CRITIQUE, DEVELOPPEMENT RESPONSABLE EN MATIERE DE … · MASSE CRITIQUE, DEVELOPPEMENT RESPONSABLE...
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MASSE CRITIQUE, DEVELOPPEMENT RESPONSABLE EN MATIERE DE SANTE ET COOPERATION INTERNATIONALE. Experience Malienne dans le domaine du paludisme et la Medicalisation des Zones Rurales Ogobara K. Doumbo, USTTB, Bamako, Mali Paris College de France, Juin 17-18, 2013
Transcript of CRITIQUE, DEVELOPPEMENT RESPONSABLE EN MATIERE DE … · MASSE CRITIQUE, DEVELOPPEMENT RESPONSABLE...
MASSE CRITIQUE, DEVELOPPEMENT RESPONSABLE EN MATIERE DE SANTE ET COOPERATION INTERNATIONALE.
Experience Malienne dans le domaine du paludisme et la Medicalisation
des Zones Rurales
Ogobara K. Doumbo, USTTB, Bamako, Mali Paris College de France, Juin 17-18, 2013
DEVELOPPEMENT SOCIO-SANITAIRE EN TANT QUE PROCESSUS D’ADAPTATION CONTINUE:
1] CO-EVOLUTION ENTRE ESPECES LINNEENNES
2] MODIFICATIONS
ECOLOGIQUES/ENVIRONNEMENTALES/SOCIETALES
3] CONNAISSANCES SCIENTIFIQUES ET TECHNIQUES
4] MODIALISATION
“ SEULES LES SOCIETES CREATIVES ET QUI PENSENT AUX SOLUTIONS S’ENSORTENT” =
NOTION DE MASSE CRITIQUE
NIAID/NIH
Extramural:
NIAID/ DMID/ FIC
MRTC/DEAP/FMPOS WRAIR
BMGF
MIM/TDR/WHO
Government of Mali
EU grants:
BioMalPar
EDCTP
CDC, USAID-PMI AFD-IRD
AMANET
Universities: Marseille, Angers, Bordeaux, Lyon, Paris, Oxford, Stokholm, Nijmegen, U Maryland, Tulane, U. Penn, John Hopkins, Notre Dame, ,LondonSHTM, Dakar, Ouagadougou, Abidjan, Conakry, Cotonou, Libreville, LiverpoolSTMH, Sorbone.
FMERIEUX
Institut Pasteur
Sanofi-Aventis, GSK, MMV , Novartis, Dafra, Pfizer Mepha, Bio-Merieux
FRANCE
Intramural :
LMIV, LIG, LMVR
BMGF
Pr. (feu) RANQUE: Fondateur du DEAP, 1976
F0.1. Génération du DEAP Fondateurs du MRTC, 1992
F1 Génération du MRTC/DEAP
F2 Génération du MRTC/DEAP F3 Génération du MRTC/DEAP F4 Génération du MRTC/DEAP F5 Génération du MRTC/DEAP
Présentateur
Commentaires de présentation
F1: Prof A Diallo, Prof Yeya Toure, Prof Ogobara Doumbo and Prof Dapa Diallo F2: Prof Dabo/Cheick/Amagana et autres F3: Djimde, Thera, Dicko, Belco,
Pr. (feu) Philippe RANQUE
Pr C. Soucko F0.1
Professeur ENSUP
Pr A. Diallo
Vice Recteur Univ. Bko
Pr Y.T. Touré
OMS- Geneva
Pr A.Tounkara
Doyen FMPOS
Pr O.K. Doumbo
Directeur PER / MRTC
F1.1 A. Dolo O. Koita A. Djimde S. Doumbia M. Diallo M. Théra A. Touré S. Diop F. Traoré S. Sow B. Traoré
F1.2
F2.3 F2.4 F2.5 En formation Mali, Afrique, Europe, USA.
A. Dicko O.B Touré I. Sagara M. Diakité B.Podiougou M S Sissoko K. Kayentao O. Thiero L Sangaré A. Bea
Prof ag. Der FMPOS Directeur
LBMA Chef Unité MEDRU
Chef Unité GIS/RS
Chef Unité Diag.Parat. Chef Unité
MVU/BMP Expert OMS
Chef Unité Anthro/Serefo
Directeur CVD-Mali
Directrice Phar-Priv
Chef Unité PREMA
Chef Unité Epi/Biosta/Data
Chef Unité BioInformatic Sc Doctorant Tulane, USA
Chef Unité Genomiq
PI -essai Vaccin Sotuba
PI -essai Vaccin Bancoumana
Expert Millienium Village
PI - Prema Kambila / Sikasso
Biostatics Der SP FMPOS
Chercheur LBMA
Chercheur MEDRU
ENFANT AFRICAIN EXPOSE IN UTERO AU PLASMODIUM IMPACT SUR SA CROISSANCE ET DEVELOPMENT BIOLOGIQUE ET INTELLECTUEL ?
IMPACT OF MALARIA ON SCHOOL PERFORMANCE IN MALI (Josselin et al. , Soc. Sci. & Med. , 201 0)
Figure 2: Nombre de cas de paludisme et pluviométrie hebdomadaire à Bandiagara.
