The epidemiology of gonorrhoea, chlamydial infection and syphilis in four African cities.

OBJECTIVES: To compare the epidemiology of gonorrhoea, chlamydial infection and syphilis in four cities in sub-Saharan Africa; two with a high prevalence of HIV infection (Kisumu, Kenya and Ndola, Zambia), and two with a relatively low HIV prevalence (Cotonou, Benin and Yaoundé, Cameroon). DESIGN: Cross-sectional study, using standardized methods, including a standardized questionnaire and standardized laboratory tests, in four cities in sub-Saharan Africa. METHODS: In each city, a random sample of about 2000 adults aged 15-49 years was taken. Consenting men and women were interviewed about their socio-demographic characteristics and their sexual behaviour, and were tested for HIV, syphilis, herpes simplex virus type 2 (HSV-2), gonorrhoea, chlamydial infection, and (women only) Trichomonas vaginalis infection. Risk factor analyses were carried out for chlamydial infection and syphilis seroreactivity. RESULTS: The prevalence of gonorrhoea ranged between 0% in men in Kisumu and 2.7% in women in Yaoundé. Men and women in Yaoundé had the highest prevalence of chlamydial infection (5.9 and 9.4%, respectively). In the other cities, the prevalence of chlamydial infection ranged between 1.3% in women in Cotonou and 4.5% in women in Kisumu. In Ndola, the prevalence of syphilis seroreactivity was over 10% in both men and women; it was around 6% in Yaoundé, 3-4% in Kisumu, and 1-2% in Cotonou. Chlamydial infection was associated with rate of partner change for both men and women, and with young age for women. At the population level, the prevalence of chlamydial infection correlated well with reported rates of partner change. Positive syphilis serology was associated with rate of partner change and with HSV-2 infection. The latter association could be due to biological interaction between syphilis and HSV-2 or to residual confounding by sexual behaviour. At the population level, there was no correlation between prevalence of syphilis seroreactivity and reported rates of partner change. CONCLUSION: Differences in prevalence of chlamydial infection could be explained by differences in reported sexual behaviour, but the variations in prevalence of syphilis seroreactivity remained unexplained. More research is needed to better understand the epidemiology of sexually transmitted infections in Africa

Ingestions Alimentaires Et Performances De Production Et De Reproduction Des Lapines (Oryctolagus Cuniculus) Gestantes Nourries Avec Des Aliments Contenant Des Feuilles De Neem (Azadirachta Indica)

This study was conducted as part of a series of experiments on the use of dried leaves for the production of complete rabbit feed. For this purpose, 120 female rabbits, distributed in 4 batches (N0, N5, N10 and N15) with the same number (30) and homogeneous average weights (2595 g to 2708.7 g) were followed before and during pregnancy. Each of the 4 lot were composed, in the same proportion, of nulliparous and multiparous females. Those animals were subjected to four Azadirachta indica leaves based foods in different proportions: N0: 0%; N5: 5%; N10: 10% and N15: 15%. Our data shows that the gestation rates were as follows for the four lots: N0 (90%), N5 (80%) and N10 (90%) and N15 (76.67%). Except a single female from lot N10, all females were pregnant and gave birth. No significant difference (P> 0.05) was found between the mean of total daily consumptions among the pregnant rabbits of the four batches that ranged from 169.40 to 198.31 g / d. The average litters of the batches N0 (5.33 rabbits / mother), N5 (6.5 rabbits / mother) and N10 (5.61 rabbits / mother) were similar (P> 0.05) but higher (P 0.05). On the other hand, no difference (P> 0.05) was observed between the average weights of the rabbits of the control batch N0 (59.06 g) and those of N5 and N15

Toxins and adhesion factors associated with Staphylococcus aureus strains isolated from diarrhoeal patients in Benin

Staphylococcus aureus is a causative agent of acute and infectious diarrhoea. In Africa, there is no sufficient information on the virulence and the degree of factors produced by its diarrhoea-isolated strains. Clinical features and virulence factors produced by S. aureus isolated from diarrhoeal-patients admitted at the Hospital Hubert Koutoukou Maga (HKM) in Cotonou was investigated. The virulence factors were screened by radial immunoprecipitation and multiplex polymerase chain reaction (PCR).Fifteen antibiotics were tested. Among independent 115 patients examined for diarrhoea, 32 had faeces positive for S. aureus isolated as pure culture. Most of these patients were hospitalized (21/32) and developed aqueous, bloody and painful diarrhoea, after antimicrobial therapy. About 62% were resistant to oxacillin. Genes encoding for clumping factor B and for laminin binding protein were detected in 62% of S. aureus isolates. About 94% of LukE-LukD producing strains have been isolated from patientsdeveloping post-antibiotic associated diarrhoea (PAAD). The Panton-Valentine Leucocidin (PVL) was produced by 19% of isolates, all from PAAD. This study points out new data concerning virulencefactors and adhesion factor produced by S. aureus strains isolated from diarrhoea in Benin. The culture of the faeces will not always allow the diagnosis. It is important to update a technique, which enablesresearchers to carry out the virulence factors produced by these bacteria

