Use of HRP-2-based rapid diagnostic test for Plasmodium falciparum malaria: assessing accuracy and cost-effectiveness in the villages of Dielmo and Ndiop, Senegal

Background: In 2006, the Senegalese National Malaria Control Programme (NMCP) has recommended artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria and, in 2007, mandated testing for all suspected cases of malaria with a Plasmodium falciparum HRP-2-based rapid diagnostic test for malaria (RDT(Paracheck (R)). Given the higher cost of ACT compared to earlier anti-malarials, the objectives of the present study were i) to study the accuracy of Paracheck (R) compared to the thick blood smear (TBS) in two areas with different levels of malaria endemicity and ii) analyse the cost-effectiveness of the strategy of the parasitological confirmation of clinically suspected malaria cases management recommended by the NMCP. Methods: A cross-sectional study was undertaken in the villages of Dielmo and Ndiop (Senegal) nested in a cohort study of about 800 inhabitants. For all the individuals consulting between October 2008 and January 2009 with a clinical diagnosis of malaria, a questionnaire was filled and finger-prick blood samples were taken both for microscopic examination and RDT. The estimated costs and cost-effectiveness analysis were made considering five scenarios, the recommendations of the NMCP being the reference scenario. In addition, a sensitivity analysis was performed assuming that all the RDT-positive patients and 50% of RDT-negative patients were treated with ACT. Results: A total of 189 consultations for clinically suspected malaria occurred during the study period. The sensitivity, specificity, positive and negative predictive values were respectively 100%, 98.3%, 80.0% and 100%. The estimated cost of the reference scenario was close to 700(sic) per 1000 episodes of illness, approximately twice as expensive as most of the other scenarios. Nevertheless, it appeared to us cost-effective while ensuring the diagnosis and the treatment of 100% of malaria attacks and an adequate management of 98.4% of episodes of illness. The present study also demonstrated that full compliance of health care providers with RDT results was required in order to avoid severe incremental costs. Conclusions: A rational use of ACT requires laboratory testing of all patients presenting with presumed malaria. Use of RDTs inevitably has incremental costs, but the strategy associating RDT use for all clinically suspected malaria and prescribing ACT only to patients tested positive is cost-effective in areas where microscopy is unavailable

Assessment of the relative success of sporozoite inoculations in individuals exposed to moderate seasonal transmission

Background: The time necessary for malaria parasite to re-appear in the blood following treatment (re-infection time) is an indirect method for evaluating the immune defences operating against pre-erythrocytic and early erythrocytic malaria stages. Few longitudinal data are available in populations in whom malaria transmission level had also been measured. Methods: One hundred and ten individuals from the village of Ndiop (Senegal), aged between one and 72 years, were cured of malaria by quinine (25 mg/day oral Quinimax T in three equal daily doses, for seven days). Thereafter, thick blood films were examined to detect the reappearance of Plasmodium falciparum every week, for 11 weeks after treatment. Malaria transmission was simultaneously measured weekly by night collection of biting mosquitoes. Results: Malaria transmission was on average 15.3 infective bites per person during the 77 days follow up. The median reappearance time for the whole study population was 46.8 days, whereas individuals would have received an average one infective bite every 5 days. At the end of the follow-up, after 77 days, 103 of the 110 individuals (93.6%; CI 95% [89.0-98.2]) had been re-infected with P. falciparum. The median reappearance time ('re-positivation') was longer in subjects with patent parasitaemia at enrolment than in parasitologically-negative individuals (58 days vs. 45.9; p = 0.03) and in adults > 30 years than in younger subjects (58.6 days vs. 42.7; p = 0.0002). In a multivariate Cox PH model controlling for the sickle cell trait, G6PD deficiency and the type of habitat, the presence of parasitaemia at enrolment and age >= 30 years were independently predictive of a reduced risk of re-infection (PH = 0.5 [95% CI: 0.3-0.9] and 0.4; [95% CI: 0.2-0.6] respectively). Conclusion: Results indicate the existence of a substantial resistance to sporozoites inoculations, but which was ultimately overcome in almost every individual after 2 1/2 months of natural challenges. Such a study design and the results obtained suggest that, despite a small sample size, this approach can contribute to assess the impact of intervention methods, such as the efficacy vector-control measures or of malaria pre-erythrocytic stages vaccines

