clove and Diarrhea

Madagascar is cited as one of the most vulnerable countries to the effects of climate change, with significant impacts to the health of its population. In this study, the vulnerability of Madagascar's health sector to climate change was assessed and appropriate adaptation measures were identified. In order to assess climate risks, vulnerability and identify adaptation options, the Madagascar Ministry of Public Health as well as the National Meteorological and Hydrological Service worked in close collaboration with a team of local experts to conduct a literature review, field surveys, and analyses of current and future climate and health trends. Four climate-sensitive diseases of primary concern are described in the study: acute respiratory infections (ARI), diarrhea, malnutrition, and malaria. Baseline conditions of these four diseases from 2000 to 2014 show acute respiratory infections and diarrheal diseases are increasing in incidence; while incidence of malnutrition and malaria decreased over this period. To assess future impacts in Madagascar, this baseline information was used with climate projections for the two scenarios-RCP 4.5 and RCP 8.5-for the periods 2016⁻2035, 2036⁻2070 and 2071⁻2100. Future climate conditions are shown to exacerbate and increase the incidence of all four climate sensitive diseases. Further analysis of the exposure, sensitivity and adaptive capacity to the climate hazards suggests that the health sector in four regions of Madagascar is particularly vulnerable. The study recommends adaptation measures to improve the monitoring and early warning systems for climate sensitive diseases, as well as to reduce population vulnerability.

Topics: Acclimatization; Adaptation, Physiological; Climate Change; Diarrhea; Environmental Monitoring; Health Status Indicators; Humans; Incidence; Madagascar; Malaria; Malnutrition; Population Surveillance; Public Health Surveillance; Respiratory Tract Infections

Among the families of enteric bacteria are globally important diarrheal agents. Despite their potential for zoonotic and environmental transmission, few studies have examined the epidemiology of these pathogens in rural systems characterized by extensive overlap among humans, domesticated and peridomestic animals. We investigated patterns of infection with Enterotoxigenic Escherichia coli, Shigella spp., Salmonella enterica, Vibrio cholerae, and Yersinia spp. (enterocolitica, and pseudotuberculosis) in Southeastern Madagascar where the potential for the aforementioned interactions is high. In this pilot project we conducted surveys to examine behaviors potentially associated with risk of infection and if infection with specific enterobacteria species was associated with diarrheal disease.. PCR was conducted on DNA from human, livestock, and rodent fecal samples from three villages. Overall, human prevalence was highest (77%), followed by rodents (51%) and livestock (18%). Rodents were ∼2.8 times more likely than livestock to carry one of the bacteria. The incidence of individual species varied between villages, with the observation that, E. coli and Shigella spp. were consistently associated with co-infections. As an aggregate, there was a significant risk of infection linked to a water source in one village. Individually, different pathogens were associated with certain behaviors, including: those who had used medication, experienced diarrhea in the past four weeks, or do not use toilets.. Different bacteria were associated with an elevated risk of infection for various human activities or characteristics. Certain bacteria may also predispose people to co-infections. These data suggest that a high potential for transmission among these groups, either directly or via contaminated water sources. As these bacteria were most prevalent in humans, it is possible that they are maintained in humans and that transmission to other species is infrequent. Further studies are needed to understand bacterial persistence, transmission dynamics, and associated consequences in this and similar systems.

Topics: Animals; Cattle; Diarrhea; DNA, Bacterial; Enterobacteriaceae; Female; Humans; Livestock; Madagascar; Male; Mice; Prevalence; Rats; Risk Factors; Swine

Pharmacokinetic studies have documented the efficacy of intrarectal quinine (IRQ) for treatment of childhood malaria. As a result, this technique has gradually supplanted intramuscular injection of quinine (IMQ), a common source of complications in children. To assess the safety of this technique, outcome was routinely monitored from 1987 to 1997. This report presents immediate tolerance observed in clinical studies involving 915 children as well as two surveys conducted in Niamey, Niger on 2764 children in 1995 and on 714 children in 1997. In the second study tolerance of IRQ (n = 364) and IMQ (n = 350) was compared. Long-term tolerance was evaluated for 11 years in a single location, i.e. Morondava, Madagascar. In 1995 IRQ accounted for 19.6 p. 100 of antimalarial treatments prescribed in Niamey. In 1997, IRQ accounted for 34.5 p. 100 of quinine prescriptions (excluding infusions) written in medical centers and 65.7 p. 100 in the Pediatric Department B of the hospital in Niamey. Overall tolerance was good, thus confirming previous clinical studies. No major and/or irreversible complication was observed. Early rejection (12.9 p. 100), intestinal transit problems (4.3 p. 100), and watery stools (12.9 p. 100) were the most common problems. In contrast, IMQ led to residual pain (3.1 p. 100), local inflammation (3.1 p. 100), abscess (0.6 p. 100), and lower extremity disability (0.3 p. 100). The precautions for use, e.g. proper dilution, and staff training requirements are reviewed in the discussion.

Topics: Administration, Rectal; Antimalarials; Child; Child, Preschool; Diarrhea; Drug Monitoring; Humans; Infant; Injections, Intramuscular; Madagascar; Niger; Quinine; Solutions; Time Factors; Treatment Outcome

To examine mortality risk factors during rehydration among 6-35 month malnourished children with diarrhoea.. Data collected prospectively during a clinical trial comparing two oral rehydration solutions (ORS).. Paediatric ward.. Study children had either a weight-for-age Z-score below -2 or a weight-for-height below 70% of NCHS median. All had diarrhoea for < 5 days. 150 were enrolled and two were excluded for intercurrent infection.. Children were randomly allocated to receiving 100 ml/kg of standard or rice-based ORS during the 6h following admission. Then they received 420 kJ/kg/day of high energy milk, progressively increased to 840 kJ/kg/day.. Mortality rate was 16% and with no difference by ORS group. In univariate analysis, the risk of dying (mean odds ratio; 95% confidence interval) was significantly higher among girls (3.5; 1.4-8.9), in non-breast-fed children (3.7; 1.4-9.6) and in children with a low weight-for-height (5.1; 1.9-14.1). Low weight, moderate or severe dehydration, low plasma specific gravity or total plasma protein and longer duration of diarrhoea before inclusion also were significant risk factors. In multivariate logistic analysis, only absence of breast-feeding was associated with a higher risk of dying among girls with a low weight-for-height. Among them, eight out of nine died, compared to 15 out of 139 for other children.. Breast-feedings protected severely malnourished girls against death from diarrhoea even when dehydration was corrected. Mechanisms underlying this selective effect are poorly understood.

