clove and Tuberculosis

Care cascades represent the proportion of people reaching milestones in care for a disease and are widely used to track progress towards global targets for HIV and other diseases. Despite recent progress in estimating care cascades for tuberculosis (TB) disease, they have not been routinely applied at national and subnational levels, representing a lost opportunity for public health impact. As researchers who have estimated TB care cascades in high-incidence countries (India, Madagascar, Nigeria, Peru, South Africa, and Zambia), we describe the utility of care cascades and identify measurement challenges, including the lack of population-based disease burden data and electronic data capture, the under-reporting of people with TB navigating fragmented and privatised health systems, the heterogeneity of TB tests, and the lack of post-treatment follow-up. We outline an agenda for rectifying these gaps and argue that improving care cascade measurement is crucial to enhancing people-centred care and achieving the End TB goals.

Topics: Cost of Illness; Humans; India; Madagascar; South Africa; Tuberculosis

The rapid commercialised ICT Tuberculosis test has been tested in Madagascar for the diagnosis of smear-positive pulmonary (SM+) and extra-pulmonary tuberculosis (EPT), using microscopy, culture and histopathology as reference tests. Specificity was 83.3% and sensitivity 68.2% for SM+ patients and 65.2% for EPT patients. With a prevalence of 22.2% for SM+ patients and 52.4% for confirmed EPT among consulting patients in the National Reference Laboratory, the ICT Tuberculosis assay was not sufficiently predictive for application in the tuberculosis control programme.

Topics: Developing Countries; Female; Humans; Madagascar; Male; Mycobacterium tuberculosis; Sensitivity and Specificity; Serologic Tests; Tuberculin Test; Tuberculosis

Quality surveillance data used to build tuberculosis (TB) transmission models are frequently unavailable and may overlook community intrinsic dynamics that impact TB transmission. Social network analysis (SNA) generates data on hyperlocal social-demographic structures that contribute to disease transmission.. We collected social contact data in five villages and built SNA-informed village-specific stochastic TB transmission models in remote Madagascar. A name-generator approach was used to elicit individual contact networks. Recruitment included confirmed TB patients, followed by snowball sampling of named contacts. Egocentric network data were aggregated into village-level networks. Network- and individual-level characteristics determining contact formation and structure were identified by fitting an exponential random graph model (ERGM), which formed the basis of the contact structure and model dynamics. Models were calibrated and used to evaluate WHO-recommended interventions and community resiliency to foreign TB introduction.. Inter- and intra-village SNA showed variable degrees of interconnectivity, with transitivity (individual clustering) values of 0.16, 0.29, and 0.43. Active case finding and treatment yielded 67%-79% reduction in active TB disease prevalence and a 75% reduction in TB mortality in all village networks. Following hypothetical TB elimination and without specific interventions, networks A and B showed resilience to both active and latent TB reintroduction, while Network C, the village network with the highest transitivity, lacked resiliency to reintroduction and generated a TB prevalence of 2% and a TB mortality rate of 7.3% after introduction of one new contagious infection post hypothetical elimination.. In remote Madagascar, SNA-informed models suggest that WHO-recommended interventions reduce TB disease (active TB) prevalence and mortality while TB infection (latent TB) burden remains high. Communities' resiliency to TB introduction decreases as their interconnectivity increases. "Top down" population level TB models would most likely miss this difference between small communities. SNA bridges large-scale population-based and hyper focused community-level TB modeling.

Topics: Humans; Latent Tuberculosis; Madagascar; Population Groups; Social Network Analysis; Tuberculosis

We diagnosed Mycobacterium tuberculosis in captive lemurs and a fossa in Antananarivo, Madagascar. We noted clinical signs in the animals and found characteristic lesions during necropsy. The source of infection remains unknown. Our results illustrate the potential for reverse zoonotic infections and intraspecies transmission of tuberculosis in captive wildlife.

Topics: Animals; Animals, Wild; Animals, Zoo; Lemur; Madagascar; Mycobacterium tuberculosis; Tuberculosis

Despite a free TB care policy, access to TB care in rural Madagascar is limited due to a markedly underfunded health care system. The World Health Organization estimated the yearly TB incidence in Madagascar at 238 cases per 100,000 people in 2020; only half of the patients with TB are being notified and treated. We describe the development, implementation, and lessons learned of an intervention to improve TB care services in a remote, rural district in southern Madagascar. We involved national, regional, and local stakeholders in assessing the multifaceted challenges in a remote, rural area and codesigning activities to address them. The overarching principles of the intervention were to (1) promote national TB guidelines, (2) build on best practices, and (3) prioritize low-cost activities to enable scale-up. An in-depth assessment of challenges in accessing and delivering TB care resulted in the following prioritization of activities: (1) fostering community engagement, (2) decentralizing service provision, (3) improving quality of care, (4) providing nutritional support, and (5) ensuring staff support and supervision. The intervention was launched in September 2019 and is ongoing as of October 2022. During mobile TB clinics conducted between September 2019 and December 2020, 4,982 presumptive patients were screened and 1,706 (34.2%) have been diagnosed with TB. Based on 2010-2020 official TB notification data, we calculated trend-adjusted additional TB notifications during the intervention, resulting in a 2.6-fold increase in cases in 2019-2020. The intervention district's TB notification rate increased from 178 cases per 100,000 people in 2018 to 424 cases per 100,000 people in 2020. Involving stakeholders from all levels of care was perceived as a key to success. The unexpected increase in the number of patients with TB in the intervention district overburdened the current paper-based TB notification system and emphasized the need for expanded diagnostics and social support services.

Topics: Humans; Incidence; Madagascar; Rural Population; Tuberculosis; World Health Organization

Tuberculosis is a public health issue. Extra-pulmonary presentations are rare and sometimes hard to diagnose and manage. Here, we report a case of tuberculosis of the chest wall in a 28-year-old man in order to discuss the mechanism, diagnostic and therapeutic problems posed by this rare localization.. The patient presented with wall swelling discovered after physical effort. Imaging was in favor of an abscess or infected hematoma. The excisional surgery established the tuberculous origin which was confirmed by histology. Anti-tuberculosis treatment during 9 months completed the surgical treatment and led to the patient's recovery.. The rarity of this localization of tuberculosis should be investigated. Etiological treatment must be instituted and regular monitoring scheduled to avoid recurrence.. Direct-acting antivirals are effective and characterized by good tolerance in these Malagasy hepatitis C patients.

Topics: Adult; Antiviral Agents; Hepatitis C, Chronic; Hospitals, Teaching; Humans; Madagascar; Male; Thoracic Wall; Tuberculosis

Continuing tuberculosis control with current approaches is unlikely to reach the World Health Organization's objective to eliminate TB by 2035. Innovative interventions such as unmanned aerial vehicles (or drones) and digital adherence monitoring technologies have the potential to enhance patient-centric quality tuberculosis care and help challenged National Tuberculosis Programs leapfrog over the impediments of conventional Directly Observed Therapy (DOTS) implementation. A bundle of innovative interventions referred to for its delivery technology as the Drone Observed Therapy System (DrOTS) was implemented in remote Madagascar. Given the potentially increased cost these interventions represent for health systems, a cost-effectiveness analysis was indicated.. A decision analysis model was created to calculate the incremental cost-effectiveness of the DrOTS strategy compared to DOTS, the standard of care, in a study population of 200,000 inhabitants in rural Madagascar with tuberculosis disease prevalence of 250/100,000. A mixed top-down and bottom-up costing approach was used to identify costs associated with both models, and net costs were calculated accounting for resulting TB treatment costs. Net cost per disability-adjusted life years averted was calculated. Sensitivity analyses were performed for key input variables to identify main drivers of health and cost outcomes, and cost-effectiveness.. Net cost per TB patient identified within DOTS and DrOTS were, respectively, $282 and $1,172. The incremental cost per additional TB patient diagnosed in DrOTS was $2,631 and the incremental cost-effectiveness ratio of DrOTS compared to DOTS was $177 per DALY averted. Analyses suggest that integrating drones with interventions ensuring highly sensitive laboratory testing and high treatment adherence optimizes cost-effectiveness.. Innovative technology packages including drones, digital adherence monitoring technologies, and molecular diagnostics for TB case finding and retention within the cascade of care can be cost effective. Their integration with other interventions within health systems may further lower costs and support access to universal health coverage.

