Implementing Preventive Chemotherapy through an Integrated National Neglected Tropical Disease Control Program in Mali

Neglected tropical diseases (NTDs) are a group of chronic infections that affect the poorest group of the populations in the world. There are currently five major NTDs targeted through mass drug treatment in the affected communities. The drug delivery can be integrated to deliver different drug packages as these NTDs often overlap in distribution. Mali is endemic with all five major NTDs. The integrated national NTD control program was implemented through the primary health care system using the community health center workers and the community drug distributors aiming at long-term sustainability. After a pilot start in three regions in 2007 without prior examples to follow on integrated mass drug administration, treatment for the five targeted NTDs was gradually scaled up and reached all endemic districts by 2009, and annual drug coverage in the targeted population has since been maintained at a high level for each of the five NTDs. Around 10 million people received one or more drug treatments each year since 2009. The country is on the way to meet the national objectives of elimination or control of these diseases. The successes and lessons learned in Mali are valuable assets to other countries looking to start similar programs

Cytotoxic CD4(+) T Cell Responses to EBV Contrast with CD8 Responses in Breadth of Lytic Cycle Antigen Choice and in Lytic Cycle Recognition

Epstein-Barr virus (EBV), a B-lymphotropic herpesvirus, encodes 2 immediate early (IE), >30 early (E) and >30 late (L) phase proteins during its replication (lytic) cycle. Despite this, lytic antigen-induced CD8 responses are strongly skewed towards IE and a few E proteins only, all expressed before HLA I presentation is blocked in lytically-infected cells. For comparison, here we (i) examined CD4(+) T cell responses to 8 IE, E or L proteins, screening 14 virus-immune donors to overlapping peptide pools in interferon-gamma Elispot assays, and (ii) established CD4(+) T cell clones against 12 defined epitopes for target recognition assays. We find that the lytic antigen-specific CD4(+) T cell response differs radically from its CD8 counterpart in that (i) it is widely distributed across IE, E and L antigen targets, often with multiple reactivities detectable per donor and with either IE, E or L epitope responses being numerically dominant, and (ii) all CD4(+) T cell clones, whether IE, E or L epitope-specific, show strong recognition of EBV-transformed B cell lines despite the lines containing only a small fraction of lytically-infected cells; efficient recognition occurs because lytic antigens are released into the culture, then acquired and processed by neighbouring latently-infected cells. These findings suggest that (i) lytic antigen-specific CD4 responses are driven by a different route of antigen display than drives CD8 responses, and (ii) such CD4 effectors could be therapeutically useful against EBV-driven lymphoproliferative disease lesions, which contain similarly small fractions of EBV-transformed cells entering lytic cycle

Decentralising Postabortion Care in Africa: A Call to Action

Unsafe abortion claims the lives of tens of thousands of women in the world each year, disproportionately affecting women in Africa. Postabortion care, including emergency treatment of incomplete abortion, is a strategy that can reduce the morbidity and mortality related to unsafe abortion, but only if services are readily accessible to women. To meet the needs of women, mid-level health professionals such as midwives should be authorised and trained to provide postabortion care. The multifaceted approach used to decentralise postabortion care services in Ghana can be used as model to improve access to postabortion care in countries throughout Africa. Countries should take immediate action to decentralise postabortion care, addressing issues of policy and standards, clinical protocols, advocacy, research, training, supervision, and community education. (Afr J Reprod Health 1999; 3 (1): 109 - 114) Key Words: Gonorrhiea, infertility, serology, Mozambiqu

ARthroscopy in Knee OsteoArthritis (ARK-OA): a multicentre study assessing compliance to national guidelines.

INTRODUCTION: The use of arthroscopy to alleviate the symptoms of osteoarthritis has been questioned by recent high quality evidence. This has led to the development of guidelines by specialist and national bodies advocating against its use. AIMS: To examine the trends of the rates of arthroscopy in patients with knee osteoarthritis over the past five years and determining compliance with guidelines. METHODS: Multi-centre, retrospective audit in five hospital trusts in the United Kingdom. The number of arthroscopies performed by month from 2013 to 2017 was identified through hospital coding. Fifty randomly selected records from the year 2017 were further analysed to assess compliance with NICE guidelines. RESULTS: Between 2013 and 2017, the number of arthroscopies performed annually in five trusts dropped from 2028 to 1099. In the year 2017, 17.7% of patients with no mechanical symptoms and moderate-to-severe arthritis pre-operatively had arthroscopy. CONCLUSION: Knee arthroscopy continues to be used as a treatment for osteoarthritis, against national guidelines. Whilst overall numbers are declining, further interventions, including implementation of high-quality conservative care is required to further eliminate unnecessary procedures

Performing dialogical truth and transitional justice : The role of art in the becoming post-apartheid of South Africa

In this article I elaborate on the potential role of the arts in the becoming post-apartheid of South Africa. As the close readings of discursive and visual artefacts such as Country of my Skull (Antjie Krog), The Man who Sang and the Woman who kept Silent (Judith Mason), and Indlovukati (Nandipha Mntambo) underline, articulating the memory of trauma in order to be able to create something new is not a linear and finite process but a cycle that has to be reiterated, time and again. Art’s dialogical character, materiality, and medium specificity allow it to perform contested truths and articulate complexities, in such a way as to help constitute new and multilayered communitie

Intraocular pressure and gonioscopic findings in rural communities mesoendemic and nonendemic for onchoceriasis, Kaduna State, Nigeria.

PURPOSE: To report on glaucoma-related ocular parameters, namely intraocular pressure and peripheral anterior synechiae, in the presence of onchocercal infection. METHODS: Two computer-generated random samples of individuals were drawn from communities mesoendemic and nonendemic for onchocerciasis respectively. Applanation tonometry and gonioscopy were carried out on these individuals. RESULTS: Four hundred and thirty-six and 319 individuals from the mesoendemic and nonendemic communities were examined respectively. The mean intraocular pressure was 1.58 mmHg lower in the individuals from the mesoendemic communities compared with those from the nonendemic communities (p < 0.001) despite the prevalence of peripheral anterior synechiae being higher in the mesoendemic communities. In these communities, there was strong evidence that the prevalence of peripheral anterior synechiae increased with increasing microfilarial load. CONCLUSIONS: Onchocercal infection produces a low-grade inflammatory process, which may result in a lowering of intraocular pressure despite the formation of peripheral anterior synechiae. Glaucomatous optic nerve damage may therefore not be the primary cause of visual loss in ocular onchocerciasis as this occurs late and is probably preceded by other blinding onchocercal pathology