Diagnostic Étiologique Échographique des Douleurs Pelviennes Aigues de la Femme en Côte d’Ivoire

Introduction : les douleurs pelviennes aigues chez la femme sont fréquentes et objet d’exploration échographique systématique dans notre pratique quotidienne. Objectif : contribuer à la recherche étiologique des douleurs pelviennes aigues (DPA) de la femme dans une zone où l’outil échographique est pratiquement le seul moyen d’imagerie accessible. Patiente et méthodes : étude prospective d’une durée de 6 mois réalisée au centre hospitalo-universitaire de Yopougon (Abidjan-Côte d’Ivoire). Une série continue de 153 femmes chez qui nous avons réalisé une échographie pelvienne au motif de DPA ont été enrôlées. Les examens échographiques ont été réalisées à l’aide de 3 sondes (convexe, linéaire et endocavitaire) en mode B et Doppler. Résultats : l’âge moyen des patientes était de 30, 2 ans avec des extrêmes de 12 et 68 ans. Les échographies étaient normales dans 25,5% et objectivaient une pathologie dans 74,5 % des cas. Ces pathologies concernaient les organes génitaux internes dans 89,5% des cas et dans 10,5% des cas il s’agissait de pathologie extra-génitale. Les ovaires étaient les organes génitaux les plus concernés (64,1%) suivis de l’utérus (28,2%) et des trompes (7,7%). Les causes extra-génitales étaient la hernie inguinale (4 cas), l’appendicite aigüe (5 cas), la sigmoïdite (1 cas) et la lithiase du bas uretère (2 cas). Conclusion : une proportion non négligeable de causes extra-génitales des douleurs pelviennes, objectivée dans notre étude, impose un examen clinique minutieux de toute la sphère hypogastrique voire abdominale par les cliniciens. L’utilisation de la sonde linéaire de haute fréquence qui n’est pas toujours sollicitée par les échographistes, au cours de la prise en charge des DPA devrait être préconisée. Introduction: Acute pelvic pain in women is common and systematically explored by ultrasound in our daily practice. Objective: Contribute to the aetiological research of women's acute pelvic pain (APD) in an area where the ultrasound tool is practically the only means of accessible imagery. Patient and methods: A prospective study lasting 6 months was carrried out at the Yopougon University Hospital Center (Abidjan-Ivory Coast). A continuous series of 153 women who had a pelvic ultrasound for DPA were enrolled. Ultrasound examinations were performed using 3 probes (convex, linear and endocavitary) in B and Doppler mode. Results: The mean age of the patients was 30, 2 years with extremes of 12 and 68 years. About a quarter (25.5%) of the ultrasound examinations were normal and in 74.5% of cases, a pathology was objectified. These pathologies concerned the internal genital organs in 89.5% of the cases and in 10.5% of cases they were extragenital pathologies. The ovaries were the most affected genitals (64.1%)followed by the uterus (28.2%) and the fallopian tubes (7.7%). Extra-genital causes were inguinal hernia (4 cases), acute appendicitis (5 cases), sigmoiditis (1 case) and lithiasis of the lower ureter (2 cases). Conclusion: a significant proportion of extragenital causes of pelvic pain, objectified in our study, requires a careful clinical examination of the whole hypogastric or even all abdominal regions by clinicians and the use of the high frequency linear probe which is not not always solicited by sonographers, during the care of the DPA

Optimizing implementation of preventive chemotherapy against soil-transmitted helminthiasis and intestinal schistosomiasis using high-resolution data: Field-based experiences from Côte d'Ivoire

