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1. Effects of a free health insurance programme for the poor on health service utilisation and financial protection in Senegal

Author

Marwân-al-Qays Bousmah, Pathé Diakhaté, Grâce à Dieu Toulao, Jean-Yves Le Hesran, Richard Lalou, Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut des sciences de la santé publique [Marseille] (ISSPAM), Campus International UCAD-IRD [Dakar, Senegal], and Mère et enfant en milieu tropical : pathogènes, système de santé et transition épidémiologique (MERIT - UMR_D 261)

Subjects
Insurance, Health, [SDV]Life Sciences [q-bio], Public Health, Environmental and Occupational Health, Prenatal Care, health policy, Senegal, Health Services Accessibility, health services research, maternal health, Cross-Sectional Studies, Socioeconomic Factors, Pregnancy, health insurance, Humans, health economics, Female, Child
Abstract

IntroductionImplemented in 2013 in Senegal, theProgramme National de Bourses de Sécurité Familiale(PNBSF) is a national cash transfer programme for poor households. Besides reducing household poverty and encouraging children’s school attendance, an objective of the PNBSF is to expand health coverage by guaranteeing free enrolment in community-based health insurance (CBHI) schemes. In this paper, we provide the first assessment of the PNBSF free health insurance programme on health service utilisation and health-related financial protection.MethodsWe collected household-level and individual-level cross-sectional data on health insurance in 2019–2020 within the Niakhar Population Observatory in rural Senegal. We conducted a series of descriptive analyses to fully describe the application of the PNBSF programme in terms of health coverage. We then used multivariate logistic and Poisson regression models within an inverse probability weighting framework to estimate the effect of being registered in a CBHI through the PNBSF—as compared with having no health insurance or having voluntarily enrolled in a CBHI scheme—on a series of outcomes.ResultsWith the exception of health facility deliveries, which were favoured by free health insurance, the PNBSF did not reduce the unmet need for healthcare or the health-related financial risk. It did not increase individuals’ health service utilisation in case of health problems, did not increase the number of antenatal care visits and did not protect households against the risk of forgoing medical care and of catastrophic health expenditure.ConclusionWe found limited effects of the PNBSF free health insurance on health service utilisation and health-related financial protection, although these failures were not necessarily due to the provision of free health insurance per se. Our results point to both implementation failures and limited programme outcomes. Greater commitment from the state is needed, particularly through strategies to reduce barriers to accessing covered healthcare.

Published
2022
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2. L'innovation en santé : technologies, organisations, changements

Author

Carine Baxerres, Egrot Marc, Sylvie Duquenois, Emmanuel N’koué Sambiéni, Jean-Yves Le Hesran, Mère et enfant en milieu tropical : pathogènes, système de santé et transition épidémiologique (MERIT - UMR_D 216), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Institut de Recherche pour le Développement (IRD), Université Paris Descartes - Paris 5 (UPD5), Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), Claudie Haxaire, Baptiste Moutaud, Cyril Farnarier, Mère et enfant face aux infections tropicales (MERIT - UMR_D 216), Haxaire, C. (dir.), Moutaud, B. (dir.), and Farnarier, C. (dir.)

Subjects
Biomédicalisation, [SHS.SOCIO]Humanities and Social Sciences/Sociology, MESH: Mortalité maternelle, ANTHROPOLOGIE DE LA SANTE, PREVENTION SANITAIRE, Santé Maternelle, [SHS.ANTHRO-SE]Humanities and Social Sciences/Social Anthropology and ethnology, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, TRAITEMENT MEDICAL, MORTALITE, GROSSESSE, BIOMEDICALISATION, MARCHANDISATION, SANTE PUBLIQUE, Changements, MILIEU URBAIN, Mortalité maternelle -- Bénin
Abstract

International audience; La mortalité maternelle est un problème majeur de santé publique en Afrique Sub-saharienne.Son taux est parmi les plus élevés au monde, de 70 à 100 fois plus que dans les pays industrialisés (Hill et al., 2007). Au Bénin, le rapport de mortalité maternelle atteint 397 décès maternels pour 100 000 naissances vivantes1. Malgré l’inscription de la baisse de la mortalité maternelle dans les Objectifs du Millénaire pour le Développement fixés par les Nations Unies et dont l’échéance était l’année 2015, les progrès ont été trop lents et les objectifs n’ont pas été atteints. La baisse de la mortalité maternelle y est globalement de moins de 1 % par an (Finlayson & Downe, 2013). Au Bénin, la mortalité maternelle a baissé de seulement environ 5 % sur les 10 dernières années (498 décès pour 100.000 naissances vivantes en 1996 et 397 en 2006).

