Traumatismes de L’abdomen en Milieu Africain : Aspects Épidémiologiques, Diagnostiques, et Thérapeutiques

Introduction : La prise en charge des plaies et contusions del’abdomen est bien codifiée avec l’existence d’algorithmes. Au Burkina Faso,les ressources humaines, les moyens diagnostiques et thérapeutiques sontlimités. A cet égard, l’objectif de cette étude était d’étudier les aspectsépidémiologiques, diagnostiques et thérapeutiques des traumatismes del’abdomen. Patients et méthodes : L’étude en question était descriptiverétrospective, durant deux ans allant de janvier 2017 à décembre 2018 au CHUSourô Sanou de Bobo-Dioulasso. Les patients inclus avaient un diagnostic deplaie ou de contusion de l’abdomen. Les patients ayant un dossier incompletont été exclus. Résultats : Durant l’étude l’information de 63 patients a étécolligée, 51 hommes et 12 femmes. L’âge moyen était de 22 ans. Les accidentsde la circulation routière étaient au nombre de 25. Parmi ces traumatismesfiguraient 39 contusions et 24 plaies de l’abdomen. Une instabilitéhémodynamique était présente chez 15 patients. Les présentations cliniquesétaient : 25 cas de douleurs abdominales, 14 cas d’hémopéritoine, 12 cas desyndrome péritonéal, 9 cas d’éviscération. Les lésions de la rate étaient présentes dans huit cas. Les polytraumatismes étaient au nombre de 16.L’échographie abdominale était réalisée dans 19 cas, l’ASP dans 22 cas. Letraitement chirurgical a été réalisé chez 26 patients. La laparotomie était nonthérapeutique (ne nécessitant pas de geste chirurgical spécifique) chez 15patients. Les complications postopératoires comportaient cinq cas desuppuration pariétale, un cas de péritonite postopératoire. Le décès étaitsurvenu chez huit (12,7%) patients et la durée d’hospitalisation moyenne étaitde 8,5 jours. Conclusion : Les traumatismes de l’abdomen concernent lesadultes jeunes de sexe masculin, et sont dus aux accidents de la circulationroutière. L’ASP et l’échographie au lit du patient ne sont pasréalisées. Le tauxde laparotomie non thérapeutique est élevé ainsi que la mortalité. Introduction: The management of wounds and contusions of theabdomen is well codified with the existence of algorithms. In Burkina Faso,human resources, diagnostic and therapeutic means are limited. This paperfocuses on studying the epidemiological, diagnostic, and therapeutic aspects of trauma in the abdomen. Patients and Methods: This study employs adescriptive retrospective for two years beginning from January 2017 toDecember 2018 in Sourô Sanou University Hospital of Bobo-Dioulasso. Thepatients included in the study were diagnosed with a wound or contusion ofthe abdomen. Patients with incomplete records were excluded. Results:During the study, the data of 63 patients were collected, 51 men and 12women. The mean age was 22 years old. There were 25 road traffic accidents.Among these injuries were 39 bruises and 24 abdominal wounds.Hemodynamic instability was present in 15 patients. The clinical presentationswere: 25 cases of abdominal pain, 14 cases of hemoperitoneum, 12 cases ofperitoneal syndrome, and 9 cases of evisceration. Lesions of the spleen werepresent in 8 cases and there were 16 polytrauma cases. Abdominal ultrasoundwas performed in 19 cases, abdominal X-rays in 22 cases. Surgical treatmentwas carried out in 26 patients. Laparotomy was non-therapeutic (not requiringa specific surgical procedure) in 15 patients. Postoperative complicationsincluded five cases of parietal suppuration, one case of postoperativeperitonitis. Death occurred in eight (12.7%) patients. The average length ofhospital stay was 8.5 days. Conclusion: Trauma to the abdomen is of interestto young adult males, and it occurs majorly due to traffic accidents. Abdominalx-rays and patient bedside ultrasound are not performed. The rate of nontherapeutic laparotomy is high as well as the mortality. &nbsp

