In order to characterize A/H5N1 viral sequences, a bioinformatics approach accurately identified ... more In order to characterize A/H5N1 viral sequences, a bioinformatics approach accurately identified viral sequences from discovery of a sequence signature, which provided enough distinctive information for sequence identification. Eight highly pathogenic H5N1 viral isolations were collected from different areas of Thailand between 2003 and 2006, and were used for analysis of H5N1 genotypic testing with a semiconductor-based oligonucleotide microarray. All H5N1 samples and H1N1, H4N8 negative controls were correctly subtyped. Sensitivity of the eight oligonucleotide probes, with optimized cut-offs, ranged from 70% (95% CI 65-75) to 87% (95% CI 84-91), and the corresponding Kappa values ranged from 0.76 (95% CI 0.72-0.80) to 0.86 (95% CI 0.83-0.89). Semi-conductor-based oligonucleotide array and oligonucleotide probes corresponded well when detecting H5N1. After fully correcting the subtype from the result of microarray signal intensity, the microarray output method combined with bioinformatics tools, identified and monitored genetic variations of H5N1. Capability of distinguishing different strains of H5N1 from Thailand was the outstanding feature of this assay. Ninety percent of HA and NA (4/5) genes were sequenced correctly, in accordance with previous examinations performed by classical diagnostic methods. The low-medium-high bioinformatics resolutions were able to predict an epidemic strain of H5N1. This study also showed the advantage of using a large genotypic database to predict the epidemic strain of H5N1. However, the monitoring protocol of this new strain has been recommended for further study with a large-scale sample.
Anaemia is common in malaria. It is important to quantitate the risk of anaemia and to distinguis... more Anaemia is common in malaria. It is important to quantitate the risk of anaemia and to distinguish factors related to the natural history of disease from potential drug toxicity. Individual-patient data analysis based on nine randomized controlled trials of treatments of uncomplicated falciparum malaria from 13 sub-Saharan African countries. Risk factors for reduced haemoglobin (Hb) concentrations and anaemia on presentation and after treatment were analysed using mixed effect models. Eight thousand eight hundred ninety-seven patients (77.0% <5 years-old) followed-up through 28 days treated with artemisinin combination therapy (ACT, 90%, n = 7968) or non-ACT. At baseline, under 5's had the highest risk of anaemia (77.6% vs. 32.8%) and higher parasitaemia (43,938 μl) than older subjects (2784 μl). Baseline anaemia increased the risk of parasitological recurrence. Hb began to fall after treatment start. In under 5's the estimated nadir was ~35 h (range 29-48), with a drop o...
This study investigates trends and age-and-sex patterns of mortality in pulmonary tuberculosis (P... more This study investigates trends and age-and-sex patterns of mortality in pulmonary tuberculosis (PTB) and PTB/HIV co-infection in a rural population of South Africa. The PTB/HIV mortality emerged in 1994, and has been rising ever since (men: P = 0.001; women: P = 0.020, test for trend). In the last 2 years, for both sexes combined, 63% (95% CI 51—74%) of PTB deaths were attributable to HIV/AIDS. PTB/HIV death rate was higher in men than in women for all ages combined (RR MH = 2.48, 95% CI 1.53—4.04, P < 0.001). PTB/HIV death rate was also higher in younger individuals (<25 years) compared with PTB without HIV/AIDS (P = 0.033), and the median age at death from PTB/HIV in women (28 years) was lower than in men (38 years, P = 0.002). While mortality from PTB without HIV remained constant over time, HIV/AIDS explained the rise in PTB mortality. In the last 3 years, the HIV/AIDS epidemic has caused the number of persons dying of PTB to increase by +117%, with the mortality excess being higher in women (+164%) than in men (+103%, P = 0.001). Combined PTB and HIV programme activities need to be reinforced to respond to the increase in PTB mortality, particularly in women.