Published
2018

3. Quand les modes de distribution pharmaceutique influencent les usages des médicaments. Une recherche comparative menée au Bénin, au Ghana et au Cambodge

Author

Carine Baxerres, Adolphe Kpatchavi, Daniel Arhinful, Ève Bureau-Point, Jean-Yves Le Hesran, Mère et enfant en milieu tropical : pathogènes, système de santé et transition épidémiologique (MERIT - UMR_D 216), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Institut de Recherche pour le Développement (IRD), Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et l’Enfance (CERPAGE), University of Abomey Calavi (UAC), Université d'Abomey-Calavi, Noguchi Memorial Institute for Medical Research [Accra, Ghana] (NMIMR), University of Ghana, Centre Norbert Elias (CNELIAS), École des hautes études en sciences sociales (EHESS)-Avignon Université (AU)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU), Institut de Recherche pour le Développement (IRD)-Université de Paris (UP), Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et l’Enfance [Cotonou, Bénin] (CERPAGE), Université d’Abomey-Calavi = University of Abomey Calavi (UAC), École des hautes études en sciences sociales (EHESS)-Avignon Université (AU)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Mère et enfant en milieu tropical : pathogènes, système de santé et transition épidémiologique (MERIT - UMR_D 261), and Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité)

Subjects
[SHS.ANTHRO-SE]Humanities and Social Sciences/Social Anthropology and ethnology, [SDE.ES]Environmental Sciences/Environmental and Society, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2016

4. The influence of environmental factors on childhood fever during the rainy season in an African city: a multilevel approach in Dakar-Senegal

Author

Mody Diop, Stéphanie Dos Santos, Iulia Rautu, Mahaman Mourtala Abdou Illou, Jean-Yves Le Hesran, Richard Lalou, Alphousseyni Ndonky, Laboratoire Population-Environnement-Développement (LPED), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Laboratoire de Toxicologie et Hydrologie, Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD), Laboratoire d’Océanologie et de Géosciences (LOG) - UMR 8187 (LOG), Centre National de la Recherche Scientifique (CNRS)-Université du Littoral Côte d'Opale (ULCO)-Université de Lille-Institut national des sciences de l'Univers (INSU - CNRS), and Institut national des sciences de l'Univers (INSU - CNRS)-Université du Littoral Côte d'Opale (ULCO)-Université de Lille-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Nord])

Subjects
medicine.medical_specialty, Sanitation, Cross-sectional study, 030231 tropical medicine, Population, Developing country, Environmental Science (miscellaneous), [SHS.DEMO]Humanities and Social Sciences/Demography, Multilevel analysis, Dengue fever, 03 medical and health sciences, 0302 clinical medicine, Environmental protection, Environmental health, medicine, Environmental factors, Urban, 030212 general & internal medicine, education, ComputingMilieux_MISCELLANEOUS, Demography, Child health, education.field_of_study, enfance, Public health, Multilevel model, [SHS.GEO]Humanities and Social Sciences/Geography, [SHS.ANTHRO-SE]Humanities and Social Sciences/Social Anthropology and ethnology, medicine.disease, Senegal, 3. Good health, [SDE.BE]Environmental Sciences/Biodiversity and Ecology, Malaria
Abstract

In African growing cities, vector-borne diseases (such as malaria and dengue) contribute to a large burden of childhood morbidity and mortality. During the peak of transmission, environmental factors can have an influence on those fevers, apart from the individual and household characteristics. A household survey conducted in 2008 in Dakar was completed by a community questionnaire on environmental threats that could be factored into multilevel analyses. Using a randomized sample of 7,300 children from 3,000 households dispatched within 50 neighborhoods, a three-level modeling process is presented. Rates of recent fever varied substantially from one neighborhood to another, ranging between 10 and 37 %. Findings indicate that the onset of fever is influenced by factors from all three hierarchical levels, with neighborhood factors playing a relatively lower role than the other two. Among the environmental factors, the effect of environmental sanitation is particularly interesting.

Published
2015
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5. Use of health care among febrile children from urban poor households in Senegal: does the neighbourhood have an impact?

