Oxytocin via Uniject (a prefi lled single-use injection) versus oral misoprostol for prevention of postpartum haemorrhage at the community level: a cluster-randomised controlled trial

Background Access to injectable uterotonics for management of postpartum haemorrhage remains limited in Senegal outside health facilities, and misoprostol and oxytocin delivered via Uniject have been deemed viable alternatives in community settings. We aimed to compare the effi cacy of these drugs when delivered by auxiliary midwives at maternity huts. Methods We did an unmasked cluster-randomised controlled trial at maternity huts in three districts in Senegal. Maternity huts with auxiliary midwives located 3–21 km from the closest referral centre were randomly assigned (1:1; via a computer-generated random allocation overseen by Gynuity Health Projects) to either 600 μg oral misoprostol or 10 IU oxytocin in Uniject (intramuscular), stratifi ed by reported previous year clinic volume (deliveries) and geographical location (inland or coastal). Maternity huts that had been included in a previous study of misoprostol for prevention of postpartum haemorrhage were excluded to prevent contamination. Pregnant women in their third trimester were screened for eligibility either during community outreach or at home-based prenatal visits. Only women delivered by the auxiliary midwives in the maternity huts were eligible for the study. Women with known allergies to prostaglandins or pregnancy complications were excluded. The primary outcome was mean change in haemoglobin concentration measured during the third trimester and after delivery. This study was registered with ClinicalTrials.gov, number NCT01713153. Findings 28 maternity hut clusters were randomly assigned—14 to the misoprostol group and 14 to the oxytocin group. Between June 6, 2012, and Sept 21, 2013, 1820 women were recruited. 647 women in the misoprostol group and 402 in the oxytocin group received study drug and had recorded pre-delivery and post-delivery haemoglobin concentrations, and overall 1412 women delivered in the study maternity huts. The mean change in haemoglobin concentrations was 3·5 g/L (SD 16·1) in the misoprostol group and 2·7 g/L (SD 17·8) in the oxytocin group. When adjusted for cluster design, the mean diff erence in haemoglobin decreases between groups was not signifi cant (0·3 g/L, 95% CI –8·26 to 8·92, p=0·71). Both drugs were well tolerated. Shivering was common in the misoprostol group, and nausea in the oxytocin group. Postpartum haemorrhage was diagnosed in one woman allocated to oxytocin, who was referred and transferred to a higher-level facility for additional care, and fully recovered. No other women were transferred. Interpretation In terms of eff ects on haemoglobin concentrations, neither oxytocin nor misoprostol was signifi cantly better than the other, and both drugs were safe and effi cacious when delivered by auxiliary midwives. The programmatic limitations of oxytocin, including short shelf life outside the cold chain, mean that misoprostol could be more appropriate for community-level prophylaxis of postpartum haemorrhage

Who has the time? A qualitative assessment of gendered intrahousehold labor allocation, time use and time poverty in rural Senegal

Achieving gender equality in agricultural development is fundamental to reductions in global poverty, hunger, and malnutrition. African women make important contributions to farming and food systems; however, their efforts are often hindered by inefficient and inequitable allocations of intrahousehold labor and time that render women time poor. Time poverty is a root cause of women’s marginalization in rural Africa and an important area of inquiry for feminist scholarship. While gendered time use and time poverty have been researched in many different contexts and countries in Africa, significant knowledge gaps remain. Most studies consider women’s time use divorced from gendered relations, and overlook children’s contributions. Other factors which may combine to influence women’s time burden but are often overlooked include seasonality, work intensity, household structure and composition, cultural norms, familial relationships and intrahousehold power dynamics. Further, the majority of research on gendered time use and time poverty in Africa uses quantitative methods applied to secondary data, which presents challenges for critically identifying and characterizing the confluence of various intrahousehold dynamics which impact women’s multiple roles, responsibilities, and consequently their work and time. This study adds important nuance to the existing body of research by offering an in-depth, qualitative assessment of intrahousehold labor allocation, time use, and time poverty amongst women, men, and children living in multi-generational, largely polygamous households reliant on peanut-farming in the Kaolack region of Senegal. Data collection took place in February 2020, with 111 individuals in three villages. We find that individual workload correlates with gender and age, but is further determined by the demographic composition of the household, the roles assumed by the individual and other family members, and the individual’s place within the social hierarchy. Women and girls in Kaolack are clearly at more risk of time poverty due to their dual responsibility for reproductive and productive work, especially during the rainy season. Furthermore, women’s workload in particular changes over the life course as they assume different roles in different life stages. As a result, women with older daughters and, especially, daughters-in-law are significantly less time poor than other women

