Results from the Survey of Antibiotic Resistance (SOAR) 2011-14 in the Democratic Republic of Congo, Ivory Coast, Republic of Senegal and Kenya

Objectives: To assess antibiotic susceptibility of community-acquired respiratory tract isolates from Ivory Coast, Kenya, Democratic Republic of Congo (DRC) and Senegal in 2011–14. Methods: Bacterial isolates were collected and MICs determined using Etest® for all antibiotics except erythromycin, for which testing was by disc diffusion. Susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. For macrolide interpretation, CLSI breakpoints were adjusted for incubation in CO2. Results: Susceptibility to penicillin (using CLSI oral or EUCAST breakpoints) was low among isolates of Streptococcus pneumoniae from the DRC and Kenya (17.4% and 19%, respectively) but higher among isolates from the Ivory Coast (70%) and Senegal (85.7%). Penicillin susceptibility using CLSI iv breakpoints was higher in all countries, but still only 69.6% in the DRC. Macrolide susceptibility (based on CLSI erythromycin disc diffusion breakpoints) was also low in Kenya (∼65%) but 87%–100% elsewhere.Haemophilus influenzae were only collected in the DRC and Senegal, with β-lactamase prevalence of 39% and 4%, respectively. Furthermore, β-lactamase-negative ampicillin-resistant (BLNAR) isolates were found in DRC (four isolates, 17%), but only two isolates were found in Senegal (by EUCAST definition). Amoxicillin/clavulanic acid in vitro susceptibility was 73.9% in the DRC and 100% in Senegal based on CLSI breakpoints, but this reduced to 65.2% in the DRC when BLNAR rates were considered. Clarithromycin susceptibility was \u3e95% in both countries. Conclusions: There was considerable variability in antibiotic susceptibility among the African countries participating in the surveillance programme. Thus, continued surveillance is necessary to track future changes in antibiotic resistance. Use of EUCAST versus CLSI breakpoints showed profound differences for cefaclor and ofloxacin against S. pneumoniae, with EUCAST showing lower susceptibility

Management of Hypertension in the Elderly Patient at Abidjan Cardiology Institute (Ivory Coast)

Background. Since the treatment of hypertension is beneficial for the elderly, we have undertaken this study that aims to evaluate the management of hypertension in elderly patient in Côte d'Ivoire. Methods. A retrospective study was conducted among 854 hypertensive elderly patients of Abidjan Cardiology Institute who were followed for a minimum of one year, between January 2000 and December 2009. Results. The patients mean age was 73.1 ± 5.3 years, and 59% were women. At the first presentation, it was mostly systolic-diastolic hypertension (51.8%) and isolated systolic hypertension (38.5%). Mean blood pressure was 169.4 ± 28.4 mmHg for systolic, 95.3 ± 15.7 mmHg for diastolic, and 74.1 ± 22.8 mmHg for pulse pressure. Pulse pressure was ≥60 mmHg in 80.4%. According to the European Guidelines stratification of the cardiovascular risk-excess attributable to high blood pressure, 82.1% of the sample had a very high added risk. The pharmacological therapy was prescribed in 93.5%. More than 66% of patients were receiving ≥2 antihypertensive drugs including fixed-dose combination drugs. The most common agents used were diuretics (63.5%) followed by angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in 61.3%. The most common agents used for monotherapy were calcium antagonists. When ≥2 drugs were used, diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were the most common. Blood pressure control was achieved in 42.6%. Conclusion. The control of elderly hypertension can be effective in Sub-Saharan Africa. He required at least two antihypertensive drugs to meet the recommended blood pressure target

Presence of susceptible wild strains of Anopheles gambiae in a large industrial palm farm located in Aboisso, South-Eastern of Côte d'Ivoire.