Positive Impact of Increases in Condom Use among Female Sex Workers and Clients in a Medium HIV Prevalence Epidemic: Modelling Results from Project SIDA1/2/3 in Cotonou, Benin

Background A comprehensive, HIV prevention programme (Projet Sida1/2/3) was implemented among female sex workers (FSWs) in Cotonou, Benin, in 1993 following which condom use among FSWs increased threefold between 1993 and 2008 while FSW HIV prevalence declined from 53.3% to 30.4%. Objective Estimate the potential impact of the intervention on HIV prevalence/incidence in FSWs, clients and the general population in Cotonou, Benin. Methods and Findings A transmission dynamics model parameterised with setting-specific bio-behavioural data was used within a Bayesian framework to fit the model and simulate HIV transmission in the high and low-risk population of Cotonou and to estimate HIV incidence and infections averted by SIDA1/2/3. Our model results suggest that prior to SIDA1/2/3 commercial sex had contributed directly or indirectly to 93% (84–98%) of all cumulative infections and that the observed decline in FSWs HIV prevalence was more consistent with the self-reported post-intervention increase in condom use by FSWs than a counterfactual assuming no change in condom use after 1993 (CF-1). Compared to the counterfactual (CF-1), the increase in condom use may have prevented 62% (52–71%) of new HIV infections among FSWs between 1993 and 2008 and 33% (20–46%) in the overall population. Conclusions Our analysis provides plausible evidence that the post-intervention increase in condom use during commercial sex significantly reduced HIV prevalence and incidence among FSWs and general population. Sex worker interventions can be effective even in medium HIV prevalence epidemics and need to be sustained over the long-term

Comparison of 8 weeks standard treatment (rifampicin plus clarithromycin) vs. 4 weeks standard plus amoxicillin/clavulanate treatment [RC8 vs. RCA4] to shorten Buruli ulcer disease therapy (the BLMs4BU trial): study protocol for a randomized controlled multi-centre trial in Benin

Background Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans that affects skin, soft tissues, and bones, causing long-term morbidity, stigma, and disability. The recommended treatment for BU requires 8 weeks of daily rifampicin and clarithromycin together with wound care, physiotherapy, and sometimes tissue grafting and surgery. Recovery can take up to 1 year, and it may pose an unbearable financial burden to the household. Recent in vitro studies demonstrated that beta-lactams combined with rifampicin and clarithromycin are synergistic against M. ulcerans. Consequently, inclusion of amoxicillin/clavulanate in a triple oral therapy may potentially improve and shorten the healing process. The BLMs4BU trial aims to assess whether co-administration of amoxicillin/clavulanate with rifampicin and clarithromycin could reduce BU treatment from 8 to 4 weeks. Methods We propose a randomized, controlled, open-label, parallel-group, non-inferiority phase II, multi-centre trial in Benin with participants stratified according to BU category lesions and randomized to two oral regimens: (i) Standard: rifampicin plus clarithromycin therapy for 8 weeks; and (ii) Investigational: standard plus amoxicillin/clavulanate for 4 weeks. The primary efficacy outcome will be lesion healing without recurrence and without excision surgery 12 months after start of treatment (i.e. cure rate). Seventy clinically diagnosed BU patients will be recruited per arm. Patients will be followed up over 12 months and managed according to standard clinical care procedures. Decision for excision surgery will be delayed to 14 weeks after start of treatment. Two sub-studies will also be performed: a pharmacokinetic and a microbiology study. Discussion If successful, this study will create a new paradigm for BU treatment, which could inform World Health Organization policy and practice. A shortened, highly effective, all-oral regimen will improve care of BU patients and will lead to a decrease in hospitalization-related expenses and indirect and social costs and improve treatment adherence. This trial may also provide information on treatment shortening strategies for other mycobacterial infections (tuberculosis, leprosy, or non-tuberculous mycobacteria infections). Trial registration ClinicalTrials.gov NCT05169554. Registered on 27 December 2021

Resistance status of Anopheles gambiae s.l. to insecticides following the 2011 mass distribution campaign of long-lasting insecticidal nets (LLINs) in the Plateau Department, south-eastern Benin