Topics: Aircraft; Antitubercular Agents; Cost-Benefit Analysis; Directly Observed Therapy; Humans; Madagascar; Medication Adherence; Prevalence; Program Evaluation; Quality-Adjusted Life Years; Robotics; Tuberculosis

Topics: COVID-19; Developing Countries; Health Resources; Humans; Madagascar; Mycobacterium tuberculosis; Pandemics; Polymerase Chain Reaction; Rifampin; SARS-CoV-2; Sensitivity and Specificity; Tuberculosis

Poor road and communication infrastructure pose major challenges to tuberculosis (TB) control in many regions of the world. TB surveillance and patient support often fall to community health workers (CHWs) who may lack the time or knowledge needed for this work. To meet the End TB Strategy goal of reducing TB incidence by 90% by 2035, the WHO calls for intensified research and innovation including the rapid uptake of new tools, interventions and strategies. Technologies that 'leapfrog' infrastructure challenges and support CHWs in TB control responsibilities have the potential to dramatically change TB outcomes in remote regions. Such technologies may strengthen TB control activities within challenged national tuberculosis treatment and control programmes (NTPs), and be adapted to address other public health challenges. The deployment of innovative technologies needs to be differentially adapted to context-specific factors. The Drone Observed Therapy System (DrOTS) project was launched in Madagascar in 2017 and integrates a bundle of innovative technologies including drones, digital adherence monitoring technology and mobile device-based educational videos to support TB control.. This mixed-methods study gathers and analyses cultural perceptions of the DrOTS project among key stakeholders: patients, community members, CHWs, village chiefs and NTP-DrOTS mobile health teams. Data from questionnaires, semistructured interviews, focus group discussions (FGD) and ethnographic observation gathered from June 2018 to June 2019 are thematically analysed and compared to identify patterns and singularities in how DrOTS stakeholders perceive and interact with DrOTS technologies, its enrolment processes, objectives and team.. Ethics approval was obtained from the National Bioethics Research Committee of Madagascar and Stony Brook University institutional review board. Study results will be submitted for peer-reviewed publication. In Madagascar, results will be presented in person to Ministry and other Malagasy decision-makers through the Institut Pasteur de Madagascar.. This study is designed to foreground the voices of patients and potential patients in the DrOTS programme. CHW participants in this study also supported the design of study information sessions and recruitment strategies. One member of the mobile health team provided detailed input on the wording and content of FGD and interview guides. Study findings will be presented via a report in French and Malagasy to CHW, mobile health team and other village-level participants who have email/internet access.

Topics: Adult; Antitubercular Agents; Attitude to Health; Clinical Protocols; Cross-Sectional Studies; Female; Focus Groups; Health Education; Humans; Interviews as Topic; Madagascar; Male; Medication Adherence; Perception; Robotics; Rural Health Services; Telemedicine; Tuberculosis; Video Recording

Lineage 1 (L1) is one of seven Mycobacterium tuberculosis complex (MTBC) lineages. The objective of this study was to improve the complex taxonomy of L1 using phylogenetic SNPs, and to look for the origin of the main L1 sublineage prevalent in Para, Brazil. We developed a high-throughput SNPs-typing assay based on 12-L1-specific SNPs. This assay allowed us to experimentally retrieve SNP patterns on nine of these twelve SNPs in 277 isolates previously tentatively assigned to L1 spoligotyping-based sublineages. Three collections were used: Pará-Brazil (71); RIVM, the Netherlands (102), Madagascar (104). One-hundred more results were generated in Silico using the PolyTB database. Based on the final SNPs combination, the samples were classified into 11 clusters (C1-C11). Most isolates within a SNP-based cluster shared a mutual spoligotyping-defined lineage. However, L1/EAI1-SOM (SIT48) and L1/EAI6-BGD1 (SIT591) showed a poor correlation with SNP data and are not monophyletic. L1/EAI8-MDG and L1/EAI3-IND belonged to C5; this result suggests that they share a common ancestor. L1.1.3/SIT129, a spoligotype pattern found in SNPs-cluster C6, was found to be shared between Pará/Brazil and Malawi. SIT129 was independently found to be highly prevalent in Mozambique, which suggests a migration history from East-Africa to Brazil during the 16th-18th slave trade period to Northern Brazil.

Topics: Black People; Brazil; Genetic Variation; Genotype; Humans; Madagascar; Mozambique; Mycobacterium tuberculosis; Netherlands; Phylogeny; Polymorphism, Single Nucleotide; Tuberculosis

Screening for HIV is recommended for all TB patients but it has not yet been initiated in some regions of Madagascar. In this study, our main objective was to determine the seroprevalence of HIV infection in TB patients and secondarily to determine the risk factors favoring TB infection in these patients. This prospective cross-sectional study took place in the pneumology department of the University Hospital of Tulear from January to April, 2017. We diagnosed 75 patients with tuberculosis, 96.05% of them new cases. The sex-ratio was 1.81. Patients' mean age was 35 years. Two patients (2.66%) were coinfected with HIV. Among the new cases diagnosed, 62.66% had pulmonary tuberculosis with positive microscopy (TPM +). Two patients reported a person with tuberculosis among their family or close friends. Living with someone in poor hygiene conditions was reported by 82.66% of the cases. Overall, 24% were unemployed. These patients had quite varied ethnic origins. The prevalence of HIV infection in TB patients was higher than in the general population. Low income and low educational levels were the main risk factors for TB infection in Madagascar.

Topics: Adult; Cross-Sectional Studies; Female; HIV Infections; Hospitals, University; Humans; Madagascar; Male; Prevalence; Prospective Studies; Risk Factors; Seroepidemiologic Studies; Tuberculosis

The country received malaria-free certification from WHO in September 2016, becoming only the second country in the WHO South East Asia region to be declared malaria-free. Imported malaria cases continue to be reported, with 278 cases reported between 2013 and 2017. The diagnosis of a severe Plasmodium vivax patient co-infected with HIV and tuberculosis is discussed with an overview of the rapid response mounted by the Anti Malaria Campaign (AMC), Sri Lanka.. It is important to consider comorbid conditions and immunosuppression when a patient with a benign form of malaria presents with severe manifestations. Measures should be strengthened to prevent importation of diseases, such as malaria and AIDS through migrant workers who return from high-risk countries.

