD
- Subjects
- Adult, Carcinoma, Papillary epidemiology, Carcinoma, Papillary pathology, Carcinoma, Papillary surgery, Ethnicity statistics & numerical data, Female, Humans, Madagascar epidemiology, Male, Middle Aged, Prevalence, Retrospective Studies, Sex Ratio, Thyroid Neoplasms pathology, Thyroid Neoplasms surgery, Thyroid Neoplasms epidemiology
- Abstract
This is a retrospective study, conducted on thyroid cancer observed for 13 months (from June 1(st) 2004 to June 30(th) 2005). Data were collected from four main surgical pathology laboratories in Antananarivo, Madagascar. Among 6,036 surgical samples, 179 were of thyroid gland, a rate that is near 3% of the total. Among them were found 40 cases of thyroid cancer, which is 0.66% of all screened samples, and 22.32% of all examined thyroid samples. In the studied population was observed a female preponderance (82%) with a mean age of 43.9 years when diagnosis was confirmed. It was evidenced a 50 % of papillary carcinoma and 45% of follicular carcinoma, with a rate of 2.5% respectively for the medullar and anaplastic carcinoma. Metastases were seen in 20%, originated from papillary type for the lymph node involvement and from the follicular type for the bone involvement. In Antananarivo, thyroid cancer is seen mainly in people from the surrounding Highlands, supposed to be sites of endemic goiter related to iodine deficiency. Despite its limits, this study may be used as reference about thyroid cancer in Madagascar. Further studies are required to find out other factors involved in the development of this disease.
- Published
- 2010
- Full Text
- View/download PDF
42. [Causes of death in a sample of cirrhotic patients from Madagascar].
- Author
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Razafimahefa SH, Rabenjanahary TH, Rakotoarivelo RA, Ramilitiana B, Ramanampamonjy RM, and Rajaona HR
- Subjects
- Female, Fever, Gastrointestinal Hemorrhage mortality, Hepatic Encephalopathy mortality, Humans, Liver Cirrhosis complications, Liver Cirrhosis epidemiology, Madagascar epidemiology, Male, Middle Aged, Cause of Death, Liver Cirrhosis mortality
- Abstract
Objective: Cirrhotic patients have poorer life expectancy than the general population. The purpose of this study was to identify causes of death in a sample of cirrhotic patients from Madagascar., Methods: A retrospective analytic and descriptive study was conducted on the files of cirrhotic inpatients admitted to the gastroenterology department of the Joseph Raseta Befelatanana University Hospital Center in Antananarivo, Madagascar from January 1, 2003 to June 30, 2007., Results: The files of 117 patients were reviewed. Death occurred in 31 cases for a mortality rate of 26.5%. The main causes of death were disorders of consciousness (51.6%) and hypovolemic shock (25.8%). Jaundice, encephalopathy, and gastrointestinal bleeding were predictive factors for mortality., Conclusion: Cirrhotic patients in this study were hospitalized at a late stage of disease. Further prospective study in a larger sample will be needed to standardize the management protocol in Madagascar.
- Published
- 2010
43. [Experience in the use of the malaria rapid diagnostic test in Madagascar].
- Author
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Rakotoarivelo RA, Andrianasolo R, Rakoto Sedson R, Randria MJ, and Rapelanoro Rabenja F
- Subjects
- Humans, Madagascar epidemiology, Registries, Malaria, Falciparum diagnosis, Malaria, Falciparum epidemiology, Reagent Kits, Diagnostic
- Abstract
Diagnosis of malaria cases depends on parasitological examination. Since 2006, the Department of Infectious Diseases at the Joseph Raseta Befelatanana University Hospital in Madagascar has been using the malaria rapid diagnostic test. The percentage of malaria cases (presumed or confirmed) in relation to the number of hospitalized patients has decreased. It was 23.4% in 2003, 10.3% in 2006 and 4.3% in 2008 (p<0.01532). To improve management of malaria cases and rationalize use of antimalarial agents, diagnosis should be confirmed by rapid diagnostic tests.
- Published
- 2010
44. [African histoplasmosis in an immunocompetent Malagasy patient.].
- Author
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Rakotoarivelo RA, Razafimahefa SH, Andrianiaina HD, and Randria MJ
- Subjects
- Adult, Amphotericin B administration & dosage, Amphotericin B adverse effects, Antifungal Agents administration & dosage, Antifungal Agents adverse effects, Fatal Outcome, Histoplasma isolation & purification, Histoplasmosis drug therapy, Histoplasmosis microbiology, Humans, Lymph Nodes microbiology, Madagascar, Male, Skin microbiology, Histoplasmosis diagnosis, Immunocompetence
- Abstract
African histoplasmosis is a rare but not an exceptional condition and recently discovered in Madagascar. We report the fifth Malagasy case involving skin and nodes in an immunocompetent patient. Management of African histoplasmosis encountered many problems because of the availability of amphotericin B and cost of the biochemical tests in order to prevent major side effects in case of failure of oral antimycotic drug.
- Published
- 2010
- Full Text
- View/download PDF
45. [Relation between Shistosoma mansoni and hepatosplenomegalies].