Abstract Background In 2011, Benin’s National Malaria Control Programme (NMCP) organized a nationwide mass distribution campaign of LLINs throughout the country. Following this intervention, it was important to assess whether the level of susceptibility of malaria vectors to insecticides had remained the same as compared to the pre-intervention period. The current study investigated this. Methods Larval collections were conducted in Ifangni, Sakété, Pobè and Kétou districts located in Plateau department, Southeastern Benin before (2009) and after (2012–2013) LLIN distribution. Anopheles gambiae sensu lato (s.l.) larvae from the 4 study districts were reared to adulthood and WHO susceptibility tests were conducted. The insecticides tested were deltamethrin (0.05%), permethrin (0.75%), bendiocarb (0.1%) and DDT (4%). Molecular species identification as well as, the characterization of the kdr L1014F mutation were also performed in the An. gambiae s.l. complex using PCR method. Results Overall, a significant decrease in mortality rates of An. gambiae s.l. to deltamethrin (0.05%), permethrin (0.75%) and DDT (4%) was observed post-LLIN distribution, respectively: (100% vs 80.9%, p &lt; 0.0001), (77.5% vs 70%, p = 0.01) and, (47.8% vs 4.4%, p &lt; 0.0001). By contrast, susceptibility of vectors to bendiocarb (0.1%) remained the same (100% mortality in the WHO susceptibility tube tests) pre- and post-intervention. An increase in the kdr L1014F frequency was observed post-LLIN distribution [F(kdr) = 0.91)] compared to the pre-intervention period [F(kdr) = 0.56], p &lt; 0.0001. Anopheles coluzzii and An. gambiae were the two molecular species identified in the study area. Conclusion The decrease susceptibility to pyrethroids and DDT as well as, the increase in the frequency of the kdr L1014F mutation after the intervention stressed at the time, the need for the development and implementation of effective insecticide resistance management strategies. At present, an update of the vectors resistance status in the area is also necessary for decision-making. </jats:sec

Resting and feeding preferences of Anopheles stephensi in an urban setting, perennial for malaria

Background: The Indian city of Chennai is endemic for malaria and the known local malaria vector is Anopheles stephensi. Plasmodium vivax is the predominant malaria parasite species, though Plasmodium falciparum is present at low levels. The urban ecotype of malaria prevails in Chennai with perennial transmission despite vector surveillance by the Urban Malaria Scheme (UMS) of the National Vector Borne Disease Control Programme (NVBDCP). Understanding the feeding and resting preferences, together with the transmission potential of adult vectors in the area is essential in effective planning and execution of improved vector control measures. Methods: A yearlong survey was carried out in cattle sheds and human dwellings to check the resting, feeding preferences and transmission potential of An. stephensi. The gonotrophic status, age structure, resting and host seeking preferences were studied. The infection rate in An. stephensi and Anopheles subpictus were analysed by circumsporozoite ELISA (CS-ELISA). Results: Adult vectors were found more frequently and at higher densities in cattle sheds than human dwellings. The overall Human Blood Index (HBI) was 0.009 indicating the vectors to be strongly zoophilic. Among the vectors collected from human dwellings, 94.2% were from thatched structures and the remaining 5.8% from tiled and asbestos structures. 57.75% of the dissected vectors were nulliparous whereas, 35.83% were monoparous and the rest 6.42% biparous. Sporozoite positivity rate was 0.55% (4/720) and 1.92% (1/52) for An. stephensi collected from cattle sheds and human dwellings, respectively. One adult An. subpictus (1/155) was also found to be infected with P. falciparum. Conclusions: Control of the adult vector populations can be successful only by understanding the resting and feeding preferences. The present study indicates that adult vectors predominantly feed on cattle and cattle sheds are the preferred resting place, possibly due to easy availability of blood meal source and lack of any insecticide or repellent pressure. Hence targeting these resting sites with cost effective, socially acceptable intervention tools, together with effective larval source management to reduce vector breeding, could provide an improved integrated vector management strategy to help drive down malaria transmission and assist in India's plan to eliminate malaria by 2030

Evaluation of direct detection of Mycobacterium tuberculosis rifampin resistance by a nitrate reductase assay applied to sputum samples in Cotonou, Benin

The aim of this study was to evaluate a nitrate reductase assay (NRA) performed on smear-positive sputa for the direct detection of rifampin resistance in Mycobacterium tuberculosis. A total of 213 smear-positive sputa with a positivity score of 1+ or more (>1 acid-fast bacillus per field by fluorescence microscopy) were used in the study. The samples were decontaminated using the modified Petroff method, and portions of the resulting suspension were used to perform the NRA. The NRA results were compared with the reference indirect proportion method for 177 specimens for which comparable results were available. NRA results were obtained at day 10 for 15 specimens (9%), results for 88 specimens (50%) were obtained at day 14, results for 66 specimens (37%) were obtained at day 18, and results for the remaining 8 specimens (4%) were obtained at day 28. Thus, 96% of NRA results were obtained in 18 days. Of the 177 specimens, there was only one discrepancy (susceptible according to the NRA and resistant according to the indirect proportion method). NRA is simple to perform and provides a rapid, accurate, and cost-effective means for the detection of rifampin resistance in M. tuberculosis isolates

