Maternal and congenital toxoplasmosis in Mayotte: Prevalence, incidence and management.

BACKGROUND: Toxoplasmosis is an infection caused by an intracellular protozoan, Toxoplasma gondii. It is usually asymptomatic, but toxoplasmosis acquired during pregnancy can cause congenital toxoplasmosis, potentially resulting in fetal damage. Epidemiological information is lacking for toxoplasmosis in Mayotte (a French overseas territory). We evaluated (1) the prevalence of maternal toxoplasmosis, (2) the incidence of maternal and congenital toxoplasmosis, and (3) the management of congenital toxoplasmosis in Mayotte. METHODOLOGY / PRINCIPAL FINDINGS: We collected all the available data for toxoplasmosis serological screening during pregnancy and maternal and congenital cases of toxoplasmosis obtained between January 2017 and August 2019 at the central public laboratory of Mayotte (Mamoudzou). Using toxoplasmosis serological data from samples collected from 16,952 pregnant women we estimated the prevalence of toxoplasmosis in Mayotte at 67.19%. Minimum maternal toxoplasmosis incidence was estimated at 0.29% (49/16,952, 95% CI (0.0022-0.0038)), based on confirmed cases of maternal primary infection only. The estimated incidence of congenital toxoplasmosis was 0.09% (16/16,952, 95% CI (0.0005-0.0015). Missing data made it difficult to evaluate management, but follow-up was better for mothers with confirmed primary infection and their infants. CONCLUSIONS / SIGNIFICANCE: The seroprevalence of toxoplasmosis among pregnant women and the incidence of toxoplasmosis are higher in Mayotte than in mainland France. There is a need to improve the antenatal toxoplasmosis screening and prevention programme, providing better information to physicians and the population, to improve management and epidemiological monitoring.

Palliative Care Needs Assessment in the Population Living in Mayotte: SPMAYOTTE, a Qualitative Study Conducted with 62 Patients, Caregivers and Healthcare Professionals.

BACKGROUND/AIM: Mayotte is a French island in the Indian Ocean. There is no palliative care structure in this territory. The island and its population have specific characteristics: insularity, poverty, coexistence of modern and traditional medicine, importance of religion (Islam) and the presence of many foreigners without health insurance. The aim of this study is to determine the palliative care needs of the Mayotte population and propose the establishment of an appropriate service. METHODS: A qualitative study was conducted in Mayotte using interviews with patients and their caregivers, and focus groups were conducted with healthcare professionals involved in their care. Patients requiring palliative care were identified and recruited from the hospital or the patient's home by healthcare professionals. RESULTS: A total of 62 people participated in the study between May and June 2019. The needs expressed were analysed and then grouped into categories: access to medical care (especially at home), management of physical symptoms (analgesia) and psychological symptoms, organisation of care (coordination between healthcare professionals) and training of healthcare professionals (pain management, palliative care, interculturality and translation), taking into account cultural and religious aspects. Regarding the foreign population, the categories were: improving access to healthcare, access to the social protection system and daily living conditions (transport, food and accommodation). CONCLUSIONS: The specific needs of the population, assessed through the study, have led to an original proposal, which differs from the usual structures of palliative care in France.

Health, illness and cancer in Mayotte: Multicultural experiences in a medically underserved French Territory.

The island of Mayotte is part of the French territory and one of the European Union's Outermost Regions but there is a significant lack of data and research on health and cancers in Mayotte. This article reviews the literature on health, disease and cancer in Mayotte, from the perspectives of social science and epidemiology. It starts by shedding light on the specificities of Mahoran demography and society, and shows the healthcare infrastructure is insufficient to meet the population's needs. It then reviews social science studies on health and illness in Mayotte and shows that the political issue of migration permeates the management and the experiences of health on the island. It ends with a focus on the epidemiology of cervical cancer and a review of the available data on screening, treatment and prevention. The article concludes with a quick review of ongoing research and urgently calls for more data and research on this critical public health issue.

A Comparative Study of the Health Care Delivery Systems in the Indian Ocean: What can Comoros Islands Learn from Mauritius and Seychelles?