African Journal of Reproductive Health, Aug 1, 2008
A qualitative study was conducted in Agincourt, a rural area of South Africa, to document the per... more A qualitative study was conducted in Agincourt, a rural area of South Africa, to document the perceptions and attitudes towards premarital fertility and late marriage among young adults of both sexes. Two focus groups and 35 individual interviews were conducted among 17-30 year olds, randomly selected. Most interviewees perceived premarital fertility as undesirable, and a new phenomenon in a context of major social changes, in particular loss of authority of parents and increasing freedom of the youth. In contrast, late marriage was perceived as positive, by both sexes, primarily for economic reasons. Much stigma was associated with premarital fertility, from friends, institutions and families who occasionally apply mild or severe sanctions. Consequences of premarital fertility were numerous: school abandonment, economic adversity, health risks, stigmatization. In extreme cases, premarital fertility might lead to exclusion and deviant behavior. Premarital fertility was ultimately due to a lack of contraception among young women, and to refusal of abortion for religious reasons, and is associated with the risk of contracting STD's. (Afr J Reprod Health 2008; 12[2]:98-110) RÉSUMÉ Contexte social de la fécondité avant le mariage en Afrique du Sud rurale. Une étude qualitative a été menée à Agincourt en Afrique du Sud, pour documenter les perceptions et les attitudes envers la fécondité avant le mariage et le mariage tardif. Deux interviews au niveau de groupes cible et 35 interviews personnelles ont été recueillies auprès des gens âgés de 17 à 30. La plupart des gens interviewés ont perçu la fécondité avant le mariage comme étant désirée et comme un nouveau phénomène dans un contexte de transformations sociales importantes, surtout la perte de l´autorité des parents et la liberté croissante de la jeunesse. Par contre, ils ont apercu le mariage tardif comme positif, principalement pour des raisons économiques. Beaucoup de stigmate était lié à la fécondité avant le mariage de la part des amis, des institutions et des familles qui de temps en temps appliquent de légères sanctions. Les conséquences de la fécondité avant le mariage étaient nombreuses: l´abandon de l´école, l'adversité économique, les risques de santé, la stigmatisation. Dans des cas extrêmes, la fécondité avant le mariage peut entrainer l´exclusion et le comportement deviant. La fécondité avant le mariage a été finalement causée par un manque de contraception chez les jeunes femmes et à cause du refus de l´avortement pour des raisons religieuses et pour des raisons liées au risque de contracter les MSTs. (Rev Afr Santé Reprod 2008; 12[2]:98-110)
Estimation des niveaux de morbidité et de mortali 10 ;é 25 millions de cas de rougeole et 150 O00... more Estimation des niveaux de morbidité et de mortali 10 ;é 25 millions de cas de rougeole et 150 O00 décès causés par la rougeole en l'an 2000, tel est l'impact estimé de la maladie dans le monde. Ces chgfres globaux recouvrent des situations très diverses puisque deux régions du monde comptent à elles seules plus des trois quarts des cas et des décès : 1 'Afrique équatoriale et tropicale (Nigéria, République démocratique du Congo, Éthiopie, Niger.. . ) et 1 'Asie du Sud et du Sud-Est (Inde, Chine, Pakistan, Afghanistan.. .
African Journal of Reproductive Health, Aug 1, 2008
The paper investigates the complex relationships between premarital fertility and HIV/AIDS in sub... more The paper investigates the complex relationships between premarital fertility and HIV/AIDS in sub-Saharan African countries. The DHS surveys provided data to compute the prevalence of premarital fertility, defined as any birth before the first marriage. The UNAIDS database provided data to compute the prevalence of HIV infection among pregnant women. Results indicate a moderate association between the prevalence of premarital fertility and the prevalence of HIV infection (correlation coefficient = 0.64, P < 0.0001), and similar geographical patterns. Compared with the average pattern, outlier countries had either high levels of premarital fertility and relatively low HIV prevalence (Liberia, Madagascar, Gabon, Congo), or high levels of HIV prevalence despite low levels of premarital fertility (Lesotho, Malawi, Zambia, Zimbabwe). The overall relationship is discussed in light of the relationships between age at marriage, permissiveness and lack of protection during intercourse and their impact on premarital fertility and HIV infection among women.
Premarital fertility is defined as fertility before the first marriage. In South Africa, in 1998,... more Premarital fertility is defined as fertility before the first marriage. In South Africa, in 1998, according to the Demographic and Health Survey (DHS), about 65% of women under age 25 had had a premarital birth and close to 39% of all births were premarital. Although the total fertility rate had decreased drastically (down to 2.9), trends showed that premarital fertility was increasing.
A qualitative study was conducted in Agincourt, a rural area of South Africa, to document the per... more A qualitative study was conducted in Agincourt, a rural area of South Africa, to document the perceptions and attitudes towards premarital fertility and late marriage among young adults of both sexes. Two focus groups and 35 individual interviews were conducted among 17-30 year olds, randomly selected. Most interviewees perceived premarital fertility as undesirable, and a new phenomenon in a context of major social changes, in particular loss of authority of parents and increasing freedom of the youth. In contrast, late marriage was perceived as positive, by both sexes, primarily for economic reasons. Much stigma was associated with premarital fertility, from friends, institutions and families who occasionally apply mild or severe sanctions. Consequences of premarital fertility were numerous: school abandonment, economic adversity, health risks, stigmatization. In extreme cases, premarital fertility might lead to exclusion and deviant behavior. Premarital fertility was ultimately du...