Topics: Adult; Case Management; Coinfection; Communicable Diseases, Imported; HIV Infections; Humans; Madagascar; Malaria, Vivax; Male; Sri Lanka; Travel; Tuberculosis

Although the Bacillus Calmette-Guérin vaccine (BCG) protects young children against serious forms of TB, protection against pulmonary TB is variable. We assessed BCG vaccine-induced cellular immune responses and determined for how long they could be detected during childhood in Antananarivo, Madagascar.. We assessed BCG vaccine-induced cellular immune responses by TST and IGRA (in-house ELISPOT assay) using BCG and PPD as stimulation antigen, and compared results between vaccinated and non-vaccinated schoolchildren of two age groups, 6-7 and 13-14 years old.. Three hundred and sixty-three healthy schoolchildren were enrolled. TST was performed on 351 children and IGRA on 142. A high proportion (66%; 229/343) of the children had no TST reactivity (induration size 0 mm). TST-positive responses (≥15 mm) were more prevalent among 13-14 year-old (31.7%) than 6-7 year old (16.5%) children, both in the non-vaccinated (43% vs. 9%, p<0.001) and vaccinated (29% vs. 13%, p=0.002) subgroups. There were no significant differences in TST responses between vaccinated and non-vaccinated children in either of the age groups. The IGRA response to BCG and to PPD stimulation was not significantly different according to BCG vaccination record or to age group. A high rate (15.5%; 22/142) of indeterminate IGRA responses was observed. There was very poor agreement between TST and IGRA-PPD findings (k= 0.08) and between TST and IGRA-BCG findings (k= 0.02).. Analysis of TST and IGRA response to stimulation with BCG and PPD revealed no difference in immune response between BCG-vaccinated and non-vaccinated children; also no decrease of the BCG vaccine-induced cellular immune response over time was observed. We conclude that TST and IGRA have limitations in assessing a role of BCG or tuberculosis-related immunity.

Topics: Adolescent; BCG Vaccine; Child; Enzyme-Linked Immunospot Assay; Female; Humans; Immunity, Cellular; Madagascar; Male; Reproducibility of Results; Students; Tuberculin Test; Tuberculosis

Tuberculosis continues to cause unacceptably high levels of disease and death worldwide. Active preventive strategies are required to improve tuberculosis control and to increase the number of cases treated in developing countries. The aim of this study was to evaluate the utility of the tuberculin skin test (TST) in first-year schoolchildren as a means of increasing the number of tuberculosis cases detected through the screening of close contacts.. All members of the households of 90 schoolchildren assigned to three groups on the basis of TST category (≤ 5 mm, [5-15)mm, ≥ 15 mm) were screened for sputum smear-positive pulmonary tuberculosis. The percentage detection of tuberculosis in close contacts was compared between TST categories.. We identified 433 close contacts of the 90 schoolchildren, who were then evaluated for tuberculosis. We identified 11 cases of pulmonary tuberculosis among the close contacts (7 already on treatment and 4 previously undiagnosed): 0 in TST category ≤ 5 mm, 3 in TST category [5-15) mm and 8 in TST category ≥ 15 mm). This approach increased the detection of tuberculosis cases by a factor of 1.6 in first-year schoolchildren of the TST ≥ 5 mm group.. TST in first-year schoolchildren is a potentially effective method for improving the detection of tuberculosis in close contacts.

Topics: Child; Female; Humans; Madagascar; Male; Tuberculin; Tuberculin Test; Tuberculosis

Topics: Case-Control Studies; Child; Child, Preschool; Female; Hospitals, University; Humans; Infant; Madagascar; Male; Malnutrition; Poverty; Retrospective Studies; Risk Factors; Tuberculosis

The majority of Mycobacterium tuberculosis (Mtb) infections remain asymptomatic with only up to 10% progressing to clinical tuberculosis. However, the constituents of the effective "protective immunity" against tuberculosis responsible for containing most infections remain unknown. Evaluating gene transcriptional profiles in tuberculosis clinical cohorts is one approach to understanding the spectrum of tuberculosis progression. It is clear that apoptosis plays a role in the control of tuberculosis but the utility of apoptosis-related genes as surrogate markers of protection against tuberculosis has not been well investigated. To characterize potential surrogate markers that could discriminate different phases of the clinical tuberculosis spectrum, we investigated gene expression of several TNF-alpha dependent apoptotic genes (TNFR1, TNFR2, FLICE, FLIPs) by real-time RT-PCR of peripheral blood cells from cohorts of individuals with active tuberculosis or potential exposure to tuberculosis. Newly diagnosed tuberculosis patients (n = 23), their close household contacts (n = 80), and community controls (n = 46) were tested at intervals over a period of up to two years. Latent infection or previous Mtb contact was assessed by ELISPOT and TST and complete blood counts were performed during the follow up. Results showed significant upregulation of FLIPs expression by infected individuals regardless of clinical status at entry to the study. A higher percentage of lymphocytes was found in the infected household contacts that remained healthy. In contrast, in individuals with active TB, a significant upregulation of TNFR2 expression, a significantly higher percentage of monocytes and a significantly decreased lymphocyte count were seen, compared to subjects that remained healthy. Moreover, the household contacts who subsequently developed signs of TB also had a significantly high number of monocytes. These data suggest tuberculosis may be associated with decreased T-cell survival (perhaps due to apoptosis) while inhibition of apoptosis in monocytes could lead to a relative increase in these cells: a situation predicted to favour Mtb.

Topics: Adolescent; Adult; Aged; Antigens, Bacterial; Apoptosis; Bacterial Proteins; Case-Control Studies; CASP8 and FADD-Like Apoptosis Regulating Protein; Child; Child, Preschool; Endemic Diseases; Enzyme-Linked Immunospot Assay; Female; Follow-Up Studies; Gene Expression Regulation; Humans; Interferon-gamma; Leukocyte Count; Madagascar; Male; Middle Aged; Mycobacterium tuberculosis; Receptors, Tumor Necrosis Factor, Type II; Tuberculin Test; Tuberculosis; Tumor Necrosis Factor-alpha; Young Adult

The tuberculin skin test (TST) is an important tool in the diagnosis of tuberculosis infection in children. However, the interpretation of TST may be complicated by prior Bacillus Calmette-Guerin (BCG) vaccination. We evaluated the effect of vaccination with BCG on TST reactivity in first-year pupils attending state schools in Antananarivo.. STs were performed on 376 first-year schoolchildren, aged 6 and 7, attending two state primary schools. The relationships between epidemiological information, BCG status (vaccination, BCG scars) and TST reactivity were assessed to compare TST sensitivity between children with and without BCG vaccination and between those with and without a BCG scar.. The prevalence of positive TST results of ≥5, ≥10 and ≥ 15 mm was 20.2% (76/376), 18.3% (69/376) and 11.4% (43/376), respectively. BCG vaccination was not associated with TST reactivity, whatever the threshold used: ≥5 mm (odds ratio (OR, 1.2; 95% confidence interval (CI), 0.7-2.0); ≥10 mm (OR, 0.9; 95% CI, 0.6-1.7); ≥15 mm (OR, 0.6; 95% CI, 0.3-1.2).. These results suggest that in Madagascar, a positive TST result indicates TB infection (active or latent) rather than past BCG vaccination. Therefore, high BCG vaccination coverage does not appear to impair the usefulness of the TST as a tool for diagnosing tuberculosis.

