Appropriate training and retention of community doctors in rural areas: a case study from Mali

Background While attraction of doctors to rural settings is increasing in Mali, there is concern for their retention. An orientation course for young practicing rural doctors was set up in 2003 by a professional association and a NGO. The underlying assumption was that rurally relevant training would strengthen doctors' competences and self-confidence, improve job satisfaction, and consequently contribute to retention. Methods Programme evaluation distinguished trainees' opinions, competences and behaviour. Data were collected through participant observation, group discussions, satisfaction questionnaires, a monitoring tool of learning progress, and follow up visits. Retention was assessed for all 65 trainees between 2003 and 2007. Results and discussion The programme consisted of four classroom modules – clinical skills, community health, practice management and communication skills – and a practicum supervised by an experienced rural doctor. Out of the 65 trained doctors between 2003 and 2007, 55 were still engaged in rural practice end of 2007, suggesting high retention for the Malian context. Participants viewed the training as crucial to face technical and social problems related to rural practice. Discussing professional experience with senior rural doctors contributed to socialisation to novel professional roles. Mechanisms underlying training effects on retention include increased self confidence, self esteem as rural doctor, and sense of belonging to a professional group sharing a common professional identity. Retention can however not be attributed solely to the training intervention, as rural doctors benefit from other incentives and support mechanisms (follow up visits, continuing training, mentoring...) affecting job satisfaction. Conclusion Training increasing self confidence and self esteem of rural practitioners may contribute to retention of skilled professionals in rural areas. While reorientations of curricula in training institutions are necessary, other types of professional support are needed. This experience suggests that professional associations dedicated to strengthening quality of care can contribute significantly to rural practitioners' morale

A framework for healthcare interventions to address maternal morbidity

© 2018 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics. The maternal health agenda is undergoing a paradigm shift from preventing maternal deaths to promoting women's health and wellness. A critical focus of this trajectory includes addressing maternal morbidity and the increasing burden of chronic and noncommunicable diseases (NCD) among pregnant women. The WHO convened the Maternal Morbidity Working Group (MMWG) to improve the scientific basis for defining, measuring, and monitoring maternal morbidity. Based on the MMWG's work, we propose paradigms for conceptualizing maternal health and related interventions, and call for greater integration between maternal health and NCD programs. This integration can be synergistic, given the links between chronic conditions, morbidity in pregnancy, and long-term health. Pregnancy should be viewed as a window of opportunity into the current and future health of women, and offers critical entry points for women who may otherwise not seek or have access to care for chronic conditions. Maternal health services should move beyond the focus on emergency obstetric care, to a broader approach that encompasses preventive and early interventions, and integration with existing services. Health systems need to respond by prioritizing funding for developing integrated health programs, and workforce strengthening. The MMWG's efforts have highlighted the changing landscape of maternal health, and the need to expand the narrow focus of maternal health, moving beyond surviving to thriving

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Perception du ‘The other’ dans la littérature du commonwealth : une analyse de Heart of darkness et A good man in Africa

Résumé : Le concept de l’Altérité constitue un mécanisme mis en adoption par un groupe de personnes majoritaire ou dominant au sein d’une communauté ou d’une société. Compte tenu de leur masse considérable s’arrogent une certaine importance, ce qui les excite à stigmatiser les autres. Et c’est de ce constat que naissent le (Soi, Nous) et le (L’Autre, Eux). En fait, les Occidentaux, en l’occurrence, les Britanniques s’attribuent le (Soi, Nous) et désignent les Africains comme (L’Autre, Eux). En effet, ils se disent plus civiliser et éduquer que les Africains. De ce fait, notre étude vise à représenter la perception de L’Autre dans la littérature du Commonwealth, c’est-à-dire dans les deux œuvres à savoirHeart of Darkness et A Good Man in Africa. Dans l’œuvre romanesque Heart of Darkness, les Britanniques conçoivent que les Africains ont des attitudes stupides, barbares et cannibales. Dans A Good Man in Africa, ils soutiennent que les traditions Africaines, c’est-à-dire la tenue des rituels funèbres sur une dépouille mérite une condamnation. Mots-clés : Altérité, Soi, Nous, L'Autre, Eu

Caractérisation des boues de vidange dépotées sur les lits de séchage de zagtouli (Ouagadougou)

