Traumatismes de L’abdomen en Milieu Africain : Aspects Épidémiologiques, Diagnostiques, et Thérapeutiques

Introduction : La prise en charge des plaies et contusions del’abdomen est bien codifiée avec l’existence d’algorithmes. Au Burkina Faso,les ressources humaines, les moyens diagnostiques et thérapeutiques sontlimités. A cet égard, l’objectif de cette étude était d’étudier les aspectsépidémiologiques, diagnostiques et thérapeutiques des traumatismes del’abdomen. Patients et méthodes : L’étude en question était descriptiverétrospective, durant deux ans allant de janvier 2017 à décembre 2018 au CHUSourô Sanou de Bobo-Dioulasso. Les patients inclus avaient un diagnostic deplaie ou de contusion de l’abdomen. Les patients ayant un dossier incompletont été exclus. Résultats : Durant l’étude l’information de 63 patients a étécolligée, 51 hommes et 12 femmes. L’âge moyen était de 22 ans. Les accidentsde la circulation routière étaient au nombre de 25. Parmi ces traumatismesfiguraient 39 contusions et 24 plaies de l’abdomen. Une instabilitéhémodynamique était présente chez 15 patients. Les présentations cliniquesétaient : 25 cas de douleurs abdominales, 14 cas d’hémopéritoine, 12 cas desyndrome péritonéal, 9 cas d’éviscération. Les lésions de la rate étaient présentes dans huit cas. Les polytraumatismes étaient au nombre de 16.L’échographie abdominale était réalisée dans 19 cas, l’ASP dans 22 cas. Letraitement chirurgical a été réalisé chez 26 patients. La laparotomie était nonthérapeutique (ne nécessitant pas de geste chirurgical spécifique) chez 15patients. Les complications postopératoires comportaient cinq cas desuppuration pariétale, un cas de péritonite postopératoire. Le décès étaitsurvenu chez huit (12,7%) patients et la durée d’hospitalisation moyenne étaitde 8,5 jours. Conclusion : Les traumatismes de l’abdomen concernent lesadultes jeunes de sexe masculin, et sont dus aux accidents de la circulationroutière. L’ASP et l’échographie au lit du patient ne sont pasréalisées. Le tauxde laparotomie non thérapeutique est élevé ainsi que la mortalité. Introduction: The management of wounds and contusions of theabdomen is well codified with the existence of algorithms. In Burkina Faso,human resources, diagnostic and therapeutic means are limited. This paperfocuses on studying the epidemiological, diagnostic, and therapeutic aspects of trauma in the abdomen. Patients and Methods: This study employs adescriptive retrospective for two years beginning from January 2017 toDecember 2018 in Sourô Sanou University Hospital of Bobo-Dioulasso. Thepatients included in the study were diagnosed with a wound or contusion ofthe abdomen. Patients with incomplete records were excluded. Results:During the study, the data of 63 patients were collected, 51 men and 12women. The mean age was 22 years old. There were 25 road traffic accidents.Among these injuries were 39 bruises and 24 abdominal wounds.Hemodynamic instability was present in 15 patients. The clinical presentationswere: 25 cases of abdominal pain, 14 cases of hemoperitoneum, 12 cases ofperitoneal syndrome, and 9 cases of evisceration. Lesions of the spleen werepresent in 8 cases and there were 16 polytrauma cases. Abdominal ultrasoundwas performed in 19 cases, abdominal X-rays in 22 cases. Surgical treatmentwas carried out in 26 patients. Laparotomy was non-therapeutic (not requiringa specific surgical procedure) in 15 patients. Postoperative complicationsincluded five cases of parietal suppuration, one case of postoperativeperitonitis. Death occurred in eight (12.7%) patients. The average length ofhospital stay was 8.5 days. Conclusion: Trauma to the abdomen is of interestto young adult males, and it occurs majorly due to traffic accidents. Abdominalx-rays and patient bedside ultrasound are not performed. The rate of nontherapeutic laparotomy is high as well as the mortality. &nbsp

[Accepted Manuscript] Anthropometry and Malaria among Children in Niger: A Cross-Sectional Study.

