Using evidence to inform response to the 2017 plague outbreak in Madagascar: a view from the WHO African Regional Office.

The 2017 plague outbreak in Madagascar was unprecedented in the African region, resulting in 2417 cases (498 confirmed, 793 probable and 1126 suspected) and 209 deaths by the end of the acute urban pneumonic phase of the outbreak. The Health Emergencies Programme of the WHO Regional Office for Africa together with the WHO Country Office and WHO Headquarters assisted the Ministry of Public Health of Madagascar in the rapid implementation of plague prevention and control measures while collecting and analysing quantitative and qualitative data to inform immediate interventions. We document the key findings of the evidence available to date and actions taken as a result. Based on the four goals of operational research - effective dissemination of results, peer-reviewed publication, changes to policy and practice and improvements in programme performance and health - we evaluate the use of evidence to inform response to the outbreak and describe lessons learned for future outbreak responses in the WHO African region. This article may not be reprinted or reused in any way in order to promote any commercial products or services.

Using real-time modelling to inform the 2017 Ebola outbreak response in DR Congo.

Important policy questions during infections disease outbreaks include: i) How effective are particular interventions?; ii) When can resource-intensive interventions be removed? We used mathematical modelling to address these questions during the 2017 Ebola outbreak in Likati Health Zone, Democratic Republic of the Congo (DRC). Eight cases occurred before 15 May 2017, when the Ebola Response Team (ERT; co-ordinated by the World Health Organisation and DRC Ministry of Health) was deployed to reduce transmission. We used a branching process model to estimate that, pre-ERT arrival, the reproduction number was R = 1.49 (95% credible interval ( 0.67, 2.81 ) ). The risk of further cases occurring without the ERT was estimated to be 0.97 (97%). However, no cases materialised, suggesting that the ERT's measures were effective. We also estimated the risk of withdrawing the ERT in real-time. By the actual ERT withdrawal date (2 July 2017), the risk of future cases without the ERT was only 0.01, indicating that the ERT withdrawal decision was safe. We evaluated the sensitivity of our results to the estimated R value and considered different criteria for determining the ERT withdrawal date. This research provides an extensible modelling framework that can be used to guide decisions about when to relax interventions during future outbreaks.

[Malaria knowledge, attitudes and practices among women living in the rural area of Poponguine, Senegal]. / Connaissances, attitudes et pratiques des femmes sur le paludisme, dans la zone rurale de Poponguine, Sénégal.

Malaria is a major public health and development problem in Senegal where it is the leading cause of morbidity and mortality. Children under five and pregnant women are the most vulnerable groups. The purpose of this transverse, descriptive, analytical study was to assess rural women's knowledge, attitudes and practices regarding malaria. It was conducted in the Poponguine district of Senegal from April 1 to 15, 2005. The estimated population size needed for this cluster survey was 800. Women between the ages of 15 and 45 years who had been living in the district for more than one year were recruited for study. The mean age of the population was 28 years (95% confidence interval, 27.7 - 28.8). Teenagers accounted for over one eighth of the population (13.75%) and three fourths (75.87%) were married. Almost half (49.6%) were attending school and nearly two thirds (65.5%) were classified at the low socioeconomic level. Most (82.25%) knew that mosquitoes transmitted malaria and that the main signs were fever or warm body (82.25% and 81% respectively). However knowledge about the clinical features of severe malaria was poor. Geographical and financial access to IB was good for most of the women interviewed. Over half had a good understanding of preventive strategies for children less than five years of age and pregnant women, i.e., use of insecticide-treated nets (ITN) (62.9%) and of intermittent preventive therapy (IPT) during pregnancy (52.4%). Most (92%) declared that they would go to the health center for care in case of malaria. The main sources of information were medical personal (60.4%) or community volunteers (62,9%). Coverage for ITN and IPT was 33% and 71.1% respectively. There was a good correlation between good knowledge and practices (p<0.05). The main predictors of good knowledge were age and level of education. Practices by mothers were correlated with age, source of income, and marital status. Based on the findings of the study our recommendations for the Poponguine district are in agreement with those of the national malaria control program, i.e., reinforcement of the behavior change program to improve public knowledge about malaria. Further study will be needed to gain more epidemiological insight.