International audienceA Ouagadougou comme dans la plupart des grandes villes africaines, il y a très peu de réseau d’égout. Les ouvrages d’assainissement autonome sont les plus couramment utilisés. Ces ouvrages produisent des boues qu’il faut vidanger et traiter adéquatement afin de préserver la santé des populations et protéger l’environnement. En effet, les risques sont réels, eu égard à l’utilisation des boues de vidange fraiches dans l’agriculture, en plus des dangers potentiels de leurs rejet à l’état brut dans la nature. A cet effet, le traitement par déshydratation constitue une solution. Les boues dépotées à la station de traitement par lits de séchage de Zagtouli (Ouagadougou) sont essentiellement issues des fosses septiques et des fosses toutes eaux. L’objectif du présent travail est de mettre en exergue les caractéristiques de ces boues pour guider le choix de technologies alternatives de traitement. A cet effet, les paramètres physico-chimiques et bactériologiques ont été mesurés selon les normes françaises. Les principaux résultats indiquent que la Demande Chimique en Oxygène (DCO) et la Demande Biochimique en Oxygène (DBO5) de ces boues fluides, présentent des valeurs moyennes respectives de 1950 mg O2/let 785 mg O2/l. Quant aux nutriments, ces boues se sont révélées particulièrement riches en azote ammoniacal avec une teneur moyenne de 557 mg/l, tandis que les nitrates et orthophosphates ont des concentrations moyennes de 24 et 39 mg/l respectivement

Influence de la floraison sur la composition chimique et l’activité anti sinusite de l’huile essentielle des feuilles de Diphasia klaineana Pierre (Rutaceae) de Côte d’Ivoire

Objectifs: Cette recherche vise à montrer l’impact de la floraison sur la composition chimique de l’huile essentielle (HE) des feuilles de Diphasia klaineana ainsi que sa propriété anti sinusite in vitro.Méthodologie et résultats: Les huiles essentielles des feuilles de Diphasia klaineana avant la floraison (H1) et pendant la floraison (H2) ont été analysées par chromatographie en phase gazeuse couplée à la spectrométrie de masse (CPG/SM) et leur propriété anti sinusite évaluée contre Staphylococcus aureus par la méthode de diffusion par disque. Ainsi 38 molécules ont été identifiées, représentant 89,17% et 94,10% des constituants respectivement de H1 et H2 avec 8 composés majoritaires dont le sabinène et le β-élémol. Les monoterpènes hydrocarbonés sont plus abondants dans H1 (45,88%) que dans H2 (34,61%). H2 est plus riche en sesquiterpènes oxygénés (56,95%) que H1 (38,36%). Seulement H1 a une activité bactéricide contre Staphylococcus aureus avec une CMI= 1,25 mg/mL.Conclusion et application des résultats: Les résultats obtenus ont montré d’une part une variabilité qualitative et quantitative de la composition chimique de HE des feuilles au cours du développement reproducteur de Diphasia klaineana : H1 est plus riche en monoterpènes hydrocarbonés et H2 est riche en sesquiterpènes oxygénés. D’autre part l’évaluation de l’activité antibactérienne sur Staphylococcus aureus a été conduite aux fins de suivre l’évolution de l’activité antisinusite de des feuilles de Diphasia klaineana contre Staphylococcus aureus avant et pendant la floraison. Les résultats obtenus ont montré que seule l’huile essentielle des feuilles avant la floraison (H1) a des propriétés bactéricides. En revanche, pour une meilleure prise en charge de la sinusite, les acteurs de la médecine traditionnelle doivent utiliser les feuilles de Diphasia klaineana avant la floraison en bain de vapeur.Mots clés: Diphasia klaineana, floraison, huile essentielle, activité bactéricideEnglish Title:  Effect of flowering on the chemical composition and anti-sinusitis activity of the essential oil of the leaves of Diphasia klaineana Pierre (Rutaceae) from Ivory CoastEnglish AbstractObjective: this study aims to show the influence of flowering on the chemical composition of the essential oil of the leaves of Diphasia klaineana as well as on its anti-sinusitis property in vitro.Methodology and Results: The essential oil of Diphasia klaineana leaves before flowering (H1) and during flowering (H2) were analyzed by gas chromatographymass spectrometry (GC-MS) and evaluated their antisinusitis property against Staphylococcus aureus by the disk diffusion method. So 38 constituents have been identified, representing 89.17% and 94.10% of the constituents respectively of H1 and H2 with 8 major compounds including sabinene and β-elemol. Hydrocarbon monoterpenes are more abundant in H1 (45.88%) than in H2 (34.61%). In contrast, H2 (56.95%) is richer in oxygenated sesquiterpenes than H1 (38.36%). In addition, only H1 has a bactericidal activity against Staphylococcus aureus with a MIC = 1.25 mg / ml.Conclusion and application of results: The results obtained showed on the one hand a qualitative and quantitative variability of the chemical composition of HE of the leaves during the reproductive development of Diphasia klaineana: H1 is richer in hydrocarbon monoterpenes and H2 is rich in oxygenated sesquiterpenes. On the other hand, the evaluation of the antibacterial activity on Staphylococcus aureus was conducted to follow the evolution of the antisinusite activity of leaves of Diphasia klaineana against Staphylococcus aureus before and during flowering. The results obtained made it possible to identify the harvest period for the traditional treatment of sinusitis, which corresponds to the high content of hydrocarbon monoterpenes. Our work has thus made it possible to highlight the chemical composition of HE of the leaves of Diphasia klaineana never studied and to evaluate the antisinusite activity of HEs before and during flowering.Keywords: Diphasia klaineana, flowering, essential oil, bactericidal activit

