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Search Results: 1 - 10 of 41173 matches for " Michel Van Herp "
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Mortality, violence and access to care in two districts of Port-au-Prince, Haiti
Frédérique Ponsar, Nathan Ford, Michel Van Herp, Silvia Mancini, Catherine Bachy
Conflict and Health , 2009, DOI: 10.1186/1752-1505-3-4
Abstract: A cross-sectional, random-sample survey among the conflict-affected populations living in Cité Soleil and Martissant was carried out over a 4-week period in 2006 using a semi-structured questionnaire to assess exposure to violence and access to health care. Household heads from 945 households (corresponding to 4,763 people) in Cité Soleil and 1,800 household (9,539 people) in Martissant provided information on household members. The average recall period was 579 days for Cité Soleil and 601 days for Martissant.In Cité Soleil 120 deaths (21 children) were reported (CMR 0.4 deaths/10,000 people/day; <5 MR 0.5 deaths/10,000/day) while in Martissant 165 deaths (8 children) were reported (CMR 0.3/10,000 people/day; <5 MR 0.2/10,000 people/day). Violence was reported as the main cause of adult mortality in both locations (mainly gunshot wounds) accounting for 29.2% of deaths in Cité Soleil and 23% of deaths in Martissant. 22.9% of families in Cité Soleil and 18.6% in Martissant reported at least one victim of violence. Destruction of property and belongings was common in both Cité Soleil (52.4% of families) and Martissant (14.9%). Access to health services was limited, with 11% (22/196) of victims of violence in Cité Soleil and 23% (49/212) in Martissant unable to access care due to insecurity or lack of money.Extrapolating to the total population of these two districts some 2,000 violent deaths occurred over the recall period. Among the survivors, violence had lasting effects in terms of physical and mental health and loss of property and possessions.Haiti is one of the poorest countries in the Northern hemisphere, with more than half its 8.5 million population living on less than $US1 per day [1]. The country has been ravaged by political violence for most of its history. The most recent wave of violence broke out in February 2004, following an armed insurrection that overthrew Jean-Bertrand Aristide, then president of Haiti. French and American forces, mandated by the
Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation
Sophie Lambert-Evans, Frederique Ponsar, Tony Reid, Catherine Bachy, Michel Van Herp, Mit Philips
International Journal for Equity in Health , 2009, DOI: 10.1186/1475-9276-8-36
Abstract: An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection was through a cross-sectional household survey of the catchment areas of 10 public health centres. A questionnaire was used to determine the accuracy of the community-identification method, households' access to health care, and costs of care. Household socioeconomic status was determined by reported expenditures and access to land.Financial access to care at the nearest health centre was ensured for 70% of the population. Of the remaining 30%, half experienced financial barriers to access and the other half chose alternative sites of care. The community-based assessment increased the number of people of the population who qualified for fee exemptions to 8.6% but many people who met the indigent criteria did not receive a card. Eighty-eight percent of the population lived under the poverty threshold. Referring to the last sickness episode, 87% of households reported having no money available and 25% risked further impoverishment because of healthcare costs even with the financial support system in place.The flat fee policy was found to reduce cost barriers for some households but, given the generalized poverty in the area, the fee still posed a significant financial burden. This report showed the limits of a programme of fee exemption for indigent households and a flat fee for others in a context of widespread poverty.Although the political situation in Burundi has now stabilised, the civil conflict of 1993-2003 deeply affected the country's inhabitants and infrastructure, particularly the health care system. In order to help rebuild the system, a countrywide cost recovery was implemented in 2002 along with a national policy where the communal authorities were supposed to issue exemption certificates for the poorest who could not afford health care costs [1]. Despite this plan, significant financial barriers to access health care continued to exist. A Save the Childre
Forecasting malaria incidence based on monthly case reports and environmental factors in Karuzi, Burundi, 1997–2003
Alberto Gomez-Elipe, Angel Otero, Michel van Herp, Armando Aguirre-Jaime
Malaria Journal , 2007, DOI: 10.1186/1475-2875-6-129