0
500
1000
1500
2000
2500
3000
3500
4000
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
No
of c
ases
/ m
onth
Month
IPTc-Combined results (Burkina & Mali, PLoS Medecine 2011, BMGF)
Protective Efficacy % (95%CI)
Clinical malaria 75 (72 – 77) <0.001
Severe malaria 81 (46 – 94) 0.002
Hosp ad. for malaria 77 (21 – 94) 0.02
Malaria infection 76 (72 – 80) <0.001
Moderate anaemia 54 (38 – 66) <0.001
% of total annual rainfall in 3 months Yellow-red = IPTc areas Green = borderline Blue = insufficient seasonality
% of total annual EIR in 3 months Yellow-red = SMC areas Green = borderline Blue = insufficient seasonality EIR maps smaller area and is more biologically plausible (no transmission in desert)
Map the areas suitable for SMC
Présentateur
Commentaires de présentation
Two broad areas emerge from these maps. The first is the Sahel region which matches well with the sites identified from the seasonality assessment of epidemiological data. The second area is in Southern Africa stretching from Namibia in the west to Mozambique and Southern Tanzania in the east (see Box 4.3). Some of the areas mapped in southern Africa have relatively low or unstable malaria incidence as shown by Hay et al [10]. The Sahel appears to be the area with the highest malaria burden among the areas mapped as suitable for IPTc; this zone contains some of the areas with the highest malaria burden in all of Africa (see annex 4). In addition, many areas potentially suitable for IPTc in eastern and southern African countries have high levels of SP resistance [11].
Source: Naidoo and Roper, Parasitology. (In press)
SP + AQ suitable
Alternative regimen needed
Distribution of dhps position 540 mutation in Africa
Présentateur
Commentaires de présentation
Map showing the distribution of the dhps position 540 mutation in Africa
Country
Under 5 population in
IPTc zone (millions)
Cases of malaria averted
Deaths averted: Method 1 Deaths Averted:
Method 2
CFR 4.5 / 1000 CFR 10 / 1000
Assuming minimal transmission outside the SMC period Sahel zone 23.4 9,166,355 41,249 91,664 101,541
Rest of Africa 11.9 1,387,164 6,242 13,872 41,953
Total 35.3 10,553,520 47,491 105,535 143,493
Assuming only 60% of annual transmission occurs during the SMC period
Sahel zone 23.4 5,499,813 24,749 54,998 60,924 Rest of Africa 11.9 832,299 3,745 8,323 25,172
Total 35.3 6,332,112 28,495 63,321 86,096
Estimate the potential impact of SMC in Africa
Présentateur
Commentaires de présentation
Our most conservative estimate suggests that 35 million children under five years of age live in areas where IPTc may be appropriate, 23 million in the Sahel or sub-Sahel. There is considerable uncertainty in the burden estimates, but our lowest estimate suggests 21.5 million malaria episodes per year and almost 100,000 deaths from malaria occur in children under 5 years of age in areas suitable for IPTc. Almost 19 million clinical cases and 84,000 deaths occur in children under 5 years of age in the Sahel region alone. Assuming 70% efficacy and 70% coverage, IPTc could approximately halve the malaria burden in areas where it is deployed and avert a considerable number of unnecessary deaths. Based on our lowest estimates of the malaria burden and our best estimate of the likely efficacy and coverage, we calculate that approximately 10 million clinical cases and between 50,000 and 150,000 deaths in children under 5 could be averted by IPTc.
Région de Sikasso : 37 médecins de campagne Région de Koulikoro :
21 médecins de campagne
Région de Kayes : 26 médecins de campagne
Région de Ségou : 24 médecins de campagne
Région de Tombouctou : 2 médecins de campagne
Région de Gao : 1 médecin de campagne
Région de Mopti : 1 médecin de campagne
MRTC – 200 BUSH DOCTORS NETWORK
Ségou
Koutiala
Mopti
Koulikoro
Sikasso
Bamako
Kayes
Tombouctou Gao
IPTp-SP-standard 2 dose reigien VS SP 3 Doses
Semaine de gestation
Conception Naissance 20 30 10
Dose 1 16 Weeks
Dose 36 Weeks
Mouvement
Présentateur
Commentaires de présentation
MAIS CELA NE DOIT PAS AFFECTER LES RECOMMANDATIONS FAITES SUR LE TPI OU LA SP EST ADMINISTREE APRES LA 16 EME SEMAINE QUAND LA FEMME SENT LES MOUVEMENTS FEOTAUX. CECI EST EMMINANMENT IMPORTANT A SAVOIR PAR LES UTILISATEURS DE CE REGIME DE SP.
IPTp-SP TO PROTECT NEW BORN BABY AGAINST MALARIA
July 4, 2013 MA5 Meeti
ng
19
Présentateur
Commentaires de présentation
The RISK of LBW is significantly reduced among HIV negative first or second pregnancies in favour of 3 dose regimen. The Overall risk reduction of LBW is also significant in favour of three dose regimen.
IPTp-SP TO PROTECT PREGNANT WOMEN AGAINST MALARIA
July 4, 2013 MA5 Meeti
ng
20
Présentateur
Commentaires de présentation
There an overall significant risk reduction of placental malaria among HIV negative women under three or monthly dose of IPTp. The risk reduction is significantly well pronounced in primi or secundigravidae.
Formation Renforcement de la Capacité de Recherche
Reseau Translationn
el
WAMI STRATEGIES Spain, BMGF, UoBko, CRESIB, UoGhana
Stratégie de 5 années: De la Lutte à l’Elimination/CDEAO
RENCONTRE MINISTERIELLE DE NOUACKHOTT
1] 6 PAYS SAHELIENS (Gambie, Mali, Mauritanie, Niger, Senegal,
Tchad 2] Partenaires: RBM, OMS, BID,
UNICEF…. 3] Plan stratégique d’Elimination du
paludisme dans le sahel : 3 ans
SANTÉ SUD
A JOURNEY WIHT A HAPPY DOCTOR AND KID IN THE BUSH www.santesud.org
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