The paper investigates the complex relationships between premarital fertility and HIV/AIDS in sub... more The paper investigates the complex relationships between premarital fertility and HIV/AIDS in sub-Saharan African countries. The DHS surveys provided data to compute the prevalence of premarital fertility, defined as any birth before the first marriage. The UNAIDS database provided data to compute the prevalence of HIV infection among pregnant women. Results indicate a moderate association between the prevalence of premarital fertility and the prevalence of HIV infection (correlation coefficient = 0.64, P < 0.0001), and similar geographical patterns. Compared with the average pattern, outlier countries had either high levels of premarital fertility and relatively low HIV prevalence (Liberia, Madagascar, Gabon, Congo), or high levels of HIV prevalence despite low levels of premarital fertility (Lesotho, Malawi, Zambia, Zimbabwe). The overall relationship is discussed in light of the relationships between age at marriage, permissiveness and lack of protection during intercourse and...
One main etiology for oral squamous cell carcinoma (OSCC) is inflammation. Inducible nitric oxide... more One main etiology for oral squamous cell carcinoma (OSCC) is inflammation. Inducible nitric oxide synthase (iNOS), vascular endothelial growth factor (VEGF) and cyclooxygenase-2 (COX-2) are the important molecules showing close relation to not only inflammation but also carcinogenesis and angiogenesis. Angiogenesis is defined as the formation of new blood vessels from existing vasculature. It is necessary for tumor growth and
Méthodes : Il s'agissait d'une étude transversale descriptive et analytique portant sur un échant... more Méthodes : Il s'agissait d'une étude transversale descriptive et analytique portant sur un échantillon de 134 agents de santé, personnel administratif, et de la Direction du Centre Hospitalier Départemental de l'Ouémé et du Plateau au sud du Bénin. Résultats : Le Centre Hospitalier (CH) a un équipement et des installations d'un niveau insuffisant en matière de lavage des mains (score = 7,54/12) Le CH dispose d'une structure naissante peu connue du personnel de santé qui oeuvre pour la promotion de l'hygiène hospitalière (score = 6/10). Le personnel a une bonne compétence en matière de lavage des mains (score = 10,48/13) mais une faible motivation au lavage des mains (score = 4,61/12). L'organisation des services pour un lavage systématique des mains est assez bonne (score = 6/9) cependant une réorganisation spatiale et un aménagement des points d'eau peuvent améliorer l'adoption de cette pratique. Dans 58,42 % des cas, les points d'eau pour le lavage des mains ne disposent pas de poubelles. Les chambres des malades ne sont pas toutes équipées de point d'eau pour le lavage des mains. L'utilisation d'eau de javel diluée mélangée avec du savon liquide pour le lavage antiseptique des mains est d'usage dans les services ce qui entraîne l'inhibition de l'action de l'eau de javel par le savon. Le savon liquide est conservé dans des flacons sans presseur. Les essuiemains sont en linge commun et le pain de savon bien que déconseillé se retrouve dans certains services. Les distributeurs de savon et d'essuies mains ne sont pas conformes aux normes. La différence de pratique du lavage systématique des mains était statistiquement significative entre ceux qui ont une disponibilité permanente de produits de lavage des mains et ceux qui n'ont pas (P = 0,02). Conclusion : Le lavage des mains dans une formation sanitaire est en relation avec l'existence de points d'eau pour lavage des mains ; l'existence de distributeur de savon ; l'existence de distributeur d'essuies mains ; la charge de travail et la disponibilité permanente de savon. Son observance au Centre Hospitalier Départemental de l'Ouémé et du Plateau est intimement liée à la disponibilité de l'équipement et du matériel pour le lavage des mains, la motivation du personnel pour la pratique de lavage des mains, la charge de travail et la fonctionnalité des structures de promotion d'hygiène hospitalière.
Background: Nucleic acid amplification provides the most sensitive and accurate method to detect ... more Background: Nucleic acid amplification provides the most sensitive and accurate method to detect and identify pathogens. This is primarily useful for epidemiological investigations of malaria because the infections, often with two or more Plasmodium species present simultaneously, are frequently associated with microscopically sub-patent parasite levels and cryptic mixed infections. Numerous distinct equally adequate amplification-based protocols have been described, but it is unclear which to select for epidemiological surveys. Few comparative studies are available, and none that addresses the issue of inter-laboratory variability.
