Evaluation of the diagnostic accuracy of a hemoglobin S and C screening test: Sickle Scan

New tools for the rapid diagnosis of hemoglobinosis could encourage the extension of their screening in Africa. Our goal was to assess the analytical performances of a rapid hemoglobin S and C detection test, the Sickle Scan. This was a cross-sectional study carried out in March 2019 at the Yopougon Teaching Hospital. The subjects followed for hemoglobinosis as well as the subjects seeking out an electrophoresis of their hemoglobin were included. We carried out the hemogram, the electrophoresis of hemoglobin at alkaline pH (reference method) coupled with the metabisulfite sickling test (Emmel test) and the rapid detection test to be evaluated. This immunochromatographic test is capable of detecting hemoglobins A, S, and C, and to infer the hemoglobin phenotype from there. The study recruited 191 individuals. The test detected hemoglobins S and C with a sensitivity of 99.4% and 97.7% respectively; a specificity of 93.3% and 99.3%. The positive likelihood ratio for hemoglobins S and C was 15 and 144 respectively. The negative likelihood ratio was 0.01 for hemoglobin S, and 0.02 for hemoglobin C. The intrinsic characteristics obtained make this test an interesting screening tool for hemoglobinosis S and C. Keywords: Diagnostic test, hemoglobinosis, Abidjan, sensitivity, specificity

How do we evaluate an innovative process? Case of the quantitative and qualitative improvement of organic manure in the field

Soil fertility in West Africa is under high anthropogenic pressure caused by the increasing population, extension of cultivated areas and abandonment of fallows. Through a participatory action research approach, the Fertipartenaires project proposed to design with farmers innovations on the use of organic manure, in three steps: increase the production capacity of organic manure by building pits, improve production quality, and integrate its application in the field. How do we assess an innovative process made up of several stages that cover different space and time scales? How do we include this assessment in a participatory approach? A participatory assessment method in three steps is proposed: (1) assessment of the direct effect of innovation (partial assessment), (2) analysis of economic, sociological and ecological indirect consequences of the innovation, and (3) analysis of innovation dynamics (adoption, dissemination, and redefinition). Two models of organic manure production have been tested: a manure pit built on the concession and a compost pit built at the edge of the field. The analysis of the direct effects of compost production shows that it is economically more advantageous than manure with its higher opportunity costs. However, the two production models are complementary and they each have a positive balance. The method used helps to assess the direct effects of innovation on the economic impact of organic manure production. It helps start discussions with farmers around the simplified illustration of the direct effects of innovation. It should however be completed by the analysis of indirect consequences and innovation dynamics so as to take into account the dimensions that were not included in the partial assessments

Assessing the impact of anaesthetic and surgical task-shifting globally:A systematic literature review

The global shortage of skilled anaesthesiologists, surgeons and obstetricians is a leading cause of high unmet surgical need. Although anaesthetic and surgical task-shifting are widely practiced to mitigate this barrier, little is known about their safety and efficacy. This systematic review seeks to highlight the existing evidence on the clinical outcomes of patients operated on by non-physicians or non-specialist physicians globally. Relevant articles were identified by searching four databases (MEDLINE, Embase, CINAHL, and Global Health) in all languages between 2008 and February 2022. Retrieved documents were screened against pre-specified inclusion and exclusion criteria and their qualities were appraised critically. Data were extracted by two independent reviewers and findings were synthesised narratively. In total, 40 studies have been included. Thirty-five focus on task-shifting for surgical and obstetric procedures, whereas four studies address anaesthetic task-shifting; one study covers both interventions. The majority are located in Sub-Saharan Africa and the United States. Seventy-five percent present perioperative mortality outcomes and 85% analyse morbidity measures. Evidence from low- and middle-income countries, which primarily concentrates on caesarean sections, hernia repairs, and surgical male circumcisions, points to the overall safety of non-surgeons. On the other hand, the literature on surgical task-shifting in high-income countries is limited to nine studies analysing tube thoracostomies, neurosurgical procedures, caesarean sections, male circumcisions, and basal cell carcinoma excisions. Finally, only five studies pertaining to anaesthetic task-shifting across all country settings answer the research question with conflicting results, making it difficult to draw conclusions on the quality of non-physician anaesthetic care. Overall, it appears that non-specialists can safely perform high-volume, low-complexity operations. Further research is needed to understand the implications of surgical task-shifting in high-income countries and to better assess the performance of non-specialist anaesthesia providers. Future studies must adopt randomised study designs and include long-term outcome measures to generate high quality evidence

Aetiology of acute febrile illness in children in a high malaria transmission area in West Africa.