In recent years, there have been significant efforts to examine the organization and performance of health systems. This study's main purpose is to compare health systems and analyze the health status of the citizens of Comoros, Mauritius, and Seychelles, with the intention of providing policy recommendations for Comoros. Peer-reviewed studies and reports published by non-governmental organizations and international agencies were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into the World Health Organization (WHO) building blocks framework. The literature review demonstrates that health outcomes have dramatically improved over the past decades in Mauritius and Seychelles but not in Comoros. As of 2015, Mauritius and Seychelles were among the few African countries to have achieved almost all the Millennium Development Goals, whereas Comoros still struggles to reduce child mortality and improve maternal health. In contrast, the total health expenditure of the three island states, as a percentage of gross domestic product (GDP), seemed similar over the studied time period.

An Overview of Healthcare Systems in Comoros: The Effects of Two Decades of Political Instability.

Background: There is ongoing scientific evidence pointing out the adverse effects of conflict on population health and development. Union of Comoros has experienced nearly two decades of political instability and military rule. This comprehensive review was carried out to ask whether the health crisis in Comoros is attributable to the consequences of the chronic political instability. Methods: This study involved a series of semi-structured interviews with key informants complemented by a comprehensive literature search of electronic databases and grey literature. A literature search was performed using all identified keywords associated with health indicators in Comoros to identify potential eligible publications in both English and French from 1975 to July 2020. Results: The analysis demonstrated that political instability and lack of proper leadership from the Government undermine the establishment of health policies which contributed dramatically to the decline in health performance. Additionally, the resurgence and emergence of old and new diseases such as cholera, chikungunya, malaria, HIV/AIDS as indicators of inadequate health services were most likely during political turmoil. Data also showed an out-migration of the health workforce and an increased overseas medical treatment demand, which indicate less attractive working conditions and weak health systems in the country. Meanwhile, an increasing performance of health status indicators was observed after the comprehensive peace process of the 2000-Fomboni Declaration. Conclusions: The chronic political instability in Comoros has contributed to the health crisis facing the Union of Comoros. It has hampered the implementation of proper institutions, which might guarantee the socio-economic development and prosperity of the population. Further studies were needed to evaluate the health burden associated with the two decades of political instability and military rule.

Physician network connections to specialists and HIV quality of care.

OBJECTIVE: To estimate novel measures of generalist physicians' network connectedness to HIV specialists and their associations with two dimensions of HIV quality of care. DATA SOURCES: Medicare and Medicaid claims and the American Medical Association Masterfile data on people living with HIV (PLWH) and the physicians providing their HIV care in California between 2007 and 2010. STUDY DESIGN: I construct regional patient-sharing physician networks from the shared treatment of PLWH and calculate (a) measures of network connectedness to all physician types and (b) specialty-weighted measures to describe connectedness to HIV specialists. Two HIV quality of care outcomes are then evaluated: medication quality (prescribing antiretroviral drugs from at least two drug classes) and monitoring quality (at least two annual HIV virus monitoring scans). Linear probability models estimate the associations between network statistics and the two dimensions of HIV quality of care, and a policy simulation demonstrates the importance of these statistical relationships. These analyses include 16 124 PLWH, 3240 generalists, and 1031 HIV specialists. DATA COLLECTION/EXTRACTION METHODS: PLWH are identified from claims for patients with any indication of HIV using an existing algorithm from the literature. PRINCIPAL FINDINGS: Generalists' network connectedness to HIV specialists is positively related with their own HIV medication quality; one additional HIV specialist connection is associated with a 1.46 percentage point (SE 0.42, P < .01) increase in generalist's medication quality. Based on the estimated associations, a simulated policy that increases connectedness between generalists and HIV specialists reduces the annual rate of HIV infections by up to 6%, roughly 290 fewer infections per year. Only network connectedness to all physician types is associated with improved monitoring quality. CONCLUSIONS: Network connectedness to HIV specialists is positively associated with generalists' HIV medication quality, which suggests that specialists provide clinical support through patient-sharing for complex treatment protocol.

Characteristics Associated With Nonreceipt of Surveillance Testing and the Relationship With Survival in Stage II and III Colon Cancer.

