L’hygiène dans l’approvisionnement et la distribution de la viande de brousse à Brazzaville – Congo

Objectif : La consommation de la viande de chasse au Congo et particulièrement à Brazzaville prend de plus en plus d’ampleur du fait de la forte demande du produit. On est arrivé à se demander si cette viande arrive dans les lieux de commercialisation dans les conditions adéquates et sous surveillance sanitaire. La présente étude initiée dans ce sens se propose de connaitre les voies d’accès de la viande de chasse à Brazzaville et d’apprécier la qualité des emballages, les conditions transport, le type de conditionnement et les conditions de conservation qui peuvent d’une part, présenter des risques de contamination pour la viande de chasse et d’autre part, constituer des conditions favorables à la contamination. Methodologie et résultats : La méthode de collecte de données a consisté à réaliser une enquête impliquant les acteurs à tous les niveaux du circuit de distribution de la viande de chasse. Cette enquête a consisté à administrer un questionnaire assez détaillé sur les voies d’accès et les modalités de ravitaillement en viande de chasse, aux vendeurs de viande dans les marchés, aux transporteurs du produit, aux grossistes et aux magasiniers, personnes auprès desquels les vendeurs confient les produits à conserver. L’enquête a duré 30 jours et s’est déroulé dans les 7 arrondissements que compte la ville de Brazzaville. Elle a concernée 157 acteurs oeuvrant dans l’approvisionnement (ravitaillement) et la vente de la viande de brousse à savoir ; les fournisseurs, les restaurateurs, les magasiniers, les vendeurs détaillants, les chauffeurs des moyens de transport, le personnel gérant les compagnies de transport aérien, les propriétaires des moyens navigants et les fonctionnaires en charge de l’hygiène et de l’assainissement. L’enquête s’est déroulée sur la base des contacts individuels afin de recueillir les opinons personnelles concernant les modalités d’approvisionnement, de transport, de distribution et d’emmagasinage de la viande de chasse. Cette enquête a pris en compte les caractéristiques sociodémographiques en relation avec l’approvisionnement, le transport, la distribution et l’emmagasinage de la viande de chasse dans la ville de Brazzaville. La population concernée est dominée à 55,70% par les femmes. La viande de chasse arrive à Brazzaville par 6 axes principaux. Il s’agit de 3 voies terrestres (routes nationales 1 & 2, route de Mayama), la voie ferrée, la voie navale et la voie aérienne. Concernant le transport, Il n’existe pas de moyens (véhicules) appropriés affectés au transport de la viande de brousse et les conditions de transport actuelles ne sont pas adaptées au transport de cet aliment destiné à la consommation. Les objets utilisés comme emballages sont des matériaux recyclés dont le plus usité (31,15%), est le sac en jute synthétique couramment désigné en langue locale par sac ‘’nguiri’’. Malgré cette prédominance, le sac ‘’nguiri’ comme les autres matériaux ne remplissent pas les qualités exigés à un objet pour qu’il joue véritablement le rôle dévolue à un emballage. Conclusion et application : En conclusion, des investigations ont été faites et ont permis d’identifier les voies d’accès de la viande de chasse et d’aider à cerner les conditions pouvant constituer les sources probables de contamination de la viande de chasse par les micro-organismes du sol. Il s’agira pour la suite des travaux d’établir en laboratoire et à partir des échantillons prélevés la qualité des micro-organismes pathogènes qui infestent la viande de chasse pendant son transport. Mots clés : Voies d’accès, commerce, viande de chasse, Brazzaville-Cong

Where are the paediatricians? An international survey to understand the global paediatric workforce

Objective: Our primary objective was to examine the global paediatric workforce and to better understand geographic differences in the number of paediatricians globally. Secondary objectives were to describe paediatric workforce expectations, who provides children with preventative care and when children transition out of paediatric care. Design: Survey of identified paediatric leaders in each country. Setting: Paediatric association leaders worldwide. Main outcome measures: Paediatrician numbers, provision of primary care for children, age of transition to adult care. Results: Responses were obtained from 121 countries (73% of countries approached). The number of paediatricians per 100 000 children ranged from a median of 0.5 (IQR 0.3–1.4) in low-income countries to 72 (IQR 4–118) in high-income countries. Africa and South-East Asia reported the lowest paediatrician density (median of 0.8 paediatricians per 100 000 children, IQR 0.4–2.6 and median of 4, IQR 3–9, respectively) and fewest paediatricians entering the workforce. 82% of countries reported transition to adult care by age 18% and 39% by age 15. Most countries (91%) but only 64% of low-income countries reported provision of paediatric preventative care (p\u3c0.001, Cochran-Armitage trend test). Systems of primary care provision varied widely. A majority of countries (63%) anticipated increases in their paediatric workforce in the next decade. Conclusions: Paediatrician density mirrors known inequities in health provider distribution. Fewer paediatricians are entering the workforce in areas with already low paediatrician density, which may exacerbate disparities in child health outcomes. In some regions, children transition to adult care during adolescence, with implications for healthcare training and delivery. Paediatrician roles are heterogeneous worldwide, and country-specific strategies should be used to address inequity in child health provisio