Plasmodium species ex vivo sensitivity assay protocols differ in the requirement for leukocyte re... more Plasmodium species ex vivo sensitivity assay protocols differ in the requirement for leukocyte removal before culturing. This study shows that the presence of leukocytes significantly increases the 50% inhibitory concentration (IC 50 ) of P. vivax and P. falciparum to artesunate and chloroquine relative to results with the paired leukocyte-free treatment. Although leukocyte removal is not an essential requirement for the conduct of ex vivo assays, its use has important implications for the interpretation of temporal and spatial antimalarial sensitivity data.
Premarital fertility, defined as birth before first marriage, is investigated in Madagascar, usin... more Premarital fertility, defined as birth before first marriage, is investigated in Madagascar, using two Demographic and Health Surveys (DHS) conducted in 1992 and 1997. About 8 per cent of all births and 23 per cent of first births take place before marriage, despite a low underlying mean age at first marriage, estimated to be 18.6 years in the absence of
Extensive use of praziquantel for treatment and control of schistosomiasis requires a comprehensi... more Extensive use of praziquantel for treatment and control of schistosomiasis requires a comprehensive understanding of efficacy and safety of various doses for different Schistosoma species. A systematic review and meta-analysis of comparative and non-comparative trials of praziquantel at any dose for any Schistosoma species assessed within two months post-treatment. Of 273 studies identified, 55 were eligible (19,499 subjects treated with praziquantel, control treatment or placebo). Most studied were in school-aged children (64%), S. mansoni (58%), and the 40 mg/kg dose (56%); 68% of subjects were in Africa. Efficacy was assessed as cure rate (CR, n=17,017) and egg reduction rate (ERR, n=13,007); safety as adverse events (AE) incidence. The WHO-recommended dose of praziquantel 40 mg/kg achieved CRs of 94.7% (95%CI 92.2-98.0) for S. japonicum, 77.1% (68.4-85.1) for S. haematobium, 76.7% (95%CI 71.9-81.2) for S. mansoni, and 63.5% (95%CI 48.2-77.0) for mixed S. haematobium/S. mansoni i...
B3-1 Transmission post-natale du virus de l'immunodéficience humaine (VIH) en fonction des modali... more B3-1 Transmission post-natale du virus de l'immunodéficience humaine (VIH) en fonction des modalités d'alimentation infantile dans un projet de prévention de la transmission mère-enfant du VIH à Abidjan, Côte d' Ivoire, 2001Ivoire, -2004
The American journal of tropical medicine and hygiene, 2006
Artemether-lumefantrine is the first registered, fixed, artemisinin-based combination treatment. ... more Artemether-lumefantrine is the first registered, fixed, artemisinin-based combination treatment. Artemisinin derivatives are highly effective antimalarials with a favorable safety profile. Concerns remain over their potential neurotoxicity, although there has been no clinical evidence of this in humans. In animals (rats, dogs, and monkeys) artemether, a derivative of artemisinin is associated with an unusual toxicity pattern in specific brain nuclei involving the auditory and vestibular pathways. A recent report from Mozambique described a small but significant and irreversible hearing loss in patients exposed to artemether-lumefantrine. To explore this issue, we conducted a case-control study using tympanometry, audiometry and auditory brain-stem responses. We assessed 68 subjects who had been treated with artemether-lumefantrine within the previous five years and 68 age- and sex-matched controls living in the malarious region along the Thailand-Myanmar border. There were no differ...
The fixed dose antimalarial combination of dihydroartemisinin-piperaquine (DP) is a promising new... more The fixed dose antimalarial combination of dihydroartemisinin-piperaquine (DP) is a promising new artemisinin-based combination therapy (ACT). We present an individual patient data analysis of efficacy and tolerability in acute uncomplicated falciparum malaria, from seven published randomized clinical trials conducted in Africa and South East Asia using a predefined in-vivo protocol. Comparator drugs were mefloquine-artesunate (MAS3) in Thailand, Myanmar, Laos and Cambodia; artemether-lumefantrine in Uganda; and amodiaquine+sulfadoxine-pyrimethamine and artesunate+amodiaquine in Rwanda. In total 3,547 patients were enrolled: 1,814 patients (32% children under five years) received DP and 1,733 received a comparator antimalarial at 12 different sites and were followed for 28-63 days. There was no significant heterogeneity between trials. DP was well tolerated with 1.7% early vomiting. There were less adverse events with DP in children and adults compared to MAS3 except for diarrhea; O...
