The impact of participation in Diversity Field Fora on farmer management of millet and Sorghum varieties in Mali

Malian farmers have been cultivating millet and sorghum for millennia, but they are slow to adopt and develop modern varieties because it is difficult to observe the difference in yields in their fields, given the challenging local growing conditions. Farmer participatory approaches are therefore recommended. This paper applies an instrumental variables method to survey data from Mali to evaluate the impacys of Diversity Field Fora, a type of farmer field school which aims to boost millet and sorghum yields by showing farmers how to manage diverse varieties. Impact indicators are expected and recalled millet and sorghum yields. the total number of unique attributes of millet and sorghum varieties stocked as seed, and the relative deprivation of the household farm with respect to these indicators. The findings suggest the project has had results at one of two sites where it has been implemented with the same local leadership and more intensively over a longer time frame

Les enjeux de la mise en œuvre des activités conjointes tuberculose et VIH dans les districts sanitaires de Bamako (Mali).

Introduction : Au Mali, le rapport du programme national de lutte contre la tuberculose (PNLT) révèle en 2015 que 541/4035 soit 13% des cas de tuberculose toutes formes dépistées sont infectées par le VIH. Le but de cette étude est de décrire le suivi biologique des patients co-infectés par le VIH et la tuberculose dans les communes de Bamako en période de crise et d’évaluer le niveau actuel de réalisation des activités conjointes TB/VIH recommandées au Mali. Méthodologie : Nous avons réalisé une étude rétro-prospective d’évaluation du niveau de réalisation des activités conjointes TB/VIH recommandées au Mali. La phase rétrospective a eu lieu de janvier 2012 à juin 2013 et celle prospective de Janvier à mars 2015 dans les communes de Bamako. Résultats : L’étude rétrospective a montré que la tuberculose est survenue chez 124 patients sur 4026 dépistés positifs au VIH soit un taux d’infection à tuberculose parmi les patients VIH+ de 2,95% de janvier 2012 à juin 2013. Le suivi biologique a été plus réalisé pour la tuberculose que le VIH chez les patients co-infecté avec un taux très faible de réalisation de la charge virale. L’étude prospective montre que le niveau de réalisation demeure faible pour la plupart des activités conjointes. Mais au plan pratique, seuls 2/10 agents enquêtés faisaient la prise en charge des deux pathologies selon les protocoles en vigueur en se basant sur les directives des chargés correspondant. Conclusion : Les mécanismes de collaboration des services intégrés de TB/VIH nécessitent d’être renforcés pour une meilleure réalisation des points inscrits dans le cadre stratégique des activités conjointes TB/VIH recommandées au Mali

Anaemia in a phase 2 study of a blood stage falciparum malaria vaccine

<p>Abstract</p> <p>Background</p> <p>A Phase 1-2b study of the blood stage malaria vaccine AMA1-C1/Alhydrogel was conducted in 336 children in Donéguébougou and Bancoumana, Mali. In the Phase 2 portion of the study (n = 300), no impact on parasite density or clinical malaria was seen; however, children who received the study vaccine had a higher frequency of anaemia (defined as haemoglobin < 8.5 g/dL) compared to those who received the comparator vaccine (Hiberix). This effect was one of many tested and was not significant after adjusting for multiple comparisons.</p> <p>Methods</p> <p>To further investigate the possible impact of vaccination on anaemia, additional analyses were conducted including patients from the Phase 1 portion of the study and controlling for baseline haemoglobin, haemoglobin types S or C, alpha-thalassaemia, G6PD deficiency, and age. A multiplicative intensity model was used, which generalizes Cox regression to allow for multiple events. Frailty effects for each subject were used to account for correlation of multiple anaemia events within the same subject. Intensity rates were calculated with reference to calendar time instead of time after randomization in order to account for staggered enrollment and seasonal effects of malaria incidence. Associations of anaemia with anti-AMA1 antibody were further explored using a similar analysis.</p> <p>Results</p> <p>A strong effect of vaccine on the incidence of anaemia (risk ratio [AMA1-C1 to comparator (Hiberix)]= 2.01, 95% confidence interval [1.26,3.20]) was demonstrated even after adjusting for baseline haemoglobin, haemoglobinopathies, and age, and using more sophisticated statistical models. Anti-AMA1 antibody levels were not associated with this effect.</p> <p>Conclusions</p> <p>While these additional analyses show a robust effect of vaccination on anaemia, this is an intensive exploration of secondary results and should, therefore, be interpreted with caution. Possible mechanisms of the apparent adverse effect on haemoglobin of vaccination with AMA1-C1/Alhydrogel and implications for blood stage vaccine development are discussed. The potential impact on malaria-associated anaemia should be closely evaluated in clinical trials of AMA1 and other blood stage vaccines in malaria-exposed populations.</p