Abstract: The study was carried out in Karuzi, a province in the Burundi highlands, using time series of monthly notifications of malaria cases from local health facilities, data from rain and temperature records, and the normalized difference vegetation index (NDVI). Using autoregressive integrated moving average (ARIMA) methodology, a model showing the relation between monthly notifications of malaria cases and the environmental variables was developed.The best forecasting model (R2adj = 82%, p < 0.0001 and 93% forecasting accuracy in the range ± 4 cases per 100 inhabitants) included the NDVI, mean maximum temperature, rainfall and number of malaria cases in the preceding month.This model is a simple and useful tool for producing reasonably reliable forecasts of the malaria incidence rate in the study area.Each year malaria affects over 100 million persons worldwide, with an annual cost in human life exceeding one million deaths, mainly children under five years of age in sub-Saharan Africa [1]. The number of disability-adjusted life years due to malaria, a measure of disease burden, was estimated at 46,486,000 for 2002, 87.8% of which was in sub-Saharan Africa [2]. Because of its strong epidemic potential, malaria continues to be an important public health problem in communities in semi-arid areas and in the highlands of Africa. These populations are exposed to factors that strongly influence the origin and magnitude of malaria epidemics, such as weakened immunity of the population associated with famine and massive displacements, failures of control measures and epidemiologic disease surveillance, and unstable environmental factors such as rainfall, temperature and vegetation [3]. There exist settings where malaria behaves as endemic malaria and other ones where it does as epidemic malaria. The attack rate and the case fatality rate of the malaria epidemics are also related with the level of partial immunity to malaria due to the previous exposition of the population to t
Vector control in a malaria epidemic occurring within a complex emergency situation in Burundi: a case study
Natacha Protopopoff, Michel Van Herp, Peter Maes, Tony Reid, Dismas Baza, Umberto D'Alessandro, Wim Van Bortel, Marc Coosemans
Malaria Journal , 2007, DOI: 10.1186/1475-2875-6-93
Abstract: Twenty nine hills (administrative areas) were selected in collaboration with the provincial health authorities for the vector control interventions combining indoor residual spraying with deltamethrin and insecticide-treated nets. Impact was evaluated by entomological and parasitological surveys. Almost all houses (99%) were sprayed and nets use varied between 48% and 63%. Anopheles indoor resting density was significantly lower in treated as compared to untreated hills, the latter taken as controls. Despite this impact on the vector, malaria prevalence was not significantly lower in treated hills except for people sleeping under a net.Indoor spraying was feasible and resulted in high coverage despite being a logistically complex intervention in the Burundian context (scattered houses and emergency situation). However, it had little impact on the prevalence of malaria infection, possibly because it was implemented after the epidemic's peak. Nevertheless, after this outbreak the Ministry of Health improved the surveillance system, changed its policy with introduction of effective drugs and implementation of vector control to prevent new malaria epidemics.In the absence of effective drugs and sufficient preparedness, present study failed to demonstrate any impact of vector control activities upon the course of a short-duration malaria epidemic. However, the experience gained lead to increased preparedness and demonstrated the feasibility of vector control measures in this specific context.Malaria epidemics are a growing problem in the African highlands with devastating effects on their immunologically naive population [1,2]. When occurring during complex emergency situations their control is even more difficult. According to WHO [3] "a complex emergency is a situation that affects large civilian populations with war or civil strife, food shortages and population displacement, resulting in excess mortality and morbidity". The approach to malaria control in the acute ph
Spatial targeted vector control in the highlands of Burundi and its impact on malaria transmission
Natacha Protopopoff, Wim Van Bortel, Tanguy Marcotty, Michel Van Herp, Peter Maes, Dismas Baza, Umberto D'Alessandro, Marc Coosemans
Malaria Journal , 2007, DOI: 10.1186/1475-2875-6-158
Abstract: In Karuzi, in 2002–2005, vector control activities combining indoor residual spraying and long-lasting insecticidal nets were implemented. The interventions were done before the expected malaria transmission period and targeted the valleys between hills, with the expectation that this would also protect the populations living at higher altitudes. The impact on the Anopheles population and on malaria transmission was determined by nine cross-sectional surveys carried out at regular intervals throughout the study period.Anopheles gambiae s.l. and Anopheles funestus represented 95% of the collected anopheline species. In the valleys, where the vector control activities were implemented, Anopheles density was reduced by 82% (95% CI: 69–90). Similarly, transmission