Syndrome de West : Profil des patients au chu de Fann Dakar-Senegal

Introduction: Le syndrome de West ou encéphalopathie épileptique avec hypsarythmie est fréquente chez le nourrisson au Sénégal. Son pronostic est étroitement lié à la pathologie sous-jacente .Il est principalement secondaire à des causes périnatales. Patients et méthodes: Il s‘est agi d‘une étude rétrospective réalisée à la Clinique Neurologique du CHU de Fann et à l‘Hôpital national pédiatrique Albert Royer, à Dakar-Sénégal, d‘Avril 2012 à Aout 2018. Sur les dossiers médicaux et les registres de suivi, nous avons recueilli les caractéristiques socio-démographiques, les données cliniques, les données paracliniques, les modalités thérapeutiques, et l‘évolution des patients. Résultats: Nous avons colligé 37 nourrissons avec une prédominance masculine (59%), dont l‘âge moyen au moment du diagnostic était de 8 ± 4mois et l‘âge moyen d‘apparition des spasmes était de 3mois. L‘EEG montrait une hypsarythmie chez tous les patients. Les causes étaient dominées par l‘atrophie cortico- sous corticale (21,62%). En première intention, le traitement associait souvent le valproate de sodium et des corticoïdes (35,13%). La pharmacorésitance nécessitait d‘associer valproate de sodium au vigabatrin (8%). L‘évolution clinique était surtout marquée par un arrêt des crises (24,32%), et une persistance des crises (19%). Discussion et Conclusion: Le syndrome de West est une encéphalopathie épileptique du nourrisson dominé par des spasmes en flexion. Dans notre contexte, les facteurs de risque sont l‘absence de suivi prénatal, la souffrance néonatale, l‘accouchement dystocique. La polythérapie permet d‘arrêter les crises, qui dans certains cas peuvent devenir pharmacorésistantes. L‘imagerie par résonnance magnétique et le bilan génétique sont presque inaccessibles, de même que le vigabatrin dont le cout est élevé. English title: West syndrome: Patient profile at Fann Dakar-Senegal Teaching Hospital Introduction: West syndrome or epileptic encephalopathy with hypsarrhythmia is common in infants in Senegal. Its prognosis is closely related to the underlying pathology. It is mainly secondary to perinatal causes. Patients and methods: This was a retrospective study conducted at the Fann University Hospital Neurological Clinic and at the Albert Royer National Pediatric Hospital in Dakar, from April 2012 to August 2018. On medical records and follow-up registers, we collected socio-demographic characteristics, clinical data, paraclinical data, therapeutic modalities, and patient outcomes. Results: We collected 37 infants with male predominance (59%), whose mean age at diagnosis was 8 ± 4 months and the mean age at the onset of spasm was 3 months. EEG showed hypsarrhythmia in all patients. The causes were dominated by cortico-subcortical atrophy (21.62%). As a first-line treatment, sodium valproate and corticosteroids were often combined (35.13%). Drug resistance required the combination of valproate sodium and vigabatrin (8%). The clinical course was mainly marked by a cessation of seizures (24.32%), and a persistence of seizures (19%). Discussion and Conclusion: West‘s syndrome is an infantile epileptic encephalopathy dominated by flexion spasm. In our context, the risk factors are the absence of prenatal follow-up, neonatal distress, and obstructed labor. Combination therapy can stop seizures, which in some cases may become drug-resistant. Magnetic resonance imaging and gene balance are almost inaccessible, as is vigabatrin, which is expensive

Evaluating the Process and Extent of Institutionalization: A Case Study of a Rapid Response Unit for Health Policy in Burkina Faso

Abstract Background: Good decision-making requires gathering and using sufficient information. Several knowledge translation platforms have been introduced in Burkina Faso to support evidence-informed decision-making. One of these is the rapid response service for health. This platform aims to provide quick access for policy-makers in Burkina Faso to highquality research evidence about health systems. The purpose of this study is to describe the process and extent of the institutionalization of the rapid response service. Methods: A qualitative case study design was used, drawing on interviews with policy-makers, together with documentary analysis. Previously used institutionalization frameworks were combined to guide the analysis. Results: Burkina Faso’s rapid response service has largely reached the consolidation phase of the institutionalization process but not yet the final phase of maturity. The impetus for the project came from designated project leaders, who convinced policy-makers of the importance of the rapid response service, and obtained resources to run a pilot. During the expansion stage, additional policy-makers at national and sub-national levels began to use the service. Unit staff also tried to improve the way it was delivered, based on lessons learned during the pilot stage. The service has, however, stagnated at the consolidation stage, and not moved into the final phase of maturity. Conclusion: The institutionalization process for the rapid response service in Burkina Faso has been fluid rather than linear, with some areas developing faster than others. The service has reached the consolidation stage, but now requires additional efforts to reach maturit

