Status of Onchocerciasis Transmission after More Than a Decade of Mass Drug Administration for Onchocerciasis and Lymphatic Filariasis Elimination in Central Nigeria: Challenges in Coordinating the Stop MDA Decision
Identifieur interne : 002503 ( Main/Exploration ); précédent : 002502; suivant : 002504Status of Onchocerciasis Transmission after More Than a Decade of Mass Drug Administration for Onchocerciasis and Lymphatic Filariasis Elimination in Central Nigeria: Challenges in Coordinating the Stop MDA Decision
Auteurs : Darin S. Evans [États-Unis] ; Kal Alphonsus [Nigeria] ; Jon Umaru [Nigeria] ; Abel Eigege [Nigeria] ; Emmanuel Miri [Nigeria] ; Hayward Mafuyai [Nigeria] ; Carlos Gonzales-Peralta [États-Unis] ; William Adamani [Nigeria] ; Elias Pede [Nigeria] ; Christopher Umbugadu [Nigeria] ; Yisa Saka [Nigeria] ; Bridget Okoeguale [Nigeria] ; Frank O. Richards [États-Unis]Source :
- PLoS Neglected Tropical Diseases [ 1935-2727 ] ; 2014.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Albendazole (administration et posologie), Albendazole (usage thérapeutique), Animaux, Anticorps, Antihelminthiques (administration et posologie), Antihelminthiques (usage thérapeutique), Antiparasitaires (administration et posologie), Antiparasitaires (usage thérapeutique), Enfant, Enfant d'âge préscolaire, Femelle, Filariose lymphatique (), Filariose lymphatique (épidémiologie), Humains, Ivermectine (administration et posologie), Ivermectine (usage thérapeutique), Jeune adulte, Microfilaria, Mâle, Nigeria (épidémiologie), Onchocercose (traitement médicamenteux), Onchocercose (transmission), Onchocercose (épidémiologie), Prévalence, Simuliidae, Études séroépidémiologiques.
- MESH :
- administration et posologie : Albendazole, Antihelminthiques, Antiparasitaires, Ivermectine.
- traitement médicamenteux : Onchocercose.
- usage thérapeutique : Albendazole, Antihelminthiques, Antiparasitaires, Ivermectine, Onchocercose.
- épidémiologie : Filariose lymphatique, Nigeria, Onchocercose.
- Adulte, Adulte d'âge moyen, Animaux, Anticorps, Enfant, Enfant d'âge préscolaire, Femelle, Filariose lymphatique, Humains, Jeune adulte, Microfilaria, Mâle, Prévalence, Simuliidae, Études séroépidémiologiques.
English descriptors
- KwdEn :
- Adult, Albendazole (administration & dosage), Albendazole (therapeutic use), Animals, Anthelmintics (administration & dosage), Anthelmintics (therapeutic use), Antibodies, Antiparasitic Agents (administration & dosage), Antiparasitic Agents (therapeutic use), Child, Child, Preschool, Elephantiasis, Filarial (epidemiology), Elephantiasis, Filarial (prevention & control), Female, Humans, Ivermectin (administration & dosage), Ivermectin (therapeutic use), Male, Microfilariae, Middle Aged, Nigeria (epidemiology), Onchocerciasis (drug therapy), Onchocerciasis (epidemiology), Onchocerciasis (transmission), Prevalence, Seroepidemiologic Studies, Simuliidae, Young Adult.
- MESH :
- chemical , administration & dosage : Albendazole, Anthelmintics, Antiparasitic Agents, Ivermectin.
- chemical , therapeutic use : Albendazole, Anthelmintics, Antiparasitic Agents, Ivermectin.
- drug therapy : Onchocerciasis.
- epidemiology : Elephantiasis, Filarial, Nigeria, Onchocerciasis.
- prevention & control : Elephantiasis, Filarial.
- transmission : Onchocerciasis.
- Adult, Animals, Antibodies, Child, Child, Preschool, Female, Humans, Male, Microfilariae, Middle Aged, Prevalence, Seroepidemiologic Studies, Simuliidae, Young Adult.
Abstract
This study was undertaken in five onchocerciasis/lymphatic filariasis (LF) co-endemic local government areas (LGAs) in Plateau and Nasarawa, Nigeria. Annual MDA with ivermectin had been given for 17 years, 8 of which were in combination with albendazole. In 2008, assessments indicated that LF transmission was interrupted, but that the MDA had to continue due to the uncertain status of onchocerciasis transmission. Accordingly, assessments to determine if ivermectin MDA for onchocerciasis could be stopped were conducted in 2009.
