ETAT DE LIEU SUR LA PRATIQUE DE LA PHYTOTHÉRAPIE UTÉROTONIQUE ET MYORELAXANTE SUR LE COL UTÉRIN AU COURS DU TRAVAIL CHEZ LES GESTANTES À TERME (LA VILLE DE LUBUMBASHI RD CONGO 2014 – 2020)

CONTEXTE :  Le fort engouement pour la médecine par les plantes et les besoins en médicaments des pays en voie de développement, pays présentement confrontés au dilemme de la volonté manifeste d’améliorer les conditions socio sanitaires des populations avec des ressources précaires, ouvre des perspectives nouvelles à la médecine traditionnelle. Le présent travail expose les résultats d’une étude ayant porté sur l’Etat de lieu de la pratique de phytothérapie utérotonique et myorelaxante du col utérin chez les gestantes à terme sur la santé de la reproduction dans la ville de Lubumbashi, RDC. MÉTHODES : Etude descriptive transversale a été menée au « Centre de Santé International Uchungu Wa Mwana » Ville de Lubumbashi dans la Province du Haut – Katanga, RDC pendant 9 mois .Sur une population des accouchées, avec un échantillonnage exhaustif aléatoire simple, sur une période allant de 2014 à 2020 ou 7 ans, collecte des données réalisée grâce à un questionnaire et interview avec la technique documentaire. Données gérés sur base d’un logiciel Word et Excel pour le stockage et le traitement en Epi info 7.2.2.6 et Epi data 6 ; Considérations éthiques s’inscrit dans le respect strict des principes d’éthique de la recherche en santé en santé publique : RÉSULTATS : Durant 7 ans, la structure a reçu 2083 accouchées avec accouchement moyen pour les 7 ans est ± 298 par an/ provenant en majorité de toutes les communes de la Ville de Lubumbashi et dont 48,44 % de la Commune de la Ruashi et 27,87 %. Près d’un accouchement sur 10 était dystocique ; La majorité des enfants (92,69 %) étaient nés vivants et 7,31 % étaient des mort-nés pour une période de 7 ans. Parmi les accouchées, 216 (11,45 %) provenaient d’autres zones de santé (ou hors zone / HZ) et 351 (18,60 %) d’autres aires de santé de la Zone de santé de la Ruashi (HAS), tandis que 1320 (69,95 %) provenaient de l’aire de santé (AS) où se situe le CSIU. Le séjour moyen des accouchées tourne autour de 2 jours, l’écart-type de 1 jour, le séjour minimal des femmes est de 0 jour soit la femme sort le même jour de l’arrivé.  Sur les 2083 cas enregistrés, le plus faible coût est élevé à 15.000 FC, le montant le plus cher est de 150.000 FC, la moyenne des frais payés relèvent à 39.000 FC, et l’écart-type est de 150.000 FC. La somme du montant payé est de 74.331.500 CONCLUSION : L’Etat de lieu sur la pratique phytothérapie utérotonique et myorelaxante du col utérin chez les gestantes à terme nous révèle que la Médecine traditionnelle est effective dans la ville et plusieurs femmes y font recourt pour le bien-être de leurs enfants, notamment en RDC.CONTEXTE :  Le fort engouement pour la médecine par les plantes et les besoins en médicaments des pays en voie de développement, pays présentement confrontés au dilemme de la volonté manifeste d’améliorer les conditions socio sanitaires des populations avec des ressources précaires, ouvre des perspectives nouvelles à la médecine traditionnelle. Le présent travail expose les résultats d’une étude ayant porté sur l’Etat de lieu de la pratique de phytothérapie utérotonique et myorelaxante du col utérin chez les gestantes à terme sur la santé de la reproduction dans la ville de Lubumbashi, RDC. MÉTHODES : Etude descriptive transversale a été menée au « Centre de Santé International Uchungu Wa Mwana » Ville de Lubumbashi dans la Province du Haut – Katanga, RDC pendant 9 mois .Sur une population des accouchées, avec un échantillonnage exhaustif aléatoire simple, sur une période allant de 2014 à 2020 ou 7 ans, collecte des données réalisée grâce à un questionnaire et interview avec la technique documentaire. Données gérés sur base d’un logiciel Word et Excel pour le stockage et le traitement en Epi info 7.2.2.6 et Epi data 6 ; Considérations éthiques s’inscrit dans le respect strict des principes d’éthique de la recherche en santé en santé publique : RÉSULTATS : Durant 7 ans, la structure a reçu 2083 accouchées avec accouchement moyen pour les 7 ans est ± 298 par an/ provenant en majorité de toutes les communes de la Ville de Lubumbashi et dont 48,44 % de la Commune de la Ruashi et 27,87 %. Près d’un accouchement sur 10 était dystocique ; La majorité des enfants (92,69 %) étaient nés vivants et 7,31 % étaient des mort-nés pour une période de 7 ans. Parmi les accouchées, 216 (11,45 %) provenaient d’autres zones de santé (ou hors zone / HZ) et 351 (18,60 %) d’autres aires de santé de la Zone de santé de la Ruashi (HAS), tandis que 1320 (69,95 %) provenaient de l’aire de santé (AS) où se situe le CSIU. Le séjour moyen des accouchées tourne autour de 2 jours, l’écart-type de 1 jour, le séjour minimal des femmes est de 0 jour soit la femme sort le même jour de l’arrivé.  Sur les 2083 cas enregistrés, le plus faible coût est élevé à 15.000 FC, le montant le plus cher est de 150.000 FC, la moyenne des frais payés relèvent à 39.000 FC, et l’écart-type est de 150.000 FC. La somme du montant payé est de 74.331.500 CONCLUSION : L’Etat de lieu sur la pratique phytothérapie utérotonique et myorelaxante du col utérin chez les gestantes à terme nous révèle que la Médecine traditionnelle est effective dans la ville et plusieurs femmes y font recourt pour le bien-être de leurs enfants, notamment en RDC