Erysipèle de jambe du nourrisson: Une observation dans l’unité dermatologie de l’hôpital régional de Gao (mali)

L’érysipèle est une dermohypodermite bactérienne aiguë non nécrosante, affectant le plus souvent les membres inférieurs. Les facteurs favorisant sa survenue sont l’existence d’une porte d’entrée (plaies traumatiques négligées, intertrigo), le lymphœdème, l’obésité et la dépigmentation volontaire. La complication la plus fréquente est la récidive. Les autres complications incluent notamment abcédassions, la fasciite et les bactériémies. Nous rapportons une première observation malienne d’érysipèle chez un nourrisson de 8 mois, de sexe féminin, amené en consultation dans l’unité dermatologique de l’hôpital régional de Gao pour l’installation brutale d’une grosse jambe rouge plus notion de fièvre et de frissons. Le diagnostic a été porté devant une tuméfaction du membre inférieur droit rouge, chaude et douloureuse surmontée de bulles tendues associée à une adénopathie inguinale et une leucocytose à l’hémogramme. Un traitement à base d’antibiotique associé à un pansement et le repos a été instauré. L’évolution a été émaillée par la disparition des lésions en dix jours. Le diagnostic positif est fondé sur la clinique renforcé par la recherche de l’origine streptococcique

La paralysie faciale péripherique peut être une manifestation neurologique révélatrice de l’infection à VIH

La paralysie faciale périphérique (PFP) est une manifestation neurologique couramment rencontrée en consultation de neurochirurgie. L’objectif de cette étude a été de faire la corrélation entre cette affection et l’infection à VIH sida. Il s’agit d’une étude rétrospective d’octobre 2008 à septembre 2012 qui a concerné tous les patients présentant une PFP en consultation de neurochirurgie. Les patients ont bénéficié d’un examen neurologique complet et d’examens paracliniques sanguins, biologiques et radiologiques. Une consultation ORL a été effectuée pour tous les patients. Notre série comportait 36 patients dont 11 femmes. L’âge variait entre 20 ans et 42 ans. La paralysie faciale était droite chez 22 patients (61,11%), la parésie intéressait toute l’hémiface. L’examen Otorhinolaryngologique était normal chez tous les patients tous comme le scanner cérébral. Dans notre série, 28 patients (77,77%) étaient connus séropositifs . L’Elisa et le western blot ont confirmé la présence du VIH 1 chez tous les patients et du VIH 2 chez 8.. Le traitement a consisté à l’administration de prednisolone et des antirétroviraux. L’évolution a été favorable chez l’ensemble des patients avec la disparition progressive de la paralysie faciale chez 20 patients en 3 mois et de 16 autres en 6 mois. La présence du VIH 1 et 2 chez 77,77% des patients fait de la paralysie faciale un indicateur du VIH sida dans le département de neurochirurgie

Genetic Diversity of a Parasitic Weed, Striga hermonthica, on Sorghum and Pearl Millet in Mali

