Serge Eholie - Academia.edu (original) (raw)

Papers by Serge Eholie

Research paper thumbnail of Prophylaxis with co-trimoxazole for HIV infected adults in Africa

British Medical Journal, 2008

Research paper thumbnail of La tuberculose à l'heure du sida au centre antituberculeux de Bouaké (Côte-d'ivoire)

Medecine Et Maladies Infectieuses, 1999

ABSTRACT

Research paper thumbnail of Prise en charge des accidents d'exposition au sang au CHU de Treichville, Abidjan (Côte-d'Ivoire)

Medecine Et Maladies Infectieuses, 2007

ObjectiveThe aim of this study was to assess care and preventive measures for accidental exposure... more ObjectiveThe aim of this study was to assess care and preventive measures for accidental exposure to blood (AEB) in Abidjan.

Research paper thumbnail of Co-trimoxazole, cART, and non-AIDS infectious diseases

Lancet, 2010

al. Randomized phase III trial of vinorelbine plus cisplatin compared with observation in complet... more al. Randomized phase III trial of vinorelbine plus cisplatin compared with observation in completely resected stage IB and II non-small-cell lung cancer: updated survival analysis of JBR-10. J Clin Oncol 2010; 28: 29-34. 12 Custodio AB, González-Larriba JL, Bobokova J, et al. Prognostic and predictive markers of benefi t from adjuvant chemotherapy in early-stage non-small cell lung cancer.

Research paper thumbnail of Ofloxacine Dans Le Traitement De La Fievre Thyphoide en Milieu Hospitalier Chu De Treichville - Abidjan - Cote D'Ivoire

SUMMARY Concerns a non randomized prospective study of 30 patients hospitalized for typhoid fever... more SUMMARY Concerns a non randomized prospective study of 30 patients hospitalized for typhoid fever. They received ofloxacin 400 mg twice daily for 10 days. We obtained 93 % of success ; after a follow-up for one month t h e re was no relapse. We estimate that ofloxacin is more advantageous thant the other antibiotics usually used in treatment of

Research paper thumbnail of Field adherence to highly active antiretroviral therapy in HIV-infected adults in Abidjan, Côte d'Ivoire

Journal of acquired immune deficiency syndromes (1999), 2007

To estimate adherence to highly active antiretroviral therapy (HAART) and its determinants in HIV... more To estimate adherence to highly active antiretroviral therapy (HAART) and its determinants in HIV-infected adults followed in field conditions in Abidjan. A standardized questionnaire was administered to all consecutive adults on HAART who attended 3 urban HIV outpatient clinics. Patients were asked to self-report their pill intake during the previous 7 days, and, when necessary, to explain the reason(s) why they missed at least 1 intake. The adherence rate was estimated as the number of pills actually taken divided by the number of pills that should have been taken. The association of incomplete adherence (adherence rate<90%) with patients' characteristics was studied using multivariate logistic regression. Three hundred eight patients (male/female ratio: 1:1, mean time on HAART: 22 months) were interviewed. The median self-reported adherence rate was 78% (interquartile range: 65%-90%), with 76% of patients considered as incompletely adherent (adherence rate<90%). The mos...

Research paper thumbnail of Plasma HIV-2 RNA According to CD4 Count Strata among HIV-2-Infected Adults in the IeDEA West Africa Collaboration

PloS one, 2015

Plasma HIV-1 RNA monitoring is one of the standard tests for the management of HIV-1 infection. W... more Plasma HIV-1 RNA monitoring is one of the standard tests for the management of HIV-1 infection. While HIV-1 RNA can be quantified using several commercial tests, no test has been commercialized for HIV-2 RNA quantification. We studied the relationship between plasma HIV-2 viral load (VL) and CD4 count in West African patients who were either receiving antiretroviral therapy (ART) or treatment-naïve. A cross sectional survey was conducted among HIV-2-infected individuals followed in three countries in West Africa from March to December 2012. All HIV-2 infected-patients who attended one of the participating clinics were proposed a plasma HIV-2 viral load measurement. HIV-2 RNA was quantified using the new ultrasensitive in-house real-time PCR assay with a detection threshold of 10 copies/ mL (cps/mL). A total of 351 HIV-2-infected individuals participated in this study, of whom 131 (37.3%) were treatment naïve and 220 (62.7%) had initiated ART. Among treatment-naïve patients, 60 (46.5...