Topics: BCG Vaccine; Child; Cross-Sectional Studies; Female; Humans; Madagascar; Male; Mycobacterium tuberculosis; Odds Ratio; Predictive Value of Tests; Tuberculin; Tuberculin Test; Tuberculosis; Vaccination

The performance of the immunochromatographic assay, SD BIOLINE TB Ag MPT64 RAPID®, was evaluated in Madagascar. Using mouse anti-MPT64 monoclonal antibodies for rapid discrimination between the Mycobacterium tuberculosis complex and nontuberculous mycobacteria, the kit was tested on mycobacteria and other pathogens using conventional methods as the gold standard. The results presented here indicate that this kit has excellent sensitivity (100%) and specificity (100%) compared to standard biochemical detection and can be easily used for the rapid identification of M. tuberculosis complex.

Topics: Animals; Antibodies, Monoclonal; Bacterial Typing Techniques; Chromatography, Affinity; Humans; Madagascar; Mice; Mycobacterium tuberculosis; Nontuberculous Mycobacteria; Sensitivity and Specificity; Tuberculosis

Madagascar's national tuberculosis control program has been operational since 1991. The purpose of this article is to provide up-to-date information about the results of this program.. Data from reports sent to the Tuberculosis Control Department between 1996 and 2004 by diagnosis and treatment centers were retrospectively studied. Special focus was placed on new cases of tuberculosis identified by positive smear.. During the study period the annual incidence of new cases of tuberculosis confirmed by positive smear increased from 65 to 82 per 100,000 inhabitants. The highest incidence of new cases was observed in the active population. The treatment success rate rose from 64.4% to 70.8% in patients with positive smear tests. The dropout rate decreased from 21% to 16.5%. However discrepancies were observed between the number of cases diagnosed and number of cases treated.. These findings indicate that tuberculosis control improved slowly over the study period. However these data do not allow identification of strategies to improve program performance. This will require detailed review of data taking into account the context in which they were obtained.

Topics: Adult; Communicable Disease Control; Female; Humans; Incidence; Madagascar; Male; Retrospective Studies; Tuberculosis

Topics: Developing Countries; Hospitals, Religious; Humans; Madagascar; Tuberculosis

Tuberculosis is highly prevalent in cattle in Madagascar. An epidemiological study based on genotyping of Mycobacterium bovis and its transmission to humans was carried out. The restriction fragment length polymorphism (IS6110 and DR markers) and spoligotyping were used to assess the genetic diversity of strains from different regions of Madagascar. One of these strains was isolated from goat, the other strains were isolated from zebu cattle. Nine IS6110 profiles, 20 DR profiles and 12 spoligotypes were obtained. About 90% of all isolates gave a single IS6110 band at about 1.8 kb. Most strains had the same spoligotype. M. bovis strains commonly lack spacers 39-43, and all Malagasy strains also lacked spacers 3-5, 8-10 and 16. This pattern has not been reported elsewhere. DR was the most discriminatory of the three markers. The patterns obtained with the three markers were combined to identify 34 different genotypes, one of which was found in 35% of the strains. No region-specific M. bovis genotype was identified, but the genotyping of 18 M. bovis strains isolated from patients showed that the human and bovine strains were identical, suggesting possible human contamination from zebu cattle.

Topics: Animals; Cattle; Deoxyribonucleases, Type II Site-Specific; DNA, Intergenic; Epidemiologic Methods; Genetic Variation; Genotype; Goats; Humans; Madagascar; Mycobacterium bovis; Polymorphism, Restriction Fragment Length; Tuberculosis; Tuberculosis, Bovine; Zoonoses

Despite well-developed tuberculosis (TB) control policies in Madagascar, the incidence of TB remains high and is estimated at about 100 new cases per 100000 inhabitants. This paper describes genetic characteristics of TB bacilli in Madagascar. Using an international spoligotyping database, SpolDB4, we also attempted to identify the origin of strains circulating in Madagascar. DNA polymorphism of 333 Mycobacterium tuberculosis complex isolates was assessed. A total of 301 isolates belonging to 60 spoligotyping-defined clusters were found, whereas 32 isolates harbored orphan patterns. By comparison with the international database, we identified a new genetic group of closely genetically related M. tuberculosis strains which we suggested to be specific from Madagascar. Most of them belonging to the East-African-Indian (EAI) superfamily of strains that are responsible for 14% of total TB cases (shared types ST1514-1525). These strains are closely related to the most prevalent shared type ST109, whose distribution is mainly confined to Madagascar. The observed distribution of genotypes shows that principal genetic group 1 strains (EAI, Beijing, CAS, Afri, "Manu") is high (35.4%) suggesting an ancient evolutionary history of tuberculosis in Madagascar, in relation to the origin of peopling and the demographic history.

Topics: Bacterial Typing Techniques; Databases, Nucleic Acid; Genotype; History, Ancient; Humans; Madagascar; Mycobacterium tuberculosis; Phylogeny; Polymorphism, Genetic; Tuberculosis

Breast tuberculosis is rare. It usually involves young women of childbearing age. The purpose of this report is to describe two cases of breast tuberculosis observed in Madagascar with focus on epidemiological, clinical, and therapeutic features. Infection of the breast is usually secondary by lymphatic, contiguous, or, more rarely haematogenous spreading. Primary infection is uncommon. The most frequent clinical form is the fistulised nodular form observed in both patients described in this report. The diffuse form is the least common form and the sclerous form occurs in the elderly. Histology is a valuable diagnostic tool if bacteriological findings are inconclusive. Patients respond favourably to antimycobacterium treatment with or without surgery.

Topics: Adolescent; Breast Diseases; Female; Humans; Madagascar; Middle Aged; Tuberculosis

Antananarivo, the capital city of Madagascar, has an endemic focus of tuberculosis (TB). We specifically studied patients with extrapulmonary TB (EPTB) and grouped patients according to infected body site. The strains were characterized by IS6110 fingerprinting and compared with those isolated from patients with pulmonary TB (PTB) during the same period in order to determine the possible association between the genotype and the clinical expression of TB. A total of 316 TB patients were included in this study: 151 individuals with EPTB, 10 with both PTB and EPTB, and 155 with PTB alone. Pleural TB was the major EPTB localization (77%) and was found more often in older patients, while PTB or EPTB in which the localization was other than pleural (other EPTB) was found in younger patients. The male-to-female ratio was slightly higher in pleural TB patients (3.06:1) than in patients with other EPTB (1.35:1). There was no significant difference in the BCG status among patients with PTB, pleural TB, and other EPTB. Analysis of IS6110 patterns showed that 167 patients (52.8%) were assigned to 37 clusters of 2 to 34 patients. Analysis of the IS6110 clusters and the IS6110 families did not show any association with a particular clinical expression of the disease. Patients with PTB or other EPTB were more likely to have strains with one IS6110 copy than patients with pleural TB. The clustering rate was found to be significantly higher in female patients (62%) than in male patients (48%) (P = 0.029), suggesting that Malagasy women were more likely to progress to disease after infection than men.

