Effet de l’extrait aqueux de l’écorce de tige de Anthocleista djalonensis A. Chev (Gentianaceae) sur la glycémie des lapins

En Côte d’Ivoire, le diabète sucré est un problème majeur de santé publique avec une prévalence estimée à 9,6%. Les remèdes à base de plantes constituent une alternative thérapeutique pour la prise en charge de cette pathologie. Parmi les phytomédicaments les plus utilisés pour le traitement du diabète, figure l’extrait aqueux des écorces de tige de Anthocleista djalonensis. L’objectif de l’étude était de rechercher l’effet hypoglycémiant de l’extrait aqueux des écorces de tige de Anthocleista djalonensis chez le lapin. Ainsi, l’effet hypoglycémiant de l’extrait aqueux a été mis en évidence par voie orale chez les lapins normoglycémiques et rendus hyperglycémiques en comparaison avec un lot témoin et un lot de référence sous glibenclamide. Au total, vingt quatre (24) lapins répartis en 8 lots de 3 ont été utilisés durant quatre heures d’expérimentation. Les résultats ont mis en évidence les propriétés hypoglycémiantes de l’extrait aqueux des écorces de tige de Anthocleista djalonensis à la concentration de 2500 mg/kg de poids corporel (p.c) chez les lapins traités. Toutefois, l’évaluation de l’effet hypoglycémiant sur une période d’expérimentation plus longue et l’étude de son innocuité sont à envisager.© 2016 International Formulae Group. All rights reserved.Mots clés: Extrait aqueux, Anthocleista djalonensis, hypoglycémiant, diabèteEnglish Title: Effect of the aqueous extract of Anthocleista djalonensis A. Chev (Gentianaceae) stem bark on the glycaemia of rabbitsEnglish AbstractIn Côte d’Ivoire, diabetes mellitus is a major public health problem with an estimated prevalence of 9.6%. Herbal remedies constitute a therapeutic alternative for the treatment of this pathology. Among phytomedicines commonly used for the treatment of diabetes, the aqueous extract of the stem bark of  Anthocleista djalonensis was described. The hypoglycemic effect of the aqueous extract was demonstrated by the oral route in normoglycemic and hyperglycemic rabbits in comparison with a control group and a batch of reference under glibenclamide. A total of twenty four (24) rabbits divided into eight batches of 3 were used for four hours of experimentation. The results showed the hypoglycemic properties of the aqueous extract of the stem bark Anthocleista djalonensis at a concentration of 2500 mg/kg.p.c in the treated rabbits. However, the evaluation of the hypoglycemic effect over a longer period of experimentation and study of its safety are considered.© 2016 International Formulae Group. All rights reserved.Keywords: Aqueous extract, hypoglycemic effect, Anthocleista djalonensis, diabete

Inequalities in child mortality in ten major African cities

Background: The existence of socio-economic inequalities in child mortality is well documented. African cities grow faster than cities in most other regions of the world; and inequalities in African cities are thought to be particularly large. Revealing health-related inequalities is essential in order for governments to be able to act against them. This study aimed to systematically compare inequalities in child mortality across 10 major African cities (Cairo, Lagos, Kinshasa, Luanda, Abidjan, Dar es Salaam, Nairobi, Dakar, Addis Ababa, Accra), and to investigate trends in such inequalities over time. Methods: Data from two rounds of demographic and health surveys (DHS) were used for this study (if available): one from around the year 2000 and one from between 2007 and 2011. Child mortality rates within cities were calculated by population wealth quintiles. Inequality in child mortality was assessed by computing two measures of relative inequality (the rate ratio and the concentration index) and two measures of absolute inequality (the difference and the Erreyger's index). Results: Mean child mortality rates ranged from about 39 deaths per 1,000 live births in Cairo (2008) to about 107 deaths per 1,000 live births in Dar es Salaam (2010). Significant inequalities were found in Kinshasa, Luanda, Abidjan, and Addis Ababa in the most recent survey. The difference between the poorest quintile and the richest quintile was as much as 108 deaths per 1,000 live births (95% confidence interval 55 to 166) in Abidjan in 2011-2012. When comparing inequalities across cities or over time, confidence intervals of all measures almost always overlap. Nevertheless, inequalities appear to have increased in Abidjan, while they appear to have decreased in Cairo, Lagos, Dar es Salaam, Nairobi and Dakar. Conclusions: Considerable inequalities exist in almost all cities but the level of inequalities and their development over time appear to differ across cities. This implies that inequalities are amenable to policy interventions and that it is worth investigating why inequalities are higher in one city than in another. However, larger samples are needed in order to improve the certainty of our results. Currently available data samples from DHS are too small to reliably quantify the level of inequalities within cities

