Atopic dermatitis in Antananarivo, Madagascar

SESSION 2 / New fields in AD: big data mining, AD in sub-Saharan Africa, neuroinflammation Fahafahantsoa RAPELANORO RABENJA (Antananrivo, Madagascar)Head of Department of DermatologyDirector of LARTICPresident of SOMADERMember of ASDV, SODAF, ADF, SFDHonorary Dean of Faculty of Medicine - Antananarivo University Overview How about MadagascarClinical presentation of AD in MadagascarProblematic of AD managementPerspectives with WHO recommendations:Implementation of Teledermatology to increase training and monitoring AD till District medical centerAfrica AI initiative PASSION project ➜ Ask questions to the author! 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 worldDeveloping countryRegion: Eastern Africa Capital city: Antananarivo22 regions / 6 provinces Area: 587 295 km²Population: 26 Millions, 60% < 24 years oldPop Density: 42.8 per km²Literacy rate: 76%< $1 / day - GDP $463 per capita6th poorest country in the world 6 Universities / 6 Faculties of Medicine1 Dermatology School, 13 Dermatologists0.86 Dr / 10.000 HaDoctors: 2236 Rapelanoro Rabenja et al. Les principales pathologies dermatologiques chez l’enfant à Antananarivo. Ann Dermatol Venereol 2001 ; 186:2S88. 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 2 yearsPrevalence 1.02 % 1999 Rapelanoro Rabenja F. et al. La dermatite atopique chez le nourrisson et l’enfant. J Med Ther 2000;2:2S---Rapelanoro Rabenja F. et al. Prevalence and associated factors of atopic dermatitis in Antananarivo Madagascar. e-poster WCD Milan 2019---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 PruritusErythemaPapules / vesiclesXerosisExcoriations, erosionsLichenificationDyspigmentation > 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 year42 AD cases: prevalence 0.53 %Mean age±SD: 39±16.3 yearsSex 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 SeveritySCORAD indexPO-SCORADEczema Area andSeverity Index (EASI) Malagasy Risks Factors of AD East, north and north-west: Humid tropical climate - Mean annual precipitation ≥ 1500mmTemperature ≥ 15°C West and southern, a semi-arid climate: Temperature ≥ 30°CProject threats: resources, stakeholder engagement Month of Consultation Birth month%January4February5March5April4May7June8July11August11September20October10November11December4 Treatment of AD High patients drop out1999: 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---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 MMMSTopical corticosteroids: 12% of MMMSTopical Calcineurine inhibitor 1 tube: 15% of MMMSpH-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 ofatopic 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-employedWhat else ?Inadequate public health infrastructure and professionnalLow income populationCan we solve theses problems ? YESWhy?We are a rich country but exploited and poorly managed Perspectives What can be done according to WHOobjectives? See NTD skin conditions WHO brochure: “Other common non-NTD skin diseases” 2.10 page 18In most communities, five common conditions account for over 80% of skin disease. un.org/sustainabledevelopment/inequality 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: un.org/sustainabledevelopment/health 3.3 end the epidemics of other communicable diseasesCommunicable 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, MadagascarChangsha, China: to supply data in Chinese SkinRegional Dermatology Training Centre (Moshi, Tanzania)Basel, Switzerland: to supply data on Caucasian skin see telederm.ai for the full team PASSION project Non-for Profit project funded by Fondation BotnarFurther information: www.telederm.ai + instagram Which Diseases did we choose? Atopic DermatitisImpetigoTineaScabiesInsect bites TOGETHER THEY MAKE UP 80% OF DERMATOSES ONSITE AND ARE AMENABLE TO MANAGEMENT STRATEGIES LOCALLY. Open to collaborationsPASSION & I-DAIR Image collection and labellingTeledermatology evaluation (diagnosis and follow-up)Involvement of other HCPs in later phases andCommunity advisory boards (CABs)Creation of educational materials…and the possibilities go on. What can be done according to WHOobjectives? SDG 3: Good Health and Well being: un.org/sustainabledevelopment/health/ 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 un.org/sustainabledevelopment/inequality 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 centerHow to finance universal health coverage according to WHO objectives and Millennium development goal? MEO: Touch pads (referent Doctor)DESIGN: Laptop (developer)INTERNET CONNECTION: 3G/4GHIGH BANDWITH : Madagascar ranks 1st in Africa & 22nd in the world with 24.87 Mbps Never again! Vernix Caseosa Never give up Welcome to Madagascar Thank you for your attention! SOMADER ➜ download as PDF Ask questions to Benja RAPELANORO: Conflict of interest : none

Atopic dermatitis in Antananarivo, Madagascar

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