Invasive bacterial infections in Gambians with sickle cell anaemia in an era of widespread Pneumococcal and Haemophilus influenzae type B vaccination

Background: There is relatively little data on the aetiology of bacterial infections in patients with sickle cell anaemia (SCA) in West Africa, and no data from countries that have implemented conjugate vaccines against both Streptococcus pneumoniae and Haemophilus influenzae type b (Hib). Methods: We conducted a retrospective analysis of SCA patients admitted to the Medical Research Council Unit, The Gambia during a five-year period when there was high coverage of Hib and Pneumococcal conjugate vaccination. We evaluated 161 admissions of 126 patients between April 2010 and April 2015. Results: Pathogenic bacteria were identified in blood cultures from 11 of the 131 admissions that had cultures taken (8.4%, 95% CI 4.5-14.1%). The most frequent isolate was Salmonella Typhimurium (6/11; 54.5%), followed by Staphylococcus aureus (2/11; 18.2%) and other enteric Gram-negative pathogens (2/11; 18.2%) and there was one case of H. influenzae non-type b bacteraemia (1/11; 9.1%). There were no episodes of bacteraemia caused by S. pneumoniae or Hib. Conclusions: The low prevalence of S. pneumoniae and Hib, and the predominance of non-typhoidal Salmonella as a cause of bacteraemia suggest the need to reconsider optimal antimicrobial prophylaxis and the empirical treatment regimens for patients with SCA

Variations in agronomic and grain quality traits of rice grown under irrigated lowland conditions in West Africa

Rice breeding in West Africa has been largely skewed toward yield enhancement and stress tolerance. This has led to the variable grain quality of locally produced rice in the region. This study sought to assess variations in the agronomic and grain quality traits of some rice varieties grown in this region, with a view to identifying sources of high grain yield and quality that could serve as potential donors in their breeding programs. Forty‐five varieties were grown under irrigated conditions in Benin and Senegal with two trials in each country. There were wide variations in agronomic and grain quality traits among the varieties across the trials. Cluster analysis using paddy yield, head rice yield, and chalkiness revealed that 68% of the total variation could be explained by five varietal groupings. One group comprising seven varieties (Afrihikari, BG90‐2, IR64, Sahel 108, WAT311‐WAS‐B‐B‐23‐7‐1, WAT339‐TGR‐5‐2, and WITA 10) had high head rice yield and low chalkiness. Of the varieties in this group, Sahel 108 had the highest paddy yield in three of the four trials. IR64 and Afrihikari had intermediate and low amylose content, respectively, with the rest being high‐amylose varieties. Another group of varieties consisting of B6144F‐MR‐6‐0‐0, C74, IR31851‐96‐2‐3‐2‐1, ITA222, Jaya, Sahel 305, WITA 1, and WITA 2 had high paddy yield but poor head rice yield and chalkiness. The use of materials from these two groups of varieties could accelerate breeding for high yielding rice varieties with better grain quality for local production in West Africa

Policy issues and regional integration : a case study of Nigeria'a policy in the economic community of West African States (ECOWAS) - 1979-1997

Bibliography: leaves 206-221.In West Africa, where most countries attained independence in 1960 or around that time, Economic co-operation and integration have been pursued at different levels with varying degree of successes. This study addresses Nigeria 's policy in the Economic Community of West African States (ECOWAS) between 1979-1997. It is an investigation of the forces that have been driving the integration efforts in West Africa. The study focuses on the period between 1979-1997. The analysis proceeds through three phases: Firstly the Alhaji Shehu Shagari Era 1979-1983; secondly, the General Muhammadu Buhari era 1983-1984; finally the General Ibrahim Babangida/Ernest Shonekan/General Sani Abacha eras 1984-1998. The policy posture of Nigeria as a regional power-broker is the focal point of analysis in relation to specific Protocols of the ECOWAS Treaty. Three policy courses pursued by Nigeria during this period have been the subject of examination in this study: the expulsion of illegal immigrants most of whom were citizens of ECOWAS member states in 1983 and 1985, the land border closure of 1984-1985, and Nigeria 's role in ECOMOG. These policies are analysed in tandem with the Protocol on the free movement of goods; persons and services, the 1979 Non-Aggression Pact, the 1981 Mutual Assistance Protocol and the Protocol dealing with landlocked and Island member states. Other sub- regional forces like the linguistic barriers between the Anglophone, Francophone and Lusophone speaking states, the involvement of external powers like France, Britain and the United States of America and the regional rivalry between Cote d 'lvoire, Senegal, Ghana, Burkina Faso and Nigeria are also interrogated. The study concludes that regional integration is the most viable alternative for the socio-economic development and political stability of countries in the subregion. However, because of the disparity in the level of economic development, the issue of free movement of persons should be handled with high political tact in order to avoid a repetition of the 1983 and 1985 Nigerian expulsions. Such moves may not be a contravention of the Protocol in question but will dampen the spirit of 'oneness' that is a sine qua non for the success of the Community. Moreover the implementation of such a sensitive Protocol as the 1979 Non-Aggression Pact and the 1981 Mutual Defence Agreement needs a clear mandate to reduce the controversy that arises over the interpretation of such Protocols. This will reduce the regional tensions and acrimony as is manifested over Nigeria 's pivotal role in ECOMOG. Finally, the study concludes that Nigeria has a very significant role to play in ECOWAS. The realisation of the dreams of the founders of the Community is highly dependent on a consistent policy course by Nigeria in the affairs of ECOWAS

