42 results on '"Thomas, Kesteman"'
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2. Spatiotemporal Evolution of SARS-CoV-2 Alpha and Delta Variants during Large Nationwide Outbreak of COVID-19, Vietnam, 2021
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Nguyen Thi Tam, Nguyen To Anh, Trinh Son Tung, Pham Ngoc Thach, Nguyen Thanh Dung, Van Dinh Trang, Le Manh Hung, Trinh Cong Dien, Nghiem My Ngoc, Le Van Duyet, Phan Manh Cuong, Hoang Vu Mai Phuong, Pham Quang Thai, Nguyen Le Nhu Tung, Dinh Nguyen Huy Man, Nguyen Thanh Phong, Vo Minh Quang, Pham Thi Ngoc Thoa, Nguyen Thanh Truong, Tran Nguyen Phuong Thao, Dao Phuong Linh, Ngo Tan Tai, Ho The Bao, Vo Trong Vuong, Huynh Thi Kim Nhung, Phan Nu Dieu Hong, Le Thi Phuoc Hanh, Le Thanh Chung, Nguyen Thi Thanh Nhan, Ton That Thanh, Do Thai Hung, Huynh Kim Mai, Trinh Hoang Long, Nguyen Thu Trang, Nguyen Thi Hong Thuong, Nguyen Thi Thu Hong, Le Nguyen Truc Nhu, Nguyen Thi Han Ny, Cao Thu Thuy, Le Kim Thanh, Lam Anh Nguyet, Le Thi Quynh Mai, Tang Chi Thuong, Le Hong Nga, Tran Tan Thanh, Guy Thwaites, H. Rogier van Doorn, Nguyen Van Vinh Chau, Thomas Kesteman, and Le Van Tan
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COVID-19 ,coronavirus disease ,SARS-CoV-2 ,severe acute respiratory syndrome coronavirus-2 ,coronaviruses ,viruses ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
We analyzed 1,303 SARS-CoV-2 whole-genome sequences from Vietnam, and found the Alpha and Delta variants were responsible for a large nationwide outbreak of COVID-19 in 2021. The Delta variant was confined to the AY.57 lineage and caused >1.7 million infections and >32,000 deaths. Viral transmission was strongly affected by nonpharmaceutical interventions.
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- 2023
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3. Feasibility, acceptability, and bacterial recovery for community-based sample collection to estimate antibiotic resistance in commensal gut and upper respiratory tract bacteria
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Hoang Huy Tran, Hien Anh Thi Nguyen, Huyen Bang Tran, Bich Ngoc Thi Vu, Tu Cam Thi Nguyen, Costanza Tacoli, Thao Phuong Tran, Tung Son Trinh, Thien Huong Ngoc Cai, Behzad Nadjm, Kieu Hương Thi Tran, Quynh Dieu Pham, Thương Hong Thi Nguyen, Trang Thu Nguyen, Thai Duy Pham, Thomas Kesteman, Duc Anh Dang, Tien Dac Tran, H. Rogier van Doorn, and Sonia Lewycka
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Medicine ,Science - Abstract
Abstract Vietnam has high rates of antibiotic use and resistance. Measuring resistance in commensal bacteria could provide an objective indicator for evaluating the impact of interventions to reduce antibiotic use and resistance. This study aimed to evaluate the feasibility, acceptability, and bacterial recovery for different sampling strategies. We conducted a cross-sectional mixed methods study in a rural community in Ha Nam Province, northern Vietnam, and collected structured interviews, samples, and in-depth interviews from households. Out of 389 households invited, 324 participated (83%), representing 1502 individuals. Samples were collected from these individuals (1498 stool, 1002 self-administered nasal swabs, and 496 HW-administered nasopharyngeal swabs). Pneumococci were recovered from 11.1% (128/1149) of the total population and 26.2% (48/183) of those under 5-years. Recovery was higher for health-worker (HW)-administered swabs (13.7%, 48/350) than self-administered swabs (10.0%, 80/799) (OR 2.06, 95% CI 1.07–3.96). Cost per swab was cheaper for self-administered ($7.26) than HW-administered ($8.63) swabs, but the overall cost for 100 positive samples was higher ($7260 and $6300 respectively). Qualitative interviews revealed that HW-administered nasopharyngeal swabs took longer to collect, caused more discomfort, and were more difficult to take from children. Factors affecting participation included sense of contribution, perceived trade-offs between benefits and effort, and peer influence. Reluctance was related to stool sampling and negative perceptions of research. This study provides important evidence for planning community-based carriage studies, including cost, logistics, and acceptability. Self-administered swabs had lower recovery, and though cheaper and quicker, this would translate to higher costs for large population-based studies. Recovery might be improved by swab-type, transport medium, and better cold-chain to lab.
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- 2022
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4. Long-Lasting Insecticide-Treated Nets Combined or Not with Indoor Residual Spraying May Not Be Sufficient to Eliminate Malaria: A Case-Control Study, Benin, West Africa
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Barikissou G. Damien, Thomas Kesteman, Gatien A. Dossou-Yovo, Amal Dahounto, Marie-Claire Henry, Christophe Rogier, and Franck Remoué
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malaria ,infection ,uncomplicated clinical cases ,LLINs ,IRS ,effectiveness ,Medicine - Abstract
In sub-Saharan Africa, despite the implementation of multiple control interventions, the prevalence of malaria infection and clinical cases remains high. The primary tool for vector control against malaria in this region is the use of long-lasting insecticide-treated nets (LLINs) combined or not with indoor residual spraying (IRS) to achieve a synergistic effect in protection. The objective of this study was to assess the effectiveness of LLINs, with or without IRS, protected against Plasmodium falciparum infection and uncomplicated clinical cases (UCC) of malaria in Benin. A case-control study was conducted, encompassing all age groups, in the urban area of Djougou and the rural area of Cobly. A cross-sectional survey was conducted that included 2080 individuals in the urban area and 2770 individuals in the rural area. In the urban area, sleeping under LLINs did not confer significant protection against malaria infection and UCC when compared to no intervention. However, certain neighbourhoods benefited from a notable reduction in infection rates ranging from 65% to 85%. In the rural area, the use of LLINs alone, IRS alone, or their combination did not provide additional protection compared to no intervention. IRS alone and LLINs combined with IRS provided 61% and 65% protection against malaria infection, respectively, compared to LLINs alone. The effectiveness of IRS alone and LLINs combined with IRS against UCC was 52% and 54%, respectively, when compared to LLINs alone. In both urban and rural areas, the use of LLINs alone, IRS alone, and their combination did not demonstrate significant individual protection against malaria infection and clinical cases when compared to no intervention. In the conditions of this study, LLINs combined or not with IRS are not effective enough to eliminate malaria. In addition to the interventions, this study identified factors associated with malaria in Benin as housing design, neglected social groups like gender-marginalised individuals and adolescents, and socio-economic conditions acting as barriers to effective malaria prevention. Addressing these factors is crucial in order to facilitate malaria elimination efforts in sub-Saharan Africa.
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- 2023
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5. Neisseria gonorrhoeae FC428 Subclone, Vietnam, 2019–2020
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Trang Minh Trinh, Tam Thi Nguyen, Thanh Viet Le, Trang Thu Nguyen, Dan Thi Ninh, Bao Hac Duong, Minh Van Nguyen, Thomas Kesteman, Lan Thi Pham, and H. Rogier van Doorn
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Neisseria gonorrhoeae ,gonorrhea ,FC428 clone ,multidrug resistance ,antimicrobial resistance ,cephalosporin resistance ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Among 114 clinical Neisseria gonorrhoeae isolates collected in Vietnam during 2019–2020, we detected 15 of subclone sequence type 13871 of the FC428 clonal complex. Fourteen sequence type 13871 isolates with mosaic penA allele 60.001 were ceftriaxone or cefixime nonsusceptible, and 3/14 were azithromycin nonsusceptible. Emergence of this subclone threatens treatment effectiveness.
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- 2022
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6. Improving antimicrobial use through antimicrobial stewardship in a lower-middle income setting: a mixed-methods study in a network of acute-care hospitals in Viet Nam
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Vu Thi Lan Huong, Ta Thi Dieu Ngan, Huynh Phuong Thao, Nguyen Thi Cam Tu, Truong Anh Quan, Behzad Nadjm, Thomas Kesteman, Nguyen Van Kinh, and H Rogier van Doorn
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Antimicrobial stewardship ,Antimicrobial prescribing ,Antimicrobial resistance ,Low- and middle-income countries ,Viet Nam ,Microbiology ,QR1-502 - Abstract
Objectives: This study aimed to analyse the current state of antimicrobial stewardship (AMS) in hospitals in Viet Nam, a lower-middle income country (LMIC), to identify factors determining success in AMS implementation and associated challenges to inform planning and design of future programmes. Methods: We conducted a mixed-methods study in seven acute-care hospitals in the antimicrobial resistance (AMR) surveillance network in Viet Nam. Data collection included 7 focus group discussions, 40 in-depth interviews and a self-administered quantitative survey of staff on AMR and AMS programmes. We summarised qualitative data by reporting the most common themes according to the core AMS elements, and analysed quantitative data using proportions and a linear mixed-effects model. Results: The findings reveal a complex picture of factors and actors involved in AMS implementation from the national level to the departmental and individual level within each hospital. The level of implementation varied, starting from the formation of an AMS committee, with or without active delivery of specific interventions. Development of treatment guidelines, pre-authorisation of antimicrobial drug classes, and post-prescription audit and feedback to doctors in selected clinical departments were the main interventions reported. A higher level of leadership support and commitment to AMS led to a higher level of engagement with AMS activities from the AMS team and effective collaboration between departments involved. Conclusion: Establishing country-specific guidelines on AMS staffing and adapting standards for AMS education and training from international resources are needed to support capacity building to implement AMS programmes effectively in LMICs such as Viet Nam.
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- 2021
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7. Family, social and cultural determinants of long-lasting insecticidal net (LLIN) use in Madagascar: secondary analysis of three qualitative studies focused on children aged 5–15 years
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Ammy Fiadanana Njatosoa, Chiarella Mattern, Dolorès Pourette, Thomas Kesteman, Elliot Rakotomanana, Bakoly Rahaivondrafahitra, Mauricette Andriamananjara, Aina Harimanana, Jocelyn Razafindrakoto, Emma Raboanary, Andry Andrianasolo, and Christophe Rogier
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Malaria ,LLIN use ,Children over five ,Sociocultural factors ,Madagascar ,Arctic medicine. Tropical medicine ,RC955-962 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Although it is accepted that long-lasting insecticidal net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; the malaria prevalence is highest in this age group. The purpose of this research is to summarize recent qualitative studies describing LLIN use among the Malagasy people with a focus on children aged 5–15 years. Methods Qualitative data from three studies on malaria conducted between 2012 and 2016 in 10 districts of Madagascar were analysed. These studies cover all malaria epidemiological profiles and 10 of the 18 existing ethnic groups in Madagascar. A thematic analysis was conducted on the collected data from semi-structured interviews, direct observation data, and informal interviews. Results A total of 192 semi-structured interviews were conducted. LLINs are generally perceived positively because they protect the health and well-being of users. However, regional representations of mosquito nets may contribute to LLIN lower use by children over 5 years of age including the association between married status and LLIN use, which leads to the refusal of unmarried young men to sleep under LLINs; the custom of covering the dead with a mosquito net, which leads to fear of LLIN use; and taboos governing sleeping spaces for siblings of opposite sexes, which leads to LLIN shortages in households. Children under 5 years of age are known to be the most vulnerable age group for acquiring malaria and, therefore, are prioritized for LLIN use when there are limited supplies in households. In contrast, children over 5 years of age, who are perceived to be at less risk for malaria, often sleep without LLINs. Conclusions Perceptions, social practices and regional beliefs regarding LLINs and vulnerability to malaria contribute to the nonuse of LLINs among children over 5 years of age in Madagascar. Modifying LLIN policies to account for these factors may increase LLIN use in this age group and reduce disease burden.
