Nationwide integrated mapping of three neglected tropical diseases in Togo: countrywide implementation of a novel approach.

OBJECTIVE: To conduct a nationwide integrated neglected tropical disease (NTD) prevalence survey to define the need for public health interventions using an innovative mapping protocol. METHODS: Two villages were selected in every peripheral health unit in endemic districts: 29 districts for schistosomiasis and STH, 15 of them for trachoma. In each village, 15 children aged 6-9 years at a randomly selected school were tested. An additional convenience sample of 35 children aged 1-5 years underwent an eye examination for trachoma. This integrated mapping was followed by a 20-cluster trachoma survey in each district that surpassed the WHO-defined threshold of 10% prevalence of trachomatous inflammation-follicular (TF). RESULTS: A total of 1096 villages were surveyed in <6 weeks. The district prevalence of schistosomiasis ranged from 2 to 49% and of STH from 5 to 70%, with prevalence at the village level ranging from 0 to 100% for both diseases. Two districts passed the threshold of 10% for active trachoma, but the cluster survey indicated this was because of misclassification bias and that the real prevalence was <1%. CONCLUSION: Results of this mapping were used by the MoH and partners to plan integrated mass drug administration (MDA). Mass drug administration for trachoma was not implemented as no district passed the threshold requiring public health intervention.

[What do we know about trachoma in the economically weakest infantile population of Kara in Togo?]. / Que savons-nous de la prévalence du trachome dans la population infantile économiquement défavorisée de la region de Kara au Togo?

PURPOSE: To describe the distribution of the trachoma in the infantile population of Kara region. MATERIALS AND METHODS: A descriptive cross sectional investigation has been achieved in 6 sanitary districts of Kara's region in November 2009. In each of the 2 villages of the sanitary area of every peripheral health unit (PHU), 15 schoolchildren aged of 6 to 9 years then 35 children of the community aged of 1 to 5 years have been examined to search signs of trachoma with the help of a lamp wipes coupled of a binocular loupe (2.5X magnification). RESULTS: To the total 10,100 children have been examined in 202 villages of the sanitary areas of 101 PHU. Among the 7070 children aged of 1-5 years, 289 presented trachomatous inflammation follicular (TF) and 131 trachomatous inflammation intense (TI), corresponding to a prevalence rate of 5.94%. Among the 3030 schoolchildren, 68 presented TF and 62 TI corresponding to 4.29% prevalence rate. The prevalence rate of the active trachoma was of 5.44% in the infantile population of this region. CONCLUSION: This investigation could confirm that active trachoma still exists in this region. Another investigation will be carried out to determine the prevalence of trachoma among the adult subjects in order to have a more complete data base in view of further action for trachoma elimination in this region.

[White blood cells counts and parasite density in malaria in children aged 6 to 60 months in urban areas of Togo]. / Numération leucocytaire et densité parasitaire dans le paludisme simple chez les enfants âgés de 6 mois à 5 ans en milieu urbain au Togo.

Rational use of the artemisinin-based combination therapies in Togo requires laboratory parasitemia values to confirm suspected malaria. This study was conducted to determine the impact of the measured white blood cell (WBC) count on the determination of malaria parasite density among children younger than 5 years old infected with uncomplicated Plasmodium falciparum in Togo. This cross-sectional study of 267 children from four pediatric centers diagnosed malaria with both thick and thin blood smears and counted WBCs with a hematology analyzer. The parasite densities, calculated with the number of WBCs and estimated with an assumed count of 8,000/µL, were compared with the Wilcoxon matched pairs signed-rank test. The children's median age was 35 months (interquartile range [24-48]), with a sex ratio of 1.32. The median WBC value was 8,300 cells/µL (range: 1,300-24,900 cells/µL). The median parasitemia value calculated with the absolute WBC count was 35,714 (range: 139-48,860 parasites/µL) was not statistically different from that estimated with the assumed value of 8,000 cells/µL - 33 125 parasites/µL (p = 0.564). This study shows that malaria parasite density obtained by assuming 8000 cells/µL does not result in overestimations for children aged 6-59 months.

[Chronic myeloid leukemia and imatinib: Experience at the Lome Campus teaching hospital (Togo)]. / Leucémie myéloïde chronique et imatinib, expérience du CHU Campus de Lomé au Togo.

BACKGROUND: Chronic myeloid leukemia (CML) is a clonal malignant myeloproliferative disorder characterized by the expansion of hematopoietic cells carrying the Philadelphia chromosome (t 9.22). Our main objective was to assess the efficacy of imatinib in CML patients, measured by their survival. METHODS: Over a six-year period (June 2003 through May 2009), 25 patients were seen regularly for CML at the Lomé Campus teaching hospital. Patients received imatinib after diagnosis and underwent regular laboratory monitoring (quantification of BCR-ABL ratio by RT-PCR). Patients' survival and treatment response were evaluated. RESULTS: Patients' mean age at diagnosis was 40 years (range: 9 to 72 years). Men predominated (17 compared with 7 women). Splenomegaly was found in 80% of cases. The mean leukocyte level was 188.71 g/L (24.4-350). Six patients (24%) had thrombocytosis with a mean platelet count of 491.15 g/L (108-2000). Six patients (24%) died after developing accelerated-phase CML or blast crisis. Estimated overall survival of patients at 6 years was 60%. Molecular biology monitoring detected a secondary G250E mutation with resistance to imatinib in one patient. Standard hematological side effects led to reduction in imatinib doses. The principal nonhematological side effects were weight gain and transient digestible disorders. CONCLUSIONS: At six years after diagnosis, imatinib was effective in treating patients with CML, even in sub-Saharan Africa. Mutation-induced resistance required regular molecular biological monitoring to determine the need to switch to later-generation tyrosine kinase inhibitors.