was decreased by 90% (95% CI: 63%–97%, p = 0.001). In the sprayed valleys, Anopheles density was further reduced by 79.5% (95% CI: 51.7–91.3, p < 0.001) in the houses with nets as compared to houses without them. No significant impact on vector density and malaria transmission was observed in the hill tops. However, the intervention focused on the high risk areas near the valley floor, where 93% of the vectors are found and 90% of the transmission occurs.Spatial targeted vector control effectively reduced Anopheles density and transmission in this highland district. Bed nets have an additional effect on Anopheles density though this did not translate in an additional impact on transmission. Though no impact was observed in the hilltops, the programme successfully covered the areas most at risk. Such a targeted strategy could prevent the emergence and spread of an epidemic from these high risk foci.Malaria epidemics occur frequently in the African highlands [1-3]. Their control is a priority and a specific plan of action was adopted by the African leaders during the 2000 Abuja summit [4]. An early warning system to increase malaria epidemic preparedness and prevention has been promoted, based on climate data, p
Varying efficacy of artesunate+amodiaquine and artesunate+sulphadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in the Democratic Republic of Congo: a report of two in-vivo studies
Maryline Bonnet, Ingrid van den Broek, Michel van Herp, Pedro Urrutia, Chantal van Overmeir, Juliet Kyomuhendo, Célestin Ndosimao, Elizabeth Ashley, Jean-Paul Guthmann
Malaria Journal , 2009, DOI: 10.1186/1475-2875-8-192
Abstract: The results of two in vivo efficacy studies, which tested AQ and sulphadoxine-pyrimethamine (SP) monotherapies and AS+SP and AS+AQ combinations in Boende (Equatorial province), and AS+SP, AS+AQ and SP in Kabalo (Katanga province), between 2003 and 2004 are presented. The methodology followed the WHO 2003 protocol for assessing the efficacy of anti-malarials in areas of high transmission.Out of 394 included patients in Boende, the failure rates on day 28 after PCR-genotyping adjustment of AS+SP and AS+AQ were estimated as 24.6% [95% CI: 16.6–35.5] and 15.1% [95% CI: 8.6–25.7], respectively. For the monotherapies, failure rates were 35.9% [95% CI: 27.0–46.7] for SP and 18.3% [95% CI: 11.6–28.1] for AQ. Out of 207 patients enrolled in Kabalo, the failure rate on day 28 after PCR-genotyping adjustment was 0 [1-sided 95% CI: 5.8] for AS+SP and AS+AQ [1-sided 95% CI: 6.2]. It was 19.6% [95% CI: 11.4–32.7] for SP monotherapy.The finding of varying efficacy of the same combinations at two sites in one country highlights one difficulty of implementing a uniform national treatment policy in a large country. The poor efficacy of AS+AQ in Boende should alert the national programme to foci of resistance and emphasizes the need for systems for the prospective monitoring of treatment efficacy at sentinel sites in the country.The Democratic Republic of Congo (DRC) is a vast country covering more than two million square kilometres and with an estimated population of 60 million people. In 2006, the malaria case fatality rate in children below five years of age was 0.61 [1]. Very few evaluations of the efficacy of artemisinin-based combinations have been conducted in DRC. In 2004, one study presented day 28 PCR genotyping-adjusted failure rates of 19.7% for artesunate+sulphadoxine-pyrimethamine (AS+SP) and 6.7% for AS+amodiaquine (AS+AQ) in South Kivu province [2]. Another study conducted in Rutshuru, a district near the Rwandan border in Eastern DRC, reported day 14 PCR- unadjusted c
Clinical Manifestations and Case Management of Ebola Haemorrhagic Fever Caused by a Newly Identified Virus Strain, Bundibugyo, Uganda, 2007–2008
Paul Roddy, Natasha Howard, Maria D. Van Kerkhove, Julius Lutwama, Joseph Wamala, Zabulon Yoti, Robert Colebunders, Pedro Pablo Palma, Esther Sterk, Benjamin Jeffs, Michel Van Herp, Matthias Borchert
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0052986
Abstract: A confirmed Ebola haemorrhagic fever (EHF) outbreak in Bundibugyo, Uganda, November 2007–February 2008, was caused by a putative new species (Bundibugyo ebolavirus). It included 93 putative cases, 56 laboratory-confirmed cases, and 37 deaths (CFR = 25%). Study objectives are to describe clinical manifestations and case management for 26 hospitalised laboratory-confirmed EHF patients. Clinical findings are congruous with previously reported EHF infections. The most frequently experienced symptoms were non-bloody diarrhoea (81%), severe headache (81%), and asthenia (77%). Seven patients reported or were observed with haemorrhagic symptoms, six of whom died. Ebola care remains difficult due to the resource-poor setting of outbreaks and the infection-control procedures required. However, quality data collection is essential to evaluate case definitions and therapeutic interventions, and needs improvement in future epidemics. Organizations usually involved in EHF case management have a particular responsibility in this respect.