Topics: Breast Feeding; Cause of Death; Child Nutrition Disorders; Child, Preschool; Dehydration; Diarrhea; Female; Fluid Therapy; Hospitalization; Humans; Infant; Infant Nutrition Disorders; Madagascar; Male; Multivariate Analysis; Odds Ratio; Prospective Studies; Risk Factors; Sex Factors; Time Factors

The genus Callistemon (syn. Melaleuca) of the myrtle family (Myrtaceae) has been documented as an integral part in the ethnobotanical system of the indigenous people of Australian mainland and many of its islands. Several Callistemons including the species subulatus were used by aboriginal Australians for making rafts, roofs for shelters, bandages, and food recipes, in addition to the management of wounds, infections, pain, cough, bronchitis, and gastrointestinal tract (GIT) disorders.. The current study is designed to document the therapeutic effect of the aqueous methanolic extract (AME) of C. sabulatus Chell (syn. M. sabulata) leaves in the management of diarrhea and pain. Also, its influence on additional pharmacological modalities that are related to oxidative stress just as skin aging. Ultimately, the polyphenolic profile of the extract is disclosed and correlated to the aforementioned bioactivities.. The extract was fractionated using various chromatography techniques and the structures of the isolated compounds were determined based on their chemical and spectral data. The antioxidant activity was assessed using multiple models, including 2,2-diphenyl-picrylhydrazyl (DPPH), oxygen radical absorbance capacity (ORAC) and β-carotene bleaching assays. The anti-skin aging effect was evaluated using different relevant enzymatic assays. The antinociceptive activity was investigated using acetic acid-induced writhing, hot plate test, and formalin-induced paw licking in mice models. The antidiarrheal activity was gauge using the castor oil induced diarrhea, enter pooling and gastrointestinal motility in vivo models.. Diverse polyphenols, including quercetin-3-O-β-D-glucuronopyranoside (1), kaempferol-3-O-β-D-glucuronopyranoside (2), strictinin (3), quercetin-3-O-(2``-O-galloyl)-β-D-glucuronopyranoside (4), afzelin (5), di-galloyl glucose (6), mono-galloyl glucose (7), acacetin (8), apigenin-6,7-dimethyl ether (9), kaempferol trimethyl ether (10), dimethoxy chrysin (11), quercetin (12), kaempferol (13), methyl gallate (14), and gallic acid (15) were identified. The extract exhibited as significant antioxidant activity even better than that of Trolox or BHT. Moreover, it exerts elastase, tyrosinase, and collagenase inhibition activities, in addition to the significant peripheral and central analgesic activity in a dose-dependent manner (P < 0.0001). In castor oil induced diarrhea model, AME significantly prolonged the diarrhea onset, decreased the frequency of defecation, and weight of feces. Likewise, it exhibited a significant reduction in the gastrointestinal motility in charcoal meal model (P < 0.0001) and a considerable inhibitory effect on gastrointestinal transit and peristaltic index with all investigated doses (P < 0.0001).. Ethnobotanicals are versatile resources for the management of various ailments by indigenous people and the experimental research is utmost to validate and uncover their pharmacological relevance. C. sabulatus leaves have strong antioxidant, analgesic, anti-skin aging, and antidiarrheal activities which are validated for the first time by various in vitro and in vivo models. The metabolic profile of the unprecedented AME of C. sabulatus leaves compromises a wide array of bioactive polyphenolic metabolites including, flavonoids, tannins, and phenolic acids that are correlated to the observed bioactivities. Altogether, ethnobotanicals with high and diverse contents of polyphenols are potential candidates for the management of various human aliments including neuropathies, GIT disorders, and skin aging conditions.

Topics: Analgesics; Animals; Antidiarrheals; Antioxidants; Diarrhea; Disease Models, Animal; Egypt; Female; Humans; Male; Mice; Myrtaceae; Oxidative Stress; Pain; Plant Extracts; Plant Leaves; Polyphenols; Rats; Rats, Sprague-Dawley

Environmental Enteric Dysfunction (EED) refers to an incompletely defined syndrome of inflammation, reduced absorptive capacity, and reduced barrier function in the small intestine. It is widespread among children and adults in low- and middle-income countries and is also associated with poor sanitation and certain gut infections possibly resulting in an abnormal gut microbiota, small intestinal bacterial overgrowth (SIBO) and stunting. We investigated bacterial pathogen exposure in stunted and non-stunted children in Antananarivo, Madagascar by collecting fecal samples from 464 children (96 severely stunted, 104 moderately stunted and 264 non-stunted) and the prevalence of SIBO in 109 duodenal aspirates from stunted children (61 from severely stunted and 48 from moderately stunted children). SIBO assessed by both aerobic and anaerobic plating techniques was very high: 85.3% when selecting a threshold of ≥105 CFU/ml of bacteria in the upper intestinal aspirates. Moreover, 58.7% of the children showed more than 106 bacteria/ml in these aspirates. The most prevalent cultivated genera recovered were Streptococcus, Neisseria, Staphylococcus, Rothia, Haemophilus, Pantoea and Branhamella. Feces screening by qPCR showed a high prevalence of bacterial enteropathogens, especially those categorized as being enteroinvasive or causing mucosal disruption, such as Shigella spp., enterotoxigenic Escherichia coli, enteropathogenic E. coli and enteroaggregative E. coli. These pathogens were detected at a similar rate in stunted children and controls, all showing no sign of severe diarrhea the day of inclusion but both living in a highly contaminated environment (slum-dwelling). Interestingly Shigella spp. was the most prevalent enteropathogen found in this study (83.3%) without overrepresentation in stunted children.