Modeling the Cost-Effectiveness of the Integrated Disease Surveillance and Response (IDSR) System: Meningitis in Burkina Faso

Background: Effective surveillance for infectious diseases is an essential component of public health. There are few studies estimating the cost-effectiveness of starting or improving disease surveillance. We present a cost-effectiveness analysis the Integrated Disease Surveillance and Response (IDSR) strategy in Africa. Methodology/Principal Findings: To assess the impact of the IDSR in Africa, we used pre- and post- IDSR meningococcal meningitis surveillance data from Burkina Faso (1996–2002 and 2003–2007). IDSR implementation was correlated with a median reduction of 2 weeks to peak of outbreaks (25 th percentile 1 week; 75 th percentile 4 weeks). IDSR was also correlated with a reduction of 43 meningitis cases per 100,000 (25 th –40: 75 th-129). Assuming the correlations between reductions in time to peak of outbreaks and cases are related, the cost-effectiveness of IDSR was $23 per case averted (25 th-$30; 75 th- cost saving), and $98 per meningitis-related death averted (25 th-$140: 75 th – cost saving). Conclusions/Significance: We cannot absolutely claim that the measured differences were due to IDSR. We believe, however, that it is reasonable to claim that IDSR can improve the cost-effectiveness of public health surveillance

ATSA synthesis : Burkina Faso chapter

Pre-publication copyTobacco control advocates are pursuing enforcement of existing smoke-free legislation. Although Burkina Faso has been traditionally a highly centralized government, in the last few years the government has taken steps to decentralize. Significant powers particularly in the area of health, have been devolved to the 359 “mayors” of the main municipalities. The African Tobacco Situational Analyses (ATSA) team is working with a sample of 45 of these elected officials and their staffs to educate them about tobacco issues and to encourage and help them enforce smoke-free policies

Poultry Production System in Mauritania before the Activities of the “Program to Alleviate Rural Poverty through Support to Subsectors” (ProLPRAF)

The objective of the present study was to display the state of poultry production in fourth (4) regions (Nouakchott, Hodh El Gharbi, Assaba and Guidimaka) covered by ProLPRAF program at the beginning of the program activities in 2011. Data were collected during surveys with different questionnaires addressed to different actors of the poultry sector. Results from farmers showed that 65.0% were female with average age of 45.3 ± 8.40 years. Production constraints remained the same as those encountered in poultry farming in developing countries. There were no poultry markets in the regions, poultry sellers in Nouakchott were male (100%) with average age of 34.8 ± 5.2 years. Traditional local chicken marketed in the regions came either from Nouakchott region (40%) and others (40%), or imported from neighboring countries (20%). In modern poultry farming, day-old chick was imported from Morocco (85%) or Senegal (15%) as well as production inputs. The price of local chicken ranged from 1385 ± 126 to 2325 ± 275 MU, while broiler chicken was between 1255 ± 60 and 1470 ± 47 MU. Local chicken was for ritual, traditions and practices (75%). Layer’s Eggs were imported from Morocco (55%) or Senegal (45%), and average unit price of one egg was around 43.0 ± 5.0 MU. Poultry meat cooked in the restaurants consisted exclusively of broilers meat (100%). Poultry farming was facing socio-political constraints that limited its development, but the ProLPRAF program has been able to tackle these constraints and the impact of the program is plausible today

Politiques publiques et lutte contre l'exclusion, phase II : rapport final

The table of contents for this item can be shared with the requester. The requester may then choose one chapter, up to 10% of the item, as per the Fair Dealing provision of the Canadian Copyright Ac

Evaluating the Process and Extent of Institutionalization: A Case Study of a Rapid Response Unit for Health Policy in Burkina Faso

