BACKGROUND: Enterobacter cloacae causes nosocomial infections in 15% of patients in low- and middle-income countries with emergence of carbapenem resistance. The utilisation of bacteriophages for therapeutic purposes is crucial for eradicating these resistant bacterial strains. OBJECTIVE: This study evaluated the efficacy of lytic phages on bacterial isolates of E. cloacae and determined their stability in various physicochemical conditions. METHODS: Twenty-nine lytic phages were isolated from the waste water of six informal settlements in Nairobi County, Kenya, from July 2019 to December 2020 and cross-reacted with 30 anonymised clinical isolates of E. cloacae. Six phages were then selected for physicochemical property studies. Phages were described as potent upon lysing any bacterial strain in the panel. RESULTS: Selected phages were stable at 4 °C - 50 °C with a 5.1% decrease in titre in four of six phages and a 1.8% increase in titre in two of six phages at 50 °C. The phages were efficient following two weeks incubation at 4 °C with optimal activity at human body temperature (37 °C) and an optimal pH of 7.5. Phages were active at 0.002 M and 0.015 M concentrations of Ca2+ ions. The efficiency of all phages decreased with increased exposure to ultraviolet light. All phages (n = 29) showed cross-reactivity against anonymised clinical isolates of E. cloacae strains (n = 30). The most potent phage lysed 67.0% of bacterial strains; the least potent phage lysed 27.0%. CONCLUSION: This study reveals the existence of therapeutic phages in Kenya that are potent enough for treatment of multi-drug resistant E. cloacae.

Abstract Hypertension (HTN) is a prevalent disease. A 30% of the population is unaware of having HTN and 65% of patients with HTN have a poor control. There is no standardized way to diagnose HTN in the inpatient set ting. This is why the focus on this population, both for the diagnosis of HT and for the detection of poor control, is relevant. It was a cross sectional study of hospitalized adult patients (>18 years old) for clinical causes, in 2017. Hypertensive emergencies were excluded. Elevated blood pressure (EBP) was defined as the registry of SBP ≥ 140 and / or DBP ≥ 90 mmHg on two or more occasions, on two different days, measured through a sphygmomanometer, and/or one-time indication of antihypertensive medication. A total of 2203 patients were included. Median age: 73 years (IIQ 25-75%: 56-86). Women: 55% (1203). Median days of hospitalization: 5 (IIQ 25-75% 4-9). A 58% of them were known hypertensive. The prevalence of EBP was 7.6% [168, 95% CI 6.6-8.8], of which 12.5% (21) were unaware of having HTN. Compared to patients without EBP, the mean SBP and DBP were higher, they were older (77 vs. 73 years, p < 0.001), had higher rates of chronic kidney disease (21% vs. 12% p < 0.001), stroke (15% vs. 10% p = 0.035) and HTN (87% vs. 56% p < 0.001). They had more events of heart failure (8% vs. 3%, p <0.001) and stroke (3.6% vs. 1.2%, p = 0.02) during hospitalization. The prevalence of EBP was lower compared to previous studies. We observed an association between cardiovascular events and EBP.

Resumen La hipertensión arterial (HTA) es una enfermedad prevalente. El 30% de la población desconoce su diagnóstico y el 65% tiene un mal control. No existe actualmente una forma estandarizada de diagnosticar HTA en internados. Es por esto que el enfoque en poblaciones tales como pacientes internados, tanto para el diagnóstico de HTA como para la detección de un pobre control, resulta relevante. Se trata de un estudio de corte transversal de pacientes adultos internados (> 18 años) por diversas causas clínicas, en 2017. Se excluyeron emergencias hipertensivas. Se definió presión arterial elevada (PAe) al registro de presión sistólica ≥ 140 y/o diastólica ≥ 90 mmHg en dos o más oportunidades, en días de internación distintos, medidas a través de un esfingomanómetro, y/o por indicación de rescate de antihipertensivos. Se incluyeron 2203 pacientes. Mediana de edad: 73 años (IIQ 25-75%: 56-86). Mujeres: 55% (1203). Mediana de días de internación: 5 (IIQ 25-75% 4-9). El 58% era hipertenso conocido. La prevalencia de PAe fue del 7.6% [168, IC 95% 6.6-8.8], del que 12.5%(21) no se conocían hipertensos. Comparado con los pacientes sin PAe, la media de presión sistólica y diastólica fue mayor, tenían mayor edad en años (77 vs. 73, p < 0.001), más antecedente de enfermedad renal crónica (21% vs. 12% p < 0,001), ACV (15% vs. 10% p = 0.035) y HTA (87% vs. 56% p < 0.001). También presentaron más eventos de insuficiencia cardíaca (8% vs. 3%, p<0.001) y ACV (3.6% vs. 1.2%, p = 0.02) en internación. La prevalencia de PAe fue menor respecto a estudios previos. Observamos una asociación entre eventos cardiovasculares y presión arterial elevada.