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- 2021
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8. Biphasic versus monophasic manual blood culture bottles for low-resource settings: an in-vitro study
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Sien Ombelet, MD, Alessandra Natale, PhD, Jean-Baptiste Ronat, MSc, Thomas Kesteman, PhD, Olivier Vandenberg, ProfPhD, Jan Jacobs, ProfPhD, and Liselotte Hardy, PhD
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Medicine (General) ,R5-920 ,Microbiology ,QR1-502 - Abstract
Summary: Background: Manual blood culture bottles (BCBs) are frequently used in low-resource settings. There are few BCB performance evaluations, especially evaluations comparing them with automated systems. We evaluated two manual BCBs (Bi-State BCB and BacT/ALERT BCB) and compared their yield and time to growth detection with those of automated BacT/ALERT system. Methods: BCBs were spiked in triplicate with 177 clinical isolates representing pathogens common in low-resource settings (19 bacterial and one yeast species) in adult and paediatric volumes, resulting in 1056 spiked BCBs per BCB system. Growth in manual BCBs was evaluated daily by visually inspecting the broth, agar slant, and, for BacT/ALERT BCB, colour change of the growth indicator. The primary outcomes were BCB yield (proportion of spiked BCB showing growth) and time to detection (proportion of positive BCB with growth detected on day 1 of incubation). 95% CI for yield and growth on day 1 were calculated using bootstrap method for clustered data using. Secondary outcomes were time to colony for all BCBs (defined as number of days between incubation and colony growth sufficient to use for further testing) and difference between time to detection in broth and on agar slant for the Bi-State BCBs. Findings: Overall yield was 95·9% (95% CI 93·9–98·0) for Bi-State BCB and 95·5% (93·3–97·8) for manual BacT/ALERT, versus 96·1% (94·0–98·1) for the automated BacT/ALERT system (p=0·61). Day 1 growth was present in 920 (90·8%) of 1013 positive Bi-State BCB and 757 (75·0%) of 1009 positive manual BacT/ALERT BCB, versus 1008 (99·3%) of 1015 automated bottles. On day 2, detection rates were 100% for BI-State BCB, 97·7% for manual BacT/ALERT BCB, and 100% for automated bottles. For Bi-State BCB, growth mostly occurred simultaneously in broth and slant (81·7%). Sufficient colony growth on the slant to perform further tests was present in only 44·1% of biphasic bottles on day 2 and 59·0% on day 3. Interpretation: The yield of manual BCB was comparable with the automated system, suggesting that manual blood culture systems are an acceptable alternative to automated systems in low-resource settings. Bi-State BCB outperformed manual BacT/ALERT bottles, but the agar slant did not allow earlier detection nor earlier colony growth. Time to detection for manual blood culture systems still lags that of automated systems, and research into innovative and affordable methods of growth detection in manual BCBs is encouraged. Funding: Médecins Sans Frontières and Department of Economy, Science and Innovation of the Flemish Government.
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- 2022
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9. Assessing feasibility of establishing antimicrobial stewardship programmes in two provincial-level hospitals in Vietnam: an implementation research study
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H Rogier van Doorn, Thomas Kesteman, Elizabeth Dodds Ashley, Vu Thi Lan Huong, Ta Thi Dieu Ngan, Huynh Phuong Thao, Le Minh Quang, Tran Thi Thu Hanh, Nguyen Thi Hien, Tran Duc, Vu Hai Vinh, Chau Minh Duc, Vo Thi Hoang Dung Em, Phan Van Be Bay, Nguyen Thi Thuy Oanh, Pham Thi Thuy Hang, Nguyen Thi Cam Tu, Truong Anh Quan, and Deverick Anderson
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Medicine - Published
- 2021
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10. Validation of Three MicroScan® Antimicrobial Susceptibility Testing Plates Designed for Low-Resource Settings
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Jean-Baptiste Ronat, Saoussen Oueslati, Alessandra Natale, Thomas Kesteman, Wael Elamin, Céline Langendorf, Liselotte Hardy, Olivier Vandenberg, and Thierry Naas
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antibiotic susceptibility testing ,low-resource settings ,clinical bacteriology ,MicroScan ,Medicine (General) ,R5-920 - Abstract
Easy and robust antimicrobial susceptibility testing (AST) methods are essential in clinical bacteriology laboratories (CBL) in low-resource settings (LRS). We evaluated the Beckman Coulter MicroScan lyophilized broth microdilution panel designed to support Médecins Sans Frontières (MSF) CBL activity in difficult settings, in particular with the Mini-Lab. We evaluated the custom-designed MSF MicroScan Gram-pos microplate (MICPOS1) for Staphylococcus and Enterococcus species, MSF MicroScan Gram-neg microplate (MICNEG1) for Gram-negative bacilli, and MSF MicroScan Fastidious microplate (MICFAST1) for Streptococci and Haemophilus species using 387 isolates from routine CBLs from LRS against the reference methods. Results showed that, for all selected antibiotics on the three panels, the proportion of the category agreement was above 90% and the proportion of major and very major errors was below 3%, as per ISO standards. The use of the Prompt inoculation system was found to increase the MIC and the major error rate for some antibiotics when testing Staphylococci. The readability of the manufacturer’s user manual was considered challenging for low-skilled staff. The inoculations and readings of the panels were estimated as easy to use. In conclusion, the three MSF MicroScan MIC panels performed well against clinical isolates from LRS and provided a convenient, robust, and standardized AST method for use in CBL in LRS.
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- 2022
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11. Dimensions de la vulnérabilité liée au paludisme dans deux zones de Madagascar : apports d’une approche mixte
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Andry Herisoa Andrianasolo, Emma Raboanary, Chiarella Mattern, Thomas Kesteman, Dolorès Pourette, and Christophe Rogier
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malaria ,fever ,vulnerability linked to malaria ,seeking treatment ,prevention ,Madagascar ,Social Sciences - Abstract
Le risque de décès, d’aggravation d’une maladie ou d’endettement dans ses suites, dépend des dispositifs et moyens disponibles et accessibles à la population pour y faire face. Ainsi, la vulnérabilité liée au paludisme dépend des contextes socio-économique et géoclimatique qui déterminent le risque de transmission, des comportements individuels ou collectifs, et des moyens des ménages pour faire face à la maladie, la prendre en charge ou la prévenir.La présente étude vise à identifier les déterminants de la vulnérabilité liée au paludisme de la population de Madagascar, en analysant le contexte et les comportements de prévention et de recours aux soins médicaux en cas de fièvre. Une étude quantitative sur 4 043 personnes de 803 ménages a été combinée à une étude qualitative reposant sur une soixantaine d’entretiens, dans deux districts, Ankazobe (Hautes Terres) et Brickaville (côte est), où le risque de paludisme et les contextes psycho-sociaux différaient. Les données ont été collectées en 2014 dans le cadre d’une thèse et d’une étude pluridisciplinaire, multicentrique et internationale (projet PALEVALUT), pour laquelle un questionnaire et des guides d’entretien ont été développés, standardisés et validés.À Brickaville, les conditions bioclimatiques (chaudes et humides) sont plus favorables au développement des moustiques vecteurs du paludisme qu’à Ankazobe. La survenue de fièvre, la connaissance d’une personne décédée du paludisme, la perception de la dangerosité de cette maladie, la citation de fausses croyances à son sujet, l’utilisation de moustiquaires, le recours à un professionnel de santé et à un test sanguin pour son diagnostic, et le paiement de frais pour le déplacement vers une structure de santé ou pour obtenir des soins en cas de fièvre, y étaient significativement plus fréquents. En revanche, l’exposition à l’éducation pour la santé, la compréhension du paludisme, le recours aux agents communautaires et la prise d’une combinaison thérapeutique à base d’artémisinine en cas de prise d’antipaludique, y étaient significativement moins fréquents qu’à Ankazobe.Ainsi, à Brickaville où la prévalence du paludisme était la plus élevée, certaines connaissances, attitudes et pratiques, associées à la prévention ou au traitement étaient plus fréquentes alors que d’autres, notamment en matière thérapeutique, étaient plus souvent inappropriées. L’écosystème, la disponibilité, l’accessibilité et la nature des lieux de recours, l’exposition à l’éducation pour la santé, les pratiques médicales des soignants et des patients, différaient significativement dans ces sites distants de moins de 300 km ou entre des sous-populations d’un même site. Ces déterminants de la vulnérabilité liée au paludisme, multidimensionnels et complexes, sont présentés et discutés ici sur les plans quantitatifs et qualitatifs.
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- 2019
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12. Evaluating Effectiveness of Mass and Continuous Long-lasting Insecticidal Net Distributions Over Time in Madagascar: A Sentinel Surveillance Based Epidemiological Study
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Florian Girond, Yoann Madec, Thomas Kesteman, Milijaona Randrianarivelojosia, Rindra Randremanana, Lea Randriamampionona, Laurence Randrianasolo, Maherisoa Ratsitorahina, Vincent Herbreteau, Judith Hedje, Christophe Rogier, and Patrice Piola
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Medicine (General) ,R5-920 - Abstract
Background: The reduction of global malaria burden over the past 15 years is much attributed to the expansion of mass distribution campaigns (MDCs) of long-lasting insecticidal nets (LLIN). In Madagascar, two LLIN MDCs were implemented and one district also benefited from a community-based continuous distribution (CB-CD). Malaria incidence dropped but eventually rebounded after a decade. Methods: Data from a sentinel surveillance network over the 2009–2015 period was analyzed. Alerts were defined as weekly number of malaria cases exceeding the 90th percentile value for three consecutive weeks. Statistical analyses assessed the temporal relationship between LLIN MDCs and (i) number of malaria cases and (ii) malaria alerts detected, and (iii) the effect of a combination of MDCs and a CB-CD in Toamasina District. Findings: Analyses showed an increase of 13.6 points and 21.4 points in the percentile value of weekly malaria cases during the second and the third year following the MDC of LLINs respectively. The percentage of alert-free sentinel sites was 98.2% during the first year after LLIN MDC, 56.7% during the second year and 31.5% during the third year. The number of weekly malaria cases decreased by 14% during the CB-CD in Toamasina District. In contrast, sites without continuous distribution had a 12% increase of malaria cases. Interpretation: These findings support the malaria-preventive effectiveness of MDCs in Madagascar but highlight their limited duration when not followed by continuous distribution. The resulting policy implications are crucial to sustain reductions in malaria burden in high transmission settings. Keywords: Malaria, Madagascar, LLINs effectiveness, Sentinel surveillance
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- 2018
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13. Investigating Pneumonia Etiology Among Refugees and the Lebanese population (PEARL): A study protocol [version 2; peer review: 2 approved, 1 approved with reservations]
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Thomas Kesteman, Ali Ghassani, Crystel Hajjar, Valentina Picot, Marwan Osman, Zahraa Alnajjar, Florence Komurian-Pradel, Melina Messaoudi, Stéphane Pouzol, PEARL Study Group, Hicham Ghazi Soulaiman, Philippe Vanhems, Octavio Ramilo, Dolla Karam-Sarkis, Josette Najjar-Pellet, Monzer Hamze, and Hubert Endtz
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Medicine - Abstract
Background: Community-acquired pneumonia (CAP), a leading cause of mortality, mainly affects children in developing countries. The harsh circumstances experienced by refugees include various factors associated with respiratory pathogen transmission, and clinical progression of CAP. Consequently, the etiology of CAP in humanitarian crisis situations may differ to that of settled populations, which would impact appropriate case management. Therefore, the Pneumonia Etiology Among Refugees and the Lebanese population (PEARL) study was initiated with the objective of identifying the causal pathogenic microorganisms in the respiratory tract of children and adults from both the refugee and host country population presenting with signs of CAP during a humanitarian crisis. Methods: PEARL, a prospective, multicentric, case-control study, will be conducted at four primary healthcare facilities in Tripoli and the Bekaa valley over 15 months (including two high-transmission seasons/winters). Sociodemographic and medical data, and biological samples will be collected from at least 600 CAP cases and 600 controls. Nasopharyngeal swabs, sputum, urine and blood samples will be analyzed at five clinical pathology laboratories in Lebanon to identify the bacterial and viral etiological agents of CAP. Transcriptomic profiling of host leukocytes will be performed. Conclusions: PEARL is an original observational study that will provide important new information on the etiology of pneumonia among refugees, which may improve case management, help design antimicrobial stewardship interventions, and reduce morbidity and mortality due to CAP in a humanitarian crisis.
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- 2019
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14. Screening for monkeypox virus infections in men who have sex with men in a sexual health clinic in Hanoi, Viet Nam
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Paul C, Adamson, Hao Thi Minh, Bui, Thomas, Kesteman, Diep Thi Ngoc, Nguyen, Thuong Thi Hong, Nguyen, Tan, Van Le, Rogier H, van Doorn, Jeffrey D, Klausner, and Giang Minh, Le
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Microbiology (medical) ,Infectious Diseases ,Virology ,Microbiology - Published
- 2023
15. The protective effectiveness of control interventions for malaria prevention: a systematic review of the literature [version 1; referees: 1 approved, 2 approved with reservations]
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Thomas Kesteman, Milijaona Randrianarivelojosia, and Christophe Rogier
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Systematic Review ,Articles ,Global Health ,Health Systems & Services Research ,Preventive Medicine ,Science & Medical Policies ,malaria ,protective effectiveness ,prevention and control ,case-control studies ,health surveys ,insecticide-treated bed nets ,indoor residual spraying ,intermittent preventive treatment - Abstract
Background: Thanks to a considerable increase in funding, malaria control interventions (MCI) whose efficacy had been demonstrated by controlled trials have been largely scaled up during the last decade. Nevertheless, it was not systematically investigated whether this efficacy had been preserved once deployed on the field. Therefore, we sought the literature to assess the disparities between efficacy and effectiveness and the effort to measure the protective effectiveness (PE) of MCI. Methods: The PubMed database was searched for references with keywords related to malaria, to control interventions for prevention and to study designs that allow for the measure of the PE against parasitemia or against clinical outcomes. Results: Our search retrieved 1423 references, and 162 articles were included in the review. Publications were scarce before the year 2000 but dramatically increased afterwards. Bed nets was the MCI most studied (82.1%). The study design most used was a cross-sectional study (65.4%). Two thirds (67.3%) were conducted at the district level or below, and the majority (56.8%) included only children even if the MCI didn’t target only children. Not all studies demonstrated a significant PE from exposure to MCI: 60.6% of studies evaluating bed nets, 50.0% of those evaluating indoor residual spraying, and 4/8 showed an added PE of using both interventions as compared with one only; this proportion was 62.5% for intermittent preventive treatment of pregnant women, and 20.0% for domestic use of insecticides. Conclusions: This review identified numerous local findings of low, non-significant PE –or even the absence of a protective effect provided by these MCIs. The identification of such failures in the effectiveness of MCIs advocates for the investigation of the causes of the problem found. Ideal evaluations of the PE of MCIs should incorporate both a large representativeness and an evaluation of the PE stratified by subpopulations.