Topics: Adult; Bacteria; Bacterial Infections; Child; Diarrhea; Escherichia coli; Feces; Humans; Intestine, Small; Madagascar; Prevalence; Shigella

Precision health mapping is a technique that uses spatial relationships between socio-ecological variables and disease to map the spatial distribution of disease, particularly for diseases with strong environmental signatures, such as diarrhoeal disease (DD). While some studies use GPS-tagged location data, other precision health mapping efforts rely heavily on data collected at coarse-spatial scales and may not produce operationally relevant predictions at fine enough spatio-temporal scales to inform local health programmes. We use two fine-scale health datasets collected in a rural district of Madagascar to identify socio-ecological covariates associated with childhood DD. We constructed generalized linear mixed models including socio-demographic, climatic and landcover variables and estimated variable importance via multi-model inference. We find that socio-demographic variables, and not environmental variables, are strong predictors of the spatial distribution of disease risk at both individual and commune-level (cluster of villages) spatial scales. Climatic variables predicted strong seasonality in DD, with the highest incidence in colder, drier months, but did not explain spatial patterns. Interestingly, the occurrence of a national holiday was highly predictive of increased DD incidence, highlighting the need for including cultural factors in modelling efforts. Our findings suggest that precision health mapping efforts that do not include socio-demographic covariates may have reduced explanatory power at the local scale. More research is needed to better define the set of conditions under which the application of precision health mapping can be operationally useful to local public health professionals.

Topics: Child; Diarrhea; Humans; Incidence; Linear Models; Madagascar; Risk Factors

Following a recommendation by the World Health Organization, Madagascar introduced rotavirus vaccine in 2014. Though national rotavirus vaccine coverage has remained <80%, rotavirus hospitalizations declined by 78%. Gavi, the Vaccine Alliance, has provided financial support for rotavirus vaccine, however the Malagasy government has increasing responsibility for the financial cost.. In this evaluation, we describe the direct medical, direct non-medical, and indirect cost of illness due to diarrhea among children <5 years old at a public pediatric referral hospital. A 3-part structured questionnaire was administered during and following the hospitalization and the child's hospital record was reviewed.. In total, 96 children were included in this analysis. The median total cost of the illness was $156.00 (IQR: 104.00, 210.86) and the median direct medical cost was $107.22. Service delivery costs represented a median of 44% of the inpatient costs; medications and diagnostic tests represented a median of 28% and 20% of the total costs of the hospitalization, respectively. The median percentage of the total illness costs paid by the household was 67%. Among households with income of <$61/month, the median costs of the illness paid by the household were $78.55, representing a median of 168% of the household's monthly expenses. Among households earning >$303/month, the median costs paid by the household were $147.30, representing a median of 53% of the household's monthly expenses. Among all household income levels, caregivers commonly paid these bills from savings, borrowed money, and donations.. Our findings will be useful in assessing the cost-effectiveness of rotavirus vaccine by decisionmakers. These results may also help hospital administrators and healthcare providers better understand the financial constraints of families.

Topics: Child; Child, Preschool; Cost of Illness; Diarrhea; Hospitalization; Humans; Infant; Madagascar; Rotavirus; Rotavirus Infections; Rotavirus Vaccines

Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Child, Preschool; Cohort Studies; Diarrhea; Female; Health Surveys; Humans; Hypertension; Infant; Infant, Newborn; Madagascar; Male; Malnutrition; Middle Aged; Rural Population; Sex Distribution; Urban Population; Young Adult

Rotavirus vaccine was introduced into the Extended Program on Immunization in Madagascar in May 2014. We analyzed trends in prevalence of all cause diarrhea and rotavirus hospitalization in children <5years of age before and after vaccine introduction and assessed trend of circulating rotavirus genotypes at Centre Hospitalier Universitaire Mère Enfant Tsaralalàna (CHU MET).. From January 2010 to December 2016, we reviewed the admission logbook to observe the rate of hospitalization caused by gastroenteritis among 19619 children <5years of age admitted at the hospital. In June 2013-December 2016, active rotavirus surveillance was also conducted at CHUMET with support from WHO. Rotavirus antigen was detected by EIA from stool specimen of children who are eligible for rotavirus gastroenteritis surveillance at sentinel site laboratory and rotavirus positive specimens were further genotyped at Regional Reference Laboratory by RT-PCR.. Diarrhea hospitalizations decreased after rotavirus vaccine introduction. The median proportion of annual hospitalizations due to diarrhea was 26% (range: 31-22%) before vaccine introduction; the proportion was 25% the year of vaccine introduction, 17% in 2015 and 16% in 2016. Rotavirus positivity paralleled patterns observed in diarrhea. Before vaccine introduction, 56% of stool specimens tested positive for rotavirus; the percent positive was 13% in 2015, 12% in 2016. Diverse genotypes were detected in the pre-vaccine period; the most common were G3P[8] (n=53; 66%), G2P[4] (n=12; 15%), and G1P[8] (n=11; 14%). 6 distinct genotypes were found in 2015; the most common genotype was G2P[4] (n=10; 67%), the remaining, 5, G12[P8], G3[P8], G1G3[P4], G3G12[P4][P8] and G1G3[NT] had one positive specimen each.. Following rotavirus vaccine introduction all-cause diarrhea and rotavirus-specific hospitalizations declined dramatically. The most common genotypes detected in the pre-vaccine period were G3P[8] and G2P[4] in 2015, the post vaccine period.

