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.

Periodontal status of HIV-1 and HIV-2 seropositive and HIV seronegative female commercial sex workers in Senegal.

Comprehensive studies of 92 commercial sex workers in Senegal, Africa included an oral examination in which we obtained measurements of decayed, missing, and filled (DMF) teeth; plaque index; gingival index; recession; probing depth (PD); clinical attachment loss (CAL); and the presence of HIV-associated periodontal lesions, under conditions wherein the examiner was unaware of the subject's HIV status. Twenty-seven subjects (29%) were HIV seropositive, 19 of whom were positive for HIV-1, 7 positive for HIV-2, and 1 positive for both. Most subjects were not taking any medications and previous dental care was limited. HIV-seronegative and HIV-seropositive subjects were similar in mean age, number of DMF teeth, percentage of sites with visible plaque, and number of sites with recession. However, the frequency of sites with gingival bleeding, with PD > or = 6 mm, and with CAL > or = 6 mm was significantly greater in seropositive than seronegative subjects. No differences were observed between HIV-1 and HIV-2 positive subjects. About 26% of HIV-seropositive subjects and about 5% of the seronegative subjects exhibited at least one site with concurrent PD > or = 6 mm and CAL > or = 6 mm. HIV-associated periodontal lesions were seen in 3 HIV-seropositive subjects (2 linear gingival erythema, 1 necrotizing periodontitis). One HIV-seronegative subject exhibited necrotizing gingivitis. In this population with multiple risks to oral health, both HIV-1 and HIV-2 infections were associated with a significantly increased prevalence of periodontal disease.

[Clinical study and treatment of hyperodontia (apropos of 8 cases)]. / Etude clinique et traitement de l'hyperodontie (à propos de 8 observations).

This study aims at elucidating a little known pathology. In the first instance, distinction is made between extra teeth, supernumerary teeth and mesiodens teeth. The report also covers treatment of this affliction, often imposed on the practitioner by orthodontic complications or infections caused by lesions.

[Problems linked to trismus in a dental office]. / Problèmes liés aux trismus dans un cabinet dentaire.

The objective of this report was to know the most frequent etiology of trismus we meet in our dental office as well as the different treatment set up. The question is an observation of 58 cases of trismus that we received in two different dental clinics: Odontology and Stomatology Institute and Social Hygen Institute of Dakar. The results we got show that trismus is an odontologist's daily problèm. Although its treatment is relatively easy, it is good to remember that etiologies other than dental exist.

[Clinical criteria for oral pathology in a history of HIV infection]. / Critères cliniques de l'histoire de l'infection à VIH en pathologie buccale.

Oral lesions have been shown to be the first clinical symptom in HIV infection by a large number of studies. A cross prospective study in Infectious Disease and Dental Service of Fann Hospital, the objectives were to evaluate the prevalence of oral lesions and to determinate correlation between oral lesions and CD4 cells count in HIV+ patients. 1.645 patients were examined, 352 were eligible. The prevalence of oral lesions was 62.7% in HIV+ patients. Among those 135 HIV+, 56.15% had a rate of CD4 < 200/mm3. In addition with studies presented in Third International Conference of Oral Lesions in HIV Disease (1996 May), oral lesions can be used as indicators for progression of HIV Disease.

[Clinical study of cysts jawbones]. / Etude clinique des kystes maxillaires.

The objective of this study was to appreciate the clinical and paraclinical aspects of cysts jawbones. It was an exploratory study about 61 cases of jawbones cysts (24 men and 37 women). It took place in the Odontostomatology Department of the General Hospital of Grand Yoff at Dakar, during a period of 5 years (February 1996 to December 2000). The mean age of patients was 29.67 years with extremes of 14 and 55 years. The mean reason of consultating was an important perish-jawbone tumefaction which can be associated with dental displacements, mobilities or pains. The radiographic assessment was essential for the diagnosis. The radiological image was characterized by an osteolysis with regular contours. We have noted the invasive appearance of the osseous lysis which is developed in several teeth concerning 50 cases (81.97%). The anatomo-pathological exam which is essential to confirm the diagnosis has been possible only for 9 patients by lack of means. Thus, in our study the diagnosis of jawbones cyst was retained while being based primarily on clinical experience and the radiological assesment. The types of diagnosed cysts are: 53 perish-apical cysts (86.89%), 5 dentigerous cysts (08.20%), 2 globulo-jawbone cycts (03.28%), and only one case of paramount cyst. The jawbones cysts are often of aggressive development with various etiologies. They may be voluminous. Their diagnosis must be exact in order to allow an adapted surgical technics and to prevent the reccurence.

[Surgical dentistry and geriatrics in Senegal]. / L'odontologie chirurgicale et la gériatrie en milieu Sénégalais.

INTRODUCTION: Geriatric medicine is developing more and more as a specialism. Odontology is not behindhand. That is why, even in an African setting, when life expectancy is still not as high as in the West, we are finding ourselves treating older and older patients. MATERIALS AND METHODS: During the course of the academic year 1989-1990, we treated 40 patients of both sexes, of different ethnic and social backgrounds aged from 55-89 years. Besides age, the patients had all undergone endo-buccal surgery, with the exception of parodontology surgery. According to sex: The forty patients comprised 27 men and 13 women. These figures are interesting and we will return to them during the discussion. According to age: The ages of our patients ranged from 55-89 years, with an average of 72. The distribution of age brackets shows a strong percentage (52.5%) of patients between 55 and 64 years of age. According to oral stage: In general, our patients neglect oral hygiene: 67.5% presented at least tartaric gingivitis. This negligence was evident in more men than women. According to general state: More than half the sample had at least one general pathological disorder. They ranged from cardio-vascular ailments, to differing digestive disorders, to neurological and endocrinal pathologics. METHODOLOGY: The data was collected using the following 3 methods which slowly built up: questionnaire clinical examination the operation RESULTS: The dividing-up of the different operations: we realised a total of 71 operations, this being an average 1.77 per patient. Distribution of pathological ailments according to type and nature: About 55% of our patients had a general pathology. Cardio-vascular ailments took first place with a frequency of 52.16%, followed by digestive problems with 26.08% neurological syndromes with 13.04% and ailments with endocrinal origins with a rate of 8.69%. Incidents during operation: incidents linked to the anaesthetic, incidents linked to the operation itself, post-operative incidents, healing. DISCUSSION: Age: The most representative age-band was between 55 and 64 years (with a six ration of 1:5). Multiple extractions: Apart from a defective oral state, these extractions are always motivated by the need for prosthesis. All the patients were missing at least one tooth, confirming the thesis of Dubois, according to which "the repercussion of oral ageing appears in all its simplicity in either partial or total toothlessness". CONCLUSION: Elderly Senegalese patients present serious oral problems since extraction comprises the main part of surgical odontological operations. A better way of dealing with these subjects, weakened by old age and general pathology, is desirable.