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- 2017
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16. Surveillance strategies using routine microbiology for antimicrobial resistance in low- and middle-income countries
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Cherry Lim, Raph L. Hamers, Direk Limmathurotsakul, Mayfong Mayxay, H. Rogier van Doorn, Thomas Kesteman, Elizabeth A. Ashley, Samuel Akech, Alejandra Corso, Iruka N. Okeke, and Paul Turner
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0301 basic medicine ,Microbiology (medical) ,Surveillance data ,business.industry ,Computer science ,030106 microbiology ,MEDLINE ,General Medicine ,Data availability ,Microbiology ,03 medical and health sciences ,Technical support ,0302 clinical medicine ,Infectious Diseases ,Diagnostic specimens ,Antibiotic resistance ,Low and middle income countries ,030212 general & internal medicine ,business ,Quality assurance - Abstract
Background: Routine microbiology results are a valuable source of antimicrobial resistance (AMR) surveillance data in low- and middle-income countries (LMICs) as well as in high-income countries. Different approaches and strategies are used to generate AMR surveillance data. Objectives: We aimed to review strategies for AMR surveillance using routine microbiology results in LMICs and to highlight areas that need support to generate high-quality AMR data. Sources: We searched PubMed for papers that used routine microbiology to describe the epidemiology of AMR and drug-resistant infections in LMICs. We also included papers that, from our perspective, were critical in highlighting the biases and challenges or employed specific strategies to overcome these in reporting AMR surveillance in LMICs. Content: Topics covered included strategies of identifying AMR cases (including case-finding based on isolates from routine diagnostic specimens and case-based surveillance of clinical syndromes), of collecting data (including cohort, point-prevalence survey, and case–control), of sampling AMR cases (including lot quality assurance surveys), and of processing and analysing data for AMR surveillance in LMICs. Implications: The various AMR surveillance strategies warrant a thorough understanding of their limitations and potential biases to ensure maximum utilization and interpretation of local routine microbiology data across time and space. For instance, surveillance using case-finding based on results from clinical diagnostic specimens is relatively easy to implement and sustain in LMIC settings, but the estimates of incidence and proportion of AMR is at risk of biases due to underuse of microbiology. Case-based surveillance of clinical syndromes generates informative statistics that can be translated to clinical practices but needs financial and technical support as well as locally tailored trainings to sustain. Innovative AMR surveillance strategies that can easily be implemented and sustained with minimal costs will be useful for improving AMR data availability and quality in LMICs.
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- 2021
17. Review of antibiotic prescriptions as part of antimicrobial stewardship programmes: results from a pilot implementation at two provincial-level hospitals in Viet Nam
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Ta Thi Dieu Ngan, Truong Anh Quan, Le Minh Quang, Vu Hai Vinh, Chau Minh Duc, Huynh Thi Nguyet, Nguyen Thi Cam Tu, Nguyen Hong Khanh, Le Ba Long, Nguyen Hong Hue, Dinh The Hung, Nguyen Duc Thanh, Nguyen Van Ve, Tran Thanh Giang, Le Thanh Tung, Truong Thanh Tuan, Thomas Kesteman, Elizabeth Dodds Ashley, Deverick J Anderson, H Rogier Van Doorn, and Vu Thi Lan Huong
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Microbiology (medical) ,Infectious Diseases ,Immunology ,Immunology and Allergy ,Microbiology - Abstract
Objectives To investigate the feasibility of retrospective prescription-based review and to describe the antibiotic prescribing patterns to provide information for an antimicrobial stewardship programme in Viet Nam Methods This study was conducted in two provincial-level hospitals between February and April 2020. Reviews were done by a clinical team consisting of leaders/senior doctors of each ward to assess the optimal level (optimal/adequate/suboptimal/inadequate/not assessable) of antibiotic prescriptions. Mixed-effect logistic regression at prescription level was used to explore factors associated with optimal antibiotic use. Results The retrospective prescription-based review was accepted by study clinical wards with varied levels of participants. One hundred and eighty-three patients (326 prescriptions) in Hospital 1 and 200 patients (344 prescriptions) in Hospital 2 were included. One hundred and nineteen of the 326 (36.5%) antibiotic prescriptions in Hospital 1 and 51/344 (14.8%) antibiotic prescriptions in Hospital 2 were determined to be optimal by the review teams. The number of adequate antibiotic prescriptions were 179/326 (54.9%) and 178 (51.7%) in Hospital 1 and Hospital 2, respectively. The optimal level was lower for surgical prophylaxis antibiotics than for empirical therapy (OR = 0.06; 95% CI 0.01–0.45), higher in prescriptions in the ICU (OR = 12.00; 95% CI 3.52–40.92), higher in definitive antibiotic therapy (OR = 48.12; 95% CI 7.17–322.57) and higher in those with an indication recorded in medical records (OR = 3.46; 95% CI 1.13–10.62). Conclusions This study provides evidence on the feasibility of retrospective prescription-based review, with adaption to the local situation. High and varying levels of optimal antibiotic prescriptions in clinical wards in hospitals were observed in Viet Nam.
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- 2022
18. Apramycin susceptibility of multidrug-resistant Gram-negative blood culture isolates in five countries in South-East Asia
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Marina Gysin, Pei Yun Hon, Pisey Tan, Amphonesavanh Sengduangphachanh, Manivone Simmalavong, Pattaraporn Hinfonthong, Napaporn Kaewphanderm, Thai Duy Pham, Thanh Ha Nguyen, Klara Haldimann, Katja Becker, H. Rogier van Doorn, Jill Hopkins, Andrew J.H. Simpson, Elizabeth A. Ashley, Thomas Kesteman, Hoang Huy Tran, Shawn Vasoo, Clare L. Ling, Tamalee Roberts, Paul Turner, Sven N. Hobbie, and University of Zurich
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Microbiology (medical) ,Colistin ,10179 Institute of Medical Microbiology ,610 Medicine & health ,General Medicine ,Microbial Sensitivity Tests ,Anti-Bacterial Agents ,Cephalosporins ,Infectious Diseases ,Aminoglycosides ,Carbapenems ,Blood Culture ,Drug Resistance, Multiple, Bacterial ,Gram-Negative Bacteria ,Pseudomonas aeruginosa ,Tobramycin ,Nebramycin ,570 Life sciences ,biology ,Pharmacology (medical) ,Gentamicins ,Amikacin ,Asia, Southeastern - Abstract
Bloodstream infections (BSIs) are a leading cause of sepsis, which is a life-threatening condition that significantly contributes to the mortality of bacterial infections. Aminoglycoside antibiotics such as gentamicin or amikacin are essential medicines in the treatment of BSIs, but their clinical efficacy is increasingly being compromised by antimicrobial resistance. The aminoglycoside apramycin has demonstrated preclinical efficacy against aminoglycoside-resistant and multidrug-resistant (MDR) Gram-negative bacilli (GNB) and is currently in clinical development for the treatment of critical systemic infections.This study collected a panel of 470 MDR GNB isolates from healthcare facilities in Cambodia, Laos, Singapore, Thailand and Vietnam for a multicentre assessment of their antimicrobial susceptibility to apramycin in comparison with other aminoglycosides and colistin by broth microdilution assays.Apramycin and amikacin MICs ≤ 16 µg/mL were found for 462 (98.3%) and 408 (86.8%) GNB isolates, respectively. Susceptibility to gentamicin and tobramycin (MIC ≤ 4 µg/mL) was significantly lower at 122 (26.0%) and 101 (21.5%) susceptible isolates, respectively. Of note, all carbapenem and third-generation cephalosporin-resistant Enterobacterales, all Acinetobacter baumannii and all Pseudomonas aeruginosa isolates tested in this study appeared to be susceptible to apramycin. Of the 65 colistin-resistant isolates tested, four (6.2%) had an apramycin MIC16 µg/mL.Apramycin demonstrated best-in-class activity against a panel of GNB isolates with resistances to other aminoglycosides, carbapenems, third-generation cephalosporins and colistin, warranting continued consideration of apramycin as a drug candidate for the treatment of MDR BSIs.
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- 2022
19. Feasibility, acceptability, and bacterial recovery for community-based biological sample collection to estimate antibiotic resistance in commensal gut and upper respiratory tract bacteria: a cross-sectional mixed-methods study
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Hoang Huy Tran, Hien Anh Thi Nguyen, Huyen Bang Tran, Bich Ngoc Thi Vu, Tu Cam Thi Nguyen, Costanza Tacoli, Thao Phuong Tran, Tung Son Trinh, Thien Hương Ngoc Cai, Behzad Nadjm, Kieu Hương Thi Tran, Quynh Dieu Pham, Thương Hong Thi Nguyen, Trang Thu Nguyen, Thai Duy Pham, Thomas Kesteman, Duc Anh Dang, Tien Dac Tran, Rogier van Doorn, and Sonia Lewycka
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BackgroundVietnam has high rates of antibiotic resistance, driven by overuse in agriculture, hospital, and community healthcare. Measures of resistance in commensal bacteria could provide a hard indicator for progress in evaluating the impact of interventions to reduce antibiotic use in the community. This study aimed to evaluate the feasibility, acceptability, and bacterial recovery for health-worker (HW) administered compared to self-administered swabs to recover Streptococcus pneumoniae, and stool collection to recover Enterobacterales in a community-based pilot study.MethodsWe conducted a cross-sectional mixed methods study in a rural community in Ha Nam Province, northern Vietnam. Between 16 July 2018 and 10 April 2019, 389 households were invited to participate in a household survey, Households were randomly selected and allocated in a 2:1 ratio to provide self-administered nasal swabs, or HW-administered nasopharyngeal swabs. Structured interviews were conducted with each household, and stool samples were self-collected from all household members. In-depth interviews with participants and health-workers were conducted in August 2018 to explore perspectives about different sample collection methods.Results324 households participated (83%), representing 1502 individuals. Stool samples were collected from 1498 individuals, self-administered nasal swabs from 1002 and HW-administered nasopharyngeal swabs from 496. S. pneumoniae were recovered from 11.1% (128/1,149) of the total population and 26.2% (48/183) of those under 5-years. Recovery was higher for HW-administered swabs (13.7%, 48/350) than self-administered swabs (10.0%, 80/799) (OR 2.06, 95% CI 1.07-3.96). Five main themes related to feasibility emerged through qualitative interviews: workload for data collectors; sample collection procedures; concerns about quality; storage and transportation; and disruptions. Nasopharyngeal swabs administered by health-workers took longer to collect, caused more discomfort and were more difficult to take from children. Costs per swab were cheaper for self-administered ($7.26) than HW-administered swabs ($8.63), but the total cost for 100 positive samples was higher ($7,260 and $6,300 respectively). Only 3 households refused to participate, representing a high acceptability of taking part. Factors affecting motivation to participate included sense of contribution, perceived trade-offs between benefits and effort, influence from others. Reluctance was related to stool sampling and negative perceptions of research. ConclusionsThis study provides important evidence for planning community-based carriage studies, including cost, logistics, and participant feedback about acceptability of different methods. Self-administered swabs had lower recovery, and though cheaper and quicker, this would translate to higher costs for large population-based studies requiring adequate numbers of positive samples for further testing. Factors that might improve recovery for self-administered swabs include swab-type, transport medium, and improved cold-chain to lab.
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- 2022
20. Biphasic versus monophasic manual blood culture bottles for low-resource settings: an in-vitro study
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Sien Ombelet, Alessandra Natale, Jean-Baptiste Ronat, Thomas Kesteman, Olivier Vandenberg, Jan Jacobs, and Liselotte Hardy
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Microbiology (medical) ,Adult ,Medicine (General) ,Bacteria ,Microbiology ,QR1-502 ,Agar ,Infectious Diseases ,R5-920 ,Blood Culture ,Virology ,Yeasts ,Humans ,Child - Abstract
Background Manual blood culture bottles (BCBs) are frequently used in low-resource settings. There are few BCB performance evaluations, especially evaluations comparing them with automated systems. We evaluated two manual BCBs (Bi-State BCB and BacT/ALERT BCB) and compared their yield and time to growth detection with those of automated BacT/ALERT system. Methods BCBs were spiked in triplicate with 177 clinical isolates representing pathogens common in low-resource settings (19 bacterial and one yeast species) in adult and paediatric volumes, resulting in 1056 spiked BCBs per BCB system. Growth in manual BCBs was evaluated daily by visually inspecting the broth, agar slant, and, for BacT/ALERT BCB, colour change of the growth indicator. The primary outcomes were BCB yield (proportion of spiked BCB showing growth) and time to detection (proportion of positive BCB with growth detected on day 1 of incubation). 95% CI for yield and growth on day 1 were calculated using bootstrap method for clustered data using. Secondary outcomes were time to colony for all BCBs (defined as number of days between incubation and colony growth sufficient to use for further testing) and difference between time to detection in broth and on agar slant for the Bi-State BCBs. Findings Overall yield was 95·9% (95% CI 93·9–98·0) for Bi-State BCB and 95·5% (93·3–97·8) for manual BacT/ALERT, versus 96·1% (94·0–98·1) for the automated BacT/ALERT system (p=0·61). Day 1 growth was present in 920 (90·8%) of 1013 positive Bi-State BCB and 757 (75·0%) of 1009 positive manual BacT/ALERT BCB, versus 1008 (99·3%) of 1015 automated bottles. On day 2, detection rates were 100% for BI-State BCB, 97·7% for manual BacT/ALERT BCB, and 100% for automated bottles. For Bi-State BCB, growth mostly occurred simultaneously in broth and slant (81·7%). Sufficient colony growth on the slant to perform further tests was present in only 44·1% of biphasic bottles on day 2 and 59·0% on day 3. Interpretation The yield of manual BCB was comparable with the automated system, suggesting that manual blood culture systems are an acceptable alternative to automated systems in low-resource settings. Bi-State BCB outperformed manual BacT/ALERT bottles, but the agar slant did not allow earlier detection nor earlier colony growth. Time to detection for manual blood culture systems still lags that of automated systems, and research into innovative and affordable methods of growth detection in manual BCBs is encouraged. Funding Médecins Sans Frontières and Department of Economy, Science and Innovation of the Flemish Government.