Topics: Antigens, Viral; Child, Preschool; Diarrhea; Feces; Gastroenteritis; Genotype; Hospital Records; Hospitalization; Humans; Immunization Programs; Infant; Madagascar; Prevalence; Rotavirus; Rotavirus Infections; Rotavirus Vaccines; Sentinel Surveillance; Vaccination; Vaccines, Attenuated

A model health district was initiated through a program of health system strengthening (HSS) in Ifanadiana District of southeastern Madagascar in 2014. We report population health indicators prior to initiation of the program.. A representative household survey based on the Demographic Health Survey was conducted using a two-stage cluster sampling design in two strata - the initial program catchment area and the future catchment area. Chi-squared and t-tests were used to compare data by stratum, using appropriate sampling weights. Madagascar data for comparison were taken from a 2013 national study.. 1522 households were surveyed, representing 8310 individuals including 1635 women ages 15-49, 1685 men ages 15-59 and 1251 children under age 5. Maternal mortality rates in the district are 1044/100,000. 81% of women's last childbirth deliveries were in the home; only 20% of deliveries were attended by a doctor or nurse/midwife (not different by stratum). 9.3% of women had their first birth by age 15, and 29.5% by age 18. Under-5 mortality rate is high: 145/1000 live births vs. 62/1000 nationally. 34.6% of children received all recommended vaccines by age 12 months (compared to 51.5% in Madagascar overall). In the 2 weeks prior to interview, approximately 28% of children under age 5 had acute respiratory infections of whom 34.7% were taken for care, and 14% of children had diarrhea of whom 56.6% were taken for care. Under-5 mortality, illness, care-seeking and vaccination rates were not significantly different between strata.. Indicators of population health and health care-seeking reveal low use of the formal health system, which could benefit from HSS. Data from this survey and from a longitudinal follow-up study will be used to target needed interventions, to assess change in the district and the impact of HSS on individual households and the population of the district.

Topics: Adolescent; Adult; Child; Child Mortality; Child, Preschool; Diarrhea; Female; Follow-Up Studies; Health Status; Health Surveys; Humans; Infant; Infant, Newborn; Madagascar; Male; Maternal Mortality; Middle Aged; Patient Acceptance of Health Care; Population Health; Respiratory Tract Infections; Vaccination Coverage; Young Adult

Essential oil from Eugenia dysenterica leaves was able to inhibit both the diarrhoea and enteropooling induced by castor oil; however, the distance travelled by charcoal meal in the intestine was not change. These data suggest that the antidiarrhoeic effect of the essential oil from E. dysenterica leaves is related to its ability to inhibit intestinal secretion and/or to increase intestinal absorption.

Topics: Animals; Castor Oil; Diarrhea; Eugenia; Gastrointestinal Motility; Intestines; Male; Mice; Oils, Volatile; Plant Extracts; Plant Leaves; Plant Oils

Diarrheal disease remains a leading cause of death in children in low-income countries. We investigated the etiology, risk factors and effects on nutritional status of severe diarrhea in children from two districts in Madagascar.. We performed a matched case-control study in 2011 to 2014, on children under the age of five years from Moramanga and Antananarivo. The cases were children hospitalized for severe diarrhea and the controls were children without diarrhea selected at random from the community. Stool samples were collected from both groups. Anthropometric measurements were made during follow-up visits about one and two months after enrolment.. We enrolled 199 cases and 199 controls. Rotavirus infection was the most frequently detected cause of diarrhea. It was strongly associated with severe diarrhea (OR: 58.3; 95% CI: 7.7-439.9), accounting for 42.4% (95% CI: 37.6-43.1) of severe diarrhea cases. At the household level, possession of cattle (OR = 0.3; 95% CI: 0.1-0.6) and living in a house with electricity (OR = 0.4; 95% CI: 0.2-0.8) were protective factors. The presence of garbage around the house was a risk factor for severe diarrhea (OR = 3.2; 95% CI: 1.9-5.4). We found no significant association between severe diarrhea and the nutritional status of the children at follow-up visits, but evident wasting at enrolment was associated with a higher risk of severe diarrhea (OR = 9; 95% CI: 4.5-17.9).. Severe childhood diarrhea is mostly caused by rotavirus infection. An anti-rotavirus vaccine has already been introduced in Madagascar and should be promoted more widely. However, post-licensing surveillance is required. Interventions to improve the nutritional status of children, preventive measures focused on household and personal hygiene and nutritional rehabilitation during severe diarrheal disease should be reinforced.

Topics: Animals; Campylobacter; Campylobacter Infections; Case-Control Studies; Cattle; Child, Preschool; Diarrhea; Dysentery, Bacillary; Enteropathogenic Escherichia coli; Escherichia coli Infections; Female; Garbage; Humans; Infant; Madagascar; Male; Nutritional Status; Risk Factors; Rotavirus; Rotavirus Infections; Shigella

As human population density continues to increase exponentially, speeding the reduction and fragmentation of primate habitat, greater human-primate contact is inevitable, making higher rates of pathogen transmission likely. Anthropogenic effects are particularly evident in Madagascar, where a diversity of endemic lemur species are threatened by rapid habitat loss. Despite these risks, knowledge of how anthropogenic activities affect lemur exposure to pathogens is limited. To improve our understanding of this interplay, we non-invasively examined six species of wild lemurs in Ranomafana National Park for enteric bacterial pathogens commonly associated with diarrheal disease in human populations in Madagascar. Patterns of infection with Enterotoxigenic Escherichia coli, Shigella spp., Salmonella enterica, Vibrio cholerae, and Yersinia spp. (enterocolitica and pseudotuberculosis) were compared between lemurs inhabiting intact forest and lemurs inhabiting degraded habitat with frequent exposure to tourism and other human activity. Fecal samples acquired from humans, livestock, and rodents living near the degraded habitat were also screened for these bacteria. Remarkably, only lemurs living in disturbed areas of the park tested positive for these pathogens. Moreover, all of these pathogens were present in the human, livestock, and/or rodent populations. These data suggest that lemurs residing in forests altered or frequented by people, livestock, or peridomestic rodents, are at risk for infection by these diarrhea-causing enterobacteria and other similarly transmitted pathogens.