Research paper thumbnail of ASSOCIATIONS VIH-INFECTIONS PARASITAIRES ET FONGIQUES EN AFRIQUE Aspects cliniques et étiopathogéniques

Bien que dans leur expression clinique elles soient identiques à celles observées dans les pays o... more Bien que dans leur expression clinique elles soient identiques à celles observées dans les pays occiden- taux, les fréquentes associations VIH-infections parasitaires et fongiques en Afrique posent des problè- mes particuliers. Assistons-nous à une résurgence ou à une aggravation du fait de l'immunodépression de certaines d'entres elles ? Quel rôle jouent-elles dans le passage vers le SIDA ? L' i

Research paper thumbnail of Commentary: Antiretroviral therapy initiation criteria in low resource settings--from 'when to start' to 'when not to start

AIDS (London, England), 2014

Research paper thumbnail of Commentary: decline of HIV-2 prevalence in West Africa: good news or bad news?

International journal of epidemiology, 2006

Research paper thumbnail of Response to “Rapid tests for HIV type discrimination in West Africa may perform differently”

Journal of the International AIDS Society, 2015

Research paper thumbnail of Decrease in sexual risk behaviours after early initiation of antiretroviral therapy: a 24-month prospective study in Côte d'Ivoire

Journal of the International AIDS Society, 2014

Whether early antiretroviral therapy (ART) initiation could impact sexual risk behaviours remains... more Whether early antiretroviral therapy (ART) initiation could impact sexual risk behaviours remains to be documented. We aimed to investigate changes in sexual behaviours within the 24 months following an early versus standard ART initiation in HIV-positive adults with high CD4 counts. We used data from a prospective behavioural study nested in a randomized controlled trial of early ART (Temprano-ANRS12136). Time trends in sexual behaviours from enrolment in the trial (M0) to 12-month (M12) and 24-month (M24) visits were measured and compared, using Generalized Estimating Equations models, between participants randomly assigned either to initiate ART immediately (early ART) or to defer ART initiation until on-going WHO starting criteria are met (standard ART). Indicators of sexual behaviours included 1) sexual activity in the past year, 2) multiple partnership in the past year, 3) unprotected sex at last intercourse and 4) risky sex (i.e. unprotected sex with a partner of HIV negative...

Research paper thumbnail of Quantiferon-TB Gold: Performance for Ruling out Active Tuberculosis in HIV-Infected Adults with High CD4 Count in Côte d'Ivoire, West Africa

PLoS ONE, 2014

To assess the performance of QuantiFERON-TB Gold In-Tube (QFT-GIT) test for active tuberculosis (... more To assess the performance of QuantiFERON-TB Gold In-Tube (QFT-GIT) test for active tuberculosis (TB) in HIV adults, and its variation over time in patients on antiretroviral therapy (ART) and/or isoniazide preventive therapy (IPT). Transversal study and cohort nested in the Temprano ANRS 12136 randomized controlled trial assessing benefits of initiating ART earlier than currently recommended by World Health Organization, with or without a 6-month IPT. Performance of QFT-GIT for detecting active TB at baseline in the first 50% participants, and 12-month incidence of conversion/reversion in the first 25% participants were assessed. QFT-GIT threshold for positivity was 0.35 IU/ml. Among the 975 first participants (median baseline CD4 count 383/mm3, positive QFT-GIT test 35%), 2.7% had active TB at baseline. QFT-GIT sensitivity, specificity, positive and negative predictive value for active TB were 88.0%, 66.6%, 6.5% and 99.5%. For the 444 patients with a second test at 12 months, rates for conversion and reversion were 9.3% and 14%. Reversion was more frequent in patients without ART and younger patients. IPT and early ART were not associated with reversion/conversion. A negative QFT-GIT could rule out active TB in HIV-infected adults not severely immunosuppressed, thus avoiding repeated TB testing and accelerating diagnosis and care for other diseases. ClinicalTrials.gov NCT00495651.