Background Good decision-making requires gathering and using sufficient information. Several knowledge translation platforms have been introduced in Burkina Faso to support evidence-informed decision-making. One of these is the rapid response service for health. This platform aims to provide quick access for policy-makers in Burkina Faso to highquality research evidence about health systems. The purpose of this study is to describe the process and extent of the institutionalization of the rapid response service. Methods A qualitative case study design was used, drawing on interviews with policy-makers, together with documentary analysis. Previously used institutionalization frameworks were combined to guide the analysis. Results Burkina Faso’s rapid response service has largely reached the consolidation phase of the institutionalization process but not yet the final phase of maturity. The impetus for the project came from designated project leaders, who convinced policy-makers of the importance of the rapid response service, and obtained resources to run a pilot. During the expansion stage, additional policy-makers at national and sub-national levels began to use the service. Unit staff also tried to improve the way it was delivered, based on lessons learned during the pilot stage. The service has, however, stagnated at the consolidation stage, and not moved into the final phase of maturity. Conclusion The institutionalization process for the rapid response service in Burkina Faso has been fluid rather than linear, with some areas developing faster than others. The service has reached the consolidation stage, but now requires additional efforts to reach maturity

Production de masse de larves de Musca domestica L. (Diptera : Muscidae) pour l’aviculture au Burkina Faso : Analyse des facteurs déterminants en oviposition naturelle

Objectifs: Une étude a été réalisée à l’ouest du Burkina Faso afin de déterminer les facteurs qui influencent l’oviposition naturelle de la mouche domestique (Musca domestica L.). L’objectif est d’améliorer la production de masse des larves de mouches pour l’élevage de la volaille au Burkina Faso.Méthodologie et Résultats: L’influence de l’humidité, de la quantité du substrat (fiente de poules pondeuses) et de trois récipients de surfaces variables sur la production des asticots a été déterminée. L’effet des saisons a été également évalué durant quatre périodes de l’année (juillet, octobre, janvier et avril). Les résultats indiquent une variation très significative de la biomasse fraîche larvaire variant de 604,9 g (4 kg + 7 l) à 5,5 g (4 kg + 10 l). Il ressort également que plus la surface d’oviposition est grande, plus la biomasse larvaire produite est importante (127,5 g pour 0,07 m2 contre 257,2 g pour 0,11 m2). La production des larves a été maximale en juillet (239 g) et faible en avril (86,06 g).Conclusion et application des résultats: L’étude montre que, lors de la production des asticots, une humidité insuffisante et un excès d’eau peuvent constituer des facteurs limitants à la production de masse. De plus, l’augmentation de la quantité du substrat par récipient n’implique pas nécessairement une augmentation de rendement, mais qu’une quantité optimale de substrat doit être trouvée en fonction des dimensions de l’ouverture du récipient utilisé. La saison des pluies est plus favorable pour une bonne production larvaire que les saisons sèches et de grande chaleur. Ces résultats permettent le développement d’une méthode durable de production de masse des asticots facilement applicable par des aviculteurs s’ils prennent en compte l’effet limitant des facteurs étudiés. En saison sèche, il est possible d’appliquer une double fermeture du substrat pour réduire les pertes d’eau par évaporation. En période froide, cet ajustement de la fermeture peut créer une condition adéquate de température permettant une éclosion des oeufs et un développement plus rapide des larves.Mots-clés: Asticots, Burkina Faso, Musca domestica (L.), production de masse, volailleEnglish Title:  Production of Musca domestica L. larvae (Diptera: Muscidae) for poultry nutrition in Burkina Faso: Analysis of determining factors in natural ovipositionEnglish AbstractObjective: A study was conducted in western Burkina Faso in order to assess the factors that influence the natural oviposition of the house fly (Musca domestica). The objective was to improve the mass production of fly larvae for poultry farming in Burkina Faso.Methodology and Results: The influence of moisture, the amount of substrate (poultry manure) and three containers with varying surfaces on larvae production were determined. The effect of season were also evaluated during four periods of the year (July, October, January and April). The results indicate a significant difference among treatments, with a fresh larval biomass varying from 604.9 g (4 kg + 7 l) to 5.5g (4 kg + 10 l). It also appeared that larval biomass production increases with the oviposition surface (127.5g for 0.07 m2 against 257.2 g for 0.11 m2). Larval production was highest in July (239 g) and low in April (86.06 g).Conclusion and application of results: The study shows that, during the production of maggots, insufficient moisture and excess water can be limiting factors to mass production. In addition, increasing the amount of the substrate per container does not necessarily imply an increase in yield, but a certain quantity of substrate has to be found according to the dimensions of the opening of the container. The rainy season is more favourable for fly larvae production than the dry and hot seasons. These results allow the development of a sustainable method of mass production of maggots that is easily applicable by poultry farmers if they take into account the limiting effect of the studied factors. In the dry season, it is possible to apply a double closure of the substrate to reduce the loss of water by evaporation. In cold weather, this closure adjustment can create an adequate temperature condition for egg hatching and faster larval development.Keywords: Burkina Faso, maggot, mass production, poultry, Musca domestica (L.