Author

Hervé Lafarge, Georges Karna Kone, Stéphanie Dos Santos, Richard Lalou, M. Audibert, Alphousseyni Ndonky, Jean-Yves Le Hesran, Centre d'Études et de Recherches sur le Développement International (CERDI), Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Population-Environnement-Développement (LPED), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CR CHUM), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM)-Université de Montréal (UdeM), Université Paris Dauphine-PSL, Université Paris sciences et lettres (PSL), Laboratoire de Parasitologie (Laboratoire de Parasitologie), IRD et Faculté de Pharmacie- Université Paris V, Université d'Auvergne - Clermont-Ferrand I (UdA) - Centre National de la Recherche Scientifique (CNRS), Institut de Recherche pour le Développement (IRD) - Aix Marseille Université (AMU), Centre de Recherche du Centre Hospitalier de l’Universite de Montreal (CR CHUM), Universite de Montreal et Universite de Daloa, University of Paris Dauphine (University of Paris Dauphine), University of Paris Dauphine, IRD et Faculté de Pharmacie - Université Paris V, and Etudes & Documents - Publications, CERDI

Subjects
[SHS.ECO] Humanities and Social Sciences/Economies and finances, medicine.medical_specialty, Economic growth, Opportunity cost, Fever, Urban Population, poverty, 030231 tropical medicine, malaria, Health Services Accessibility, 03 medical and health sciences, Antimalarials, equity, 0302 clinical medicine, Environmental health, Surveys and Questionnaires, 11. Sustainability, Health care, medicine, Humans, 030212 general & internal medicine, [SHS.ECO] Humanities and Social Sciences/Economics and Finance, Child, Neighbourhood (mathematics), Poverty, Family Characteristics, business.industry, Health Policy, Public health, 1. No poverty, Urban Health, Questionnaire, Social Support, medicine.disease, Dakar, [SHS.ECO]Humanities and Social Sciences/Economics and Finance, Senegal, 3. Good health, Malaria, Socioeconomic Factors, Scale (social sciences), Child, Preschool, Access to health care, multilevel analysis, social network, business, neighbourhood
Abstract

Urban malaria is considered a major public health problem in Africa. The malaria vector is well adapted in urban settings and autochthonous malaria has increased. Antimalarial treatments prescribed presumptively or after rapid diagnostic tests are also highly used in urban settings. Furthermore, health care strategies for urban malaria must comply with heterogeneous neighbourhood ecosystems where health-related risks and opportunities are spatially varied. This article aims to assess the capacity of the urban living environment to mitigate or increase individual or household vulnerabilities that influence the use of health services. The data are drawn from a survey on urban malaria conducted between 2008 and 2009. The study sample was selected using a twostage randomized sampling. The questionnaire survey covered 2952 households that reported a case of fever episode in children below 10 years during the month before the survey. Self-medication is a widespread practice for children, particularly among the poorest households in Dakar. For rich households, self-medication for children is more a transitional practice enabling families to avoid opportunity costs related to visits to health facilities. For the poorest, it is a forced choice and often the only treatment option. However, the poor that live in well-equipped neighbourhoods inhabited by wealthy residents tend to behave as their rich neighbours. They grasp the opportunities provided by the area and adjust their behaviours accordingly. Though health care for children is strongly influenced by household socio-economic characteristics, neighbourhood resources (facilities and social networks) will promote health care among the poorest and reduce access inequalities. Without being a key factor, the neighbourhood of residence—when it provides resources— may be of some help to overcome the financial hurdle. Findings suggest that the neighbourhood (local setting) is a relevant scale for health programmes in African cities.

Published
2015

6. IgG responses to the gSG6-P1 salivary peptide for evaluating human exposure to Anopheles bites in urban areas of Dakar region, Sénégal

