Efficacy and tolerability of a new formulation of artesunate-mefloquine for the treatment of uncomplicated malaria in adult in Senegal: open randomized trial

BACKGROUND: Prompt treatment of malaria attacks with arteminisin-based combination therapy (ACT) is an essential tool for malaria control. A new co-blister tablet of artesunate-mefloquine (AM) with 25 mg/kg mefloquine has been developed for the management of uncomplicated malaria attacks. This non-inferiority randomized trial, was conducted to evaluate the efficacy and safety of the new formulation of AM in comparison to artemether-lumefantrine (AL) for the treatment of acute uncomplicated Plasmodium falciparum malaria in adults in Senegal. METHODS: The study was carried out from September to December 2010 in two health centres in Senegal. The study end points included (i) PCR corrected adequate clinical and parasitological response (ACPR) at day 28, (ii) ACPR at days 42 and 63, (iii) parasites and fever clearance time, (iv) incidence of adverse events and patients biological profile at day 7 using the WHO 2003 protocol for anti-malarial drug evaluation. RESULTS: Overall, 310 patients were randomized to receive either AM (n = 157) or AL (n = 153). PCR corrected ACPR at day 28 was at 95.5% in the AM arm while that in the AL arm was at 96.7% (p = 0.83). Therapeutic efficacy was at 98.5% in the AM arm versus 98.2% in the AL group at day 42 (p = 1). At day 63, ACPR in the AM and AL arms was at 98.2% and 97.7%, respectively (p = 0.32). The two treatments were well tolerated with similar biological profile at day 7. However, dizziness was more frequent in the AM arm. CONCLUSION: Artesunate-mefloquine (25 mg/Kg mefloquine) is efficacious and well-tolerated for the treatment of uncomplicated P. falciparum malaria in adult patients

Intégration horticulture ‑ élevage dans les systèmes agricoles urbains de la zone des Niayes (Sénégal)

Les contre‑performances de l'agriculture rurale et le déficit alimentaire encouragent depuis plusieurs décennies le développement d'une activité agricole urbaine et péri urbaine dont les principaux domaines sont l'horticulture et l'élevage. La contribution de cette agriculture urbaine à l'approvisionnement des villes est mal connue au Sénégal. Les rares sources disponibles indiquent que Dakar a lui seul prend 40% de la demande totale de légumes du Sénégal et cette région couvre plus de 60 % d..

Effectiveness of Seasonal Malaria Chemoprevention in Children under Ten Years of Age in Senegal: A Stepped-Wedge Cluster-Randomised Trial.

BACKGROUND: Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ), given each month during the transmission season, is recommended for children living in areas of the Sahel where malaria transmission is highly seasonal. The recommendation for SMC is currently limited to children under five years of age, but, in many areas of seasonal transmission, the burden in older children may justify extending this age limit. This study was done to determine the effectiveness of SMC in Senegalese children up to ten years of age. METHODS AND FINDINGS: SMC was introduced into three districts over three years in central Senegal using a stepped-wedge cluster-randomised design. A census of the population was undertaken and a surveillance system was established to record all deaths and to record all cases of malaria seen at health facilities. A pharmacovigilance system was put in place to detect adverse drug reactions. Fifty-four health posts were randomised. Nine started implementation of SMC in 2008, 18 in 2009, and a further 18 in 2010, with 9 remaining as controls. In the first year of implementation, SMC was delivered to children aged 3-59 months; the age range was then extended for the latter two years of the study to include children up to 10 years of age. Cluster sample surveys at the end of each transmission season were done to measure coverage of SMC and the prevalence of parasitaemia and anaemia, to monitor molecular markers of drug resistance, and to measure insecticide-treated net (ITN) use. Entomological monitoring and assessment of costs of delivery in each health post and of community attitudes to SMC were also undertaken. About 780,000 treatments were administered over three years. Coverage exceeded 80% each month. Mortality, the primary endpoint, was similar in SMC and control areas (4.6 and 4.5 per 1000 respectively in children under 5 years and 1.3 and 1.2 per 1000 in children 5-9 years of age; the overall mortality rate ratio [SMC: no SMC] was 0.90, 95% CI 0.68-1.2, p = 0.496). A reduction of 60% (95% CI 54%-64%, p < 0.001) in the incidence of malaria cases confirmed by a rapid diagnostic test (RDT) and a reduction of 69% (95% CI 65%-72%, p < 0.001) in the number of treatments for malaria (confirmed and unconfirmed) was observed in children. In areas where SMC was implemented, incidence of confirmed malaria in adults and in children too old to receive SMC was reduced by 26% (95% CI 18%-33%, p < 0.001) and the total number of treatments for malaria (confirmed and unconfirmed) in these older age groups was reduced by 29% (95% CI 21%-35%, p < 0.001). One hundred and twenty-three children were admitted to hospital with a diagnosis of severe malaria, with 64 in control areas and 59 in SMC areas, showing a reduction in the incidence rate of severe disease of 45% (95% CI 5%-68%, p = 0.031). Estimates of the reduction in the prevalence of parasitaemia at the end of the transmission season in SMC areas were 68% (95% CI 35%-85%) p = 0.002 in 2008, 84% (95% CI 58%-94%, p < 0.001) in 2009, and 30% (95% CI -130%-79%, p = 0.56) in 2010. SMC was well tolerated with no serious adverse reactions attributable to SMC drugs. Vomiting was the most commonly reported mild adverse event but was reported in less than 1% of treatments. The average cost of delivery was US$0.50 per child per month, but varied widely depending on the size of the health post. Limitations included the low rate of mortality, which limited our ability to detect an effect on this endpoint. CONCLUSIONS: SMC substantially reduced the incidence of outpatient cases of malaria and of severe malaria in children, but no difference in all-cause mortality was observed. Introduction of SMC was associated with an overall reduction in malaria incidence in untreated age groups. In many areas of Africa with seasonal malaria, there is a substantial burden in older children that could be prevented by SMC. SMC in older children is well tolerated and effective and can contribute to reducing malaria transmission. TRIAL REGISTRATION: ClinicalTrials.gov NCT00712374