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- 2022
21. Improving antimicrobial use through antimicrobial stewardship in a lower-middle income setting: a mixed-methods study in a network of acute-care hospitals in Viet Nam
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Thomas Kesteman, Huynh Phuong Thao, H. Rogier van Doorn, Truong Anh Quan, Nguyen Van Kinh, Vu Thi Lan Huong, Ta Thi Dieu Ngan, Nguyen Thi Cam Tu, and Behzad Nadjm
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Microbiology (medical) ,medicine.medical_specialty ,Immunology ,education ,Psychological intervention ,Staffing ,Antimicrobial prescribing ,Qualitative property ,Antimicrobial resistance ,Microbiology ,Article ,Antimicrobial Stewardship ,Nursing ,Anti-Infective Agents ,Acute care ,medicine ,Immunology and Allergy ,Antimicrobial stewardship ,Humans ,Data collection ,Low- and middle-income countries ,Capacity building ,Focus group ,QR1-502 ,Hospitals ,Anti-Bacterial Agents ,Vietnam ,Viet Nam ,Business - Abstract
Highlights • Antimicrobial stewardship (AMS) in low- and middle-income settings has multiple players. • Leadership commitment greatly influences AMS implementation in hospitals. • Staff showed good perception of AMS but misperceptions on local resistance levels. • Guidelines on staffing and training standards are needed to support implementation. • More support is needed to promote active roles of pharmacists and microbiologists., Objectives This study aimed to analyse the current state of antimicrobial stewardship (AMS) in hospitals in Viet Nam, a lower-middle income country (LMIC), to identify factors determining success in AMS implementation and associated challenges to inform planning and design of future programmes. Methods We conducted a mixed-methods study in seven acute-care hospitals in the antimicrobial resistance (AMR) surveillance network in Viet Nam. Data collection included 7 focus group discussions, 40 in-depth interviews and a self-administered quantitative survey of staff on AMR and AMS programmes. We summarised qualitative data by reporting the most common themes according to the core AMS elements, and analysed quantitative data using proportions and a linear mixed-effects model. Results The findings reveal a complex picture of factors and actors involved in AMS implementation from the national level to the departmental and individual level within each hospital. The level of implementation varied, starting from the formation of an AMS committee, with or without active delivery of specific interventions. Development of treatment guidelines, pre-authorisation of antimicrobial drug classes, and post-prescription audit and feedback to doctors in selected clinical departments were the main interventions reported. A higher level of leadership support and commitment to AMS led to a higher level of engagement with AMS activities from the AMS team and effective collaboration between departments involved. Conclusion Establishing country-specific guidelines on AMS staffing and adapting standards for AMS education and training from international resources are needed to support capacity building to implement AMS programmes effectively in LMICs such as Viet Nam.
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- 2022
22. 'Tazomoka Is Not a Problem'. Local Perspectives on Malaria, Fever Case Management and Bed Net Use in Madagascar.
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Chiarella Mattern, Dolorès Pourette, Emma Raboanary, Thomas Kesteman, Patrice Piola, Milijaona Randrianarivelojosia, and Christophe Rogier
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Medicine ,Science - Abstract
BACKGROUND:Although its incidence has been decreasing during the last decade, malaria is still a major public health issue in Madagascar. The use of Long Lasting Insecticidal Nets (LLIN) remains a key malaria control intervention strategy in Madagascar, however, it encounters some obstacles. The present study aimed to explore the local terminology related to malaria, information channels about malaria, attitude towards bed nets, and health care seeking practices in case of fever. This article presents novel qualitative findings about malaria. Until now, no such data has been published for Madagascar. METHODS:A comparative qualitative study was carried out at four sites in Madagascar, each differing by malaria epidemiology and socio-cultural background of the populations. Seventy-one semi-structured interviews were conducted with biomedical and traditional caregivers, and members of the local population. In addition, observations of the living conditions and the uses of bed net were conducted. RESULTS:Due to the differences between local and biomedical perspectives on malaria, official messages did not have the expected impact on population in terms of prevention and care seeking behaviors. Rather, most information retained about malaria was spread through informal information circulation channels. Most interviewees perceived malaria as a disease that is simple to treat. Tazomoka ("mosquito fever"), the Malagasy biomedical word for malaria, was not used by populations. Tazo ("fever") and tazomahery ("strong fever") were the terms more commonly used by members of the local population to refer to malaria related symptoms. According to local perceptions in all areas, tazo and tazomahery were not caused by mosquitos. Each of these symptoms required specific health recourse. The usual fever management strategies consisted of self-medication or recourse to traditional and biomedical caregivers. Usage of bed nets was intermittent and was not directly linked to protection against malaria in the eyes of most Malagasy people. CONCLUSIONS:This article highlights the conflicting understanding of malaria between local perceptions and the biomedical establishment in Madagascar. Local perceptions of malaria present a holistic vision of the disease that includes various social and cultural dimensions, rather than reflecting one universal understanding, as in the biomedical image. The consideration of this "holistic vision" and other socio-cultural aspects surrounding the understanding of malaria is essential in implementing successful control intervention strategies.
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- 2016
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23. Family, social and cultural determinants of long-lasting insecticidal net (LLIN) use in Madagascar: secondary analysis of three qualitative studies focused on children aged 5–15 years
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Andry Andrianasolo, Ammy Fiadanana Njatosoa, Chiarella Mattern, Bakoly Rahaivondrafahitra, Christophe Rogier, Mauricette Andriamananjara, Aina Harimanana, Thomas Kesteman, Dolorès Pourette, Elliot Rakotomanana, Jocelyn Razafindrakoto, Emma Raboanary, Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université de Paris (UP), Unité de Recherche sur le Paludisme [Antananarivo, Madagascar], Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Oxford University Clinical Research Unit [Hanoi] (OUCRU), Population Services International Madagascar [Antananarivo], Population Services International [Washington], Ministère de la Santé Publique [Antananarivo, Madagascar], U.S. President’s Malaria Initiative [Antananarivo] (PMI), U.S. President's Malaria Initiative [Atlanta, GA,], Institut international des sciences sociales [Antananarivo] (IISS), Primum Vitare, The publication process of this paper has been funded by USAID through the Research, Innovation, Surveillance and Evaluation (RISE) programme., Institut de Recherche pour le Développement (IRD), and Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité)
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Male ,medicine.medical_specialty ,Mosquito Control ,lcsh:Arctic medicine. Tropical medicine ,Adolescent ,lcsh:RC955-962 ,LLIN use ,030231 tropical medicine ,[SHS.ANTHRO-BIO]Humanities and Social Sciences/Biological anthropology ,Ethnic group ,Qualitative property ,[SHS]Humanities and Social Sciences ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,parasitic diseases ,medicine ,Madagascar ,Humans ,lcsh:RC109-216 ,030212 general & internal medicine ,Children over five ,Insecticide-Treated Bednets ,Child ,Disease burden ,Research ,Public health ,[SHS.ANTHRO-SE]Humanities and Social Sciences/Social Anthropology and ethnology ,medicine.disease ,3. Good health ,Malaria ,Infectious Diseases ,Geography ,Child, Preschool ,Mosquito net ,Female ,Parasitology ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Thematic analysis ,Sociocultural factors ,Qualitative research - Abstract
BackgroundAlthough it is accepted that long-lasting insecticidal net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; the malaria prevalence is highest in this age group. The purpose of this research is to summarize recent qualitative studies describing LLIN use among the Malagasy people with a focus on children aged 5–15 years.MethodsQualitative data from three studies on malaria conducted between 2012 and 2016 in 10 districts of Madagascar were analysed. These studies cover all malaria epidemiological profiles and 10 of the 18 existing ethnic groups in Madagascar. A thematic analysis was conducted on the collected data from semi-structured interviews, direct observation data, and informal interviews.ResultsA total of 192 semi-structured interviews were conducted. LLINs are generally perceived positively because they protect the health and well-being of users. However, regional representations of mosquito nets may contribute to LLIN lower use by children over 5 years of age including the association between married status and LLIN use, which leads to the refusal of unmarried young men to sleep under LLINs; the custom of covering the dead with a mosquito net, which leads to fear of LLIN use; and taboos governing sleeping spaces for siblings of opposite sexes, which leads to LLIN shortages in households. Children under 5 years of age are known to be the most vulnerable age group for acquiring malaria and, therefore, are prioritized for LLIN use when there are limited supplies in households. In contrast, children over 5 years of age, who are perceived to be at less risk for malaria, often sleep without LLINs.ConclusionsPerceptions, social practices and regional beliefs regarding LLINs and vulnerability to malaria contribute to the nonuse of LLINs among children over 5 years of age in Madagascar. Modifying LLIN policies to account for these factors may increase LLIN use in this age group and reduce disease burden.
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- 2021
24. Social vulnerability of children aged 5 to 15 years to malaria in Madagascar: secondary analysis of 3 qualitative studies of LLIN use
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Mauricette Andriamananjara, Thomas Kesteman, Elliot Rakotomanana, Bakoly Rahaivondrafahitra, Andry Andrianasolo, Ammy Fiadanana Njatosoa, Christophe Rogier, Dolorès Pourette, Aina Harimanana, Chiarella Mattern, Jocelyn Razafindrakoto, and Emma Raboanary
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Geography ,Secondary analysis ,Environmental health ,parasitic diseases ,medicine ,medicine.disease ,Social vulnerability ,Malaria ,Qualitative research - Abstract
Background: Although it is accepted that long lasting insecticidal net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; the malaria prevalence is highest in this age group. The purpose of this article is to summarize recent qualitative studies describing LLIN use among children aged 5-15 years and explore options to increase their use in this age group.Methods: Qualitative data from three studies on malaria conducted between 2012 and 2016 in 10 districts of Madagascar were analyzed. These studies cover all malaria epidemiological profiles and 10 of the 18 existing ethnic groups in Madagascar. A thematic analysis was conducted on the collected data from semi-structured interviews, direct observation data, and informal interviews.Results: A total of 192 semi-structured interviews were conducted. LLINs are generally perceived positively because they protect the health and well-being of users. However, regional representations of mosquito nets may contribute to LLIN nonuse by children over 5 years of age including the association between married status and LLIN use, which leads to the refusal of unmarried young men to sleep under LLINs; the custom of covering the dead with a mosquito net, which leads to fear of LLIN use; and taboos governing sleeping spaces for siblings of opposite sexes, which leads to LLIN shortages in households. Children under 5 years of age are known to be the most vulnerable age group for acquiring malaria and therefore are prioritized for LLIN use when there are limited supplies in households. In contrast, children over 5 years of age, who are perceived to be at less risk for malaria, often sleep without LLINs.Conclusions: Perceptions, social practices and regional beliefs regarding LLINs and vulnerability to malaria contribute to the nonuse of LLINs among children over 5 years of age in Madagascar. Modifying LLIN policies to account for these factors may increase LLIN use in this age group and reduce disease burden.Trial registration: Not applicable
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- 2021
25. Biphasic Versus Monophasic Manual Blood Culture Bottles for Low-Resource Settings: An In-Depth in vitro Evaluation Using Simulated Blood Cultures
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Olivier Vandenberg, Liselotte Hardy, Alessandra Natale, Jean-Baptiste Ronat, Sien Ombelet, Thomas Kesteman, and Jan F. Jacobs
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Veterinary medicine ,food.ingredient ,medicine.diagnostic_test ,business.industry ,Low resource ,University hospital ,food ,Blood culture bottles ,Medicine ,Agar ,Blood culture ,Subculture (biology) ,Detection rate ,business ,Blood bank - Abstract
Introduction: Manual (visually read) blood culture bottles (BCB) are frequently used in low-resource settings (LRS) where automated alternatives are less suitable. Yet performance evaluations of these BCBs are lacking, especially in comparison to automated systems. We evaluated two manual BCB types (the Bi-State BCB, Autobio; visually read BacT/ALERT bottles, bioMerieux) and used BacT/ALERT BCB monitored in a BacT/ALERT automate as a reference method. Methods: BCBs were spiked in triplicate with 177 clinical isolates representing pathogens frequently found in LRS (19 bacterial, 1 yeast species) for both adult and pediatric formulations. Growth in manual BCBs was evaluated by visually inspecting the broth, agar slant, and – for BacT/ALERT BCB – color change of the growth indicator. Blind subculture was conducted after overnight incubation (Day 1). Results: Overall yield was 95·9% and 95·5% for Bi-State and manual BacT/ALERT respectively, versus 96·1% for the reference method. The lowest yield occurred for Neisseria meningitidis and Burkholderia cepacia (83·3% and 83·1%) and was consistent among the three BC systems. On Day 1, growth was detected in 90·7% and 75·0% of grown BCBs in Bi-State and BacT/ALERT respectively, versus 99·3% for the reference method. On Day 2 detection rates were 100%, 97·7% and 100% respectively. Among 1013 grown Bi-State BCBs, growth mostly co-occurred in broth and slant (81·7%). Sufficient colony growth on the slant to perform further tests was present in only 44·1% and 59·0% of biphasic bottles on Day 2 and Day 3 respectively. Blind subculture generated colonies on Day 2 for 99·7% grown Bi-State and 99·2% of manual BacT/ALERT bottles respectively. Conclusion: In these in-vitro experiments, the yield and time-to-detection of manual BCBs were comparable to an automated system. Bi-State BCBs outperformed manual BacT/ALERT bottles, but the agar slant did not allow earlier detection nor earlier colony growth when compared to blind subculture on Day 1. Funding Statement: This research was funded by Medecins Sans Frontieres (Mini-Lab project). Medecins Sans Frontieres participated in study design, interpretation and writing of the manuscript. Declaration of Interests: None to declare. Ethics Approval Statement: Leftover blood from blood bank volunteers was used under research contract (file number CM20180327A). Clinical strains were obtained from ITM travel clinic and microbiological surveillance studies (Surveillance of antimicrobial resistance among consecutive blood culture isolates in tropical settings, Institutional Review Board 613/08, Ethical Committee University Hospital of Antwerp 8/20/96).