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Développement d'une intervention de lutte intégrée à base environnementale et communautaire dans les agrosystèmes de l'Afrique de l'Ouest

Le paludisme demeure un problème majeur de santé publique en Afrique sub-saharienne, en particulier dans les communautés rurales qui vivent dans une extrême pauvreté. Ce problème est aggravé par un accès limité aux soins de santé appropriés en dépit de l’existence des outils de contrôle efficaces comme la thérapie combinée à base d'Artémisinine (CTA) et les moustiquaires imprégnées d'insecticide. L'objectif global du projet est de développer une approche de lutte intégrée à base environnementale et communautaire contre le paludisme dans trois agrosystèmes de l’Afrique de l'Ouest: zone de barrage hydro-électrique et de riziculture irrigué au Mali, zone de riziculture fluviale au Niger et zone marécageuse de culture maraîchère au Cameroun. Durant la première année de ce projet, une recherche formative et des enquêtes quantitatives ont été réalisées pour identifier les facteurs de vulnérabilité au paludisme en relation aux différents agrosystèmes (ex : connaissances endogènes sur la maladie, pratiques agricoles exacerbant les risques de la transmission à travers la prolifération des gites larvaires des moustiques… etc,). Les résultats de cette recherche de base ont guidé le développement d'un paquet d'intervention de lutte intégrée contre le paludisme basé sur l’approche ‘’Agro-Ecosanté ‘’. L’approche ‘’Agro-écosanté’’ est une approche innovante de lutte contre le paludisme combinant 1] la promotion des bonnes pratiques agricoles (pouvant réduire la production de moustiques et contribuer à la préservation de l’environnement) et l’éducation sur le paludisme à travers les « Champs–école des producteurs agricoles », et 2] l’approche participative communautaire pour la promotion et la mise en oeuvre d’actions de prévention contre le paludisme à travers les comités villageois de veille pour la lutte anti-paludique. Les principales réalisations sont: (i) la mise en place d'une plate-forme agro-écosanté pour améliorer la production agricole et la lutte antivectorielle (labour minimal pour réduire l'agressivité du sol et la production de gites larvaires) (ii) l'établissement d'un programme à base communautaire à travers les comités de veille pour l'amélioration de l'hygiène et la lutte antivectorielle, (iii) Réduction de l’utilisation excessive de pesticides de synthèse et la préservation de l'environnement à travers les ‘’champs-école des producteurs’’. Le projet a permis le renforcement des capacités des communautés par l'auto-appropriation des interventions de lutte contre le paludisme et créer un cadre de concertation, d'échanges entre les partenaires du secteur agricole, celui de la santé et les communautés pour promouvoir les innovations de lutte contre le paludisme. Toute fois, des études plus approfondies sont nécessaires pour évaluer la pérennité et l’impact de l’approche agro-écosanté sur la transmission du paludisme

Sexuality of adolescent girls born with HIV in Senegal: an anthropological analysis

