Closing the GAP in Antimicrobial Resistance Policy in Benin and Burkina Faso

Antimicrobial resistance (AMR) is a global concern that is geographically unevenly distributed, with low- and middle-income countries and African countries suffering in particular. The World Health Organization (WHO) Global Action Plan (GAP) for antimicrobial resistance identified five key objectives that aim to ensure the continued treatment and prevention of infectious diseases with the use of antibiotics. Countries signatory to the WHO GAP are expected to develop their own national action plans (NAPs) based on the global model. How low-income countries are able to achieve the GAP objectives is not well understood. This paper analyzes the progress of two West African countries in achieving the GAP targets, Benin and Burkina Faso, countries among the lowest bracket in the World Development Index. We present qualitative data from interviews and focus group discussions with local policy-makers, nurses, doctors, animal breeders, veterinarians, and laboratory researchers, supported by participant observations and surveys within rural communities. The analysis is organized according to the five WHO GAP objectives to show the countries' challenges in fulfilling them. The analysis shows that there are shortcomings in all of the WHO GAP areas in the two countries, making it a compounded and multifactorial problem-a stacking of lacks. In such contexts, calibrating a society toward AMR resilience/prevention requires overall development and attention to interdependencies. Active local research and policy communities with international, sustained financial support are essential for achieving the targets. IMPORTANCE The burden of antimicrobial resistance (AMR) is unequally distributed across the globe. Low-income countries face a more severe AMR situation and have fewer means to solve the problem. This paper brings out the voices of local experts, policy-makers, and members of the community in Benin and Burkina Faso across human health, animal health, and food production sectors, where the majority of antibiotic use is concentrated. We describe the difficulties that they face in implementing global action plans, targets set by the World Health Organization, for securing antibiotics and preventing the spread of antimicrobial resistance. This paper argues that the various deficits in implementation are stacked, multisectoral, and compounded. We highlight the role of active local scientists and policy-maker networks in setting priorities to address the AMR problem; however, their activities need technical and financial support from international partners.Peer reviewe

Fertilisation des sols avec la litiere foliaire en zone Subsahelienne du Burkina Faso: Diversite des especes, effets sur les rendements du sorgho

Organic matter sources management for soil fertility improvement has been the subject of many researches. Agroforestry is one of the topics addressed by these researches. In Burkina Faso\u2019s Northern Center, leaf litter of woody species is collected, piled, crumbled before spreading in fields. This practice is not well known in the rest of the country. The present study aims to provide information on the diversity of spontaneous plant species concerned, farmers\u2019 motivations of litter crumbling and to evaluate, empirically the effects of litter spreading on sorghum yields. A participatory study, using qualitative surveys and biometric field measurements, was conducted in five villages in the Northern Center of Burkina Faso. Because of their availability, accessibility, and agronomic performance, plants such as Vitellaria paradoxa , Anogeissus leiocarpa , Combretum micranthum , Lannea microcarpa and Diospyros mespiliformis were the species whose leaf litter was valued most. Measurements achieved in situ indicate that sorghum yields from fields that received Vitellaria leaf litter for the first time were lower than those in the control plots. On the other hand, fields that received this litter for three consecutive years were more productive. A scientific study on leaf litter chemical characteristics and their influence on soil fertility parameters should be considered in order to validate local knowledge and to improve knowledge about these practices.La gestion des sources de mati\ue8res organiques, pour am\ue9liorer la fertilit\ue9 des sols, a fait l\u2019objet de nombreuses recherches. L\u2019agroforesterie est une des th\ue9matiques abord\ue9es par ces recherches. Dans le Centre-Nord du Burkina Faso, la liti\ue8re foliaire des esp\ue8ces ligneuses est ramass\ue9e, mise en tas, \ue9miett\ue9e avant d\u2019\ueatre \ue9pandue dans les champs. Cette pratique est peu connue dans le reste du pays. La pr\ue9sente \ue9tude visait \ue0 fournir des informations sur la diversit\ue9 des esp\ue8ces v\ue9g\ue9tales spontan\ue9es concern\ue9es, les motivations paysannes de l\u2019\ue9miettement de la liti\ue8re et \ue0 \ue9valuer, empiriquement et par des mesures, les effets de l\u2019\ue9pandage de ces liti\ue8res sur les rendements du sorgho. Une \ue9tude participative, \ue0 l\u2019aide d\u2019enqu\ueates qualitatives et des mesures biom\ue9triques dans des champs, a \ue9t\ue9 men\ue9e dans cinq villages du Centre Nord du Burkina Faso. A cause de leur disponibilit\ue9, leur accessibilit\ue9, leur performance agronomique, les plantes telles que Vitellaria paradoxa , Anogeissus leiocarpa , Combretum micranthum , Lannea microcarpa , Diospyros mespiliformis ont \ue9t\ue9 cit\ue9es comme \ue9tant les esp\ue8ces dont la liti\ue8re des feuilles est valoris\ue9e. Les mesures r\ue9alis\ue9es in situ montrent que, les rendements du sorgho dans les champs ayant re\ue7u de la liti\ue8re foliaire de Vitellaria pour la premi\ue8re fois, ont \ue9t\ue9 inf\ue9rieurs \ue0 ceux des parcelles t\ue9moin. Par contre, les champs ayant re\ue7u cette liti\ue8re pendant trois ann\ue9es cons\ue9cutives ont \ue9t\ue9 plus productifs. Dans l\u2019optique de valider les savoirs locaux et d\u2019approfondir les connaissances sur l\u2019effet des liti\ue8res foliaires sur la fertilit\ue9 du sol, une \ue9tude scientifique sur leur caract\ue9ristique chimique et sur leur influence sur les param\ue8tres de fertilit\ue9 du sol, est \ue0 envisager