Development and validation of quantitative PCR assays for HIV-associated cryptococcal meningitis in sub-Saharan Africa: a diagnostic accuracy study

Background: HIV-associated cryptococcal meningitis is the second leading cause of AIDS-related deaths, with a 10-week mortality rate of 25–30%. Fungal load assessed by colony-forming unit (CFU) counts is used as a prognostic marker and to monitor response to treatment in research studies. PCR-based assessment of fungal load could be quicker and less labour-intensive. We sought to design, optimise, and validate quantitative PCR (qPCR) assays for the detection, identification, and quantification of Cryptococcus infections in patients with cryptococcal meningitis in sub-Saharan Africa. Methods: We developed and validated species-specific qPCR assays based on DNA amplification of QSP1 (QSP1A specific to Cryptococcus neoformans, QSP1B/C specific to Cryptococcus deneoformans, and QSP1D specific to Cryptococcus gattii species) and a pan-Cryptococcus assay based on a multicopy 28S rRNA gene. This was a longitudinal study that validated the designed assays on cerebrospinal fluid (CSF) of 209 patients with cryptococcal meningitis at baseline (day 0) and during anti-fungal therapy (day 7 and day 14), from the AMBITION-cm trial in Botswana and Malawi (2018–21). Eligible patients were aged 18 years or older and presenting with a first case of cryptococcal meningitis. Findings: When compared with quantitative cryptococcal culture as the reference, the sensitivity of the 28S rRNA was 98·2% (95% CI 95·1–99·5) and of the QSP1 assay was 90·4% (85·2–94·0) in CSF at day 0. Quantification of the fungal load with QSP1 and 28S rRNA qPCR correlated with quantitative cryptococcal culture (R2=0·73 and R2=0·78, respectively). Both Botswana and Malawi had a predominant C neoformans prevalence of 67% (95% CI 55–75) and 68% (57–73), respectively, and lower C gattii rates of 21% (14–31) and 8% (4–14), respectively. We identified ten patients that, after 14 days of treatment, harboured viable but non-culturable yeasts based on QSP1 RNA detection (without any positive CFU in CSF culture). Interpretation: QSP1 and 28S rRNA assays are useful in identifying Cryptococcus species. qPCR results correlate well with baseline quantitative cryptococcal culture and show a similar decline in fungal load during induction therapy. These assays could be a faster alternative to quantitative cryptococcal culture to determine fungal load clearance. The clinical implications of the possible detection of viable but non-culturable cells in CSF during induction therapy remain unclear. Funding: European and Developing Countries Clinical Trials Partnership; Swedish International Development Cooperation Agency; Wellcome Trust/UK Medical Research Council/UKAID Joint Global Health Trials; and UK National Institute for Health Research

Development and validation of quantitative PCR assays for HIV-associated cryptococcal meningitis in sub-Saharan Africa: a diagnostic accuracy study