We investigated characteristics of patients with colon cancer that predicted nonreceipt of posttreatment surveillance testing and the subsequent associations between surveillance status and survival outcomes. This was a retrospective cohort study of the Surveillance, Epidemiology, and End Results database combined with Medicare claims. Patients diagnosed between 2002 and 2009 with disease stages II and III and who were between 66 and 84 years of age were eligible. A minimum of 3 years' follow-up was required, and patients were categorized as having received any surveillance testing (any testing) versus none (no testing). Poisson regression was used to obtain risk ratios with 95% confidence intervals for the relative likelihood of No Testing. Cox models were used to obtain subdistribution hazard ratios with 95% confidence intervals for 5- and 10-year cancer-specific and noncancer deaths. There were 16,009 colon cancer cases analyzed. Patient characteristics that predicted No Testing included older age, Black race, stage III disease, and chemotherapy. Patients in the No Testing group had an increased rate of 10-year cancer death that was greater for patients with stage III disease (subdistribution hazard ratio = 1.79, 95% confidence interval: 1.48, 2.17) than those with stage II disease (subdistribution hazard ratio = 1.41, 95% confidence interval: 1.19, 1.66). Greater efforts are needed to ensure all patients receive the highest quality medical care after diagnosis of colon cancer.

Culture-Confirmed Staphylococcus aureus Infection after Elective Hysterectomy: Burden of Disease and Risk Factors.

Background: Our study sought to describe the incidence of culture-confirmed postsurgical Staphylococcus aureus infection after elective hysterectomy and evaluate patient characteristics, risk factors, and economic consequences associated with Staphylococcus aureus infection. Methods: This was a retrospective cohort study of patients in the United States (≥18 years old; Kaiser Permanente health plan members) who underwent elective hysterectomy from 2007 to 2013. Hysterectomies were categorized by surgical setting (inpatient vs. outpatient) and procedure (abdominal, laparoscopic, or vaginal). We estimated the cumulative incidence of culture-confirmed Staphylococcus aureus infection (90 days post-surgery) and compared healthcare resource utilization and costs (within 120 days post-surgery) among patients with/without Staphylococcus aureus infection or with other infection. Results: Among 30,960 patients identified, 20,675 underwent inpatient hysterectomy (abdominal: 47.8%; laparoscopic: 24.8%; vaginal: 27.3%), and 10,285 underwent outpatient hysterectomy (laparoscopic: 86.1%; vaginal: 13.9%). The incidence of culture-confirmed Staphylococcus aureus infection was 0.8% and 0.4% for inpatient (abdominal: 1.2%; laparoscopic: 0.5%; vaginal: 0.2%) and outpatient (laparoscopic: 0.5%; vaginal: 0.1%) surgery, respectively. Patients with Staphylococcus aureus infection had more emergency department visits, hospitalizations, and re-operations compared with patients without infection or with non-Staphylococcus aureus infection. Mean total costs for patients with Staphylococcus aureus infection were higher (inpatient: $18,261; outpatient: $4,422) compared with patients without infection (inpatient: $6,171; p < 0.0001; outpatient: $905; p = 0.0023) or non-Staphylococcus aureus infection (inpatient: $11,207; p = 0.0117; outpatient: $3,005; p = 0.2117). Conclusions: Culture-confirmed postsurgical Staphylococcus aureus infection incidence was predominately associated with procedure type rather than surgical setting. Patients with post-surgical Staphylococcus aureus infection had higher health care utilization and costs than those without infection or with other infection types. Additional effective infection control strategies are needed to reduce the morbidity and costs associated with Staphylococcus aureus infection.

The Epidemiology of COVID-19: A Review.

COVID-19 is a new lethal disease with limited information on its transmissibility, the severity of its sequelae, its clinical manifestations, and epidemiology. This commentary analyzed the global epidemiology of COVID-19 among the vulnerable population. The analysis revealed that most pediatric COVID-19 cases are not severe, but related severe illness still occurs in children. All ages of children are susceptible to COVID-19, and no significant gender difference exists. COVID-19 infection during pregnancy produced fatal outcomes for mothers, but less risky for the baby. The hot spot clusters for COVID-19 are the prisons/jails, nursing/group homes, and long-term facilities where most of the vulnerable populations reside. Ethnic minority groups in the USA and UK are disproportionately exposed to COVID-19 infection and death than Caucasians. The difference may be because ethnic minorities are exposed to higher risks at work and the long-standing structural economic and health disparities in the two countries. There are now changes in guidelines on who is qualified to receive ventilators in dire situations in many countries around the world if the healthcare system is overwhelmed.

