Influence des systemes agraires sur la dynamique de regeneration naturelle du karite: Vitellaria paradoxa CF gaernt (Sapotaceae) en C&#244te D'Ivoire

The shea tree (Vitellaria paradoxa) is one of the wild species of socioeconomic and environmental interest, valorised by the local populations of Sudanese and Guinean savannas of Africa. To contribute to the development of management strategies in favour of the resource, an ecological survey was carried out, in order to assess the influence of agrarian systems on the regeneration dynamics of this naturally-occurring species. The survey was undertaken in 40 sampling units, distributed in two savannah regions of Côte d'Ivoire. The results showed that shea natural regeneration dynamics varied from one area to the other. Under fallow systems, the number of young plantations was 960 in Tengrela, against 636 in Korhogo localities. similarly, in the fields, this number was 373 for young plantations in Tengrela, against 45 in Korhogo, using the same sample size. The number of young shea trees varied according to plant. Indeed, the number of young plantations inventoried in the two zones was 1596 in the fallows against 418 in the fields. Likewise, the number of adult trees was 2.5 times more important in the fallows than in the farmed fields. In the sampling unit, situated in the fields, Shea young plantations densities were 55 % in the manual system, 39 % in the harmessed system and 6 % in the towed system. For the same area sampled, the number of adult trees was 51, 20, and 13 in the manual, harnessed and towed systems, respectively. These differences show the influence of human activities on the natural regeneration of the shea tree. Le karité (Vitellaria paradoxa) est une espèce alimentaire sauvage d'intérêt socio-économique et environnemental suffisamment valorisée par les populations locales des savanes soudano-guinéennesd'Afrique. Pour contribuer au développement des stratégies de gestion et d'utilisation durable des ressources de cette plante, un inventaire écologique a été conduit dans la perspective de cerner l'influencedes systèmes agraires sur la dynamique de régénération naturelle de l'espèce. L'étude a été conduite dans 40 unités d'échantillonnage réparties dans deux départements de la région des savanes de Côte d'Ivoire.Les résultats montrent que la dynamique de régénération naturelle du karité a varié d'un département à l'autre. Dans les jachères, le nombre de jeunes plants de karité a été de 960 plants à Tengrela, contre 636à Korhogo. De même, dans les champs, ce nombre a été de 373 jeunes plants à Tengrela et de 45 à Korhogo, sur la même zone échantillonnée. Le nombre de jeunes karités a varié aussi, selon la formation végétale.En effet, sur l'ensemble des deux zones échantillonnées, le nombre de jeunes karités a été de 1596 plants dans les jachères, contre 418 dans les champs. De même, le nombre d'arbres adultes a été 2,5 fois plusimportant dans les jachères que dans les champs. Sur les unités d'échantillonnage situées dans les champs, le taux de jeunes plants de karité été de 55 % dans le système manuel, 39 % dans le système atteléet 6 % dans le système tracté. Pour la même surface échantillonnée, le nombre d'arbres adultes a été de 51 dans le système manuel, contre 20 dans le système attelé et 13 dans le système tracté. Ces différencesrévèlent une influence des activités anthropiques sur la régénération naturelle du karité

Gastro-entérites en milieux des réfugiés au Tchad

Les réfugiés et déplacés de guerre sont des personnes vulnérables. C’est pourquoi, nous avons entrepris une étude des gastro-entérites dans leurs milieux au Sud et à l’Est du Tchad. Cette étude a concerné 53 patients dans les camps du Sud dont 28,30% sont des enfants de 0 à 5 ans. Elle a été couplée d’une enquête sur l’état nutritionnel de 205 réfugiés dans les deux zones. L’isolement et l’identification des entéropathogènes dans les selles ont été réalisés au laboratoire de l’Hôpital Général de Référence Nationale (HGRN), en utilisant les milieux Hektoen, Mueller-Hinton, EMB, Saboraud Chloramphénicol et la galerie API® 20 E. La microscopie, les tests de filamentation et biochimiques ont permis de caractériser et de déterminer les taux des infestations parasitaires, fongiques et d’infections bactériennes qui sont respectivement de 18,86%, 11,32% et 24,52%. La caractérisation de la sensibilité des agents bactériens Salmonella, Shigella et Escherichia coli a montré une résistance de 85% aux bêta-lactamines. En revanche, 98% des germes sont sensibles aux fluoroquinolones. Cette étude nous a permis non seulement de connaître les caractéristiques des diarrhées liées à l’état nutritionnel des réfugiés, mais également, de mettre en évidence une antibiothérapie efficace permettant la mise en place d’un programme de prévention contre les maladies diarrhéiques et d’amélioration de leur état nutritionnel dans les milieux confinés. L’amélioration de l’état nutritionnel des enfants pourrait comporter : la distribution régulière et complète des aliments riches en vitamines ; l’extension des programmes d’alimentation d’appoint et le logement adéquat pour les réfugiés.Mots clés: Diarrhée, entéropathogènes, nutritionnel, antibiotique, HGRN