In order to characterize A/H5N1 viral sequences, a bioinformatics approach accurately identified ... more In order to characterize A/H5N1 viral sequences, a bioinformatics approach accurately identified viral sequences from discovery of a sequence signature, which provided enough distinctive information for sequence identification. Eight highly pathogenic H5N1 viral isolations were collected from different areas of Thailand between 2003 and 2006, and were used for analysis of H5N1 genotypic testing with a semiconductor-based oligonucleotide microarray. All H5N1 samples and H1N1, H4N8 negative controls were correctly subtyped. Sensitivity of the eight oligonucleotide probes, with optimized cut-offs, ranged from 70% (95% CI 65-75) to 87% (95% CI 84-91), and the corresponding Kappa values ranged from 0.76 (95% CI 0.72-0.80) to 0.86 (95% CI 0.83-0.89). Semi-conductor-based oligonucleotide array and oligonucleotide probes corresponded well when detecting H5N1. After fully correcting the subtype from the result of microarray signal intensity, the microarray output method combined with bioinformatics tools, identified and monitored genetic variations of H5N1. Capability of distinguishing different strains of H5N1 from Thailand was the outstanding feature of this assay. Ninety percent of HA and NA (4/5) genes were sequenced correctly, in accordance with previous examinations performed by classical diagnostic methods. The low-medium-high bioinformatics resolutions were able to predict an epidemic strain of H5N1. This study also showed the advantage of using a large genotypic database to predict the epidemic strain of H5N1. However, the monitoring protocol of this new strain has been recommended for further study with a large-scale sample.
Anaemia is common in malaria. It is important to quantitate the risk of anaemia and to distinguis... more Anaemia is common in malaria. It is important to quantitate the risk of anaemia and to distinguish factors related to the natural history of disease from potential drug toxicity. Individual-patient data analysis based on nine randomized controlled trials of treatments of uncomplicated falciparum malaria from 13 sub-Saharan African countries. Risk factors for reduced haemoglobin (Hb) concentrations and anaemia on presentation and after treatment were analysed using mixed effect models. Eight thousand eight hundred ninety-seven patients (77.0% <5 years-old) followed-up through 28 days treated with artemisinin combination therapy (ACT, 90%, n = 7968) or non-ACT. At baseline, under 5's had the highest risk of anaemia (77.6% vs. 32.8%) and higher parasitaemia (43,938 μl) than older subjects (2784 μl). Baseline anaemia increased the risk of parasitological recurrence. Hb began to fall after treatment start. In under 5's the estimated nadir was ~35 h (range 29-48), with a drop o...
This study investigates trends and age-and-sex patterns of mortality in pulmonary tuberculosis (P... more This study investigates trends and age-and-sex patterns of mortality in pulmonary tuberculosis (PTB) and PTB/HIV co-infection in a rural population of South Africa. The PTB/HIV mortality emerged in 1994, and has been rising ever since (men: P = 0.001; women: P = 0.020, test for trend). In the last 2 years, for both sexes combined, 63% (95% CI 51—74%) of PTB deaths were attributable to HIV/AIDS. PTB/HIV death rate was higher in men than in women for all ages combined (RR MH = 2.48, 95% CI 1.53—4.04, P < 0.001). PTB/HIV death rate was also higher in younger individuals (<25 years) compared with PTB without HIV/AIDS (P = 0.033), and the median age at death from PTB/HIV in women (28 years) was lower than in men (38 years, P = 0.002). While mortality from PTB without HIV remained constant over time, HIV/AIDS explained the rise in PTB mortality. In the last 3 years, the HIV/AIDS epidemic has caused the number of persons dying of PTB to increase by +117%, with the mortality excess being higher in women (+164%) than in men (+103%, P = 0.001). Combined PTB and HIV programme activities need to be reinforced to respond to the increase in PTB mortality, particularly in women.