Impact of East Coast fever on Grande Comore: assessment taking a participatory epidemiology approach.

East Coast fever (ECF), one of the most serious tick-borne diseases in sub-Saharan and eastern Africa, was introduced to the island of Grande Comore in 2002 through zebu import from Tanzania, resulting in at least a 10% loss of livestock. A participatory epidemiology initiative was launched in 2015 to gain a better understanding of ECF epidemiology. Thirty-six villages were investigated involving 36 focus group sessions and 120 individual questionnaires. Farmers' knowledge of ECF and of priority diseases affecting the country was assessed, and the impacts of ECF and other major diseases were compared by a scoring method. The results showed that 69.4% (95% CI [51.3, 87.5%]) of the farmers had good to very good knowledge of ECF. The most important cattle diseases on Grande Comore were considered to be East Coast fever, heartwater, babesiosis, and cutaneous diseases. About 58% of the farmers (95% CI [49.2, 66.8%]) use curative treatments when cattle were sick. Between January and September 2015, the ECF incidence was estimated at 18.5% (95% CI [15.5, 21.4%]), and 87.5% (95% CI [72.7, 100%]) of the cattle infected by ECF died. The ECF incidence estimated in our study was found to be less when compared to that observed in Tanzania even though the climatic conditions in the Union of the Comoros are suitable for the biological vector of ECF, the tick species Rhipicephalus appendiculatus. Access to chemical treatment and its effectiveness against ECF, as well as controlling borders and organizing quarantine, are discussed.

Socioeconomic Disparities in Health Outcomes and Access to Health Care across Three Islands in Comoros.

The purpose of this paper is two-fold. First, to give an overview of the size and measure trends in health inequalities in the Comoros islands (Comoros) since 1996. Second, to assess the wide differences in health and health care across rural/urban areas and islands in Comoros, by using available and comparable leading indicators, in order to promote regular monitoring of policy goals. This assessment is aimed at reducing health inequalities and providing adequate or equal access to health care between islands. Data from the Demographic and Health Survey, Multiple Indicators Cluster Surveys from 1996, 2000 and 2012, the World Health Organization, the World Bank, the African Development Bank data sources, were analyzed for a population health-oriented approach characterized by measuring health differences from the population average, taking account of the population size of the social groups on both relative and absolute scales. The results showed that there exist geographic disparities in health in Comoros, mainly in maternal and child health.

Taxonomy- or trait-based ecological assessment for tropical rivers? Case study on benthic diatoms in Mayotte island (France, Indian Ocean).

Diatom-based ecological quality assessment methods have been implemented and used regularly in the Water Framework Directive. These indices use the species' abundance profiles along a specific environmental gradient, which they aim to assess. However, this approach has several problematic issues including the unstable and fast-changing diatom taxonomy. The use of traits can be a solution if their responses to the environmental pressure are well-defined. Here, we developed taxonomy-based and trait-based diatom assemblage indices to assess the ecological status of riverine sites on a tropical island. The two indices are based on two sub-indices that measure the diatom assemblage response to a nutrient and organic matter/turbidity gradient. Both taxonomy- and trait-based indices correlated significantly with the selected environmental gradients of the test database, which was not used during index development. We showed that traits could be used for quality assessment of the Mayotte rivers and require much less effort than taxonomy-based indices. There were differences between the two types of indices, which are discussed in this paper. As a perspective for further studies, tests of trait-based indices among different eco-regions would be challenging.

Cost of treatment of peripheral neuropathic pain with pregabalin or gabapentin in routine clinical practice: impact of their loss of exclusivity.