Profil de résistance des agents étiologiques des diarrhées isolés au Tchad

La résistance aux antibiotiques des entéropathogènes impliqués dans les maladies diarrhéiques est une préoccupation d’ampleur mondiale. C’est pourquoi la présente étude était entreprise en vue de tester la sensibilité de ces microorganismes aux antibiotiques couramment utilisés au Tchad. Les selles des patients ont été prélevées dans des flacons stériles et analysées selon les procédures standards de microbiologie dans le laboratoire de Bactériologie de l’Hôpital Général de Référence Nationale de N’Djamena (HGRN). L’isolement et l’identification des entéropathogènes dans les selles étaient réalisés, en utilisant les milieux Hektoen, EMB (éosine bleu de méthylène), TCBS (thiosulfate, citrate, bile, saccharose) (BioRad) et la galerie API® 20E et API® 20 NE (BioMérieux). L’antibiogramme a été effectué selon la méthode de Kirby Bauer en utilisant le milieu Mueller-Hinton. Le test antigénique était réalisé conformément aux instructions de Kaufmann-White. Au total, les selles de 1164 patients ont été analysées, desquelles 275 entéropathogènes étaient isolés, identifiés et testés aux antibiotiques. Parmi les souches d’entérobactéries étudiées, les Escherichia coli étaient résistants de 70% aux Bêta-lactamines. Les Vibrio cholerae O 1 en particulier ont exprimé un taux de résistance de 15,30% à l’ampicilline, 100% à l’amoxicilline + acide clavulanique et triméthoprime/cotrimoxazole, 98,90% à l’acide nalidixique et 12,56% à la ceftriaxone. Ces résultats attestent de la circulation des entéropathogènes résistants aux antibiotiques usuels au Tchad.Mots clés : Diarrhée, entéropathogène, antibiotique, résistance, HGRN, Tchad

A Cross-Sectional Study to Assess HPV Knowledge and HPV Vaccine Acceptability in Mali

Despite a high prevalence of oncogenic human papilloma virus (HPV) infection and cervical cancer mortality, HPV vaccination is not currently available in Mali. Knowledge of HPV and cervical cancer in Mali, and thereby vaccine readiness, may be limited. Research staff visited homes in a radial pattern from a central location to recruit adolescent females and males aged 12–17 years and men and women aged ≥18 years (N = 51) in a peri-urban village of Bamako, Mali. Participants took part in structured interviews assessing knowledge, attitudes, and practices related to HPV, cervical cancer, and HPV vaccination. We found low levels of HPV and cervical cancer knowledge. While only 2.0% of respondents knew that HPV is a sexually transmitted infection (STI), 100% said they would be willing to receive HPV vaccination and would like the HPV vaccine to be available in Mali. Moreover, 74.5% said they would vaccinate their child(ren) against HPV. Men were found to have significantly greater autonomy in the decision to vaccinate themselves than women and adolescents (p = 0.005), a potential barrier to be addressed by immunization campaigns. HPV vaccination would be highly acceptable if the vaccine became widely available in Bamako, Mali. This study demonstrates the need for a significant investment in health education if truly informed consent is to be obtained for HPV vaccination. Potential HPV vaccination campaigns should provide more information about HPV and the vaccine. Barriers to vaccination, including the significantly lower ability of the majority of the target population to autonomously decide to get vaccinated, must also be addressed in future HPV vaccine campaigns

