RESUMEN
The failure of programs implemented to improve public health in the world, the poor performance of health care systems, and the difficulty in anticipating and reacting to emerging disease suggest that a more global approach to individual and community health problems is needed. Risk and disease must be correlated in space and time based on precise identification of their respective determinants, predictive factors, preventive targets, and diagnostic and prognostic indicators. For this purpose it could be useful to revive the pathogenic complex concept defined by the geographer Maximillien Sorre in 1933 in the light of new tools allowing better identification of biologic determinants (molecular genetics), of environmental factors (geographic information systems), and of behavior related to health care service activities. This concept could be used to place disease threats in a global context and to assess the consequences of current upheavals such as globalization of populations and products, exploding demographics, rapid urbanization, deforestations, rapid changes in behavior, and health care systems that can lead to both good and bad effects.
Asunto(s)
Sistemas de Información Geográfica , Control de Infecciones , Salud Pública , Medicina Tropical/tendencias , Enfermedades Transmisibles , Diagnóstico Diferencial , Salud Global , Humanos , Cooperación Internacional , Pronóstico , Factores de RiesgoRESUMEN
In Togo, chloroquine (CQ) remains the first-line drug for the treatment of uncomplicated, Plasmodium falciparum malaria. In the absence of recent data on the level of parasite resistance to antimalarial drugs, Togo's National Malaria Control Programme (NMCP) decided to assess the current efficacy of CQ in the treatment of uncomplicated, P. falciparum malaria at three sentinel sites in the north of the country. Between the September and November of 2001, the World Health Organization's standard 14-day protocol was used to investigate 153 malarious children aged 6-59 months old (46 from Sokode, 54 from Niamtougou and 53 from Dapaong). Of the subjects from Sokode, Niamtougou and Dapaong, early treatment failure was observed in 0%, 7% and 12%, late treatment failure in 0%, 11% and 17%, and overall parasitological failure in 0%, 45% [with a 95% confidence interval (CI) of 39%-51%] and 62% (CI=54%-70%), respectively. Even within northern Togo, there is clearly considerable geographical variation in the level of resistance to CQ. Before an efficient antimalarial-drug policy can be developed, there is an urgent need to develop and use the national surveillance system further, to collect relevant data on the efficacies of CQ and other antimalarial drugs, such as amodiaquine and sulfadoxine-pyrimethamine.