[Tuberculosis dactylis: a case report]. / La tuberculose digitale: à propos d'un cas.

INTRODUCTION: Tuberculosis dactylis is exceptional. We report one case in an 11 years old girl. OBSERVATION: N.D., 11 years old, was admitted for a right hand second finger tumour evolving since six months and linked to a trauma. Clinical examination founded a painful fusiform of the right second finger with limited movements of the finger. The hand radiography showed a second phalange osteitis of the finger without periosteitis reaction. The sedimentation rate was accelerated to 130 mm at the first hour. The intracutaneous reaction with tuberculin was positive to 19 mm. In her preceding, her mother would have suffered from pulmonary tuberculosis two years before incompletely treated during eight months. Histological examination showed a caseous necrosis and an epithelial giant cellular follicle. A twelve months antituberculosis polychimiotherapy permitted a healing without sequelae. DISCUSSION: Tuberculosis dactylis has to be evoked with epidemiological, clinical, radiological and immunological arguments. The antituberculosis treatment permitted to do the retrospective diagnosis and to get a healing.

[Perforation and haemorrhage duodenal bulbar ulcers in a child: a case report]. / Perforation et hémorragie d'ulcères du bulbe duodénal chez une enfant.

A perforation rarely reveals a primary duodenal ulcer. The occurring of digestive haemorrhage in post operative followings evokes spontaneously a stress ulcer. We report an observation of a child who presented on fourth day delay after operation an ulcer of the anterior duodenal bulbar face and a haemorrhage of the posterior bulbar face. A 7-year-old girl with no particular pathological antecedent was admitted for abdominal pain, bile vomiting and constipation evolving since 6 days. Clinical examination revealed a general state thickening, an infectious syndrome, a meteoric and general abdominal sensitivity. The abdominal radiography without preparation showed a pneumoperitoneum. The surgical exploration discovered a perforated ulcer on the bulbar anterior face. A simple closure associated with omental patch was performed. Four days after operation, she presented an abundant digestive haemorrhage with shock. The resuscitation did not improve the patient's general state. The upper digestive endoscopy revealed a haemorrhage of the posterior bulbar face. An adrenalin injection stopped the bleeding. The treatment by neutron pump inhibitors and an eradicating treatment of Helicobacter pylori permitted the healing of the ulcers. The occurring of digestive haemorrhage in the followings of surgical intervention for perforated ulcer involves an upper digestive endoscopy. This examination can reveal misdiagnosed ulcer during the surgical exploration and permits to perform a haemostatic act.

[Prune Belly syndrome: epidemiologic, clinic and therapeutic aspects]. / Syndrome de Prune Belly : aspects épidémiologiques, cliniques et thérapeutiques.

UNLABELLED: Prune Belly syndrome (PBS) is a rare complex malformation with male predominance. His pathogeny is not yet completely elucidated. The goal of this work is to analyze the epidemiological, anatomoclinical and treatment aspects of a retrospective trial in Aristide-Le-Dantec Hospital. PATIENTS AND METHODS: We carried out a retrospective study about 22 cases collected in the departments of urology-andrology and pediatric surgery in Aristide-Le-Dantec Hospital between April 1995 and November 2004. RESULTS: The mean age of the patients was 15 months with extremes of one day and 10 years. The somatic examination revealed 20 cases of complete abdominal muscle aplasia, one right partial form and the last case had a left partial form. Nineteen patients were managed with conservative treatment and three patients benefited a surgical act for urinary abnormalities. The Montfort intervention was performed in two patients respectively aged eight and 10 years. The orchidopexy, stage 1, by Fowler-Stephens technique was performed in 13 cases. Five cases of death and nine cases of testicular atrophy after orchidopexy occurred. The followings were satisfactory in the three operated patients for urinary abnormalities. CONCLUSION: The renal failure is the main cause of death. The management of the urinary tract abnormalities must be performed individually. The testis descending should be performed in newborn period to enhance the fertility chances. The abdominoplasty also should be done early for aesthetic reason and to improve pulmonary, defecation, and voiding functions.