Author

Christophe Rogier, Sylvie Cornelie, Papa M. Drame, Stéphanie Dos Santos, Frédéric Pagès, Mbacké Sembène, Vanessa Machault, A. Diallo, Richard Lalou, Anne Poinsignon, Franck Remoue, Jean-Yves Le Hesran, Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle ( MIVEGEC ), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD [France-Sud] ), Laboratoire d'aérologie - LA ( LA ), Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut national des sciences de l'Univers ( INSU - CNRS ) -Observatoire Midi-Pyrénées ( OMP ) -Centre National de la Recherche Scientifique ( CNRS ), Centre National d'Etudes Spatiales ( CNES ), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes ( URMITE ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR48, INSB-INSB-Centre National de la Recherche Scientifique ( CNRS ), Santé de la mère et de l'enfant en milieu tropical : épidémiologie génétique et périnatale, Université Paris Descartes - Paris 5 ( UPD5 ), Laboratoire Population-Environnement-Développement ( LPED ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ), Faculté des Sciences et Techniques (FST), Université Cheikh Anta Diop ( UCAD ), Institut de recherche pour le développement ( IRD [Sénégal] ), Institut Pasteur de Madagascar, Institut Pasteur de Madagascar-Réseau International des Instituts Pasteur ( RIIP ), PMD was supported by a PhD scholarship provided by IRD (DSF Department) then a fellowship from InfectioPole Sud Fundation. VM received financial support from the Direction Générale de l'Armement (DGA-Contrat d'Objectif n°07CO402) and the Centre National d'Etudes Spatiales (CNES). AD is a PhD student supported by IRDDSF Department. AP was supported by a fellowship from F. Lacoste., Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), Laboratoire d'aérologie (LAERO), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Observatoire Midi-Pyrénées (OMP), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Météo-France -Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Météo-France -Centre National de la Recherche Scientifique (CNRS), Centre National d'Études Spatiales [Toulouse] (CNES), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Université Paris Descartes - Paris 5 (UPD5), Vector Control Group (MIVEGEC-VCG), Evolution des Systèmes Vectoriels (ESV), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), Transmission-Interactions-Adaptations hôtes/vecteurs/pathogènes (MIVEGEC-TRIAD), Laboratoire Population-Environnement-Développement (LPED), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD), Institut de recherche pour le développement (IRD [Sénégal]), Réseau International des Instituts Pasteur (RIIP), Institut de Recherche pour le Développement (IRD [France-Sud])-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Laboratoire d'aérologie (LA), Centre National de la Recherche Scientifique (CNRS)-Observatoire Midi-Pyrénées (OMP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), and Météo France-Centre National d'Études Spatiales [Toulouse] (CNES)-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Météo France-Centre National d'Études Spatiales [Toulouse] (CNES)-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3)

Subjects
Male, Urban Population, Anopheles gambiae, [SDV]Life Sciences [q-bio], MESH : Analysis of Variance, MESH : Child, Preschool, 0302 clinical medicine, MESH : Child, MESH: Child, MESH : Insect Vectors, MESH: Animals, MESH : Female, 030212 general & internal medicine, Child, 2. Zero hunger, MESH: Immunoglobulin G, education.field_of_study, biology, MESH : Salivary Proteins and Peptides, Transmission (medicine), Anopheles, MESH: Salivary Proteins and Peptides, Environmental exposure, MESH : Adult, MESH : Senegal, Senegal, MESH: Antibody Formation, 3. Good health, MESH: Urban Population, Infectious Diseases, MESH : Anopheles, MESH: Young Adult, Child, Preschool, MESH : Urban Population, Female, Adult, lcsh:Arctic medicine. Tropical medicine, MESH : Immunoglobulin G, lcsh:RC955-962, MESH : Male, 030231 tropical medicine, Population, MESH: Environmental Exposure, MESH : Young Adult, MESH: Insect Vectors, MESH : Antibody Formation, Insect bites and stings, lcsh:Infectious and parasitic diseases, MESH: Anopheles, Young Adult, 03 medical and health sciences, MESH: Insect Bites and Stings, MESH: Senegal, MESH : Insect Bites and Stings, Environmental health, MESH: Analysis of Variance, parasitic diseases, medicine, Animals, Humans, lcsh:RC109-216, Salivary Proteins and Peptides, education, Analysis of Variance, MESH: Humans, [ SDV ] Life Sciences [q-bio], Research, MESH: Child, Preschool, MESH : Humans, Insect Bites and Stings, MESH: Adult, Environmental Exposure, biology.organism_classification, medicine.disease, MESH: Male, Insect Vectors, Parasitology, Immunoglobulin G, Antibody Formation, Immunology, MESH : Animals, MESH: Female, MESH : Environmental Exposure, Malaria
Abstract