BACKGROUND: Despite efforts to control neglected tropical diseases (NTDs) using preventive chemotherapy (PC), soil-transmitted helminthiases and schistosomiasis remain widely prevalent in sub-Saharan Africa. The current PC regimen in endemic settings is defined based on health district-level prevalence. This work aims to highlight the need for high-resolution data when elimination, rather than morbidity control, is the targeted goal. METHODOLOGY: Cross-sectional parasitological surveys were conducted from July to August 2019 and from September to October 2019, respectively, across the entire Dabou and Jacqueville health districts in southern Cote d'Ivoire. From every village, 60 school-aged children (6-15 years) were randomly selected and invited to provide one fresh stool sample, whereof duplicate Kato-Katz thick smears were prepared and read by two independent technicians. PRINCIPAL FINDINGS: 4338 school-aged children from 77 villages were screened from the Dabou (n = 2174; 50.12%, 39 villages) and Jacqueville (n = 2164; 49.88%, 38 villages) health districts. The prevalence of any soil-transmitted helminth (STH) infection was 12.47% and 11.09% in the Dabou and Jacqueville health districts, respectively. Species-specific district-level prevalence remained below 10%, varying between 0.51% (hookworm in Jacqueville) and 9.06% (Trichuris trichiura in Dabou). However, when considering sub-districts or villages only, several STH infection hotspots (five sub-districts with >/=20% and four villages with more than 50% infected) were observed. Schistosoma mansoni infection was found in less than 1% of the examined children in each health district. CONCLUSIONS/SIGNIFICANCE: We conclude that keeping health district-level prevalence as a reference for PC implementation leaves many high-risk sub-districts or villages requiring PC (>/=20% prevalence) untreated. To avoid maintaining those high-risk villages as STH reservoirs by skipping control interventions and jeopardizing the successes already achieved in STH control through PC during the past two decades, precision mapping is required. Further investigation is needed to assess cost-efficient approaches to implement small-scale disease surveillance

Plant yields and fodder quality related characteristics of millet-stylo intercropping systems in the Sahel

In trials at Sadoré, Niger in 1988-90, Pennisetum glaucum cv. Composite Inter-Varietal de Tarna, Stylosanthes fruticosa cv. ILCA 13860 and S. hamata cv. Verano were grown for 1 or 2 years as pure stands or as cereal-legume intercrops with different row ratios. In the 2-year intercrop, P. glaucum was resown on land on which the legume would regrow from the previous crop stubble. Intercropping the legumes with P. glaucum for 1 year in alternate single rows did not affect P. glaucum grain yield because of poor legume competition. Total DM yield of the intercrop was similar to pure P. glaucum, while CP concentration increased significantly with intercropping. During the 2nd year of association the legumes were more competitive, depressing P. glaucum yield by 67% in 1989 and 48% in 1990 compared with pure stands. Yield was decreased more by S. hamata than by S. fruticosa in 1990 but not in 1989, and alternate triple-row sowing of P. glaucum with the legumes gave higher grain yields than alternate single-row sowing in 1990 while the reverse pattern occurred in 1989. Total DM and CP yields, and CP concentration of the harvested fodder were, respectively, 1.4, 3.0 and 2.3 times greater in intercrops than in pure P. glaucum stand

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

BACKGROUND: In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high. We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy (ART), 6-month isoniazid preventive therapy (IPT), or both among HIV-infected adults with high CD4+ cell counts in Ivory Coast. METHODS: We included participants who had HIV type 1 infection and a CD4+ count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization (WHO) guidelines. Participants were randomly assigned to one of four treatment groups: deferred ART (ART initiation according to WHO criteria), deferred ART plus IPT, early ART (immediate ART initiation), or early ART plus IPT. The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome (AIDS), non-AIDS-defining cancer, non-AIDS-defining invasive bacterial disease, or death from any cause at 30 months. We used Cox proportional models to compare outcomes between the deferred-ART and early-ART strategies and between the IPT and no-IPT strategies. RESULTS: A total of 2056 patients (41% with a baseline CD4+ count of ≥500 cells per cubic millimeter) were followed for 4757 patient-years. A total of 204 primary end-point events were observed (3.8 events per 100 person-years; 95% confidence interval [CI], 3.3 to 4.4), including 68 in patients with a baseline CD4+ count of at least 500 cells per cubic millimeter (3.2 events per 100 person-years; 95% CI, 2.4 to 4.0). Tuberculosis and invasive bacterial diseases accounted for 42% and 27% of primary end-point events, respectively. The risk of death or severe HIV-related illness was lower with early ART than with deferred ART (adjusted hazard ratio, 0.56; 95% CI, 0.41 to 0.76; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.56; 95% CI, 0.33 to 0.94) and lower with IPT than with no IPT (adjusted hazard ratio, 0.65; 95% CI, 0.48 to 0.88; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.61; 95% CI, 0.36 to 1.01). The 30-month probability of grade 3 or 4 adverse events did not differ significantly among the strategies. CONCLUSIONS: In this African country, immediate ART and 6 months of IPT independently led to lower rates of severe illness than did deferred ART and no IPT, both overall and among patients with CD4+ counts of at least 500 cells per cubic millimeter. (Funded by the French National Agency for Research on AIDS and Viral Hepatitis; TEMPRANO ANRS 12136 ClinicalTrials.gov number, NCT00495651.)

First report of a phytoplasma affecting cassava orchards in Cote d'Ivoire

Annex 46 of 48 for CIFSRF-IDRC/GAC Final technical report: http://hdl.handle.net/10625/56415This work was carried out with the aid of a grant from Canada’s International Development Research Centre (IDRC), and with financial support from the Government of Canada, provided through Global Affairs Canada (GAC)This is the first report of a phytoplasma affecting cassava in Côte d'Ivoire. The findings suggest that cassava may be a potential alternative host for the Côte d'Ivoire lethal yellowing (CILY) phytoplasma, which poses a serious threat for the food security of smallholder coconut and cassava farmers, especially women, in Grand-Lahou, Côte d’Ivoire. Leaf samples were collected at random from 12 symptom-bearing and two symptomless cassava plants from two villages. Illustrations/ figures depict the symptoms of yellowing. Cassava (Manihot esculenta) is one of the staple foods in Africa, cultivated in 40 countries and producing more than three million tonnes per year

Effect of isoniazid preventive therapy on risk of death in west African, HIV-infected adults with high CD4 cell counts: long-term follow-up of the Temprano ANRS 12136 trial.

BACKGROUND: Temprano ANRS 12136 was a factorial 2 × 2 trial that assessed the benefits of early antiretroviral therapy (ART; ie, in patients who had not reached the CD4 cell count threshold used to recommend starting ART, as per the WHO guidelines that were the standard during the study period) and 6-month isoniazid preventive therapy (IPT) in HIV-infected adults in Côte d'Ivoire. Early ART and IPT were shown to independently reduce the risk of severe morbidity at 30 months. Here, we present the efficacy of IPT in reducing mortality from the long-term follow-up of Temprano. METHODS: For Temprano, participants were randomly assigned to four groups (deferred ART, deferred ART plus IPT, early ART, or early ART plus IPT). Participants who completed the trial follow-up were invited to participate in a post-trial phase. The primary post-trial phase endpoint was death, as analysed by the intention-to-treat principle. We used Cox proportional models to compare all-cause mortality between the IPT and no IPT strategies from inclusion in Temprano to the end of the follow-up period. FINDINGS: Between March 18, 2008, and Jan 5, 2015, 2056 patients (mean baseline CD4 count 477 cells per μL) were followed up for 9404 patient-years (Temprano 4757; post-trial phase 4647). The median follow-up time was 4·9 years (IQR 3·3-5·8). 86 deaths were recorded (Temprano 47 deaths; post-trial phase 39 deaths), of which 34 were in patients randomly assigned IPT (6-year probability 4·1%, 95% CI 2·9-5·7) and 52 were in those randomly assigned no IPT (6·9%, 5·1-9·2). The hazard ratio of death in patients who had IPT compared with those who did not have IPT was 0·63 (95% CI, 0·41 to 0·97) after adjusting for the ART strategy (early vs deferred), and 0·61 (0·39-0·94) after adjustment for the ART strategy, baseline CD4 cell count, and other key characteristics. There was no evidence for statistical interaction between IPT and ART (pinteraction=0·77) or between IPT and time (pinteraction=0·94) on mortality. INTERPRETATION: In Côte d'Ivoire, where the incidence of tuberculosis was last reported as 159 per 100 000 people, 6 months of IPT has a durable protective effect in reducing mortality in HIV-infected people, even in people with high CD4 cell counts and who have started ART. FUNDING: National Research Agency on AIDS and Viral Hepatitis (ANRS)

Quantitative estimates of glacial refugia for chimpanzees (Pan troglodytes) since the Last Interglacial (120,000 BP).

Paleoclimate reconstructions have enhanced our understanding of how past climates have shaped present-day biodiversity. We hypothesize that the geographic extent of Pleistocene forest refugia and suitable habitat fluctuated significantly in time during the late Quaternary for chimpanzees (Pan troglodytes). Using bioclimatic variables representing monthly temperature and precipitation estimates, past human population density data, and an extensive database of georeferenced presence points, we built a model of changing habitat suitability for chimpanzees at fine spatio-temporal scales dating back to the Last Interglacial (120,000 BP). Our models cover a spatial resolution of 0.0467° (approximately 5.19 km2 grid cells) and a temporal resolution of between 1000 and 4000 years. Using our model, we mapped habitat stability over time using three approaches, comparing our modeled stability estimates to existing knowledge of Afrotropical refugia, as well as contemporary patterns of major keystone tropical food resources used by chimpanzees, figs (Moraceae), and palms (Arecacae). Results show habitat stability congruent with known glacial refugia across Africa, suggesting their extents may have been underestimated for chimpanzees, with potentially up to approximately 60,000 km2 of previously unrecognized glacial refugia. The refugia we highlight coincide with higher species richness for figs and palms. Our results provide spatio-temporally explicit insights into the role of refugia across the chimpanzee range, forming the empirical foundation for developing and testing hypotheses about behavioral, ecological, and genetic diversity with additional data. This methodology can be applied to other species and geographic areas when sufficient data are available

The bii4africa dataset of faunal and floral population intactness estimates across Africa’s major land uses

Sub-Saharan Africa is under-represented in global biodiversity datasets, particularly regarding the impact of land use on species’ population abundances. Drawing on recent advances in expert elicitation to ensure data consistency, 200 experts were convened using a modified-Delphi process to estimate ‘intactness scores’: the remaining proportion of an ‘intact’ reference population of a species group in a particular land use, on a scale from 0 (no remaining individuals) to 1 (same abundance as the reference) and, in rare cases, to 2 (populations that thrive in human-modified landscapes). The resulting bii4africa dataset contains intactness scores representing terrestrial vertebrates (tetrapods: ±5,400 amphibians, reptiles, birds, mammals) and vascular plants (±45,000 forbs, graminoids, trees, shrubs) in sub-Saharan Africa across the region’s major land uses (urban, cropland, rangeland, plantation, protected, etc.) and intensities (e.g., large-scale vs smallholder cropland). This dataset was co-produced as part of the Biodiversity Intactness Index for Africa Project. Additional uses include assessing ecosystem condition; rectifying geographic/ taxonomic biases in global biodiversity indicators and maps; and informing the Red List of Ecosystems

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Bayesian risk mapping and model-based estimation of Schistosoma haematobium : Schistosoma mansoni co-distribution in Côte d'Ivoire

Schistosoma haematobium and Schistosoma mansoni are blood flukes that cause urogenital and intestinal schistosomiasis, respectively. In Côte d'Ivoire, both species are endemic and control efforts are being scaled up. Accurate knowledge of the geographical distribution, including delineation of high-risk areas, is a central feature for spatial targeting of interventions. Thus far, model-based predictive risk mapping of schistosomiasis has relied on historical data of separate parasite species.; We analyzed data pertaining to Schistosoma infection among school-aged children obtained from a national, cross-sectional survey conducted between November 2011 and February 2012. More than 5,000 children in 92 schools across Côte d'Ivoire participated. Bayesian geostatistical multinomial models were developed to assess infection risk, including S. haematobium-S. mansoni co-infection. The predicted risk of schistosomiasis was utilized to estimate the number of children that need preventive chemotherapy with praziquantel according to World Health Organization guidelines.; We estimated that 8.9% of school-aged children in Côte d'Ivoire are affected by schistosomiasis; 5.3% with S. haematobium and 3.8% with S. mansoni. Approximately 2 million annualized praziquantel treatments would be required for preventive chemotherapy at health districts level. The distinct spatial patterns of S. haematobium and S. mansoni imply that co-infection is of little importance across the country.; We provide a comprehensive analysis of the spatial distribution of schistosomiasis risk among school-aged children in Côte d'Ivoire and a strong empirical basis for a rational targeting of control interventions