Increasing access to integrated ESKD care as part of Universal Health Coverage

The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle–income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide

Fistule vésico-cutanée par plaie pénétrante de la region glutéale par arme blanche associée à une lésion du nerf sciatique. A propos d\'un cas

No Abstract. African Journal of Urology Vol. 11(3) 2005: 244-24

Particularities of COVID-19 infection in chronic hemodialysis patients in Sub-Saharan Africa: experience from Senegal (West Africa)

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in December 2019 in China and has rapidly become a major global health concern. Patients with end-stage renal disease receiving dialysis treatment are very exposed to the SARS-CoV-2 during their frequent visits to healthcare facilities and immune induced by uremia. The aim of our work was to describe the particularity of COVID-19 infection in hemodialysis patients in sub-Saharan Africa and in Ziguinchor, south of Senegal, particularly. To do this, we conducted a monocentric prospective study over a period of 16 months at the Ziguinchor hemodialysis center and compared our results to a study that focuses on the seroprevalence of SARS-CoV-2 in chronic hemodialysis patients. We found a low prevalence of COVID-19 infection while the majority of our patients were in contact with the virus

Efficacy of artesunate-amodiaquine for the treatment of acute uncomplicated falciparum malaria in southern Mauritania

Background: A regular evaluation of therapeutic efficacy in sentinel sites and a system of surveillance are required to establish treatment guidelines and adapt national anti-malarial drug policy to the rapidly changing epidemiology of drug-resistant malaria. The current anti-malarial treatment guideline in Mauritania, officially recommended since 2006, is based on artemisinin-based combination therapy. The aim of the present study was to evaluate clinical efficacy and tolerance of artesunate-amodiaquine, the first-line treatment for acute uncomplicated malaria, in Mauritanian paediatric and adult patients to validate its continued use in the country. Methods: Plasmodium falciparum-infected symptomatic patients aged > six months were enrolled in Kobeni and Timbedra in southern Mauritania in September to October 2013. Co-formulated artesunate-amodiaquine was administered at the recommended dose over three days. Patients were followed until day 28. Parasitological and clinical response was classified according to the standard 2009 World Health Organization protocol. Results: A total of 130 patients (65 in Kobeni and 65 in Timbedra) were enrolled in the study. Seventeen patients (13.1%) were either excluded (before PCR correction) or lost to follow-up. Based on the per protocol analysis, artesunate-amodiaquine efficacy (i.e., the proportion of adequate clinical and parasitological response) was 96.6% in Kobeni and 98.2% in Timbedra before PCR correction. Late clinical failure was observed in two patients in Kobeni and one patient in Timbedra. After PCR correction, the efficacy rate in the two study sites was 98.2%. On day 3, all patients were afebrile and had negative smears. Treatment was well tolerated. Conclusions: Artesunate-amodiaquine is well tolerated and highly efficacious for the treatment of uncomplicated P. falciparum malaria. In the majority of patients, fever and parasitaemia were rapidly cleared before day 3. The results support the national anti-malarial drug guideline for a continued use of artesunate-amodiaquine as a first-line drug for uncomplicated malaria in southern Mauritania

Efficacy of chloroquine for the treatment of Plasmodium vivax in the Saharan zone in Mauritania

Background: In 2006, the Mauritanian Ministry of Health adopted a new therapeutic strategy based on the systematic use of artemisinin-based combination therapy (ACT), artesunate-amodiaquine and artemether-lumefantrine, for the first-and second-line treatment of uncomplicated malaria, respectively, regardless of Plasmodium spp. In the Saharan zone of the country, recent studies have shown that Plasmodium vivax largely predominates over Plasmodium falciparum. Anti-malarial drug response of P. vivax has not been evaluated in Mauritania. The aim of the present study was to evaluate the clinical efficacy and tolerance of chloroquine to treat P. vivax malaria in Mauritanian patients. Methods: Plasmodium vivax-infected patients aged > 6 months old were enrolled in Nouakchott and Atar in September-October 2013. Chloroquine was administered at the standard dose of 25 mg base/kg body weight over three days. Patients were followed until day 28, according to the standard 2009 World Health Organization protocol. Results: A total of 128 patients (67 in Nouakchott and 61 in Atar) were enrolled in the study. Seven patients (5.5%) were either excluded or lost to follow-up. Based on the per protocol analysis, chloroquine efficacy (adequate clinical and parasitological response) was 100%. Treatment was well-tolerated. One patient was excluded on day 1 due to urticaria and treated with artesunate-amodiaquine. Conclusions: Although the current national treatment guideline recommends artesunate-amodiaquine for the first-line treatment of uncomplicated malaria, including P. vivax malaria, chloroquine may still have an important role to play in anti-malarial chemotherapy in Mauritania. Further epidemiological studies are required to map the distribution of P. vivax and P. falciparum in the country