Topics: Animals; Diarrhea; Ecosystem; Enterobacteriaceae; Escherichia coli; Feces; Forests; Human Activities; Humans; Lemur; Livestock; Madagascar; Rodentia; Shigella; Vibrio cholerae; Yersinia

Traditional medicine remains the only health care available in many rural areas in Madagascar like the rural community of Ambalabe, located in a very remote area in the eastern part of the country. With limited access to modern medicine, the local population uses medicinal plants to treat most diseases. In this study, we aimed to inventory medicinal plants used by local people and how those relate to the treatment of the most frequent diseases encountered in Ambalabe.. We interviewed participants in order to identify the most frequent diseases in the region and the medicinal plants used to treat them. The local physician was asked about the most frequent diseases, and ethnobotanical surveys to record medicinal plants and their uses, using semi-structured interviews and free listing, were conducted among 193 informants in local villages, of which 54 % were men and 46 % were women, ageing from 16 to 86 years. The local names, the uses of each plant species and the way they are prepared and administered were recorded and accompanied by herbarium specimens for identification. We also interviewed four traditional healers to elicit more details on the preparation and the use of plants.. Our research allowed us to identify six most frequent diseases, namely diarrhea, malaria, stomach-ache, cough, bilharzia and dysentery. Among 209 plant species identified as having medicinal use, 83 species belonging to 49 families and 77 genera were used to treat these diseases. Our analyses highlighted the 11 commonly used species for their treatment, and also 16 species with a high fidelity level (FL ≥ 75 %) for each ailment. Diarrhea is one of the diseases with high number of species recorded.. This study highlighted the closed relationship between people in Ambalabe and plant species, especially when faced with frequent diseases. However, most of the species used were collected in the surroundings of the villages. Few species were from Vohibe forest in which a management system on the use of plant species was already established. Therefore, a sustainable use management should be considered for wild species from which medicinal plants are highly abundant.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Diarrhea; Ethnobotany; Female; Humans; Madagascar; Male; Medicine, Traditional; Middle Aged; Phytotherapy; Plants, Medicinal; Rural Population; Young Adult

Diarrheal diseases are a major public health problem in developing countries, and are one of the main causes of hospital admissions in Madagascar. The Pasteur Institute of Madagascar undertook a study to determine the prevalence and the pathogenicity of bacterial, viral and protozoal enteropathogens in diarrheal and non-diarrheal stools of children aged less than 5 years in Madagascar. We present here the results of the analysis of antimicrobial susceptibility of the bacteria isolated during this study.. The study was conducted in the community setting in 14 districts of Madagascar from October 2008 to May 2009. Conventional methods and PCR were used to identify the bacteria; antimicrobial susceptibility was determined using an agar diffusion method for enterobacteriaceae and MICs were measured by an agar dilution method for Campylobacter sp. In addition to the strains isolated during this study, Salmonella sp and Shigella sp isolated at the Pasteur Institute of Madagascar from 2005 to 2009 were included in the analysis to increase the power of the study.. Twenty-nine strains of Salmonella sp, 35 strains of Shigella sp, 195 strains of diarrheagenic E. coli, 203 strains of C. jejuni and 71 strains of C. coli isolated in the community setting were tested for antibiotic resistance. Fifty-five strains of Salmonella sp and 129 strains of Shigella sp isolated from patients referred to the Pasteur Institute of Madagascar were also included in the study. Many E. coli and Shigella isolates (around 80%) but fewer Salmonella isolates were resistant to ampicillin and trimethoprim/sulfamethoxazole. A small proportion of strains of each species were resistant to ciprofloxacin and only 3% of E. coli strains presented a resistance to third generation cephalosporins due to the production of extended-spectrum beta-lactamases. The resistance of Campylobacter sp to ampicillin was the most prevalent, whereas less than 5% of isolates were resistant to each of the other antibiotics.. The highest prevalence of antimicrobial resistance was to ampicillin and trimethoprim/sulfamethoxazole. Antibiotic treatment is not recommended for children with diarrhea in Madagascar and the emphasis should be placed on oral rehydration.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Child; Child, Preschool; Developing Countries; Diarrhea; Drug Resistance, Bacterial; Enterobacteriaceae; Escherichia coli; Feces; Female; Geography; Humans; Infant; Madagascar; Microbial Sensitivity Tests; Middle Aged; Polymerase Chain Reaction; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Campylobacter infection is the most common cause of bacterial gastroenteritis in developing countries, including Madagascar. Reports of pathogenicity have not been consistent and repeated exposures over time seem to lead to the development of protective immunity in developing areas. We conducted this study to support evidence for these hypotheses by exploring the association between infection and age, the reoccurrence of infection and the pathogenicity of Campylobacter.. We carried out a community-based longitudinal study of children under the age of 24 months in two rural villages in Moramanga, Madagascar. Children were visited twice a week and a stool specimen was collected in cases of diarrhoea. Stools specimens were collected bimonthly from all children enrolled, regardless of symptoms. Children were followed-up until the age of 36 months.. Between January 2010 and May 31st 2012, 508 children were included in the cohort. We detected 319 episodes of Campylobacter infection in total, and 43.3% (n = 220) of the children had at least one episode of intestinal Campylobacter infection. The rate of Campylobacter isolation from stool specimens was 9.3%. The annual incidence rate for symptomatic Campylobacter infection was 0.05 episodes/child. The probability of Campylobacter infection was highest between the ages of six and 23 months. Taking children under six months of age as the reference group, the age-specific odds ratio for the association was 5.0 (95% CI: 2.9-8.6) for children aged six to 11 months, 5.7 (95% CI: 3.3-10.0) for children aged 12 to 17 months and 3.3 (95% CI: 1.8-5.8) for children aged 18 to 23 months. A second episode of infection occurred 63 days after the first episode in children with primary infections, and after 137 days in children with multiple infections (p < 0.01). First episodes of Campylobacter infection were associated with diarrhoea (odds ratio = 16.1; 95% CI: 1.8-140.8).. Our findings suggest that protective immunity to Campylobacter may be acquired over time, following repeated exposures. However, Campylobacter infection prevention measures should be reinforced in the first year of life, as this age seems to be associated with the highest risk of diarrhoea during Campylobacter infection.