To analyze the effect of loss of exclusivity of data on the cost of treatment of peripheral neuropathic pain (PNP) with pregabalin or gabapentin in routine clinical practice. A retrospective observational study, with electronic medical records for patients enrolled at primary care centers managed by the health care provider Badalona Serveis Assistencials, who initiated treatment of PNP with pregabalin or gabapentin. The analysis used drugs and resources prices for year 2015. The 1163 electronic medical records (pregabalin; N = 764, gabapentin; N = 399) for patients (62.2% women) with a mean (standard deviation) age of 59.2 (14.7) years were analyzed. Treatment duration was slightly shorter with pregabalin than with gabapentin (5.2 vs 5.5 months; P = 0.124), with mean doses of 227.4 (178.6) mg and 900.0 (443.4) mg, respectively. The average study drug cost per patient was higher for pregabalin than for gabapentin; €214.6 (206.3) vs €157.4 (181.9), P < 0.001, although the cost of concomitant analgesic medication was lower; €176.5 (271.8) vs €306.7 (529.2), P < 0.001. The adjusted average total cost per patient was lower in those treated with pregabalin than in those treated with gabapentin; €2,413 (2119-2708) vs €3201 (2806-3.597); P = 0.002, owing to significantly lower health care costs; €1307 (1247-1367) vs €1538 (1458-1618), P < 0.001, and also non-health care costs; €1106 (819-1393) vs €1663 (1279-2048), P = 0.023, that was caused by a significantly lower use of concomitant medication, fewer medical visits to primary care, and fewer days of sick leave. After loss of exclusivity of both drugs, pregabalin continued to show lower health care and non-health care costs than gabapentin in the treatment of PNP in routine clinical practice.

[Poisoning with Jatropha curcas: 24 cases reported to Paris and Marseille Poisons Centers]. / Intoxications par pignons d'Inde (Jatropha curcas): 24 observations rapportées aux centres antipoison de Paris et Marseille.

Jatropha curcas L. is an inedible plant belonging to the Euphorbiaceae family that is growing in subtropical zones of all continents. We report a series of 24 cases of poisoning with J. curcas seeds or fruits reported to poison centers in Paris and Marseille between December 2000 and June 2014. Fifteen adults and 9 children ingested J. curcas seeds or fruits. All patients experienced gastrointestinal disorders, within the first hours following ingestion: nausea, vomiting, diarrhea and abdominal pain. Laboratory investigations performed in 10 patients revealed minor abnormalities: CK elevation (8 cases), dehydration (5 cases) with moderate elevation of serum creatinine levels (3 cases), and mildly increased serum bilirubin (8 cases). Complete remission of all clinical signs was observed within 48 hours in the 20 cases for which the outcome was known. Previously published cases of J. curcas poisoning were very similar to ours: As in our series, gastrointestinal disorders were always present. They were sometimes associated with neurological or cardiovascular signs, and hepatic or renal disorders; these were generally interpreted as complications of severe gastroenteritis, although direct toxic effects could not be formally excluded. In most cases, simple supportive measures were sufficient to ensure complete recovery within 24-48 hours. J Curcas poisoning incidence is certainly increasing because the plant is cultivated to produce biodiesel and is now largely present in most subtropical countries. As a consequence, local health professionals should be informed of the toxic properties of this plant.

[Dental health status of 15 year-old schoolchildren in Comoros]. / Etat de santé dentaire des élèves de 15 ans aux Comores.

The epidemiological situation of decay evolves differently in the world. In industrialized countries, prevalence has declined significantly due to preventive measures, while in developing countries many studies have shown that caries was increasing. The aim of this study was to assess the state of dental health of schoolchildren aged 15 in Grand Comore (Comoros). This was a descriptive cross-sectional study on 15 year-old schoolchildren in colleges in Grande Comore who agreed to be examined. Four hundred schoolchildren were chosen by a stratified sampling weighted according to the area of living. Three groups of indicators of dental caries were used: the components D, M and F, the average DMFT and prevalence. The WHO modified questionnaire for the assessment of dental health was used to collect data; continuous data were compared by Student t test and qualitative ones by Chi-square test. Fifty two percent of schoolchildren were male and 63.5% lived in urban area. From the 888 teeth bearing the stigmata of decay, 83.2% were decayed, 12.5% missed and 4.3% filled. These components of DMF were associated with sex (p = 0.039) and not with area (p = 0.12). The 2.22 DMFT average was not associated with sex (p = 0.58) neither with area (p = 0.57). The caries prevalence was higher in rural than in urban areas (p = 0.001) and was not associated with sex (p = 0.61). These results suggest that schoolchildren need decay treatments. The dental programs will have much more success when they will be integrated into more comprehensive programs to promote schoolchildren health.