Epidemiological links between malaria parasitaemia and hypertension : findings from a population-based survey in rural Côte d'Ivoire

Although potential links between malaria parasitaemia and hypertension have been hypothesized, there is paucity of epidemiologic evidence on this link. We investigated in a population-based survey, the association between malaria parasitaemia and hypertension in Ivorian adults.; We estimated the adjusted odds ratios (OR) and 95% confidence intervals (CI) of hypertension in relation to malaria parasitaemia using multinomial regression, in 997 randomly selected adults in the 'Côte d'Ivoire Dual Burden of Disease Study' (CoDuBu), in south-central Côte d'Ivoire. We defined malaria parasitaemia as a positive rapid diagnostic test or identification of Plasmodium spp. on microscopy. Using the mean of the last two of three blood pressure (BP) measurements and questionnaire data, we defined hypertension as SBP at least 140 mmHg or DBP at least 90 mmHg or clinician-diagnosed hypertension.; Prevalence of malaria parasitaemia and hypertension were 10 and 22%, respectively. Malaria parasitaemia was negatively associated with hypertension in participants with body temperature 36.5 °C or less [OR 0.23 (95% CI 0.06-0.84)]. Contrastingly, microscopic malaria parasitaemia showed positive associations with hypertension in participants with elevated body temperature [>36.5 °C; OR: 2.93 (95% CI 0.94-9.14)]. Participants having microscopic malaria parasitaemia with elevated body temperature had three-fold higher odds of hypertension [OR: 3.37 (95% CI 1.12-10.0)] than malaria parasitaemia-negatives with lower body temperature.; Malaria parasitaemia and hypertension are prevalent and seemingly linked comorbidities in African settings. This link may depend on malaria parasitaemia symptomaticity/latency where individuals with more latent/asymptomatic malaria parasitaemia have lower risk of hypertension and those with more acute/symptomatic malaria parasitaemia have a tendency toward higher BP. The cross-sectional nature of the study limited the distinction of short-term BP elevation (interim pathophysiological stress) from hypertension development. Future longitudinal studies considering malaria/hypertension phenotypes and host molecular variations are needed to clarify involved biological mechanisms, toward comorbidity management

Asymptomatic Plasmodium infection and glycemic control in adults: Results from a population-based survey in south-central Côte d'Ivoire

We investigated the cross-sectional associations of Plasmodium infection (PI) with fasting glucose (FG) and glycated hemoglobin (HbA1c) in malaria-endemic south-central Côte d'Ivoire.; We studied 979 participants (non-pregnant; no treated diabetes; 51% males; 18-87 years) of the Côte d'Ivoire Dual Burden of Disease study. Fasting venous blood was obtained for PI, FG, and HbA1c assessment. We defined PI as a positive malaria rapid diagnostic test (RDT) or microscopic identification of Plasmodium species. We applied multivariable linear regressions to assess beta coefficients (β) and 95% confidence intervals (CIs) of PI positivity for FG and HbA1c independent of diabetes risk factors.; Prevalence of PI was 10.1% (5.5% microscopy; 9.7% RDT) without clinical fever. Prevalence of FG-based prediabetes (45.8%) and diabetes (3.6%) were considerably higher than HbA1c-based values (2.7% and 0.7%, respectively). PI was independently associated with FG among participants with higher body temperature (β 0.34, 95% CI 0.06-0.63, p; heterogeneity; = 0.028), or family history of diabetes (β 0.88, 95% CI 0.28-1.47, p; heterogeneity; = 0.009). Similar patterns observed with HbA1c were obliterated on accounting for FG. We also observed consistent associations with parasite density.; FG-based diabetes diagnosis in the presence of asymptomatic PI may misclassify or overestimate diabetes burden in malaria-endemic settings. Longitudinal studies are needed to confirm these findings and determine the risk for diabetes

Evaluation des indicateurs d’alerte précoce de la résistance du VIH aux ARV en Côte d’Ivoire en 2011