Strengthening and utilizing response groups for emergencies flagship: a narrative review of the roll out process and lessons from the first year of implementation

The World Health Organization Regional Office for Africa (WHO/AFRO) faces members who encounter annual disease epidemics and natural disasters that necessitate immediate deployment and a trained health workforce to respond. The gaps in this regard, further exposed by the COVID-19 pandemic, led to conceptualizing the Strengthening and Utilizing Response Group for Emergencies (SURGE) flagship in 2021. This study aimed to present the experience of the WHO/AFRO in the stepwise roll-out process and the outcome, as well as to elucidate the lessons learned across the pilot countries throughout the first year of implementation. The details of the roll-out process and outcome were obtained through information and data extraction from planning and operational documents, while further anonymized feedback on various thematic areas was received from stakeholders through key informant interviews with 60 core actors using open-ended questionnaires. In total, 15 out of the 47 countries in WHO/AFRO are currently implementing the initiative, with a total of 1,278 trained and validated African Volunteers Health Corps-Strengthening and Utilizing Response Groups for Emergencies (AVoHC-SURGE) members in the first year. The Democratic Republic of Congo (DRC) has the highest number (214) of trained AVoHC-SURGE members. The high level of advocacy, the multi-sectoral-disciplinary approach in the selection process, the adoption of the one-health approach, and the uniqueness of the training methodology are among the best practices applauded by the respondents. At the same time, financial constraints were the most reported challenge, with ongoing strategies to resolve them as required. Six countries, namely Botswana, Mauritania, Niger, Rwanda, Tanzania, and Togo, have started benefiting from their trained AVoHC-SURGE members locally, while responders from Botswana and Rwanda were deployed internationally to curtail the recent outbreaks of cholera in Malawi and Kenya

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Les relations franco-sénégalaises à l'épreuve du naufrage du bateau le Joola

The Senegalese and French states have an international reputation for maintaining an intimate historical relationship. Indeed, since 1960, they have been able to transform their colonialist relations into fairly peaceful North-South cooperation. Consequently, it is of the order of the unprecedented to specify a test in such relations. However, the time of the test will start from a legal fact having previously found cooperation recently in forced mutation. This news, in reputedly intimate reports, is justified by an international situation calling them to economic and political awareness. Globalization has been invited in these intimate relationships pushing the Senegalese state to liberalize its economy and its political partners. The result is a decline in the hegemony of the French state in Senegal. Unarmed or poorly prepared for this new deal, the two states will have new postures including, in the resolution of the JOOLA case. However, it seems that their intimate collaboration would be stronger than the relational disruption. It will be reborn from these ashes, proving that the ordeal was surmountable. However, it also shows that a re-adaptation of tier reports was unavoidable. Indeed, the JOOLA affair unveiled this requirement. And the Senegalese people will end up appropriating this requirement by imposing it on their political power. This would undoubtedly trigger a change in Franco-Senegalese relations by a reconsideration of Senegal's foreign policy towards France. Good governance has become a citizen requirement in Senegal. It is likely to permanently disturb Françafrique.Les Etats sénégalais et français ont la réputation internationale d'entretenir une relation historique de nature intimiste. En effet, depuis 1960, ils ont su transformer leurs rapports de source colonialiste en une coopération Nord-Sud assez pacifique. Dès lors, c'est de l'ordre de l'inédit de spécifier une épreuve dans de telles relations. Cependant, l'heure de l'épreuve partira d'un fait juridique ayant trouvé préalablement une coopération récemment en mutation forcée. Cette nouvelle donne, dans des rapports réputés intimistes, se justifie par une conjoncture internationale les convoquant à une prise de conscience économique et politique. La mondialisation s'est invitée dans ces relations intimistes poussant l'Etat sénégalais à libéraliser son économie et ses partenaires politiques. Il en résulte un recul de l'hégémonie de l'Etat français au Sénégal. Peu armés ou mal préparés à cette nouvelle donne, les deux Etats auront des postures inédites notamment, dans la résolution de l'affaire du JOOLA. Toutefois, il semblerait que leur collaboration intimiste serait plus forte que la perturbation relationnelle. Elle saura renaître de ces cendres prouvant ainsi que l'épreuve était surmontable. En effet, l'affaire du JOOLA a dévoilé cette exigence. Et le peuple sénégalais finira par s'approprier cette exigence en l'imposant à son pouvoir politique. Ceci allait incontestablement impulser une mutation des relations franco-sénégalaises par une reconsidération de la politique étrangère du Sénégal envers la France. La bonne gouvernance est devenue une exigence citoyenne au Sénégal. C'est de nature à perturber durablement la Françafrique

