HIV-1 and HIV-2 seropositivity among female sex workers in the Tenere Desert, Niger.
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Adult↗
Biomedical subjects
J Julvez
Publications and source records attributed to J Julvez.
[In vivo study of chloroquine resistance of Plasmodium falciparum malaria in Mayotte].
According to the existence of Plasmodium falciparum chloroquine-resisting cases in Madagascar and, someone, in the Comoro Archipelago, a study using in vivo W.H.O. test was conducted in Mayotte Island. Between the end of 1985 and 1987, despite the great difficulties for ambulatory blood collection in a rural population, 24% of malaria cases had been followed up during 28 days, using a dose of 25 mg/Kg in 3 days. During 1986 and 1987, 5 cases showed positive serology of thin blood films. Either the possibility of reinfection cannot be excluded, these cases may be notified as R I and R II resistant type according to the W.H.O. standard test. In vitro W.H.O. test is necessary to confirm this fact but is not possible in local laboratory conditions. Thus, the surveillance of chemosensitivity of Plasmodium falciparum local strains is a priority. Nevertheless, chloroquine remains efficient for prophylactic (new travelers only) or curative purpose in the main cases.
Animals↗
[Short-term clinical and histological evaluation of combination drug therapy of leprosy in Mayotte].
Leprosy in Mayotte affects 480 persons in a population of 80,000 inhabitants. 229 patients have been treated every day by association of Rifampicin, Clofazimine and Isoniazide. This study make a clinical, histological and bacteriological valuation after treatment, during a period of 3 years. With paucibacillary patients, whom received 1 year of mean treatment and after 2 years under observation, histology for short-dated can stay positive and active. With multibacillary patients, whom received 26 months of mean treatment and most of the time after 1 year under observation, the all of morphological index is negative, sometime bacteriology is positive, less often than histology. For middle- and long-dated, histology should allow a good valuation for disease evolution, specially for interpolar leprosy patients.
Clofazimine↗
[Current epidemiologic aspects of leprosy on the Island of Reunion (Indian Ocean].
In the view of a cost/effectiveness study of the anti-leprosy organization in French Reunion island, an epidemiological evaluation had been realized from all existing records. 324 cards had been collected but only 62% of known patients are followed under surveillance. The clinical spectrum is characterized by a greater part of lepromatous or border-line types by the mere fact of male forms. The prevalence is 0.5 per 1000 and the average incidence is 0.02 per 1000. Nevertheless, the patients show few disabilities. This low endemic level, the positive growing old of leprosy population, the high frequency of relationship amongst patients, induce the idea that the disease is under extinction with a low intra-familiar contamination. But the main goal will be a better surveillance of known patients.
Adolescent↗
[Education in public health in Mauritius. Presentation of an experience].
In December 1991, fourteen physicians in the public sector received a degree entitled "Methods in public health", awarded by the dean of Université de Bordeaux II (France) and the Mauritius minister of health. The ceremony crowned a two-year course consisting of 350 hours of lectures and other teaching exercises, broken down into 12 subject areas (epidemiology, biostatistics, medical informatics, demographics, health care, planning, health economics, etc.). The graduates did an average of 10 year's field work in a primary health care center. The degree was awarded after completion of a mini-thesis based on an original study of a selected Mauritian public health problem. In 1992 and 1993, a new, shorter course in community health was offered to other Mauritian physicians by staff from Université de Bordeaux II. We consider that such initiatives would be profitable in other countries like Mauritius, where commonly encountered health care problems of the developing countries coexist with those found in the industrialized world. This will also be an important initiative in countries where initial training in various contexts and therefore can benefit from a common continuing medical education, particularly in public health. One key factor in the success of such projects is their full integration within the medical sciences.
Curriculum↗
[Human diffusion of arthropod disease vectors throughout the world].