Objectives: In Senegal, the dominant social norm upholds virginity before marriage and edifies abstinence for adolescents as a cardinal moral value. Currently, sex outside of marriage remains socially condemned. The onset of sex for adolescent girls born with HIV in Senegal brings up several challenges. In Dakar, initiatives, especially through digital applications, are being developed to support these young people. These programs are much rarer in rural settings. A study conducted in 2021 explored how adolescent girls born with HIV who live outside of Dakar experience sexuality, what socio-health constraints they face, and what support they receive from the healthcare system. Method: An anthropological study titled ‘Treatment Failure among Children and Adolescents Living with HIV in Senegal, Outside Dakar’ (ETEA-VIH, ANRS 12421) was conducted in 2021 in 14 regional hospitals and health centers. Semi-structured interviews were conducted with 87 HIV-positive children and adolescents, 95 parents/guardians, and 47 health care workers. Adolescent girls’ onset of sexuality was specifically analyzed for 40 adolescent girls age 12–19 years old. Results: Generally, parents feign oblivion about their children’s sexual lives. Mothers dread a pregnancy out of marriage because they are responsible for overseeing sex education and would be ‘blamed’ for the transgression. The occurrence of an unintended pregnancy can lead to exclusion from the family and a risk of transmitting HIV to the child due to the lack of medical and social support. HIV remains a stigmatizing disease that families keep secret. The risk of disclosure is a major concern. Despite sexual and reproductive health (SRH) programs, most healthcare workers are reluctant to discuss sexuality or to offer contraception to adolescent girls. Information spaces have been set up in some regional hospitals by associations trained in SRH. They are rarer in health centers. Accessibility to digital applications and discussion forums is limited due to the lack of smartphones and Internet access. Conclusion: In rural settings, HIV-positive adolescent girls are confronted with the silence that surrounds sexuality and HIV. An individualized approach and confidential access to contraception should be prioritized to support them with assistance from PLHIV associations

Dietary salt intake and kidney function in rural Senegalese populations: a cross-sectional study

Abstract Introduction High salt intake is a major risk factor for hypertension and its complications such as chronic kidney disease (CKD) and cardiovascular diseases. The present study aimed to determine level of sodium consumption and its relation with kidney function in the rural populations of Ferlo (centre of Senegal). Subjects and methods We performed a cross-sectional study including 400 volunteers aged > 18 years. Clinical, biological and dietary data were collected during household visits. Daily sodium intake was measured in the 24 h-urine outpout and CKD was defined as eGFR  60 years, overweight and CKD. However, gender and hypertension were not significantly associated with salt intake. Industrial broths (91.5%) and bread (85%) represented the main sources of dietary salt. Conclusion This study revealed high levels of daily salt intake contrasting with low potassium intakes in the majority of participants. Participants with CKD, overweight and age > 60 years presented higher salt consumption. Stategies to reduce salt consumption are urgently needed to reduce burden of CKD in rural Senegalese populations

Diagnosis, Management, and Outcome of Bart’s Syndrome Observed in a Sub-Saharan African Country (Senegal, Dakar): 2 Case Reports

Introduction: Bart’s syndrome is an uncommon inherited congenital disorder associating congenital cutaneous aplasia of the extremities and inherited epidermolysis bullosa. Bilateral and symmetrical involvement of the limbs is exceptionally described on black skin. In most cases, the diagnosis is clinical; however, the management remains very difficult and the extended forms are a real therapeutic challenge. We report 2 cases of Bart’s syndrome observed in a sub-Saharan African country (Senegal, Dakar). Case Presentation: It was about 2 premature female and male newborns. On physical examination, the girl presented with a total absence of skin on the limbs, associated with cutaneous detachment of the trunk representing a detached and detachable skin surface of 46%; the boy underwent a total absence of skin of more than 50% of the skin surface. The diagnosis of Bart’s syndrome was set based on the typical clinical aspect. The blood count and CRP were normal for the girl whereas it revealed some disorders for the boy. The 2 newborns were urgently admitted to an incubator, and the intensive care was started with hyperhydration, anti-staphylococcal prophylaxis, and daily dermatological care with antiseptic baths and fatty dressings. Conclusion: Bart’s syndrome is an uncommon genodermatosis characterized by a clinical triad associating congenital cutaneous aplasia of the extremities, inherited epidermolysis bullosa suspected in the presence of bubbles, and areas of cutaneous fragility and nail deformity. All types of which can be associated with this syndrome. The easy clinical diagnosis but the difficult management encumber the vital prognosis of our cases