A four-month gatifloxacin-containing regimen for treating tuberculosis.

BACKGROUND: Shortening the course of treatment for tuberculosis would be a major improvement for case management and disease control. This phase 3 trial assessed the efficacy and safety of a 4-month gatifloxacin-containing regimen for treating rifampin-sensitive pulmonary tuberculosis. METHODS: We conducted a noninferiority, randomized, open-label, controlled trial involving patients 18 to 65 years of age with smear-positive, rifampin-sensitive, newly diagnosed pulmonary tuberculosis in five sub-Saharan African countries. A standard 6-month regimen that included ethambutol during the 2-month intensive phase was compared with a 4-month regimen in which gatifloxacin (400 mg per day) was substituted for ethambutol during the intensive phase and was continued, along with rifampin and isoniazid, during the continuation phase. The primary efficacy end point was an unfavorable outcome (treatment failure, recurrence, or death or study dropout during treatment) measured 24 months after the end of treatment, with a noninferiority margin of 6 percentage points, adjusted for country. RESULTS: A total of 1836 patients were assigned to the 4-month regimen (experimental group) or the standard regimen (control group). Baseline characteristics were well balanced between the groups. At 24 months after the end of treatment, the adjusted difference in the risk of an unfavorable outcome (experimental group [21.0%] minus control group [17.2%]) in the modified intention-to-treat population (1356 patients) was 3.5 percentage points (95% confidence interval, -0.7 to 7.7). There was heterogeneity across countries (P=0.02 for interaction, with differences in the rate of an unfavorable outcome ranging from -5.4 percentage points in Guinea to 12.3 percentage points in Senegal) and in baseline cavitary status (P=0.04 for interaction) and body-mass index (P=0.10 for interaction). The standard regimen, as compared with the 4-month regimen, was associated with a higher dropout rate during treatment (5.0% vs. 2.7%) and more treatment failures (2.4% vs. 1.7%) but fewer recurrences (7.1% vs. 14.6%). There was no evidence of increased risks of prolongation of the QT interval or dysglycemia with the 4-month regimen. CONCLUSIONS: Noninferiority of the 4-month regimen to the standard regimen with respect to the primary efficacy end point was not shown. (Funded by the Special Program for Research and Training in Tropical Diseases and others; ClinicalTrials.gov number, NCT00216385.)

Maternal-fetal prognosis of obstetric emergencies at the maternity ward of the Mamou regional hospital

Background: Pregnant women may be at risk of unpredictable obstetric complications such as: bleeding, dystocia, acute fetal suffering, pre-eclampsia and eclampsia. This maternal-fetal prognosis of obstetric emergencies is influenced by factors that are most often related to complications that alter the course or outcome of a pregnancy and require prompt care. The objectives of this study are to analyze the factors that influence the maternal-fetal prognosis of obstetric emergencies; determine their frequency, describe the clinical profiles of patients and evaluate the maternal-fetal prognosis.Methods: The study was conducted at the Mamou Regional Hospital. It was a 6-month quantitative, descriptive and analytical study, from July 1st to December 31st, 2016, including all parturient women whose term is greater than or equal to 28 weeks of amenorrhoea.Results: The study covered 377 obstetric emergencies out of a total of 1273 deliveries, or 29.61%. Factors influencing the prognosis were: young age, parity, unfavorable socio-economic conditions and difficult baseline conditions. The main obstetric emergencies recorded were acute fetal suffering, disproportion and narrowed pelvis. The dominant mode of delivery was caesarean section with a frequency of 89.65%. Maternal lethality is 3.44% and fetal lethality is 5.14%.Conclusions: Obstetric emergency is a frequent situation where better management would improve the prognosis of the mother and fetus

