Facteurs Explicatifs de la Pratique Contraceptive Moderne des Femmes Fréquentant les Formations Sanitaires du District de Youwarou au Mali

Objectif : Mettre en exergue les déterminants de la pratique contraceptive moderne des femmes fréquentant les centres de santé du district de Youwarou au Mali. L’étude part du constat que la situation sanitaire est non satisfaisante avec un faible taux de fréquentation des centres de santé qui est de 15 %, exacerbée par la crise sécuritaire déclenchée en 2012. Ainsi, le taux d’utilisation des méthodes contraceptives modernes est également très faible soit 1,07%. En effet, l’utilisation de la contraception moderne selon la cinquième Enquête Démographique et de Santé du Mali (EDSM-5) est de 9,6% au niveau national et de 2,7% dans la région de Mopti. Méthode : Etude transversale quantitative dont l’enquête fut réalisée du 1er mai au 30 juin 2015, et a porté sur 200 femmes âgées de 15-49 ans fréquentant les 07 centres de santé dans le district de Youwarou. Les données collectées par un questionnaire ont été vérifiées, compilées à l’aide du logiciel le Sphinx Plus² version 4.5, puis transférées sur le logiciel stata 10 pour l’analyse statistique. Pour l’analyse des données, nous avons eu recours à deux méthodes dans ce travail : la méthode d’analyse descriptive (analyse bivariée) et la méthode d’analyse explicative (analyse multivariée). Résultats : L’étude montrent que la prévalence contraceptive moderne est de 8,8%. Les femmes de centre de Guidio-sare utilisent les contraceptives modernes plus que leurs consoeurs du district. Enfin les déterminants de la pratique contraceptive sont notamment l’ethnie, l’âge et le statut matrimonial de la femme. Conclusion : A la lumière de cette étude, nous suggérons qu’un accent particulier doit être mis sur les déterminants révélés afin de promouvoir les méthodes contraceptives modernes. Objective: Highlight the determinants of modern contraceptive practice among women attending health centers in the Youwarou health district of Mali. The study was carried out based on the observation that the health situation is unsatisfactory with a low utilization rate of health centers is 15%, exacerbated by the security crisis triggered in 2012. Thus, the rate of use of modern contraceptive methods is also very low is 1.07%. Indeed, the use of modern contraception according to the fifth Demographic and Health Survey of Mali (EDSM-5) is 9.6% at the national level and 2.7% in the Mopti region. Methods: A quantitative cross-sectional study was carried out from May 1th to June 30th 2015, and covered 200 women aged 15-49 attending the 07 health centers in the district of Youwarou. The data collected by a questionnaire was verified, compiled using the software Sphinx Plus² version 4.5, and then transferred to the Stata 10 software for statistical analysis. For data analysis, two methods were used in this work: the descriptive analysis method (bivariate analysis) and the explanatory analysis method (multivariate analysis). Results: The study shows that modern contraceptive prevalence is 8.8%. women of Guidio-sare Center use modern contraceptives more than their sisters of district. Finally, the determinants of contraceptive practice include the ethnicity, age and marital status of women. Conclusion: In the light of this study, we suggest that emphasis should be placed on the identified determinants in order to promote modern contraceptive methods

Trends in socioeconomic disparities in a rapid under-five mortality transition: a longitudinal study in United Republic of Tanzania

Abstract: Objective To explore trends in socioeconomic disparities and under-five mortality rates in rural parts of United Republic of Tanzania between 2000 and 2011. Methods: We used longitudinal data on births, deaths, migrations, maternal educational attainment and household characteristics from the Ifakara and Rufiji health and demographic surveillance systems. We estimated hazard ratios (HR) for associations between mortality and maternal educational attainment or relative household wealth, using Cox hazard regression models. Findings: The under-five mortality rate declined in Ifakara from 132.7 deaths per 1000 live births (95% confidence interval, CI: 119.3–147.4) in 2000 to 66.2 (95%CI: 59.0–74.3) in 2011 and in Rufiji from 118.4 deaths per 1000 live births (95% CI: 107.1– 130.7) in 2000 to 76.2 (95% CI: 66.7–86.9) in 2011. Combining both sites, in 2000– 2001, the risk of dying for children of uneducated mothers was 1.44 (95% CI: 1.08– 1.92) higher than for children of mothers who had received education beyond primary school. In 2010–2011, the HR was 1.18 (95% CI: 0.90–1.55). In contrast mortality disparities between richest and poorest quintiles worsened in Rufiji, from 1.20 (95% CI: 0.99–1.47) in 2000–2001 to 1.48 (95% CI: 1.15–1.89) in 2010–2011, while in Ifakara, disparities narrowed from 1.30 (95% CI: 1.09–1.55) to 1.15 (95% CI: 0.95–1.39) in the same period. Conclusion: While childhood survival has improved, mortality disparities still persist, suggesting a need for policies and programmes that both reduce child mortality and address socioeconomic disparities

Determinants of early initiation of breastfeeding in rural Tanzania

Background Breastfeeding is widely known for its imperative contribution in improving maternal and newborn health outcomes. However, evidence regarding timing of initiation of breastfeeding is limited in Tanzania. This study examines the extent of and factors associated with early initiation of breastfeeding in three rural districts of Tanzania. Methods Data were collected in 2011 in a cross–sectional survey of random households in Rufiji, Kilombero and Ulanga districts of Tanzania. From the survey, 889 women who had given birth within 2 years preceding the survey were analyzed. Both descriptive and inferential statistical analyses were conducted. Associations between the outcome variable and each of the independent variables were tested using chi–square. Logistic regression was used for multivariate analysis. Results Early initiation of breastfeeding (i.e. breastfeeding initiation within 1 h of birth) stood at 51 %. The odds of early initiation of breastfeeding was significantly 78 % lower following childbirth by caesarean section than vaginal birth (adjusted odds ratio (OR) = 0.22; 95 % confidence interval (CI) 0.14, 0.36). However, this was almost twice as high for women who gave birth in health facilities as for those who gave birth at home (OR = 1.75; 95 % CI 1.25, 2.45). Furthermore, maternal knowledge of newborn danger signs was negatively associated with early initiation of breastfeeding (moderate vs. high: OR = 1.73; 95 % CI 1.23, 2.42; low vs. high: OR = 2.06; 95 % CI 1.43, 2.96). The study found also that early initiation of breastfeeding was less likely in Rufiji compared to Kilombero (OR = 0.52; 95 % CI 0.31, 0.89), as well as among ever married than currently married women (OR = 0.46; 95 % CI 0.25, 0.87). Conclusions To enhance early initiation of breastfeeding, using health facilities for childbirth must be emphasized and facilitated among women in rural Tanzania. Further, interventions to promote and enforce early initiation of breastfeeding should be devised especially for caesarean births. Women residing in rural locations and women who are not currently married should be specifically targeted with interventions aimed at enhancing early initiation of breastfeeding to ensure healthy outcomes for newborns

Does Proximity to Health Facilities Improve Child Survival? New Evidence from a Longitudinal Study in Rural Tanzania

Distance to health facilities is often cited as a major barrier limiting access to care in sub-Saharan and other developing countries. There are however limited data on the causal effects of distance to facilities on child survival. Existing estimates may be biased because 1) most existing data are on distance to health care facilities are cross-sectional, and 2) existing analyses do not account for the endogeneity of residential choices and health services location. This paper uses unique longitudinal data collected in a rural district of Tanzania to test whether enhanced proximity to health services arising from investment in dispensaries contributed to the rapid decline in underfive mortality recently observed in Tanzania. Data on births, deaths, household socioeconomic characteristics and migrations have been recorded every 120 days since 1999 (n≈85,000). Geographic data on the precise location of households and health facilities have also been collected over time. We use multivariate analysis 1) to measure the causal effects of distance to health facilities on child survival and 2) to test for possible interactions between distance to health facilities and socioeconomic characteristics of households (e.g., educational attainment, wealth). Initial results indicate that, from 2000 to 2010, child mortality declined close to 40% (from 110 to 70 per 1000). The distance to the closest health facility remained a strong determinant of child survival, even after adjusting for endogeneity biases. The development of community-based primary health care in rural communities by posting community health assistants, and conducting regular household visits, can improve health outcomes. It can also increase equity by offsetting the detrimental effects of low maternal education, householdpoverty and distance to health facilities

QTL mapping and validation of fertility restoration in West African sorghum A1 cytoplasm and identification of a potential causative mutation for Rf2

Abstract Key message Major A 1 cytoplasm fertility restoration loci, Rf 2 and Rf 5 , were found in the West African sorghum. A potential causative mutation for Rf 2 was identified. KASP markers were validated on independent material. Abstract To accelerate the identification and development of hybrid parental lines in West African (WA) sorghum, this study aimed to understand the genetics underlying the fertility restoration (Rf) in WA A1 cytoplasmic male sterility system and to develop markers for a routine use in WA breeding programs. We genotyped by sequencing three F2 populations to map the Rf quantitative trait loci (QTL), validated the molecular KASP markers developed from those QTL in two F2:3 populations, and assessed the most promising markers on a set of 95 R- and B-lines from WA breeding programs. Seven QTL were found across the three F2 populations. On chromosome SBI-05, we found a major fertility restorer locus (Rf5) for two populations with the same male parent, explaining 19 and 14% of the phenotypic variation in either population. Minor QTL were detected in these two populations on chromosomes SBI-02, SBI-03, SBI-04 and SBI-10. In the third population, we identified one major fertility restorer locus on chromosome SBI-02, Rf2, explaining 31% of the phenotypic variation. Pentatricopeptide repeat genes in the Rf2 QTL region were sequenced, and we detected in Sobic.002G057050 a missense mutation in the first exon, explaining 81% of the phenotypic variation in a F2:3 population and clearly separating B- from R-lines. The KASP marker developed from this mutation stands as a promising tool for routine use in WA breeding programs