- Author
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Rakotonirina EJ, Andrianjaka P, Rakotoarivelo RA, Ramanampamonjy RM, Randria MJ, and Rakotomanga JD
- Subjects
- Adult, Animals, Cross-Sectional Studies, Dysentery epidemiology, Female, Hepatomegaly epidemiology, Humans, Hypertension, Portal parasitology, Longitudinal Studies, Madagascar epidemiology, Male, Middle Aged, Prevalence, Schistosoma mansoni, Schistosomiasis mansoni epidemiology, Schistosomiasis mansoni etiology, Splenomegaly epidemiology, Hepatomegaly parasitology, Schistosomiasis mansoni complications, Splenomegaly parasitology
- Abstract
Introduction: Although they remain a neglected transmissible disease, affecting mainly people in poor countries, the combined forms of schistosomiasis are second only to malaria as a major parasitic disease. Although both urinary and intestinal schistosomiasis are endemic in Madagascar, this study focuses only on the intestinal forms. The symptoms may remain unnoticed or be ignored, for the seriousness of intestinal schistosomiasis is due mainly to its hepatosplenic complications., Objectives: To estimate the etiological fraction of Schistosoma mansoni involved in hepatomegaly (HM), splenomegaly (SM) and hepatosplenomegaly (HSM), with or without signs of portal hypertension (PHT)., Methods: This file-based retrospective study includes patients admitted to the University Hospital of Antananarivo, Madagascar, between January 2005 and July 2008, who presented with HM, SM, HSM and/or PHT. The case was attributed to schistosomiasis if blood serology, tested with ELISA, was positive for this parasite. The statistical analysis used three approaches: a cross-sectional approach, a longitudinal approach (retrospective cohort), and a "case-control" approach., Results: Of 7308 admissions during this period, 269 (4%) were diagnosed with a hepatosplenic complication and were retained. The average age (+/- standard deviation) was 47.8 (+/- 16.4) years. HM accounted for 55.4% of cases, SM 18.9%, HTP 18.6% and HSM 18.6%. Serology was positive for schistosomiasis in 21.6% of cases. The sex ratio (men:women) for these cases was 1.9, and 67.3% of the patients were aged 30 years or older. The main schistosomiasis complications were SM (n=22) and HTP (n=22). The age group most affected depended on the specific complication: for HM, 28.6% of patients were aged between 40 and 49 years; for HSM, 57.1% were aged between 30 and 40 years. The prevalence of SM was lower in subjects between 50 and 59 years of age (4.5%) than the other complications. Patients with positive serology results were significantly younger than those with negative results, or whose serology was not checked (37.8 years vs. 50.5 years, p < 0.001). Stratification according to complication showed that the etiological fraction of schistosomiasis was 76% for patients with SM, 79% for HTP, 58% for HSM and 4.9% for HM. The retrospective cohort and the case-control analyses both showed that a history of dysentery and frequent contact with water were the main factors associated with complicated schistosomiasis. It is important to note that urban and rural residents had the same risk of developing schistosomiasis with complications (OR: 0.9 [0.4; 1.9])., Conclusion: This study showed that schistosomiasis infection is strongly associated with hepatosplenic pathologies. One of the shortcomings of the study is the absence of any analysis of the course and outcome in the study patients. Nevertheless, the course of oesophageal varices, SM or HSM in patients with HTP indicates that schistosomiasis was often fatal.
- Published
- 2010
- Full Text
- View/download PDF
46. [Epidemiological, clinical and therapeutic aspects of severe malaria in adults in hospital in Antananarivo, Madagascar].
- Author
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Rakotoarivelo RA, Raveloson HF, Andrianasolo R, Razafimahefa SH, and Randria MJ
- Subjects
- Adult, Antimalarials, Consciousness Disorders etiology, Early Diagnosis, Female, Hospital Mortality, Hospitals, University statistics & numerical data, Hospitals, Urban statistics & numerical data, Humans, Jaundice etiology, Madagascar epidemiology, Malaria, Falciparum complications, Malaria, Falciparum diagnosis, Malaria, Falciparum drug therapy, Male, Pregnancy, Pregnancy Complications, Infectious mortality, Retrospective Studies, Seizures etiology, Self Medication, Treatment Outcome, Young Adult, Malaria, Falciparum epidemiology
- Abstract
Few data are available about severe malaria in Madagascar. Our aims were to describe epidemiological, clinical and therapeutic aspects of severe malaria in patients in Antananarivo. We conducted a retrospective study from 1 March 2006 to 31 March 2008 at the infectious disease department. We recorded 61 cases of severe malaria among 1,803 in patients. Sex ratio was 2 and average age was 35.3 years old. Three pregnant women were recorded among women (15.8%). Self-medication was registered in 23%. Among 35 patients who received first medical care, no one had parasitological examination. The treatment was inadequate for all patients (n = 19). Conscience impairment (65.6%), jaundice (24.6%), seizure (18%) and prostration (14.8%) were the major severe signs. Diagnosis was made 6.54 days after the onset of the disease. Mortality rate was 11.5%. Self-medication, inappropriate primary care and delayed diagnosis represented risk factors for severe malaria in our cohort.
- Published
- 2009
47. [A misleading case of hypereosinophilia revealing colonic adenocarcinoma in a patient from a tropical area].
- Author
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Laingo Andrianarison JF, Ranoharison D, Rakotoarivelo RA, Razafimahefa SH, Andriamampionona TF, Rabarijaona L, Rafaramino F, and Rajaona HR
- Subjects
- Female, Humans, Madagascar, Middle Aged, Tropical Climate, Adenocarcinoma diagnosis, Eosinophilia etiology, Sigmoid Neoplasms diagnosis
- Abstract
Although paraneoplastic hypereosinophilia has been documented in patients with colon cancer, this association is rare. The purpose of this report is to describe a case of paraneoplastic hypereosinophilia associated with colic adenocarcinoma. This case underlines the value of methodical investigation of hypereosinophilia in tropical areas where parasitic aetiologies are frequent.
- Published
- 2009
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