RESUMONo presente estudo, foram coletadas amostras endometriais de 14 vacas Nelore nos dias zero (dia da ovulação), cinco, nove, 13 e 19 do ciclo estral (grupo controle), e em 15 fêmeas essas coletas não foram realizadas (grupo controle). As biópsias foram realizadas no corno uterino contralateral ao ovário contendo o corpo lúteo. Amostras plasmáticas foram coletadas nos momentos -24, -16, -8, 0 +8, +16 e +24 horas em relação à queda de progesterona (<1ng/mL, momento zero) e avaliadas quanto à concentração de 13, 14-di-hidro-15-ceto prostaglandina F2-alpha (PGFM) por radioimunoensaio (RIA). As concentrações plasmáticas de progesterona foram avaliadas a cada 24 horas também por RIA. Os dados foram analisados por ANOVA empregando-se PROC GLM e MIXED do SAS. O valor médio de PGFM durante todo o período avaliado foi maior no grupo biópsia. A concentração média de PGFM no momento zero não diferiu entre os grupos, e foi maior no grupo biópsia antes e após a queda de progesterona. A concentração máxima observada não foi diferente entre os grupos, porém a concentração mínima diferiu com maiores valores observados no grupo biópsia. Embora as concentrações de PGFM fossem maior no grupo biópsia, ambos os grupos apresentaram o mesmo comprimento do ciclo estral, demonstrando que a coleta repetitiva de biópsias endometriais no corno uterino contraletral ao ovário contendo o corpo lúteo não afeta a luteólise e o comprimento do ciclo estral.

ABSTRACTIn this study, endometrial samples were collected in 14 Nelore cows on days zero (ovulation), five, nine, thirteen and nineteen of the estrous cycle (biopsy group), and in 15 females these collections weren't performed (control group). Biopsies were done on the uterine horn endometrium contralateral to the ovary with corpus luteum. Blood samples were taken at -24, -16, -8, 0 +8, +16 and +24 hours in relation to progesterone drop (<1ng/mL, zero moment) and evaluated for 13, 14-dihydro-15-keto prostaglandin F2-alpha (PGFM) by radioimmunoassay (RIA). Plasma progesterone concentration was determined by RIA every 24 hours. Data were analyzed by ANOVA using the PROC GLM and MIXED of the SAS. The mean value for PGFM during the entire period evaluated was greater in the biopsy group. The mean concentration of PGFM at moment zero was not different between the groups; the mean concentration of PGFM was higher in the biopsy group before and after the drop in progesterone level. The maximum mean concentration observed was not different between the groups; however, the mean minimum concentration was different with high values in the biopsy group. Although the PGFM concentrations were higher in the biopsy group, the biopsy and control groups had similar length of estrous cycle showing that repeated endometrial biopsy on the side contralateral to the ovary with corpus luteum does not affect luteolysis and the length of the estrous cycle.

Analisou-se a piometra de 31 cadelas, de raças e idades variadas, sendo 25 cadelas com piometra de cérvice aberta e seis de cérvice fechada. Após ovariossalpingo-histerectomia, foram coletados fragmentos da cérvice e do útero para a avaliação imunoistoquímica. Foram analisados os receptores de estrógenos α e β, progesterona e colágenos I e III. Foram realizadas imunomarcações em diferentes regiões da cérvice, como o epitélio glandular, o epitélio luminal e o estroma glandular, assim como em diferentes regiões do útero, como o epitélio glandular e o estroma glandular. As imunomarcações de colágenos I e III foram realizadas nas regiões glandular e muscular da cérvice e do útero. Concentrações de receptores de progesterona foram maiores em cadelas com piometra fechada.