Research paper thumbnail of Prophylaxie antirétrovirale après expositions non professionnelles au VIH à Abidjan (Cote d’Ivoire)

Médecine et Maladies Infectieuses, 2010

c Programme national de prise en médicale des personnes vivant avec le VIH, Abidjan, Cote-d'Ivoir... more c Programme national de prise en médicale des personnes vivant avec le VIH, Abidjan, Cote-d'Ivoire Reçu le 30 juillet 2009 ; reçu sous la forme révisée 12 novembre 2009 ; accepté le 21 avril 2010

Research paper thumbnail of Évolution des conditions d’initiation du traitement antirétroviral des patients infectés par le VIH en Afrique de l’Ouest

Medecine Et Maladies Infectieuses, 2010

ObjectiveWe studied the evolution of drug combinations used, as well as the clinical and immunolo... more ObjectiveWe studied the evolution of drug combinations used, as well as the clinical and immunological profile of patients at initiation of highly active antiretroviral therapy (HAART) between 1996 and 2006 in West Africa.

Research paper thumbnail of Étude retrospective des méningites bactériennes et à cryptocoques chez des sujets adultes infectés par le VIH à Abidjan (Côte d’Ivoire)

Journal de Mycologie Médicale / Journal of Medical Mycology, 2007

Journal de Mycologie Médicale (2007) 17, 82-86 MOTS CLÉS Méningites ; S. pneumoniae ; Cryptoccocu... more Journal de Mycologie Médicale (2007) 17, 82-86 MOTS CLÉS Méningites ; S. pneumoniae ; Cryptoccocus neoformans ; VIH ; Mortalité ; Abidjan ; Côte d'Ivoire Résumé Objectifs.-Préciser la prévalence du VIH dans les méningites bactérienne et à cryptocoques à Abidjan et en rapporter les caractéristiques épidémiologiques, cliniques, paracliniques et évolutives. Méthodes.-Il s'agit d'une étude rétrospective portant sur 370 patients VIH positifs hospitalisés du 1 er novembre 2001 au 1 er avril 2003 dans les services de médecine interne et des maladies infectieuses du CHU de Treichville pour méningites bactériennes et à cryptocoques.

Research paper thumbnail of How to optimize HCV treatment impact on life years saved in resource-constrained countries

Hepatology (Baltimore, Md.), Jan 10, 2015

In resource-constrained countries where the prevalence of HCV disease is usually high, it is impo... more In resource-constrained countries where the prevalence of HCV disease is usually high, it is important to know which population should be treated first in order to increase treatment effectiveness. The objective was to estimate the effectiveness of different HCV treatment eligibility scenarios in three different countries. Using a Markov model we estimated the number of life years saved (LYS) with different treatment eligibility scenarios according to fibrosis stage (F1-F4, or F3-4), compared to base-case (F2-F4), at a constant treatment rate, of patients aged between 18 and 60 years, at stages F0/F1 to F4, without liver complications or co-infections, chronically infected by HCV, and treated with pegylated interferon/ribavirin or more efficacious therapies (i.e. interferon-free). We conducted the analysis in Egypt (prevalence=14.7%, 45,000 patients treated/year), Thailand (prevalence=2.2%, 1,000 patients treated/year), and Côte d'Ivoire (prevalence=3%, 150 patients treated/year...

Research paper thumbnail of Apport De La Fibroscopie Bronchique Dans Le Diagnostic Des Cancers Bronchiques Primitifs a Abidjan - Cote D'Ivoire

Research paper thumbnail of Re-testing and misclassification of HIV-2 and HIV-1&2 dually reactive patients among the HIV-2 cohort of The West African Database to evaluate AIDS collaboration

Journal of the International AIDS Society, 2014

Research paper thumbnail of Reducing the neglected burden of viral hepatitis in Africa: Strategies for a global approach

Journal of hepatology, 2015

The burden of liver disease may dramatically increase in the near future in Africa, where screeni... more The burden of liver disease may dramatically increase in the near future in Africa, where screening and access to care and treatment are hampered by inadequate disease surveillance, lack of high-quality tools to assess chronic liver disease, and underestimated needs for human and financial resources. Chronic hepatitis may be considered as silent and neglected killer, fuelled by many years of global inertia from stakeholders and policy makers alike. However, the global battle against viral hepatitis is facing a new era owing to the advent of highly effective drugs, innovative tools for screening and clinical follow-up, and recent signs that governments, advocacy groups and global health organizations are mobilizing to advocate universal access-to-treatment. This review details the barriers to prevention, screening and treatment of viral hepatitis on the African continent, focuses on the urgent need for operational and research programmes, and suggests integrated ways to tackle the gl...