African Journal of Reproductive Health, Aug 1, 2008
A qualitative study was conducted in Agincourt, a rural area of South Africa, to document the per... more A qualitative study was conducted in Agincourt, a rural area of South Africa, to document the perceptions and attitudes towards premarital fertility and late marriage among young adults of both sexes. Two focus groups and 35 individual interviews were conducted among 17-30 year olds, randomly selected. Most interviewees perceived premarital fertility as undesirable, and a new phenomenon in a context of major social changes, in particular loss of authority of parents and increasing freedom of the youth. In contrast, late marriage was perceived as positive, by both sexes, primarily for economic reasons. Much stigma was associated with premarital fertility, from friends, institutions and families who occasionally apply mild or severe sanctions. Consequences of premarital fertility were numerous: school abandonment, economic adversity, health risks, stigmatization. In extreme cases, premarital fertility might lead to exclusion and deviant behavior. Premarital fertility was ultimately due to a lack of contraception among young women, and to refusal of abortion for religious reasons, and is associated with the risk of contracting STD's. (Afr J Reprod Health 2008; 12[2]:98-110) RÉSUMÉ Contexte social de la fécondité avant le mariage en Afrique du Sud rurale. Une étude qualitative a été menée à Agincourt en Afrique du Sud, pour documenter les perceptions et les attitudes envers la fécondité avant le mariage et le mariage tardif. Deux interviews au niveau de groupes cible et 35 interviews personnelles ont été recueillies auprès des gens âgés de 17 à 30. La plupart des gens interviewés ont perçu la fécondité avant le mariage comme étant désirée et comme un nouveau phénomène dans un contexte de transformations sociales importantes, surtout la perte de l´autorité des parents et la liberté croissante de la jeunesse. Par contre, ils ont apercu le mariage tardif comme positif, principalement pour des raisons économiques. Beaucoup de stigmate était lié à la fécondité avant le mariage de la part des amis, des institutions et des familles qui de temps en temps appliquent de légères sanctions. Les conséquences de la fécondité avant le mariage étaient nombreuses: l´abandon de l´école, l'adversité économique, les risques de santé, la stigmatisation. Dans des cas extrêmes, la fécondité avant le mariage peut entrainer l´exclusion et le comportement deviant. La fécondité avant le mariage a été finalement causée par un manque de contraception chez les jeunes femmes et à cause du refus de l´avortement pour des raisons religieuses et pour des raisons liées au risque de contracter les MSTs. (Rev Afr Santé Reprod 2008; 12[2]:98-110)
Estimation des niveaux de morbidité et de mortali 10 ;é 25 millions de cas de rougeole et 150 O00... more Estimation des niveaux de morbidité et de mortali 10 ;é 25 millions de cas de rougeole et 150 O00 décès causés par la rougeole en l'an 2000, tel est l'impact estimé de la maladie dans le monde. Ces chgfres globaux recouvrent des situations très diverses puisque deux régions du monde comptent à elles seules plus des trois quarts des cas et des décès : 1 'Afrique équatoriale et tropicale (Nigéria, République démocratique du Congo, Éthiopie, Niger.. . ) et 1 'Asie du Sud et du Sud-Est (Inde, Chine, Pakistan, Afghanistan.. .
African Journal of Reproductive Health, Aug 1, 2008
The paper investigates the complex relationships between premarital fertility and HIV/AIDS in sub... more The paper investigates the complex relationships between premarital fertility and HIV/AIDS in sub-Saharan African countries. The DHS surveys provided data to compute the prevalence of premarital fertility, defined as any birth before the first marriage. The UNAIDS database provided data to compute the prevalence of HIV infection among pregnant women. Results indicate a moderate association between the prevalence of premarital fertility and the prevalence of HIV infection (correlation coefficient = 0.64, P < 0.0001), and similar geographical patterns. Compared with the average pattern, outlier countries had either high levels of premarital fertility and relatively low HIV prevalence (Liberia, Madagascar, Gabon, Congo), or high levels of HIV prevalence despite low levels of premarital fertility (Lesotho, Malawi, Zambia, Zimbabwe). The overall relationship is discussed in light of the relationships between age at marriage, permissiveness and lack of protection during intercourse and their impact on premarital fertility and HIV infection among women.
Premarital fertility is defined as fertility before the first marriage. In South Africa, in 1998,... more Premarital fertility is defined as fertility before the first marriage. In South Africa, in 1998, according to the Demographic and Health Survey (DHS), about 65% of women under age 25 had had a premarital birth and close to 39% of all births were premarital. Although the total fertility rate had decreased drastically (down to 2.9), trends showed that premarital fertility was increasing.
A qualitative study was conducted in Agincourt, a rural area of South Africa, to document the per... more A qualitative study was conducted in Agincourt, a rural area of South Africa, to document the perceptions and attitudes towards premarital fertility and late marriage among young adults of both sexes. Two focus groups and 35 individual interviews were conducted among 17-30 year olds, randomly selected. Most interviewees perceived premarital fertility as undesirable, and a new phenomenon in a context of major social changes, in particular loss of authority of parents and increasing freedom of the youth. In contrast, late marriage was perceived as positive, by both sexes, primarily for economic reasons. Much stigma was associated with premarital fertility, from friends, institutions and families who occasionally apply mild or severe sanctions. Consequences of premarital fertility were numerous: school abandonment, economic adversity, health risks, stigmatization. In extreme cases, premarital fertility might lead to exclusion and deviant behavior. Premarital fertility was ultimately du...
