Impact of biomass fuel smoke on respiratory health of children under 15 years old in Madagascar.

BACKGROUND: Children exposed to biomass used in households are at risk to develop diseases or respiratory symptoms. In Madagascar more than 95% of households use it daily. The main objective is to study the impact of chronic exposure to biomass on respiratory health of children under 15 years old in Madagascar. METHODS: Descriptive cross-sectional study conducted with questionnaires among urban and rural population of Antananarivo and Mahajanga provinces between 2016 and 2017. Variables were collected: number of hours spent in kitchen per day, respiratory symptoms and spirometric data. Categorized symptoms score and exposure index expressing chronic exposure to biomass were analyzed with multinomial logistic regression models. RESULTS: Of the 661 children included in the analysis, 27.7% had 1 respiratory symptom and 29.3% had 2 or more respiratory symptoms. Moderate exposure index (aOR=1.57; CI95%=[1.30-1.89]; p<0.001) and high exposure index (aOR=1.76; CI95%=[1.39-2.24]; p<0.001) were significantly associated with 1 respiratory symptom, adjusted with provinces, household members and visitors smoking, perceived discomfort related to air pollution and birthweight. Exposure index was not significantly associated with an increased risk of having 2 or more respiratory symptoms (p = 0.754). CONCLUSION: Respiratory symptoms were associated with exposure to biomass, living in coastal areas, birthweight, tobacco and perceived discomfort related to air pollution. Recommendations and actions must be implemented in order to improve respiratory health related to biomass among children.

COVID-19 complicated with chronic necrotizing pulmonary aspergillosis and aspergilloma progressing to fibrosing aspergillosis: A case report.

Aspergillosis superinfections have been reported as acute complications of COVID-19. We report a rare case of combined chronic necrotizing pulmonary aspergillosis, aspergilloma, and fibrosing aspergillosis in a 31-year-old woman with a history of COVID-19. Chest scan remains an important imaging method assisting in the diagnosis and management of post-COVID-19 patients.

Pulmonary arteriovenous malformation revealing Osler-Weber-Rendu disease: A case report.

Osler-Weber-Rendu disease is a genetic disease characterized by mucocutaneous and visceral telangiectasias. Pulmonary arteriovenous malformation is one of the main visceral complications revealing Osler-Weber-Rendu disease. The present case was a 34-year-old woman with exertional dyspnea and severe hypoxemia revealing pulmonary arteriovenous malformations on chest CT scan.

Impact of a Novel, Low-Cost and Sustainable Health Education Program on the Knowledge, Attitudes, and Practices Related to Intestinal Schistosomiasis in School Children in a Hard-to-Reach District of Madagascar.

Schistosomiasis control requires multisectoral approaches including praziquantel treatment, access to safe water, sanitation and hygiene, and health education. Community input can help ensure health education programs are culturally appropriate to effectively direct protective behavior change. This study reports on the three-stage development of an education program for Malagasy children, with an impact evaluation on their knowledge, attitudes, and practices (KAP) related to intestinal schistosomiasis. A cross-sectional study took place in 2017 with follow-up in 2018 in the hard-to-reach Marolambo district, Madagascar. A novel schistosomiasis education program (SEP) was designed in collaboration with researchers, stakeholders, and local community and included cartoon books, games, songs, puzzles, and blackboard lessons, costing $10 USD per school. KAP questionnaires were completed by 286 children pre-SEP and 273 children post-SEP in 2017, and by 385 and 337 children pre-SEP and post-SEP, respectively, in 2018. Improvements were observed in responses to all questions between pre- and post-education answers in 2017 (53-77%, P < 0.0001) and 2018 (72-98%, P < 0.0001) and in the pre-education answers between years (53-72%, P < 0.0001). Praziquantel mass drug administration attendance improved, rising from 64% to 91% (P < 0.0001), alongside improved latrine use, from 89% to 96% (P = 0.005). This community-consulted and -engaged SEP resulted in substantial improvements in children's understanding of schistosomiasis, with improvements in praziquantel uptake and latrine use. Socioculturally tailored education programs can help gain schistosomiasis control. Continued investment in SEP will help promote the future well-being of children through increased participation in control and treatment activities.

Five-Year Follow-Up on the Prevalence and Intensity of Infections of Schistosoma mansoni in a Hard-to-Reach District of Madagascar.

