Search

This study provides new findings on the flexible activity of Prolemur simus in an anthropogenically modified habitat in the rural commune of Tsaratanana, eastern Madagascar. Based on camera-trap data, we compared the temporal distribution of activity of one group of lemurs between the forest edge and the forest core. We also investigated the possible influence of nocturnal luminosity on the activity cycle. The analysis was conducted using Kernel Density estimates and the R package OVERLAP. The distribution across the 24-h cycle confirmed that Prolemur simus is cathemeral in the wild. The lemurs displayed three peaks of activity: one during the night and two coinciding with morning and evening twilights. The highest proportions of nocturnal activity occurred at the forest edge and at low moon luminosity suggesting a possible anti-predator and/or human-avoidance strategy. The flexible activity of Prolemur simus may contribute to the tolerance of this Critically Endangered species to anthropogenic disturbance.

Cette réflexion portera sur la place des inférences dans l'enseignement du français. Comment faire un lien entre une littérature classique et la réalité des élèves ? Il sera question de voir comment les interprétations digressives participent à la création et à l'actualisation de la littérature.

Background Post-exposure prophylaxis (PEP) is highly effective at preventing human rabies deaths, however access to PEP is limited in many rabies endemic countries. The 2018 decision by Gavi to add human rabies vaccine to its investment portfolio should expand PEP availability and reduce rabies deaths. We explore how geographic access to PEP impacts the rabies burden in Madagascar and the potential benefits of improved provisioning. Methodology & principal findings We use spatially resolved data on numbers of bite patients seeking PEP across Madagascar and estimates of travel times to the closest clinic providing PEP (N = 31) in a Bayesian regression framework to estimate how geographic access predicts reported bite incidence. We find that travel times strongly predict reported bite incidence across the country. Using resulting estimates in an adapted decision tree, we extrapolate rabies deaths and reporting and find that geographic access to PEP shapes burden sub-nationally. We estimate 960 human rabies deaths annually (95% Prediction Intervals (PI): 790–1120), with PEP averting an additional 800 deaths (95% PI: 640–970) each year. Under these assumptions, we find that expanding PEP to one clinic per district (83 additional clinics) could reduce deaths by 19%, but even with all major primary clinics provisioning PEP (1733 additional clinics), we still expect substantial rabies mortality. Our quantitative estimates are most sensitive to assumptions of underlying rabies exposure incidence, but qualitative patterns of the impacts of travel times and expanded PEP access are robust. Conclusions & significance PEP is effective at preventing rabies deaths, and in the absence of strong surveillance, targeting underserved populations may be the most equitable way to provision PEP. Given the potential for countries to use Gavi funding to expand access to PEP in the coming years, this framework could be used as a first step to guide expansion and improve targeting of interventions in similar endemic settings where PEP access is geographically restricted and baseline data on rabies risk is lacking. While better PEP access should save many lives, improved outreach, surveillance, and dog vaccination will be necessary, and if rolled out with Gavi investment, could catalyze progress towards achieving zero rabies deaths., Author summary Canine rabies causes an estimated 60,000 deaths each year across the world, primarily in low- and middle-income countries where people have limited access to both human vaccines (post-exposure prophylaxis or PEP) and dog rabies vaccines. Given that we have the tools to prevent rabies deaths, a global target has been set to eliminate deaths due to canine rabies by 2030, and recently, Gavi, a multilateral organization that aims to improve access to vaccines in the poorest countries, added human rabies vaccine to it’s portfolio. In this study, we estimated reported incidence of patients seeking PEP in relation to travel times to clinics provisioning PEP and extrapolate human rabies deaths in Madagascar. We find that PEP currently averts around 800 deaths each year, but that the burden remains high (1000 deaths/year), particularly in remote, hard-to-reach areas. We show that expanding PEP availability to more clinics could significantly reduce rabies deaths in Madagascar, but our results reaffirm that expansion alone is will not achieve the global goal of zero human deaths from dog-mediated rabies by 2030. Combining PEP expansion with outreach, surveillance, and mass dog vaccination programs will be necessary to move Madagascar, and other Low- and Middle-Income countries, forward on the path to rabies elimination.

