SESSION 2 / New fields in AD: big data mining, AD in sub-Saharan Africa, neuroinflammation
Fahafahantsoa RAPELANORO RABENJA (Antananrivo, Madagascar)
Head of Department of Dermatology
Director of LARTIC
President of SOMADER
Member of ASDV, SODAF, ADF, SFD
Honorary Dean of Faculty of Medicine – Antananarivo University
Overview
- How about Madagascar
- Clinical presentation of AD in Madagascar
- Problematic of AD management
- Perspectives with WHO recommendations:
- Implementation of Teledermatology to increase training and monitoring AD till District medical center
- Africa AI initiative PASSION project
Authors retain copyright.
Challenge in the management of Atopic Dermatitis in Madagascar:
What can be done according to WHO objectives
How about Madagascar
- 4th biggest island in the world
- Developing country
- Region: Eastern Africa
- Capital city: Antananarivo
- 22 regions / 6 provinces
- Area: 587 295 km²
- Population: 26 Millions, 60% < 24 years old
- Pop Density: 42.8 per km²
- Literacy rate: 76%
- < $1 / day – GDP $463 per capita
- 6th poorest country in the world
- 6 Universities / 6 Faculties of Medicine
- 1 Dermatology School, 13 Dermatologists
- 0.86 Dr / 10.000 Ha
- Doctors: 2236
- Pathology with dry skin: 55.5%
- Skin diseases: 30% of the consultations included in 10 main diseases in Madagascar
Aim
How to adapt the management of AD in Madagascar according to its specificity, lack of dermatologist and to apply international data.
P Schmid-Grendelmeier et al Position Statement on Atopic Dermatitis in Sub‐Saharan Africa: current status and roadmap. J Eur Acad of Dermatol Venereol 33(11):2019-2028.
Prevalence of Atopic dermatitis
- 2665 chlidren < 15 years seen during the period of our study
- Prevalence 5.6 % 2020: 151 AD cases
- 80 cases (53 %): 0 – 2 years
- 71 cases ( 47%): > 2 years
- Prevalence 1.02 % 1999
Rapelanoro Rabenja F. et al. La dermatite atopique chez le nourrisson et l’enfant. J Med Ther 2000;2:2S
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Rapelanoro Rabenja F. et al. Prevalence and associated factors of atopic dermatitis in Antananarivo Madagascar. e-poster WCD Milan 2019
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F. A. Sendrasoa1 … F. Rapelanoro Rabenja. Epidemiology and associated factors of atopic dermatitis in Malagasy children. Allergy Asthma Clin Immunol 2020; 16:4
Diagnostic of AD in Children
Typical findings, but in skin types IV, V
- Pruritus
- Erythema
- Papules / vesicles
- Xerosis
- Excoriations, erosions
- Lichenification
- Dyspigmentation
> 25 %
Unusual topography
Rapelanoro Rabenja F. et al. Prevalence and associated factors of atopic dermatitis in Antananarivo Madagascar. e-poster WCD Milan 2019
Diagnostic of AD in adult
Epidemiology
- 7875 adults > 18 years seen during the period of our study 1 year
- 42 AD cases: prevalence 0.53 %
- Mean age±SD: 39±16.3 years
- Sex ratio: 0.5
F. A. Sendrasoa1 … F. Rapelanoro Rabenja. Epidemiology and associated factors of atopic dermatitis in Malagasy children. Allergy Asthma Clin Immunol 2020; 16:4
2 – 6 %: Pruritus and Chronic lesion
Assessment of AD
Clinical assessment
- Severity
- SCORAD index
- PO-SCORAD
- Eczema Area and
- Severity Index (EASI)
Malagasy Risks Factors of AD
East, north and north-west:
- Humid tropical climate – Mean annual precipitation ≥ 1500mm
- Temperature ≥ 15°C
West and southern, a semi-arid climate:
- Temperature ≥ 30°C
- Project threats: resources, stakeholder engagement
Month of Consultation
| Birth month | % |
| January | 4 |
| February | 5 |
| March | 5 |
| April | 4 |
| May | 7 |
| June | 8 |
| July | 11 |
| August | 11 |
| September | 20 |
| October | 10 |
| November | 11 |
| December | 4 |
Treatment of AD