Volcanic-aerosol-induced changes in stratospheric ozone following the eruption of Mount Pinatubo

Measurements of lower stratospheric ozone in the Tropics using electrochemical concentrations cell (ECC) sondes and the airborne UV Differential Absorption Lidar (DIAL) system after the eruption of Mt. Pinatubo are compared with the Stratospheric Aerosol and Gas Experiment 2 (SAGE 2) and ECC sonde measurements from below the eruption to determine what changes have occurred as a result. Aerosol data from the Advanced Very High Resolution Radiometer (AVHRR) and the visible and IR wavelengths of the lidar system are used to examine the relationship between aerosols and ozone changes. Ozone decreases of 30 percent at altitudes between 19 and 26 km, partial column (16-28 km) decreases of about 27 D.U., and slight increases (5.4 D.U.) between 28 and 31 km are found in comparison with SAGE 2 climatological values

High body mass index is not associated with atopy in schoolchildren living in rural and urban areas of Ghana

<p>Abstract</p> <p>Background</p> <p>Factors which determine the development of atopy and the observed rural-urban gradient in its prevalence are not fully understood. High body mass index (BMI) has been associated with asthma and potentially atopy in industrialized countries. In developing countries, the transition from rural to urban areas has been associated with lifestyle changes and an increased prevalence of high BMI; however, the effect of high BMI on atopy remains unknown in this population. We therefore investigated the association between high BMI and atopy among schoolchildren living in rural and urban areas of Ghana.</p> <p>Methods</p> <p>Data on skin prick testing, anthropometric, parasitological, demographic and lifestyle information for 1,482 schoolchildren aged 6-15 years was collected. Atopy was defined as sensitization to at least one tested allergen whilst the Centres for Disease Control and Prevention (CDC, Atlanta) growth reference charts were used in defining high BMI as BMI ≥ the 85^thpercentile. Logistic regression was performed to investigate the association between high BMI and atopy whilst adjusting for potential confounding factors.</p> <p>Results</p> <p>The following prevalences were observed for high BMI [Rural: 16%, Urban: 10.8%, p < 0.001] and atopy [Rural: 25.1%, Urban: 17.8%, p < 0.001]. High BMI was not associated with atopy; but an inverse association was observed between underweight and atopy [OR: 0.57, 95% CI: 0.33-0.99]. Significant associations were also observed with male sex [Rural: OR: 1.49, 95% CI: 1.06-2.08; Urban: OR: 1.90, 95% CI: 1.30-2.79], and in the urban site with older age [OR: 1.76, 95% CI: 1.00-3.07], family history of asthma [OR: 1.58, 95% CI: 1.01-2.47] and occupational status of parent [OR: 0.33, 95% CI: 0.12-0.93]; whilst co-infection with intestinal parasites [OR: 2.47, 95% CI: 1.01-6.04] was associated with atopy in the rural site. After multivariate adjustment, male sex, older age and family history of asthma remained significant.</p> <p>Conclusions</p> <p>In Ghanaian schoolchildren, high BMI was not associated with atopy. Further studies are warranted to clarify the relationship between body weight and atopy in children subjected to rapid life-style changes associated with urbanization of their environments.</p

Provider perspectives on demand creation for maternal vaccines in Kenya [version 1; referees: 2 approved]

Background. Expansion of maternal immunization, which offers some of the most effective protection against morbidity and mortality in pregnant women and neonates, requires broad acceptance by healthcare providers and their patients. We aimed to describe issues surrounding acceptance and demand creation for maternal vaccines in Kenya from a provider perspective. Methods. Nurses and clinical officers were recruited for semi-structured interviews covering resources for vaccine delivery, patient education, knowledge and attitudes surrounding maternal vaccines, and opportunities for demand creation for new vaccines. Interviews were conducted in English and Swahili, transcribed verbatim from audio recordings, and analyzed using codes developed from interview guide questions and emergent themes. Results. Providers expressed favorable attitudes about currently available maternal immunizations and introduction of additional vaccines, viewing themselves as primarily responsible for vaccine promotion and patient education.  The importance of educational resources for both patients and providers to maintain high levels of maternal immunization coverage was a common theme. Most identified barriers to vaccine acceptance and delivery were cultural and systematic in nature. Suggestions for improvement included improved patient and provider education, including material resources, and community engagement through religious and cultural leaders. Conclusions. The distribution of standardized, evidence-based print materials for patient education may reduce provider overwork and facilitate in-clinic efforts to inform women about maternal vaccines. Continuing education for providers should address communication surrounding current vaccines and those under consideration for introduction into routine schedules. Engagement of religious and community leaders, as well as male decision-makers in the household, will enhance future acceptance of maternal vaccines

Assessment of Cardiac, Vascular, and Pulmonary Pathobiology In Vivo During Acute COVID-19.