[Particularities of liver abscesses in children in Senegal: Description of a series of 26 cases]. / Particularités des abcès du foie chez l'enfant au Sénégal : description d'une série de 26 cas.

UNLABELLED: Liver abscess is a serious infection that can cause life-threatening complications. OBJECTIVE: To describe the epidemiology, diagnosis, and progression of liver abscess at the Dakar National Albert-Royer Children's Hospital. METHOD: A retrospective study was conducted from over a period of 5 years (1st January 2010 to 31st December 2014). All children aged 0-15 years hospitalized for liver abscess with ultrasound confirmation were included. We collected demographic data (age, gender, socioeconomic status, origin), clinical data (general and hepatic symptoms), diagnostic data (ultrasound, bacteriology) and progression (death, complications, sequelae). The data were analyzed with Epi-info (P<0.05 was considered significant). RESULTS: We collected 26 cases of liver abscesses, representing a hospital prevalence of 100 cases per 100,000 admissions. Males predominated (sex ratio: 1.36). The children's average age was 7.2 years. Most of the children came from urban areas of Dakar. Low socioeconomic status and precarious lifestyle were the contributing factors. Anemia (69.2%), malnutrition (42.3%), and abdominal trauma (15.3%) were the main causes found. The Fontan triad characteristic of the liver abscess was found in 57.7% of cases. At ultrasound, a single abscess was found in 21 cases. The abscess was located in the right lobe in 18 cases, the left lobe in three cases, and in both lobes in three cases. Segment VI (four cases) was the most frequently involved. Bacteriologically, the abscess was pyogenic in 17 cases and an amoebic abscess in nine cases. The main pyogenic sources found were Klebsiella pneumoniae in two cases, Pseudomonas aeruginosa in one case, Streptococcus pneumoniae in one case, and Staphylococcus aureus in one case. The average duration of antibiotic treatment was 14.5 days. Liver drainage was carried out in 24 cases. The outcome was favorable in all children. CONCLUSION: The prevalence of liver abscesses at the Albert-Royer Children's Hospital is relatively high, compared to the literature data. Percutaneous drainage combined with antibiotics remains the treatment of choice. The prognosis is favorable.

[Monitoring and evaluation of health care programs in Subsaharian Africa]. / Monitoring et évaluation des programmes de santé en Afrique subsaharienne.

The monitoring and evaluation is usually the weakest component of health programs in sub-Saharan Africa, what is undermining the sustainability of funding. The problems are complex and the weaknesses of the health systems are reflected on the monitoring and evaluation of specific programs. This paper gives an insight of the problems faced during field missions for monitoring and evaluation. The steps for building the M&E system have been reviewed and keys points for implementation have been provided.

[Management of thermal severe burns in children in Le Dantec University Teaching Hospital]. / Prise en charge des brûlures thermiques Graves de l'Enfant au CHU le Dantec.

INTRODUCTION: Bums in children are serious public health problem. Burns management in developing countries encounters huge problems at any stage. The goals of this study were to descrive the epidemiological, clinical and therapeutic characterics. MATERIALS AND METHODS: In the university Teaching Hospital of Dakar from January to December 2003, we conducted a retrospective survey of 41 patients less than 16 years admitted for severe thermal burns. We carried a year retrospective study in ICU and pediatric surgery unit of Aristide Le Dantec Hospital. Were involved all. The following parameters were studied: age, sex, mechanism and circumstances of the burns, period time between the injury and the admission, clinical status of the patient, management and outcome. RESULTS: The age range between 5 days and 13 years, 47.72% are less than 3 years. The average period before admission was 33 hours (2 hours to 7 days). The accident occurs in 75% of cases in the kitchen. Bum by hot water was the most frequent mechanism with a percentage of 62%. Areas interested the whole body with frequent face localisation (n=18) and the perineal region (n=22). Immediate complications were shock in 37% of children and acute respiratory failure in 7 patients. Fluids and electrolytes resuscitation using Parkland formula (75%) or Carvajal formula (25%). Feeding was done to enteral route. Spontaneous epitheliasation through secondary heeling was the main therapeutic attitude, skin grafting was performed in 10 childrens. Total mortality was 18.18%; These death concerns patients for whom the UBS score range between 75 and 140 UB and the ABSI score between 9 and 12. Sepsis was the direct main cause of death. Sequellaes were jointed a nd facial contractures. CONCLUSION: The authors emphasize on the need in setting up adequate preventive measures towards high risk population (under 3 years), and specialized unit for adapted management.