Antimicrobial susceptibility of extended-spectrum beta-lactamase producing Enterobacteriaceae causing urinary tract infections in Ouagadougou, Burkina Faso

Objective: To determine the frequency of extended-spectrum beta lactamase producing Enterobacteriaceae (ESBL) and other antibioticsresistant bacteria in urinary tract isolates.Study Design: prospective and experimental study.Methodology: Place and duration of study :YalgadoOuedraogo University Hospital Center, Charles De Gaulle Pediatric Hospital Center, Saint Camille Hospital and National Public Health Laboratory, Ouagadougou, from November 2014 to October 2015.AllEnterobacteriaceaestrains isolated from urinary samples of patients were identifiedusing API 20E chemical gallery (BioMerieux, France). All strains were subjected to an array of 14 antibiotics to study their drug susceptibility by using Kirby- Baeurdisk diffusion method. Detection of ESBL was carried out by double disk diffusion technique. Statistical analysis was performed by Microsoft Excel and Anova one-way GrapPad Prism version 5.01. Chi-square (χ2) test was used to determine significance. A p˂ 0.05was considered to be statistically significant.Results: A total of 324 isolates of Enterobacteriaceae were identified during the study period, including211(65%) E. coli, 75 (23%)Klebsiella spp., 18 (6%) Enterobacter spp., 11 (3%)Proteus spp., 5 (2%) Citrobacter spp., Serratia spp. 3 (1%).All the clinical isolates were susceptible to imipenem. Resistance to amikacinwas 14% (45/324); gentamicin 54% (175/324); tobramycin 58% (187/324); nalidixic acid 72% (234/324),ciprofloxacin 63% (204/324) and to cotrimoxazole 83% (269/324).The overall rate of the EBSL producing strains was 35% (114/324). Their susceptibility to antibiotics was (imipenem,amikacin, cefoxitin and fosfomycin) 100% (114/114), 93% (106/114), 74% (84/114) and 84% (96/114) respectively. ESBL positivity within individual organism group was highest inEscherichia coli 64% (73/324) followed byKlebsiellaspp. 28% (32/324), Enterobacterspp. 3% (4/324), Proteus spp. and Citrobacterspp. 2% (2/324).Conclusion: The results showeda high frequency of ESBL producing Enterobacteriaceae, especially Escherichia coli and Klebsiellaspp. The data points to theneed of routine detection and surveillance of ESBL producing bacteria in Burkina Faso.Keywords: Antimicrobial susceptibility, Enterobacteriaceae, Urine, Burkina Fas

Key factors predicting suspected severe malaria case management and health outcomes: an operational study in the Democratic Republic of the Congo

BACKGROUND: Evidence suggests that pre-referral Rectal Artesunate (RAS) can be a life-saving intervention for severe malaria in remote settings in Africa. Recognition of danger signs indicative of severe malaria is critical for prompt and appropriate case management. METHODS: This was an observational study conducted in three Health Zones of the Democratic Republic of the Congo to determine the distribution of dangers signs for severe malaria and assess their impact on RAS use, referral completion, injectable treatment and ACT provision, and health outcomes including death. An individual-level analysis was carried out, using multilevel-mixed effects logistic regression models. Severely ill febrile children < 5 years seeking care from community-based healthcare providers were recruited into a patient surveillance system based on the presence of key danger signs. Clinical and case management data were collected comprehensively over a 28 days period. Treatment seeking was elicited and health outcomes assessed during 28 days home visits. RESULTS: Overall, 66.4% of patients had iCCM general danger signs. Age of 2-5 years and iCCM general danger signs predicted RAS use (aOR = 2.77, 95% CI 2.04-3.77). RAS administration positively affected referral completion (aOR = 0.63, 95% CI 0.44-0.92). After RAS rollout, 161 children died (case fatality ratio: 7.1%, 95% CI 6.1-8.2). RAS improved the health status of the children on Day 28 (aOR = 0.64, 95% CI 0.45-0.92) and there was a non-significant trend that mortality was higher in children not receiving RAS (aOR = 1.50, 95% CI 0.86-2.60). Full severe malaria treatment at the RHF including injectable anti-malarial and a course of ACT was highly protective against death (aOR = 0.26, 95% CI 0.09-0.79). CONCLUSIONS: The main findings point towards the fact that danger signs are reasonably well recognized by health provider at the primary care level, and that RAS could influence positively health outcomes of such severe disease episodes and death. Its effectiveness is hampered by the insufficient quality of care at RHF, especially the provision of a full course of ACT following parenteral treatment. These are simple but important findings that requires urgent action by the health system planners and implementers