Research paper thumbnail of Prophylaxis with co-trimoxazole for HIV infected adults in Africa

British Medical Journal, 2008

Research paper thumbnail of La tuberculose à l'heure du sida au centre antituberculeux de Bouaké (Côte-d'ivoire)

Medecine Et Maladies Infectieuses, 1999

ABSTRACT

Research paper thumbnail of Prise en charge des accidents d'exposition au sang au CHU de Treichville, Abidjan (Côte-d'Ivoire)

Medecine Et Maladies Infectieuses, 2007

ObjectiveThe aim of this study was to assess care and preventive measures for accidental exposure... more ObjectiveThe aim of this study was to assess care and preventive measures for accidental exposure to blood (AEB) in Abidjan.

Research paper thumbnail of Co-trimoxazole, cART, and non-AIDS infectious diseases

Lancet, 2010

al. Randomized phase III trial of vinorelbine plus cisplatin compared with observation in complet... more al. Randomized phase III trial of vinorelbine plus cisplatin compared with observation in completely resected stage IB and II non-small-cell lung cancer: updated survival analysis of JBR-10. J Clin Oncol 2010; 28: 29-34. 12 Custodio AB, González-Larriba JL, Bobokova J, et al. Prognostic and predictive markers of benefi t from adjuvant chemotherapy in early-stage non-small cell lung cancer.

Research paper thumbnail of Ofloxacine Dans Le Traitement De La Fievre Thyphoide en Milieu Hospitalier Chu De Treichville - Abidjan - Cote D'Ivoire

SUMMARY Concerns a non randomized prospective study of 30 patients hospitalized for typhoid fever... more SUMMARY Concerns a non randomized prospective study of 30 patients hospitalized for typhoid fever. They received ofloxacin 400 mg twice daily for 10 days. We obtained 93 % of success ; after a follow-up for one month t h e re was no relapse. We estimate that ofloxacin is more advantageous thant the other antibiotics usually used in treatment of

Research paper thumbnail of Field adherence to highly active antiretroviral therapy in HIV-infected adults in Abidjan, Côte d'Ivoire

Journal of acquired immune deficiency syndromes (1999), 2007

To estimate adherence to highly active antiretroviral therapy (HAART) and its determinants in HIV... more To estimate adherence to highly active antiretroviral therapy (HAART) and its determinants in HIV-infected adults followed in field conditions in Abidjan. A standardized questionnaire was administered to all consecutive adults on HAART who attended 3 urban HIV outpatient clinics. Patients were asked to self-report their pill intake during the previous 7 days, and, when necessary, to explain the reason(s) why they missed at least 1 intake. The adherence rate was estimated as the number of pills actually taken divided by the number of pills that should have been taken. The association of incomplete adherence (adherence rate<90%) with patients' characteristics was studied using multivariate logistic regression. Three hundred eight patients (male/female ratio: 1:1, mean time on HAART: 22 months) were interviewed. The median self-reported adherence rate was 78% (interquartile range: 65%-90%), with 76% of patients considered as incompletely adherent (adherence rate<90%). The mos...

Research paper thumbnail of Plasma HIV-2 RNA According to CD4 Count Strata among HIV-2-Infected Adults in the IeDEA West Africa Collaboration

PloS one, 2015

Plasma HIV-1 RNA monitoring is one of the standard tests for the management of HIV-1 infection. W... more Plasma HIV-1 RNA monitoring is one of the standard tests for the management of HIV-1 infection. While HIV-1 RNA can be quantified using several commercial tests, no test has been commercialized for HIV-2 RNA quantification. We studied the relationship between plasma HIV-2 viral load (VL) and CD4 count in West African patients who were either receiving antiretroviral therapy (ART) or treatment-naïve. A cross sectional survey was conducted among HIV-2-infected individuals followed in three countries in West Africa from March to December 2012. All HIV-2 infected-patients who attended one of the participating clinics were proposed a plasma HIV-2 viral load measurement. HIV-2 RNA was quantified using the new ultrasensitive in-house real-time PCR assay with a detection threshold of 10 copies/ mL (cps/mL). A total of 351 HIV-2-infected individuals participated in this study, of whom 131 (37.3%) were treatment naïve and 220 (62.7%) had initiated ART. Among treatment-naïve patients, 60 (46.5...