Topics: Adolescent; Adult; Aged; Bacterial Typing Techniques; Child; Child, Preschool; Cluster Analysis; DNA Transposable Elements; Female; Genotype; Humans; Infant; Madagascar; Male; Middle Aged; Mycobacterium tuberculosis; Polymorphism, Restriction Fragment Length; Tuberculosis; Tuberculosis, Pulmonary

Tuberculosis during childhood is often due to Mycobacterium tuberculosis primo-infection. Tuberculosis is highly prevalent in Madagascar and most people are infected during childhood. Our objectives were to evaluate the primary resistance of M. tuberculosis and to determine the genotypes responsible for recent infection in the population. Thus we studied 142 isolated strains from 97 children (66 with pulmonary tuberculosis and 31 with extra-pulmonary tuberculosis) recruited in different health centers in Antananarivo from 1997 to 2000. Excepting one strain resistant to isoniazide, all strains were susceptible to the four antibiotics (streptomycin, isoniazid, ryfampicin and ethambutol). This result confirms the low rate of primary resistance reported during the two surveys in 1994-1995 and 1999-2000. 67 strains of 1997-2000 were typed with the genetic marker IS6110, 44 has been assigned to 13 clusters containing each 2 to 8 similar strains. Some IS6110 clusters have already been reported in 1994-1995. Some genotypes observed in 1994-1995 seemed to have disappeared in 1997-2000. (As the rate of the frequency of some genetic variants according to the period are more likely due to a difference in strain virulence). Since there is minimal antibiotic resistance versus M. tuberculosis in Madagascar, one can not explain the appearance or disappearance of certain variants because of drug resistance. Rather, this is due to the virulence of the various M. tuberculosis strains.

Topics: Age Distribution; Antitubercular Agents; Child; Child, Preschool; Cluster Analysis; DNA, Bacterial; Drug Resistance, Bacterial; Genes, Dominant; Genotype; Health Surveys; Humans; Incidence; Infant; Infant, Newborn; Madagascar; Microbial Sensitivity Tests; Molecular Epidemiology; Mycobacterium tuberculosis; Polymorphism, Genetic; Polymorphism, Restriction Fragment Length; Population Surveillance; Tuberculosis; Urban Health

Since June 1997, a quarterly quality control of sputum smear exam for the tubercle diagnosis, depending on double reading of slides, was implemented between both central laboratories of the Mycobacteria National Reference Centre in Madagascar (mycobactoria laboratories of Institut Pasteur Madagascar [IPM] and Institut Hygiène Sociale [IHS]--Health Ministry). In 2000, four controls were done, in the course of which 240 slides were coloured by auramine, coming both from IPM and IHS, and another 80 slides from IHS were coloured by Ziehl-Neelsen. All the results were in agreement for the samples stained with auramine, while two false negatives were found for the samples stained with Ziehl-Neelsen. The maintenance of this quality control between the two laboratories is necessary to insure the reliability of their results and the controls that they make for the peripheral laboratories.

Topics: Bacteriological Techniques; Clinical Laboratory Techniques; Humans; Madagascar; National Health Programs; Quality Assurance, Health Care; Quality Control; Specimen Handling; Sputum; Tuberculosis

Tuberculosis is worldwide considered as a major health problem with high morbidity and mortality rates. Diagnosis of tuberculosis can be problematic. Microscopy, as the basic diagnostic method, stands inadequately alone due to a low sensitivity, and culture suffers from being time-consuming. A rapid, sensitive and simple diagnostic test, applicable in the field is therefore highly needed. A diagnostic method for the detection of M. tuberculosis by immunocapture technique has been developed using magnetic beads coated with polyclonal anti-M. tuberculosis. The detection of captured bacilli using biotinylated anti-APA monoclonal antibody (APA is a minor secreted antigen) was found more sensitive than microscopy. The results suggest that the development of a rapid strip test to detect major antigen could be a useful tool for the control of tuberculosis.

Topics: Antibodies, Monoclonal; Antigens, Bacterial; Biopsy; Case-Control Studies; Humans; Immunomagnetic Separation; Madagascar; Microscopy; Mycobacterium tuberculosis; Sensitivity and Specificity; Sputum; Time Factors; Tuberculosis

APA complex (45/47 kDa) is an antigen specifically excreted by Mycobacterium tuberculosis and could therefore be a good candidate for diagnosis.. To develop three APA immunocapture ELISA assays using monoclonal antibodies (Mabs) and one IgG anti-APA ELISA test, and to determine their usefulness for the diagnosis of tuberculosis in Madagascar.. For the Ag assays, 23 negative sputum and serum samples and 64 pairs of sputum and serum from active smear-positive patients (PTM+) were tested. For antibody assay, 116 negative controls, 143 PTM+ and 54 extra-pulmonary tuberculosis patients were tested.. The sensitivities of the APA antigen detection assays were low (less than 40%) for a specificity of 95.6%, using either monoclonal antibodies or clinical specimens. The anti-APA serology was more sensitive (76.9% for PTM+ patients) but less specific (73.2%). Due to their poor predictive values, these tests cannot be recommended for the routine diagnosis of tuberculosis in Madagascar.

Topics: Antibodies, Bacterial; Bacterial Proteins; Case-Control Studies; Enzyme-Linked Immunosorbent Assay; Glycoproteins; Humans; Immunoglobulin G; Madagascar; Mycobacterium tuberculosis; Reproducibility of Results; Sensitivity and Specificity; Sputum; Tuberculosis

The prevalence of tuberculosis in the Antananarivo prison is 16 times higher than that in the general population of Madagascar. We compared the clustering of Mycobacterium tuberculosis strains within and outside the prison and studied the transmission of strains in the prison. M. tuberculosis strains isolated in 1994 to 1995 from 146 prisoners and from 260 nonprisoner patients from Antananarivo were typed using the genetic markers IS6110 and direct repeat. We compared the strains isolated from prisoners and nonprisoners and found that the clustering rate was higher within (58.9%) than outside the prison (40%) suggesting that the transmission rate was higher in prison. Of the 146 incarcerated patients, 82 were grouped into 22 clusters. We checked for possible tuberculosis transmission between prisoners with identical strains by epidemiological investigation of the various prison clusters. We found that 9.5% of the incarcerated patients could have been sources of infection and that only 15.1% could have been infected in the prison. One hundred and twenty-seven prison patients were new cases. Epidemiological data suggested that 37% of them resulted from a reactivation of an old infection, due to poor living conditions or recent transmission from an index case outside the prison.

Topics: Adolescent; Adult; Aged; DNA Transposable Elements; Female; Humans; Madagascar; Male; Middle Aged; Mycobacterium tuberculosis; Polymorphism, Restriction Fragment Length; Prisoners; Prisons; Tuberculosis

We conducted a 5-year (1989-1993) retrospective analysis on a series of patients screened and treated for tuberculosis in order to determine the epidemiological aspects of the disease in mid-western Madagascar. Pulmonary forms affected 97% of patients, and predominantly men (sex ratio: 1.4); 83% of patients with pulmonary tuberculosis were coughing up acido-alcoholo-resitant bacilli. Haemoptysis and general deterioration, the most frequently met pathological signs, were observed respectively in 62% and 24% of cases. This explains the high rate of hospitalisation (42%), especially for patients with difficult access to services. Significantly, in terms of socio-professional category, live-stock breeders and farmers represented 32% of notified cases, and cattle-traders 18%. We draw attention to the possible role played by Mycobacterium bovis in human case-findings in a region characterised by cattle-breeding.