Background Urban malaria can be a serious public health problem in Africa. Human-landing catches of mosquitoes, a standard entomological method to assess human exposure to malaria vector bites, can lack sensitivity in areas where exposure is low. A simple and highly sensitive tool could be a complementary indicator for evaluating malaria exposure in such epidemiological contexts. The human antibody response to the specific Anopheles gSG6-P1 salivary peptide have been described as an adequate tool biomarker for a reliable assessment of human exposure level to Anopheles bites. The aim of this study was to use this biomarker to evaluate the human exposure to Anopheles mosquito bites in urban settings of Dakar (Senegal), one of the largest cities in West Africa, where Anopheles biting rates and malaria transmission are supposed to be low. Methods One cross-sectional study concerning 1,010 (505 households) children (n = 505) and adults (n = 505) living in 16 districts of downtown Dakar and its suburbs was performed from October to December 2008. The IgG responses to gSG6-P1 peptide have been assessed and compared to entomological data obtained in or near the same district. Results Considerable individual variations in anti-gSG6-P1 IgG levels were observed between and within districts. In spite of this individual heterogeneity, the median level of specific IgG and the percentage of immune responders differed significantly between districts. A positive and significant association was observed between the exposure levels to Anopheles gambiae bites, estimated by classical entomological methods, and the median IgG levels or the percentage of immune responders measuring the contact between human populations and Anopheles mosquitoes. Interestingly, immunological parameters seemed to better discriminate the exposure level to Anopheles bites between different exposure groups of districts. Conclusions Specific human IgG responses to gSG6-P1 peptide biomarker represent, at the population and individual levels, a credible new alternative tool to assess accurately the heterogeneity of exposure level to Anopheles bites and malaria risk in low urban transmission areas. The development of such biomarker tool would be particularly relevant for mapping and monitoring malaria risk and for measuring the efficiency of vector control strategies in these specific settings.

Published
2012
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7. Adherence and effectiveness of drug combination in curative treatment among children suffering uncomplicated malaria in rural Senegal

Author

Diarietou Sow, Aurélia Souares, Jean-Yves Le Hesran, Richard Lalou, Ibra Sene, Santé de la mère et de l'enfant en milieu tropical : épidémiologie génétique et périnatale, Université Paris Descartes - Paris 5 (UPD5), Laboratoire Population-Environnement-Développement (LPED), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), and Institut de Recherche pour le Développement (IRD) - Université de Provence - Aix-Marseille 1 - Aix Marseille Université (AMU)

Subjects
Male, Pediatrics, medicine.medical_treatment, Rural Health, Parasitemia, Drug resistance, 0302 clinical medicine, Chloroquine, MESH: Child, MESH: Animals, 030212 general & internal medicine, Malaria, Falciparum, Treatment outcome, Child, MESH: Plasmodium falciparum, MESH: Treatment Outcome, education.field_of_study, MESH: Malaria, Falciparum, Drug combination therapy, General Medicine, MESH: Caregivers, MESH: Patient Compliance, MESH: Infant, Senegal, 3. Good health, Drug Combinations, Pyrimethamine, Treatment Outcome, Infectious Diseases, Caregivers, Child, Preschool, Drug Therapy, Combination, Female, Attitude to Health, medicine.drug, medicine.medical_specialty, Sulfadoxine, MESH: Pyrimethamine, Plasmodium falciparum, 030231 tropical medicine, Population, MESH: Attitude to Health, Amodiaquine, Medication Adherence, Antimalarials, 03 medical and health sciences, MESH: Senegal, parasitic diseases, medicine, Animals, Humans, [SDV.EE.SANT] Life Sciences [q-bio]/Ecology, environment/Health, education, MESH: Amodiaquine, MESH: Drug Combinations, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, MESH: Humans, business.industry, MESH: Child, Preschool, Public Health, Environmental and Occupational Health, Infant, MESH: Medication Adherence, MESH: Rural Health, medicine.disease, MESH: Antimalarials, MESH: Male, Malaria, MESH: Drug Therapy, Combination, Clinical research, Adherence, Patient Compliance, Parasitology, business, MESH: Female, MESH: Sulfadoxine
Abstract

Increased Plasmodium falciparum resistance to chloroquine has prompted national malaria programs to develop new policies in several African countries. Less than a year after the introduction of amodiaquine/sulfadoxine-pyrimethamine (AQ/SP) as first-line treatment in Senegal, we examined adherence rates to therapy and its efficacy among children. The study was conducted in five dispensaries in rural Senegal. Children aged 2-10 years with a presumptive diagnosis of malaria were prescribed AQ/SP. Thick blood film analyses were carried out on days 0, 3, 7, 14 and 28. Blood and urine samples were collected on day 3 for drug level measurements. The principal caregivers were questioned on treatment adherence. Among the 289 recruited children, 144 had a parasitemia >2500/microl. The results demonstrated markedly good efficacy for the treatment, as no detectable parasitemia was observed on day 28 for 97.9% of the children. However, we noticed that 35.3% of children did not comply with the recommended doses and 62.3% did not exactly adhere to the drug schedule. Despite the good efficacy of the drugs, adherence to the therapeutic scheme was poor. Strategies to promote patient adherence would improve drug performance and thus might help to prevent the rapid emergence of drug resistance.

