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Saint-Sauveur-en-Rue, France

Tricou V.,Institute Pasteur Of Bangui | Bouscaillou J.,Medecins du Monde France | Kamba Mebourou E.,Institute Pasteur Of Bangui | Koyanongo F.D.,Service de Sante Publique Veterinaire | And 2 more authors.
PLoS Neglected Tropical Diseases

Background: Although rabies represents an important public health threat, it is still a neglected disease in Asia and Africa where it causes tens of thousands of deaths annually despite available human and animal vaccines. In the Central African Republic (CAR), an endemic country for rabies, this disease remains poorly investigated. Methods: To evaluate the extent of the threat that rabies poses in the CAR, we analyzed data for 2012 from the National Reference Laboratory for Rabies, where laboratory confirmation was performed by immunofluorescence and PCR for both animal and human suspected cases, and data from the only anti-rabies dispensary of the country and only place where post-exposure prophylaxis (PEP) is available. Both are located in Bangui, the capital of the CAR. For positive samples, a portion of the N gene was amplified and sequenced to determine the molecular epidemiology of circulating strains. Results: In 2012, 966 exposed persons visited the anti-rabies dispensary and 632 received a post-exposure rabies vaccination. More than 90% of the exposed persons were from Bangui and its suburbs and almost 60% of them were under 15-years of age. No rabies-related human death was confirmed. Of the 82 samples from suspected rabid dogs tested, 69 were confirmed positive. Most of the rabid dogs were owned although unvaccinated. There was a strong spatiotemporal correlation within Bangui and within the country between reported human exposures and detection of rabid dogs (P<0.001). Phylogenetic analysis indicated that three variants belonging to Africa I and II lineages actively circulated in 2012. Conclusions: These data indicate that canine rabies was endemic in the CAR in 2012 and had a detrimental impact on human health as shown by the hundreds of exposed persons who received PEP. Implementation of effective public health interventions including mass dog vaccination and improvement of the surveillance and the access to PEP are urgently needed in this country. © 2016 Tricou et al. Source

Giugliani C.,Federal University of Rio Grande do Sul | Duncan B.B.,Federal University of Rio Grande do Sul | Harzheim E.,Federal University of Rio Grande do Sul | Breysse S.,Medecins du Monde France | Jarrige L.,Medecins du Monde France
Archives of Disease in Childhood

Objective: To measure the impact of practice review and in-service supervision based on WHO guidelines on outcomes of severely malnourished children in a rural facility with minimal resources staffed only by nurses. Design: Intervention (January to August 2006) with historical comparison of outcomes (January to August 2005). Setting: Therapeutic feeding centre in rural Angola. Patients: All children admitted to the feeding centre during the study period. Intervention: Médecins Du Monde implemented an intervention that consisted of weekly physician supervision of staff activities and establishment of a study group composed of nurses in the centre. Main outcome measures: Routine practices in the centre and measured indicators for outcomes of admitted children, which were compared to indicators before the intervention. Results: During the intervention the authors observed improved delivery of important tasks such as frequent feeding and avoidance of intravenous rehydration. Among the 379 children admitted during the intervention, compared to the 358 children admitted previously, successful treatment increased from 73.2% to 82.6% (RR 1.13; 95% CI 1.04 to 1.22) and fatalities decreased from 15.6% to 8.7% (RR 0.56; 95% CI 0.37 to 0.83). Conclusion: This short-term intervention with in-service supervision based on the WHO guidelines in a setting of limited resources apparently contributed to a reduction in fatality rates. These findings support the view that such guidelines can be effectively implemented in under-resourced facilities in Angola and similar settings if they are introduced using an interactive approach and if in-service supervision continues to be provided. Source

Luhmann N.,Medecins du Monde France | Champagnat J.,Medecins du Monde France | Golovin S.,International Treatment Preparedness Coalition in Eastern Europe and Central Asia | Maistat L.,International HIV AIDS Alliance in Ukraine | And 5 more authors.
International Journal of Drug Policy