The pyometra in 31 bitches of different breeds and ages, 25 with pyometra cervix open and 6 closed cervix was analyzed. After the ovariohysterectomy procedure, samples were collected from the cervix and uterus to evaluate immunohistochemistry. For immunohistochemical evaluation estrogen receptors α and β, progesterone and collagen I and III were analyzed. Immunostainings were performed in different regions of the cervix such as glandular epithelium, luminal epithelium and glandular stroma, as well as in different regions of the uterus, such as glandular epithelium and glandular stroma. The immunostainings for collagen I and III were performed in muscular and glandular regions of the cervix and uterus. The concentration the progesterone receptors were elevated in bitches from the closed pyometra.

High production levels achieved in animal exploitation is due largely to the selection work that has developed in the main species of economic interest. The use of the molecular information in the programs of assisted selection has opened a big field in the animal improvement. The methodology for the simultaneous genoptyping of the genes that encode the six major milk proteins, growth hormone and bovine prolactin is described. Three techniques were used for genotyping: restriction enzyme digestion, sequencing and minisequencing to determine SNPs (Single Nucleotide Polymorphisms), where the first two were used as control to the Results of minisequencing. This latter methodology enables the automation of analysis, simultaneous work with several samples and ten or more markers in a single reaction. It was found that the genes encoding for αs2-casein and prolactin behaved as monomorphic. For the αs1-casein the alleles B and C were identified; in the β-casein the alleles A and B were identified; on the other hand for the kcasein the alleles A and B were the observed ones. In the a-lactoalbumin and β-lactoglobulin the alleles A and B were identified, moreover for the growth hormone, alleles L and V were observed. In all cases the most frequent alleles are the described ones. It was confirmed that the minisequencing technique simplifies the analysis and it is useful for the molecular characterization focused a future targeted molecular markerassisted selection.

Los altos niveles de producción alcanzados en la explotación animal se deben en gran medida al trabajo de selección que se ha desarrollado en las principales especies de interés económico. El empleo de la información molecular en los programas de selección asistida ha abierto un amplio campo en la mejora animal. Se describe la metodología empleada para el genotipado simultáneo de los genes que codifican para las seis principales proteínas lácteas, la hormona del crecimiento y prolactina bovinas. Fueron utilizadas tres técnicas para el genotipado: digestión con enzimas de restricción, secuenciación y minisecuenciación para determinar SNPs (Single Nucleotide Polymorphisms), donde las dos primeras se usaron como control de los resultados obtenidos por minisecuenciación. Esta última metodología permite la automatización del análisis, el trabajo simultáneo con varias muestras y 10 o más marcadores en una sola reacción. Se observó que los genes que codifican para αs2-caseína y prolactina se comportaron monomórficos. Para la as1-caseína se identificaron los alelos B y C; en la β-caseína se identificaron los alelos A y B; por otra parte para la k-caseína fueron los alelos A y B los observados. En la α-lactoalbúmina y β-lactoglobulina se identificaron los alelos A y B, mientras que para la hormona del crecimiento se observaron los alelos L y V. En todos los casos resultaron ser los alelos que con mayor frecuencia se describen. Se corroboró que la técnica de minisecuenciación simplifica el análisis y es útil en la caracterización molecular dirigida a una futura selección asistida por marcadores.

Foram utilizadas 24 vacas Nelore P.O., em anestro pós-parto, diagnosticado pelo histórico reprodutivo, por avaliações ultrassonográficas transretais e por dosagem de progesterona plasmática, que foram submetidas à colheita de fragmento uterino via transcervical. Os animais foram divididos em dois grupos conforme o máximo diâmetro folicular: grupo 1: folículos <6mm (n=12); grupo 2: folículos >6mm (n=12). Para avaliar receptor de estrógeno e receptor de progesterona no epitélio glandular e no estroma, foi utilizada a técnica de imunoistoquímica. Altas contagens relativas e alta intensidade de marcação para receptor de estrógeno e progesterona no epitélio glandular e no estroma foram observadas nos dois grupos. No entanto, a intensidade de marcação para o receptor de progesterona no epitélio glandular foi mais alta no grupo 2 comparado ao grupo 1. Quando o epitélio glandular e o estroma foram comparados, o número relativo de receptor de estrógeno no grupo 1 foi mais alto no epitélio glandular comparado ao estroma, e a intensidade de marcação para o receptor de progesterona no grupo 2 foi mais alta no epitélio glandular comparado ao estroma. Os resultados sugerem que os mecanismos que controlam a expressão de receptores no anestro são semelhantes aos observados durante o ciclo estral.