Schistosomiasis is a major public health problem in Madagascar. The WHO recommends preventive chemotherapy by mass drug administration (MDA) with praziquantel as the primary approach to control Schistosoma mansoni-related morbidity in endemic populations, alongside complementary interventions such as health education. The impact of annual MDA and health education programs was assessed in the hard-to-reach Marolambo district of eastern Madagascar, an area endemic for S. mansoni. Repeated cross-sectional studies undertaken 2015-2019 examined between 300 and 381 school-aged children (aged 5-14 years) annually. The prevalence and infection intensity of S. mansoni were assessed by urine-circulating cathodic antigen (CCA) dipsticks and coproscopy using Kato-Katz (KK) methodologies. After four rounds of annual MDA, a reduction in S. mansoni prevalence was seen in CCA (93.9% in year 1-87.7% in year 5; P = 0.007) and KK (73.9% in year 1-59.4% in year 5; P < 0.0001). The prevalence of heavy-intensity infections roughly halved from 23.7% to 10.1% (P < 0.0001), and the mean intensity of infection fell by 55.0% (480.2-216.3 eggs per gram of feces). A malacological survey found Biomphalaria pfeifferi snail intermediate hosts in multiple water contact sites including rice paddies, streams, and Nosivolo River. Despite reductions in infection prevalence and intensity, schistosomiasis still poses a significant public health challenge in Marolambo district. Twice yearly MDA cycles and/or community-wide MDA are suggested to better reduce infections. Expanding health education, improving standards of water, sanitation and hygiene, and attention on snail-related control will also be important, especially in rice paddy irrigated areas.

[Diagnostic delay in bronchopulmonary cancers at the USFR Befelatanana Pneumology, Antananarivo, Madagascar]. / Le délai diagnostique des cancers broncho-pulmonaires vus à l'USFR de Pneumologie Befelatanana, Antananarivo, Madagascar.

The time between clinical symptoms onset and the diagnosis of bronchial cancer should be as short as possible so that it can be managed early and effectively. In Madagascar, this diagnostic delay is unknown. Therefore this study aims to evaluated the diagnostic delay of bronchopulmonary cancers at the the USFR Befelatanana Pneumology, Antananarivo, Madagascar. We conducted a retrospective descriptive study of patients with bronchopulmonary cancers diagnosed at the USFR Befelatanana Pneumology over the period 1st January 2011 to 31st December 2015 (5 years). All patients hospitalized during the study period and receiving anatomopathologically-confirmed diagnosis of bronchopulmonary cancer were included in the study. During the study period we collected data from 43 medical records of patients with bronchopulmonary cancer confirmed histologically, reflecting a rate of 0.64% of hospitalized patients. Pre-hospital delay, hospital delay and total delay were 171.74 days, 13.97 days and 185.71 days respectively. The time between symptom onset and consultation with a doctor was less than three months in 30 cases (69.76%), between 3 and 6 months in 8 cases (18.60%). Pre-hospital delay was very long according to the international recommendation for delayed diagnosis of bronchopulmonary cancers. An effort should be made to improve the diagnostic delay.

High burden of Schistosoma mansoni infection in school-aged children in Marolambo District, Madagascar.

BACKGROUND: A school-based survey was undertaken to assess prevalence and infection intensity of schistosomiasis in school-aged children in the Marolambo District of Madagascar. METHODS: School-aged children from six purposively selected schools were tested for Schistosoma haematobium by urine filtration and Schistosoma mansoni using circulating cathodic antigen (CCA) and Kato-Katz stool analysis. The investigators did not address soil-transmitted helminths (STH) in this study. RESULTS: Of 399 school-aged children screened, 93.7% were infected with S. mansoni based on CCA analysis. Kato-Katz analysis of stool revealed S. mansoni infection in 73.6% (215/ 292). Heavy infections (> 400 eggs per gram) were common (32.1%; 69/ 215), with a mean of 482 eggs per gram of stool. Moderate infection intensities were detected in 31.2% (67/ 215) and light infection intensities in 36.7% (79/ 215) of infected participants. No infection with S. haematobium was detected by urine filtration. CONCLUSIONS: Intestinal schistosomiasis appears a considerable public health issue in this remote area of Madagascar where there is a pressing need for mass drug administration.