Topics: Campylobacter; Campylobacter Infections; Child; Child Welfare; Child, Preschool; Cohort Studies; Developing Countries; Diarrhea; Female; Humans; Infant; Longitudinal Studies; Madagascar; Male; Odds Ratio; Rural Population

In the context of the possible introduction of a preventive vaccine against rotaviruses in Madagascar, the G and P genotypes distribution of the rotaviruses circulating in the children in Madagascar was studied, and the presence of emerging genotypes and unusual strains were assessed. From February 2008 to May 2009, 1,679 stools specimens were collected from children ≤5 years old with diarrhea. ELISA was used for antigen detection, and molecular amplification of VP7 and VP4 gene fragments was used for genotyping. Rotavirus antigen was detected in 104 samples (6.2%). Partial sequences of VP7 and VP4 genes were obtained from 81 and 80 antigen-positive stools, respectively. The most frequent G and P types combinations detected were G9P[8] (n = 51; 64.6%), followed by G1P[8] (n = 15; 18.9%), and G1P[6] (n = 8; 10.1%). A few unusual G-P combinations, such as G4P[6] (n = 3; 3.8%), G9P[6] (n = 1; 1.3%), and G3P[9] reassortant feline human virus (n = 1; 1.3%) were identified. Both VP4 and VP7 sequences in one of the three G4P[6] isolates were closely related to those in porcine strains, and one was a reassortant human porcine virus. These findings give an overview of the strains circulating in Madagascar and should help public health authorities to define a vaccine strategy.

Topics: Antigens, Viral; Capsid Proteins; Child, Preschool; Cluster Analysis; Diarrhea; Feces; Female; Genetic Variation; Genotype; Humans; Infant; Infant, Newborn; Madagascar; Male; Molecular Epidemiology; Molecular Sequence Data; Phylogeny; Prevalence; Rotavirus; Rotavirus Infections; Sequence Analysis, DNA

Acute diarrhea is a major cause of childhood morbidity and mortality worldwide. Its microbiological causes and clinico-epidemiological aspects were examined during the rainy seasons from 2008 to 2009 in 14 districts in Madagascar.. Stool specimens of 2196 children with acute diarrhea and 496 healthy children were collected in a community setting. Intestinal parasites were diagnosed by microscopy and bacteria by culturing methods. Rota-, astro and adenoviruses were identified using commercially available ELISA kits and rotaviruses were confirmed using reverse transcriptase polymerase chain reaction (RT-PCR).. Intestinal microorganisms were isolated from 54.6% of diarrheal patients and 45.9% of healthy subjects (p = <0.01). The most common pathogens in diarrheic patients were intestinal parasites (36.5%). Campylobacter spp. and Rotavirus were detected in 9.7% and 6.7% of diarrheic patients. The detection rates of Entamoeba histolytica, Trichomonas intestinalis and Giardia lamblia were much greater in diarrheal patients than in non diarrheal subjects (odds ratios of 5.1, 3.2, 1.7 respectively). The abundance of other enteropathogens among the non diarrheal group may indicate prolonged excretion or limited pathogenicity.. In developing countries, where the lack of laboratory capacities is great, cross sectional studies of enteropathogens and their spatial distribution, including diarrheal and non diarrheal subjects, are interesting tools in order to advise regional policies on treatment and diarrheic patient management.

Topics: Case-Control Studies; Child, Preschool; Cross-Sectional Studies; Diarrhea; Enzyme-Linked Immunosorbent Assay; Female; Geography; Humans; Infant; Infant, Newborn; Madagascar; Male; Reverse Transcriptase Polymerase Chain Reaction

Plinia cauliflora (Mart.) Kausel, widespread in South America, has edible fruits, and its bark is commonly used against diarrhea and other disorders, on account of its astringency. Because diarrhea is still one of the most important causes of illness and death among children in developing countries, where the population turns to traditional medicine for its treatment, the present study determined the composition of fruit and leaf extracts of P. cauliflora, analyzed the activity against diarrhea by antimicrobial and gastrointestinal motility, and evaluated the cytotoxicity of the extracts. Chemical composition was determined by high-performance liquid chromatograpy-ultraviolet/photodiode array detection. Antimicrobial activity was analyzed by agar diffusion and the microdilution method against etiological agents of diarrhea. The effect on gastrointestinal motility was analyzed using an experimental model in mice. Cytotoxicity was evaluated in vitro with the fibroblast cell line SIRC CCL 60, and leaf extract showed a 50% inhibitory concentration of 0.48 μg/mL. Gallic acid, ellagic acid, and flavonoid derivatives were detected in the extracts. It was observed that fruit and leaf extracts showed some activity against Enterococcus faecalis, Escherichia coli, Salmonella sp., and Shigella sp. However, neither extract had any effect on gastrointestinal motility.

Topics: Animals; Anti-Infective Agents; Antidiarrheals; Cell Line; Diarrhea; Ellagic Acid; Enterococcus faecalis; Escherichia coli; Female; Flavonoids; Fruit; Gallic Acid; Gastrointestinal Motility; Mice; Microbial Sensitivity Tests; Myrtaceae; Plant Extracts; Plant Leaves; Salmonella; Shigella sonnei; South America

