Isolation of Trypanosoma brucei gambiense from Cured and Relapsed Sleeping Sickness Patients and Adaptation to Laboratory Mice

Human African trypanosomiasis, or sleeping sickness, is still a major public health problem in central Africa. Melarsoprol is widely used for treatment of patients where the parasite has already reached the brain. In some regions in Angola, Sudan, Uganda and Democratic Republic of the Congo, up to half of the patients cannot be cured with melarsoprol. From previous investigations it is not yet clear what causes these high relapse rates. Therefore we aimed to establish a parasite collection isolated from cured as well as relapsed patients for downstream comparative drug sensitivity profiling. From 360 sleeping sickness patients, blood and cerebrospinal fluid (CSF) was collected before treatment and along the prescribed 24 months follow-up. Blood and CSF were inoculated in thicket rats (Grammomys surdaster), Natal multimammate mice (Mastomys natalensis) and immunodeficient laboratory mice (Mus musculus). Thus, we established a unique collection of Trypanosoma brucei gambiense type I parasites, isolated in the same disease focus and within a limited period, including 12 matched strains isolated from the same patient before treatment and after relapse. This collection is now available for genotypic and phenotypic characterisation to investigate the mechanism behind abnormally high treatment failure rates in Mbuji-Mayi, Democratic Republic of the Congo

Environmental impacts of tilapia fish cage aquaculture on water physico-chemical parameters of Lake Kivu, Democratic Republic of the Congo

In Africa, cage aquaculture has been growing due to its potential to address food insecurity concerns, provide livelihoods, and contribute to local economies. However, there is a need for continued research on the sustainability and potential ecological effects of cage aquaculture in African lakes and reservoirs. Even with an adequate amount of water, lakes and reservoirs cannot provide ecosystem services if their water quality is not properly managed. The current study on Lake Kivu, DRC focuses on understanding the effects of tilapia cage aquaculture on selected water quality physico-chemical parameters in the Bukavu sub-basin, DRC. The research was conducted in both caged and uncaged sampling stations, on the spatial and temporal scale from April to September 2023 at three bays serving as sampling stations: two caged (Ndendere, Honga) and one non-caged (Nyofu). Some physico-chemical parameters were measured in situ, whereas chlorophyll a and nutrients analysis were performed at the Institut Supérieur Pédagogique (I.S.P) laboratory in Bukavu. The parameters were used to calculate three indices water quality indices: the water quality index (WQI) to classify the water quality at the stations, the organic pollution index (OPI) to determine the level of organic pollution, the Carlson's Trophic Status Index (CTSI) to classify the trophic state of the stations. Chlorophyll a concentration was a measure of algal biomass. All physico-chemical parameters, apart from DO, ammonium and temperature showed no significant differences among stations and depths. Interaction between stations and between seasons was only observed on turbidity. The WQI for all the sampling stations ranged from medium to good quality (51–90). The OPI for all stations showed minimal level of pollution (4.6–5.0) hence lake's water still organically unpolluted. CTSI results indicated the sampling stations are in a eutrophic state (50 to 70). Fish cage aquaculture does not yet pose harm to the water quality of the two Lake Kivu stations under consideration, according to the study's findings. However with the anticipated growth of cage fish farming activities to meet the rising fish demand, continuous monitoring of water quality in the Lake should be done to inform management decisions and for sustainable aquaculture

Table_1_Environmental impacts of tilapia fish cage aquaculture on water physico-chemical parameters of Lake Kivu, Democratic Republic of the Congo.docx

In Africa, cage aquaculture has been growing due to its potential to address food insecurity concerns, provide livelihoods, and contribute to local economies. However, there is a need for continued research on the sustainability and potential ecological effects of cage aquaculture in African lakes and reservoirs. Even with an adequate amount of water, lakes and reservoirs cannot provide ecosystem services if their water quality is not properly managed. The current study on Lake Kivu, DRC focuses on understanding the effects of tilapia cage aquaculture on selected water quality physico-chemical parameters in the Bukavu sub-basin, DRC. The research was conducted in both caged and uncaged sampling stations, on the spatial and temporal scale from April to September 2023 at three bays serving as sampling stations: two caged (Ndendere, Honga) and one non-caged (Nyofu). Some physico-chemical parameters were measured in situ, whereas chlorophyll a and nutrients analysis were performed at the Institut Supérieur Pédagogique (I.S.P) laboratory in Bukavu. The parameters were used to calculate three indices water quality indices: the water quality index (WQI) to classify the water quality at the stations, the organic pollution index (OPI) to determine the level of organic pollution, the Carlson's Trophic Status Index (CTSI) to classify the trophic state of the stations. Chlorophyll a concentration was a measure of algal biomass. All physico-chemical parameters, apart from DO, ammonium and temperature showed no significant differences among stations and depths. Interaction between stations and between seasons was only observed on turbidity. The WQI for all the sampling stations ranged from medium to good quality (51–90). The OPI for all stations showed minimal level of pollution (4.6–5.0) hence lake's water still organically unpolluted. CTSI results indicated the sampling stations are in a eutrophic state (50 to 70). Fish cage aquaculture does not yet pose harm to the water quality of the two Lake Kivu stations under consideration, according to the study's findings. However with the anticipated growth of cage fish farming activities to meet the rising fish demand, continuous monitoring of water quality in the Lake should be done to inform management decisions and for sustainable aquaculture.</p

Analysis of tourism policy in a developing country: the case of Morocco

The strong growth of mass tourism since 1950 has made this industry one of the most important in the world. Many national governments have thus implemented policies aimed at generating income from tourism. This research analyses the evolution of the Moroccan tourism policy and various development strategies carried out by the government over the last 60 years. Moroccan policy managed to position the country as the top tourist destination in Africa in 2014. This study assesses public policies to demonstrate the important role played by the state in this growth process. It analyses the main tourism plans implemented by the Moroccan government, and proposes a discussion around the current tourism development model linked to international investment.‘National Plan of Scientific Research (R+D+i, 2015-2018), Ministry of Science and Innovation, Spain’, grant number (CSO2015-64468-P) ‘Crisis and restructuring of tourist areas of the Spanish coast’

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa