Hospitalizations in neonatal intensive care unit at Mahajanga: impacts on parents

Background: Experiencing a birth with a pathology imposes on parents a lot of frustration. Objectives of this study were to describe the general profiles of newborns and to describe the hospitalization’s psychosomatic impact on parents; in intensive care unit of the neonatalogy ward at the mother-child complex at the university Hospital Androva Mahajanga Madagascar.Methods: It was prospective descriptive study, by a survey of parents, among 3 months, from 01st May to 31th July.Results: Were included 102 newborns. Mains reasons of admission are low birth weigth (51.9%), prematurity (42.1%) and perinatal asphyxia (23.5%). One hundred mothers and 90 fathers had answered our survey. Sleep distturance (all parents), negative feelings (70% of fathers and 75% of mothers), depressed mood (52.2% of fathers and 78% of mothers) and guilt (25.5% of fathers and 58% of mothers) were the most prominent psycological manifestations among parents; then somatic manifestations as digestive, cardiovascular type; weight loss was objectified on 33% of fathers.Conclusions: Newborns’s hospitalization is a difficult situation for parents. Caregivers have an important role in enabling the family to build up

A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar

Background: Madagascar needs major efforts to achieve the UN Sustainable Development Goals, despite the considerable reduction of child mortality during past years. In this context, implementation of emergency triage assessment and treatment (ETAT) plays an important role. In recent years, ETAT training activities rarely took place in Madagascar. To strengthen ETAT in Madagascar, a pilot training course was conducted in December 2019 at the University Hospital Mahajanga. Objective: This study aims to evaluate if the ETAT+ pilot training content matches clinical needs in Madagascar and whether participants achieved their learning objectives. Methods: In this cross-sectional mixed-methods study, a 41-item questionnaire was used at the end of the ETAT+ training to evaluate their learning experience from the 12 participants (paediatricians, physicians, nurses and midwives). Six weeks after the training, guided interviews were conducted among five participants to describe how training content could be transferred into clinical practice in five health facilities. Results: Results suggest that this pilot project designed to contribute to the re-establishment of ETAT in Madagascar meets participants’ needs and is adapted to clinical realities in terms of transmitted knowledge, skills and competencies. However, results also show that considerable multidisciplinary efforts are needed to advance ETAT+ implementation in Madagascar. Conclusions: Implementation processes of ETAT training programmes need re-evaluation to assure their validity to contribute to quality of care improvements efficiently. Further operational research is required to evaluate sustainable, innovative implementation strategies adapted to contexts in Madagascar

Navigating spaces between conservation research and practice: are we making progress?

1. Despite aspirations for conservation impact, mismatches between research and implementation have limited progress towards this goal. There is, therefore, an urgent need to identify how we can more effectively navigate the spaces between research and practice. 2. In 2014, we ran a workshop with conservation researchers and practitioners to identify mismatches between research and implementation that needed to be overcome to deliver evidence‐informed conservation action. Five mismatches were highlighted: spatial, temporal, priority, communication, and institutional. 3. Since 2014, thinking around the ‘research–implementation gap’ has progressed. The term ‘gap’ has been replaced by language around the dynamic ‘spaces’ between research and action, representing a shift in thinking around what it takes to better align research and practice. 4. In 2019, we ran a follow‐up workshop reflecting on this shift, whether the five mismatches identified in the 2014 workshop were still present in conservation, and whether progress had been made to overcome these mismatches during the past 5 years. We found that while there has been progress, we still have some way to go across all dimensions. 5. Here, we report on the outcomes of the 2019 workshop, reflect on what has changed over the past 5 years, and offer 10 recommendations for strengthening the alignment of conservation research and practice

Patterns of Loss and Regeneration of Tropical Dry Forest in Madagascar: The Social Institutional Context

Loss of tropical forests and changes in land-use/land-cover are of growing concern worldwide. Although knowledge exists about the institutional context in which tropical forest loss is embedded, little is known about the role of social institutions in influencing regeneration of tropical forests. In the present study we used Landsat images from southern Madagascar from three different years (1984, 1993 and 2000) and covering 5500 km(2), and made a time-series analysis of three distinct large-scale patterns: 1) loss of forest cover, 2) increased forest cover, and 3) stable forest cover. Institutional characteristics underlying these three patterns were analyzed, testing the hypothesis that forest cover change is a function of strength and enforcement of local social institutions. The results showed a minor decrease of 7% total forest cover in the study area during the whole period 1984–2000, but an overall net increase of 4% during the period 1993–2000. The highest loss of forest cover occurred in a low human population density area with long distances to markets, while a stable forest cover occurred in the area with highest population density and good market access. Analyses of institutions revealed that loss of forest cover occurred mainly in areas characterized by insecure property rights, while areas with well-defined property rights showed either regenerating or stable forest cover. The results thus corroborate our hypothesis. The large-scale spontaneous regeneration dominated by native endemic species appears to be a result of a combination of changes in precipitation, migration and decreased human population and livestock grazing pressure, but under conditions of maintained and well-defined property rights. Our study emphasizes the large capacity of a semi-arid system to spontaneously regenerate, triggered by decreased pressures, but where existing social institutions mitigate other drivers of deforestation and alternative land-use

Latent HIV-1 is activated by exosomes from cells infected with either replication-competent or defective HIV-1

Background: Completion of HIV life cycle in CD4+ T lymphocytes needs cell activation. We recently reported that treatment of resting CD4+ T lymphocytes with exosomes produced by HIV-1 infected cells induces cell activation and susceptibility to HIV replication. Here, we present data regarding the effects of these exosomes on cells latently infected with HIV-1. Results: HIV-1 latently infecting U937-derived U1 cells was activated upon challenge with exosomes purified from the supernatant of U937 cells chronically infected with HIV-1. This effect was no more detectable when exosomes from cells infected with HIV-1 strains either nef-deleted or expressing a functionally defective Nef were used, indicating that Nef is the viral determinant of exosome-induced HIV-1 activation. Treatment with either TAPI-2, i.e., a specific inhibitor of the pro-TNFaα-processing ADAM17 enzyme, or anti-TNFaα Abs abolished HIV-1 activation. Hence, similar to what previously demonstrated for the exosome-mediated activation of uninfected CD4+ T lymphocytes, the Nef-ADAM17-TNFaα axis is part of the mechanism of latent HIV-1 activation. It is noteworthy that these observations have been reproduced using: (1) primary CD4+ T lymphocytes latently infected with HIV-1; (2) exosomes from both primary CD4+ T lymphocytes and macrophages acutely infected with HIV-1; (3) co-cultures of HIV-1 acutely infected CD4+ T lymphocytes and autologous lymphocytes latently infected with HIV-1, and (4) exosomes from cells expressing a defective HIV-1. Conclusions: Our results strongly suggest that latent HIV-1 can be activated by TNFaα released by cells upon ingestion of exosomes released by infected cells, and that this effect depends on the activity of exosome-associated ADAM17. These pieces of evidence shed new light on the mechanism of HIV reactivation in latent reservoirs, and might also be relevant to design new therapeutic interventions focused on HIV eradication