The parents 'educational conditions are one of the factors of health inequalities among children. During May 2009, the parents' instruction level of children admitted at the triage unit of a Pediatric Service in Antananarivo, Madagascar was evaluated and related to the severity of their children' health status and to the mode of reference. All the surviving children (from 2 months to 15 years old) were included in this study. Patients were classified by the IMCI guideline and we analyzed the educational level of their mothers. Each patient was classified as severe illness or without severe illness, according to IMCI algorithm. The quality of referring physician was recorded: public physicians, liberal physicians, nurses, or without referral. Among 296 children, 9 (3%) died before admission, 217 (75.6%) were included. Among them, 123 (56.7%) had a severe illness and 38,2% general signs of danger. The severity (92.3 versus 54.4%; P = 0.003), the number of severe dehydration (15.4 versus 3.9%; P = 0,027) and malnutrition (15.4 versus 4.4%; P = 0.039) were related with a poor parents educational level. The referral agents were mostly liberal physicians (56.7%), public physicians (26.7%) or nurses (1.8%). Mothers with higher educational level preferred to attend liberal physicians (58 versus 41.9%; P = 0.1). The reference delay was shorter if there was a severe illness (6.41 versus 19.6 days; P < 0.000) or no medical referral (51.1 versus 24.4%; P > 0.000). Despite the fact that access to hospital care was respectful of a two-step process (85.3%), the number of patients with severe illness was high among families with low educational level. Theses results suggest to educate in priority the mother with low education, in order to recognize the general signs of danger and facilitate early first health care.

Topics: Adolescent; Algorithms; Anemia; Child; Child, Preschool; Dehydration; Diagnosis-Related Groups; Diarrhea; Educational Status; Emergencies; Emergency Service, Hospital; Female; Fever; Hospitals, Urban; Humans; Infant; Madagascar; Male; Malnutrition; Mothers; Pneumonia; Prospective Studies; Referral and Consultation; Severity of Illness Index; Socioeconomic Factors

The aim of the study was to determine in vitro activity of the bark of Ozoroa sphaerocarpa R. Fern & A. Fern (Anacardiaceae), Breonadia salicina (Vahl) Hepper & J.I.R. Wood (Rubiaceae) and Syzygium cordatum Hochst ex C Krauss (Myrtaceae) against a diarrhoea-causing pathogen, Escherichia coli; as well as the pharmacological interactions present in their combination.. In consultation with traditional healers, the plants were collected from the wild, dried and extracted with dichloromethane:methanol (1:1). Thereafter, antimicrobial activity of the individual plants and their different combinations was tested using a common diarrhoea pathogen, Escherichia coli by employing the minimum inhibitory concentration assay.. Ozoroa sphaerocarpa was the most potent inhibitor of antimicrobial growth (MIC value of 1.2 mg/ml), followed by Syzygium cordatum (MIC value of 1.44 mgl/ml) and lastly Breonadia salicina (MIC value of 10.89 mg/ml). The combination between Syzygium cordatum and Ozoroa sphaerocarpa gave the strongest synergistic interaction (MIC value of 0.33 mg/ml); whilst that between Syzygium cordatum and Breonadia salicina was mildly synergistic (MIC value of 1.00 mg/ml). The triple combination (1:1:1) was also very effective in inhibiting microbial growth (MIC value of 0.44 mg/ml). The combined effect of these plants on toxicity was predominantly synergistic except for the combination of Ozoroa sphaerocarpa and Syzygium cordatum which was predominantly antagonistic (ΣFIC value of 1.48 ± 0.25). The triple combination had a favourable toxicity profile with an IC(50) value of 155.76 ± 11.86 μg/ml.. This study supports the rationale by traditional healers to use the bark of Syzygium cordatum, Breonadia salicina and Ozoroa sphaerocarpa in combination for the treatment of diarrhoea.

Topics: Anacardiaceae; Anti-Infective Agents; Antidiarrheals; Diarrhea; Drug Synergism; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Eswatini; Inhibitory Concentration 50; Medicine, Traditional; Microbial Sensitivity Tests; Myrtaceae; Phytotherapy; Plant Bark; Plant Extracts; Rubiaceae

A 13-month study of children presenting with acute diarrhoeal disease at hospitals and rehydration clinics in Antananarivo, Madagascar, was undertaken between May 2004 and May 2005. Cryptosporidiosis accounted for diarrhoea in 12 (5.6%) of the 215 children investigated. Cases of cryptosporidiosis were detected only in the rainy season, and the median age of cases was 13.5 months (range=1 day-27 months). As 11 of the cases of cryptosporidiosis were caused by Cryptosporidium hominis and only one by C. parvum, most of the cases were probably the result of anthroponotic transmission. GP60/45/15 gene polymorphisms indicated that the causative pathogens were of subtypes Ia, Id, Ie and IIc.

Topics: Animals; Child, Preschool; Cryptosporidiosis; Cryptosporidium; Diarrhea; Feces; Female; Genotype; Humans; Infant; Infant, Newborn; Madagascar; Male; Seasons

Rural populations disproportionately lack access to improved water supplies. We evaluated a novel scheme that employed community-based sales agents to disseminate the Safe Water System (SWS)--a household-level water chlorination and safe storage intervention--in rural Madagascar. Respondents from 242 households in 4 villages were interviewed; all used surface water for drinking water. Respondents from 239 households (99%) had heard of Sûr'Eau, the SWS disinfectant; 226 (95%) reported having ever used Sûr'Eau, and 166 (73%) reported current use. Current Sûr'Eau use was confirmed in 54% of households. Community sales agents effectively motivated their neighbors to adopt a new health behavior that prevents diarrhea. Future work should focus on strategies for sustaining SWS use, factors that motivate community-based sales agents to promote SWS, and the feasibility of scaling up this approach.