Background: HIV-associated cryptococcal meningitis is the second leading cause of AIDS-related deaths, with a 10-week mortality rate of 25–30%. Fungal load assessed by colony-forming unit (CFU) counts is used as a prognostic marker and to monitor response to treatment in research studies. PCR-based assessment of fungal load could be quicker and less labour-intensive. We sought to design, optimise, and validate quantitative PCR (qPCR) assays for the detection, identification, and quantification of Cryptococcus infections in patients with cryptococcal meningitis in sub-Saharan Africa. Methods: We developed and validated species-specific qPCR assays based on DNA amplification of QSP1 (QSP1A specific to Cryptococcus neoformans, QSP1B/C specific to Cryptococcus deneoformans, and QSP1D specific to Cryptococcus gattii species) and a pan-Cryptococcus assay based on a multicopy 28S rRNA gene. This was a longitudinal study that validated the designed assays on cerebrospinal fluid (CSF) of 209 patients with cryptococcal meningitis at baseline (day 0) and during anti-fungal therapy (day 7 and day 14), from the AMBITION-cm trial in Botswana and Malawi (2018–21). Eligible patients were aged 18 years or older and presenting with a first case of cryptococcal meningitis. Findings: When compared with quantitative cryptococcal culture as the reference, the sensitivity of the 28S rRNA was 98·2% (95% CI 95·1–99·5) and of the QSP1 assay was 90·4% (85·2–94·0) in CSF at day 0. Quantification of the fungal load with QSP1 and 28S rRNA qPCR correlated with quantitative cryptococcal culture (R2=0·73 and R2=0·78, respectively). Both Botswana and Malawi had a predominant C neoformans prevalence of 67% (95% CI 55–75) and 68% (57–73), respectively, and lower C gattii rates of 21% (14–31) and 8% (4–14), respectively. We identified ten patients that, after 14 days of treatment, harboured viable but non-culturable yeasts based on QSP1 RNA detection (without any positive CFU in CSF culture). Interpretation: QSP1 and 28S rRNA assays are useful in identifying Cryptococcus species. qPCR results correlate well with baseline quantitative cryptococcal culture and show a similar decline in fungal load during induction therapy. These assays could be a faster alternative to quantitative cryptococcal culture to determine fungal load clearance. The clinical implications of the possible detection of viable but non-culturable cells in CSF during induction therapy remain unclear

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

Development and validation of quantitative PCR assays for HIV-associated cryptococcal meningitis in sub-Saharan Africa: a diagnostic accuracy study

Background: HIV-associated cryptococcal meningitis is the second leading cause of AIDS-related deaths, with a 10-week mortality rate of 25–30%. Fungal load assessed by colony-forming unit (CFU) counts is used as a prognostic marker and to monitor response to treatment in research studies. PCR-based assessment of fungal load could be quicker and less labour-intensive. We sought to design, optimise, and validate quantitative PCR (qPCR) assays for the detection, identification, and quantification of Cryptococcus infections in patients with cryptococcal meningitis in sub-Saharan Africa. Methods: We developed and validated species-specific qPCR assays based on DNA amplification of QSP1 (QSP1A specific to Cryptococcus neoformans, QSP1B/C specific to Cryptococcus deneoformans, and QSP1D specific to Cryptococcus gattii species) and a pan-Cryptococcus assay based on a multicopy 28S rRNA gene. This was a longitudinal study that validated the designed assays on cerebrospinal fluid (CSF) of 209 patients with cryptococcal meningitis at baseline (day 0) and during anti-fungal therapy (day 7 and day 14), from the AMBITION-cm trial in Botswana and Malawi (2018–21). Eligible patients were aged 18 years or older and presenting with a first case of cryptococcal meningitis. Findings: When compared with quantitative cryptococcal culture as the reference, the sensitivity of the 28S rRNA was 98·2% (95% CI 95·1–99·5) and of the QSP1 assay was 90·4% (85·2–94·0) in CSF at day 0. Quantification of the fungal load with QSP1 and 28S rRNA qPCR correlated with quantitative cryptococcal culture (R2=0·73 and R2=0·78, respectively). Both Botswana and Malawi had a predominant C neoformans prevalence of 67% (95% CI 55–75) and 68% (57–73), respectively, and lower C gattii rates of 21% (14–31) and 8% (4–14), respectively. We identified ten patients that, after 14 days of treatment, harboured viable but non-culturable yeasts based on QSP1 RNA detection (without any positive CFU in CSF culture). Interpretation: QSP1 and 28S rRNA assays are useful in identifying Cryptococcus species. qPCR results correlate well with baseline quantitative cryptococcal culture and show a similar decline in fungal load during induction therapy. These assays could be a faster alternative to quantitative cryptococcal culture to determine fungal load clearance. The clinical implications of the possible detection of viable but non-culturable cells in CSF during induction therapy remain unclear. Funding: European and Developing Countries Clinical Trials Partnership; Swedish International Development Cooperation Agency; Wellcome Trust/UK Medical Research Council/UKAID Joint Global Health Trials; and UK National Institute for Health Research