An Exhaustive, Non-Euclidean, Non-Parametric Data Mining Tool for Unraveling the Complexity of Biological Systems – Novel Insights into Malaria

Complex, high-dimensional data sets pose significant analytical challenges in the post-genomic era. Such data sets are not exclusive to genetic analyses and are also pertinent to epidemiology. There has been considerable effort to develop hypothesis-free data mining and machine learning methodologies. However, current methodologies lack exhaustivity and general applicability. Here we use a novel non-parametric, non-euclidean data mining tool, HyperCube®, to explore exhaustively a complex epidemiological malaria data set by searching for over density of events in m-dimensional space. Hotspots of over density correspond to strings of variables, rules, that determine, in this case, the occurrence of Plasmodium falciparum clinical malaria episodes. The data set contained 46,837 outcome events from 1,653 individuals and 34 explanatory variables. The best predictive rule contained 1,689 events from 148 individuals and was defined as: individuals present during 1992–2003, aged 1–5 years old, having hemoglobin AA, and having had previous Plasmodium malariae malaria parasite infection ≤10 times. These individuals had 3.71 times more P. falciparum clinical malaria episodes than the general population. We validated the rule in two different cohorts. We compared and contrasted the HyperCube® rule with the rules using variables identified by both traditional statistical methods and non-parametric regression tree methods. In addition, we tried all possible sub-stratified quantitative variables. No other model with equal or greater representativity gave a higher Relative Risk. Although three of the four variables in the rule were intuitive, the effect of number of P. malariae episodes was not. HyperCube® efficiently sub-stratified quantitative variables to optimize the rule and was able to identify interactions among the variables, tasks not easy to perform using standard data mining methods. Search of local over density in m-dimensional space, explained by easily interpretable rules, is thus seemingly ideal for generating hypotheses for large datasets to unravel the complexity inherent in biological systems

Prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis

ObjectivesThis study aimed to determine the prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa.MethodsThis systematic review and meta-analysis used the PRISMA guideline on sepsis data in sub-Saharan Africa. The bibliographic search was carried out on the following databases: Medline/PubMed, Cochrane Library, African Index Medicus, and Google Scholar. Additionally, the reference lists of the included studies were screened for potentially relevant studies. The last search was conducted on 15 October 2022. The Joanna Briggs Institute quality assessment checklist was applied for critical appraisal. Estimates of the prevalence of maternal and neonatal sepsis were pooled using a random-effects meta-analysis model. Heterogeneity between studies was estimated using the Q statistic and the I2 statistic. The funnel plot and Egger’s regression test were used to assess the publication bias.ResultsA total of 39 studies were included in our review: 32 studies on neonatal sepsis and 7 studies on maternal sepsis. The overall pooled prevalence of maternal and neonatal sepsis in Sub-Saharan Africa was 19.21% (95% CI, 11.46–26.97) and 36.02% (CI: 26.68–45.36), respectively. The meta-analyses revealed that Apgar score < 7 (OR: 2.4, 95% CI: 1.6–3.5), meconium in the amniotic fluid (OR: 2.9, 95% CI: 1.8–4.5), prolonged rupture of membranes >12 h (OR: 2.8, 95% CI: 1.9–4.1), male sex (OR: 1.2, 95% CI: 1.1–1.4), intrapartum fever (OR: 2.4, 95% CI: 1.5–3.7), and history of urinary tract infection in the mother (OR: 2.7, 95% CI: 1.4–5.2) are factors associated with neonatal sepsis. Rural residence (OR: 2.3, 95% CI: 1.01–10.9), parity (OR: 0.5, 95% CI: 0.3–0.7), prolonged labor (OR: 3.4, 95% CI: 1.6–6.9), and multiple digital vaginal examinations (OR: 4.4, 95% CI: 1.3–14.3) were significantly associated with maternal sepsis.ConclusionThe prevalence of maternal and neonatal sepsis was high in sub-Saharan Africa. Multiple factors associated with neonatal and maternal sepsis were identified. These factors could help in the prevention and development of strategies to combat maternal and neonatal sepsis. Given the high risk of bias and high heterogeneity, further high-quality research is needed in the sub-Saharan African context, including a meta-analysis of individual data.Systematic review registration: PROSPERO (ID: CRD42022382050)