Human candidate gene polymorphisms and risk of severe malaria in children in Kilifi, Kenya: a case-control association study

Background: Human genetic factors are important determinants of malaria risk. We investigated associations between multiple candidate polymorphisms—many related to the structure or function of red blood cells—and risk for severe Plasmodium falciparum malaria and its specific phenotypes, including cerebral malaria, severe malaria anaemia, and respiratory distress. Methods: We did a case-control study in Kilifi County, Kenya. We recruited as cases children presenting with severe malaria to the high-dependency ward of Kilifi County Hospital. We included as controls infants born in the local community between Aug 1, 2006, and Sept 30, 2010, who were part of a genetics study. We tested for associations between a range of candidate malaria-protective genes and risk for severe malaria and its specific phenotypes. We used a permutation approach to account for multiple comparisons between polymorphisms and severe malaria. We judged p values less than 0·005 significant for the primary analysis of the association between candidate genes and severe malaria. Findings: Between June 11, 1995, and June 12, 2008, 2244 children with severe malaria were recruited to the study, and 3949 infants were included as controls. Overall, 263 (12%) of 2244 children with severe malaria died in hospital, including 196 (16%) of 1233 with cerebral malaria. We investigated 121 polymorphisms in 70 candidate severe malaria-associated genes. We found significant associations between risk for severe malaria overall and polymorphisms in 15 genes or locations, of which most were related to red blood cells: ABO, ATP2B4, ARL14, CD40LG, FREM3, INPP4B, G6PD, HBA (both HBA1 and HBA2), HBB, IL10, LPHN2 (also known as ADGRL2), LOC727982, RPS6KL1, CAND1, and GNAS. Combined, these genetic associations accounted for 5·2% of the variance in risk for developing severe malaria among individuals in the general population. We confirmed established associations between severe malaria and sickle-cell trait (odds ratio [OR] 0·15, 95% CI 0·11–0·20; p=2·61 × 10−58), blood group O (0·74, 0·66–0·82; p=6·26 × 10−8), and –α3·7-thalassaemia (0·83, 0·76–0·90; p=2·06 × 10−6). We also found strong associations between overall risk of severe malaria and polymorphisms in both ATP2B4 (OR 0·76, 95% CI 0·63–0·92; p=0·001) and FREM3 (0·64, 0·53–0·79; p=3·18 × 10−14). The association with FREM3 could be accounted for by linkage disequilibrium with a complex structural mutation within the glycophorin gene region (comprising GYPA, GYPB, and GYPE) that encodes for the rare Dantu blood group antigen. Heterozygosity for Dantu was associated with risk for severe malaria (OR 0·57, 95% CI 0·49–0·68; p=3·22 × 10−11), as was homozygosity (0·26, 0·11–0·62; p=0·002). Interpretation: Both ATP2B4 and the Dantu blood group antigen are associated with the structure and function of red blood cells. ATP2B4 codes for plasma membrane calcium-transporting ATPase 4 (the major calcium pump on red blood cells) and the glycophorins are ligands for parasites to invade red blood cells. Future work should aim at uncovering the mechanisms by which these polymorphisms can result in severe malaria protection and investigate the implications of these associations for wider health. Funding: Wellcome Trust, UK Medical Research Council, European Union, and Foundation for the National Institutes of Health as part of the Bill & Melinda Gates Grand Challenges in Global Health Initiative