Eleven populations of witchweed, Striga hermonthica, were collected in four regions of Mali and investigated with 12 microsatellite markers. Extensive genetic diversity was observed, with most plants heterozygous for most markers. Allelic diversity was broadly distributed across populations with little genetic differentiation and large amounts of gene flow. Nearby fields of pearl millet and sorghum were found to have indistinguishable witchweed populations. Some population structure was apparent, but did not correlate with the local environment or host genotype, suggesting that seed transportation or other human-driven variables act to differentiate central Malian S. hermonthica populations from southern Malian populations

The Plasmodium falciparum-Specific Human Memory B Cell Compartment Expands Gradually with Repeated Malaria Infections

Immunity to Plasmodium falciparum (Pf) malaria is only acquired after years of repeated infections and wanes rapidly without ongoing parasite exposure. Antibodies are central to malaria immunity, yet little is known about the B-cell biology that underlies the inefficient acquisition of Pf-specific humoral immunity. This year-long prospective study in Mali of 185 individuals aged 2 to 25 years shows that Pf-specific memory B-cells and antibodies are acquired gradually in a stepwise fashion over years of repeated Pf exposure. Both Pf-specific memory B cells and antibody titers increased after acute malaria and then, after six months of decreased Pf exposure, contracted to a point slightly higher than pre-infection levels. This inefficient, stepwise expansion of both the Pf-specific memory B-cell and long-lived antibody compartments depends on Pf exposure rather than age, based on the comparator response to tetanus vaccination that was efficient and stable. These observations lend new insights into the cellular basis of the delayed acquisition of malaria immunity

Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care

BACKGROUND: Maternal mortality is the vital indicator with the greatest disparity between developed and developing countries. The challenging nature of measuring maternal mortality has made it necessary to perform an action-oriented means of gathering information on where, how and why deaths are occurring; what kinds of action are needed and have been taken. A maternal death review is an in-depth investigation of the causes and circumstances surrounding maternal deaths. The objectives of the present study were to describe the socio-cultural and health service factors associated with maternal deaths in rural Gambia. METHODS: We reviewed the cases of 42 maternal deaths of women who actually tried to reach or have reached health care services. A verbal autopsy technique was applied for 32 of the cases. Key people who had witnessed any stage during the process leading to death were interviewed. Health care staff who participated in the provision of care to the deceased was also interviewed. All interviews were tape recorded and analyzed by using a grounded theory approach. The standard WHO definition of maternal deaths was used. RESULTS: The length of time in delay within each phase of the model was estimated from the moment the woman, her family or health care providers realized that there was a complication until the decision to seeking or implementing care was made. The following items evolved as important: underestimation of the severity of the complication, bad experience with the health care system, delay in reaching an appropriate medical facility, lack of transportation, prolonged transportation, seeking care at more than one medical facility and delay in receiving prompt and appropriate care after reaching the hospital. CONCLUSION: Women do seek access to care for obstetric emergencies, but because of a variety of problems encountered, appropriate care is often delayed. Disorganized health care with lack of prompt response to emergencies is a major factor contributing to a continued high mortality rate

TIGER : The gene expression regulatory variation landscape of human pancreatic islets

Genome-wide association studies (GWASs) identified hundreds of signals associated with type 2 diabetes (T2D). To gain insight into their underlying molecular mechanisms, we have created the translational human pancreatic islet genotype tissue-expression resource (TIGER), aggregating >500 human islet genomic datasets from five cohorts in the Horizon 2020 consortium T2DSystems. We impute genotypes using four reference panels and meta-analyze cohorts to improve the coverage of expression quantitative trait loci (eQTL) and develop a method to combine allele-specific expression across samples (cASE). We identify >1 million islet eQTLs, 53 of which colocalize with T2D signals. Among them, a low-frequency allele that reduces T2D risk by half increases CCND2 expression. We identify eight cASE colocalizations, among which we found a T2D-associated SLC30A8 variant. We make all data available through the TIGER portal (http://tiger.bsc.es), which represents a comprehensive human islet genomic data resource to elucidate how genetic variation affects islet function and translates into therapeutic insight and precision medicine for T2D.Peer reviewe