Twenty-four postpartum anestrous Nelore purebred cows were used in the study. Anestrous was determined based on the reproductive history which was confirmed in each cow based on plasma progesterone concentration and by transrectal ultrasonography. Endometrial biopsies were collected. The animals were separated into two groups according to maximum follicular diameter- Group 1: follicles <6mm (n=12) and Group 2: follicles >-6mm follicles (n=12). The immunohistochemistry technique was employed to evaluate the presence of estrogen and progesterone receptors in the uterine glandular epithelium and stroma. High counts of positive nuclei and high intensity of immunostain for estrogen and progesterone receptors in the glandular epithelium and stroma were observed in the two groups. However, the immunostain intensity of progesterone receptors in the glandular epithelium was higher in Group 2 compared to Group 1. When glandular epithelium and stroma were compared within each group, the relative number of estrogen receptors in the Group 1 was higher in the glandular epithelium compared to stroma and the immunostain intensity for the progesterone receptor in Group 2 was higher in the glandular epithelium compared to stroma. The results suggest that the mechanisms that control the expression of endomerial receptors in the anestrus are similar to the ones observed during the estrus cycle.

Introduction We report our early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC) and evaluate the efficacy, tolerability and complicactions. Material and methods Retrospective review of patients treated in our hospital with kidney ecoguide RF. All of them diagnosed with renal tumor and not candidates for surgery because of bilateral tumor, significant comorbidity or refusal to surgical treatment. We use an Amitech® 220 Watts generator with an electrode tip 3cm. Straight knitting needles and hooks. Controls were performed with axial tomography at 24h, 7 days, 1, 3 and 6 months and every 6 months thereafter. Results 11 tumors, 9 patients. The mean age was 76 years (63-85 years). The average tumor size was 3.5cm (2,2-5,8cm). In 2 tumors was needed prior chemoembolization. In other two new RF session was needed. 9 tumors with treatment considered effective. Mean follow-up was 17.5 months (3-52 months). One patient had local recurrence at 14 months and needed a laparoscopic radical nephrectomy and two patients developed lung metastases 41.5 months after RF. There were no clinically relevant complications. Conclusions In our experience, we believe that RF is considered an alternative treatment for renal tumors with clinical stage T1 or T2 very symptomatic in patients in whom surgery is not possible, with acceptable results in the medium term, a good tolerance, reduced consumption of hospital resources and low complication rate.

Introducción: Presentamos nuestra serie inicial de tumores renales tratados mediante radiofrecuencia (RF) continua percutánea y evaluamos la eficacia, la tolerabilidad y las complicaciones de la técnica. Material y métodos: Revisión retrospectiva de los pacientes tratados en nuestro hospital con RF renal ecoguiada. Todos diagnosticados de tumor renal y no candidatos a cirugía por tumor bilateral, comorbilidad importante o rechazo al tratamiento quirúrgico. Utilizamos un generador Amitech® de 220W con una punta de electrodo de 3cm, agujas de punta recta y en gancho. Los controles fueron realizados mediante una tomografía computarizada toracoabdominopélvica a las 24h, a los 7 días, al mes, a los 3 meses y a los 6 meses, y cada 6 meses después. Resultados: Se hallaron 11 tumores en 9 pacientes. La media de edad fue de 76 años (63-85). La media de tamaño tumoral fue de 3,5cm (2,2-5,8). En 2 tumores se necesitó de quimioembolización previa y en otros dos se necesitó una nueva sesión de RF. Hubo 9 tumores con tratamiento considerado como eficaz. La media de seguimiento fue de 17,5 meses (3-52). Un paciente tuvo persistencia de enfermedad a los 3 meses con necesidad de nefrectomía radical laparoscópica y otros dos tuvieron metástasis pulmonares a los 26,5 meses de media. No hubo complicaciones relevantes clínicamente. Conclusiones: En nuestra experiencia, estimamos que la RF es un tratamiento considerado como una alternativa para los tumores renales de estadio clínico T1 o T2 muy sintomáticos, en pacientes en los que no es posible la cirugía, con unos resultados aceptables a medio plazo, una buena tolerancia, un escaso consumo de recursos hospitalarios y un bajo índice de complicaciones.

