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.

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.

[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.

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.

[Intestinal helminthiasis diagnosed in Dakar, Senegal]. / Prévalence des helminthoses digestives diagnostiquées à l'hôpital Le Dantec de Dakar, Sénégal.

The goal of this study was to determine the prevalence of digestive helminthiasis among patients referred to the laboratory of Parasitology and mycology at Le Dantec Hospital in Dakar for examination of stool samples from 2004 to 2009. Of 1 526 direct stool examinations (Ritchie and Baerman techniques) analyzed at the laboratory of Parasitology and Mycology of Le Dantec Hospital from 2004 to 2009, 310 were positive for intestinal helminthiasis, for a prevalence of 20.3%. The main species found were: Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis, Tænia saginata and Tænia solium. Most patients had a single parasite (90.1%, versus 9% with two and 0.9% with three). Men are infected more often than women, accounting respectively for 58% and 42% of the infections, for a sex ratio of 1.38. Children aged 10 to 15 years had the highest prevalence of infection: 34.5%. The results show that digestive helminthiasis is endemic in Dakar, where it is necessary to implement campaigns of deworming, health education and environmental improvement.

[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.

[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.

[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.

Osteomyelite chronique de la clavicule. A propos d'un cas

Nous rapportons un cas d'osteomyelite chronique de la clavicule chez un garcon de cinq ans; du a un traumatisme par chute de cheval. Le diagnostic etait suspecte par la persistance d'une fistule cutanee productive en regard de la clavicule gauche; l'existence d'un fragment osseux exteriorise et confirme par la radiographie standard de l'epaule. La bacteriologie etait negative et la vitesse de sedimentation acceleree. Le traitement etait chirurgical et consistait en une sequestrectomie de la totalite de la clavicule laissant en place l'involucrum. L'evolution etait favorable en trois semaines avec disparition du syndrome inflammatoire et reconstitution de la clavicule

Connaissances, attitudes et pratiques des femmes sur le paludisme, dans la zone rurale de Poponguine, Sénégal

Au Sénégal, le paludisme est un problème majeur de santé publique et de développement, car il représente la première cause de morbidité et de mortalité. Ce sont les enfants de 0-5 ans et les femmes enceintes qui sont les plus vulnérables. L'objectif est d'évaluer les connaissances, attitudes et pratiques des femmes en zone rurale sur le paludisme. Il s'agit d'une étude transversale, descriptive et analytique menée dans le district de Poponguine du 1er au 15 avril 2005. Il s'agissait d'une enquête en grappe. La taille de l'échantillon calculée était égale à 800. La population d'étude était constituée par des femmes vivant dans le district depuis plus de 1 an et âgées de 15 à 45 ans. L'âge moyen des femmes était de 28 ans, (intervalle de confiance à 95% = 27,7 ­ 28,8). Parmi ces femmes, 49,6% étaient scolarisées et 65,5% avaient un niveau socioéconomique faible. 82,25% savaient que le paludisme est dû à la piqûre d'un moustique. Le signe principal (la fièvre ou corps chaud) a été cité dans 81% des cas. Cependant les signes du paludisme grave n'étaient pas bien connus. Il existait une bonne connaissance des mesures préventives aussi bien chez l'enfant que chez la femme enceinte : la Moustiquaire Imprégnée (MI) (62,9%) et la pratique du Traitement Préventif Intermittent (TPI) lors de la grossesse (52,4%). Il existait une bonne accessibilité géographique et financière des femmes interrogées par rapport aux MI. Plus de la moitié des femmes interrogées (92%) disait avoir recours à la structure sanitaire en cas de grossesse et/ou pour un enfant suspect de paludisme. Le personnel de santé (60,4%) et les relais communautaires (62,9%) constituaient la principale source d'information. La couverture en MI était de 33% et le taux d'utilisation du TPI de 71,1%. Il existait une relation significative entre le niveau de connaissances et les pratiques (p < 0,05). Les facteurs déterminant les connaissances étaient l'âge et le niveau d'instruction. Les pratiques des mères étaient influencées par l'âge, la source de revenus et la situation matrimoniale. A l'issue de cette étude, nous recommandons, pour le district de Poponguine, en accord avec le programme national de lutte contre le paludisme de renforcer le programme de sensibilisation afin d'amener les populations à améliorer leur connaissance en matière de paludisme et à changer de comportement mais aussi de mener une enquête qualitative pour compléter cette étude épidémiologique

Les hernies inguinales etranglees de l'enfant en milieu africain: a propos de 135 cas

