Search

While the incidence of cholera is decreasing in Haiti, the time required to render stool culture results with antibiogram using the standard method practiced at the National Public Health Laboratory (LNSP) remains at an average of 80 hours. This delay can be further lengthened by the process of rendering the analysis reports to the sites of care which significantly delays the community responses to cholera. Through this study, we have aimed to assess the reliability of partial results. We have studied 250 stool samples that were analyzed between January and September 2017 at the LNSP by determining the specificity, positive predictive value and positive likelihood ratio of i) the identification of yellowish colonies and ii) the identification of yellowish colonies with a positive oxidase assay in comparison to the stool culture. Compared to the entire process, the identification of yellowish colonies showed a specificity of 56%, a positive predictive value of 69% and a positive likelihood ratio of 2.27. The identification of yellowish colonies with a positive oxidase assay showed a specificity of 77%, a positive predictive value of 81% and a positive likelihood ratio of 4.31. The communication of partial results at these steps would likely guide community interventions despite a relative decrease in reliability of the results.Le temps nécessaire au rendu des résultats de culture des selles avec antibiogramme par la méthode classique pratiquée au Laboratoire national de santé publique (LNSP) d’Haïti s’étale sur une durée de 80 heures en moyenne. Ce délai peut être encore allongé par le processus de rendu des rapports d’analyse aux sites de prise en charge, ce qui retarde de manière significative les réponses communautaires face au choléra. Cette étude vise à évaluer la fiabilité de résultats partiels par rapport au processus complet. Nous avons inclus 250 échantillons de selles analysés au LNSP de janvier à septembre 2017 en déterminant la spécificité, la valeur prédictive positive et le rapport de vraisemblance positif de l’identification des colonies jaunâtres et de l’identification des colonies jaunâtres oxydase positive. Par rapport au processus complet de culture des selles, l’identification des colonies jaunâtres a montré une spécificité de 56 %, une valeur prédictive positive de 69 % et un rapport de vraisemblance positif de 2,27. Quant à l’identification des colonies jaunâtres oxydase positive, la spécificité est de 77 %, la valeur prédictive positive de 81 % et le rapport de vraisemblance positif de 4,31. La communication de résultats partiels aux équipes de terrain à ces étapes serait utile pour guider les interventions en dépit d’une relative diminution de leur fiabilité par rapport au gold standard.

Before 2006 in Senegal, in the absence of clinical diagnosis, all fever cases were considered as malaria and treated with chloroquine. Between 2004-2006, to face the dramatic increase of Plasmodium falciparum resistance to chloroquine, the combination of amodiaquine plus sulfadoxine-pyriméthamine was recommended for treatment. In 2006, rapid diagnostic tests were introduced and the treatment with a combination of artesunate plus amodiaquine (ASAQ) became the national recommendation for malaria treatment in 2007. This coincided with a decrease of the prevalence of malaria cases and change in fever management. Since 1995 in Mlomp in Casamance, thin and thick blood smear examination has systematically been done in patients with fever and clinical signs of malaria, and treatment with ASAQ given as experimental procedure. Between 2000 and 2012, 70,892 outpatients were attending the health center, and 51.2% of them for fever. Among these fever cases, 72.4% were suspected of malaria and 27.6% were identified as bacterial and viral infections. Confirmed malaria cases decreased dramatically from 1365 in 2000 to 53 in 2012. While comparing the 2 periods 2000-2006 and 2007-2012, the number of fever cases decreased by half, the number of fever identified as non malaria doubled and malaria treatment given decreased by 86%. Improvement of fever management in Mlomp has contributed to a better identification of their cause and to a decrease of inappropriate malaria treatments.