Pre and Post Training Knowledge of Cassava Viral Disease among Farmer and Extension Officer in Nigeria

This study presents findings of a train-the trainer cassava stakeholders training workshop conducted in 2017. Farmers and agricultural extension officers from 12 states and the Federal Capital Territory (FCT) in Nigeria were invited for a 2-day workshop aimed at raising awareness and educating participants on cassava virus disease management. An open-ended questionnaire was used to measure pre and post workshop knowledge alongside practices and needs. A total of 74 persons, 49 farmers and 25 extension officers were included in the study. Participants were mostly males who had been cultivating cassava for 12±9 years or had been providing extension services for 17±9 years. Pre-workshop knowledge on cassava viral diseases among cassava farmers was poor with farmers scoring an average of 2.04±1.1 out of 5 obtainable points on knowledge. Disease management practices were poor among farmers with 40.8% obtaining planting materials from unverified sources. Post-workshop evaluation showed that farmers’ knowledge of cassava viral diseases had increased as adjudged by an average knowledge score of 7.98±1.80 out of 11 obtainable points. This study highlights the effectiveness of training in improving farmers’ knowledge and equipping them to contribute to the management of cassava viral diseases

Antiretroviral Therapy‑related Problems among Human Immunodeficiency Virus‑infected Patients: A Focus on Medication Adherence and Pill Burden

Background: There are problems associated with antiretroviral therapy despite its achievement. Poor medication adherence and inability to tolerate large pill burden are major problems facing patients with chronic illnesses. These drug therapy problems are under-studied among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Nigeria. We evaluated adherence and pill burden among this set of patients in a tertiary hospital in Lagos. Methods: Data for eligible HIV‑infected adults were documented from case notes and through interviews using a well‑structured  questionnaire. Important details extracted were sociodemographics, pills information, and CD4 counts. The main outcome measures were drug adherence, as assessed by the four‑item Morisky Medication Adherence Scale and pill burden, as measured by daily pill >5. Results: Of the 296 patients, 219 (74%) were females. Median age (interquartile range) was 40 (35.0–47.7) years. Majority (262; 88.5%) were married, had at least a secondary education (142:48.0%), and CD4 count >500 cells/ml (215; 72.6%). Pill burden >5 pills/day was observed in 12.2% of the patients, while adherence was documented for 83.4% of the patients. Majority (259; 87.5%) were receiving fixed‑dose  combination of antiretroviral drugs. Forgetfulness (16.5%) and being too busy to take pills (10.5%) were the most common reasons for nonadherence. Pill burden in those who were not receiving fixed‑dose combination was significantly associated with medication nonadherence. However, only pill burden was found to be an independent prognosticator of non-adherance. (Odd ratio = 0.67, confidenceinterval = 0.03–1.66, P < 0.00). Conclusion: Medication nonadherence and pill burden were observed in more than one‑tenth of patients. These were the two major  antiretroviral therapy‑related problems reported in this study. Keywords: Adherence, antiretroviral therapy, human immunodeficiency virus, people living with human immunodeficiency virus/acquiredimmunodeficiency syndrome, pill burde

Emergence and spread of two SARS-CoV-2 variants of interest in Nigeria.

Identifying the dissemination patterns and impacts of a virus of economic or health importance during a pandemic is crucial, as it informs the public on policies for containment in order to reduce the spread of the virus. In this study, we integrated genomic and travel data to investigate the emergence and spread of the SARS-CoV-2 B.1.1.318 and B.1.525 (Eta) variants of interest in Nigeria and the wider Africa region. By integrating travel data and phylogeographic reconstructions, we find that these two variants that arose during the second wave in Nigeria emerged from within Africa, with the B.1.525 from Nigeria, and then spread to other parts of the world. Data from this study show how regional connectivity of Nigeria drove the spread of these variants of interest to surrounding countries and those connected by air-traffic. Our findings demonstrate the power of genomic analysis when combined with mobility and epidemiological data to identify the drivers of transmission, as bidirectional transmission within and between African nations are grossly underestimated as seen in our import risk index estimates

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

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Ethnopharmacological survey of Nigerian medicinal plants of potential use for typhoid fever treatment in Lagos metropolis

No Abstrac

An overview of cancer of the prostate diagnosis and management in Nigeria: The experience in a Nigerian tertiary hospital