Topics: Chlorine Compounds; Diarrhea; Disinfectants; Entrepreneurship; Health Behavior; Health Knowledge, Attitudes, Practice; Household Products; Humans; Interviews as Topic; Madagascar; Marketing; Rural Health; Safety; Social Marketing; Water Purification

In the developing world, more than 1 billion people lack access to safe water. To address this problem, the US Centers for Disease Control and Prevention developed the Safe Water System (SWS), a household-based intervention with three elements: water disinfection, safe storage and behaviour change techniques, and tested these in three countries. In Zambia, social marketing (SM) was used to implement the SWS, and 100 randomly selected households also received motivational interviewing (MI). In Madagascar, the SWS was implemented using SM and community mobilisation (CM). In rural Western Kenya, the SWS was also implemented with SM and CM. In Zambia, 3 months after the SM project launch, 14% of households in the SM-only group had adopted the disinfectant compared with 78% of households in the SM plus MI group. Through SM, over 1 million bottles of disinfectant were sold in 3 years in Zambia. In Antananarivo, Madagascar, 6 months after launch of the water disinfectant, 8% of households in an early stage of the CM process were using the disinfectant compared with 20% in households at a late stage of the CM process. In 1 year, over 500,000 bottles of disinfectant were sold in Madagascar. In Kenya, adoption of the water disinfectant exceeded 60% in intervention households and diarrhoea rates decreased by 58% in children < 5 years. Social marketing permits widespread dissemination of interventions, but may have limited penetration into economically disadvantaged communities. Additional, targeted interventions, such as MI and CM, can increase product adoption. A combination of behaviour change interventions can increase project impact.

Topics: Communicable Disease Control; Community-Institutional Relations; Developing Countries; Diarrhea; Disinfection; Health Behavior; Humans; Hygiene; Kenya; Madagascar; Motivation; Social Conditions; Social Marketing; Water Supply; Zambia

A study on human intestinal parasites was carried out from November 1996 until January 1997, in Mahajanga's hospital, on the western coast of Madagascar. We collected the faeces from 401 patients and the sera from 112 of them. Faecal examination using direct examination and MIF method revealed that 67.6% of the stools contained at least one parasite. The frequency of the protozoa was high (47.7%). The prevalence of the nematodosis reached 23.4%. Hymenolepis nana, Taenia saginata or solium and Schistosoma mansoni were less frequent (respectively 2.5%, 0.75% and 3.7%). More than 50% of the sera contained antibodies anti-Ascaris lumbricoides and anti-Strongyloides stercoralis. Serology by IFI using Schistosoma antigen was positive in 15.2% of the cases. The serological and microscopical exams showed that Entamoeba histolytica was present in this region and that amoebiasis should be considered as one of the etiologies of diarrhoea. The study pointed out also the frequency of the transmitted fecal infections. Preventive measures as water distribution, sanitary installations, hygiene education should be implemented.

Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Child, Preschool; Diarrhea; Feces; Female; Health Education; Humans; Infant; Intestinal Diseases, Parasitic; Madagascar; Male; Middle Aged; Needs Assessment; Parasite Egg Count; Population Surveillance; Prevalence; Primary Prevention; Residence Characteristics; Seroepidemiologic Studies

An epidemiological study of rotavirus infections was conducted in Tananrive, Madagascar, from November 1988 to October 1990. Rotavirus antigen was detected by ELISA in faecal specimens of 183 of 1,659 children with acute diarrhoea (11%) and in 11 of 631 specimens from children without diarrhoea (1.7%). Rotaviral diarrhoeas were most frequently found in infants aged 6 to 18 months and occurred throughout the year with a definite peak during the first winter months. Analysis of the viral RNA by polyacrylamide gel electrophoresis permitted the characterisation of 170 and 194 strains identified. Nine different electropherotypes (A-I) and one mixed infection were observed. The "short" electropherotypes (A-E) were predominant and represented 140 strains (82.4%), and the "long" electropherotypes (F-I and M) represented 30 strains (17.6%). The "short" electropherotype A (cafb) was the most frequent in our environment (45.3% of cases) and was predominant during the first 14 months of the study. The "long" electropherotype F (bbea) appeared in July 1990 and was predominant during the last three months. Among these children with diarrhoea, the presence of rotavirus was significantly associated with vomiting, fever, and moderate to severe dehydration. However, no significant differences in the occurrence of these symptoms were found between the "short" and "long" electropherotypes.

Topics: Adolescent; Child; Child, Preschool; Diarrhea; Humans; Infant; Infant, Newborn; Madagascar; Rotavirus; Rotavirus Infections; Seasons

From November 1988 to October 1989, an etiological study showed off the prevalence and the part of several enteropathogen agents which are not yet studied in MADAGASCAR. 1,523 stool's samples from 884 children with diarrhea and 639 children without diarrhea from 0 to 14 years old have been investigated. A bacterial, parasitical or viral etiology was found from 36.3% of diarrheic children and 11.2% of healthy children. The three agents the most frequently identified from children with diarrhea are EPEC (10.5%), Campylobacter jejuni (10.3%) and rotavirus (10%) and associations of two or three pathogen agents are frequent (6.2%).

Topics: Adolescent; Child; Child, Preschool; Diarrhea; Diarrhea, Infantile; Humans; Infant; Infant, Newborn; Intestinal Diseases; Intestinal Diseases, Parasitic; Madagascar; Prevalence; Seasons

From November 1988 to March 1989, stools from 804 Malagasy children were examined, thirty-seven strains of Shigella were isolated, from which 5 S. dysenteriae serotype 1 (= Shiga bacillus) strains were found to be resistant to ampicillin, carbenicillin, streptomycin, chloramphenicol, tetracycline, sulphonamide and even to trimethoprim. Resistance to trimethoprim has appeared only recently in Madagascar.

Topics: Adolescent; Child; Child, Preschool; Diarrhea; Drug Resistance, Microbial; Dysentery, Bacillary; Humans; Infant; Infant, Newborn; Madagascar; Shigella dysenteriae; Shigella flexneri; Trimethoprim Resistance

From November 1988 to March 1989, 804 Malagasy children stools were studied and 37 Shigella strains isolated. 5 Shigella dysenteriae type 1 from Malagasy East coast (Mananjary), presented a multiply resistance to ampicillin, carbenicillin, streptomycin, chloramphenicol, tetracycline, sulphonamides and trimethoprim. This last resistance has recently appeared in this area.

Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Diarrhea; Drug Resistance, Microbial; Humans; Infant; Madagascar; Shigella dysenteriae; Trimethoprim

Topics: Child, Preschool; Diarrhea; Diarrhea, Infantile; Female; Humans; Infant; Infant, Newborn; Madagascar; Male; Rotavirus Infections