Search

Chelonitoxism is a form of food poisoning due to the consumption of sea turtle flesh or viscera, which contain marine toxins called chelonitoxins. Because the passage of these toxins into breast milk is thought to be fatal to breastfed babies, we sought to confirm the possibility of this transmission of toxins through breastfeeding and to determine the symptoms of mothers and the severity of poisoning in babies. A recent case of collective consumption of sea turtle meat from the species Eretmochelys imbricata in western Madagascar affected 76 victims. We conducted a retrospective descriptive study of the lactating women and their babies (7 of each) in that group. The maximum latency period was 24 hours for all breastfed babies. The initial clinical signs of mothers and babies differed. Signs of severity were present in the four breastfed babies who died. No maternal deaths were reported. Breast milk seems to be as toxic as turtle meat, especially when a large amount of milk is consumed; prognosis was good for the babies whose mothers did not breast-feed them after they ate sea turtle. During cases of poisoning by marine animals or episodes of chelonitoxism, breastfeeding must be suspended immediately.

Emergency care systems (ECS) are undergoing a period of rapid development on the African continent. What were formerly large intake zones are now being shaped into dedicated emergency units. Emergency care providers are being trained via certificate and even residency programs. However, significant challenges still exist. Resource limitations, staffing, and other system inputs are often the easiest issues to identify, but they only account for part of the problem. There are other prominent barriers to the delivery of high quality emergency care including lack of governmental leadership, poor system and facility organization, lack of provider training, and community misunderstanding of ECS functions. Released in May 2019, World Health Assembly (WHA) 72 resolution 12.9 "Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured" has squarely placed ECS strengthening as a priority item to member state governments. Moving forward, it will be important to ensure that these systems are set up for success, as high-quality emergency care systems have the potential to avert half of all deaths in low- and middle-income countries (LMIC). With momentum building from the recent WHA amendment and the health systems community more focused than ever on the consideration of quality in health systems design, it is of the utmost importance that ECS planners dovetail these interests such that these nascent systems are designed while 1) applying a systems thinking lens and 2) maintaining a focus on quality. This article helps to accomplish this by breaking down ECS into five major categories for evaluation as defined by the WHO Emergency Care Systems Assessment tool, providing an understanding of the functions of each, and identifying which indicators might be used to gauge performance. We also reinforce the notion that these indicators must dive deeper than system inputs and health outcomes, they must be patient centered in order to truly be reflective of success.

Le chelonitoxisme est une intoxication par ingestion de tortue marine qui se voit surtout dans les regions littorales. Il constitue encore un probleme de sante publique a Madagascar malgre l’interdiction de la chasse aux tortues marines. L’objectif de cette etude est de decrire l’aspect epidemio-clinique et evolutif afin de mieux connaitre et prevenir ce type d’intoxication. Une intoxication collective par consommation de tortue Eretmochelys imbricata etait survenue en mai 2014 et touchait la population d’un village de pecheur situe au nord-ouest de Mahajanga, Madagascar. Tous ceux qui ont consomme venaient consulter au centre de sante de base CSB I d’Antsanitia. Ils ont ensuite ete adresses au CHU Pzaga Mahajanga dans le service des urgences adultes et en pediatrie. Soixante-seize personnes ont ete intoxiquees, 51 adultes et 25 enfants. Les patients etaient âges de 3 mois a 79 ans. Les signes cliniques predominants etaient digestifs et neurologiques. Les signes ORL-buccaux caracterisaient l’intoxication. L’ingestion de la graisse de l’animal etait a l’origine de la forme intermediaire et la forme grave de l’adulte. L’allaitement maternel constitue un facteur pronostique chez l’enfant. Les signes de gravite apparaissent dans les 72 heures chez l’adulte. Apres une reanimation intensive, les signes d’intoxication disparaissent en 12 jours. La forme grave predominait chez l’enfant, le deces est precoce ou tardif entre le deuxieme et le sixieme jour de la consommation. Une sensibilisation de toute la population des zones cotieres de Madagascar s’avere fondamentale pour prevenir ce type d’intoxication.