Projets de développement rural et question foncière dans la région du Nord-Cameroun : des innovations mais quelle pérennité ?

International audienceLa Région du Nord Cameroun est une zone d'accueil de populations migrantes, qui connaît depuis bientôt 20 ans une accélération de la compétition entre usagers pour l'accès aux ressources naturelles. Cette situation met en évidence l'émergence de la question foncière, qui n'a été intégrée dans les projets de développement qu'à partir des années 90. En adoptant d'abord l'approche gestion des terroirs puis l'approche participative, les projets innovent et mettent en place des accords et des structures chargées de trouver des solutions aux conflits liés à l'accès aux ressources. Mais quelle est la pérennité de ces dispositifs ? Cette communication s'appuie sur une série d'entretiens réalisés dans le lamidat de Touroua où sont intervenus successivement les projets DPGT, ESA et PDOB, qui ont amené les agriculteurs et les éleveurs à négocier des règles d'accès et à créer des espaces sécurisés (hurum, forêt, piste à bétail) gérés par des comités composés de représentants des usagers. Ces actions sont positives sur le court terme et permettent de résoudre des conflits ponctuels entre agriculteurs et éleveurs. Cependant, après la clôture de ces projets, le manque de financement, de formation et d'encadrement des comités mis en place limite leur fonctionnement. Cette situation pose la question de la légitimité de ces structures (implication, participation et représentativité). Mais elle souligne aussi la nécessité d'une action suivie à plus long terme et intégrée dans une politique régionale d'aménagement du territoire

Tuberculosis-HIV Co-infection in Kiev City, Ukraine

In 2004, we tested all patients with newly diagnosed tuberculosis (TB) for HIV in Kiev City. The results were compared to information from medical records of 2002, when co-infection prevalence was 6.3%. Of 968 TB patients, 98 (10.1%) were HIV infected. TB-HIV co-infection is increasing, especially in injecting drug users

Antiretroviral Therapy during Tuberculosis Treatment and Marked Reduction in Death Rate of HIV-Infected Patients, Thailand1

Antiretroviral therapy is associated with a substantial reduction in deaths during TB treatment for HIV-infected TB patients

Pneumocystis jirovecii pneumonia in tropical and low and middle income countries: a systematic review and meta-regression

Objective: Pneumocystis jirovecii pneumonia (PCP), the commonest opportunistic infection in HIV-infected patients in the developed world, is less commonly described in tropical and low and middle income countries (LMIC). We sought to investigate predictors of PCP in these settings. Design Systematic review and meta-regression. METHODS: Meta-regression of predictors of PCP diagnosis (33 studies). Qualitative and quantitative assessment of recorded CD4 counts, receipt of prophylaxis and antiretrovirals, sensitivity and specificity of clinical signs and symptoms for PCP, co-infection with other pathogens, and case fatality (117 studies). RESULTS: The most significant predictor of PCP was per capita Gross Domestic Product, which showed strong linear association with odds of PCP diagnosis (p30%; treatment was largely appropriate. Prophylaxis appeared to reduce the risk for development of PCP, however 24% of children with PCP were receiving prophylaxis. CD4 counts at presentation with PCP were usually <200×10 3/ ml. CONCLUSIONS: There is a positive relationship between GDP and risk of PCP diagnosis. Although failure to diagnose infection in poorer countries may contribute to this, we also hypothesise that poverty exposes at-risk patients to a wide range of infections and that the relatively non-pathogenic P. jirovecii is therefore under-represented. As LMIC develop economically they eliminate the conditions underlying transmission of virulent infection: P. jirovecii , ubiquitous in all settings, then becomes a greater relative threat

The role for government health centers in provision of same-day voluntary HIV counseling. and testing in Kenya

Objective: To explore the role of primary health centers in provision of voluntary counseling and testing (VCT) in Kenya. Design and Setting: Prospective service evaluation at 3 (1 urban and 2 rural) government health centers. Subjects: Consecutive adult clients. Main Outcome Measures: Uptake of services, user characteristics, quality of service. Results: Counseling services received 2315 new clients over 26 months. The last quarter averaged 101 clients per clinic. More than 80% of clients lived locally. Overall 93% opted to test, 91% receiving results, 82% on the same day. Most clients tested HIV negative (81%). Youth and men were well represented. Few couples (10%) attended. Seventeen percent of women were pregnant. Self-referral was common and illness was an uncommon reason for testing

Cotrimoxazole prophylaxis in adults infected with HIV in low-income countries

Two recent placebo-controlled trials of cotrimoxazole in HIV-infected adults, conducted by independent groups but in the same city (Abidjan, Côte d'Ivoire), have both shown important positive impacts. One study where cotrimoxazole or placebo was given to tuberculosis-HIV co-infected patients showed a significant reduction in mortality; the second study with a similar protocol, in HIV-infected patients without major co-morbidity at trial entry, showed a significant reduction in morbidity but no effect on mortality. These data have been interpreted by some as conclusive enough to recommend cotrimoxazole for all people with HIV/AIDS in Africa. Others have been more cautious, noting that Abidjan has an atypically low rate of cotrimoxazole resistance among bacterial pathogens, and consider more data are needed before such a sweeping policy decision can be made. Recent data from Senegal showed no benefit but this trial, like several others, was terminated prematurely because the investigators felt it unethical to continue after the Abidjan results were released. The situation is somewhat confused and confusing. This review attempts to put the current debate into context and to review the current position of cotrimoxazole in relation to other primary prophylaxis strategies in Africa