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- 2021
26. Testing bio-efficacy of insecticidetreated nets with fewer mosquitoes for enhanced malaria control
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Sébastien Boyer, Emilie Pothin, Christophe Rogier, Thomas Kesteman, Sanjiarizaha Randriamaherijaona, Unité d'Entomologie Médicale [Antananarivo, Madagascar] (IPM), Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Institut Pasteur du Cambodge, Réseau International des Instituts Pasteur (RIIP), Swiss Tropical and Public Health Institute [Basel], Ecole doctorale Science de la vie et de l'Environnement, Université d'Antananarivo, Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes (URMITE), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche Biomédicale des Armées [Brétigny-sur-Orge] (IRBA), Fondation Mérieux, This research was supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria via the Initiative 5% Programme initiated by the French Ministry of Foreign Affairs and France Expertise Internationale (grant #12INI210). This work was also funded by the President’s Malaria Initiative (PMI) and the opinions expressed herein are those of the authors and do not necessarily reflect the views of PMI., INSB-INSB-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), and Institut de Recherche Biomédicale des Armées (IRBA)
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0301 basic medicine ,[SDV.OT]Life Sciences [q-bio]/Other [q-bio.OT] ,Mosquito Control ,030231 tropical medicine ,lcsh:Medicine ,Article ,Toxicology ,03 medical and health sciences ,0302 clinical medicine ,parasitic diseases ,medicine ,Confidence Intervals ,Animals ,Insecticide-Treated Bednets ,lcsh:Science ,Insecticide treated nets ,Bio efficacy ,Mathematics ,Laboratory methods ,Multidisciplinary ,lcsh:R ,Bayes Theorem ,medicine.disease ,Confidence interval ,3. Good health ,Malaria ,030104 developmental biology ,lcsh:Q ,Biological Assay ,Decision process ,Malaria control - Abstract
Malaria control programs implementing Long-Lasting Insecticidal Nets (LLINs) are encouraged to conduct field monitoring of nets’ survival, fabric integrity and insecticidal bio-efficacy. The reference method for testing the insecticide activity of LLINs needs 100 two-to-five-day-old female mosquitoes per net, which is highly resource-intensive. We aimed at identifying an alternative protocol, using fewer mosquitos, while ensuring a precision in the main indicator of ±5 percentage points (pp). We compared different laboratory methods against the probability of the LLIN to fail the test as determined by a hierarchical Bayesian model. When using 50 mosquitoes per LLIN and considering mortality only instead of mortality or knock-down as validity criteria, the average error in the measure of the proportion of nets considered as valid was 0.40 pp. The 95% confidence interval of this value never exceed 5 pp when the number of LLIN tested was ≥40. This method slightly outperforms the current recommendations. As a conclusion, testing the bio-efficacy of LLINs with half as many mosquitoes provides a valid evaluation of the proportion of valid LLINs. This approach could increase entomology labs’ testing capacity and decrease costs, with no impact in the decision process for public health purposes.
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- 2020
27. Social vulnerability of children aged 5 to 15 years to malaria in Madagascar: 3 anthropological studies LLIN use
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Ammy Fiadanana NJATOSOA, Chiarella Mattern, Dolorès Pourette, Thomas Kesteman, Elliot Rakotomanana, Bakoly Rahaivondrafahitra, Mauricette Andriamananjara, Aina Harimanana, Jocelyn Razafindrakoto, Emma Raboanary, Andry Andrianasolo, and Christophe Rogier
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parasitic diseases - Abstract
BackgroundAlthough it is accepted that long lasting insecticide bed net (LLIN) use is an effective means to prevent malaria, children aged 5 to 15 years do not appear to be sufficiently protected in Madagascar; malaria prevalence is highest in this age group. The purpose of this article is to summarize recent qualitative studies describing LLIN use among children aged 5–15 years and explore options to increase their use in this age group.MethodsQualitative data from three anthropological studies on malaria conducted between 2012 and 2016 in 10 districts of Madagascar were analyzed. These studies cover all malaria epidemiological profiles and 10 of the 18 existing ethnic groups in Madagascar. A thematic analysis was conducted on the collected data from semi-structured interviews, direct observation data, and informal interviews.ResultsA total of 192 semi-structured interviews were conducted. LLINs are generally perceived positively because they protect the health and well-being of users. However, regional representations of mosquito nets may contribute to LLIN nonuse by children over 5 years of age including the association between married status and LLIN use, which leads to the refusal of unmarried young men to sleep under LLINs; the custom of covering the dead with a mosquito net, which leads to fear of LLIN use; and taboos governing sleeping spaces for siblings of opposite sexes, which leads to LLIN shortages in households. Children under 5 years of age are known to be the most vulnerable age group for acquiring malaria and therefore are prioritized for LLIN use when there are limited supplies in households. In contrast, children over 5 years of age, who are perceived to be at less risk for malaria, often sleep without LLINs.ConclusionsPerceptions, social practices and regional beliefs regarding LLINs s and vulnerability to malaria contribute to the nonuse of LLINs among children over 5 years of age in Madagascar. Modifying LLIN policies to account for these factors may increase LLIN use in this age group and reduce disease burden.Trial registrationNot applicable
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- 2020
28. School-Based Serosurveys to Assess the Validity of Using Routine Health Facility Data to Target Malaria Interventions in the Central Highlands of Madagascar
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Odile Mercereau-Puijalon, Tsikiniaina Rasoloharimanana, Laura C. Steinhardt, Thomas Kesteman, Emma Rakotomalala, Christophe Rogier, Aina Harimanana, Seheno Razanatsiorimalala, Sixte Zigirumugabe, Elisabeth Ravaoarisoa, Anny M Randriamoramanana, Milijaona Randrianarivelojosia, Inès Vigan-Womas, Judith Hedje, Ryan E. Wiegand, Patrice Piola, Annett H. Cotte, Jessica Butts, Ronald Perraut, Jean Marius Rakotondramanga, Arsène Ratsimbasoa, Centers for Disease Control and Prevention [Atlanta] (CDC), Centers for Disease Control and Prevention, G4 malaria group [Antananarivo, Madagascar] (IPM), Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Université d'Antananarivo, Unité d'Epidémiologie [Antananarivo, Madagascar] (IPM), U.S. President’s Malaria Initiative [Antananarivo] (PMI), U.S. President's Malaria Initiative [Atlanta, GA,], U.S.President's Malaria Initiative (PMI), AGENCY FOR INTERNATIONAL DEVELOPMENT WASHINGTON USA, Partenaires IRSTEA, Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA), Fondation Mérieux, Unité d'immunologie des maladies infectieuses [Antananarivo, Madagascar] (IPM), Département Parasites et Insectes vecteurs - Department of Parasites and Insect Vectors, Institut Pasteur [Paris] (IP), Institut Pasteur de Dakar, Réseau International des Instituts Pasteur (RIIP), Ministère de la Santé Publique - Ministry of Public Health [Antananarivo, Madagascar], Institut Hospitalier Universitaire Méditerranée Infection (IHU Marseille), Unité d'Épidémiologie et de Santé Publique [Phnom Penh], Institut Pasteur du Cambodge, This work was supported by the US President’s Malaria Initiative program (grant number AID-687-G-13-00003 Surveillance and Data for Management Project)., We express our gratitude to the population of the districts and communes investigated and especially to the children, parents, guardians, and teachers who participated to the study. We also thank those who facilitated the survey, that is heads of communes and fokontany, local administration authorities, and health authorities from Ministry of Health and National Malaria Control Program. We also thank the survey teams., Institut Pasteur [Paris], and Ministère de la Santé Publique [Antananarivo, Madagascar]
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030231 tropical medicine ,Indoor residual spraying ,malaria ,serology ,[SDV.BC]Life Sciences [q-bio]/Cellular Biology ,Serology ,03 medical and health sciences ,0302 clinical medicine ,stratification ,Health facility ,Seroepidemiologic Studies ,Environmental health ,parasitic diseases ,school-based surveys ,Madagascar ,Immunology and Allergy ,Medicine ,Seroprevalence ,Humans ,030212 general & internal medicine ,Seroconversion ,2. Zero hunger ,Schools ,business.industry ,[SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology ,medicine.disease ,Confidence interval ,3. Good health ,Infectious Diseases ,[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology ,Data quality ,[SDV.IMM]Life Sciences [q-bio]/Immunology ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Health Facilities ,business ,Malaria - Abstract
Background In low-malaria–transmission areas of Madagascar, annual parasite incidence (API) from routine data has been used to target indoor residual spraying at subdistrict commune level. To assess validity of this approach, we conducted school-based serological surveys and health facility (HF) data quality assessments in 7 districts to compare API to gold-standard commune-level serological measures. Methods At 2 primary schools in each of 93 communes, 60 students were randomly selected with parents and teachers. Capillary blood was drawn for rapid diagnostic tests (RDTs) and serology. Multiplex bead-based immunoassays to detect antibodies to 5 Plasmodium falciparum antigens were conducted, and finite mixture models used to characterize seronegative and seropositive populations. Reversible catalytic models generated commune-level annual seroconversion rates (SCRs). HF register data were abstracted to assess completeness and accuracy. Results RDT positivity from 12 770 samples was 0.5%. Seroprevalence to tested antigens ranged from 17.9% (MSP-1) to 59.7% (PF13). Median commune-level SCR was 0.0108 (range, 0.001–0.075). Compared to SCRs, API identified 71% (95% confidence interval, 51%–87%) of the 30% highest-transmission communes; sensitivity declined at lower levels. Routine data accuracy did not substantially affect API performance. Conclusions API performs reasonably well at identifying higher-transmission communes but sensitivity declined at lower transmission levels.