Topics: Female; Hospitalization; Humans; Madagascar; Male; Mycobacterium tuberculosis; Retrospective Studies; Sputum; Tuberculosis

In Madagascar, tuberculosis remains an important cause of morbidity and letality with a Risk of Annual Tubercular Infection about 1% in 1996 in spite of a vaccination rate of 82.6% and tubercular drugs free of charge. In 1995, the National Tubercular Control Program detected 7,000 cases of pulmonary tuberculosis and expected more than 12,000 cases per year. This study was carried out in order to review the management and the treatment of the child tuberculosis in Madagascar. This retrospective study was conducted in four pediatric units of the General hospital of Befelatanana (A and B), Ambohimiandra Hospital and Regional Hospital Centre of Toliara for a twenty four months period from January 1997 to December 1998. All the less than 15-year-old children medical files were consulted. 214 cases were suspected of tuberculosis. 133 of them were treated upon clinical presumption basis and/or radiological exams (33 bacteriological and/or histopathological exams were only realized). 56% of the cases were vaccinated by BCG vaccine. Respiratory diseases with fever motive 46% of hospitalization. The majority of these children are living in poor conditions and 38% of them had malnutrition. Were found as clinical manifestations: 47% of pulmonary tuberculosis (among them 20% were smear-positive pulmonary tuberculosis), 12% had ganglionar tuberculosis, 10% peritoneal tuberculosis, 8% a tubercular meningitis, 5% a Pott-disease and 2% a miliary-disease. Mortality increases with suffocation. 18% of cases died, especially infants and in tubercular meningitis. The authors conclude that management and treatment of tuberculosis need an early diagnosis. But the diagnosis is difficult in front of non specific clinical manifestations in children and due to lack of means and national agreement which settle up diagnosis and therapy. A scoring system based upon clinical signs in agreement with complementary medical tests is desirable.

Topics: Adolescent; Antitubercular Agents; BCG Vaccine; Child; Child Nutrition Disorders; Child, Preschool; Hospital Units; Hospitalization; Humans; Infant; Madagascar; Medical Audit; Morbidity; Needs Assessment; Pediatrics; Poverty; Practice Guidelines as Topic; Practice Patterns, Physicians'; Retrospective Studies; Risk Factors; Severity of Illness Index; Time Factors; Tuberculin Test; Tuberculosis; Vaccination

The prevalence of human tuberculosis (TB) due to Mycobacterium bovis was determined in Madagascar in 1994-1995. A prevalence of M. bovis of 1.25% was observed among sputum smear-positive patients and 1.3% among extra-pulmonary TB patients. This study was conducted in urban areas and will be extended to rural zones, where the majority of the population lives.

Topics: Adolescent; Adult; Age Distribution; Aged; Child; Child, Preschool; Female; Humans; Infant; Madagascar; Male; Middle Aged; Mycobacterium bovis; Risk Factors; Seroepidemiologic Studies; Sex Distribution; Tuberculosis; Tuberculosis, Pulmonary; Urban Population

Patient compliance remains one of the main obstacles that need to be overcome by tuberculosis control programmes, in the developing world as well as in industrialised countries. A better understanding of the various factors accounting for treatment default could help to achieve better compliance from patients.. To increase the understanding of the determining factors of default in an urban environment where medical facilities are accessible. Different kinds of determinants were studied: objective socio-demographic factors, subjective psychological factors, attitudes and behaviour of patients in relation to chemotherapy, quality of relationships with the medical staff, knowledge and attitudes regarding tuberculosis.. Risk factors for default were assessed by a retrospective case-control study in a sample of 38 patients who had not completed treatment for pulmonary tuberculosis, compared with 111 controls who had completed treatment under comparable conditions.. Default appears to be significantly linked to transportation time, the sex of the patient, patient information and the quality of communication between patients and health workers. False addresses given by patients are both a methodological bias and a risk factor for future default.. Improved communication skills and attention from the medical staff could encourage more patients to complete their TB treatment.

Topics: Adult; Attitude of Health Personnel; Case-Control Studies; Communication; Demography; Female; Health Knowledge, Attitudes, Practice; Humans; Madagascar; Male; Patient Compliance; Physician-Patient Relations; Retrospective Studies; Risk Factors; Sex Factors; Socioeconomic Factors; Transportation; Tuberculosis; Urban Population

This article reports the results of a national tuberculin skin test survey of childhood age group. The survey period was from december 1991 to june 1994. For the calculation of annual risk of tuberculous infection, 1544 schoolchildren, aged 6 to 10 years old, without scare related to BCG, were included. The antigen used was tuberculin PPD Mérieux; in order to define a mode of positivity, this tuberculin was first tested with 250 confirmed pulmonary tuberculous patients: the mode was 16mm. With the hypothesis of a cut-off point of positivity at 14 mm, the prevalence of tuberculous infection was found at 9.6% (with a confidence interval of 1.6%); then, the annual risk of tuberculous infection was calculated at 1.21% (from 1% to 1.42%). With the hypothesis of a mode at 16 mm, the prevalence of tuberculous infection was found at 10.2% (with a confidence interval of 2.3%); then, the annual risk of tuberculous infection was calculated at 1.29% (from 0.97% to 1.59%). Considering separately two age groups, the annual risk was 1.25% for 6-8 years old children and 1.32% for 9-10 years old children. In conclusion, the authors stress the important constraints in the achievement of such a survey in developing countries. Though the difficulties that arised, the standardised methodology used in this survey gives reliable information. These results could be compared with those of future surveys using the same methodological approach.

Topics: Child; Female; Humans; Infant, Newborn; Madagascar; Male; Risk Factors; Tuberculin Test; Tuberculosis

As part of the National Tuberculosis Program (NTP), a quality control of the slides (search of acido-fast-bacilli in the sputa) of the Treatment and Diagnosis Centers (TDC) forming the National Laboratory Network was carried out in 1996. 60 TDC of the 165 TDC (36%) had been controlled according to the system of double reading of the smears. The global concordance of the results in the 60 TDC is satisfactory since it was of 94%. Reliability of smears positive was of 83%. For the negative smears reliability, 14% of the TDC had a low or insufficient level. A good quality of smears was observed in 40% of the centers. The TDC that had both positive and negative reliability at 100% were 23 (38%) of which 13 had good quality of smears. Those were especially found in Antananarivo, Toliara, Fianarantsoa and Mahajanga.

Topics: Bacteriological Techniques; False Negative Reactions; False Positive Reactions; Humans; Laboratories; Madagascar; Microscopy; Quality Assurance, Health Care; Quality Control; Single-Blind Method; Specimen Handling; Sputum; Tuberculosis

Comparative study of compulsory declarations registered at the provincial level and at the central level between January 1st 1993 and 31st December 1994 showed a high prevalence of tuberculosis in the province of Mahajanga and an under-declaration of cases at the provincial level was almost 25% with regard to data collected at the central level. Smear-positive pulmonary tuberculosis patients were the most frequent (86%), which showed respect towards the National Control Programme instructions. Extrapulmonary tuberculosis were under-estimated (less than 10%) because of the weak diagnosis means. Smear-positive pulmonary tuberculosis under treatment in the city of Mahajanga were cured globally at 80%. The difference between the centres diminished between 1992 and 1993, then it persisted requiring the improvement of tubercular management conditions within the province structures and most particularly within the city of Mahajanga structures which are at the present taking charge of more than 50% of the province tubercular.