Subsurface chlorophyll maximum and hydrodynamics of the water column

The vertical distributions of chlorophyll a (in vivo fluorescence) and hydrodynamic properties were monitored in the Gulf of St. Lawrence (Canada) from 6 to 10 August 1983, using an automatic yo-yo profiling system and a chain of 4 current meters. Spectral analyses of temperature and in vivo fluorescence series showed that dominant frequencies were associated with internal waves (∼16 h inertial frequency). A subsurface chlorophyll maximum was continuously observed in the lower part of the 20 m thick photic layer, at a depth corresponding with maximum vertical stability of the water column, just above the nutricline.The depth of maximum phytoplankton production, at least on sunny days, corresponded to that of the subsurface chlorophyll maximum and of the maximum in vertical stability. This close association persisted despite strong horizontal advection and vertical movements caused by internal waves. Photosynthetic adjustment did occur in the water column: higher vertical stability at depth favored shade adaptation of the phytoplankton in the layer of maximum stability, as compared to the more light-adapted cells of the upper well-mixed layer. At our sampling station, vertical turbulent diffusion seemed to be high enough to replenish nutrients in the photic layer, so that they never became completely exhausted, even in surface waters. Therefore, the observed subsurface chlorophyll maximum not only resulted from environmental conditions more favorable for phytoplankton accumulation and growth, but it also involved active photosynthetic responses of phytoplankton

Prevalence and Correlates of Herbal Medicine Use among Women Seeking Care for Infertility in Freetown, Sierra Leone

© 2018 Peter Bai James et al. In resource-poor countries where access to infertility care is limited, women may turn to traditional medicine to achieve motherhood. It is unknown whether Sierra Leonean women with such condition use herbal medicine. This study investigates the prevalence and factors associated with herbal medicine use among women seeking care for infertility. This was a questionnaire-based cross-sectional study conducted among women seeking care for infertility at various clinics within Freetown, Sierra Leone. Data analysis included Chi-square tests and logistic regression. Out of the 167 women that participated, 36.5% used herbal medicine for infertility treatment. Women with no formal (AOR 4.03, CL: 1.38-11.76, p=0.011), primary education (AOR: 6.23, CL: 2.02-19.23, p=0.001) and those that visited a traditional medicine practitioner (AOR: 20.05, CL: 2.10-192.28, p=0.009) as well as women suffering from other reproductive health problems (AOR: 2.57, CL: 1.13-5.83, p=0.024) were more likely to use herbal medicines. Friends and family (n=57, 96.7%) were the main influencers of herbal medicine use. Only (n=12) 19.7% of users disclosed their status to their healthcare provider. Over half (n=32, 52.5%) could not remember the name of the herb they used. Luffa acutangula (n=29, 100%) was the herbal medicinal plant users could recall. Herbal medicine use among women seeking care for infertility in Freetown is common. Healthcare providers should be aware of the potential dyadic use of herbal and allopathic medicines by their patients and be knowledgeable about commonly used herbal remedies as well as being proactive in communicating the potential risks and benefits associated with their use

Aménagements hydro-agricoles et santé (vallée du fleuve Sénégal)

Près de 1 500 personnes résidant dans les villages rattachés au périmètre irrigué MO 6bis (périmètre de Diomandou, département de Podor) ont fait l'objet de prélèvements d'urine et/ou de selle afin de déterminer la prévalence de la bilharziose urinaire, de la bilharziose intestinale ainsi que des autres parasitoses entériques. Chez les riverains du périmètre, 1 295 urines ont été examinées, parmi lesquelles sept contenaient des oeufs viables de #Schistosoma haematobium$, ce qui représente un taux de prévalence de 0,5$, ce qui correspond à un indice d'infestation de 0,1%. Il s'agissait là aussi d'un individu dont la contamination avait eu lieu en dehors de la zone d'étude. #Eschirichia coli$est la parasite entérique le plus répandu avec 17,2$, #Strongyloïdes stercoralis, #Ascaris lumbricoïdes et #Trichiuris trichiura$ sont rares et ne concernent qu'un peu moins de 2% des sujets examinés. Ces résultats démontrent l'absence, pour l'instant tout au moins, de foyers de transmission des bilharzioses dans les villages du périmètre de Diomandou. Le risque d'apparition de ces maladies est cependant important et dépend à la fois de l'évolution des infrastructures et de l'éventuelle apparition d'hôtes intermédiaires encore absent du réseau hydrographique de ce périmètre mis en place récemment. (Résumé d'auteur