Virology. Mutation rate and genotype variation of Ebola virus from Mali case sequences.

The occurrence of Ebola virus (EBOV) in West Africa during 2013-2015 is unprecedented. Early reports suggested that in this outbreak EBOV is mutating twice as fast as previously observed, which indicates the potential for changes in transmissibility and virulence and could render current molecular diagnostics and countermeasures ineffective. We have determined additional full-length sequences from two clusters of imported EBOV infections into Mali, and we show that the nucleotide substitution rate (9.6 × 10(-4) substitutions per site per year) is consistent with rates observed in Central African outbreaks. In addition, overall variation among all genotypes observed remains low. Thus, our data indicate that EBOV is not undergoing rapid evolution in humans during the current outbreak. This finding has important implications for outbreak response and public health decisions and should alleviate several previously raised concerns.

[Cystic form of extralobar pulmonary sequestration. A propos of a case]. / Forme kystique de séquestration pulmonaire extra-lobaire. A propos d'une observation.

Case of bronchogenic cyst associated with extralobar pulmonary sequestration is presented in a 10-month-old baby. At thoracotomy, the tumor was an extralobar pulmonary sequestration with a central cyst surrounded by two pulmonary lobes vascularised by systemic vessels. Resection was easy. The cyst had a respiratory mucosa and was benign. The pathogenesis of the malformation is discussed.

[Pelvic ring fractures in children. Apropos of 47 cases]. / Les fractures du bassin chez l'enfant. A propos de 47 observations.

PURPOSE OF THE STUDY: The aim of this study was to report the different anatomical types, associated injuries, morbidity and mortality of pelvic ring disruption in child in Dakar traumatological centers. MATERIAL AND METHODS: [corrected] Forty seven children were admitted in two of three traumatology centers in Dakar between 1968 and 1992. This retrospective and intermittent study excluded tendon-bone avulsions and acetabular fractures. Twenty eight boys and nineteen girls presented a fracture with or without ring disruption according to Ducloyer and Filipe classification. In this first group, they make difference between an isolated or combined fracture and distinguished an anterior and a posterior one. Forty five children were treated by a non-operative methods. RESULTS: Forty three boys and girls sustained their injuries in a pedestrian-motor vehicle accidents and 4 among were struck by a truck. A massive fracture-dislocation with complete pelvic disruption was found in 70.3 per cent. Half of them (34.4 per cent) presented an anterior isolated anatomic type. In the other group the high energy forces caused major pelvic instability and also various associated soft-tissue injuries. The majority of complications were open pelvic fractures (21.1 per cent), genito-urinary (34.4 per cent), vascular (16.6 per cent), neurological and perineo-rectal injuries. Four children (8.4 per cent) died. At the last review others presented orthopaedic, genito-urinary, neurological or perineo-rectal sequelae. DISCUSSION: The frequency of pelvic fractures in child present a peak between 6 and 12 years old. These types of fractures are the results of a high energy injury in pedestrian motor vehicle accidents in Dakar suburbs. The anatomo-radiographic types had an interesting bimodal pattern: Among the benign types: a double fracture of the iliopubic ramus is dangerous for the bladder (1 case), and leads to a dysplastic acetabulum with time (1 case). Unstable fractures (70.3 per cent): some of them (23.3 per cent) present a complex dislocation of the pelvis. The present review focuses on double urethral injuries (2 cases), open pelvic fractures (10 cases) and mortal hemorrhagic shock (4 cases). The morbidity rate is high (38.4 per cent) caused by skeletal and soft-tissue sequelae and also management difficulties. CONCLUSION: Pelvic fracture in children requires early diagnosis and management. In our countries, morbidity and mortality of these injuries must decrease with the popularization of road safety, multidisciplinary management and improvement of working conditions.