Les données démographiques Africaines sont-elles capables de bien informer les décideurs sur les besoins de la population âgée Africaine?

It is unclear whether adequate data exist to assess accurately the numbers of older Africans, let alone provide the detailed information needed to inform policy decision making. We examine the quality of data on older Africans produced by the Demographic and Health surveys and censuses for 17 African countries in order to evaluate the quality of age reporting and the extent to which the older population is captured by these major data collection exercises. Our analyses show (1) that the quality of age data is rough or very rough for most countries outside Southern Africa (2) that in a number of Sahelian countries DHS surveys seem to omit a considerable proportion of older women and (3) the data on older people produced by the DHS and the census are inconsistent and contradictory. We then analyse in-depth interviews with data producers and users in Burkina Faso, Tanzania and Uganda on the available and required data in these countries on older people. We demonstrate a virtuous circle in Uganda where new policies for provision of services and resources for older people are generating new demands for data on older peoples’ situations and needs. This contrasts with the situations in Tanzania and Burkina Faso where there is little recognition of older people as a vulnerable population with specific needs and no widespread perception that better quality data are required

APOBEC3G variants and protection against HIV-1 infection in Burkina Faso

Studies on host factors, particularly the APOBEC3G gene, have previously found an association with AIDS progression in some populations and against some HIV-1 strains but not others. Our study had two main objectives: firstly, to screen a population from Burkina Faso for three variants of APOBEC3G previously described, and secondly to analyze the effect of these three variants and their haplotypes on HIV-1 infection with Circulating Recombinant Forms (CRFs) present in Burkina Faso. This case control study involved 708 seropositive and seronegative individuals. Genotyping was done by the TaqMan allelic discrimination method. Minor allele frequencies of rs6001417 (p<0.05), rs8177832 (P<0.05), and rs35228531 (P<0.001) were higher in seronegative subjects. The rs6001417 and rs8177832 SNPs were associated with HIV-1 infection in an additive model (P<0.01). Furthermore the SNP rs35228531 was also associated with HIV-1 infection in a dominant model (P<0.001). Odds ratio analysis of genotypes and alleles of the different APOBEC3G variants showed that there is a strong association between the minor genetic variants, genotype of the three SNPs, and HIV-1 status. Haplotype analysis demonstrated that rs6001417, rs8177832, and rs35228531 are in linkage disequilibrium. The haplotype GGT from the rs6001417, rs8177832 and rs35228531 respectively has a protective effect OR = 0.54 [0.43-0.68] with P<0.001. There was also associations between the haplotypes GGC OR = 1.6 [1.1;-2.3] P<0.05, and CGC OR = 5.21 [2.4-11.3] P<0.001, which increase the risk of infection by HIV-1 from almost two (2) to five (5) fold. This study demonstrates an association of rs6001417, rs8177832, and rs35228531 of APOBEC3G with HIV-1 infection in a population from Burkina Faso

The influence of C3 and C4 vegetation on soil organic matter dynamics in contrasting semi-natural tropical ecosystems