The complex relationship between malnutrition and malaria affects morbidity and mortality in children younger than 5 years, particularly in parts of sub-Saharan Africa where these conditions occur together seasonally. Previous research on this relationship has been inconclusive. Here, we examine the association between anthropometric indicators and malaria infection in a population-based sample of children younger than 5 years in Niger. This cross-sectional study is a secondary analysis of a cluster-randomized trial comparing treatment strategies for trachoma in Niger. We included children aged 6-60 months residing in the 48 communities enrolled in the trial who completed anthropometric and malaria infection assessments at the final study visit. We evaluated the association between anthropometric indicators, including height-for-age z-score (HAZ) and weight-for-age z-score (WAZ) and indicators of malaria infection, including malaria parasitemia and clinical malaria. In May 2013, we collected data from 1,649 children. Of these, 780 (47.3%) were positive for malaria parasitemia and 401 (24.3%) had clinical malaria. In models of malaria parasitemia, the adjusted odds ratio (aOR) was 1.05 (95% confidence interval [CI]: 1.00-1.10) for HAZ and 1.07 (95% CI: 0.99, 1.15) for WAZ. In models of clinical malaria, the aOR was 1.07 (95% CI: 1.02-1.11) for HAZ and 1.09 (95% CI: 1.01-1.19) for WAZ. Overall, we did not find evidence of an association between most anthropometric indicators and malaria infection. Greater height may be associated with an increased risk of clinical malaria

Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health workers: results from a large-scale pragmatic trial in rural Niger

Community health workers (CHWs) are recommended to screen for acute malnutrition in the community by assessing mid-upper arm circumference (MUAC) on children between 6 and 59 months of age. MUAC is a simple screening tool that has been shown to be a better predictor of mortality in acutely malnourished children than other practicable anthropometric indicators. This study compared, under program conditions, mothers and CHWs in screening for severe acute malnutrition (SAM) by color-banded MUAC tapes. METHODS: This pragmatic interventional, non-randomized efficacy study took place in two health zones of Niger's Mirriah District from May 2013 to April 2014. Mothers in Dogo (Mothers Zone) and CHWs in Takieta (CHWs Zone) were trained to screen for malnutrition by MUAC color-coded class and check for edema. Exhaustive coverage surveys were conducted quarterly, and relevant data collected routinely in the health and nutrition program. An efficacy and cost analysis of each screening strategy was performed. RESULTS: A total of 12,893 mothers and caretakers were trained in the Mothers Zone and 36 CHWs in the CHWs Zone, and point coverage was similar in both zones at the end of the study (35.14 % Mothers Zone vs 32.35 % CHWs Zone, p = 0.9484). In the Mothers Zone, there was a higher rate of MUAC agreement (75.4 % vs 40.1 %, p <0.0001) and earlier detection of cases, with median MUAC at admission for those enrolled by MUAC <115 mm estimated to be 1.6 mm higher using a smoothed bootstrap procedure. Children in the Mothers Zone were much less likely to require inpatient care, both at admission and during treatment, with the most pronounced difference at admission for those enrolled by MUAC < 115 mm (risk ratio = 0.09 [95 % CI 0.03; 0.25], p < 0.0001). Training mothers required higher up-front costs, but overall costs for the year were much lower ($8,600 USD vs$21,980 USD.). CONCLUSIONS: Mothers were not inferior to CHWs in screening for malnutrition at a substantially lower cost. Children in the Mothers Zone were admitted at an earlier stage of SAM and required fewer hospitalizations. Making mothers the focal point of screening strategies should be included in malnutrition treatment programs.BioMed Central open acces

Community Risk Factors for Ocular Chlamydia Infection in Niger: Pre-Treatment Results from a Cluster-Randomized Trachoma Trial

Trachoma is one of the most important neglected tropical diseases because it is the leading cause of blindness from an infection in the world. There are about 1.3 million persons blind from the disease and many more at risk of blindness in the future. It is caused by the common bacterium Chlamydia trachomatis and can be treated with mass drug administrations (MDA) of azithromycin. We have begun a clinical trial in Niger, a country with limited resources in Africa, to determine the best treatment strategy. Our study from May to July 2010, which began before MDA's were given, showed that 26% of children aged 0–5 years were infected with the disease. In these children, we found that discharge from the nose, presence of flies on the face, and the number of years of education completed by the head of the household were risk factors for infection in 48 different communities. We hope to use this information about risk factors of infection to help guide future studies for trachoma and also to help with the WHO goal of eliminating the disease worldwide by the year 2020

Exploring water, sanitation, and hygiene coverage targets for reaching and sustaining trachoma elimination: G-computation analysis