[Critical analysis of requirements for scientific assessment as a basis for good governance: case of the chikungunya epidemic on Reunion Island and Mayotte in 2005 and 2006]. / L'analyse critique du respect des conditions de bonne gouvernance en matière d'evaluation scientifique des risques: le cas de l'epidémie de chikungunya a La Réunion et a Mayotte en 2005 et 2006.

The constitutional precautionary principle as applied in laws governing health care at the community level requires rigorous scientific assessment. The goal of this assessment is to provide authorities with sound evidence as a basis for implementing precautionary measures in function of degree of risk and other parameters such as the level of public health protection that is high in the EU. As the political authority, the government can act independently of conclusions issued by scientific commissions provided that the commission's level of expertise meets national and European standards and that research methodology and findings are consistent with scientific data published in the international literature. These requirements were not meet for the chikungunya pandemic that struck France on Reunion Island and Mayotte from 2004 to 2006. This epidemic that was preceded by many outbreaks in Indonesia between 2001 and 2003 began in Africa and then swept across the Indian Ocean to India and Asia. After an overview of the scientific assessment, this article raises arguments supporting possible allegations of gross misgovernance by the state and experts.

Medical and financial risks associated with surgery in the elderly obese.

OBJECTIVE: To study the medical and financial outcomes associated with surgery in elderly obese patients and to ask if obesity itself influences outcomes above and beyond the effects from comorbidities that are known to be associated with obesity. BACKGROUND: Obesity is a surgical risk factor not present in Medicare's risk adjustment or payment algorithms, as BMI is not collected in administrative claims. METHODS: A total of 2045 severely or morbidly obese patients (BMI ≥ 35 kg/m, aged between 65 and 80 years) selected from 15,914 elderly patients in 47 hospitals undergoing hip and knee surgery, colectomy, and thoracotomy were matched to 2 sets of 2045 nonobese patients (BMI = 20-30 kg/m). A "limited match" controlled for age, sex, race, procedure, and hospital. A "complete match" also controlled for 30 additional factors such as diabetes and admission clinical data from chart abstraction. RESULTS: Mean BMI in the obese patients was 40 kg/m compared with 26 kg/m in the nonobese. In the complete match, obese patients displayed increased odds of wound infection: OR (odds ratio) = 1.64 (95% CI: 1.21, 2.21); renal dysfunction: OR = 2.05 (1.39, 3.05); urinary tract infection: OR = 1.55 (1.24, 1.94); hypotension: OR = 1.38 (1.07, 1.80); respiratory events: OR = 1.44 (1.19, 1.75); 30-day readmission: OR = 1.38 (1.08, 1.77); and a 12% longer length of stay (8%, 17%). Provider costs were 10% (7%, 12%) greater in obese than in nonobese patients, whereas Medicare payments increased only 3% (2%, 5%). Findings were similar in the limited match. CONCLUSIONS: Obesity increases the risks and costs of surgery. Better approaches are needed to reduce these risks. Furthermore, to avoid incentives to underserve this population, Medicare should consider incorporating incremental costs of caring for obese patients into payment policy and include obesity in severity adjustment models.

[Reality of healthcare access for migrant children in Mayotte]. / La réalité de l'accès aux soins des enfants de migrants à Mayotte.

The implementation of the social security system in 2005 in Mayotte has resulted in the end of free healthcare for all non-affiliated residents, primarily Comorians, due to the absence of the State Medical Aid (AME) in this department. Doctors of the World France opened a paediatric clinic in December 2009. The sociomedical data were collected during 5286 consultations in 2010. Analysis of these data demonstrates a link between access to healthcare for children and the residential status of their parents. The analysis concerns 2,350 patients met during consultations held by Doctors of the World France in Mayotte in 2010. The data have been electronically recorded and analysed by the Sphinx software. The results show that there are several obstacles to healthcare resulting in non-attendance. This situation is made worse if one of the parents has an irregular residential status and all the more so if both the parents have an irregular status. Affiliation to the social security system, however, improves the situation. The results show a delay in accessing healthcare, a poor vaccination programme and disturbing data on severe acute malnutrition. The specific healthcare measures in Mayotte do not respect the International Convention on the Rights of the Child. Direct affiliation to the social security system for children would entail a reduction in health insecurity for the children of parents with irregular residential status. It would also be necessary to reduce the factors that provoke fear of displacement, which would facilitate physical access to consultations.