Introduction L’Organisation mondiale de la sante estime qu’en 2030, le diabete serait la 7e cause de mortalite mondiale. A Madagascar, peu de recherches ont ete effectuees sur les facteurs de risque du diabete en communaute. L’objectif de cette etude consiste a comparer trois methodes de selection de variables pour l’evaluation de ces facteurs de risque. Methodes Les donnees utilisees proviennent d’une etude transversale en 2014 chez les adultes tires au sort parmi la population de l’Observatoire de sante de Moramanga a Madagascar. Un modele de regression logistique a ete utilise. Pour la methode de selection pas-a-pas descendante selon la valeur de p (p-value, p) et celle selon le critere d’information d’Akaike (AIC), les variables etudiees, avec une valeur de p inferieure a 0,25 en univariee ont ete retenues pour les analyses multivariees. Le seuil de significativite a ete fixe a 0,05. La troisieme methode repose sur la selection par la methode Lasso avec validation croisee, partant de ces memes variables puis de toutes les variables etudiees, cherchant les parametres optimaux. Les modeles construits ont ete deux a deux compares, utilisant le logiciel R, par l’analyse de variance (Anova) et le test de rapport de vraisemblance (lrtest du package lmtest). Resultats Au total, 1424 individus ont ete inclus dans l’etude. La prevalence du diabete a ete estimee a 1,4 % avec un intervalle de confiance a 95 % de [0,9–2,2]. La selection de variables selon la p-value a retenu les facteurs de risque : âge elevee (p = 0,042), hypertension arterielle (p = 0,005), corpulence (p = 0,021), et consommation de tubercules comme effet protecteur (p = 0,007). La selection selon l’AIC a retenu ces memes variables legerement differenciees pour les valeurs de p, et des variables supplementaires : existence d’antecedents de familles diabetiques (p = 0,115), trop de consommation de fruits (p = 0,123), activite physique faible (p = 0,117). Concernant la methode Lasso (avec lambda.min), aucune variable n’a ete retenue partant des memes variables initiales que precedemment. Neanmoins, en partant de toutes les variables etudiees, celles des deux precedents modeles ont ete retenues avec en plus l’origine ethnique (Merina, p = 0,040), la consommation de sucre rapide (p = 0,255), le tabagisme important (p = 0,812), le faible niveau socioeconomique (p = 0,508), le sexe (femme, p = 0,823). Les comparaisons des modeles ont toutes donnees des valeurs de p superieures a 0,05. Conclusion Les modeles obtenus sont emboites et ne presentent aucune difference significative. Dans notre population d’etude, les trois methodes ont revele des facteurs de risque connus du diabete, ce qui laisse penser que l’utilisation de l’une ou l’autre de ces methodes serait toujours interessante. La comparaison de ces methodes dans d’autres contextes qui partirait des memes variables initiales pourrait peut-etre reveler celle la plus adaptee.

To determine how sensitive Plasmodium falciparum is to the major antimalarial drugs in Madagascar.Assessment of Plasmodium falciparum isolates sensitivity to antimalarials, by use of the in-vitro radioisotope method.Ankazobe and Saharevo in the foothill areas; and Toamasina and Tolagnaro in the coastal areas (between January 1998 and November 1999).Primary Plasmodium falciparum isolates from patients with uncomplicated malaria attack.Between January 1998 and November 1999, of the 293 in-vitro tests done with at least one antimalarial, 70% (205/293) were interpretable. As there was no significant difference between results from the four study sites, the data have been expressed as a whole. All of the successfully tested isolates were sensitive to halofantrine (n = 56) and to quinine (n = 199), 5.8% (12/205) of the isolates were resistant to chloroquine and 2% (4/199) to mefloquine. The geometric mean IC50 was 0.3 microg/L for halofantrine (95% CI = 0.1-0.4 microg/L); 9.4 microg/L for chloroquine (95% CI = 7.3-10.8 microg/L); 3.8 microg/L for mefloquine (95% CI = 3.3-4.3 microg/L); and 26.8 microg/L for quinine (95% CI = 24.3-29.4 microg/L). The low positive correlation found between halofantrine and chloroquine IC50s (n = 56; r = 0.41, P = 0.002) suggests a risk of cross-resistance between these two drugs.The degree and frequency of chloroquine resistance in-vitro is stationary in Madagascar compared to previous results during the last decade. The in-vitro sensitivity of P. falciparum to quinine, mefloquine and halofantrine encourages the use of these drugs as alternative in case of chloroquine treatment failure. Nevertheless, it is important to maintain and to extend malaria and drug sensitivity surveillance in Madagascar.