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Variations in the carbon isotopic composition of soil organic matter (SOM) in bulk and fractionated samples were used to assess the influence of C3 and C4 vegetation on SOM dynamics in semi-natural tropical ecosystems sampled along a precipitation gradient in West Africa. Differential patterns in SOM dynamics in C3/C4 mixed ecosystems occurred at various spatial scales. Relative changes in C/ N ratios between two contrasting SOM fractions were used to evaluate potential site-scale differences in SOM dynamics between C3- and C4-dominated locations. These differences were strongly controlled by soil texture across the precipitation gradient, with a function driven by bulk δ 13C and sand content explaining 0.63 of the observed variability. The variation of δ 13C with soil depth indicated a greater accumulation of C3-derived carbon with increasing precipitation, with this trend also being strongly dependant on soil characteristics. The influence of vegetation thickening on SOM dynamics was also assessed in two adjacent, but structurally contrasting, transitional ecosystems occurring on comparable soils to minimise the confounding effects posed by climatic and edaphic factors. Radiocarbon analyses of sand-size aggregates yielded relatively short mean residence times (τ ) even in deep soil layers, while the most stable SOM fraction associated with silt and clay exhibited shorter τ in the savanna woodland than in the neighbouring forest stand. These results, together with the vertical variation observed in δ 13C values, strongly suggest that both ecosystems are undergoing a rapid transition towards denser closed canopy formations. However, vegetation thickening varied in intensity at each site and exerted contrasting effects on SOM dynamics. This study shows that the interdependence between biotic and abiotic factors ultimately determine whether SOM dynamics of Published by Copernicus Publications on behalf of the European Geosciences Union. 5042 G. Saiz et al.: Influence of C3/C4 on SOM in tropical biomes C3- and C4-derived vegetation are at variance in ecosystems where both vegetation types coexist. The results highlight the far-reaching implications that vegetation thickening may have for the stability of deep SOM.UK National Environment Research CouncilAustralian Institute of Nuclear Science and Engineering (AINSE Ltd

The influence of C3 and C4 vegetation on soil organic matter dynamics in contrasting semi-natural tropical ecosystems

Variations in the carbon isotopic composition of soil organic matter (SOM) in bulk and fractionated samples were used to assess the influence of C3 and C4 vegetation on SOM dynamics in semi-natural tropical ecosystems sampled along a precipitation gradient in West Africa. Differential patterns in SOM dynamics in C3/C4 mixed ecosystems occurred at various spatial scales. Relative changes in C=N ratios between two contrasting SOM fractions were used to evaluate potential site-scale differences in SOM dynamics between C3- and C4-dominated locations. These differences were strongly controlled by soil texture across the precipitation gradient, with a function driven by bulk 13C and sand content explaining 0.63 of the observed variability. The variation of 13C with soil depth indicated a greater accumulation of C3-derived carbon with increasing precipitation, with this trend also being strongly dependant on soil characteristics. The influence of vegetation thickening on SOM dynamics was also assessed in two adjacent, but structurally contrasting, transitional ecosystems occurring on comparable soils to minimise the confounding effects posed by climatic and edaphic factors. Radiocarbon analyses of sand-size aggregates yielded relatively short mean residence times ( ) even in deep soil layers, while the most stable SOM fraction associated with silt and clay exhibited shorter in the savanna woodland than in the neighbouring forest stand. These results, together with the vertical variation observed in 13C values, strongly suggest that both ecosystems are undergoing a rapid transition towards denser closed canopy formations.However, vegetation thickening varied in intensity at each site and exerted contrasting effects on SOM dynamics. Thisstudy shows that the interdependence between biotic and abiotic factors ultimately determine whether SOM dynamics of C3- and C4-derived vegetation are at variance in ecosystems where both vegetation types coexist. The results highlight the far-reaching implications that vegetation thickening may have for the stability of deep SOM. © 2015, Copernicus Publications

Foliar trait contrasts between African forest and savanna trees: Genetic versus environmental effects

Journal ArticleVariations in leaf mass per unit area (Ma) and foliar concentrations of N, P, C, K, Mg and Ca were determined for 365 trees growing in 23 plots along a West African precipitation gradient ranging from 0.29 to 1.62m a-1. Contrary to previous studies, no marked increase in Ma with declining precipitation was observed, but savanna tree foliar [N] tended to be higher at the drier sites (mass basis). Generally, Ma was slightly higher and [N] slightly lower for forest vs savanna trees with most of this difference attributable to differences in soil chemistry. No systematic variations in [P], [Mg] and [Ca] with precipitation or between trees of forest vs savanna stands were observed. We did, however, find a marked increase in foliar [K] of savanna trees as precipitation declined, with savanna trees also having a significantly lower [K] than those of nearby forest. These differences were not related to differences in soil nutrient status and were accompanied by systematic changes in [C] of opposite sign. We suggest an important but as yet unidentified role for K in the adaption of savanna species to periods of limited water availability; with foliar [K] being also an important factor differentiating tree species adapted to forest vs savanna soils within the 'zone of transition' of Western Africa.Natural Environment Research Council TROBIT Consortium projectRoyal Society - University Research Fellowshi