We evaluated nodule, microfilarial (mf) skin snip, and antibody (IgG4 response to OV16) prevalence in adults and children in six sentinel sites where baseline data from the 1990s were available. We applied the 2001 WHO criteria for elimination of onchocerciasis that defined transmission interruption as an infection rate of <0.1% in children (using both skin snip and OV16 antibody) and a rate of infective (L3) blackflies of <0.05%.
Among adult residents in sentinel sites, mean mf prevalence decreased by 99.37% from the 1991–1993 baseline of 42.95% (64/149) to 0.27% (2/739) in 2009 (p<0.001). The OV16 seropositivity of 3.52% (26/739) among this same group was over ten times the mf rate. No mf or nodules were detected in 4,451 children in sentinel sites and ‘spot check’ villages, allowing the exclusion of 0.1% infection rate with 95% confidence. Seven OV16 seropositives were detected, yielding a seroprevalence of 0.16% (0.32% upper 95%CI). No infections were detected in PCR testing of 1,568
Interruption of transmission of onchocerciasis in these five LGAs is highly likely, although the number of flies caught was insufficient to exclude 0.05% with 95% confidence (upper CI 0.23%). We suggest that ivermectin MDA could be stopped in these LGAs if similar results are seen in neighboring districts.
Url:
DOI: 10.1371/journal.pntd.0003113
PubMed: 25233351
PubMed Central: 4169246
Affiliations:
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Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Adamani, William" sort="Adamani, William" uniqKey="Adamani W" first="William" last="Adamani">William Adamani</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>The Carter Center Nigeria, Jos, Plateau, Nigeria</addr-line></nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>The Carter Center Nigeria, Jos, Plateau</wicri:regionArea><wicri:noRegion>Plateau</wicri:noRegion></affiliation></author><author><name sortKey="Pede, Elias" sort="Pede, Elias" uniqKey="Pede E" first="Elias" last="Pede">Elias Pede</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Plateau State Ministry of Health, Jos, Plateau, Nigeria</addr-line></nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>Plateau State Ministry of Health, Jos, Plateau</wicri:regionArea><wicri:noRegion>Plateau</wicri:noRegion></affiliation></author><author><name sortKey="Umbugadu, Christopher" sort="Umbugadu, Christopher" uniqKey="Umbugadu C" first="Christopher" last="Umbugadu">Christopher Umbugadu</name><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Nasarawa State Ministry of Health, Lafia, Nasarawa, Nigeria</addr-line></nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>Nasarawa State Ministry of Health, Lafia, Nasarawa</wicri:regionArea><wicri:noRegion>Nasarawa</wicri:noRegion></affiliation></author><author><name sortKey="Saka, Yisa" sort="Saka, Yisa" uniqKey="Saka Y" first="Yisa" last="Saka">Yisa Saka</name><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Department of Public Health, Federal Ministry of Health, Abuja, FCT, Nigeria</addr-line></nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>Department of Public Health, Federal Ministry of Health, Abuja, FCT</wicri:regionArea><wicri:noRegion>FCT</wicri:noRegion></affiliation></author><author><name sortKey="Okoeguale, Bridget" sort="Okoeguale, Bridget" uniqKey="Okoeguale B" first="Bridget" last="Okoeguale">Bridget Okoeguale</name><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Department of Public Health, Federal Ministry of Health, Abuja, FCT, Nigeria</addr-line></nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>Department of Public Health, Federal Ministry of Health, Abuja, FCT</wicri:regionArea><wicri:noRegion>FCT</wicri:noRegion></affiliation></author><author><name sortKey="Richards, Frank O" sort="Richards, Frank O" uniqKey="Richards F" first="Frank O." last="Richards">Frank O. Richards</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>The Carter Center, Atlanta, Georgia, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>The Carter Center, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author></analytic><series><title level="j">PLoS Neglected Tropical