Topics: Adult; Disease Notification; Female; Humans; Madagascar; Male; Patient Compliance; Population Surveillance; Prevalence; Registries; Retrospective Studies; Rural Health; Tuberculosis; Urban Health

Within 42 months, from June 1990 to December 1993, 454 cases of tuberculosis have been recorded in the central remand home of Antananarivo. The tubercular prevalence observed was there eight times superior to that of the global population of Madagascar. Among the 360 pulmonary tuberculosis, only one did not have any bacteriological proof; among the 94 extrapulmonary tuberculosis, 37 have been proved by histology or bacteriology. Among the extrapulmonary tuberculosis, pleurisies were obviously preeminent (79/94). Association of tubercular localizations could be observed with 21% of the patients. New cases of smear-positive pulmonary tuberculosis (PMT+) represented 81% of all the PMT+, recurrences were 9% and revivals 10%. Since February 1991, the 8 months short course regimen was the standard applied; before, the lack of stock did not allowed any standardization. The PMT+ new cases recovery rate increased from 42.5% in 1990 to 74% in 1993, whereas lethality decreased from 23% in 1990 to 8% in 1993. Patient dropouts were noted only with released or escaped individuals. Treatment failure rate was 4%. The diminution of cases despite the constancy of prisoners number and the carrying out of activities by the same health team make questionable the explanatory factors of the burst of tuberculosis-diseases in a prison milieu. Because of the importance of prison tubercular foci in terms of public health and the satisfactory results obtained, the Programme proposes to apply the model of partnership developed between the Tonga soa NGO and the prison administration to other prisons in Madagascar.

Topics: Adolescent; Adult; Aged; Female; Humans; Madagascar; Male; Mass Screening; Middle Aged; Patient Dropouts; Population Surveillance; Prevalence; Prisons; Treatment Failure; Tuberculosis; Urban Health

Because of the known epidemiological links between tuberculosis and HIV infection in developing countries, a systematic study of HIV infection prevalence among tuberculous patients has been conducted since 1989 in some centres of the capital and extended to other towns in 1992. HIV infection prevalence is still low (<200/100,000) with tuberculous patients. This result must incite to continue the surveillance of the ineluctable growth of HIV prevalence and to strengthen the tuberculosis Program in anticipation of subsequent problems.

Topics: Adult; AIDS-Related Opportunistic Infections; Female; HIV Seroprevalence; Humans; Madagascar; Male; Population Surveillance; Tuberculosis

The experience of a 51 months continuous action of tuberculosis control in a pneumophysiology department of an important general hospital which works according to the principle of cost recovery, is reported. This centre, with an average of 345 annual cases, is the third in Madagascar. During the studied period (from September 1989 to December 1993), 1418 tubercular patients have been diagnosed, distributed into 57.7% of pulmonary tuberculosis and 42.3% of extrapulmonary tuberculosis. The number of extrapulmonary tuberculosis is obviously higher than in the rest of the country structure (16%); among them, pleurisies are distinctly prevailing (present in 29.6% of tubercular patients), other serositis take an important place, immediately after peripheric adenopathies (101 cases that is to say 7.1%); the high proportion of laryngitis shows the importance and oldness of bacilli infected pulmonary lesions. 13.7% of the patients have two or more tubercular localizations. Bacteriological proof has been done for 97.3% of the pulmonary tuberculosis and 7% of the extrapulmonary tuberculosis. A certitude proof has globally been acquired for 82.5% of the patients. 97.9% of the sick started a treatment. 7% of death were noted (95 cases), two thirds of them during the first month after diagnosis and two thirds due to pulmonary tuberculosis with positive microscopy. The average recovery rate within the studied period was 68.2% for all patients without distinction; 67.6% (456/674) for pulmonary tuberculosis with positive microscopy and 76% (265/349) for pulmonary tuberculosis with positive microscopy among civil servants and equivalent. It has been noted that private persons who pay their medical expenses showed a significantly less good compliance (60.9% of recovery rate) than civil servants whose medical expenses are entirely refunded.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cause of Death; Child; Child, Preschool; Female; Hospital Mortality; Hospitals, General; Hospitals, Military; Hospitals, Urban; Humans; Infant; Insurance, Health; Madagascar; Male; Middle Aged; Patient Compliance; Retrospective Studies; Treatment Outcome; Tuberculosis

A group of 122 observations of pediatric tuberculosis has been studied. Nurslings represented 34% of the group, children under 8 years old 75% and only 10% were above 12. The sex ratio was 1,1. In a statistically significant way, tuberculous children were less often immunized by BCG than reference children not infected by tuberculosis. Contact has been traced back to close family in 42% of cases. Weight loss was significant at diagnosis time and after treatment the difference with the reference group disappeared. Extrapulmonary localizations were less frequent with children under 2, pulmonary and extrapulmonary localizations associations could be observed with 14% of children under 2 and with 31% of the whole children developing a proved tuberculosis. The importance of bronchial fibroscopy has been pointed out, for it allowed to detect 30% of abnormalities and to prove the diagnosis of tuberculous in 25% of cases. It is regrettable that the National Tuberculosis Control Programme did not prescribe chemoprophylaxis of contact children in its routine instructions, yet it is well known that child tuberculosis is rarely contagious and is not considered a priority by a programme. Finally, the authors reported that the number of pediatric tuberculosis managed in the country showed an obvious underestimation of the problem and they hope this work would lead to think more frequently of that diagnosis in the future.

Topics: Adolescent; Age Distribution; BCG Vaccine; Child; Child, Preschool; Contact Tracing; Female; Health Priorities; Hospitals, Urban; Humans; Infant; Infant, Newborn; Madagascar; Male; Retrospective Studies; Sex Distribution; Tuberculosis

This study briefly reports the results of a survey conducted by the National Tuberculosis Control Programme (NTCP) to asses the Catholic Centres and particularly the leper colonies activities of tuberculosis control. Among the 34 Catholic Centres taking care of the lepers, 11 take part in the NTCP. Within less than 3 years, most of these centres have taken charge of twice more tuberculous patients: the number of cases increased from 540 to 1045. Leprosy prevalence is constantly decreasing, thus multibacillary leprosy cases declared by these centres decreased of 28% from 1992, to 1994. Centres which did not begin conversion would feel this necessity soon. Germs responsible for leprosy and for tuberculosis are "first cousins". Technical and operational approaches for the control of both affections are very much alike. Those considerations logically induce to propose the conversion of antileprosy centres for tuberculosis control. Other arguments are partially exposed in this work. The Central Division knows the existence of 28 Catholic Centres throughout the country, taking charge of tuberculous patients. In 1994, they put more than 1600 patients under treatment, thus 15% of the tubercular in Madagascar. Those Catholic Centres implementing tuberculosis control programme ought set up a "federation" as a privileged interlocutor for the NTCP and for the financial backers when allowing support. Responsibles of the Programme expect to convince Centres of the necessity of conversion and of the interest of tuberculosis control.

Topics: Bed Conversion; Catholicism; Health Services Research; Hospitals, Religious; Humans; Leprosy; Madagascar; Population Surveillance; Prevalence; Tuberculosis

In 1991, the National Tuberculosis Control Program could start in Madagascar, thanks to the financial support of the French Cooperation. Within 3 years, this allocation of resources allowed the management, respecting the new standards, of 56% of the country's health structures and of more than 75% of the sick. The number of detected and treated patients increased of 80%. During the same period, the recovery rate increased from less than 35% to more than 65%. Those primary results were satisfactory in terms of working but they were not enough in epidemiological terms as the aims were still far: the detection rate of smear-positive pulmonary tuberculosis was 40% whereas it ought be 60%, and their recovery rate was 65% whereas it ought to be over 80%. The geographic extension of the Program and its progress depend on a structural strengthening needing an obvious political will and on the intervention of financial partners cooperating with France and willing to set up a long lasting partnership.

