Hernie inguinale en Afrique subsaharienne: quelle place pour la technique de Shouldice?

L'objectif était d'étudier l'aspect épidémio-clinique et thérapeutique de la hernie inguinale selon la technique de Shouldice. Nous avons réalisé une étude  rétrospective, portant sur les patients opérés pour hernie inguinale selon la technique de Shouldice dans le service de chirurgie B du CHU du Point G, Bamako, Mali. Il a été  enregistré 225patients opérés selon la technique de Shouldice. L'âge moyen était de 49 ans +/- 17,7. Il y avait 90,7% (204) hommes soit un sex-ratio de 9,7. Les cultivateurs, les ménagères et les ouvriers ont représenté 51,1% (115). Dans 75,2% (169) les patients ont consulté pour tuméfaction inguinale. En pré opératoire, la hernie était compliquée chez 82 (36,4%) patients dont 24 cas de récidive. L'étranglement herniaire a été la principale complication pré opératoire  58,5% (48/82). Les suites opératoires à un an ont été simples chez 94,2%(210) des patients; elles étaient marquées par 8 cas de récidive, 4 cas de névralgie, 2  cas d'atrophie testiculaire, 1 cas de chéloïde. La technique de Shouldice est la technique de choix pour la cure de la hernie inguinale dans les pays en voie de  développement à cause du bon résultat et son coût peu onéreux par rapport aux autres techniques utilisant des dispositifs médicaux.Key words: Hernie inguinale, technique de Shouldice, récidive

Prevalence of trachoma in the Kayes region of Mali eight years after stopping mass drug administration

<div><p>Background</p><p>In 2009, three years after stopping mass treatment with azithromycin, a trachoma impact survey in four health districts in the Kayes region of Mali found a prevalence of trachomatous inflammation—follicular (TF) among children aged 1 to 9 years of >5% and a trachomatous trichiasis (TT) prevalence within the general population (≥1-year-old) of <1%. As a result, the government’s national trachoma program expanded trichiasis surgery and related activities required to achieve trachoma elimination.</p><p>Methodology/Principal findings</p><p>In 2015, to assess progress towards elimination, a follow-up impact survey was conducted in the Kayes, Kéniéba, Nioro and Yélimané health districts. The survey used district level two-stage cluster random sampling methodology with 20 clusters of 30 households in each evaluation unit. Subjects were eligible for examination if they were ≥1 year. TF and TT cases were identified and confirmed by experienced ophthalmologists. In total 14,159 people were enumerated and 11,620 (82%) were examined. TF prevalence (95% confidence interval (CI)) was 0.5% (0.3–1%) in Kayes, 0.8% (0.4–1.7%) in Kéniéba, 0.2% (0–0.9%) in Nioro and 0.3% (0.1–1%) in Yélimané. TT prevalence (95% CI) was 0.04% (0–0.25%) in Kayes, 0.29% (0.11–0.6%) in Kéniéba, 0.04% (0–0.25%) in Nioro and 0.07% (0–0.27%) in Yélimané.</p><p>Conclusions/Significance</p><p>Eight years after stopping MDA and intensifying trichiasis surgery outreach campaigns, all four districts reached the TF elimination threshold of <5% and three of four districts reached the TT elimination threshold of <0.1%.</p></div

Multicentre studies of insecticide-treated durable wall lining in Africa and South-East Asia: entomological efficacy and household acceptability during one year of field use.

BACKGROUND: Indoor residual spraying (IRS) is a primary method of malaria vector control, but its potential impact is constrained by several inherent limitations: spraying must be repeated when insecticide residues decay, householders can tire of the annual imposition and campaign costs are recurrent. Durable lining (DL) can be considered an advanced form of long-lasting IRS where insecticide is gradually released from an aesthetically attractive wall lining material to provide vector control for several years. A multicentre trial was carried out in Equatorial Guinea, Ghana, Mali, South Africa and Vietnam to assess the feasibility, durability, bioefficacy and household acceptability of DL, compared to conventional IRS or insecticide-treated curtains (LLITCs), in a variety of operational settings. METHODS: This study was conducted in 220 households in traditional rural villages over 12-15 months. In all sites, rolls of DL were cut to fit house dimensions and fixed to interior wall surfaces (usually with nails and caps) by trained teams. Acceptability was assessed using a standardized questionnaire covering such topics as installation, exposure reactions, entomology, indoor environment, aesthetics and durability. Bioefficacy of interventions was evaluated using WHO cone bioassay tests at regular intervals throughout the year. RESULTS: The deltamethrin DL demonstrated little to no decline in bioefficacy over 12-15 months, supported by minimal loss of insecticide content. By contrast, IRS displayed a significant decrease in bioactivity by 6 months and full loss after 12 months. The majority of participants in DL households perceived reductions in mosquito density (93%) and biting (82%), but no changes in indoor temperature (83%). Among those households that wanted to retain the DL, 73% cited protective reasons, 20% expressed a desire to keep theirs for decoration and 7% valued both qualities equally. In Equatorial Guinea, when offered a choice of vector control product at the end of the trial (DL, IRS or LLITCs), DL consistently emerged as the most popular intervention regardless of the earlier household allocation. CONCLUSIONS: Just as long-lasting insecticidal nets overcame several of the technical and logistical constraints associated with conventionally treated nets and then went to scale, this study demonstrates the potential of DL to sustain user compliance and overcome the operational challenges associated with IRS

Comparison of trachoma TF and TT prevalence between 2009 and 2015.

<p>Comparison of trachoma TF and TT prevalence between 2009 and 2015.</p

Prevalence of active trachoma (TF) and trichiasis (TT) in four districts in Kayes region in 2015.

<p>Prevalence of active trachoma (TF) and trichiasis (TT) in four districts in Kayes region in 2015.</p

Clean faces and access to latrines and water sources in the surveyed clusters in Kayes region in 2015.

<p>Clean faces and access to latrines and water sources in the surveyed clusters in Kayes region in 2015.</p

Transdisciplinary innovation in irrigated smallholder agriculture in Africa

SIInternational audienceBoosting the productivity of smallholder farming systems continues to be a major need in Africa. Challenges relating to how to improve irrigation are multi‐factor and multisectoral, and they involve a broad range of actors who must interact to reach decisions collectively. We provide a systematic reflection on findings from the research project EAU4Food, which adopted a transdisciplinary approach to irrigation for food security research in five case studies in Ethiopia, Mali, Mozambique, South Africa and Tunisia. The EAU4Food experiences emphasize that actual innovation at irrigated smallholder farm level remains limited without sufficient improvement of the enabling environment and taking note of the wider political economy environment. Most project partners felt at the end of the project that the transdisciplinary approach has indeed enriched the research process by providing different and multiple insights from actors outside the academic field. Local capacity to facilitate transdisciplinary research and engagement with practitioners was developed and could support the continuation and scaling up of the approach. Future projects may benefit from a longer time frame to allow for deeper exchange of lessons learned among different stakeholders and a dedicated effort to analyse possible improvements of the enabling environment from the beginning of the research process. © 2020 The Authors. Irrigation and Drainage published by John Wiley & Sons Ltd on behalf of International Commission for Irrigation and Drainag