The effectiveness of malaria control programmes through implementation of vector control activities is challenged by the emergence of insecticide resistance. In the South-Eastern region of Côte d'Ivoire, where palm oil plantations remain the predominant agricultural crop, the susceptibility of wild Anopheles gambiae sensu lato species is still unknown and thus requires a particular attention. The current study was carried out to address the gap by in-depth characterization of susceptibility level of An. gambiae mosquitoes from Ehania-V1 to WHO-recommended doses of six insecticides belonging to available classes and also to screen a subset for target site mutations and possible inhibition of P450 enzymes. Overall results showed variable resistance profile across WHO-recommended insecticides tested. Mortalities ranged from 8.3% (the lowest mortality was recorded with DDT) to 98% (the highest mortality was recorded with fenitrothion). Importantly, mortality to deltamethrin, an important pyrethroid used in public health for impregnation of mosquito nets was close to 98%, precluding a possible susceptibility to this insecticide, albeit further investigations are required. Pre-exposure of An. gambiae s.l. to PBO did not show any significant variation across insecticides (p = 0.002), although a partial increase was detected for alphacypermethrin and bendiocarb, suggesting a low of activity of cytochrome P450 enzymes (p = 0.277). High frequency of kdr L1014F was recorded in both Anopheles coluzzii (91%) and in An. gambiae (96%), associated with ace-1 (R) G119S mutation at low frequency (<20%). The high mortality rate to deltamethrin, organophosphate and the non-detection of P450 activity in resistance observed in Ehania-V1 appears as a positive outcome for further control strategies as metabolic-based P450 resistance remains major challenge to manage. These results should help the National Malaria Control Programme when designing strategies for vector control in palm oil areas of Côte d'Ivoire

Pneumococcal carriage in sub-Saharan Africa--a systematic review.

BACKGROUND: Pneumococcal epidemiology varies geographically and few data are available from the African continent. We assess pneumococcal carriage from studies conducted in sub-Saharan Africa (sSA) before and after the pneumococcal conjugate vaccine (PCV) era. METHODS: A search for pneumococcal carriage studies published before 2012 was conducted to describe carriage in sSA. The review also describes pneumococcal serotypes and assesses the impact of vaccination on carriage in this region. RESULTS: Fifty-seven studies were included in this review with the majority (40.3%) from South Africa. There was considerable variability in the prevalence of carriage between studies (I-squared statistic = 99%). Carriage was higher in children and decreased with increasing age, 63.2% (95% CI: 55.6-70.8) in children less than 5 years, 42.6% (95% CI: 29.9-55.4) in children 5-15 years and 28.0% (95% CI: 19.0-37.0) in adults older than 15 years. There was no difference in the prevalence of carriage between males and females in 9/11 studies. Serotypes 19F, 6B, 6A, 14 and 23F were the five most common isolates. A meta-analysis of four randomized trials of PCV vaccination in children aged 9-24 months showed that carriage of vaccine type (VT) serotypes decreased with PCV vaccination; however, overall carriage remained the same because of a concomitant increase in non-vaccine type (NVT) serotypes. CONCLUSION: Pneumococcal carriage is generally high in the African continent, particularly in young children. The five most common serotypes in sSA are among the top seven serotypes that cause invasive pneumococcal disease in children globally. These serotypes are covered by the two PCVs recommended for routine childhood immunization by the WHO. The distribution of serotypes found in the nasopharynx is altered by PCV vaccination

Rainfall risk over the city of Abidjan (Côte d'Ivoire): first contribution of the joint analysis of daily rainfall from a historical record and a recent network of rain gauges

Every year, rains cause material damage and human losses, in Abidjan (Côte d'Ivoire). The objective of this study is to contribute to the characterization of the rain hazard in the District of Abidjan. The available data are made up of daily rainfall from a historical station “Abidjan airport” (1961–2014) and an academic network of rain gauges (21) progressively implemented in Abidjan since 2015. A descriptive analysis (date of occurrence, rainfall depth, mean wet days intensity and number of rainy days) on the Highest Cumulative Rainfall Periods (HCRP: 60 d) is conducted on the long-term station. The periods of highest risk of flooding during the long and short rainy seasons are characterized. The Experimental variograms of extreme rainfalls derived from the current network, allow to evaluate their extensions according to the rainy season.</p