[A case report of epididymo-testicular bilharziasis in a child]. / A propos d'un cas de bilharziome épididymo-testiculaire chez l'enfant.

The disease was revealed by a tumor of the left testis. Ultrasound showed an enlargement of testis and epididymis with some hypoechogenic areas resembling epididymo-orchitis or tumor. The location of bilharzial lesions in the testis is very rare. The main sign of urogenital bilharziosis, hematuria, was present. Orchidectomy is the treatment of choice when the testis is destroyed and only histological study is able to confirm the nature of testicular mass.

[Malaria prevention in the army: experience in senegal]. / Prophylaxie du paludisme dans les armées: l'expérience du Sénégal.

The Senegalese army has acquired extensive experience in malaria prophylaxis in Sub-Saharan Africa. Until the early 90s, chloroquine-based drug prophylaxis was routinely administered during the transmission season. Currently this policy has been abandoned inside the country in favor of early treatment of infection. This change was made possible by the presence of qualified staff in all barracks. For extraterritorial interventions in Sub-Saharan Africa, drug prophylaxis is still used since most of the Senegalese population lives in the Sahelian zone without immunity to malaria and most host countries are in areas of high transmission. Treatment protocols have been defined in function of Plasmodium drug sensitivity in each country. For all West African nations except Nigeria, the protocol involves a combination of choroquine and proguanil at a dose of 300 mg per week and 200 mg per day respectively. For Central African nations in the south and east as well as for Nigeria, either mefloquine at a dose of 250 mg per week or doxycycline at a dose of 100 mg per day are used. Although acceptance has been slow, use of impregnated bednets is now an integral part of the prevention strategy. The insecticide used inside the country is deltametrin, but other products may be used during extraterritorial operations depending on vector sensitivity in the facilities host country. Vector control by spraying of insectides in and eliminating larval deposits is also an important part of the prevention strategy used by the Senegalese army which maintains a mobile unit for that purpose.

[Bloodless emergent laparotomy for acute abdominal syndrome]. / Laparotomies blanches en urgence pour syndrome abdominal aigu.

Bloodless laparotomy (BL) is defined as an opened exploration of the abdominal cavity that yields negative results, i.e., "provides no information as to the cause of the clinical and paraclinical symptoms responsible for prompting the surgical investigation". The authors report a retrospective study spanning January 1975 to December 1989, on the incidence of and mortality associated with emergent BL in patients with acute abdominal syndrome, with the intent of reducing its frequency. Over this period, 24 BL occurred in 3480 emergent laparotomies, i.e., 0.63%. These involved 7 men, 5 women, 5 boys and 7 girls, aged 4 to 52 years (mean age = 19.5 years). Indications for surgery were based on clinical signs, as well as on laboratory findings such as chest X-ray and plain radiography and needle-puncture of the abdomen. Surgical data indicated:liver cirrhosis--3 cases; mesenteric adenopathy--3 cases; intestinal parasitosis--1 case; bilateral adnescitis--1 case; polycystic ovaries--1 case; wall abscess--1 case; unexplained pain--14 cases. The mortality rate was 2/24. Use of other paraclinical investigations, namely ultrasonography, laparoscopy and peritoneal lavage, and of computer science methods after a prior clinical examination initiated by history-taking, might help reduce the rate of BLs, which are non-devoid of mortality.

[Intussusception in children: about 20 cases]. / Invagination intestinale de l'enfant a propos de 20 cas.

The authors report on a retrospective study 20 cases of intussusception in senegalese children. The diagnosis is essentially clinical. In difficult cases plane abdominal X-rays, barium meal and echography are indispensable exams. In our context the diagnosis is most of the time late and it is due to the unknown nature of the affection and early consultation to the traditional practitionners. The lateness of the diagnosis leads to the lateness of the management. This explains the importance of intestinal necrosis noticed in our serie and the high mortality rate which is 10%. The authors suggest recommendations to ameliorate the prognosis of this ailment which is good elsewhere.

[Fractures of the medial humeral epicondyle in child: preliminary study about 18 cases]. / Les fractures de l'epitrochlée chez l'enfant: etude préliminaire a propos de 18 cas.