Background Acute COVID-19-related myocardial, pulmonary, and vascular pathology and how these relate to each other remain unclear. To our knowledge, no studies have used complementary imaging techniques, including molecular imaging, to elucidate this. We used multimodality imaging and biochemical sampling in vivo to identify the pathobiology of acute COVID-19. Specifically, we investigated the presence of myocardial inflammation and its association with coronary artery disease, systemic vasculitis, and pneumonitis. Methods and Results Consecutive patients presenting with acute COVID-19 were prospectively recruited during hospital admission in this cross-sectional study. Imaging involved computed tomography coronary angiography (identified coronary disease), cardiac 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography/computed tomography (identified vascular, cardiac, and pulmonary inflammatory cell infiltration), and cardiac magnetic resonance (identified myocardial disease) alongside biomarker sampling. Of 33 patients (median age 51 years, 94% men), 24 (73%) had respiratory symptoms, with the remainder having nonspecific viral symptoms. A total of 9 patients (35%, n=9/25) had cardiac magnetic resonance-defined myocarditis. Of these patients, 53% (n=5/8) had myocardial inflammatory cell infiltration. A total of 2 patients (5%) had elevated troponin levels. Cardiac troponin concentrations were not significantly higher in patients with and without myocarditis (8.4 ng/L [interquartile range, IQR: 4.0-55.3] versus 3.5 ng/L [IQR: 2.5-5.5]; P=0.07) or myocardial cell infiltration (4.4 ng/L [IQR: 3.4-8.3] versus 3.5 ng/L [IQR: 2.8-7.2]; P=0.89). No patients had obstructive coronary artery disease or vasculitis. Pulmonary inflammation and consolidation (percentage of total lung volume) was 17% (IQR: 5%-31%) and 11% (IQR: 7%-18%), respectively. Neither were associated with the presence of myocarditis. Conclusions Myocarditis was present in a third patients with acute COVID-19, and the majority had inflammatory cell infiltration. Pneumonitis was ubiquitous, but this inflammation was not associated with myocarditis. The mechanism of cardiac pathology is nonischemic and not attributable to a vasculitic process. Registration URL: https://www.isrctn.com; Unique identifier: ISRCTN12154994

A Comprehensive Genetic Analysis of Candidate Genes Regulating Response to Trypanosoma congolense Infection in Mice

About one-third of cattle in sub-Saharan Africa are at risk of contracting “Nagana”—a disease caused by Trypanosoma parasites similar to those that cause human “Sleeping Sickness.” Laboratory mice can also be infected by trypanosomes, and different mouse breeds show varying levels of susceptibility to infection, similar to what is seen between different breeds of cattle. Survival time after infection is controlled by the underlying genetics of the mouse breed, and previous studies have localised three genomic regions that regulate this trait. These three “Quantitative Trait Loci” (QTL), which have been called Tir1, Tir2 and Tir3 (for Trypanosoma Infection Response 1–3) are well defined, but nevertheless still contain over one thousand genes, any number of which may be influencing survival. This study has aimed to identify the specific differences associated with genes that are controlling mouse survival after T. congolense infection. We have applied a series of analyses to existing datasets, and combined them with novel sequencing, and other genetic data to create short lists of genes that share polymorphisms across susceptible mouse breeds, including two promising “candidate genes”: Pram1 at Tir1 and Cd244 at Tir3. These genes can now be tested to confirm their effect on response to trypanosome infection

Genetic Control of Resistance to Trypanosoma brucei brucei Infection in Mice

Trypanosoma brucei are extracellular protozoa transmitted to mammalian host by the tsetse fly. They developed several mechanisms that subvert host's immune defenses. Therefore analysis of genes affecting host's resistance to infection can reveal critical aspects of host-parasite interactions. Trypanosoma brucei brucei infects many animal species including livestock, with particularly severe effects in horses and dogs. Mouse strains differ greatly in susceptibility to T. b. brucei. However, genes controlling susceptibility to this parasite have not been mapped. We analyzed the genetic control of survival after T. b. brucei infection using CcS/Dem recombinant congenic (RC) strains, each of which contains a different random set of 12.5% genes of their donor parental strain STS/A on the BALB/c genetic background. The RC strain CcS-11 is even more susceptible to parasites than BALB/c or STS/A. In F2 hybrids between BALB/c and CcS-11 we detected and mapped four loci, Tbbr1-4 (Trypanosoma brucei brucei response 1–4), that control survival after T. b. brucei infection. Tbbr1 (chromosome 3) and Tbbr2 (chromosome 12) have independent effects, Tbbr3 (chromosome 7) and Tbbr4 (chromosome 19) were detected by their mutual inter-genic interaction. Tbbr2 was precision mapped to a segment of 2.15 Mb that contains 26 genes

Track E Implementation Science, Health Systems and Economics

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138412/1/jia218443.pd