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- 2020
29. Evaluating Effectiveness of Mass and Continuous Long-lasting Insecticidal Net Distributions Over Time in Madagascar: A Sentinel Surveillance Based Epidemiological Study
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Laurence Randrianasolo, Thomas Kesteman, Maherisoa Ratsitorahina, Yoann Madec, Patrice Piola, Vincent Herbreteau, Florian Girond, Milijaona Randrianarivelojosia, Christophe Rogier, Rindra Randremanana, Lea Randriamampionona, Judith Hedje, UMR 228 Espace-Dev, Espace pour le développement, Université de Guyane (UG)-Université des Antilles (UA)-Institut de Recherche pour le Développement (IRD)-Université de Perpignan Via Domitia (UPVD)-Avignon Université (AU)-Université de La Réunion (UR)-Université de Montpellier (UM), Unité d'Epidémiologie [Antananarivo, Madagascar] (IPM), Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Elimination 8 (E8), Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology, Pasteur-Cnam Risques infectieux et émergents (PACRI), Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), Fondation Mérieux, Unité de Recherche sur le Paludisme [Antananarivo, Madagascar], Direction de la Veille Sanitaire et de la Surveillance Epidémiologique [Madagascar] (DVSSE), Ministère de la Santé Publique [Antananarivo, Madagascar], Centers for Disease Control and Prevention [Atlanta] (CDC), Centers for Disease Control and Prevention, U.S. President’s Malaria Initiative [Antananarivo] (PMI), U.S. President's Malaria Initiative [Atlanta, GA,], Réseau International des Instituts Pasteur (RIIP), Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes (URMITE), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche Biomédicale des Armées (IRBA), Unité d'Épidémiologie et de Santé Publique [Phnom Penh], Institut Pasteur du Cambodge, This research was supported by ASPR within the US DHHS (Assistant Secretary for Preparedness and Response with the US Department of Health and Human Services, grant No. 5 IDSEP140020-03-00) and by the USAID (grant No. AID-687-G-13-00003)., RANDRIAMANANTSOA, Volatiana Manohisoa, Institut de Recherche pour le Développement (IRD)-Université de Perpignan Via Domitia (UPVD)-Avignon Université (AU)-Université de La Réunion (UR)-Université de Montpellier (UM)-Université de Guyane (UG)-Université des Antilles (UA), Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Ministère de la Santé Publique - Ministry of Public Health [Antananarivo, Madagascar], and Institut de Recherche Biomédicale des Armées [Brétigny-sur-Orge] (IRBA)
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Long lasting ,EPIDEMIOLOGIE ,medicine.medical_specialty ,030231 tropical medicine ,Sentinel surveillance ,03 medical and health sciences ,0302 clinical medicine ,High transmission ,Statistical analyses ,SURVEILLANCE ,Epidemiology ,parasitic diseases ,Madagascar ,Medicine ,[SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology ,030212 general & internal medicine ,ANALYSE STATISTIQUE ,lcsh:R5-920 ,ANALYSE DIACHRONIQUE ,business.industry ,1. No poverty ,General Medicine ,Percentile value ,PALUDISME ,PREVENTION SANITAIRE ,medicine.disease ,LLINs effectiveness ,3. Good health ,Malaria ,Malaria incidence ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,INSECTICIDE CHIMIQUE ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,lcsh:Medicine (General) ,business ,[SDV.MP.PAR] Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology ,Demography ,Research Paper - Abstract
Background: The reduction of global malaria burden over the past 15 years is much attributed to the expansion of mass distribution campaigns (MDCs) of long-lasting insecticidal nets (LLIN). In Madagascar, two LLIN MDCs were implemented and one district also benefited from a community-based continuous distribution (CB-CD). Malaria incidence dropped but eventually rebounded after a decade. Methods: Data from a sentinel surveillance network over the 2009–2015 period was analyzed. Alerts were defined as weekly number of malaria cases exceeding the 90th percentile value for three consecutive weeks. Statistical analyses assessed the temporal relationship between LLIN MDCs and (i) number of malaria cases and (ii) malaria alerts detected, and (iii) the effect of a combination of MDCs and a CB-CD in Toamasina District. Findings: Analyses showed an increase of 13.6 points and 21.4 points in the percentile value of weekly malaria cases during the second and the third year following the MDC of LLINs respectively. The percentage of alert-free sentinel sites was 98.2% during the first year after LLIN MDC, 56.7% during the second year and 31.5% during the third year. The number of weekly malaria cases decreased by 14% during the CB-CD in Toamasina District. In contrast, sites without continuous distribution had a 12% increase of malaria cases. Interpretation: These findings support the malaria-preventive effectiveness of MDCs in Madagascar but highlight their limited duration when not followed by continuous distribution. The resulting policy implications are crucial to sustain reductions in malaria burden in high transmission settings. Keywords: Malaria, Madagascar, LLINs effectiveness, Sentinel surveillance
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- 2018
30. Clinical bacteriology in low-resource settings: today's solutions
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John Stelling, Olivier Vandenberg, Marie-France Phoba, David A. B. Dance, Daniel Seifu, Elisabeth Delarocque-Astagneau, Erika Vlieghe, Cedric P. Yansouni, Timothy R. Walsh, Makeda Semret, Yves Gille, Octavie Lunguya, Palpouguini Lompo, Heidi Schütt-Gerowitt, Paul N. Newton, Céline Langendorf, Barbara Barbé, Tjalling Leenstra, Delphine Martiny, Heiman F. L. Wertheim, Thomas Kesteman, Jan Jacobs, Janneke A. Cox, Samuel Kariuki, Gunnar Kahlmeter, Sayda El Safi, Awa Aidara Kane, Dadi Falay, Claude Mambo Muvunyi, Thierry Naas, Thong Phe, Constance Schultsz, Maurice Page, Joanne Letchford, Jean-Baptiste Ronat, Dissou Affolabi, Sien Ombelet, Newton, P, Dance, D, and Bacteriology Low Resource Settings
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0301 basic medicine ,Information management ,Quality Assurance, Health Care ,Referral ,media_common.quotation_subject ,030106 microbiology ,MEDLINE ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,Health care ,Humans ,Quality (business) ,Developing Countries ,media_common ,Bacteriological Techniques ,Cross Infection ,business.industry ,Bacteriology ,Drug Resistance, Microbial ,Microbiological Techniques ,Identification (information) ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,Infectious Diseases ,Risk analysis (engineering) ,Health Resources ,Human medicine ,Laboratories ,business ,Quality assurance - Abstract
Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementation of clinical bacteriology. In this Personal View, we explore what constitutes successful implementation of clinical bacteriology in low-resource settings and describe a framework for implementation that is suitable for general referral hospitals in low-income and middle-income countries with a moderate infrastructure. Most microbiological techniques and equipment are not developed for the specific needs of such settings. Pending the arrival of a new generation diagnostics for these settings, we suggest focus on improving, adapting, and implementing conventional, culture-based techniques. Priorities in low-resource settings include harmonised, quality assured, and tropicalised equipment, consumables, and techniques, and rationalised bacterial identification and testing for antimicrobial resistance. Diagnostics should be integrated into clinical care and patient management; clinically relevant specimens must be appropriately selected and prioritised. Open-access training materials and information management tools should be developed. Also important is the need for onsite validation and field adoption of diagnostics in low-resource settings, with considerable shortening of the time between development and implementation of diagnostics. We argue that the implementation of clinical bacteriology in low-resource settings improves patient management, provides valuable surveillance for local antibiotic treatment guidelines and national policies, and supports containment of antimicrobial resistance and the prevention and control of hospital-acquired infections.
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- 2018
31. Assessing feasibility of establishing antimicrobial stewardship programmes in two provincial-level hospitals in Vietnam: an implementation research study
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Vu Hai Vinh, Nguyen Thi Cam Tu, Ta Thi Dieu Ngan, Vu Thi Lan Huong, Tran Thi Thu Hanh, Phan Van Be Bay, Pham Thi Thuy Hang, Tran Duc, Elizabeth Dodds Ashley, Truong Anh Quan, H. Rogier van Doorn, Deverick J. Anderson, Nguyen Thi Thuy Oanh, Thomas Kesteman, Chau Minh Duc, Huynh Phuong Thao, Le Minh Quang, Nguyen Thi Thu Hien, and Vo Thi Hoang Dung Em
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health services administration & management ,Psychological intervention ,Audit ,Pharmacists ,health & safety ,quality in health care ,Antimicrobial Stewardship ,Nursing ,Humans ,Medicine ,Antimicrobial stewardship ,SWOT analysis ,business.industry ,public health ,Stakeholder ,health policy ,General Medicine ,Hospitals ,Clinical pharmacy ,Outreach ,internal medicine ,Infectious Diseases ,Vietnam ,Feasibility Studies ,Implementation research ,business - Abstract
ObjectivesTo investigate the feasibility of establishing hospital-based antimicrobial stewardship (AMS) programmes comprising action-planning, educational interventions and data feedback in two provincial-level hospitals in Viet Nam.Design and settingThis was an implementation research using participatory action process and existing resources from the Duke Antimicrobial Stewardship Outreach Network with local adjustments. A national stakeholder meeting and Strengths-Weaknesses-Opportunities-Threats (SWOT) analysis were conducted to identify gaps and potential interventions.ParticipantsHospital AMS staff implemented activities throughout the study phases. Routinely collected patient data were analysed to support planning, implementation and evaluation.InterventionsHospitals were considered as a complex adaptive system and leveraged their unique characteristics and interconnections to develop 1-year plans containing core interventions (data use, educational training, prospective audit with feedback (PAF) and evaluations).Outcome measuresWe assessed feasibility using outputs from stakeholder meeting, SWOT analysis, baseline data, planning process and implementation.ResultsThe stakeholder meeting identified three gaps for AMS at national level: supportive policies, AMS training and core competencies and collaboration. At the hospitals, AMS programmes took 1 year for planning due to lack of hospital-specific procedures and relevant staff competencies. Baseline data (January–December 2019) showed variations in antibiotic consumption: 951 days of therapy (DOT) per 1000 days present in the control and 496 in the intervention wards in hospital 1, and 737 and 714 in hospital 2, respectively. During 1-year implementation, clinical pharmacists audited 1890 antibiotic prescriptions in hospital 1 (June 2020–May 2021) and 1628 in hospital 2 (July 2020–July 2021), and will continue PAF in their daily work.ConclusionOur data confirmed the need to contextualise AMS programmes in low-income and middle-income countries (LMICs) and demonstrated the usefulness of implementation research design in assessing programme feasibility. Developing staff competencies, using local data to stimulate actions and integrating programme activities in routine hospital work are key to success in LMICs.
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- 2021
32. Post-deployment effectiveness of malaria control interventions on Plasmodium infections in Madagascar: a comprehensive phase IV assessment
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Thomas Kesteman, Milijaona Randrianarivelojosia, Patrice Piola, and Christophe Rogier
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Adult ,Male ,Veterinary medicine ,Mosquito Control ,Adolescent ,Cross-sectional study ,Health surveys ,030231 tropical medicine ,Psychological intervention ,Indoor residual spraying ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Environmental health ,Surveys and Questionnaires ,parasitic diseases ,Prevalence ,Disease Transmission, Infectious ,Madagascar ,Medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,Child ,Health Education ,Mass screening ,Aged ,Aged, 80 and over ,business.industry ,Diagnostic Tests, Routine ,Research ,Infant ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Malaria ,Prevention and control ,Mosquito control ,Infectious Diseases ,Cross-Sectional Studies ,Communicable Disease Control ,Parasitology ,Female ,Health Services Research ,business - Abstract
Background Because international funding for malaria control is plateauing, affected countries that receive foreign funding are expected to maintain a constant budget while continuing to reduce Plasmodium transmission. To investigate the appropriateness of a malaria control policy in Madagascar, the effectiveness of all currently deployed malaria control interventions (MCIs) was measured. Methods A nationwide cross-sectional survey was conducted in 2012–2013 at 62 sites throughout Madagascar. A total of 15,746 individuals of all ages were tested for Plasmodium infection using rapid diagnostic tests and were interviewed about their use of long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS), intermittent preventive treatment of pregnant women (IPTp), and exposure to information, education and communication (IEC) campaigns. The association between Plasmodium infection and MCI exposure was calculated using multivariate multilevel models, and the protective effectiveness (PE) of an intervention was defined as one minus the odds ratio of this association. Results The individual PE of regular LLIN use was high and significant (41 %, 95 % confidence interval [CI] 23–54), whereas its community PE was not. The PE of IRS at the household level was significant in one transmission pattern only (44 %, 95 % CI 11–65), and the community PE with high IRS coverage (>75 %) was high and significant overall (78 %, 95 % CI 44–91). Using LLINs after IRS increased the PE, and the reciprocal was also true. The maternal PE of IPTp was high but non-significant (65 %, 95 % CI −32 to 91). The PE of IEC was low, non-significant and restricted to certain areas (24 %, 95 % CI −34 to 57). Conclusions This snapshot of the effectiveness of MCIs confirms that integrated vector control is required in malaria control policies in Madagascar and suggests combining MCIs when one is questionable. Policymakers should consider the local effectiveness of all deployed MCIs through a similar phase IV assessment. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1376-5) contains supplementary material, which is available to authorized users.
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- 2016
33. 'Tazomoka Is Not a Problem'. Local Perspectives on Malaria, Fever Case Management and Bed Net Use in Madagascar
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Dolorès Pourette, Thomas Kesteman, Christophe Rogier, Patrice Piola, Emma Raboanary, Milijaona Randrianarivelojosia, and Chiarella Mattern
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Male ,Veterinary medicine ,Health Knowledge, Attitudes, Practice ,Epidemiology ,lcsh:Medicine ,Fevers ,Disease ,Disease Vectors ,Pathology and Laboratory Medicine ,Mosquitoes ,Geographical Locations ,Families ,0302 clinical medicine ,Medicine and Health Sciences ,Hofstede's cultural dimensions theory ,Public and Occupational Health ,030212 general & internal medicine ,lcsh:Science ,Children ,education.field_of_study ,Multidisciplinary ,Mosquito Nets ,Middle Aged ,Insects ,Infectious Diseases ,Female ,Research Article ,Adult ,medicine.medical_specialty ,Arthropoda ,Infectious Disease Control ,Fever ,030231 tropical medicine ,Population ,03 medical and health sciences ,Signs and Symptoms ,Environmental health ,Intervention (counseling) ,Terminology as Topic ,parasitic diseases ,medicine ,Parasitic Diseases ,Madagascar ,Animals ,Humans ,education ,Aged ,business.industry ,Public health ,lcsh:R ,Organisms ,Biology and Life Sciences ,Patient Acceptance of Health Care ,medicine.disease ,Tropical Diseases ,Invertebrates ,Malaria ,Insect Vectors ,Health Care ,Age Groups ,People and Places ,Africa ,lcsh:Q ,Population Groupings ,Health Statistics ,Morbidity ,business ,Case Management ,Qualitative research - Abstract
Background Although its incidence has been decreasing during the last decade, malaria is still a major public health issue in Madagascar. The use of Long Lasting Insecticidal Nets (LLIN) remains a key malaria control intervention strategy in Madagascar, however, it encounters some obstacles. The present study aimed to explore the local terminology related to malaria, information channels about malaria, attitude towards bed nets, and health care seeking practices in case of fever. This article presents novel qualitative findings about malaria. Until now, no such data has been published for Madagascar. Methods A comparative qualitative study was carried out at four sites in Madagascar, each differing by malaria epidemiology and socio-cultural background of the populations. Seventy-one semi-structured interviews were conducted with biomedical and traditional caregivers, and members of the local population. In addition, observations of the living conditions and the uses of bed net were conducted. Results Due to the differences between local and biomedical perspectives on malaria, official messages did not have the expected impact on population in terms of prevention and care seeking behaviors. Rather, most information retained about malaria was spread through informal information circulation channels. Most interviewees perceived malaria as a disease that is simple to treat. Tazomoka (“mosquito fever”), the Malagasy biomedical word for malaria, was not used by populations. Tazo (“fever”) and tazomahery (“strong fever”) were the terms more commonly used by members of the local population to refer to malaria related symptoms. According to local perceptions in all areas, tazo and tazomahery were not caused by mosquitos. Each of these symptoms required specific health recourse. The usual fever management strategies consisted of self-medication or recourse to traditional and biomedical caregivers. Usage of bed nets was intermittent and was not directly linked to protection against malaria in the eyes of most Malagasy people. Conclusions This article highlights the conflicting understanding of malaria between local perceptions and the biomedical establishment in Madagascar. Local perceptions of malaria present a holistic vision of the disease that includes various social and cultural dimensions, rather than reflecting one universal understanding, as in the biomedical image. The consideration of this “holistic vision” and other socio-cultural aspects surrounding the understanding of malaria is essential in implementing successful control intervention strategies.