Diseases</title><idno type="ISSN">1935-2727</idno><idno type="eISSN">1935-2735</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Albendazole (administration & dosage)</term><term>Albendazole (therapeutic use)</term><term>Animals</term><term>Anthelmintics (administration & dosage)</term><term>Anthelmintics (therapeutic use)</term><term>Antibodies</term><term>Antiparasitic Agents (administration & dosage)</term><term>Antiparasitic 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qualifier="therapeutic use" xml:lang="en"><term>Albendazole</term><term>Anthelmintics</term><term>Antiparasitic Agents</term><term>Ivermectin</term></keywords><keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Albendazole</term><term>Antihelminthiques</term><term>Antiparasitaires</term><term>Ivermectine</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Onchocerciasis</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Elephantiasis, Filarial</term><term>Nigeria</term><term>Onchocerciasis</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Elephantiasis, Filarial</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Onchocercose</term></keywords><keywords scheme="MESH" qualifier="transmission" xml:lang="en"><term>Onchocerciasis</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Albendazole</term><term>Antihelminthiques</term><term>Antiparasitaires</term><term>Ivermectine</term><term>Onchocercose</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Filariose lymphatique</term><term>Nigeria</term><term>Onchocercose</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Animals</term><term>Antibodies</term><term>Child</term><term>Child, Preschool</term><term>Female</term><term>Humans</term><term>Male</term><term>Microfilariae</term><term>Middle Aged</term><term>Prevalence</term><term>Seroepidemiologic Studies</term><term>Simuliidae</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Animaux</term><term>Anticorps</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Femelle</term><term>Filariose lymphatique</term><term>Humains</term><term>Jeune adulte</term><term>Microfilaria</term><term>Mâle</term><term>Prévalence</term><term>Simuliidae</term><term>Études séroépidémiologiques</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>This study was undertaken in five onchocerciasis/lymphatic filariasis (LF) co-endemic local government areas (LGAs) in Plateau and Nasarawa, Nigeria. Annual MDA with ivermectin had been given for 17 years, 8 of which were in combination with albendazole. In 2008, assessments indicated that LF transmission was interrupted, but that the MDA had to continue due to the uncertain status of onchocerciasis transmission. Accordingly, assessments to determine if ivermectin MDA for onchocerciasis could be stopped were conducted in 2009.</p></sec><sec><title>Methods</title><p>We evaluated nodule, microfilarial (mf) skin snip, and antibody (IgG4 response to OV16) prevalence in adults and children in six sentinel sites where baseline data from the 1990s were available. We applied the 2001 WHO criteria for elimination of onchocerciasis that defined transmission interruption as an infection rate of <0.1% in children (using both skin snip and OV16 antibody) and a rate of infective (L3) blackflies of <0.05%.</p></sec><sec><title>Results</title><p>Among adult residents in sentinel sites, mean mf prevalence decreased by 99.37% from the 1991–1993 baseline of 42.95% (64/149) to 0.27% (2/739) in 2009 (p<0.001). The OV16 seropositivity of 3.52% (26/739) among this same group was over ten times the mf rate. No mf or nodules were detected in 4,451 children in sentinel sites and ‘spot check’ villages, allowing the exclusion of 0.1% infection rate with 95% confidence. Seven OV16 seropositives were detected, yielding a seroprevalence of 0.16% (0.32% upper 95%CI). No infections were detected in PCR testing of 1,568 <italic>Simulium damnosum</italic> s.l. flies obtained from capture sites around the six sentinel sites.</p></sec><sec><title>Conclusion</title><p>Interruption of transmission of onchocerciasis in these five LGAs is highly likely, although the number of flies caught was insufficient to exclude 0.05% with 95% confidence (upper CI 0.23%). We suggest that ivermectin MDA could be stopped in these LGAs if similar results are seen in neighboring districts.