Research paper thumbnail of ASSOCIATIONS VIH-INFECTIONS PARASITAIRES ET FONGIQUES EN AFRIQUE Aspects cliniques et étiopathogéniques

Bien que dans leur expression clinique elles soient identiques à celles observées dans les pays o... more Bien que dans leur expression clinique elles soient identiques à celles observées dans les pays occiden- taux, les fréquentes associations VIH-infections parasitaires et fongiques en Afrique posent des problè- mes particuliers. Assistons-nous à une résurgence ou à une aggravation du fait de l'immunodépression de certaines d'entres elles ? Quel rôle jouent-elles dans le passage vers le SIDA ? L' i

Research paper thumbnail of Commentary: Antiretroviral therapy initiation criteria in low resource settings--from 'when to start' to 'when not to start

AIDS (London, England), 2014

Research paper thumbnail of Commentary: decline of HIV-2 prevalence in West Africa: good news or bad news?

International journal of epidemiology, 2006

Research paper thumbnail of Response to “Rapid tests for HIV type discrimination in West Africa may perform differently”

Journal of the International AIDS Society, 2015

Research paper thumbnail of Decrease in sexual risk behaviours after early initiation of antiretroviral therapy: a 24-month prospective study in Côte d'Ivoire

Journal of the International AIDS Society, 2014

Whether early antiretroviral therapy (ART) initiation could impact sexual risk behaviours remains... more Whether early antiretroviral therapy (ART) initiation could impact sexual risk behaviours remains to be documented. We aimed to investigate changes in sexual behaviours within the 24 months following an early versus standard ART initiation in HIV-positive adults with high CD4 counts. We used data from a prospective behavioural study nested in a randomized controlled trial of early ART (Temprano-ANRS12136). Time trends in sexual behaviours from enrolment in the trial (M0) to 12-month (M12) and 24-month (M24) visits were measured and compared, using Generalized Estimating Equations models, between participants randomly assigned either to initiate ART immediately (early ART) or to defer ART initiation until on-going WHO starting criteria are met (standard ART). Indicators of sexual behaviours included 1) sexual activity in the past year, 2) multiple partnership in the past year, 3) unprotected sex at last intercourse and 4) risky sex (i.e. unprotected sex with a partner of HIV negative...

Research paper thumbnail of Quantiferon-TB Gold: Performance for Ruling out Active Tuberculosis in HIV-Infected Adults with High CD4 Count in Côte d'Ivoire, West Africa

PLoS ONE, 2014

To assess the performance of QuantiFERON-TB Gold In-Tube (QFT-GIT) test for active tuberculosis (... more To assess the performance of QuantiFERON-TB Gold In-Tube (QFT-GIT) test for active tuberculosis (TB) in HIV adults, and its variation over time in patients on antiretroviral therapy (ART) and/or isoniazide preventive therapy (IPT). Transversal study and cohort nested in the Temprano ANRS 12136 randomized controlled trial assessing benefits of initiating ART earlier than currently recommended by World Health Organization, with or without a 6-month IPT. Performance of QFT-GIT for detecting active TB at baseline in the first 50% participants, and 12-month incidence of conversion/reversion in the first 25% participants were assessed. QFT-GIT threshold for positivity was 0.35 IU/ml. Among the 975 first participants (median baseline CD4 count 383/mm3, positive QFT-GIT test 35%), 2.7% had active TB at baseline. QFT-GIT sensitivity, specificity, positive and negative predictive value for active TB were 88.0%, 66.6%, 6.5% and 99.5%. For the 444 patients with a second test at 12 months, rates for conversion and reversion were 9.3% and 14%. Reversion was more frequent in patients without ART and younger patients. IPT and early ART were not associated with reversion/conversion. A negative QFT-GIT could rule out active TB in HIV-infected adults not severely immunosuppressed, thus avoiding repeated TB testing and accelerating diagnosis and care for other diseases. ClinicalTrials.gov NCT00495651.