The present distribution of animals and plants throughout the world is the result of an evolutionary process involving tectonic, climatic and biotic factors. Humans, since their appearance, have contributed to the spreading of many species including disease vectors and pests. When humans left their native African home, they brought with them ectoparasites such as lice and acarids. During the neolithic era, humans were leading domesticated animals which carried their own parasites into new areas. Dwelling commensals, flea, bugs, triatomids, flies, and cockroaches followed human migrations. In the second millennium, sailboats transported mosquito species which were resistant and reproduced on board, including Culex quinquefasciatus, Aedes aegypti, and Ae. albopictus. Steamers further shortened the length of trips and allowed the transport of anophelines. The opening of the Tamatave-Port-Louis line was immediately followed by the transport of An. gambiae from Madagascar to Mauritius and Reunion, and epidemics of malaria occurred on the two islands which had been free of the disease. Also, An. gambiae was transported from Senegal to Brazil. Old tires destined for recycling carried Ae. albopictus to the USA, Brazil, and then Italy. The pandemic of the plague at the end of the nineteenth century was propagated from harbour to harbour by steamers carrying both infected rats and their fleas Xenopsylla cheopsis. Aircrafts have reduced the travel time so much that in less than two days an insect could reach every point of the world. As soon as the airports had been built on the islands of French Polynesia, they were all colonized by Ae. aegypti. The same phenomenon occurred with midges (Fig. 2). Also, the construction of the airport on a Galapagos Island coincided with the importation of the blackfly Simulium bipunctatum from the continent. In addition, infected malaria mosquitos imported from tropical countries reached Europe and contaminated airport employees and local inhabitants. Six cases of malaria were recorded during the summer of 1994 around the Charles de Gaulle Airport, north of Paris, suggesting that the anophelines could have been imported from West and Central African countries which are served by this airport. The serious threat of vector importation is moderated by the vector's difficulty in adapting to new conditions. However any prediction is questionable.
Animals↗
[Malaria knowledge and practice. Medical study in Songhay-Zarma (Niger)].
Two randomized studies were performed in 1992 and 1994 in the Niger river valley where malaria transmission is thought to be permanent and is reinforced during the rainy season. The sample covered 114 families either in Niamey, the capital of Niger, or in Karma, a rural village 20 km to the west, and its surroundings. The questionnaire contained closed and open questions on the perception of malaria causes, treatment and prevention, including the use of mosquito bed nets. Most of the 114 families studied were monogamic with an average of 4 children per father. The most frequent occupation was agricultural farming (millet and rice) for the sedentary part of this population. During the rainy season, some moved to farms in the neighbouring valley of Taksaba. During the wet season, others migrated to the West African coast. The houses were traditional, being straw huts or made from banco; all the openings were small the the rooms were dark and poorly ventilated. These features constituted good conditions for malaria vectors. Domestic animals, such as goats, sheep, cows and sometimes donkeys, were very frequent in the courtyards. However, there was never any stagnant water in the courtyards or around the water pumps because of the intense sunshine. Drinking water was carried on the head from the public foot pumps or the river and stored in earth calabashes closed by a plate. In the Songhay-Zarma language, Hémar Izé is a symptomatic complex which corresponds closely to a clinical case of malaria. The main sign of this complex is fever known as konni (hot body). But this word is also used as the general name for all diseases with fever. Associated symptoms, well known by the community members, included vomiting, headache and diarrhoea. Hémar Izé was considered to be the most frequent cause of morbidity and the most severe disease, more significant than any other fever or diarrhoea. As perceived by the community members, the leading cause of malaria was described to be mosquitos (44.7%), followed by the rainy season, God, and less commonly, dirtiness, parasites, or the sun. The majority of cases were diagnosed by the parents, and were self-treated at home either with medicinal plant infusions or oral drugs. The self-treatment was not common, because Nivaquine was the only medication known by the people and was often unavailable. It is necessary to manage a regular drug supply with a public awareness campaign about dosage for self-treatment of malaria. Also, the public needs to be informed about any new policies of supplying essential drugs under generic names. Despite some confusion, the people generally believed that mosquitos were responsible for the disease. Thus, the use of mosquito netting over the beds was justified and widespread throughout the population. The traditional practice could be improved upon with an impregnated net even if the comprehension about the causes of the disease remains limited.