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Basa Ez, Mg" uniqKey="Basa Ez M">MG Basáñez</name></author><author><name sortKey="Pion, Sds" uniqKey="Pion S">SDS Pion</name></author><author><name sortKey="Boakes, E" uniqKey="Boakes E">E Boakes</name></author><author><name sortKey="Filipe, Jan" uniqKey="Filipe J">JAN Filipe</name></author><author><name sortKey="Churcher, Ts" uniqKey="Churcher T">TS Churcher</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Plaisier, Ap" uniqKey="Plaisier A">AP Plaisier</name></author><author><name sortKey="Van Oortmarssen, Gj" uniqKey="Van Oortmarssen G">GJ van Oortmarssen</name></author><author><name sortKey="Habbema, Gj" uniqKey="Habbema G">GJ Habbema</name></author><author><name sortKey="Remme, J" uniqKey="Remme J">J Remme</name></author><author><name sortKey="Alley, Es" uniqKey="Alley E">ES Alley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Winnen, M" uniqKey="Winnen M">M Winnen</name></author><author><name sortKey="Plaisier, Ap" uniqKey="Plaisier A">AP Plaisier</name></author><author><name sortKey="Alley, Es" uniqKey="Alley E">ES Alley</name></author><author><name sortKey="Nagelkerke, Nj" uniqKey="Nagelkerke N">NJ Nagelkerke</name></author><author><name sortKey="Vanoortmarssen, G" uniqKey="Vanoortmarssen G">G vanOortmarssen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cupp, Ew" uniqKey="Cupp E">EW Cupp</name></author><author><name sortKey="Cupp, Ms" uniqKey="Cupp M">MS Cupp</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Richards, F" uniqKey="Richards F">F Richards</name></author><author><name sortKey="Gonzales Peralta, C" uniqKey="Gonzales Peralta C">C Gonzales-Peralta</name></author><author><name sortKey="Jallah, E" uniqKey="Jallah E">E Jallah</name></author><author><name sortKey="Miri, E" uniqKey="Miri E">E Miri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Miri, Es" uniqKey="Miri E">ES Miri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Richards, Fo" uniqKey="Richards F">FO Richards</name></author><author><name sortKey="Eigege, A" uniqKey="Eigege A">A Eigege</name></author><author><name sortKey="Miri, Es" uniqKey="Miri E">ES Miri</name></author><author><name sortKey="Alphonsus, K" uniqKey="Alphonsus K">K Alphonsus</name></author><author><name sortKey="Umaru, J" uniqKey="Umaru J">J Umaru</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="King, Jd" uniqKey="King J">JD King</name></author><author><name sortKey="Eigege, A" uniqKey="Eigege A">A Eigege</name></author><author><name sortKey="Umaru, J" uniqKey="Umaru J">J Umaru</name></author><author><name sortKey="Nimzing, J" uniqKey="Nimzing J">J Nimzing</name></author><author><name sortKey="Miri, E" uniqKey="Miri E">E Miri</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Lindblade, Ka" uniqKey="Lindblade K">KA Lindblade</name></author><author><name sortKey="Arana, B" uniqKey="Arana B">B Arana</name></author><author><name sortKey="Zea Flores, G" uniqKey="Zea Flores G">G Zea-Flores</name></author><author><name sortKey="Rizzo, N" uniqKey="Rizzo N">N Rizzo</name></author><author><name sortKey="Porter, Ch" uniqKey="Porter C">CH Porter</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gonzalez, Rj" uniqKey="Gonzalez R">RJ Gonzalez</name></author><author><name sortKey="Cruz Ortiz, N" uniqKey="Cruz Ortiz N">N Cruz-Ortiz</name></author><author><name sortKey="Rizzo, N" uniqKey="Rizzo N">N Rizzo</name></author><author><name sortKey="Richards, J" uniqKey="Richards J">J Richards</name></author><author><name sortKey="Zea Flores, G" uniqKey="Zea Flores G">G Zea-Flores</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Higazi, Tb" uniqKey="Higazi T">TB Higazi</name></author><author><name sortKey="Zarroug, Ima" uniqKey="Zarroug I">IMA Zarroug</name></author><author><name sortKey="Mohamed, Ha" uniqKey="Mohamed H">HA Mohamed</name></author><author><name sortKey="Elmubark, Wa" uniqKey="Elmubark W">WA ElMubark</name></author><author><name sortKey="Deran, Tcm" uniqKey="Deran T">TCM Deran</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Katabarwa, Mn" uniqKey="Katabarwa