Uptake of plasmodium falciparum gametocytes during mosquito bloodmeal by direct and membrane feeding

Plasmodium falciparum remains one of the leading causes of child mortality, and nearly half of the world’s population is at risk of contracting malaria. While pathogenesis results from replication of asexual forms in human red blood cells, it is the sexually differentiated forms, gametocytes, which are responsible for the spread of the disease. For transmission to succeed, both mature male and female gametocytes must be taken up by a female Anopheles mosquito during its blood meal for subsequent differentiation into gametes and mating inside the mosquito gut. Observed circulating numbers of gametocytes in the human host are often surprisingly low. A pre-fertilization behavior, such as skin sequestration, has been hypothesized to explain the efficiency of human-to-mosquito transmission but has not been sufficiently tested due to a lack of appropriate tools. In this study, we describe the optimization of a qPCR tool that enables the relative quantification of gametocytes within very small input samples. Such a tool allows for the quantification of gametocytes in different compartments of the host and the vector that could potentially unravel mechanisms that enable highly efficient malaria transmission. We demonstrate the use of our gametocyte quantification method in mosquito blood meals from both direct skin feeding on Plasmodium gametocyte carriers and standard membrane feeding assay. Relative gametocyte abundance was not different between mosquitoes fed through a membrane or directly on the skin suggesting that there is no systematic enrichment of gametocytes picked up in the skin

Health system readiness and the implementation of rectal artesunate for severe malaria in sub-Saharan Africa: an analysis of real-world costs and constraints

BACKGROUND: Rectal artesunate, an efficacious pre-referral treatment for severe malaria in children, was deployed at scale in Uganda, Nigeria, and DR Congo. In addition to distributing rectal artesunate, implementation required additional investments in crucial but neglected components in the care for severe malaria. We examined the real-world costs and constraints to rectal artesunate implementation. METHODS: We collected primary data on baseline health system constraints and subsequent rectal artesunate implementation expenditures. We calculated the equivalent annual cost of rectal artesunate implementation per child younger than 5 years at risk of severe malaria, from a health system perspective, separating neglected routine health system components from incremental costs of rectal artesunate introduction. FINDINGS: The largest baseline constraints were irregular health worker supervisions, inadequate referral facility worker training, and inadequate malaria commodity supplies. Health worker training and behaviour change campaigns were the largest startup costs, while supervision and supply chain management accounted for most annual routine costs. The equivalent annual costs of preparing the health system for managing severe malaria with rectal artesunate were US$2.63,$2.20, and $4.19 per child at risk and$322, $219, and$464 per child treated in Uganda, Nigeria, and DR Congo, respectively. Strengthening the neglected, routine health system components accounted for the majority of these costs at 71.5%, 65.4%, and 76.4% of per-child costs, respectively. Incremental rectal artesunate costs accounted for the minority remainder. INTERPRETATION: Although rectal artesunate has been touted as a cost-effective pre-referral treatment for severe malaria in children, its real-world potential is limited by weak and under-financed health system components. Scaling up rectal artesunate or other interventions relying on community health-care providers only makes sense alongside additional, essential health system investments sustained over the long term. FUNDING: Unitaid. TRANSLATION: For the French translation of the abstract see Supplementary Materials section

Field Evaluation of Calypte’s AWARE™ Blood Serum Plasma (BSP) and Oral Mucosal Transudate (OMT) Rapid Tests for Detecting Antibodies to HIV-1 and 2 in Plasma and Oral Fluid