Prolifération de rongeurs dans les milieux urbains et agricoles d’Afrique subsaharienne: Le côté obscur des rodenticides chimiques de synthèse

Nous tenons à remercier Valérie Golaz (INED-LPED), Marc Egrot (IRD-LPED) et les organisateurs de la conférence internationale « Mise en œuvre des politiques publiques et pesticides dans les Suds » qui s’est tenue en octobre 2021 à Bouaké, Côte d’Ivoire, projet PoPPesCI (Politiques publiques et pesticides en agriculture urbaine), pour avoir stimulé la rédaction de cet article.International audienceAround 400 million people in the world are affected by zoonoses associated with rodents. In addition, at least 280 million cases of undernourishment could be avoided in the world by the effective management of populations of rodents which destroy crops and stores of crops. Consequently, managing rodent populations which are reservoirs of pathogenic agents or which destroy crops and stores of crops is a challenge both in terms of food security as well as public health. In terms of public policy, many African countries have established farming intensification programmes aiming to improve their food self-sufficiency, with the direct risk of the prolifera-tion of rodents. In this article, which is the first in a two-part series, we present the background to controlling rodents in Africa in rural and urban areas, followed by an overview of the regu-lations and uses of rodenticides. We will go on to document the problematic situations which result from this, illustrating them with case studies. The use of synthetic chemical rodenticidesis the most widely used method to control rodents and is not only toxic for humans, other animals and the environment, but also ineffective against rodent populations (for example, it is costly, leads to a build-up of resistance, and the avoidance of bait). The circulation and uncontrolled use of these rodenticides in many African countries is associated with conside-rable risks to health and the environment, without leading to any significant improvements in terms of rodent control or reducing the damage they cause.Dans le monde, environ 400 millions de personnes sont touchées chaque année par des zoonoses associées aux rongeurs. En outre, au moins 280 millions de cas de sous-alimentation pourraient être évités grâce à une gestion efficace des populations de rongeurs ravageurs des cultures et des stocks. Par conséquent, la gestion des populations de rongeurs, qui sont des réservoirs d'agents pathogènes ou des ravageurs des stocks et des cultures, est un enjeu tant pour la sécurité alimentaire que pour la santé publique. En termes de politiques publiques, de nombreux pays africains ont mis en place des programmes d'intensification agricole visant à améliorer l'autosuffisance alimentaire, avec des risques directs de prolifération des rongeurs. Dans cet article, nous présentons le contexte du contrôle des rongeurs en Afrique dans les milieux ruraux et urbains, puis un aperçu de la réglementation et des utilisations des rodenticides, et nous documentons les situations problématiques qui en résultent à l'aide d'études de cas illustratifs. L'utilisation de rodenticides chimiques de synthèse est la méthode de gestion des rongeurs la plus couramment pratiquée, qui est non seulement toxique pour les humains, les autres animaux et l'environnement, mais aussi peu efficace contre les populations de rongeurs (par exemple, coûteuse en ressources, évolution de résistances, évitement des appâts). La circulation et l'utilisation incontrôlées de ces rodenticides dans de nombreux pays africains sont associées à des risques considérables pour la santé et l'environnement sans aucune amélioration significative en termes de contrôle des rongeurs ou d'atténuation de leurs nuisances