The paper investigates the complex relationships between premarital fertility and HIV/AIDS in sub... more The paper investigates the complex relationships between premarital fertility and HIV/AIDS in sub-Saharan African countries. The DHS surveys provided data to compute the prevalence of premarital fertility, defined as any birth before the first marriage. The UNAIDS database provided data to compute the prevalence of HIV infection among pregnant women. Results indicate a moderate association between the prevalence of premarital fertility and the prevalence of HIV infection (correlation coefficient = 0.64, P < 0.0001), and similar geographical patterns. Compared with the average pattern, outlier countries had either high levels of premarital fertility and relatively low HIV prevalence (Liberia, Madagascar, Gabon, Congo), or high levels of HIV prevalence despite low levels of premarital fertility (Lesotho, Malawi, Zambia, Zimbabwe). The overall relationship is discussed in light of the relationships between age at marriage, permissiveness and lack of protection during intercourse and...
One main etiology for oral squamous cell carcinoma (OSCC) is inflammation. Inducible nitric oxide... more One main etiology for oral squamous cell carcinoma (OSCC) is inflammation. Inducible nitric oxide synthase (iNOS), vascular endothelial growth factor (VEGF) and cyclooxygenase-2 (COX-2) are the important molecules showing close relation to not only inflammation but also carcinogenesis and angiogenesis. Angiogenesis is defined as the formation of new blood vessels from existing vasculature. It is necessary for tumor growth and
Méthodes : Il s'agissait d'une étude transversale descriptive et analytique portant sur un échant... more Méthodes : Il s'agissait d'une étude transversale descriptive et analytique portant sur un échantillon de 134 agents de santé, personnel administratif, et de la Direction du Centre Hospitalier Départemental de l'Ouémé et du Plateau au sud du Bénin. Résultats : Le Centre Hospitalier (CH) a un équipement et des installations d'un niveau insuffisant en matière de lavage des mains (score = 7,54/12) Le CH dispose d'une structure naissante peu connue du personnel de santé qui oeuvre pour la promotion de l'hygiène hospitalière (score = 6/10). Le personnel a une bonne compétence en matière de lavage des mains (score = 10,48/13) mais une faible motivation au lavage des mains (score = 4,61/12). L'organisation des services pour un lavage systématique des mains est assez bonne (score = 6/9) cependant une réorganisation spatiale et un aménagement des points d'eau peuvent améliorer l'adoption de cette pratique. Dans 58,42 % des cas, les points d'eau pour le lavage des mains ne disposent pas de poubelles. Les chambres des malades ne sont pas toutes équipées de point d'eau pour le lavage des mains. L'utilisation d'eau de javel diluée mélangée avec du savon liquide pour le lavage antiseptique des mains est d'usage dans les services ce qui entraîne l'inhibition de l'action de l'eau de javel par le savon. Le savon liquide est conservé dans des flacons sans presseur. Les essuiemains sont en linge commun et le pain de savon bien que déconseillé se retrouve dans certains services. Les distributeurs de savon et d'essuies mains ne sont pas conformes aux normes. La différence de pratique du lavage systématique des mains était statistiquement significative entre ceux qui ont une disponibilité permanente de produits de lavage des mains et ceux qui n'ont pas (P = 0,02). Conclusion : Le lavage des mains dans une formation sanitaire est en relation avec l'existence de points d'eau pour lavage des mains ; l'existence de distributeur de savon ; l'existence de distributeur d'essuies mains ; la charge de travail et la disponibilité permanente de savon. Son observance au Centre Hospitalier Départemental de l'Ouémé et du Plateau est intimement liée à la disponibilité de l'équipement et du matériel pour le lavage des mains, la motivation du personnel pour la pratique de lavage des mains, la charge de travail et la fonctionnalité des structures de promotion d'hygiène hospitalière.
Background: Nucleic acid amplification provides the most sensitive and accurate method to detect ... more Background: Nucleic acid amplification provides the most sensitive and accurate method to detect and identify pathogens. This is primarily useful for epidemiological investigations of malaria because the infections, often with two or more Plasmodium species present simultaneously, are frequently associated with microscopically sub-patent parasite levels and cryptic mixed infections. Numerous distinct equally adequate amplification-based protocols have been described, but it is unclear which to select for epidemiological surveys. Few comparative studies are available, and none that addresses the issue of inter-laboratory variability.
Plasmodium species ex vivo sensitivity assay protocols differ in the requirement for leukocyte re... more Plasmodium species ex vivo sensitivity assay protocols differ in the requirement for leukocyte removal before culturing. This study shows that the presence of leukocytes significantly increases the 50% inhibitory concentration (IC 50 ) of P. vivax and P. falciparum to artesunate and chloroquine relative to results with the paired leukocyte-free treatment. Although leukocyte removal is not an essential requirement for the conduct of ex vivo assays, its use has important implications for the interpretation of temporal and spatial antimalarial sensitivity data.