Objective: To determine how sensitive Plasmodium falciparum is to the major antimalarial drugs in Madagascar. Design: Assessment of Plasmodium falciparum isolates sensitivity to antimalarials, by use of the in-vitro radioisotope method. Setting: Ankazobe and Saharevo in the foothill areas; and Toamasina and Tolagnaro in the coastal areas (between January 1998 and November 1999). Subjects: Primary Plasmodium falciparum isolates from patients with uncomplicated malaria attack. Results: Between January 1998 and November 1999, of the 293 in-vitro tests done with at least one antimalarial, 70% (205/293) were interpretable. As there was no significant difference between results from the four study sites, the data have been expressed as a whole. All of the successfully tested isolates were sensitive to halofantrine (n = 56) and to quinine (n = 199), 5.8% (12/205) of the isolates were resistant to chloroquine and 2% (4/199) to mefloquine. The geometric mean IC50 was 0.3 µg/L for halofantrine (95% CI = 0.1 - 0.4 µg/L); 9.4 µg/L for chloroquine (95% CI = 7.3 - 10.8 µg/L); 3.8 µg/L for mefloquine (95% CI = 3.3 - 4.3 µg/L); and 26.8 µg/L for quinine (95% CI = 24.3 - 29.4 µg/L). The low positive correlation found between halofantrine and chloroquine IC50s (n=56; r = 0.41, P = 0.002) suggests a risk of cross-resistance between these two drugs. Conclusion: The degree and frequency of chloroquine resistance in-vitro is stationary in Madagascar compared to previous results during the last decade. The in-vitro sensitivity of P. falciparum to quinine, mefloquine and halofantrine encourages the use of these drugs as alternative in case of chloroquine treatment failure. Nevertheless, it is important to maintain and to extend malaria and drug sensitivity surveillance in Madagascar. (East African Medical Journal: 2002 79(5): 237-241))

Objective : To determine how sensitive Plasmodium falciparum is to the major antimalarial drugs in Madagascar. Design : Assessment of Plasmodium falciparum isolates sensitivity to antimalarials, by use of the in-vitro radioisotope method. Setting : Ankazobe and Saharevo in the foothill areas; and Toamasina and Tolagnaro in the coastal areas (between January 1998 and November 1999). Subjects : Primary Plasmodium falciparum isolates from patients with uncomplicated malaria attack. Results : Between January 1998 and November 1999, of the 293 in-vitro tests done with at least one antimalarial, 70% (205/293) were interpretable. As there was no significant difference between results from the four study sites, the data have been expressed as a whole. All of the successfully tested isolates were sensitive to halofantrine (n = 56) and to quinine (n = 199), 5.8% (12/205) of the isolates were resistant to chloroquine and 2% (4/199) to mefloquine. The geometric mean IC50 was 0.3 µg/L for halofantrine (95% CI = 0.1 - 0.4 µg/L); 9.4 µg/L for chloroquine (95% CI = 7.3 - 10.8 µg/L); 3.8 µg/L for mefloquine (95% CI = 3.3 - 4.3 µg/L); and 26.8 µg/L for quinine (95% CI = 24.3 - 29.4 µg/L). The low positive correlation found between halofantrine and chloroquine IC50s (n=56; r = 0.41, P = 0.002) suggests a risk of cross-resistance between these two drugs. Conclusion : The degree and frequency of chloroquine resistance in-vitro is stationary in Madagascar compared to previous results during the last decade. The in-vitro sensitivity of P. falciparum to quinine, mefloquine and halofantrine encourages the use of these drugs as alternative in case of chloroquine treatment failure. Nevertheless, it is important to maintain and to extend malaria and drug sensitivity surveillance in Madagascar. (East African Medical Journal: 2002 79(5): 237-241))

National audience