Published
2008
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8. Development of cellular immune responses to Plasmodium falciparum blood stage antigens from birth to 36 months of age in Cameroon

Author

Philippe Deloron, Nadine Fievet, Samuel M’bidias, Bertrand Maubert, Michel Cot, Philippe Personne, Jean-Yves Le Hesran, Daniel Etye’ale, Jean Thioulouse, Ecologie quantitative et évolutive des communautés, Département écologie évolutive [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), and Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Cellular immunity, Aging, [SDV.OT]Life Sciences [q-bio]/Other [q-bio.OT], Veterinary (miscellaneous), medicine.medical_treatment, Plasmodium falciparum, Antigens, Protozoan, Immune system, Th2 Cells, children, Antigen, Immunity, parasitic diseases, medicine, Animals, Humans, Cameroon, Longitudinal Studies, Malaria, Falciparum, biology, Infant, Newborn, Infant, Th1 Cells, biology.organism_classification, medicine.disease, Acquired immune system, immunity, cytokines, Infectious Diseases, Cytokine, Insect Science, Child, Preschool, Immunology, Parasitology, Malaria
Abstract

Naturally acquired immunity to Plasmodium falciparum is related to immune system that changes during normal development and ageing. The effects of repeated infections during the early life on the maturation of the immune system are still unknown. Elucidation of these effects is of considerable interest given that malaria originates high mortality, especially during the first years of life. We conducted a cohort study to identify naturally acquired immune responses to P. falciparum. Cellular responses of Cameroonian neonates from birth to 36 months of age were evaluated every 6 months by cell proliferation and cytokines (IFN-gamma, IL-2 and IL-4) production after in vitro culture in the presence of schizont extract and Pf155/RESA peptides. Data were analyzed by a multiple correspondence analysis (MCA) exhibiting three main findings. Firstly, the lack of time-dependant evolution of specific immune pathways recruitment in the response to a given antigen, no antigen inducing a specific mode of response at a given time-point. Secondly, most of the data variability was expressed by IFN-gamma and IL-4 productions, and the major variation of the immune response with age involved this change in IFN-gamma production. Thirdly, the age-related immune response evolution is characterized by the acquisition of the capacity to mount a IFN-gamma response, a transient phase during which children produce a high IL-4 response, and the fast vanishing of the dominance of the IL-2 response. These results suggest that P. falciparum specific immune responses are first oriented towards a Th2-type of response, and later switch to Th1-type of response. (c) 2006 Elsevier B.V. All rights reserved.

Published
2006

9. Conflits de légitimité autour d’une maladie génétique au Bénin

Author

Bonnet, Doris, Lainé, Agnès, Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Centre d'Etudes des Mondes Africains (CEMAf), Université Paris 1 Panthéon-Sorbonne (UP1)-Université de Provence - Aix-Marseille 1-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS), Ministère de la recherche (France) dans le cadre de ces actions concertées incitatives (ACI) Prosodie., Laurent Pordié, Emmanuelle Simon, Intitulé du projet Médicaments émergents dans le contexte de la mondialisation: produits et acteurs, savoirs et usages. Bénin, Burkina Faso, Sénégal (2002-2005) Avec Doris Bonnet, Marc Egrot, Bernard Taverne, Carine Baxerres, Bila-Ouédraogo, Jean-Yves Le Hesran. Coordination : Alice Desclaux (CRESSC), Centre population et développement ( CEPED - UMR_D 196 ), Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ), Centre d'Etudes des Mondes Africains ( CEMAf ), Université Panthéon-Sorbonne ( UP1 ) -Université de Provence - Aix-Marseille 1-École pratique des hautes études ( EPHE ) -Centre National de la Recherche Scientifique ( CNRS ), Université Paris 1 Panthéon-Sorbonne (UP1)-Université de Provence - Aix-Marseille 1-École Pratique des Hautes Études (EPHE), and Université Panthéon-Sorbonne (UP1)-Université de Provence - Aix-Marseille 1-École pratique des hautes études (EPHE)-Centre National de la Recherche Scientifique (CNRS)

Subjects
[ SHS.HIST ] Humanities and Social Sciences/History, Tradithérapeutes, legitimacy, entrepreneurs, [SHS]Humanities and Social Sciences, conflicts, [ SHS ] Humanities and Social Sciences, Traditional practitioners, conflits, Benin, transformations sociales, légitimité, médecine, [SHS.HIST]Humanities and Social Sciences/History, guérison, social changes, Medicin
Published
2013

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