- High patients drop out
- 1999: 13 %
- 2016: 64.2 %
- 2020: 66.8 %
➜ Strengthen therapeutic education +++
- Basic emollient treatment coconut oil
Rapelanoro Rabenja et al. PEC de La dermatite atopique chez le nourrisson et l’enfant à Madagascar. Raft – UNFM 25/07/2011; 13/02/2014
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Rapelanoro Rabenja et al. Prevalence and associated factors of atopic dermatitis in Antananarivo Madagascar. e-poster WCD Milan 2019
Direct economic burden of AD
MMMS (Malagasy Minimum Monthly Salary)
- Emollient cost: 15% of MMMS
- Topical corticosteroids: 12% of MMMS
- Topical Calcineurine inhibitor 1 tube: 15% of MMMS
- pH-balanced cleanser: 1tube 200ml 36% of MMMS
- « Wet-wrapp » and systemic traitement: not practiced because of the difficulty of followup
F. A. Sendrasoa1 … F. Rapelanoro Rabenja. Epidemiology and associated factors of
atopic dermatitis in Malagasy children. Allergy Asthma Clin Immunol 2020; 16:4
What is the problematic in AD Management in Madagascar ?
Is it an economic problem ? YES
- Why? No medical coverage for self-employed
- What else ?
- Inadequate public health infrastructure and professionnal
- Low income population
- Can we solve theses problems ? YES
- Why?
We are a rich country but exploited and poorly managed
Perspectives
What can be done according to WHO
objectives?
See NTD skin conditions WHO brochure:
“Other common non-NTD skin diseases” 2.10 page 18
In most communities, five common conditions account for over 80% of skin disease.
Original reference: Hay RJ et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014)
SDG 3: Good Health and Well being:
3.3 end the epidemics of other communicable diseases
Communicable diseases concerns 3 of our disease foci (infected eczema, impetigo and scabies).
Introducing AI: Hypotheses?
- Can some diseases be diagnosed using Artificial Intelligence / ML ? (Specialized techniques)
- Research project with a Global collaboration:
- University of Antananarivo, Madagascar
- Changsha, China: to supply data in Chinese Skin
- Regional Dermatology Training Centre (Moshi, Tanzania)
- Basel, Switzerland: to supply data on Caucasian skin
PASSION project
- Non-for Profit project funded by Fondation Botnar
- Further information: www.telederm.ai + instagram
Which Diseases did we choose?
- Atopic Dermatitis
- Impetigo
- Tinea
- Scabies
- Insect bites
TOGETHER THEY MAKE UP 80% OF DERMATOSES ONSITE AND ARE AMENABLE TO MANAGEMENT STRATEGIES LOCALLY.
Open to collaborations
PASSION & I-DAIR
- Image collection and labelling
- Teledermatology evaluation (diagnosis and follow-up)
- Involvement of other HCPs in later phases and
- Community advisory boards (CABs)
- Creation of educational materials
- …and the possibilities go on.
What can be done according to WHO
objectives?
SDG 3: Good Health and Well being:
3.8 Achieve universal health coverage
…access to quality essential health-care services… Specifically to the field of Dermatology, we intend to use AI for 5 skin diseases to begin with.
SDG 10: Reduce inequalities
Health care insurance coverage
- The country starts to implement an effective universal health-care coverage policy.
- Implementation of Teleconsultation Cabin to increase training and monitoring AD till District medical center
- How to finance universal health coverage according to WHO objectives and Millennium development goal?
DESIGN: Laptop (developer)
INTERNET CONNECTION: 3G/4G
HIGH BANDWITH : Madagascar ranks 1st in Africa & 22nd in the world with 24.87 Mbps
Never again!
Never give up
Welcome to Madagascar
Thank you for your attention!
Ask questions to Benja RAPELANORO:
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Conflict of interest : none