Objectifs: Rapporter les aspects epidemiologiques; cliniques et chirurgicaux de la hernie inguinale etranglee chez l'enfant en milieu africain .Patients et methodes: Il s'agit d'une etude retrospective allant de juin 1994 a Juin 2004 portant sur les cas des hernies inguinales admis dans le seul service de Chirurgie Pediatrique du Senegal. Les dossiers de 135 enfants presentant une hernie inguinale etranglee ont ete revus. L'age; le sexe; la prevalence de l'etranglement; le delai de consultation; le mode de revelation de l'etranglement; les pathologies associees; la voie d'abord chirurgicale; le viscere hernie; les gestes pratiques ainsi que les suites operatoires ont ete analyses.Resultats: L'age moyen des enfants etait de 2;3 ans avec des extremes de 17 jours et 15 ans. Le sex-ratio etait de 11;75 / 1. La prevalence de l'etranglement etait de 13;5. Le delai moyen de consultation etait de 31;5h. Les enfants etaient surtout vus pour une tumefaction inguinale douloureuse (77;78); des vomissements (48;15) ou un syndrome occlusif (22;22). La hernie inguinale controlaterale et la cryptorchidie homolaterale etaient les principales pathologies associees. La hernie etait abordee par une incision transversale passant par le pli abdominal inferieur. L'intestin grele etait le principal organe retrouve dans le sac herniaire (76;3). Huit cas de necrose intestinale et six cas d'infarcissement gonadique etaient retrouves. Tous les enfants avaient beneficie d'une reduction de la hernie suivie de la ligature-section haute du sac. Une resection-anastomose intestinale ou une orchidectomie etaient realisees chez les enfants presentant une necrose intestinale ou gonadique. Quinze cas de suppuration parietale; 10 cas de recidive et deux cas d'atrophie testiculaire etaient notes. Conclusion: L'etranglement est plus frequent chez les nouveaux-nes et les nourrissons. Le mauvais etat general ainsi que la morbidite elevee s'expliquent par un traitement tardif

Strangulated umbilical hernias in children.

Umbilical hernia is a frequent pathology of the anterior abdominal wall in children. The hernia ring closes usually before 4 years, but a strangulation can occur. It is an exceptional complication according to the literature data. Since this complication is rare, we undertook a retrospective study of these strangulations in a 5-year period from January 1997 to December 2001 at Aristide Le Dantec hospital. We collected 41 cases that underwent emergency surgery operations for strangulated umbilical hernias, which represent about 15% of umbilical hernias operated during the same period. The age range was 8 months to 10 years and the average age was 14 months. All the children were examined within 24 h after the onset of the disease and the surgery was immediately performed. In five cases the bowel was necrosed and perforated and we performed a resection followed immediately by an anastomosis. In the follow up, two children presented wound infections and a hernia recurred in one child. There was no mortality. This study conducts us to question western reports which recommend conservative therapy for umbilical hernia in children.

[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.

[Umbilical reconstruction in children. Prospective report of 77 cases]. / Les plasties cutanées ombilicales chez l'enfant. Etude prospective chez 77 patients.

Umbilical hernia is as frequent pathology in our country. The skin excess is a real problem for the surgeon because it is inesthetical. We report 77 cases of children with umbilical hernia who we operated between 1999 and 2000. Fifty-five of them have a umbilical plasty. For this, we used three surgical techniques: lateral left plasty, "horseshoe" plasty and umbilical graft. We classed our results into three groups: 40 good results, seven middle results and three bad results. Twenty-seven patients are lost. These three surgical techniques are a simple and safe solution to this problem of skin excess in the umbilical hernia.

[Evaluation of the management of femoral shaft fractures in children by flexible intramedullary nailing]. / Evaluation du traitement des fractures de la diaphyse fémorale chez l'enfant par embrochage centromédullaire elastique stable (ECMES).

The purpose of this study was to evaluate the morphological and functional outcomes of femoral shaft fractures of the child using a centromedullary elastic nailing. We led a retrospective study including 22 children operated from January 1997 to December 2000 at the surgical emergency department of "Hôpital Aristide Le Dantec". The follow-up was made in the department of paediatric surgery. The patients included 16 boys and 6 girls presenting a total of 23 femoral shaft fractures. The main circumstance was traffic accident(15 cases). All the children underwent an ascending centromedullary elastic nailing controlled by a C-arm after a period of traction. The outcomes were appreciated after a period of 10 months. We observed: A union in all cases, four infections well managed by antibiotics, one vicious callus of 15 degrees, a mobility limitation of knee in two cases (45 degrees and 100 degrees), an inferior limb length inequality in one case, scabs in one patient who died at the 3rd month of a septicopyohemia. The functional evaluation of the outcomes (flexion, extension, limb length inequality) and morphological outcomes (axis, consolidation) showed 21 good results and one bad result. The centromedullary elastic nailing is a safe procedure owing to the low complication rates and the rapid consolidation allowing an early walk in femoral shaft fractures, compared with the orthopaedic treatment.

[Evaluation of the management of omphalocele at Dakar]. / Evaluation de la prise en charge de l'omphalocèle a Dakar.

Omphalocele is a congenital malformation of the abdominal wall of children, characterized by an ombilical defect living the abdominal organ visible through a translucent amniotic membrana. The goals of this study were to describe the epidemiological, clinical and therapeutic characteristics at the University Teaching Hospital of Dakar. We conducted a retrospective study at the UniversityTeaching Hospital of Dakar from January 1997 to December 2002. Fifty cases of Omphalocele diagnosed at the Unit of Paediatric Surgery of the Department of General Surgery at Aristide Le Dantec Hospital, were included in this study. We described the epidemiological, clinical and therapeutic characteristics of omphalocele. Omphalocele is a condition diagnosed late in boys from poor sphere. The study revealed that weight from birth, omphalocele size, local state, and existance of associated malformation correlated with death rate. The treatment option was a spontaneous epidermisation as described by Grob in the absence of omphalocele rupture wich imposed a primary closure of abdominal wall. The overall death rate was 42%. The improvement of results will need an antenative diagnosis, paediatric reanimation unit wich will notably reduce death rate.