The Tanzania Connect Project: a cluster-randomized trial of the child survival impact of adding paid community health workers to an existing facility-focused health system

Background: Tanzania has been a pioneer in establishing community-level services, yet challenges remain in sustaining these systems and ensuring adequate human resource strategies. In particular, the added value of a cadre of professional community health workers is under debate. While Tanzania has the highest density of primary health care facilities in Africa, equitable access and quality of care remain a challenge. Utilization for many services proven to reduce child and maternal mortality is unacceptably low. Tanzanian policy initiatives have sought to address these problems by proposing expansion of community-based providers, but the Ministry of Health and Social Welfare (MoHSW ) lacks evidence that this merits national implementation. The Tanzania Connect Project is a randomized cluster trial located in three rural districts with a population of roughly 360,000 ( Kilombero, Rufiji, and Ulanga). Description of intervention: Connect aims to test whether introducing a community health worker into a general program of health systems strengthening and referral improvement will reduce child mortality, improve access to services, expand utilization, and alter reproductive, maternal, newborn and child health seeking behavior; thereby accelerating progress towards Millennium Development Goals 4 and 5. Connect has introduced a new cadre — Community Health Agents (CHA) — who were recruited from and work in their communities. To support the CHA, Connect developed supervisory systems, launched information and monitoring operations, and implemented logistics support for integration with existing district and village operations. In addition, Connect’s district-wide emergency referral strengthening intervention includes clinical and operational improvements. Evaluation design: Designed as a community-based cluster-randomized trial, CHA were randomly assigned to 50 of the 101 villages within the Health and Demographic Surveillance System (HDSS) in the three study districts. To garner detailed information on household characteristics, behaviors, and service exposure, a random sub-sample survey of 3,300 women of reproductive age will be conducted at the baseline and endline. The referral system intervention will use baseline, midline, and endline facility-based data to assess systemic changes. Implementation and impact research of Connect will assess whether and how the presence of the CHA at village level provides added life-saving value to the health system. Discussion: Global commitment to launching community-based primary health care has accelerated in recent years, with much of the implementation focused on Africa. Despite extensive investment, no program has been guided by a truly experimental study. Connect will not only address Tanzania’s need for policy and operational research, it will bridge a critical international knowledge gap concerning the added value of salaried professional community health workers in the context of a high density of fixed facilities. Trial registration: ISRCTN9681984

Plasmodium falciparum Choline Kinase Inhibition Leads to a Major Decrease in Phosphatidylethanolamine Causing Parasite Death

This work was supported by Agencia Aragonesa para la Investigación y Desarrollo (ARAID), Ministerio de Economía y Competitividad (CTQ2013-44367-C2-2-P to R.H.-G.) and Diputación General de Aragón (DGA; B89 to R.H.-G.) and the EU Seventh Framework Programme (2007–2013) under BioStruct-X (grant agreement 283570 and BIOSTRUCTX 5186, to R.H.-G.). T.K.S. was supported by the Wellcome Trust grant 093228 and European Community’s Seventh Framework Programme under grant agreement No. 602773 (Project KINDRED).Malaria is a life-threatening disease caused by different species of the protozoan parasite Plasmodium, with P. falciparum being the deadliest. Increasing parasitic resistance to existing antimalarials makes the necessity of novel avenues to treat this disease an urgent priority. The enzymes responsible for the synthesis of phosphatidylcholine and phosphatidylethanolamine are attractive drug targets to treat malaria as their selective inhibition leads to an arrest of the parasite’s growth and cures malaria in a mouse model. We present here a detailed study that reveals a mode of action for two P. falciparum choline kinase inhibitors both in vitro and in vivo. The compounds present distinct binding modes to the choline/ethanolamine-binding site of P. falciparum choline kinase, reflecting different types of inhibition. Strikingly, these compounds primarily inhibit the ethanolamine kinase activity of the P. falciparum choline kinase, leading to a severe decrease in the phosphatidylethanolamine levels within P. falciparum, which explains the resulting growth phenotype and the parasites death. These studies provide an understanding of the mode of action, and act as a springboard for continued antimalarial development efforts selectively targeting P. falciparum choline kinase.Publisher PDFPeer reviewe