The value and benefits of using seasonal climate forecasts in agriculture: evidence from cowpea and sesame sectors in climate-smart villages of Burkina Faso

This infonote summarizes initial findings of a project entitled “Impact of communicating seasonal climate forecasts to cowpea and sesame farmers in Yatenga region, North Burkina Faso’” undertaken during the 2014 main agricultural season by scientists from the CCAFS West Africa programme and the Institut de l’Environnement et de Recherches Agricoles (INERA), Burkina Faso. Sesame is a cash crop promoted in recent years to respond to a growing global demand. Quite versatile and produced across the country, yields remain low with an average of 300-350kg/ha. National production was estimated at around 60,000 tons in 2012, mostly for export. Cowpea is a key legume crop, mostly cultivated by smallholder farmers in intercropping with cereals (95%). Yields are low (around 300kg/ha) while it could reach 1,500kg/ha in monoculture. Just a minority (5%) of farmers use modern inputs (improved seeds, fertilizer) and market their grain for the regional market. This project aims at assessing: The effect of climate information services on farm productivity and incomes for cowpea and sesame farmers in the Yatenga region; Farmers’ willingness to pay for such climate information services Lessons learned for potential scaling up of communicating climate forecasts services in the cowpea and sesame sector as a way to improve farmer climate resilience and productivity. Such studies are also being carried out in climate-smart villages in Senegal (Kaffrine region)

Role of seasonal importation and genetic drift on selection for drug-resistant genotypes of Plasmodium falciparum in high-transmission settings

Historically Plasmodium falciparum has followed a pattern of drug resistance first appearing in low-transmission settings before spreading to high-transmission settings. Several features of low-transmission regions are hypothesized as explanations: higher chance of symptoms and treatment seeking, better treatment access, less within-host competition among clones and lower rates of recombination. Here, we test whether importation of drug-resistant parasites is more likely to lead to successful emergence and establishment in low-transmission or high-transmission periods of the same epidemiological setting, using a spatial, individual-based stochastic model of malaria and drug-resistance evolution calibrated for Burkina Faso. Upon controlling for the timing of importation of drug-resistant genotypes and examination of key model variables, we found that drug-resistant genotypes imported during the low-transmission season were (i) more susceptible to stochastic extinction due to the action of genetic drift, and (ii) more likely to lead to establishment of drug resistance when parasites are able to survive early stochastic loss due to drift. This implies that rare importation events are more likely to lead to establishment if they occur during a high-transmission season, but that constant importation (e.g. neighbouring countries with high levels of resistance) may produce a greater risk during low-transmission periods

An aggregation function to solve multicriteria ranking problem involving several decision makers

Multiple Criteria Decision Aiding (MCDA) has been studied in a single decision maker framework for a long time. Nowadays, the need to take into account several conflicting opinions handled by several decisions makers arises. So, researchers are interested with multicriteria problems involving several decision makers. In this context, to solve ranking problem, we develop an aggregation model of several additive value functions. Comparisons with a derivative ELECTRE I method is done on numerical data. Clearly, it appears that the proposed aggregation function is better according to calculation complexity and computation time. Way for further research in this field is proposed

Development of a health education intervention strategy using an implementation research method to control taeniasis and cysticercosis in Burkina Faso