OBJECTIVES: Areas with declining malaria transmission in sub-Saharan Africa have recently witnessed important changes in the aetiology of childhood acute febrile illness (AFI). We describe the aetiology of AFI in a high malaria transmission area in rural Burkina Faso. METHODS: In a prospective hospital-based diagnostic study, children aged 3 months to 15 years with AFI were recruited and assessed using a systematic diagnostic protocol, including blood cultures, whole blood PCR on a selection of bacterial pathogens, malaria diagnostics and a multiplex PCR on nasopharyngeal swabs targeting 21 viral and 4 bacterial respiratory pathogens. RESULTS: A total of 589 children with AFI were enrolled from whom an infectious disease was considered in 575 cases. Acute respiratory tract infections, malaria and invasive bacterial infections (IBI) accounted for 179 (31.1%), 175 (30.4%) and 75 (13%) of AFI cases respectively; 16 (21.3%) of IBI cases also had malarial parasitaemia. A viral pathogen was demonstrated from the nasopharynx in 157 children (90.7%) with respiratory tract symptoms. Of all children with viral respiratory tract infections, 154 (92.4% received antibiotics, whereas no antibiotic was provided in 13 (17%) of IBI cases. CONCLUSIONS: Viral respiratory infections are a common cause of childhood AFI in high malaria transmission areas, next to malaria and IBI. These findings highlight the importance of interventions to improve targeted treatment with antimicrobials. Most patients with viral infections received antibiotics unnecessarily, while a considerable number with IBI did not receive antibiotics.status: Published onlin

Gender differences in sociodemographic and behavioural factors associated with BMI in an adult population in rural Burkina Faso - an AWI-Gen sub-study.

The global health transition is linked with an increased burden of non-communicable diseases with cardiovascular diseases leading the epidemic. In sub-Saharan Africa (SSA), the prevalence of obesity has increased during the past decades and there is a need to investigate the associated driving factors. In Burkina Faso obesity remains low, especially in rural areas. In this study we recruited middle-aged adults, as part of a larger study on genetic and environmental contributions to cardiometabolic disease among Africans.info:eu-repo/semantics/publishe

Infection Manager System (IMS) as a new hemocytometry-based bacteremia detection tool: A diagnostic accuracy study in a malaria-endemic area of Burkina Faso

Background New hemocytometric parameters can be used to differentiate causes of acute febrile illness (AFI). We evaluated a software algorithm–Infection Manager System (IMS)—which uses hemocytometric data generated by Sysmex hematology analyzers, for its accuracy to detect bacteremia in AFI patients with and without malaria in Burkina Faso. Secondary aims included comparing the accuracy of IMS with C-reactive protein (CRP) and procalcitonin (PCT). Methods In a prospective observational study, patients of ≥ three-month-old (range 3 months– 90 years) presenting with AFI were enrolled. IMS, blood culture and malaria diagnostics were done upon inclusion and additional diagnostics on clinical indication. CRP, PCT, viral multiplex PCR on nasopharyngeal swabs and bacterial- and malaria PCR were batch-tested retrospectively. Diagnostic classification was done retrospectively using all available data except IMS, CRP and PCT results. Findings A diagnosis was affirmed in 549/914 (60.1%) patients and included malaria (n = 191) bacteremia (n = 69), viral infections (n = 145), and malaria-bacteremia co-infections (n = 47). The overall sensitivity, specificity, and negative predictive value (NPV) of IMS for detection of bacteremia in patients of ≥ 5 years were 97.0% (95% CI: 89.8–99.6), 68.2% (95% CI: 55.6–79.1) and 95.7% (95% CI: 85.5–99.5) respectively, compared to 93.9% (95% CI: 85.2–98.3), 39.4% (95% CI: 27.6–52.2), and 86.7% (95% CI: 69.3–96.2) for CRP at ≥20mg/L. The sensitivity, specificity and NPV of PCT at 0.5 ng/ml were lower at respectively 72.7% (95% CI: 60.4–83.0), 50.0% (95% CI: 37.4–62.6) and 64.7% (95% CI: 50.1–77.6) The diagnostic accuracy of IMS was lower among malaria cases and patients <5 years but remained equal to- or higher than the accuracy of CRP. Interpretation IMS is a new diagnostic tool to differentiate causes of AFI. Its high NPV for bacteremia has the potential to improve antibiotic dispensing practices in healthcare facilities with hematology analyzers. Future studies are needed to evaluate whether IMS, combined with malaria diagnostics, may be used to rationalize antimicrobial prescription in malaria endemic areas. Trial registration ClinicalTrials.gov (NCT02669823) https://clinicaltrials.gov/ct2/show/NCT0266982