M">MN Katabarwa</name></author><author><name sortKey="Walsh, F" uniqKey="Walsh F">F Walsh</name></author><author><name sortKey="Habomugisha, P" uniqKey="Habomugisha P">P Habomugisha</name></author><author><name sortKey="Lakwo, Tl" uniqKey="Lakwo T">TL Lakwo</name></author><author><name sortKey="Agunyo, S" uniqKey="Agunyo S">S Agunyo</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Diawara, L" uniqKey="Diawara L">L Diawara</name></author><author><name sortKey="Traore, Mo" uniqKey="Traore M">MO Traoré</name></author><author><name sortKey="Bdji, A" uniqKey="Bdji A">A Bdji</name></author><author><name sortKey="Bissan, Y" uniqKey="Bissan Y">Y Bissan</name></author><author><name sortKey="Doumbia, Y" uniqKey="Doumbia Y">Y Doumbia</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tekle, Ah" uniqKey="Tekle A">AH Tekle</name></author><author><name sortKey="Elhassen, E" uniqKey="Elhassen E">E Elhassen</name></author><author><name sortKey="Isliyaku, S" uniqKey="Isliyaku S">S Isliyaku</name></author><author><name sortKey="Amazigo, Uv" uniqKey="Amazigo U">UV Amazigo</name></author><author><name sortKey="Bush, S" uniqKey="Bush S">S Bush</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Rodriguez Perez, Ma" uniqKey="Rodriguez Perez M">MA Rodríguez-Pérez</name></author><author><name sortKey="Adeleke, Ma" uniqKey="Adeleke M">MA Adeleke</name></author><author><name sortKey="Burkett Cadena, Nd" uniqKey="Burkett Cadena N">ND Burkett-Cadena</name></author><author><name sortKey="Garza Hernandez, Ja" uniqKey="Garza Hernandez J">JA Garza-Hernández</name></author><author><name sortKey="Reyes Villanueva, F" uniqKey="Reyes Villanueva F">F Reyes-Villanueva</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Katabarwa, M" uniqKey="Katabarwa M">M Katabarwa</name></author><author><name sortKey="Lakwo, T" uniqKey="Lakwo T">T Lakwo</name></author><author><name sortKey="Habumogisha, P" uniqKey="Habumogisha P">P Habumogisha</name></author><author><name sortKey="Richards, F" uniqKey="Richards F">F Richards</name></author><author><name sortKey="Eberhard, M" uniqKey="Eberhard M">M Eberhard</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Nigeria</li><li>États-Unis</li></country><region><li>Géorgie (États-Unis)</li></region></list><tree><country name="États-Unis"><region name="Géorgie (États-Unis)"><name sortKey="Evans, Darin S" sort="Evans, Darin S" uniqKey="Evans D" first="Darin S." last="Evans">Darin S. Evans</name></region><name sortKey="Gonzales Peralta, Carlos" sort="Gonzales Peralta, Carlos" uniqKey="Gonzales Peralta C" first="Carlos" last="Gonzales-Peralta">Carlos Gonzales-Peralta</name><name sortKey="Richards, Frank O" sort="Richards, Frank O" uniqKey="Richards F" first="Frank O." last="Richards">Frank O. Richards</name></country><country name="Nigeria"><noRegion><name sortKey="Alphonsus, Kal" sort="Alphonsus, Kal" uniqKey="Alphonsus K" first="Kal" last="Alphonsus">Kal Alphonsus</name></noRegion><name sortKey="Adamani, William" sort="Adamani, William" uniqKey="Adamani W" first="William" last="Adamani">William Adamani</name><name sortKey="Eigege, Abel" sort="Eigege, Abel" uniqKey="Eigege A" first="Abel" last="Eigege">Abel Eigege</name><name sortKey="Mafuyai, Hayward" sort="Mafuyai, Hayward" uniqKey="Mafuyai H" first="Hayward" last="Mafuyai">Hayward Mafuyai</name><name sortKey="Miri, Emmanuel" sort="Miri, Emmanuel" uniqKey="Miri E" first="Emmanuel" last="Miri">Emmanuel Miri</name><name sortKey="Okoeguale, Bridget" sort="Okoeguale, Bridget" uniqKey="Okoeguale B" first="Bridget" last="Okoeguale">Bridget Okoeguale</name><name sortKey="Pede, Elias" sort="Pede, Elias" uniqKey="Pede E" first="Elias" last="Pede">Elias Pede</name><name sortKey="Saka, Yisa" sort="Saka, Yisa" uniqKey="Saka Y" first="Yisa" last="Saka">Yisa Saka</name><name sortKey="Umaru, Jon" sort="Umaru, Jon" uniqKey="Umaru J" first="Jon" last="Umaru">Jon Umaru</name><name sortKey="Umbugadu, Christopher" sort="Umbugadu, Christopher" uniqKey="Umbugadu C" first="Christopher" last="Umbugadu">Christopher Umbugadu</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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