The aim of this work is to study the epidemiological, radiological, clinical views of fractures of the medial humeral epicondyle in child and mainly to appreciate the results of surgical treatment. For this, we looked at again in a retrospective study eighteen (18) files of children with fracture of the medial humeral epicondyle. The average age of children was eleven (11) and the male sex most represented (16 boys versus 2 girls). Medial humeral epicondyle's fracture often occurs by accident in playing (15 cases). Accurate diagnostic of the fracture of the medial humeral epicondyle was rarely formulated on the clinical plan. It's the radiography who shown the fracture of the medial humeral epicondyle and permitted to specially the type in accordance with Marion's and Faysse's classifications and also Lechevallier. It was always surgical and consisted on a open reduction and fixation by pins or a periostee's stich. With ten (10) months of background, we assessed our results either on morphological plan than the functional plan. 1/ On morphological plan: an hypertrophy of the medial humeral epicondyle is 3-fold mentioned. Others children have not presented a morphological animaly. 2/ On functional plan: Ten children had an elbow's mobility considered as normal after self reeducation at home. Six enjoyed physical therapy in a specialized department. Two of the children had an extension gap from 30 degrees to 35 degrees respectively. We obtained thirsteen (13) good results in general, three (3) means results and two (2) bad results. In conclusion, the fracture of medial humeral epicondyle occurs around ten (10) years old in boy victim in playing. Diagnostic is sometimes difficult. Surgical treatment gives good results. However, it can be the origin of sequellaes which can justify correct previous refunding.

[Ureteral-pelvic junction syndrome in the child. Apropos of 8 cases]. / Le syndrome de la jonction pyélo-urétérale chez l'enfant. A propos de 8 observations.

Eight cases of uretero-pelvic junction syndrom collected in the ten past years are reported. They are 4 males and 4 females ranged from 18 months to 15 years with a mean age of 4.5 years. This age too late is probably due to the misknowlege but also to the lack of information about the pathology. The main characteristics of this syndrome are analysed according to the literature. All patients except one underwent nephrectomy because the irreverible lesions of the kidney. The authors emphasize the importance of early diagnosis done by antenatal echography but it can be made with a good clinical examination followed by the results of I.V.P. It is necessary for them to make parents, general practitioners and paediatricians sensitive to that pathology to avoid such operating act whose consequence are very serious where as it is benign.

[Ectopia testicular in child: about 3 cases]. / Les ectopies testiculaires de l'enfant: a propos de trois cas.

The authors report 3 cases of testicular ectopia. Of these 3 cases, two proved tobe cases of penial ectopia whose diagnosis was mentionned before the intervention. One case proved tobe a case of tranverse testicular ectopia diagnosed as an inguino-scrotal hernia. Surgical exploration has always allowed to reach a correct diagnosis. In all three cases the testicle was of normal size and the cord long enough to lower the testicle between the skin an the dartos Surraco's procedure. The authors discuss the pathogenis of this affection, echography contribution in the diagnosis, and the therapeutics aspects.

[The ovarian tumors in children. A report of 12 cases]. / Les tumeurs ovariennes de l'enfant: a propos de 12 cas.

The objectives emphasize the diagnosis and therapical problems concerning the child's ovary tumors for a better care in our conditions of work. We collected in a retrospective study 12 cases of ovarian tumors during 30 years. The middle age of the patients was of 11 years with extremes of 2 years and 15. The circumstances of discovery of the tumor were represented by order of frequency by an abdominal tumor (10 cases), an abdominal pain (8 cases) and of the compression signs digestive or urinary (6 cases). The medical imagery (echography, intravenous urography, Chest X-ray) permitted to evoke in the majority of the cases the ovarian origin of the mass. The surgical treatment consisted in an ovariectomy (5 times), an salpingo - ovariectomy (6 times) and a surgery of partial exeresis associated to a chemotherapy. The operative continuations were simple. A patient died of intercurrentes complications. The histological exam of the operative piece showed that it was about benign tumors. However a brought closer surveillance proves to be necessary had consideration to the two noted recidivisms.