Background: Taeniasis and cysticercosis are two diseases caused by Taenia solium, a parasite transmitted between humans and pigs, leading to considerable economic loss and disabilities. Transmission of the parasite is linked to environmental and behavioural factors such as inadequate sanitation and hygiene, poor pig management, and consumption of infected pork. This study used implementation research method to design a health education intervention strategy for reducing T. solium infections in Burkina Faso, a country endemic for the parasite. Methods: Eighteen group discussions were conducted with 8-18 participants each in three villages. In addition, structured interviews were conducted among 4 777 participants and 2 244 pig owners, who were selected through cluster random sampling in 60 villages of three provinces of Burkina Faso. Both approaches assessed knowledge and practices related to T. solium. The information obtained was used to develop a community-adapted health education intervention strategy to control taeniasis and cysticercosis in Burkina Faso. Results: The group discussions revealed that participants had a poor quality of life due to the diseases as well as inadequate access to latrines, safe water, and healthcare services. In addition, it was found that pig production was an important economic activity, especially for women. Furthermore, financial and knowledge constraints were important limitations to improved pig management and latrine construction. The survey data also showed that open defecation and drinking unboiled water were common behaviours, enhanced by a lack of knowledge regarding the transmission of the parasite, perceived financial barriers to the implementation of control measures, lack of public sensitization, as well as a lack of self-efficacy towards control of the parasite. Nevertheless, the perceived financial benefits of controlling porcine cysticercosis could be emphasized by an education program that discourages open defecation and encourages drinking safe water. The final intervention strategy included a Participatory Hygiene and Sanitation Transformation (PHAST) approach, as well as a 52-min film and an accompanying comic booklet. Conclusions: The main problem in the study communities regarding the transmission of T. solium cysticercosis is the random disposal of human faeces, which can be contaminated with parasite eggs. Prevention of open defecation requires the building of latrines, which can be quite problematic in economically challenged settings. Providing the community with the skills to construct durable latrines using low-cost locally available materials would likely help to resolve this problem. Further studies are required to implement and evaluate the T. solium control strategy developed in this study

An aggregation function to solve multicriteria ranking problem involving several decision makers

Multiple Criteria Decision Aiding (MCDA) has been studied in a single decision maker framework for a long time. Nowadays, the need to take into account several conflicting opinions handled by several decisions makers arises. So, researchers are interested with multicriteria problems involving several decision makers. In this context, to solve ranking problem, we develop an aggregation model of several additive value functions. Comparisons with a derivative ELECTRE I method is done on numerical data. Clearly, it appears that the proposed aggregation function is better according to calculation complexity and computation time. Way for further research in this field is proposed

Predictors and pathways of language and motor development in four prospective cohorts of young children in Ghana, Malawi, and Burkina Faso

BackgroundPrevious reviews have identified 44 risk factors for poor early child development (ECD) in low- and middle-income countries. Further understanding of their relative influence and pathways is needed to inform the design of interventions targeting ECD.MethodsWe conducted path analyses of factors associated with 18-month language and motor development in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements (iLiNS) Project in Ghana (n = 1,023), Malawi (n = 675 and 1,385), and Burkina Faso (n = 1,122). In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9 months. In multiple linear regression and structural equation models (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors expected to be associated with ECD.ResultsOut of 42 indicators of the 34 factors examined, 6 were associated with 18-month language and/or motor development in 3 or 4 cohorts: child linear and ponderal growth, variety of play materials, activities with caregivers, dietary diversity, and child hemoglobin/iron status. Factors that were not associated with child development were indicators of maternal Hb/iron status, maternal illness and inflammation during pregnancy, maternal perceived stress and depression, exclusive breastfeeding during 6 months postpartum, and child diarrhea, fever, malaria, and acute respiratory infections. Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child biomedical conditions, while this pattern for motor development was not consistent across cohorts.ConclusionsKey elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status

Polymorphisms in Plasmodium falciparum chloroquine resistance transporter and multidrug resistance 1 genes: parasite risk factors that affect treatment outcomes for P. falciparum malaria after artemether-lumefantrine and artesunate-amodiaquine.