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- 2016
34. Effectiveness of malaria control interventions in Madagascar: a nationwide case-control survey
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Vaomalala Raharimanga, Patrice Piola, Laurence Randrianasolo, Thomas Kesteman, Milijaona Randrianarivelojosia, Christophe Rogier, Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP), Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes (URMITE), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Fondation Mérieux, Unité d'Epidémiologie [Antananarivo, Madagascar] (IPM), Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Institut de Recherche Biomédicale des Armées [Brétigny-sur-Orge] (IRBA), This research was supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria via the Initiative 5 % programme initiated by the French Ministry of Foreign Affairs and France Expertise Internationale (Grant #12INI109)., ANR-05-PADD-0012,PRODDIG,Promotion du Développement Durable par les Indications Géographiques(2005), INSB-INSB-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), and Institut de Recherche Biomédicale des Armées (IRBA)
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Adult ,Male ,medicine.medical_specialty ,Veterinary medicine ,Mosquito Control ,Multivariate analysis ,Adolescent ,Cross-sectional study ,Health surveys ,030231 tropical medicine ,Psychological intervention ,Indoor residual spraying ,Case-control studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,parasitic diseases ,Madagascar ,Humans ,Medicine ,030212 general & internal medicine ,Insecticide-Treated Bednets ,Child ,Insecticide-treated bed nets ,business.industry ,Research ,Public health ,Odds ratio ,medicine.disease ,Vector control ,Case–control studies ,3. Good health ,Malaria ,Prevention and control ,Cross-Sectional Studies ,Infectious Diseases ,Tropical medicine ,Female ,Parasitology ,Morbidity ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Background Madagascar, as other malaria endemic countries, depends mainly on international funding for the implementation of malaria control interventions (MCI). As these funds no longer increase, policy makers need to know whether these MCI actually provide the expected protection. This study aimed at measuring the effectiveness of MCI deployed in all transmission patterns of Madagascar in 2012–2013 against the occurrence of clinical malaria cases. Methods From September 2012 to August 2013, patients consulting for non-complicated malaria in 31 sentinel health centres (SHC) were asked to answer a short questionnaire about long-lasting insecticidal nets (LLIN) use, indoor residual spraying (IRS) in the household and intermittent preventive treatment of pregnant women (IPTp) intake. Controls were healthy all-ages individuals sampled from a concurrent cross-sectional survey conducted in areas surrounding the SHC. Cases and controls were retained in the database if they were resident of the same communes. The association between Plasmodium infection and exposure to MCI was calculated by multivariate multilevel models, and the protective effectiveness (PE) of an intervention was defined as 1 minus the odds ratio of this association. Results Data about 841 cases (out of 6760 cases observed in SHC) and 8284 controls was collected. The regular use of LLIN provided a significant 51 % PE (95 % CI [16–71]) in multivariate analysis, excluding in one transmission pattern where PE was −11 % (95 % CI [−251 to 65]) in univariate analysis. The PE of IRS was 51 % (95 % CI [31–65]), and the PE of exposure to both regular use of LLIN and IRS was 72 % (95 % CI [28–89]) in multivariate analyses. Vector control interventions avoided yearly over 100,000 clinical cases of malaria in Madagascar. The maternal PE of IPTp was 73 %. Conclusions In Madagascar, LLIN and IRS had good PE against clinical malaria. These results may apply to other countries with similar transmission profiles, but such case–control surveys could be recommended to identify local failures in the effectiveness of MCI. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1132-x) contains supplementary material, which is available to authorized users.
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- 2016
35. PREVALENCE AND GENETIC HETEROGENEITY OFBORRELIA BURGDORFERISENSU LATO INIXODESTICKS IN BELGIUM
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P Martin, Véronique Avesani, J Brouillard, Camelia Rossi, Thomas Kesteman, P Bastien, N Olive, and Michel Delmée
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Lyme Disease ,Tick-borne disease ,Ixodes ,biology ,Borrelia valaisiana ,General Medicine ,bacterial infections and mycoses ,biology.organism_classification ,medicine.disease ,Borrelia afzelii ,medicine.disease_cause ,Polymerase Chain Reaction ,Virology ,Microbiology ,Genetic Heterogeneity ,Belgium ,Borrelia burgdorferi Group ,Borrelia ,parasitic diseases ,medicine ,Animals ,Borrelia garinii ,Borrelia burgdorferi ,Borrelia spielmanii - Abstract
Borrelia burgdorferi sensu lato is a genetically diverse group of spirochetes that includes the agent of Lyme borreliosis in which genospecies tend to be associated with specific clinical features. The aim of the study was to determine the prevalence and genetic diversity of Borrelia burgdorferi sensu lato in 524 ticks collected in woods of a western province of Belgium. Presence of spirochetes in ticks was determined by phase contrast microscopy. The mean infection rate of ticks was 12.0%. Variability was observed in the prevalence of infection among the five sites examined, ranging from 2.8 to 21.6%. Identification to genospecies was determined by PCR and sequencing. The most common genomospecies were Borrelia afzelii (55%) and Borrelia garinii (21%). For the first time in Belgium, we detected Borrelia valaisiana and Borrelia spielmanii, representing 14% and 2%, respectively. Borrelia burgdorferisensu stricto counted only for 2%. Co-infections were present in 8% of ticks. We emphasize the need for clinical studies to assess the prevalence of specific genospecies-related clinical manifestations of Lyme borreliosis in Belgium.
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- 2010
36. Investigating Pneumonia Etiology Among Refugees and the Lebanese population (PEARL): A study protocol
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Thomas, Kesteman, Ali, Ghassani, Crystel, Hajjar, Valentina, Picot, Marwan, Osman, Zahraa, Alnajjar, Florence, Komurian-Pradel, Melina, Messaoudi, Hicham Ghazi, Soulaiman, Philippe, Vanhems, Octavio, Ramilo, Dolla, Karam-Sarkis, Josette, Najjar-Pellet, Monzer, Hamze, and Hubert, Endtz
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Refugees ,Etiology ,Epidemiology ,Health Policy ,Public Health, Environmental and Occupational Health ,Medicine (miscellaneous) ,Articles ,Biochemistry, Genetics and Molecular Biology (miscellaneous) ,Prevention & Control ,Study Protocol ,Immunology and Microbiology (miscellaneous) ,Risk Factors ,Case-Control Studies ,Community-Acquired Pneumonia ,Lebanon - Abstract
Background: Community-acquired pneumonia (CAP), a leading cause of mortality, mainly affects children in developing countries. The harsh circumstances experienced by refugees include various factors associated with respiratory pathogen transmission, and clinical progression of CAP. Consequently, the etiology of CAP in humanitarian crisis situations may differ to that of settled populations, which would impact appropriate case management. Therefore, the Pneumonia Etiology Among Refugees and the Lebanese population (PEARL) study was initiated with the objective of identifying the causal pathogenic microorganisms in the respiratory tract of children and adults from both the refugee and host country population presenting with signs of CAP during a humanitarian crisis. Methods: PEARL, a prospective, multicentric, case-control study, will be conducted at four primary healthcare facilities in Tripoli and the Bekaa valley over 15 months (including two high-transmission seasons/winters). Sociodemographic and medical data, and biological samples will be collected from at least 600 CAP cases and 600 controls. Nasopharyngeal swabs, sputum, urine and blood samples will be analyzed at five clinical pathology laboratories in Lebanon to identify the bacterial and viral etiological agents of CAP. Transcriptomic profiling of host leukocytes will be performed. Conclusions: PEARL is an original observational study that will provide important new information on the etiology of pneumonia among refugees, which may improve case management, help design antimicrobial stewardship interventions, and reduce morbidity and mortality due to CAP in a humanitarian crisis.
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- 2018
37. Impact of migration origin on individual protection strategies against sexual transmission of HIV in Paris metropolitan area, SIRS cohort study, France
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Dominique Costagliola, Pierre Chauvin, Annabelle Lapostolle, Thomas Kesteman, Véronique Massari, Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP), Epidémiologie, Systèmes d'Information, Modélisation, Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), The 2010 data collection of the SIRS cohort study was supported by theInstitute for Public Health Research (IRESP) and has also benefited from thesupport of the Mutualité Française. This study was part of a specific researchproject supported by the French National Agency for Research on AIDS(ANRS) and Sidaction., Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), and Duchange, Nathalie
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Adult ,Male ,Gerontology ,Paris ,medicine.medical_specialty ,Sexual transmission ,Sexual Behavior ,Sexually Transmitted Diseases ,Ethnic group ,HIV Infections ,Cohort Studies ,Young Adult ,Africa, Northern ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Epidemiology ,Ethnicity ,medicine ,Humans ,Healthcare Disparities ,Young adult ,10. No inequality ,Africa South of the Sahara ,Cultural Characteristics ,business.industry ,Public health ,1. No poverty ,Public Health, Environmental and Occupational Health ,Emigration and Immigration ,Middle Aged ,Metropolitan area ,3. Good health ,Logistic Models ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Female ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Biostatistics ,business ,Research Article ,Demography ,Cohort study - Abstract
Background The impact of migration and country or region of origin on sexual behaviours and prevention of the sexual transmission of HIV has been scarcely studied in France. The objective of this study was to evaluate if and how individual attitudes of prevention towards HIV infection are different according to country or region of origins in Paris area, France. Methods 3006 individuals were interviewed in the Paris metropolitan area in 2010. Outcome variables were (i) the intention of the individual to protect oneself against HIV, and (ii) the adoption of a condom-based approach for protection against HIV. To explore factors associated with these outcomes, we constructed multivariate logistic regression models, first taking into account only demographic variables –including country of origin-, then successively adding socioeconomic variables and variables related to sexual behaviour and HIV perception and prevention behaviour. Results French and foreign people who have origins in Sub-Saharan Africa declared more intentions to protect themselves than French people with French parents (in foreign men, aOR = 3.43 [1.66–7.13]; in foreign women, aOR = 2.94 [1.65–5.23]), but did not declare more recourse to a condom-based approach for protection against HIV (in foreign men, aOR = 1.38 [0.38–4.93]; in foreign women, aOR = 0.93 [0.40–2.18]). Conversely, foreign women and French women from foreign origin, especially from Maghreb (Northern Africa), reported less intention of protection than French women with French parents. Conclusions These results underline the importance of taking culture and origins of target populations into consideration when designing information, education and communication about HIV and sexually transmitted diseases. These results also draw attention to fractions of the general population that could escape from prevention messages. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2051-4) contains supplementary material, which is available to authorized users.
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- 2015
38. Nationwide evaluation of malaria infections, morbidity, mortality, and coverage of malaria control interventions in Madagascar
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Vaomalala Raharimanga, Emma Raboanary, Thomas Kesteman, Patrice Piola, Christophe Rogier, Chiarella Mattern, Laurence Randrianasolo, Florian Girond, Milijaona Randrianarivelojosia, and Dolorès Pourette
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Health surveys ,Cross-sectional study ,Population ,Psychological intervention ,Indoor residual spraying ,Case management ,Young Adult ,Pregnancy ,Environmental health ,parasitic diseases ,Disease Transmission, Infectious ,Madagascar ,Prevalence ,Humans ,Medicine ,Mortality ,education ,Cause of death ,Insecticide-treated bed nets ,education.field_of_study ,business.industry ,Research ,Public health ,Middle Aged ,medicine.disease ,Vector control ,Malaria ,Surgery ,Prevention and control ,Cross-Sectional Studies ,Infectious Diseases ,Communicable Disease Control ,Epidemiological Monitoring ,Cross-sectional studies ,Female ,Parasitology ,Morbidity ,Rural area ,business - Abstract
Background In the last decade, an important scale-up was observed in malaria control interventions. Madagascar entered the process for pre-elimination in 2007. Policy making needs operational indicators, but also indicators about effectiveness and impact of malaria control interventions (MCI). This study is aimed at providing data about malaria infection, morbidity, and mortality, and MCI in Madagascar. Methods Two nationwide surveys were simultaneously conducted in 2012–2013 in Madagascar: a study about non-complicated clinical malaria cases in 31 sentinel health facilities, and a cross-sectional survey (CSS) in 62 sites. The CSS encompassed interviews, collection of biological samples and verbal autopsies (VA). Data from CSS were weighted for age, sex, malaria transmission pattern, and population density. VA data were processed with InterVA-4 software. Results CSS included 15,746 individuals of all ages. Parasite rate (PR) as measured by rapid diagnostic tests was 3.1%, and was significantly higher in five to 19 year olds, in males, poorer socio-economic status (SES) quintiles and rural areas. Long-lasting insecticidal nets (LLIN) use was 41.7% and was significantly lower in five to 19 year olds, males and wealthier SES quintiles. Proportion of persons covered by indoor residual spraying (IRS) was 66.8% in targeted zones. Proportion of persons using other insecticides than IRS was 22.8%. Coverage of intermittent preventive treatment during pregnancy was 21.5%. Exposure to information, education and communication messages about malaria was significantly higher in wealthier SES for all media but information meetings. The proportion of fever case managements considered as appropriate with regard to malaria was 15.8%. Malaria was attributed as the cause of death in 14.0% of 86 VA, and 50% of these deaths involved persons above the age of five years. The clinical case study included 818 cases of which people above the age of five accounted for 79.7%. In targeted zones, coverage of LLIN and IRS were lower in clinical cases than in general population. Conclusions This study provides valuable data for the evaluation of effectiveness and factors affecting MCI. MCI and evaluation surveys should consider the whole population and not only focus on under-fives and pregnant women in pre-elimination or elimination strategies. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-465) contains supplementary material, which is available to authorized users.