Objective: To review our experience with cancer of prostate management, highlighting the mode of presentation, method of diagnosis, and the treatment outcome. Methods: Medical records of patients managed for cancer of prostate were retrospectively reviewed over a 10-year period. Relevant information which included the year of diagnosis, age at presentation, mode of presentation, digital rectal examination (DRE) findings, ultrasound (USS) assessment of the prostate, the prostate-specific antigen (PSA) value, the histology report, treatment offered and the outcome were extracted. Data were analyzed with SPSS version 11 software. Results: A total of 192 patients were managed for cancer of prostate within the study period but only 90 case notes were available for analysis. There was a 7.7 fold increase in the incidence of cancer of prostate. The mean age (±SD) at presentation was 68.4 (±10.1) years with an age range of 47-91 years and the peak incidence occurred in the seventh and eighth decades of life. The mean duration of symptoms prior to presentation was 10.3 (±17.1) months. A total of 66.7% of cases presented within 6 months of the onset of symptoms as against 14.4% of cases presented after a year. Majority of cases (88.9%) presented as locally advanced or metastatic disease and only 4.4% of cases were found incidentally. Only 38.9% had histologic confirmation of the diagnosis before management was instituted. DRE gave a false negative finding in 28.6% in this study. The sensitivity and false negative value of USS was 50% each and 3.3% had PSA within normal value. Bilateral orchidectomy was offered to 64 of 90 (71.1%) and the cancer related death (CRD) was 15.6%. The maximum follow-up period was 36 months in this study and 36.9% are still attending follow-up clinic. Conclusion: There was an apparent increase in the incidence of cancer of prostate from the present study with majority still presenting with advanced disease. The sensitivity of DRE was high; this probably accounted for the treatment without establishing the histologic diagnosis in majority of the cases. Such a practice of clinical diagnosis alone should be discouraged.Objectif: Pour consulter notre expérience avec le cancer de la prostate gestion, mise en évidence du mode de présentation, méthode de diagnostic et le résultat du traitement. Méthodes: Les dossiers médicaux des patients gérés pour le cancer de la prostate ont été examinées a posteriori sur une période de 10 ans. Des informations pertinentes qui inclus l’année de diagnostic, l’âge, à la présentation, le mode de présentation, les conclusions numérique toucher rectal (TR), évaluation des ultrasons (USS) de la prostate, la valeur de l’antigène prostatique spécifique (PSA), le rapport de l’histologie, traitement offerts et les résultats ont été extraites. Les données ont été analysées avec SPSS version 11 logiciels. Résultats: Un total de 192 patients étaient gérés pour le cancer de la prostate au sein de la période d’étude, mais seulement 90 notes de cas étaient disponibles pour l’analyse. Il y avait une augmentation de 7,7 pli dans l’incidence du cancer de la prostate. La moyenne d’âge (±SD) à la présentation était 68.4 (±10.1) ans avec une tranche d’âge de 47–91 ans et l’incidence de pointe s’est produite dans les décennies septième et huitième de la vie. La durée moyenne de symptômes avant à la présentation était 10.3 (±17.1) mois. Un total de 66,7% de cas présentées dans un délai de 6 mois à compter de l’apparition des symptômes contre 14,4% des cas présentés après un an. La majorité des cas (88,9%), présenté comme une maladie localement avancée ou METASTATIQUE et seulement 4,4% des cas ont été trouvés par ailleurs. Seulement 38,9% avaient histologiques confirmation du diagnostic avant de gestion a été instituée. Y a donné une fausse conclusion négative de 28,6% dans cette étude. La valeur négative de l’USS, sensibilité et false avait 50% chacun et 3,3% PSA au sein de la valeur normale. Orchidectomy bilatéral a été offerte à 64 de 90 (71,1%) et le cancer liés à la mort (CRD) était 15,6%. La période maximale de suivi a été 36 mois dans cette étude et 36,9% fréquentent toujours suivi clinique. Conclusion: Il y a une augmentation apparente de l’incidence du cancer de la prostate de la présente étude à majorité présentant encore les avancé de la maladie. La sensibilité de l’évaluation était élevée; cela représentait probablement le traitement sans établir le diagnostic histologiques dans la majorité des cas. Une telle pratique de diagnostic clinique seul devrait être déconseillée

An overview of cancer of the prostate diagnosis and management in Nigeria: The experience in a Nigerian tertiary hospital