Background: People who inject drugs (PWID) are disproportionately affected by the hepatitis C (HCV) epidemic. Of the estimated 16 million PWID worldwide, approximately 8 million live with chronic HCV, and around 26% and 23% of the global HCV infections among PWID occur in East/Southeast Asia and Eastern Europe respectively. Globally, few PWID have access to treatment for HCV. Methods: We conducted a systematic literature review and internet survey in 2014 to document the burden of disease, access to diagnosis and treatment and the existence of national policy and treatment guidelines for HCV. We included Georgia, Russia, Ukraine, Myanmar and Indonesia as countries with injection drug use epidemics. Findings: HCV antibody prevalence among the general population ranged from 0.80% in Indonesia to 5% in Georgia, and among PWID from 48.1% in Myanmar to 92% in Georgia. PWID carried a significant burden of disease, ranging from 2.7% in Indonesia to 40.4% in Russia. Yearly treatment uptake was under 1% for the general population and PWID in all countries. Diagnostic tools and disease staging investigations as well as pegylated interferon/ribavirin treatment were available at a range of prices. Despite policy and treatment protocols for HCV in the majority of countries, strategies focusing on PWID were largely absent. Conclusion: PWID are a priority group for treatment, and access to treatment should be based on sound national policy, accessible public treatment programmes and functional surveillance systems. © 2015 Elsevier B.V. Source

Bowring A.L.,Burnet Institute | Luhmann N.,Medecins du Monde France | Pont S.,Medecins du Monde Tanzania | Debaulieu C.,Medecins du Monde Tanzania | And 8 more authors.
International Journal of Drug Policy

Background: Injecting drug use (IDU) is a growing concern in Tanzania compounded by reports of high-risk injecting and sexual risk behaviours among people who inject drugs (PWID). These behaviours have implications for transmission of blood-borne viruses, including HIV and hepatitis C (HCV). Methods: We recruited 267 PWID (87% male) from Temeke District, Dar-es-Salaam through snowball and targeted sampling. A behavioural survey was administered alongside repeated rapid HIV and HCV antibody testing. HIV and HCV prevalence estimates with 95% confidence intervals (CIs) were calculated. Results: Among PWID, 34.8% (95%CI 29.1-40.9) tested HIV positive (29.9% of males and 66.7% of females); 27.7% (95%CI 22.0-34.0) tested HCV antibody positive. Almost all (97%) participants were aware of HIV and 34% of HCV. 45% of male and 64% of female PWID reported a previous HIV test; only five (2%) PWID reported a previous HCV test. Of HIV and HCV positive tests, 73% and 99%, respectively, represented newly diagnosed infections. Conclusion: High prevalence of HIV and HCV were detected in this population of PWID. Rapid scale-up of targeted primary prevention and testing and treatment services for PWID in Tanzania is needed to prevent further transmission and consequent morbidities. © 2012 Elsevier B.V. Source

Chappuis M.,Medecins du Monde France | Antonielli A.B.,Medecins du Monde France | Laurence S.,Medecins du Monde France | Rochefort J.,Medecins du Monde France | And 2 more authors.
Bulletin du Cancer

Introduction If cervical cancer and breast cancer screening are frequent practices in general population, studies indicate that these practices are less common among underprivileged women. Doctors of the World conducted a study to measure cancer prevention and screening among women attending medical consultation in their health care centers (Caso) in France. Method The survey was conducted in 5 Caso. A questionnaire was proposed to all women (aged 14 years and older) attending medical consultation. Results 203 women participated in the survey. Only 33.1% of women aged 25-65 declared that they have ever realized a cervical smear in their lives. More than a third of the concerned women did not know cervical smear and 72% of the women under 35 years old do not know the HPV vaccine. 70.8% of women aged 50-74 said they had never realized a mammogram. Conclusion The survey highlights less use of cancer screening among underprivileged women compared to the general population, underlines the need for appropriate actions for these populations and the need to facilitate health coverage access for women facing multiple vulnerability factors. © 2014 Société Française du Cancer. Source

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