Cutaneous leishmaniasis in French Guiana: revising epidemiology with PCR-RFLP.

BACKGROUND: The development of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique for species identification among patients presenting leishmaniasis allowed to better determine the main circulating species in French Guiana. METHODS: A descriptive study of the Leishmania species was identified, and their spatiotemporal distribution was conducted using patient records between 2006 and 2013, with 1017 new cases of leishmaniasis diagnosed. Identification was realized by PCR-RFLP on 745 cases. RESULTS: The average proportions for different species were 86.2% for Leishmania (Vianna) guyanensis; 9.7% for Leishmania (Vianna) braziliensis; 2.8% for Leishmania (Leishmania) amazonensis; and 1.3% for Leishmania (Vianna) lainsoni, and no case of Leishmania (Vianna) naiffi was identified. Over this period, the proportion of cases due to L. (V.) braziliensis seemed to increase from 8.9% in 2006 to 13.0% in 2013 notably near the gold mining zones. CONCLUSIONS: The use of molecular tools has transformed the view of the local epidemiology of cutaneous leishmaniasis in French Guiana.

Dengue epidemics and adverse obstetrical outcomes in French Guiana: a semi-ecological study.

OBJECTIVE: To determine whether dengue epidemics are associated with an increase in adverse obstetrical outcomes. METHODS: Semi-ecological study combining individual data on obstetrical events from the perinatal registry and aggregated exposure data from the epidemiologic surveillance of dengue in Cayenne, French Guiana between 2004 and 2007. RESULTS: After adjustment for individual risk factors, analysis showed that an epidemic level of dengue transmission during the first trimester was associated with an increased risk of post-partum haemorrhage and preterm birth. The associated risks seemed to depend on the epidemic level. CONCLUSIONS: Despite its limitations, this study suggests that dengue in the first trimester may be related to preterm birth and to post-partum bleeding, thus leading to specific hypotheses that should be tested in prospective studies.

Climate and leishmaniasis in French Guiana.

To study the link between climatic variables and the incidence of leishmaniasis a study was conducted in Cayenne, French Guiana. Patients infected between January 1994 and December 2010. Meteorological data were studied in relation to the incidence of leishmaniasis using an ARIMA model. In the final model, the infections were negatively correlated with rainfall (with a 2-month lag) and with the number of days with rainfall > 50 mm (lags of 4 and 7 months). The variables that were positively correlated were temperature and the Multivariate El Niño Southern Oscillation Index with lags of 8 and 4 months, respectively. Significantly greater correlations were observed in March for rainfall and in November for the Multivariate El Niño/Southern Oscillation Index. Climate thus seems to be a non-negligible explanatory variable for the fluctuations of leishmaniasis. A decrease in rainfall is linked to increased cases 2 months later. This easily perceptible point could lead to an interesting prevention message.

Corruption kills: estimating the global impact of corruption on children deaths.

BACKGROUND: Information on the global risk factors of children mortality is crucial to guide global efforts to improve survival. Corruption has been previously shown to significantly impact on child mortality. However no recent quantification of its current impact is available. METHODS: The impact of corruption was assessed through crude Pearson's correlation, univariate and multivariate linear models coupling national under-five mortality rates in 2008 to the national "perceived level of corruption" (CPI) and a large set of adjustment variables measured during the same period. FINDINGS: The final multivariable model (adjusted R(2)= 0.89) included the following significant variables: percentage of people with improved sanitation (p.value<0.001), logarithm of total health expenditure (p.value = 0.006), Corruption Perception Index (p.value<0.001), presence of an arid climate on the national territory (p = 0.006), and the dependency ratio (p.value<0.001). A decrease in CPI of one point (i.e. a more important perceived corruption) was associated with an increase in the log of national under-five mortality rate of 0.0644. According to this result, it could be roughly hypothesized that more than 140000 annual children deaths could be indirectly attributed to corruption. INTERPRETATIONS: Global response to children mortality must involve a necessary increase in funds available to develop water and sanitation access and purchase new methods for prevention, management, and treatment of major diseases drawing the global pattern of children deaths. However without paying regard to the anti-corruption mechanisms needed to ensure their proper use, it will also provide further opportunity for corruption. Policies and interventions supported by governments and donors must integrate initiatives that recognise how they are inter-related.