BACKGROUND: Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission. METHODS/FINDINGS: We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive. CONCLUSIONS: Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma

Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys

PURPOSE: Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS: Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS: Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION: This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets

Efforts de modernisation de l’elevage au centre Songhaï et leurs effets socioeconomiques : cas du centre atagara de la commune de Parakou au Benin

La présente étude est réalisée pour apprécier les essais de modernisation de l’élevage au centre Songhaï et ses effets socioéconomiques dans la commune de Parakou au Bénin. Les recherches menées à l’aide de guide d’observation, de guide d’entretien et de focus group ont permis d’analyser les techniques mises en oeuvre pour la modernisation, l’organisation de la commercialisation, d’évaluer les recettes et apprécier les incidences socioéconomiques des activités menées par le centre Atagara dans la commune de Parakou. Ainsi, la vente des produits issus de l’agriculture, de l’élevage (légumes, légumineuses, fruits, reproducteurs ou géniteurs, oeufs frais, lait de vache, viande, poissons, etc.) et de la transformation agroalimentaire génère une recette moyenne annuelle de l’ordre de 156.700. 000 francs CFA. Le centre participe à la réduction du chômage par le nombre de travailleurs occasionnels ou permanents employés et contribue à limiter l’insécurité alimentaire en offrant aux consommateurs une gamme variée de produits agro-alimentaires. Les recettes contribuent également à la formation des jeunes en entreprenariat agricole. Ces derniers sont installés dans des fermes et bénéficient d’un appui matériel, technique et financier. Mais, certaines difficultés persistent comme celles d’ordre organisationnel, environnemental et sanitaire et de gestion. Il est impérieux d’améliorer le système de production afin d’obtenir de meilleurs résultats et de promouvoir un élevage moderne pour maximiser les impacts positifs d’un tel centre à vocation régionale.Mots clés : Atagara (Centre Songhaï - Bénin), élevage, modernisation, effets socioéconomiques.ABSTRACTThe present study aimed at appreciating the modernization tests of farming at the center of Songhai and its social and economic effects in the commune of Parakou (Benin). The research activities carried out with the help of observation and interview guides and focus group allow us to analyze the techniques used for the modernization, the organization of trade and to assess the takings and appreciate the social and economic impacts of the activities carried out by the Atagara center in Parakou. Thus the sale of the products stemming from farming (vegetables, fruits, eggs milk of cow, meat, fish, etc.) and agroindustry generates a revenue of one 156,700,000 FCFA. Thus the center contributes to reduce unemployment rate by offering temporal and permanent jobs and to solve food insecurity problems by offering a large range of agro food products. The revenue also contributes to train young entrepreneurs in the field of agroindustry. These entrepreneurs established in farms receive material, technical and financial aids. However, some difficulties such as organizational, environmental and sanitary problems persist. Thus it is urgent to improve the production system in order to boost the yield and promote a modern farming to enhance the positive impacts of such a regional vocational center.Keywords: Atagara (Songhaï center-Bénin), farming, modernization, social and economic effects

Prevalence and risk factors for trachoma and ocular Chlamydia trachomatis infection in Niger

AIMS: To determine the association of personal and household risk factors for trachoma and ocular Chlamydia trachomatis infection in Niger. METHODS: 12 villages were randomly selected. A census of all households was carried out, and 651 children aged 1–5 years were randomly selected and examined. Household and personal characteristics were determined, trachoma was clinically assessed and a swab for ocular C trachomatis infection was taken. RESULTS: The prevalence of trachoma was 43% (95% confidence interval (CI) 39% to 47%) and of infection was 21% (95% CI 18% to 24%). Children aged 3–5 years had a stronger association of clinical signs with infection, compared with those aged 1–2 years. Those with unclean faces were three times more likely to have clinical trachoma or ocular C trachomatis infection, compared with those with clean faces (OR 3.1 (95% CI 1.6 to 6.2) and 3.0 (95% CI 1.4 to 6.3), respectively). 75% of compounds were within 30 min of a water source. Flies on the face were a risk factor for trachoma but not for C trachomatis infection. CONCLUSIONS: The different association of clinical signs with infection in younger versus older children may be an age‐dependent difference in the duration of clinical disease. In Niger, unclean faces are a major risk factor for trachoma. The ready availability of water for washing suggests that further research on the effect of a strong health education campaign promoting clean children is warranted in this area