Appropriate training and retention of community doctors in rural areas: a case study from Mali

Abstract Background While attraction of doctors to rural settings is increasing in Mali, there is concern for their retention. An orientation course for young practicing rural doctors was set up in 2003 by a professional association and a NGO. The underlying assumption was that rurally relevant training would strengthen doctors' competences and self-confidence, improve job satisfaction, and consequently contribute to retention. Methods Programme evaluation distinguished trainees' opinions, competences and behaviour. Data were collected through participant observation, group discussions, satisfaction questionnaires, a monitoring tool of learning progress, and follow up visits. Retention was assessed for all 65 trainees between 2003 and 2007. Results and discussion The programme consisted of four classroom modules – clinical skills, community health, practice management and communication skills – and a practicum supervised by an experienced rural doctor. Out of the 65 trained doctors between 2003 and 2007, 55 were still engaged in rural practice end of 2007, suggesting high retention for the Malian context. Participants viewed the training as crucial to face technical and social problems related to rural practice. Discussing professional experience with senior rural doctors contributed to socialisation to novel professional roles. Mechanisms underlying training effects on retention include increased self confidence, self esteem as rural doctor, and sense of belonging to a professional group sharing a common professional identity. Retention can however not be attributed solely to the training intervention, as rural doctors benefit from other incentives and support mechanisms (follow up visits, continuing training, mentoring...) affecting job satisfaction. Conclusion Training increasing self confidence and self esteem of rural practitioners may contribute to retention of skilled professionals in rural areas. While reorientations of curricula in training institutions are necessary, other types of professional support are needed. This experience suggests that professional associations dedicated to strengthening quality of care can contribute significantly to rural practitioners' morale.</p

HLA-A2 Supertype-Restricted Cell-Mediated Immunity by Peripheral Blood Mononuclear Cells Derived from Malian Children with Severe or Uncomplicated Plasmodium falciparum Malaria and Healthy Controls

Understanding HLA-restricted adaptive host immunity to defined epitopes of malarial antigens may be required for the development of successful malaria vaccines. Fourteen epitopes of preerythrocytic malarial antigens known to mediate cytotoxic T-lymphocyte responses against target cells expressing HLA-A2-restricted epitopes were synthesized and pooled based on antigen: thrombospondin-related anonymous protein (TRAP), circumsporozoite protein (CSP), and export protein 1 (Exp-1) peptides. HLA-A2 supertype (*0201, *0202, *0205, *6802) peripheral blood mononuclear cells collected from 774 Malian children, aged 3 months to 14 years, with severe Plasmodium falciparum malaria matched to uncomplicated malaria or healthy controls were stimulated with the HLA-A2-restricted peptide pools. Significant gamma interferon production, determined by enzyme-linked immunospot assay to at least one of the three peptide pools, was observed in 24/58 (41%) of the severe malaria cases, 24/57 (42%) of the uncomplicated malaria cases, and 34/51 (67%) of the healthy controls. Significant lymphoproliferation to these peptides was observed in 12/44 (27%) of the severe malaria cases, 13/55 (24%) of the uncomplicated malaria cases, and 18/50 (36%) of the healthy controls. Responses to individual peptide pools were limited. These studies confirm the presence of adaptive cell-mediated immunity to preerythrocytic malaria antigens in volunteers from Mali and demonstrate that suballeles of the HLA-A2 supertype can effectively present antigenic epitopes. However, whether these immune responses to TRAP, CSP, and Exp-1 malarial proteins play a substantial role in protection remains a matter of controversy