Adequate clinical and parasitologic cure by artemisinin combination therapies relies on the artemisinin component and the partner drug. Polymorphisms in the Plasmodium falciparum chloroquine resistance transporter (pfcrt) and P. falciparum multidrug resistance 1 (pfmdr1) genes are associated with decreased sensitivity to amodiaquine and lumefantrine, but effects of these polymorphisms on therapeutic responses to artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) have not been clearly defined. Individual patient data from 31 clinical trials were harmonized and pooled by using standardized methods from the WorldWide Antimalarial Resistance Network. Data for more than 7,000 patients were analyzed to assess relationships between parasite polymorphisms in pfcrt and pfmdr1 and clinically relevant outcomes after treatment with AL or ASAQ. Presence of the pfmdr1 gene N86 (adjusted hazards ratio = 4.74, 95% confidence interval = 2.29 - 9.78, P < 0.001) and increased pfmdr1 copy number (adjusted hazards ratio = 6.52, 95% confidence interval = 2.36-17.97, P < 0.001 : were significant independent risk factors for recrudescence in patients treated with AL. AL and ASAQ exerted opposing selective effects on single-nucleotide polymorphisms in pfcrt and pfmdr1. Monitoring selection and responding to emerging signs of drug resistance are critical tools for preserving efficacy of artemisinin combination therapies; determination of the prevalence of at least pfcrt K76T and pfmdr1 N86Y should now be routine

Path Analyses of Risk Factors for Linear Growth Faltering in Four Prospective Cohorts of Young Children in Ghana, Malawi and Burkina Faso

Stunting prevalence is an indicator of a country’s progress towards United Nations’ Sustainable Development Goal 2, which is to end hunger and achieve improved nutrition. Accelerating progress towards reducing stunting requires a deeper understanding of the factors that contribute to linear growth faltering. We conducted path analyses of factors associated with 18-month length-for-age z-score (LAZ) in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements Project in Ghana (n=1039), Malawi (n=684 and 1504) and Burkina Faso (n=2619). In two cohorts, women were enrolled during pregnancy. In two other cohorts, infants were enrolled at 6 or 9 months. We examined the association of 42 indicators of environmental, maternal, caregiving and child factors with 18-month LAZ. Using structural equation modelling, we examined direct and indirect associations through hypothesised mediators in each cohort. Out of 42 indicators, 2 were associated with 18-month LAZ in three or four cohorts: maternal height and body mass index (BMI). Six factors were associated with 18-month LAZ in two cohorts: length for gestational age z-score (LGAZ) at birth, pregnancy duration, improved household water, child dietary diversity, diarrhoea incidence and 6-month or 9-month haemoglobin concentration. Direct associations were more prevalent than indirect associations, but 30%–62% of the associations of maternal height and BMI with 18-month LAZ were mediated by LGAZ at birth. Factors that were not associated with LAZ were maternal iron status, illness and inflammation during pregnancy, maternal stress and depression, exclusive breast feeding during 6 months post partum, feeding frequency and child fever, malaria and acute respiratory infections. These findings may help in identifying interventions to accelerate progress towards reducing stunting; however, much of the variance in linear growth status remained unaccounted for by these 42 individual-level factors, suggesting that community-level changes may be needed to achieve substantial progress

Markets and climate are driving rapid change in farming practices in Savannah West Africa

Agricultural practices have constantly changed in West Africa, and understanding the factors that have driven the changes may help guide strategies to promote sustainable agriculture in the region. To contribute to such efforts, this paper analyzes drivers of change in farming practices in the region using data obtained from surveys of 700 farming households in five countries (Burkina Faso, Ghana, Mali, Niger and Senegal). The results showed that farmers have adopted various practices in response to the challenges they have faced during the last decade. A series of logit models showed that most changes farmers made to their practices are undertaken for multiple reasons. Land use and management changes including expanding farmed areas and using mineral fertilization and manure are positively related to perceived changes in the climate, such as more erratic rainfall. Planting new varieties, introducing new crops, crop rotation, expanding farmed area and using pesticides are positively associated with new market opportunities. Farm practices that require relatively high financial investment such as use of pesticides, drought-tolerant varieties and improved seeds were positively associated with the provision of technical and financial support for farmers through development projects and policies. Changes in markets and climate are both helping to promote needed changes in farming practices in West Africa. Therefore, policies that foster the development of markets for agricultural products, and improved weather- and climate-related information linked to knowledge of appropriate agricultural innovations in different environments are needed