As programs to prevent and care for HIV-infected persons are scaled-up in Africa, there is the need for continuous evaluation of the performance of test kits that could best support these programs. The present study evaluated the sensitivity, specificity, ease of use, and cost of AWARE ™ Blood Serum Plasma (BSP) and Oral Mucosal Transudate (OMT) Rapid HIV-1/2 test kits using real-time and archived samples of HIV-infected persons from Cameroon. Matched whole blood and OMT specimens were collected prospectively from HIV-positive and HIV-negative persons from different regions of Cameroon and tested using the AWARE ™ BSP and OMT test kits, respectively. These results were compared to the gold standard that included a combination of Determine HIV-1/2 and Enzygnost HIV-1/2. The BSP Rapid test kit was further evaluated using well characterized panels of HIV-2 and HIV-1 group O samples. Cost and end-user analysis of the OMT test kit was done by comparing its actual cost, consumables, safety, bench time and manipulation with other test kits. Of the 732 matched samples, 412 (56.3%) and 320 (43.7%) were from females and males, respectively. Of these samples, 23 (3.1%) gave discordant results between Determine HIV-1/2 and Enzygnost HIV1/2 and were excluded from the analysis. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the AWARE™ BSP were 100%. The AWARE™ OMT had 98.8% sensitivity, 98.9% specificity, 98.0% PPV and 99.4% NPV. The results of a well-characterized archived panel of HIV-2 (n=7) and HIV-1 group O (n=3) samples using the AWARE™ BSP Rapid test kit gave 100% concordance. Total per patient cost of the AWARE OMT rapid test kit was US$4.72 compared to a mean cost of US$7.33 ± 0.11 for the other test kits. Both the AWARE™ BSP and OMT Rapid test kits demonstrated high sensitivities and specificities on all samples tested and were well adapted for use in resource-constrained settings with high HIV heterogeneity such as Cameroon. The AWARE ™ HIV-1/2 OMT Rapid test kit appears to be the cheapest, safest and easiest to use compared with other available test kits

Psychosocial, Behavioural and Health System Barriers to Delivery and Uptake of Intermittent Preventive Treatment of Malaria in Pregnancy in Tanzania - Viewpoints of Service Providers in Mkuranga and Mufindi Districts.

Intermittent preventive treatment of malaria in pregnancy (IPTp) using sulphurdoxine-pyrimethamine (SP) is one of key malaria control strategies in Africa. Yet, IPTp coverage rates across Africa are still low due to several demand and supply constraints. Many countries implement the IPTp-SP strategy at antenatal care (ANC) clinics. This paper reports from a study on the knowledge and experience of health workers (HWs) at ANC clinics regarding psychosocial, behavioural and health system barriers to IPTp-SP delivery and uptake in Tanzania. Data were collected through questionnaire-based interviews with 78 HWs at 28 ANC clinics supplemented with informal discussions with current and recent ANC users in Mkuranga and Mufindi districts. Qualitative data were analysed using a qualitative content analysis approach. Quantitative data derived from interviews with HWs were analysed using non-parametric statistical analysis. The majority of interviewed HWs were aware of the IPTp-SP strategy's existence and of the recommended one month spacing of administration of SP doses. Some HWs were unsure of that it is not recommended to administer IPTp-SP and ferrous/folic acid concurrently. Others were administering three doses of SP per client following instruction from a non-governmental agency while believing that this was in conflict with national guidelines. About half of HWs did not find it appropriate for the government to recommend private ANC providers to provide IPTp-SP free of charge since doing so forces private providers to recover the costs elsewhere. HWs noted that pregnant women often register at clinics late and some do not comply with the regularity of appointments for revisits, hence miss IPTp and other ANC services. HWs also noted some amplified rumours among clients regarding health risks and treatment failures of SP used during pregnancy, and together with clients' disappointment with waiting times and the sharing of cups at ANC clinics for SP, limit the uptake of IPTp-doses. HWs still question SP's treatment advantages and are confused about policy ambiguity on the recommended number of IPTp-SP doses and other IPTp-SP related guidelines. IPTp-SP uptake is further constrained by pregnant women's perceived health risks of taking SP and of poor service quality