Infection Manager System (IMS) as a new hemocytometry-based bacteremia detection tool: A diagnostic accuracy study in a malaria-endemic area of Burkina Faso

Contains fulltext : 231530.pdf (publisher's version ) (Open Access)BACKGROUND: New hemocytometric parameters can be used to differentiate causes of acute febrile illness (AFI). We evaluated a software algorithm-Infection Manager System (IMS)-which uses hemocytometric data generated by Sysmex hematology analyzers, for its accuracy to detect bacteremia in AFI patients with and without malaria in Burkina Faso. Secondary aims included comparing the accuracy of IMS with C-reactive protein (CRP) and procalcitonin (PCT). METHODS: In a prospective observational study, patients of ≥ three-month-old (range 3 months- 90 years) presenting with AFI were enrolled. IMS, blood culture and malaria diagnostics were done upon inclusion and additional diagnostics on clinical indication. CRP, PCT, viral multiplex PCR on nasopharyngeal swabs and bacterial- and malaria PCR were batch-tested retrospectively. Diagnostic classification was done retrospectively using all available data except IMS, CRP and PCT results. FINDINGS: A diagnosis was affirmed in 549/914 (60.1%) patients and included malaria (n = 191) bacteremia (n = 69), viral infections (n = 145), and malaria-bacteremia co-infections (n = 47). The overall sensitivity, specificity, and negative predictive value (NPV) of IMS for detection of bacteremia in patients of ≥ 5 years were 97.0% (95% CI: 89.8-99.6), 68.2% (95% CI: 55.6-79.1) and 95.7% (95% CI: 85.5-99.5) respectively, compared to 93.9% (95% CI: 85.2-98.3), 39.4% (95% CI: 27.6-52.2), and 86.7% (95% CI: 69.3-96.2) for CRP at ≥20mg/L. The sensitivity, specificity and NPV of PCT at 0.5 ng/ml were lower at respectively 72.7% (95% CI: 60.4-83.0), 50.0% (95% CI: 37.4-62.6) and 64.7% (95% CI: 50.1-77.6) The diagnostic accuracy of IMS was lower among malaria cases and patients <5 years but remained equal to- or higher than the accuracy of CRP. INTERPRETATION: IMS is a new diagnostic tool to differentiate causes of AFI. Its high NPV for bacteremia has the potential to improve antibiotic dispensing practices in healthcare facilities with hematology analyzers. Future studies are needed to evaluate whether IMS, combined with malaria diagnostics, may be used to rationalize antimicrobial prescription in malaria endemic areas. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02669823) https://clinicaltrials.gov/ct2/show/NCT02669823

Pre-delivery administration of azithromycin to prevent neonatal sepsis and death: a phase iii double-blind randomized clinical trial (PregnAnZI-2 trial).

BACKGROUND: Despite reduction in the risk of under-5 mortality in the last decade and a half, neonatal deaths have remained stable globally. Gram-positive bacterial infections are leading causes of neonatal sepsis and death. Because the mother is an important source for bacterial transmission to babies during the perinatal period, interventions that lower risk of transmission can potentially reduce invasive bacterial infections. The primary objective of the trial will assess the effect of intrapartum azithromycin on neonatal sepsis and mortality. Secondary objectives include the impact of the intervention on prevalence of carriage and resistance, puerperal infections, and infant growth. METHODS: This is a phase III, double-blinded, placebo-controlled randomized trial in which 12,000 women in labour are randomized to either a single dose of 2 g of oral azithromycin (AZI) or placebo in The Gambia and Burkina Faso. Mother/newborn pairs are followed-up at 28-days post-delivery to assess health and mortality. Passive visits are conducted to collect adverse events including hospitalizations. When clinically indicated, samples are collected for assessment of neonatal and puerperal sepsis. A cohort of 250 mother/newborn pair per country have been included in the carriage sub-study to assess bacterial colonization at day 0, 6, 28 and 4 months. Children of the first 1000 mothers recruited in each country are followed-up at 6 and 12 months for anthropometric assessments. CONCLUSIONS: If successful, this simple implementable intervention has the potential to achieve wide coverage in Sub-Saharan Africa (SSA) where low-cost interventions to reduce neonatal sepsis and mortality and morbidity in mothers are urgently needed. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov: NCT0319954