Topics: Financial Support; Health Care Rationing; Humans; Madagascar; Organizational Objectives; Population Surveillance; Prevalence; Program Evaluation; Tuberculosis

Ever since its establishment in Madagascar, the Lutheran Church has been very active in medical field. In 1983, the creation of a medical non governmental organization called SALFA (Sampanasa Loteriana momba ny Fahasalamana) gave a new impulse. Since 1987, the SALFA has been seriously involved in the management of tuberculous patients. This document is a synthesis of actions conducted by SALFA whose experience in tuberculosis control is widely recognized by the Health Department and specially by the National Tuberculosis Control Program (NTCP). With an annual average of 1250 tuberculosis taken in charge, this NGO assumes 10% of the whole of the Program work. The diagnosis work is good (more than 85% Of PMT+) and therapeutic follow up of patients is excellent (more than 80% of the cured); those two elements of screening-treatment, basis of all tuberculosis control program incited us to describe this exemplary program.

Topics: Christianity; Health Services Research; Humans; Madagascar; Program Evaluation; Retrospective Studies; Treatment Outcome; Tuberculosis; Voluntary Health Agencies

The setting up of a new nationwide tuberculosis control programme allowed the creation of a National Mycobacteria Reference Laboratory. This latter originated from the small bacteriology laboratory of the antitubercular dispensary of the Institut d'Hygiène Sociale (IHS) and its activities increased tenfold within three years. Extension of rooms, a more numerous staff and the acquisition of a modern equipment explained those results. However, to carry out the tasks of such a laboratory a rapid modification of structures and a new job distribution facilitated by a cooperation with the Institut Pasteur de Madagascar are necessary.

Topics: Academies and Institutes; Bacteriology; Health Services Research; Humans; Laboratories; Madagascar; Organizational Objectives; Population Surveillance; Seasons; Tuberculosis

In 1991, the Laboratory of Mycobacteria was a small laboratory, part of the Clinical Biology Centre (CBC) of the Institut Pasteur de Madagascar: 656 pathological samples have been analysed for the account of the CBC and the National Control Programme activities. Within 4 years, the number of samples tested increased by more than threefold and the technical ability has evolved in an important way, specially for the identification and the antibiotic sensitivity testing. The scientific equipment have been modernized and the rooms surface increased by fourfold. In 1995, this laboratory was officially designated as the National Reference Laboratory for the culture, the identification and antibiogramme for the account of the National Control programme and for the private clinicians. It also participates to the tuberculosis research programmes of Institut Pasteur de Madagascar. It is associated to the Laboratory of Mycobacteria in the Institut d'Hygiène Sociale of Antananarivo which is the National Reference Laboratory for the bacilloscopy, the teaching and the supervision of the peripheral laboratories.

Topics: Academies and Institutes; Bacteriological Techniques; Bacteriology; Humans; Laboratories; Madagascar; Microbial Sensitivity Tests; Population Surveillance; Sputum; Tuberculosis

The authors describe on the basis of their own experience, the difficulties that may arise during the achievement of a nationwide survey of the Annual Risk of Tubercular Infection and the analysis of the results. They stress the need of a close methodology at all stages of the survey, from conception to analysis, in order to get reliable and comparative results.

Topics: Adolescent; Child; Child, Preschool; Data Interpretation, Statistical; Humans; Madagascar; Mass Screening; Population Surveillance; Reproducibility of Results; Research Design; Risk Factors; School Health Services; Tuberculin Test; Tuberculosis

Patient dropouts are one of the main concerns of tuberculosis programme in high prevalence countries. Perception of renunciation factors are generally weak or/and feeble from the part of agents working within programmes, while there are some a priori and confusions. This work proposes the setting up of a malagasy study, after the adequate definition of some hypothesis, then the writing of a survey form. The aim is to draw remedial behaviours and to make physicians and paramedical working close to tubercular patients, aware of the importance of a good mutual comprehension.

Topics: Attitude to Health; Humans; Madagascar; Patient Compliance; Patient Dropouts; Patient Education as Topic; Research Design; Retrospective Studies; Risk Factors; Surveys and Questionnaires; Tuberculosis

We describe the state of extrapulmonary tuberculosis in the capital of Antananarivo, a city of high endemicity for tuberculosis but very low endemicity for HIV infection. The Laboratory of Mycobacteria in the Institut Pasteur of Madagascar had examined from August 94 to April 95, 543 pathological samples issued from 295 patients clinically suspected of extrapulmonary tuberculosis (64% male and 36% female). The diagnosis of tuberculosis was confirmed for 47.7% of the patients (141/295), using either the culture technique or the histopathological method: 93% of them had an unique localization whereas 7% had a double localization. The most frequent form encountered was the pleural localization (77.8%), followed by the lymphadenopathic form (8,4%) and the abdominal form (6.9%). The confirmation rate on biopsies was 67% by histopathological method compared to 55% by the culture. On the fluid samples, the confirmation rate was 20.9% using the culture. The agreement between histology and culture was 70.3%. Of the 138 strains identified, 135 were M. tuberculosis, 1 M. bovis and 2 environmental mycobacteria.

Topics: Adolescent; Adult; Biopsy; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Madagascar; Male; Middle Aged; Mycobacterium bovis; Mycobacterium tuberculosis; Population Surveillance; Sputum; Tuberculosis; Urban Health

A 33 months retrospective study (from September 1992 to May 1995) of 8525 patients indicated that the incidence of histologic extrapulmonary tuberculosis (EPT) was 7,7%. The 8341 malagasy native patients presented an incidence of 7.8%. Male are more frequently infected than female. Most samples came from Antananarivo, with a prevalence reaching 12,5% while it was only 2,9% in the provinces. Most pathologic EPT were pleural tuberculosis (55,6%) and ganglial tuberculosis (34%). Peritoneal tuberculosis were much less frequent. According to literature data in Madagascar, the incidence of histologic EPT is obviously increasing.

Topics: Adolescent; Adult; Age Distribution; Aged; Biopsy; Child; Child, Preschool; Female; Humans; Incidence; Infant; Infant, Newborn; Madagascar; Male; Middle Aged; Population Surveillance; Prevalence; Retrospective Studies; Sex Distribution; Tuberculosis

In Madagascar, the estimated incidence of tuberculosis is high (320 per 100,000) when human immunodeficiency virus (VIH) infection progress slowly. The authors have studied HIV seroprevalence in a group of tubercular patients and in two reference groups (general population and outpatients of the Clinical Biology Centre of Institut Pasteur). Circulation of HIV1 virus was observed with a low prevalence rate in all the 3 groups. There was no significant difference between tubercular patients and healthy population. Tubercular people ought to be a watch group for the epidemiological surveillance of HIV infection evolution in Madagascar.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; AIDS-Related Opportunistic Infections; Child; Child, Preschool; Disease Notification; Female; HIV Seroprevalence; HIV-1; Humans; Infant; Madagascar; Male; Middle Aged; Retrospective Studies; Sentinel Surveillance; Seroepidemiologic Studies; Tuberculosis

Topics: AIDS Serodiagnosis; Female; HIV Infections; Humans; Madagascar; Pregnancy; Pregnancy Complications, Infectious; Seroepidemiologic Studies; Syphilis; Syphilis Serodiagnosis; Tuberculosis

Topics: Community Health Services; Economics; Health Workforce; Humans; Madagascar; Mass Screening; Tuberculosis