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- 2014
39. Listeria infections associated with infliximab: case reports
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Patrick Durez, Jean Cyr Yombi, Jacques Gigi, and Thomas Kesteman
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Male ,musculoskeletal diseases ,medicine.medical_specialty ,Population ,Arthritis ,Listeria infection ,Gastroenterology ,Arthritis, Rheumatoid ,Diagnosis, Differential ,Sepsis ,Rheumatology ,Internal medicine ,Humans ,Medicine ,Listeriosis ,education ,Aged ,education.field_of_study ,Tumor Necrosis Factor-alpha ,business.industry ,Antibodies, Monoclonal ,General Medicine ,Middle Aged ,medicine.disease ,Listeria monocytogenes ,Infliximab ,Antirheumatic Agents ,Rheumatoid arthritis ,Immunology ,Female ,Septic arthritis ,business ,medicine.drug - Abstract
Infliximab is a human-murine chimeric monoclonal antibody directed against tumor necrosis factor alpha (TNFalpha). Infliximab and other TNF blockers are used to treat inflammatory diseases such as rheumatoid arthritis (RA). TNF blockers are suspected to play a key role in some infections. We report here two cases of Listeria monocytogenes sepsis associated with infliximab treatment for RA. The first patient developed a terminal ileitis and a bacteraemia after three doses of infliximab; the second RA patient presented a bacteraemia associated with a prosthetic joint arthritis of the left hip, both related to Listeria. Those two cases occurred in a population of 518 patients treated with TNF blockers in our hospitals since the year 2000. Those events are of particular interest because of the severity of the infection, because the treatment differs from other infections, and because that, in the rheumatology unit, septic arthritis can mimic RA symptoms. They enhance the likelihood for this drug to increase the risk for infections with germs like Listeria.
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- 2007
40. Relative fecal abundance of extended-spectrum-ß-lactamase-producing Escherichia coli strains and their occurrence in urinary tract infections in women
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Radu Cojocaru, Cécile Angebault, Elisabeth Paramythiotou, Brandusa Elena Lixandru Lixandru, Etienne Ruppé, Claire Visseaux, Cagri Buke, Olga Burduniuc, Olivier Clermont, Laurence Armand-Lefevre, Ingrid Cecile Djuikoue, Marion Perrier, Antoine Andremont, Candice Marcel, Thomas Kesteman, Erick Denamur, Esra Erdem, Assiya El Mniai, and Ege Üniversitesi
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Antibiotics ,Gene Expression ,Urine ,medicine.disease_cause ,Feces ,0302 clinical medicine ,polycyclic compounds ,Agar ,Pharmacology (medical) ,030212 general & internal medicine ,Urinary Tract ,Escherichia coli Infections ,Aged, 80 and over ,0303 health sciences ,Middle Aged ,3. Good health ,Anti-Bacterial Agents ,Bacterial Typing Techniques ,ComputingMilieux_MANAGEMENTOFCOMPUTINGANDINFORMATIONSYSTEMS ,Infectious Diseases ,Urinary Tract Infections ,Female ,InformationSystems_MISCELLANEOUS ,Adult ,food.ingredient ,Adolescent ,medicine.drug_class ,Virulence Factors ,Urinary system ,Virulence ,Biology ,beta-Lactamases ,Microbiology ,Epidemiology and Surveillance ,03 medical and health sciences ,food ,medicine ,Escherichia coli ,Humans ,Aged ,Pharmacology ,030306 microbiology ,ComputerSystemsOrganization_COMPUTER-COMMUNICATIONNETWORKS ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,bacterial infections and mycoses ,Bacterial Load ,Cross-Sectional Studies ,ComputingMethodologies_PATTERNRECOGNITION ,bacteria ,Bacteria - Abstract
WOS: 000323285500054, PubMed ID: 23836184, Extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli (ESBL E. coli) strains are of major concern because few antibiotics remain active against these bacteria. We investigated the association between the fecal relative abundance (RA) of ESBL-producing E. coli (ESBL-RA) and the occurrence of ESBL E. coli urinary tract infections (UTIs). The first stool samples passed after suspicion of UTI from 310 women with subsequently confirmed E. coli UTIs were sampled and tested for ESBL-RA by culture on selective agar. Predictive values of ESBL-RA for ESBL E. coli UTI were analyzed for women who were not exposed to antibiotics when the stool was passed. ESBL E. coli isolates were characterized for ESBL type, phylogroup, relatedness, and virulence factors. The prevalence of ESBL E. coli fecal carriage was 20.3%, with ESBL E. coli UTIs being present in 12.3% of the women. The mean ESBL-RA (95% confidence interval [CI]) was 13-fold higher in women exposed to antibiotics at the time of sampling than in those not exposed (14.3% [range, 5.6% to 36.9%] versus 1.1% [range, 0.32% to 3.6%], respectively; P, ECO-NET (an Egide program); FP7 Health Program (EvoTAR project) [282004]; FP7 Health Program (R-GNOSIS project) [282512]; Oseo (Nosobio program); Federation of European Microbiological Societies (FEMS Research Fellowship), This work was supported in part by ECO-NET (an Egide program [http://www.egide.asso.fr/]), by the FP7 Health Program (EvoTAR project, contract no. 282004, and R-GNOSIS project, contract no. 282512), and by Oseo (http://www.oseo.fr/) (Nosobio program). T. K. was supported by a grant from the Federation of European Microbiological Societies (FEMS Research Fellowship).
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- 2013
41. Multiple causes of an unexpected malaria outbreak in a high-transmission area in Madagascar
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Arsène Ratsimbasoa, Alyssa Finlay, Solofoniaina A. Rafalimanantsoa, Vaomalala Raharimanga, Laurence Randrianasolo, J. Ratovonjato, Benjamin Ramarosandratana, Nohal Elissa, Thomas Kesteman, Harimahefa Razafimandimby, Milijaona Randrianarivelojosia, Christophe Rogier, and Heriniaina H. Rasamimanana
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Male ,Veterinary medicine ,Plasmodium ,Epidemiology ,law.invention ,Disease Outbreaks ,0302 clinical medicine ,law ,Pyrethrins ,030212 general & internal medicine ,Socioeconomics ,Child ,education.field_of_study ,biology ,Middle Aged ,Transmission (mechanics) ,Infectious Diseases ,Child, Preschool ,Female ,Adult ,medicine.medical_specialty ,Adolescent ,030231 tropical medicine ,Population ,03 medical and health sciences ,Antimalarials ,Young Adult ,Infectious disease outbreaks ,Nitriles ,parasitic diseases ,medicine ,Madagascar ,Humans ,Insecticide-Treated Bednets ,education ,business.industry ,Public health ,Research ,Outbreak ,Infant ,medicine.disease ,biology.organism_classification ,Malaria ,Cross-Sectional Studies ,Tropical medicine ,Parasitology ,business - Abstract
Background The malaria burden in Madagascar dropped down last decade, largely due to scale-up of control measures. Nevertheless, a significant rise of malaria cases occurred in 2011–2012 in two regions of the rainy South-Eastern Madagascar, where malaria is considered as mesoendemic and the population is supposed to be protected by its acquired immunity against Plasmodium. A multidisciplinary investigation was conducted in order to identify the causes of the outbreak. Methods In March 2012, a cross-sectional study was conducted in 20 randomly selected clusters, involving the rapid diagnostic testing of all ≥6 month-old members of households and a questionnaire about socio-demographic data and exposure to malaria control interventions. Changes in environmental conditions were evaluated by qualitative interview of local authorities, climatic conditions were evaluated by remote-sensing, and stock outs of malaria supplies in health facilities were evaluated by quantitative means. Two long-lasting insecticidal nets (LLINs) were sampled in each cluster in order to evaluate their condition and the remanence of their insecticidal activity. The entomological investigation also encompassed the collection Anopheles vectors in two sites, and the measure of their sensitivity to deltamethrin. Results The cross-sectional survey included 1615 members of 440 households. The mean Plasmodium infection rate was 25.6 % and the mean bed net use on the day before survey was 71.1 %. The prevalence of Plasmodium infections was higher in 6–14 year-old children (odds ratio (OR) 7.73 [95 % CI 3.58–16.68]), in rural areas (OR 6.25 [4.46–8.76]), in poorest socio-economic tercile (OR 1.54 [1.13–2.08]), and it was lower in individuals sleeping regularly under the bed net (OR 0.51 [0.32–0.82]). Stock outs of anti-malarial drugs in the last 6 months have been reported in two third of health facilities. Rainfalls were increased as compared with the three previous rainy seasons. Vectors collected were sensitive to pyrethroids. Two years after distribution, nearly all LLINs collected showed a loss of physical integrity and insecticide activity, Conclusions Increased rainfall, decreasing use and reduced insecticide activity of long-lasting insecticide-treated nets, and drug shortages may have been responsible for, or contributed to, the outbreak observed in South-Eastern Madagascar in 2011–2012. Control interventions for malaria elimination must be sustained at the risk of triggering harmful epidemics, even in zones of high transmission.
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42. Assessing the impact of vector control interventions by measuring their effectiveness - what has been done in Madagascar
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Patrice Piola, Thomas Kesteman, Christophe Rogier, and Milijaona Randrianarivelojosia
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Veterinary medicine ,medicine.medical_specialty ,Rapid diagnostic test ,business.industry ,Indoor residual spraying ,Psychological intervention ,Ecological study ,medicine.disease ,law.invention ,Transmission (mechanics) ,Infectious Diseases ,law ,Environmental health ,parasitic diseases ,Tropical medicine ,medicine ,Oral Presentation ,Parasitology ,business ,Malaria ,Disease burden - Abstract
The impact of disease control can be either evaluated by a classical ecological study, or by multiplication of the effectiveness of control intervention and the disease burden. The latter approach has the advantage of circumventing ecological biases. To evaulate the effectiveness of the malaria control program implemented in Madagascar, we conducted a nationwide survey in 2012-2013 in 62 study sites. This survey included (1) a cross-sectional study to measure the effectiveness of each control intervention on reducing the transmission, and (2) a case-control study to measure the effectiveness on reducing the morbidity. We present here the results related to vector control interventions, i.e. Long Lasting Insecticidal Nets (LLIN) distribution and Indoor Residual Spraying (IRS) campaigns. The cross-sectional survey included 15,734 individuals of all age groups among which 3.7% had a positive Rapid Diagnostic Test (RDT). LLIN daily use was 52.3% in areas covered by universal distribution and IRS coverage was 64.8% in targeted areas. 818 uncomplicated clinical malaria cases were compared to 7,767 controls living in the same villages. Multilevel analysis of factors associated with a positive RDT or with the occurrence of an episode of non-complicated malaria revealed that LLIN daily use had a 45% protective effectiveness (PE) against infection (aOR 0.55 [95% CI 0.42, 0.72]) and a 48% PE against morbidity (aOR 0.52 [0.28, 0.96]). The PE of IRS was evaluated to be 23% against infection (aOR 0.77 [0.53, 1.13]) and 49% against morbidity (aOR 0.51 [0.39, 0.66]). In areas where both activities are implemented, coverage of LLIN was 21.3 percentage points lower than in areas where LLIN only were deployed. Combining IRS with LLIN provided almost no gain in preventing infection, but the PE of LLIN use against morbidity increased from 51% (aOR 0.49 [0.20, 1.20]) to 66% (aOR 0.34 [0.16, 0.74]) when IRS was added, although non significantly. Our results indicate that, taken separately, LLIN and IRS perform satisfactorily but that their concurrent use might have a limited benefit as compared with efforts to improve the coverage of a single intervention. Given that in Madagascar, approx. 220,000 clinical malaria cases and 770,000 malaria infections occur each year, we calculated that vector control interventions prevented approx. 96,000 malaria cases and 197,000 malaria infections annually. Distributions of LLIN were implicated in the major part of cases (73.7%) and infections (80.5%) prevented, while IRS campaigns were implicated in 37.3% of cases and 31.2% of infections prevented.
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