The franco-senegalese relations in the test of sinking of the boat the Joola

Les Etats sénégalais et français ont la réputation internationale d'entretenir une relation historique de nature intimiste. En effet, depuis 1960, ils ont su transformer leurs rapports de source colonialiste en une coopération Nord-Sud assez pacifique. Dès lors, c'est de l'ordre de l'inédit de spécifier une épreuve dans de telles relations. Cependant, l'heure de l'épreuve partira d'un fait juridique ayant trouvé préalablement une coopération récemment en mutation forcée. Cette nouvelle donne, dans des rapports réputés intimistes, se justifie par une conjoncture internationale les convoquant à une prise de conscience économique et politique. La mondialisation s'est invitée dans ces relations intimistes poussant l'Etat sénégalais à libéraliser son économie et ses partenaires politiques. Il en résulte un recul de l'hégémonie de l'Etat français au Sénégal. Peu armés ou mal préparés à cette nouvelle donne, les deux Etats auront des postures inédites notamment, dans la résolution de l'affaire du JOOLA. Toutefois, il semblerait que leur collaboration intimiste serait plus forte que la perturbation relationnelle. Elle saura renaître de ces cendres prouvant ainsi que l'épreuve était surmontable. En effet, l'affaire du JOOLA a dévoilé cette exigence. Et le peuple sénégalais finira par s'approprier cette exigence en l'imposant à son pouvoir politique. Ceci allait incontestablement impulser une mutation des relations franco-sénégalaises par une reconsidération de la politique étrangère du Sénégal envers la France. La bonne gouvernance est devenue une exigence citoyenne au Sénégal. C'est de nature à perturber durablement la Françafrique.The Senegalese and French states have an international reputation for maintaining an intimate historical relationship. Indeed, since 1960, they have been able to transform their colonialist relations into fairly peaceful North-South cooperation. Consequently, it is of the order of the unprecedented to specify a test in such relations. However, the time of the test will start from a legal fact having previously found cooperation recently in forced mutation. This news, in reputedly intimate reports, is justified by an international situation calling them to economic and political awareness. Globalization has been invited in these intimate relationships pushing the Senegalese state to liberalize its economy and its political partners. The result is a decline in the hegemony of the French state in Senegal. Unarmed or poorly prepared for this new deal, the two states will have new postures including, in the resolution of the JOOLA case. However, it seems that their intimate collaboration would be stronger than the relational disruption. It will be reborn from these ashes, proving that the ordeal was surmountable. However, it also shows that a re-adaptation of tier reports was unavoidable. Indeed, the JOOLA affair unveiled this requirement. And the Senegalese people will end up appropriating this requirement by imposing it on their political power. This would undoubtedly trigger a change in Franco-Senegalese relations by a reconsideration of Senegal's foreign policy towards France. Good governance has become a citizen requirement in Senegal. It is likely to permanently disturb Françafrique