ABSTRACT White spot syndrome virus (WSSV) causes high mortality to farmed shrimp and serious economic losses. Its unique sequence and genome structure has placed WSSV in its own new family Nimaviridae. Recently, high performance molecular techniques have made it possible to identify and characterize several WSSV structural proteins. These include `shotgun' sequencing and isobaric tags for relative and absolute quantification (iTRAQ). Such techniques have made it possible to characterize 14 new WSSV proteins. Location and characterization of structural proteins can help to understand WSSV morphogenesis and pathogenesis. Both processes are essential to understand the mechanism of infection and to develop novel control methods. At present no effective treatments exist to fight WSSV in the field. WSSV structural proteins such as VP28 and VP19 have been evaluated to reduce the impact of WSSV. These molecules are essential early in the infection. Neutralization assays using specific antibodies against WSSV structural proteins have shown an increased survival of treated shrimp. Recently, RNA interference (RNAi) constructs directed against structural proteins have been used as a new tool to reduce/inhibit WSSV replication. A better comprehension of the host-pathogen interaction would allow the development of new methods to control WSSV. The use of high throughput techniques to determine the location and function of structural proteins will contribute to develop new strategies against infection. Intervention strategies aimed to block virus entry into the host cells may be a valuable output from these studies.

RESUMEN El virus del síndrome de mancha blanca (WSSV) provoca graves mortandades en granjas de cultivo de camarones peneidos y serias pérdidas económicas. La secuencia y estructura genética excepcionales de WSSV lo colocan en su propia nueva familia, Nimaviridae. Recientemente, novedosas técnicas moleculares de alto rendimiento han permitido identificar y caracterizar varias proteínas estructurales de WSSV. Estas incluyen la secuenciación por `shotgun' y marcadores isobáricos para cuantificación absoluta y relativa (iTRAQ). Dichas técnicas han permitido caracterizar 14 nuevas proteínas de WSSV. La caracterización y localización de proteínas estructurales pueden ayudar a conocer la morfogénesis y patogénesis de WSSV. Ambos procesos son esenciales para entender el mecanismo de infección y para desarrollar nuevos métodos de control. Hasta ahora no existen tratamientos efectivos para combatir este virus en campo. Proteínas estructurales de WSSV como VP28 y VP19 han sido evaluadas para reducir el impacto de WSSV. Estas moléculas son esenciales en las etapas tempranas de infección. Bioensayos de neutralización usando anticuerpos específicos contra proteínas estructurales de WSSV han aumentado la supervivencia de camarones tratados. Recientemente, construcciones de RNA de interferencia (RNAi) dirigidos contra proteínas estructurales han sido usadas como una nueva herramienta para reducir/inhibir la replicación de WSSV. Una mejor comprensión de las interacciones hospedero-patógeno permitirá desarrollar nuevos métodos para controlar este virus. La localización y función de proteínas estructurales usando métodos de alto rendimiento contribuirá a implementar nuevas estrategias contra la infección. Métodos de intervención para bloquear la entrada del virus a la célula podrían ser valiosos productos de este tipo de investigaciones.

OBJECTIVE: To quantify the public health and economic burden of endemic canine rabies in Africa and Asia. METHODS: Data from these regions were applied to a set of linked epidemiological and economic models. The human population at risk from endemic canine rabies was predicted using data on dog density, and human rabies deaths were estimated using a series of probability steps to determine the likelihood of clinical rabies developing in a person after being bitten by a dog suspected of having rabies. Model outputs on mortality and morbidity associated with rabies were used to calculate an improved disability-adjusted life year (DALY) score for the disease. The total societal cost incurred by the disease is presented. FINDINGS: Human mortality from endemic canine rabies was estimated to be 55 000 deaths per year (90% confidence interval (CI) = 24 000-93 000). Deaths due to rabies are responsible for 1.74 million DALYs lost each year (90% CI = 0.75-2.93). An additional 0.04 million DALYs are lost through morbidity and mortality following side-effects of nerve-tissue vaccines. The estimated annual cost of rabies is US$ 583.5 million (90% CI = US$ 540.1-626.3 million). Patient-borne costs for post-exposure treatment form the bulk of expenditure, accounting for nearly half the total costs of rabies. CONCLUSION: Rabies remains an important yet neglected disease in Africa and Asia. Disparities in the affordability and accessibility of post-exposure treatment and risks of exposure to rabid dogs result in a skewed distribution of the disease burden across society, with the major impact falling on those living in poor rural communities, in particular children.