Premarital fertility, defined as birth before first marriage, is investigated in Madagascar, usin... more Premarital fertility, defined as birth before first marriage, is investigated in Madagascar, using two Demographic and Health Surveys (DHS) conducted in 1992 and 1997. About 8 per cent of all births and 23 per cent of first births take place before marriage, despite a low underlying mean age at first marriage, estimated to be 18.6 years in the absence of
Extensive use of praziquantel for treatment and control of schistosomiasis requires a comprehensi... more Extensive use of praziquantel for treatment and control of schistosomiasis requires a comprehensive understanding of efficacy and safety of various doses for different Schistosoma species. A systematic review and meta-analysis of comparative and non-comparative trials of praziquantel at any dose for any Schistosoma species assessed within two months post-treatment. Of 273 studies identified, 55 were eligible (19,499 subjects treated with praziquantel, control treatment or placebo). Most studied were in school-aged children (64%), S. mansoni (58%), and the 40 mg/kg dose (56%); 68% of subjects were in Africa. Efficacy was assessed as cure rate (CR, n=17,017) and egg reduction rate (ERR, n=13,007); safety as adverse events (AE) incidence. The WHO-recommended dose of praziquantel 40 mg/kg achieved CRs of 94.7% (95%CI 92.2-98.0) for S. japonicum, 77.1% (68.4-85.1) for S. haematobium, 76.7% (95%CI 71.9-81.2) for S. mansoni, and 63.5% (95%CI 48.2-77.0) for mixed S. haematobium/S. mansoni i...
B3-1 Transmission post-natale du virus de l'immunodéficience humaine (VIH) en fonction des modali... more B3-1 Transmission post-natale du virus de l'immunodéficience humaine (VIH) en fonction des modalités d'alimentation infantile dans un projet de prévention de la transmission mère-enfant du VIH à Abidjan, Côte d' Ivoire, 2001Ivoire, -2004
The American journal of tropical medicine and hygiene, 2006
Artemether-lumefantrine is the first registered, fixed, artemisinin-based combination treatment. ... more Artemether-lumefantrine is the first registered, fixed, artemisinin-based combination treatment. Artemisinin derivatives are highly effective antimalarials with a favorable safety profile. Concerns remain over their potential neurotoxicity, although there has been no clinical evidence of this in humans. In animals (rats, dogs, and monkeys) artemether, a derivative of artemisinin is associated with an unusual toxicity pattern in specific brain nuclei involving the auditory and vestibular pathways. A recent report from Mozambique described a small but significant and irreversible hearing loss in patients exposed to artemether-lumefantrine. To explore this issue, we conducted a case-control study using tympanometry, audiometry and auditory brain-stem responses. We assessed 68 subjects who had been treated with artemether-lumefantrine within the previous five years and 68 age- and sex-matched controls living in the malarious region along the Thailand-Myanmar border. There were no differ...
The fixed dose antimalarial combination of dihydroartemisinin-piperaquine (DP) is a promising new... more The fixed dose antimalarial combination of dihydroartemisinin-piperaquine (DP) is a promising new artemisinin-based combination therapy (ACT). We present an individual patient data analysis of efficacy and tolerability in acute uncomplicated falciparum malaria, from seven published randomized clinical trials conducted in Africa and South East Asia using a predefined in-vivo protocol. Comparator drugs were mefloquine-artesunate (MAS3) in Thailand, Myanmar, Laos and Cambodia; artemether-lumefantrine in Uganda; and amodiaquine+sulfadoxine-pyrimethamine and artesunate+amodiaquine in Rwanda. In total 3,547 patients were enrolled: 1,814 patients (32% children under five years) received DP and 1,733 received a comparator antimalarial at 12 different sites and were followed for 28-63 days. There was no significant heterogeneity between trials. DP was well tolerated with 1.7% early vomiting. There were less adverse events with DP in children and adults compared to MAS3 except for diarrhea; O...
Background: Artemisinin combination treatments (ACT) are recommended as first line treatment for ... more Background: Artemisinin combination treatments (ACT) are recommended as first line treatment for falciparum malaria throughout the malaria affected world. We reviewed the efficacy of a 3-day regimen of mefloquine and artesunate regimen (MAS 3 ), over a 13 year period of continuous deployment as first-line treatment in camps for displaced persons and in clinics for migrant population along the Thai-Myanmar border.
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Papers by Julien Zwang