Marginality: Addressing the Root Causes of Extreme Poverty

The need to address extreme poverty from the perspective of marginality arises from the frustration that the number of the poorest and hungry remains unacceptably high. This triggered the call for an innovative approach from the side of science and action. The conceptual and analytical framework developed here views marginality as a root cause of extreme poverty. We define marginality as an involuntary position and condition of an individual or group at the edge of social, economic, and ecological systems, preventing the access to resources, assets, services, restraining freedom of choice, preventing the development of capabilities, and causing extreme poverty. Causal complexes tie the marginalized poor in systems from which they want to escape or in which they want to improve their lives. The rural and agricultural context is of particular relevance here, as we assume that large segments of the extreme poor live in rural areas. The poorest themselves have described their situation, for instance, as being trapped in a 'complex knot which can lead to further knots if the wrong threads are pulled.' While poverty is objectively a matter of absolute deficiencies, we explain why the way in which poverty is perceived by the poor themselves requires looking at poverty as a relative, subjective, dynamic and systemic phenomenon. We conceptualize marginality as patterns of causal complexes in societal and spatial dimensions. These causal complexes can, for instance, comprise different types of livelihood systems or different types of poverty traps. They include proximate as well as underlying causes of extreme poverty and specifically address social exclusion, restrained access to assets, opportunities and transport, communication and public services infrastructure. An analytical framework is developed, outlining the various steps required for the analysis of marginality in a systematic, re&#x0081;]iterative and participatory manner, involving those affected by extreme poverty themselves. From each causal complex of marginality, leverage points can be identified which match with specific intervention packages, relevant for livelihood management, policy formulation and implementation. The approach to the investigation of extreme poverty is applied and relevant for managing change towards inclusive development. Points of entry for public and private investments are being identified

Lower limb fractures in adult patients with residua of poliomyelitis

Few studies have been published in the literature regarding fractures of limbs in patients with poliomyelitis. We have conducted a retrospective study from 1992 to 2004 in order to present our data on fractures of lower limbs in adult patients with residua of poliomyelitis. During the thirteen-year period under study, only eight fractures of the lower limbs in seven patients were observed. There were three males and four females with a mean age of 42.6 years at the time of the injury. Fractures were caused by moderate trauma in four patients and severe trauma in three. Six patients were walking while one used wheelchair before the injury. The femur was the bone injured in all cases. Treatment performed in four patients consisted of surgical operation. However although the small number of patients remains the primary limitation of this investigation, the patients constitute a homogeneous group which is representative of the condition in respect of the location of fractures and mechanism. We think that in our medical environment, despite the influence of traditional bonesetters, every effort should be made to maintain the patient's independence by surgical treatment of displaced femoral fractures in adults with residua of poliomyelitis. This can allow for a quick return to the pre-injury level.Keywords:adult, fracture, lower limb, poliomyelitis Nigerian Medical Practitioner Vol. 48(3) 2005: 67-6

Caractérisation et modélisation des pertes de puissance dans un environnement résidentiel avec plusieurs murs dans plusieurs bandes de fréquences

International audience—Multi-technology wireless networks enable the combination of the strength and usage of different wireless systems such as Wi-Fi, mobile and IoT networks. The design of such networks requires primarily the study of the radio coverage of wireless technologies that, most of the time, operate in different frequency bands. For this purpose, this paper presents a multi-wall and multi-frequency indoor path loss model based on measurements performed from 800 MHz to 6 GHz in the same residential environment. The presented results are focused on the carrier frequency effect and on the level of details of the building representation. Index Terms—path loss, multi-wall model, residential environment

Characterization of hydrometeors in Sahelian convective systems with an X-band radar and comparison with in situ measurements. Part II : a simple brightband method to infer the density of icy hydrometeors

A simple scheme that is based on the shape and intensity of the radar bright band is used to infer the density of hydrometeors just above the freezing level in Sahelian mesoscale convective systems (MCS). Four MCS jointly observed by a ground-based X-band radar and by an instrumented aircraft as part of the Megha-Tropiques algorithm-validation campaign during August 2010 in Niamey, Niger, are analyzed. The instrumented aircraft (with a 94-GHz radar and various optical probes on board) provided mass-diameter laws for the particles sampled during the flights. The mass-diameter laws derived from the ground-radar vertical profile of reflectivity (VPR) for each flight are compared with those derived from the airborne measurements. The density laws derived by both methods are consistent and encourage further use of the simple VPR scheme to quantify hydrometeor density laws and their variability for various analyses (microphysical processes and icy-hydrometeor scattering and radiative properties)