Introduction: en 2001, l'Organisation des Nations Unies recommandait de rendre disponible les médicaments antirétroviraux dans les pays à ressources limitées. Cependant, l'utilisation de ces médicaments à grande échelle s'accompagne du développement de résistance du virus. En Côte d'Ivoire, plusieurs sites prescrivent les antirétroviraux. Cette étude avait pour objectif d'évaluer les facteurs programmatiques associés à un risque élevé d'émergence de résistance du VIH aux antirétroviraux. Méthodes: il s'agit d'une cohorte rétrospective sur 20 sites de prise en charge des personnes vivant avec le VIH. La population d'étude était constituée des personnes ayant initié leur traitement antirétroviral sur les sites en 2008-2009. L'estimation de la taille de l'échantillon a été faite à partir de la stratégie d'échantillonnage de l'OMS. Résultats: sur 20 sites, 98% des prescriptions initiales étaient conformes aux directives nationales et 20% des sites avaient 100% de prescriptions conformes. Au total, 33% des patients étaient perdus de vue au cours des 12 premiers mois de traitement antirétroviral et 20% des sites avaient moins de 20% de perdus de vue. A 12 mois, 51% des patients demeuraient sous traitement de première intention approprié et 11% des sites ont atteint le seuil d'au moins 70% de patients sous traitement de première intention approprié. Un seul site n'a pas connu de rupture d'antirétroviraux sur les 12 mois. Conclusion: des insuffisances relevées dans la prise en charge des personnes vivant avec le VIH traduisent l'existence d'un risque important de résistance du virus aux antirétroviraux en 2008-2009. Pour minimiser ce risque les pratiques de prescription devraient être améliorées, un système de recherche des absents aux rendez-vous devrait être mis en place et la disponibilité constante des antirétroviraux devraient être assurée.The Pan African Medical Journal 2016;2

Côte d'Ivoire Dual Burden of Disease (CoDuBu): Study Protocol to Investigate the Co-occurrence of Chronic Infections and Noncommunicable Diseases in Rural Settings of Epidemiological Transition

Individual-level concomitance of infectious diseases and noncommunicable diseases (NCDs) is poorly studied, despite the reality of this dual disease burden for many low- and middle-income countries (LMICs).; This study protocol describes the implementation of a cohort and biobank aiming for a better understanding of interrelation of helminth and Plasmodium infections with NCD phenotypes like metabolic syndrome, hypertension, and diabetes.; A baseline cross-sectional population-based survey was conducted over one year, in the Taabo health and demographic surveillance system (HDSS) in south-central Côte d'Ivoire. We randomly identified 1020 consenting participants aged ≥18 years in three communities (Taabo-Cité, Amani-Ménou, and Tokohiri) reflecting varying stages of epidemiological transition. Participants underwent health examinations consisting of NCD phenotyping (anthropometry, blood pressure, renal function, glycemia, and lipids) and infectious disease testing (infections with soil-transmitted helminths, schistosomes, and Plasmodium). Individuals identified to have elevated blood pressure, glucose, lipids, or with infections were referred to the central/national health center for diagnostic confirmation and treatment. Aliquots of urine, stool, and venous blood were stored in a biobank for future exposome/phenome research. In-person interviews on sociodemographic attributes, risk factors for infectious diseases and NCDs, medication, vaccinations, and health care were also conducted. Appropriate statistical techniques will be applied in exploring the concomitance of infectious diseases and NCDs and their determinants. Participants' consent for follow-up contact was obtained.; Key results from this baseline study, which will be published in peer-reviewed literature, will provide information on the prevalence and co-occurrence of infectious diseases, NCDs, and their risk factors. The Taabo HDSS consists of rural and somewhat more urbanized areas, allowing for comparative studies at different levels of epidemiological transition. An HDSS setting is ideal as a basis for longitudinal studies since their sustainable field work teams hold close contact with the local population.; The collaboration between research institutions, public health organizations, health care providers, and staff from the Taabo HDSS in this study assures that the synthesized evidence will feed into health policy towards integrated infectious disease-NCD management. The preparation of health systems for the dual burden of disease is pressing in low- and middle-income countries. The established biobank will strengthen the local research capacity and offer opportunities for biomarker studies to deepen the understanding of the cross-talk between infectious diseases and NCDs.; International Standard Randomized Controlled Trials Number (ISRCTN): 87099939; http://www.isrctn.com/ISRCTN87099939 (Archived by WebCite at http://www.webcitation.org/6uLEs1EsX)