Objective: To review our experience with cancer of prostate management, highlighting the mode of presentation, method of diagnosis, and the treatment outcome. Methods: Medical records of patients managed for cancer of prostate were retrospectively reviewed over a 10-year period. Relevant information which included the year of diagnosis, age at presentation, mode of presentation, digital rectal examination (DRE) findings, ultrasound (USS) assessment of the prostate, the prostate-specific antigen (PSA) value, the histology report, treatment offered and the outcome were extracted. Data were analyzed with SPSS version 11 software. Results: A total of 192 patients were managed for cancer of prostate within the study period but only 90 case notes were available for analysis. There was a 7.7 fold increase in the incidence of cancer of prostate. The mean age (\ub1SD) at presentation was 68.4 (\ub110.1) years with an age range of 47-91 years and the peak incidence occurred in the seventh and eighth decades of life. The mean duration of symptoms prior to presentation was 10.3 (\ub117.1) months. A total of 66.7% of cases presented within 6 months of the onset of symptoms as against 14.4% of cases presented after a year. Majority of cases (88.9%) presented as locally advanced or metastatic disease and only 4.4% of cases were found incidentally. Only 38.9% had histologic confirmation of the diagnosis before management was instituted. DRE gave a false negative finding in 28.6% in this study. The sensitivity and false negative value of USS was 50% each and 3.3% had PSA within normal value. Bilateral orchidectomy was offered to 64 of 90 (71.1%) and the cancer related death (CRD) was 15.6%. The maximum follow-up period was 36 months in this study and 36.9% are still attending follow-up clinic. Conclusion: There was an apparent increase in the incidence of cancer of prostate from the present study with majority still presenting with advanced disease. The sensitivity of DRE was high; this probably accounted for the treatment without establishing the histologic diagnosis in majority of the cases. Such a practice of clinical diagnosis alone should be discouraged.Objectif: Pour consulter notre exp\ue9rience avec le cancer de la prostate gestion, mise en \ue9vidence du mode de pr\ue9sentation, m\ue9thode de diagnostic et le r\ue9sultat du traitement. M\ue9thodes: Les dossiers m\ue9dicaux des patients g\ue9r\ue9s pour le cancer de la prostate ont \ue9t\ue9 examin\ue9es a posteriori sur une p\ue9riode de 10 ans. Des informations pertinentes qui inclus l\u2019ann\ue9e de diagnostic, l\u2019\ue2ge, \ue0 la pr\ue9sentation, le mode de pr\ue9sentation, les conclusions num\ue9rique toucher rectal (TR), \ue9valuation des ultrasons (USS) de la prostate, la valeur de l\u2019antig\ue8ne prostatique sp\ue9cifique (PSA), le rapport de l\u2019histologie, traitement offerts et les r\ue9sultats ont \ue9t\ue9 extraites. Les donn\ue9es ont \ue9t\ue9 analys\ue9es avec SPSS version 11 logiciels. R\ue9sultats: Un total de 192 patients \ue9taient g\ue9r\ue9s pour le cancer de la prostate au sein de la p\ue9riode d\u2019\ue9tude, mais seulement 90 notes de cas \ue9taient disponibles pour l\u2019analyse. Il y avait une augmentation de 7,7 pli dans l\u2019incidence du cancer de la prostate. La moyenne d\u2019\ue2ge (\ub1SD) \ue0 la pr\ue9sentation \ue9tait 68.4 (\ub110.1) ans avec une tranche d\u2019\ue2ge de 47\u201391 ans et l\u2019incidence de pointe s\u2019est produite dans les d\ue9cennies septi\ue8me et huiti\ue8me de la vie. La dur\ue9e moyenne de sympt\uf4mes avant \ue0 la pr\ue9sentation \ue9tait 10.3 (\ub117.1) mois. Un total de 66,7% de cas pr\ue9sent\ue9es dans un d\ue9lai de 6 mois \ue0 compter de l\u2019apparition des sympt\uf4mes contre 14,4% des cas pr\ue9sent\ue9s apr\ue8s un an. La majorit\ue9 des cas (88,9%), pr\ue9sent\ue9 comme une maladie localement avanc\ue9e ou METASTATIQUE et seulement 4,4% des cas ont \ue9t\ue9 trouv\ue9s par ailleurs. Seulement 38,9% avaient histologiques confirmation du diagnostic avant de gestion a \ue9t\ue9 institu\ue9e. Y a donn\ue9 une fausse conclusion n\ue9gative de 28,6% dans cette \ue9tude. La valeur n\ue9gative de l\u2019USS, sensibilit\ue9 et false avait 50% chacun et 3,3% PSA au sein de la valeur normale. Orchidectomy bilat\ue9ral a \ue9t\ue9 offerte \ue0 64 de 90 (71,1%) et le cancer li\ue9s \ue0 la mort (CRD) \ue9tait 15,6%. La p\ue9riode maximale de suivi a \ue9t\ue9 36 mois dans cette \ue9tude et 36,9% fr\ue9quentent toujours suivi clinique. Conclusion: Il y a une augmentation apparente de l\u2019incidence du cancer de la prostate de la pr\ue9sente \ue9tude \ue0 majorit\ue9 pr\ue9sentant encore les avanc\ue9 de la maladie. La sensibilit\ue9 de l\u2019\ue9valuation \ue9tait \ue9lev\ue9e; cela repr\ue9sentait probablement le traitement sans \ue9tablir le diagnostic histologiques dans la majorit\ue9 des cas. Une telle pratique de diagnostic clinique seul devrait \ueatre d\ue9conseill\ue9e