Antimicrobial susceptibilities and plasmid patterns of Neisseria gonorrhoeae

This study describes antimicrobial susceptibility patterns of Neisseria gonorrhoeae isolates obtained from female sex workers in Cotonou, Bénin. All isolates were susceptible to spectinomycin, ceftriaxone and ciprofloxacin, and susceptible to moderately susceptible to kanamycin; 9.8% of isolates were resistant to thiamphenicol; 9%, 87.5% and 3.5% were susceptible, moderately susceptible, resistant to trimethoprim-sulfamethoxazole, respectively; 94.4% and 99.3% were resistant to penicillin and tetracycline, respectively. All isolates with a minimal inhibitory concentration of tetracycline of >8 mg/l carried the 'American type' tetM plasmid; 94% and 6% of penicillinase-producing isolates possessed a 3.2 MDa and a 4.4MDa beta-lactamase plasmid, respectively. Surveillance of antimicrobial susceptibility of N. gonorrhoeae isolates to currently used drugs in Africa should become part of sexually transmitted diseases (STDs) control programmes

Maintien de l’abstinence chez les patients alcoolo-dependants: étude comparee de la disponibilite et du cout du traitement par le baclofene, l’acamprosate, et la naltrexone a Cotonou (Benin) et a Lome (Togo)

Contexte et but de l’étude: L’alcoolisme chronique est devenu un problème de santé publique en Afrique subsaharienne. En plus des moyens psychothérapeutiques, sa prise en charge passe par la chimiothérapie. Dans notre contexte, très peu de moyens chimiothérapeutiques existent. Le but de cette étude est de comparer le Baclofène, l’Acamprosate et la Naltrexone sur le plan disponibilité et coût du traitement mensuel de l’alcoolisme chronique au Togo et au Bénin.Méthode d’étude: Il s’est agi d’une étude transversale et analytique portant sur la disponibilité et le coût du traitement mensuel de l’alcoolisme chronique par le Baclofène, l’Acamprosate et la Naltrexone à Lomé et à Cotonou du 17 février 2014 au 14 avril 2014.Résultats: Le Baclofène est disponible dans 42,1% des pharmacies à Cotonou et dans 27,3% des pharmacies à Lomé. Aucune pharmacie ne dispose ni de l’Acamprosate, ni  de la Naltrexone. En spécialité, le traitement mensuel à base du Baclofène varie entre 106512 et 117600 CFA à Cotonou et entre 99960 et 118608 CFA à Lomé. En générique, le traitement mensuel à base du Baclofène varie entre 40824 et 50400 CFA à Cotonou et entre 36624 et 61488 CFA à Lomé. La non prescription a été la première raison de l’indisponibilité des autres médicaments à Cotonou comme à Lomé.Conclusion: Dans nos milieux, du fait que le Baclofène est le seul disponible, il peut être considéré comme une solution alternative dans le maintien de l’abstinence chez l’alcoolo-dépendant.Mots clés: Alcoolisme, Baclofène, Acamprosate, Naltrexone, AfriqueEnglish Title: Maintaining in alcohol-dependent patients:comparative study on the availability and cost of treatment with baclofen, acamprosate and naltrexone in Cotonou (Benin) and Lomé (Togo)English AbstractContext and purpose of the study: Chronic alcoholism became a public health problem in sub-Saharan Africa. Besides the psychotherapeutic means, its support passes by medicines. In our context, very few medicines exist. The goal of this study is to compare the Baclofen, Acamprosate and Naltrexone on the availability plan and cost of the monthly treatment of chronic alcoholism in Togo and Benin.Method of study: It was about a cross-sectional study and analytical bearing on the availability and the cost of the monthly treatment of chronic alcoholism by the Baclofen, Acamprosate and Naltrexone in Lome and Cotonou from February 17th, 2014 to April 14th, 2014.Results: Baclofen is available in 42.1% of pharmacies in Cotonou and 27.3% of pharmacies in Lomé. No pharmacy has neither Acamprosate, nor Naltrexone. In speciality, the monthly treatment with baclofen varies between 106,512 and 117,600 CFA in Cotonou and between 99,960 and 118,608 CFA in Lomé. In generic, the monthly treatment with the baclofen varies between 40,824 and 50,400 CFA in Cotonou and between 36624 and 61488 CFA in Lomé. No prescription was the first reason of the unavailability of the other drugs in Cotonou as in Lome.Conclusion: In our circles, owing to the fact that the Baclofen is the only available one, it can be considered as an alternative in maintaining abstinence in the alcoholic-dependent.Keywords: Alcoholism, Baclofen, Acamprosate, Naltrexone, Afric