Improving postpartum care delivery and uptake by implementing context-specific interventions in four countries in Africa: a realist evaluation of the Missed Opportunities in Maternal and Infant Health (MOMI) project.

Postpartum care (PPC) has remained relatively neglected in many interventions designed to improve maternal and neonatal health in sub-Saharan Africa. The Missed Opportunities in Maternal and Infant Health project developed and implemented a context-specific package of health system strengthening and demand generation in four African countries, aiming to improve access and quality of PPC. A realist evaluation was conducted to enable nuanced understanding of the influence of different contextual factors on both the implementation and impacts of the interventions. Mixed methods were used to collect data and test hypothesised context-mechanism-outcome configurations: 16 case studies (including interviews, observations, monitoring data on key healthcare processes and outcomes), monitoring data for all study health facilities and communities, document analysis and participatory evaluation workshops. After evaluation in individual countries, a cross-country analysis was conducted that led to the development of four middle-range theories. Community health workers (CHWs) were key assets in shifting demand for PPC by 'bridging' communities and facilities. Because they were chosen from the community they served, they gained trust from the community and an intrinsic sense of responsibility. Furthermore, if a critical mass of women seek postpartum healthcare as a result of the CHWs bridging function, a 'buzz' for change is created, leading eventually to the acceptability and perceived value of attending for PPC that outweighs the costs of attending the health facility. On the supply side, rigid vertical hierarchies and defined roles for health facility workers (HFWs) impede integration of maternal and infant health services. Additionally, HFWs fear being judged negatively which overrides the self-efficacy that could potentially be gained from PPC training. Instead the main driver of HFWs' motivation to provide comprehensive PPC is dependent on accountability systems for delivering PPC created by other programmes. The realist evaluation offers insights into some of the contextual factors that can be pivotal in enabling the community-level and service-level interventions to be effective

Variations saisonnières et facteurs de risques des trypanosomoses animales dans un contexte de chimiorésistance dans la zone de Sikasso au Mali

The naturally occurring pentacyclic diterpenoid gibberellic acid (<b>1</b>) was used in the generation of a drug-like amide library using parallel-solution-phase synthesis. Prior to the synthesis, a virtual library was generated and prioritized based on drug-like physicochemical parameters such as log P, hydrogen bond donor/acceptor counts, and molecular weight. The structures of the synthesized analogues (<b>2</b>–<b>13</b>) were elucidated following analysis of the NMR, MS, UV, and IR data. Compound <b>12</b> afforded crystalline material, and its structure was confirmed by X-ray crystallographic analysis. All compounds were evaluated <i>in vitro</i> for cytotoxicity and deregulation of lipid metabolism in LNCaP prostate cancer cells. While no cytotoxic activity was identified at the concentrations tested, synthesized analogues <b>3</b>, <b>5</b>, <b>7</b>, <b>10</b>, and <b>11</b> substantially reduced cellular uptake of free cholesterol in prostate cancer cells, suggesting a novel role of gibberellic acid derivatives in deregulating cholesterol metabolism

Variations saisonnières et facteurs de risques des trypanosomoses animales dans un contexte de chimiorésistance dans la zone de Sikasso au Mali

ABSTRACT IN FRENCH: Une série de trois enquêtes longitudinales sur des bovins a été conduite entre Août 2003 et Avril 2004 autour de Sikasso au Mali. Ces enquêtes avaient pour objectif de faire une étude épidémiologique saisonnière des trypanosomoses animales dans un contexte de chimiorésistance aux trypanocides. Du point de vue parasitologique, il existe une hétérogénéité dans l’évolution de la maladie. De fortes prévalences parasitologiques ont été enregistrées au mois d’Août correspondant à la saison pluvieuse, dans les sites de Diassadiè (34%) et de Wahibéra (28,89%). Ces deux villages ont été les seuls à présenter une variation saisonnière significative (p< 0,05) des valeurs de prévalences observées. Les infections étaient majoritairement dues à Trypanosoma congolense (64,81 à 67,12% des cas), suivi de Trypanosoma vivax (28,77 à 35,19%) et rarement de Trypanosoma brucei (1,37%). La valeur moyenne de l’hématocrite en saison pluvieuse était la plus forte (26,49% + 0,43) avec une variation saisonnière significative. Sur le plan entomologique, deux espèces de glossines riveraines ont été identifiées en toute saison avec des densités apparentes par piège (DAP) allant de 3,45 à 5,29 pour l’espèce Glossina palpalis gambiensis et variant entre 0,98 et 2,80 pour Glossina tachinoides. Une corrélation significative (a=0,05) entre la densité apparente de Glossina palpalis gambiensis et le taux d’infection des bovins a été observée en saison pluvieuse. Des échecs de traitement (résistance) à l’acéturate de diminazène ont été suspectés dans plusieurs sites. ABSTRACT IN ENGLISH: Three longitudinal surveys were carried out on cattle between August 2003 and April 2004 around Sikasso in Mali. The goal was to make a seasonal epidemiological assessment of the animal trypanosomoses in a chemoresistance context. From a parasitological viewpoint, heterogeneity exists in the evolution of the disease. High parasitological prevalences were recorded during the rainy season (August) at Diassadiè (34%) and at Wahibéra (28.89%). These two villages were the only to present a significant seasonal variation (p<0.05) of the observed prevalence values. The infections were mostly caused by Trypanosoma congolense (64.81 - 67.12%), followed by Trypanosoma vivax (28.77 - 35.19%) and rarely by Trypanosoma brucei (1.37%). The hematocrit average value was the highest in the rainy season (26.49% + 0.43) with a significant seasonal variation. Entomologically, two species of tsetse flies were identified during all seasons with apparent fly densities per trap (DAP) of 3.45 to 5.29 for Glossina palpalis gambiensis and 0.98 to 2.80 for Glossina tachinoides. A significant correlation (a =0.05) between the density of Glossina palpalis gambiensis and the rate of infection on the cattle was observed during the rainy season. Diminazene aceturate treatment failures (resistance) were suspected in several sites

Preventing and containing trypanocide resistance in the cotton zone of West Africa

Trypanocidal drugs are the most commonly purchased and used livestock input by resource-poor farmers in sub-Saharan Africa. The effective use of trypanocidal drugs by smallholder farmers is threatened by the development of widespread resistance. This is a particular concern for smallholder crop-livestock farmers in the cotton zone of West Africa. A recent project funded by the Germany Ministry for Economic Cooperation and Development (BMZ) confirmed significant resistance to trypanocidal drugs in villages with high trypanosomosis risk in Burkina Faso and Mali. Strategies for resistance prevention were investigated. Keeping trypanotolerant cattle was found to be an effective disease management strategy, but farmers' preference for trypano-susceptible breeds, for reasons unrelated to animal health, suggest that the intromission of zebu genotype will continue. Community vector control was found to be effective in managing trypanosomosis in the presence of resistance and the high-level participatory approach tested was found to be more sustainable than low-level approaches previously used in the region. This suggests that participatory vector control with appropriate external support is likely to be a viable option for implementing resistance 'clean-up'. Promoting rational drug use (RDU) emerged as a promising prevention strategy, with clear improvements in farmer knowledge, farmer practice and animal health outcomes. However, policy studies showed low understanding of the problem of resistance and the absence of an enabling environment for RDU. Engagement was initiated with actors involved in the problem of resistance and for its solution, including manufacturers, sellers and users of drugs, regulators and extension providers

Répartition spatiale des trypanosomoses animales en relation avec la chimiorésistance dans la zone cotonnière de l’Afrique de l’Ouest (Mali et Guinée)

Cross sectional surveys (2002-2004) achieved in 89 villages, carried on 5474 cattle and 1908 tse tse flies (G. palpalis: 53%; G. tachinoides: 45% and G. morsitans: 2%) have been captured. Following these investigations, several suspected villages have been chosen for longitudinal surveys in order to put out the failures of treatments to the trypanocides (isometamidium chloride and diminazene aceturate) on cattle. The spatial analysis of the results shows heterogeneity in the distribution. The size of the phenomenon decreases from the East to the West of the zone. In Mali, the average parasitological prevalence is 4.5% for a peak value of 22% against an average prevalence of 2.8% for a peak value of 11.7% in Guinea. The infections in Mali are caused by T. congolense (49%) and T. vivax (51%). Those of Guinea are characterized by the predominance of T. brucei (59%) followed of T. congolense (36%) and T. vivax (5%). On the entomological plan, one notices the absence of G. morsitans in the East part in Mali, but in Guinea it is G. tachinoides who is absent. Different levels of chemoresistance have been identified in the zone

Fertility after Endoscopic Surgery for Ectopic Pregnancy Management in Point "G” Teaching Hospital, Bamako-Mali

Endoscopic surgery of ectopic pregnancy is actually the gold standard for the management of fallopian tubal diseases. A survey was conducted to evaluate fertility in patients who underwent endoscopic management for ectopic pregnancy. A retrospective study was conducted at the department of general and endoscopic surgery of the Point "G" teaching hospital, in Bamako, Mali, from January 1st 2007 to December 31, 2016. Forty-eight (48) patients who underwent endoscopic management of tubal ectopic pregnancy and who have been followed up for fertility were included in this study. Statistical tests used were X2 or Fisher test and their confident interval, p&lt;1 % has been considered as statistically significant. The therapeutic score of Pouly was less than 4 in 25.0% (n = 12). The return to fertility was observed among 48.0% of patients (n = 23). The chance of conception was less than 80.0% after the fourth postoperative year (p=0.001). The outcome of pregnancies has been seventeen full-term pregnancies, three ectopic pregnancies and three miscarriages. The occurrence of pregnancy after endoscopic management indicated for ectopicpregnancy is possible. However, many factors can influence the future conception. Keywords: Extra-uterine pregnancy, tubal abnormality, endoscopic management, Mal

Relativistic-intensity near-single-cycle light source at 1kHz

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