Research paper thumbnail of Prophylaxie antirétrovirale après expositions non professionnelles au VIH à Abidjan (Cote d’Ivoire)

Médecine et Maladies Infectieuses, 2010

c Programme national de prise en médicale des personnes vivant avec le VIH, Abidjan, Cote-d'Ivoir... more c Programme national de prise en médicale des personnes vivant avec le VIH, Abidjan, Cote-d'Ivoire Reçu le 30 juillet 2009 ; reçu sous la forme révisée 12 novembre 2009 ; accepté le 21 avril 2010

Research paper thumbnail of Évolution des conditions d’initiation du traitement antirétroviral des patients infectés par le VIH en Afrique de l’Ouest

Medecine Et Maladies Infectieuses, 2010

ObjectiveWe studied the evolution of drug combinations used, as well as the clinical and immunolo... more ObjectiveWe studied the evolution of drug combinations used, as well as the clinical and immunological profile of patients at initiation of highly active antiretroviral therapy (HAART) between 1996 and 2006 in West Africa.

Research paper thumbnail of Étude retrospective des méningites bactériennes et à cryptocoques chez des sujets adultes infectés par le VIH à Abidjan (Côte d’Ivoire)

Journal de Mycologie Médicale / Journal of Medical Mycology, 2007

Journal de Mycologie Médicale (2007) 17, 82-86 MOTS CLÉS Méningites ; S. pneumoniae ; Cryptoccocu... more Journal de Mycologie Médicale (2007) 17, 82-86 MOTS CLÉS Méningites ; S. pneumoniae ; Cryptoccocus neoformans ; VIH ; Mortalité ; Abidjan ; Côte d'Ivoire Résumé Objectifs.-Préciser la prévalence du VIH dans les méningites bactérienne et à cryptocoques à Abidjan et en rapporter les caractéristiques épidémiologiques, cliniques, paracliniques et évolutives. Méthodes.-Il s'agit d'une étude rétrospective portant sur 370 patients VIH positifs hospitalisés du 1 er novembre 2001 au 1 er avril 2003 dans les services de médecine interne et des maladies infectieuses du CHU de Treichville pour méningites bactériennes et à cryptocoques.

Research paper thumbnail of How to optimize HCV treatment impact on life years saved in resource-constrained countries

Hepatology (Baltimore, Md.), Jan 10, 2015

In resource-constrained countries where the prevalence of HCV disease is usually high, it is impo... more In resource-constrained countries where the prevalence of HCV disease is usually high, it is important to know which population should be treated first in order to increase treatment effectiveness. The objective was to estimate the effectiveness of different HCV treatment eligibility scenarios in three different countries. Using a Markov model we estimated the number of life years saved (LYS) with different treatment eligibility scenarios according to fibrosis stage (F1-F4, or F3-4), compared to base-case (F2-F4), at a constant treatment rate, of patients aged between 18 and 60 years, at stages F0/F1 to F4, without liver complications or co-infections, chronically infected by HCV, and treated with pegylated interferon/ribavirin or more efficacious therapies (i.e. interferon-free). We conducted the analysis in Egypt (prevalence=14.7%, 45,000 patients treated/year), Thailand (prevalence=2.2%, 1,000 patients treated/year), and Côte d'Ivoire (prevalence=3%, 150 patients treated/year...

Research paper thumbnail of Apport De La Fibroscopie Bronchique Dans Le Diagnostic Des Cancers Bronchiques Primitifs a Abidjan - Cote D'Ivoire

Research paper thumbnail of Re-testing and misclassification of HIV-2 and HIV-1&2 dually reactive patients among the HIV-2 cohort of The West African Database to evaluate AIDS collaboration

Journal of the International AIDS Society, 2014

Research paper thumbnail of Reducing the neglected burden of viral hepatitis in Africa: Strategies for a global approach

Journal of hepatology, 2015

The burden of liver disease may dramatically increase in the near future in Africa, where screeni... more The burden of liver disease may dramatically increase in the near future in Africa, where screening and access to care and treatment are hampered by inadequate disease surveillance, lack of high-quality tools to assess chronic liver disease, and underestimated needs for human and financial resources. Chronic hepatitis may be considered as silent and neglected killer, fuelled by many years of global inertia from stakeholders and policy makers alike. However, the global battle against viral hepatitis is facing a new era owing to the advent of highly effective drugs, innovative tools for screening and clinical follow-up, and recent signs that governments, advocacy groups and global health organizations are mobilizing to advocate universal access-to-treatment. This review details the barriers to prevention, screening and treatment of viral hepatitis on the African continent, focuses on the urgent need for operational and research programmes, and suggests integrated ways to tackle the gl...