PLoS One

Objectives Mental health is a largely neglected issue among in Sub-Saharan Africa, especially among key populations at risk for HIV. The aim of this study was to estimate the prevalence of psychological distress (PD) and to assess the factors associated among males who have sex with males (MSM), female sex workers (FSW) and drug users (DU) in Togo in 2017. Study design A cross-sectional bio-behavioral study was conducted in August and September 2017 using a respondent-driven sampling (RDS) method, in eight cities in Togo. Methods A standardized questionnaire was used to record sociodemographic characteristics and sexual behaviors. The Alcohol Use Disorders Identification Test (AUDIT) and a subset of questions from the Tobacco Questions for Survey were used to assess alcohol and tobacco consumption respectively. PD was assessed with the Kessler Psychological Distress Scale. A blood sample was taken to test for HIV. Descriptive statistics, univariable and multivariable ordinal regression models were used for analysis. Results A total of 2044 key populations including 449 DU, 952 FSW and 643 MSM with a median age of 25 years, interquartile range (IQR) [21–32] were recruited. The overall prevalence of mild PD among the three populations was 19.9% (95%CI = [18.3–21.8]) and was 19.2% (95%CI = [17.5–20.9]) for severe/moderate PD. HIV prevalence was 13.7% (95%CI = [12.2–15.2]). High age (≥ 25 years) [aOR = 1.24 (95% CI: 1.02–1.50)], being HIV positive [aOR = 1.80 (95% CI: 1.31–2.48)] and hazardous alcohol consumption [aOR = 1.52 (95% CI: 1.22–1.87)] were risk factors for PD. Secondary [aOR = 0.52 (95% CI: 0.42–0.64)] or higher [aOR = 0.46 (95% CI: 0.32–0.64)] education levels were protective factors associated with PD. FSW [OR = 0.55 (95% CI: 0.43–0.68)] and MSM [OR = 0.33 (95% CI: 0.24–0.44)] were less likely to report PD compared with DU. Conclusion and recommendations This is the first study conducted among a large, nationally representative sample of key populations in Togo. The prevalence of PD is high among these populations in Togo and was associated to HIV infection. The present study indicates that mental health care must be integrated within health programs in Togo with a special focus to key populations through interventions such as social support groups

A Randomized Trial to Assess the Impact of a Package of Diagnostic Tools and Diagnostic Algorithm on Antibiotic Prescriptions for the Management of Febrile Illnesses Among Children and Adolescents in Primary Health Facilities in Burkina Faso.

BACKGROUND: Low- and middle-income countries face significant challenges in differentiating bacterial from viral causes of febrile illnesses, leading to inappropriate use of antibiotics. This trial aimed to evaluate the impact of an intervention package comprising diagnostic tests, a diagnostic algorithm, and a training-and-communication package on antibiotic prescriptions and clinical outcomes. METHODS: Patients aged 6 months to 18 years with fever or history of fever within the past 7 days with no focus, or a suspected respiratory tract infection, arriving at 2 health facilities were randomized to either the intervention package or standard practice. The primary outcomes were the proportions of patients who recovered at day 7 (D7) and patients prescribed antibiotics at day 0. RESULTS: Of 1718 patients randomized, 1681 (97.8%; intervention: 844; control: 837) completed follow-up: 99.5% recovered at D7 in the intervention arm versus 100% in standard practice (P = .135). Antibiotics were prescribed to 40.6% of patients in the intervention group versus 57.5% in the control arm (risk ratio: 29.3%; 95% CI: 21.8-36.0%; risk difference [RD]: -16.8%; 95% CI: -21.7% to -12.0%; P < .001), which translates to 1 additional antibiotic prescription saved every 6 (95% CI: 5-8) consultations. This reduction was significant regardless of test results for malaria, but was greater in patients without malaria (RD: -46.0%; -54.7% to -37.4%; P < .001), those with a respiratory diagnosis (RD: -38.2%; -43.8% to -32.6%; P < .001), and in children 6-59 months old (RD: -20.4%; -26.0% to -14.9%; P < .001). Except for the period July-September, the reduction was consistent across the other quarters (P < .001). CONCLUSIONS: The implementation of the package can reduce inappropriate antibiotic prescription without compromising clinical outcomes. CLINICAL TRIALS REGISTRATION: clinicaltrials.gov; NCT04081051