OBJETIVO: Cuantificar la carga que supone la rabia canina endémica en África y Asia en términos económicos y de salud pública. MÉTODOS: Se aplicaron datos de esas regiones a un conjunto de modelos epidemiológicos y económicos relacionados. La población humana expuesta al riesgo de sufrir rabia canina endémica se predijo a partir de los datos disponibles sobre la densidad de perros, y las defunciones por rabia humana se estimaron usando una serie de pasos probabilísticos para determinar el riesgo de aparición de rabia clínica en una persona que hubiera sido mordida por un perro sospechoso de albergar rabia. Los resultados modelizados sobre la mortalidad y la morbilidad asociadas a la rabia se usaron para obtener un valor mejorado de los años de vida ajustados en función de la discapacidad (AVAD) para la enfermedad. Se presenta el costo social total asociado a esta dolencia. RESULTADOS: La mortalidad humana por rabia canina endémica se estimó en 55 000 defunciones anuales (intervalo de confianza (IC) del 90% = 24 000-93 000). Las defunciones por rabia causan unas pérdidas de 1,74 millones de AVAD cada año (IC90% = 0,75-2,93). Otros 40 000 AVAD se pierden como consecuencia de la morbilidad y mortalidad asociadas a los efectos colaterales de las vacunas obtenidas con tejido nervioso. El costo anual estimado de la rabia asciende a US$ 583,5 millones (IC90% = US$ 540,1 - 626,3 millones). Los costos del tratamiento postexposición asumidos por los pacientes constituyen el grueso del gasto correspondiente, pues suponen casi la mitad del costo total de la rabia. CONCLUSIÓN: La rabia sigue siendo una importante y sin embargo descuidada enfermedad en África y Asia. Las disparidades en la asequibilidad y accesibilidad del tratamiento postexposición y en el riesgo de exposición a perros rabiosos se traducen en una distribución asimétrica de la carga de morbilidad en la sociedad, de tal manera que el impacto principal de la enfermedad recae en los habitantes de las comunidades rurales pobres, sobre todo en los niños.

OBJECTIF: Quantifier le fardeau économique et la charge pour la santé publique que représente la rage canine endémique en Afrique et en Asie. MÉTHODES: Les données provenant de ces régions ont été appliquées à un ensemble de modèles épidémiologiques et économiques associés. On a estimé le nombre de personnes qui seraient exposées à la rage canine endémique à partir des données de la densité canine et le nombre des décès humains dus à la rage au moyen d'un modèle de probabilité pas à pas utilisé pour déterminer la probabilité qu'une personne mordue par un chien présumé enragé présente la maladie. La mortalité et la morbidité liées à la rage fournies par les modèles ont été utilisées pour affiner le calcul des années de vie ajustées sur l'incapacité (DALY) pour la maladie. Le coût social total de la maladie est présenté. RÉSULTATS: On a estimé à 55 000 [intervalle de confiance (IC) à 90% = 24 000-93 000] le nombre annuel des décès humains dus à la rage canine endémique. Les décès dus à la rage sont responsables de 1,74 million d'années de vie ajustées sur l'incapacité perdues chaque année (IC à 90% = 0,75-2,93). Quelque 0,04 million d'années de vie ajustées sur l'incapacité supplémentaires sont en outre perdues du fait de la morbidité et de la mortalité dues aux effets secondaires des vaccins préparés sur tissu nerveux. Le coût annuel estimatif de la rage est de US$ 583,5 millions (IC à 90% = US$ 540,1 - 626,3 millions). Le coût des traitements post-exposition supporté par les malades constitue l'essentiel des dépenses, soit près de la moitié du coût total de la rage. CONCLUSION: La rage reste une maladie importante mais négligée en Afrique et en Asie. Les écarts aux plans de l'accessibilité financière et physique du traitement post-exposition et du risque d'exposition aux chiens enragés rendent inégale la distribution de la charge de morbidité dans la société, les personnes les plus touchées étant les habitants des communautés rurales défavorisées, et en particulier les enfants.