Assessing Antimalarial Efficacy in a Time of Change to Artemisinin-Based Combination Therapies: The Role of Médecins Sans Frontières
Jean-Paul Guthmann ,Francesco Checchi,Ingrid van den Broek,Suna Balkan,Michel van Herp,Eric Comte,Oscar Bernal,Jean-Marie Kindermans,Sarah Venis,Dominique Legros,Philippe J Guerin
PLOS Medicine , 2008, DOI: 10.1371/journal.pmed.0050169
Abstract:
Different methodological approaches to the assessment of in vivo efficacy of three artemisinin-based combination antimalarial treatments for the treatment of uncomplicated falciparum malaria in African children
Elizabeth A Ashley, Loretxu Pinoges, Eleanor Turyakira, Grant Dorsey, Francesco Checchi, Hasifa Bukirwa, Ingrid van den Broek, Issaka Zongo, Pedro Urruta, Michel van Herp, Suna Balkan, Walter R Taylor, Piero Olliaro, Jean-Paul Guthmann
Malaria Journal , 2008, DOI: 10.1186/1475-2875-7-154
Abstract: Data from different in vivo studies of ACT treatment of uncomplicated falciparum malaria were combined in a single database. Efficacy at day 28 corrected by PCR genotyping was estimated using four methods. In the first two methods, failure rates were calculated as proportions with either (1a) reinfections excluded from the analysis (standard WHO per-protocol analysis) or (1b) reinfections considered as treatment successes. In the second two methods, failure rates were estimated using the Kaplan-Meier product limit formula using either (2a) WHO (2001) definitions of failure, or (2b) failure defined using parasitological criteria only.Data analysed represented 2926 patients from 17 studies in nine African countries. Three ACTs were studied: artesunate-amodiaquine (AS+AQ, N = 1702), artesunate-sulphadoxine-pyrimethamine (AS+SP, N = 706) and artemether-lumefantrine (AL, N = 518).Using method (1a), the day 28 failure rates ranged from 0% to 39.3% for AS+AQ treatment, from 1.0% to 33.3% for AS+SP treatment and from 0% to 3.3% for AL treatment. The median [range] difference in point estimates between method 1a (reference) and the others were: (i) method 1b = 1.3% [0 to24.8], (ii) method 2a = 1.1% [0 to21.5], and (iii) method 2b = 0% [-38 to19.3].The standard per-protocol method (1a) tended to overestimate the risk of failure when compared to alternative methods using the same endpoint definitions (methods 1b and 2a). It either overestimated or underestimated the risk when endpoints based on parasitological rather than clinical criteria were applied. The standard method was also associated with a 34% reduction in the number of patients evaluated compared to the number of patients enrolled. Only 2% of the sample size was lost when failures were classified on the first day of parasite recurrence and survival analytical methods were used.The primary purpose of an in vivo study should be to provide a precise estimate of the risk of antimalarial treatment failure due to drug res
Disentangling the dynamic core: a research program for a neurodynamics at the large-scale
LE VAN QUYEN,MICHEL;
Biological Research , 2003, DOI: 10.4067/S0716-97602003000100006
Abstract: my purpose in this paper is to sketch a research direction based on francisco varela's pioneering work in neurodynamics (see also rudrauf et al. 2003, in this issue). very early on he argued that the internal coherence of every mental-cognitive state lies in the global self-organization of the brain activities at the large-scale, constituting a fundamental pole of integration called here a "dynamic core". recent neuroimaging evidence appears to broadly support this hypothesis and suggests that a global brain dynamics emerges at the large scale level from the cooperative interactions among widely distributed neuronal populations. despite a growing body of evidence supporting this view, our understanding of these large-scale brain processes remains hampered by the lack of a theoretical language for expressing these complex behaviors in dynamical terms. in this paper, i propose a rough cartography of a comprehensive approach that offers a conceptual and mathematical framework to analyze spatio-temporal large-scale brain phenomena. i emphasize how these nonlinear methods can be applied, what property might be inferred from neuronal signals, and where one might productively proceed for the future. this paper is dedicated, with respect and affection, to the memory of francisco varela.
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