Adult↗
[History of insular malaria in the southwestern Indian Ocean: an eco-epidemiologic approach].
Madagascar has been isolated from the African continent since the Mesozoic era. The archipelago in this region emerged from volcanism during the early and the beginning of the late Cenozoic era. Consequently, during the prehistoric period, these islands were populated by only birds. Parasites and their vectors have been imported. In Madagascar (with the exception of the highlands) and in certain Comoro Islands, their implantation in a favorable biotope was contemporary with the coming of humans. The late introduction of malaria in the "Grand" Comoro island was the result of major human modification of the environment (construction of rainwater tanks), which was associated with the adaptation of the vector. In these zones, malaria is a stable type, with permanent transmission and seasonal reinforcement. From Madagascar, the vector was possibly introduced to Mauritius via a steamship line. This hypothesis is consistent with the biological constraints of the anopheles vector in that the inter-island distance was shortened. Also, transport of the vector by wind during a cyclone from Mauritius to Réunion cannot be excluded. Once introduced, the vectors were in an environment sufficiently reshaped by humans (deforestation) to allow implantation of a heliophile species like A. gambiae s.l. In Mauritius, after repeated eradication campaigns by spraying within the homes, anopheles emerged without transmission of malaria. The islands of Rodriguez and the Seychelles, protected by their geographical isolation, remain unscathed due to the absence of the vector.
History, 16th Century↗
[The development of public health education: the Mauritius experience].
A public course has been initiated in 1990 in Mauritius for covering the national growing needs of public health specialists. This training course was organized jointly by the Ministry of Health, the University of Bordeaux II and the French Cooperation. After 3 sessions dedicated specifically to the Mauritian physicians, the course has been re-designed for the needs of the other countries of the region. A feasibility study performed in 1994 in the countries of the Indian ocean region showed that during the past decade, the district level had become the focus point to integrate the health programs. This process has progressively transferred a wider and stronger part of the responsibilities from the central level to the district level and the survey showed that most of the health district managers were physicians that did not have the proper background for carrying such responsibilities. According to these results, a course curriculum was created by the Mauritian Ministry of Health and the University of Bordeaux II and submitted to various organisms supporting health program development in the region. This proposal was strongly supported by several agencies (the french Cooperation, Unicef, WHO, World Bank...) who agreed to sponsor candidates for that training course. The first session was organized in 1995, a second one in 1996. This training course is targeted to the medical doctors who are in charge of the management of health services at the district level. It is divided in two parts: A six-weeks intensive training course performed in Mauritius that include formal teaching and practical exercises in small groups for a total of 210 hours. The curriculum is mainly targeted on the various aspects of management as the management of health information (biostatistics epidemiology and computing), the management of human resources, financial resources and material resources. In addition to these main topics, there is an introduction to pedagogy, communication skills and applied research methodology. Following this six-weeks, training the students come back to work in their country and have 8 months to perform a thesis supervised by a local public health specialist. The subject of the thesis has to be closely related with one of the topic taught and should provide an obvious improvement for the public health situation in the district where this physician is acting. In 1995, 22 candidates attend to the course (13 from Madagascar, 4 from Mauritius, 3 from Comoros, 1 from Angola, 1 from Equatorial Guinea and 1 from Tchad), 19 had successively completed all the modules and got the diploma of public health delivered by the University of Bordeaux II. This diploma has been recognized as an equivalent to a master in public health in Mauritius. The evaluation of the courses-performed by the students, the teachers and the financial agencies gave a very positive results although the workload was considered as too important for a six-weeks training course. The recommendations of the 1995 session were included in the 1996 programs which is still on going for 23 candidates. The 97 session will probably extend the number of students up to 40, divided in 4 subgroups for practical exercises. In parallel to the course, a quarterly bulletin will be created and sent to the present and past candidates of this course in order to support a continuous medical education training program targeted to the district physicians.
Communication↗