The renewal of the control and litigation of public procurement in the WAEMU area ; Contribution to the study of public procurement law

Sous l'influence du droit communautaire de l'UEMOA, lui-même influencé l'internationationlisation du droit de la commande publique, le droit des marchés publics sénégalais connait un nouveau souffle. Le cadre juridique et institutionnel se peaufine prenant en compte les objectif fixés par les standards internationaux. Des organes de régulations, autorités administratives indépendantes sont instituées pour mettre en œuvre un contrôle plus préventif que curatif. L'office des juges administratif, financier et pénal subit une mutation. Le droit public sénégalais se trouve au cœur d'une transformation entre contrôle interne régulation et déjudiciarisation. L'intérêt de cette étude est de faire le point sur le contrôle et le contentieux des marchés publics. Ainsi, on assiste d'une part à un renouvellement des fondements juridico-institutionnels du contrôle dans lequel l'élément transparence occupe une place centrale et d'autre part, à un contrôle faisant intervenir plusieurs organes et plusieurs juges. L'étude se propose de cerner la problématique du contrôle et du contentieux des marchés publics en mettant l'accent sur son effectivité et son efficacité. De ce fait, sont passés en revue ses principes et moyens de fonctionnement, ses fondements juridico-institutionnels, ses modalités de mis en œuvre, les organes chargés du contrôle, qu'ils soient administratifs ou juridictionnels, mais ses acquis et ses insuffisances. Pour ce faire, il nous parait indiqué de faire du droit comparé. Cette comparaison s'est faite non seulement dans le cadre interne et communautaire mais aussi international. Il faudra dès lors étudier l'existant en jetant un regard sur l'évolution de l'environnement juridique du contrôle et du contentieux des des marchés publics.Under the influence of WAEMU Community law, which in turn influenced the internationalization of public procurement law, Senegalese public procurement law is experiencing a new lease of life. The legal and institutional framework is being refined taking into account the objectives set by international standards. Regulatory bodies, independent administrative authorities are established to implement a control more preventive than curative. The Office of Administrative, Financial and Criminal Judges is undergoing a change. Senegalese public law is at the heart of a transformation between internal control regulation and diversion. The interest of this study is to take stock of the control and litigation of public procurement. Thus, on the one hand, we are witnessing a renewal of the legal-institutional foundations of control in which the transparency element occupies a central place and, on the other hand, a control involving several bodies and several judges. The study aims to identify the problem of control and litigation of public procurement by focusing on its effectiveness and effectiveness. As a result, its principles and means of operation, its legal-institutional foundations, its methods of implementation, the bodies responsible for control, whether administrative or judicial, but its achievements and shortcomings are reviewed.To do this, it seems appropriate to us to do comparative law. This comparison was made not only within the internal and Community framework but also internationally. It will therefore be necessary to study the existing by taking a look at the evolution of the legal environment for the control and litigation of public procurement

Ethno Apicultural Survey of Melliferous Plant Species in the Great Green Wall Widou and Koyli Alpha, Senegal

Dispositif de recherche interdisciplinaire sur les Interactions Hommes-Milieu

Les langues du roman

Cet ouvrage s’interroge sur les faits et effets de langue dans le roman et sur les stratégies d’écriture mises en œuvre pour y intégrer le plurilinguisme. La cohabitation des langues et des niveaux de langue – ou, si l’on préfère, l’hétérogénéité langagière – apparaît en effet comme un enjeu esthétique fondamental du roman, dans sa volonté de rendre compte de la diversité du réel. Les études rassemblées ici par Lise Gauvin, dans le cadre des travaux du Groupe de recherche interuniversitaire sur les interactions langues/littératures, font souvent référence aux concepts élaborés par Mikhaïl Bakhtine et Édouard Glissant, à la forme polyphonique du roman et à la créolisation du monde. Elles s’intéressent à des auteurs, comme Joyce, Derrida ou Semprun, dont la langue d’écriture ne correspond pas toujours à leur langue maternelle. Elles traitent de littératures francophones - belge, sénégalaise, québécoise, acadienne et guadeloupéenne -, et du rapport variable qu’elles entretiennent avec leur particularisme langagier. Les Langues du roman constitue un recueil passionnant où les questions de littérature renvoient constamment à la situation d’un monde plurilingue, creuset des cultures et des langues ou nouvelle tour de Babel