Les relations franco-sénégalaises à l'épreuve du naufrage du bateau le Joola

The Senegalese and French states have an international reputation for maintaining an intimate historical relationship. Indeed, since 1960, they have been able to transform their colonialist relations into fairly peaceful North-South cooperation. Consequently, it is of the order of the unprecedented to specify a test in such relations. However, the time of the test will start from a legal fact having previously found cooperation recently in forced mutation. This news, in reputedly intimate reports, is justified by an international situation calling them to economic and political awareness. Globalization has been invited in these intimate relationships pushing the Senegalese state to liberalize its economy and its political partners. The result is a decline in the hegemony of the French state in Senegal. Unarmed or poorly prepared for this new deal, the two states will have new postures including, in the resolution of the JOOLA case. However, it seems that their intimate collaboration would be stronger than the relational disruption. It will be reborn from these ashes, proving that the ordeal was surmountable. However, it also shows that a re-adaptation of tier reports was unavoidable. Indeed, the JOOLA affair unveiled this requirement. And the Senegalese people will end up appropriating this requirement by imposing it on their political power. This would undoubtedly trigger a change in Franco-Senegalese relations by a reconsideration of Senegal's foreign policy towards France. Good governance has become a citizen requirement in Senegal. It is likely to permanently disturb Françafrique.Les Etats sénégalais et français ont la réputation internationale d'entretenir une relation historique de nature intimiste. En effet, depuis 1960, ils ont su transformer leurs rapports de source colonialiste en une coopération Nord-Sud assez pacifique. Dès lors, c'est de l'ordre de l'inédit de spécifier une épreuve dans de telles relations. Cependant, l'heure de l'épreuve partira d'un fait juridique ayant trouvé préalablement une coopération récemment en mutation forcée. Cette nouvelle donne, dans des rapports réputés intimistes, se justifie par une conjoncture internationale les convoquant à une prise de conscience économique et politique. La mondialisation s'est invitée dans ces relations intimistes poussant l'Etat sénégalais à libéraliser son économie et ses partenaires politiques. Il en résulte un recul de l'hégémonie de l'Etat français au Sénégal. Peu armés ou mal préparés à cette nouvelle donne, les deux Etats auront des postures inédites notamment, dans la résolution de l'affaire du JOOLA. Toutefois, il semblerait que leur collaboration intimiste serait plus forte que la perturbation relationnelle. Elle saura renaître de ces cendres prouvant ainsi que l'épreuve était surmontable. En effet, l'affaire du JOOLA a dévoilé cette exigence. Et le peuple sénégalais finira par s'approprier cette exigence en l'imposant à son pouvoir politique. Ceci allait incontestablement impulser une mutation des relations franco-sénégalaises par une reconsidération de la politique étrangère du Sénégal envers la France. La bonne gouvernance est devenue une exigence citoyenne au Sénégal. C'est de nature à perturber durablement la Françafrique

La femme toucouleur et le développement rural en Mauritanie (analyse des groupements féminins maraîchers dans la Wilaya du Gorgol)

L'objet de la thèse est d'étudier la femme toucouleur dans le développement rural de la Mauritanie en s'appuyant sur l'exemple des groupements féminins maraîchers de la Wilaya du Gorgol. L'étude tend à montrer la contribution capitale des femmes à l'économie agricole et la sécurité alimentaire. Elle tend à promouvoir une meilleure connaissance des femmes toucouleurs de Mauritanie auxquelles peu d'études ont été consacrées. La thèse comporte deux parties de trois chapitres à chacune et une conclusion à chacune. La première partie fait une présentation ge ographique et sociopolitique de la société et de la femme toucouleur en Mauritanie. Elle insiste plus particulièrement sur les données sociodémographiques relatives aux femmes. Dans cette partie sont aussi analysées sur la base du profil socioéconomique des femmes, les contraintes qui pèsent sur leurs contrIbutions domestiques et économiques. L'étude met en exergue les différences de statut et l'hétérogénéité des situations des femmes toucouleurs et maures. La promotion féminine et la genèse du mouvement coopératif qui la favorise sont étudiées dans le cadre de développement de la vallée du fleuve sénégal. Les organismes publics et agences de coopération sont également présentés. Dans la deuxième partie, la thèse étudie le rôle de la femme toucouleur dans le développement rural et la promotion féminine dans la Wilaya du Gorgol. Les groupements féminins maraîchers du département de Kaedi sont pris en exemple. Après une présentation de la Wilaya, l'étude s'attache plus spécifiquement à l'analyse des coopératives féminines de Civé, Tokomadji et Djéol. Dans cette partie aussi est analysée le rôle des femmes dans le développement rural à travers leur implication au sein des groupements féminins maraîchers, ainsi que les contraintes qui pèsent sur leurs activités. En fait la thèse encourage la promotion des groupements féminins maraîchers comme facteur d'intégration des femmes rurales au processus de développement. fis sont essentiels au développement du milieu rura1, dans la mesure où ils assurent la sécurité alimentaire, freinent l'exode rural et positionnent les femmes dans les enjeux du développementPARIS1-BU Pierre Mendès-France (751132102) / SudocSudocFranceF