New Antenatal Model in Africa and India (NAMAI) study: implementation research to improve antenatal care using WHO recommendations

Background: In 2020, an estimated 287 000 women died globally from pregnancy‐related causes and 2 million babies were stillborn. Many of these outcomes can be prevented by quality healthcare during pregnancy and childbirth. Within the continuum of maternal health, antenatal care (ANC) is a key moment in terms of contact with the health system, yet it remains an underutilized platform. This paper describes the protocol for a study conducted in collaboration with Ministries of Health and country research partners that aims to employ implementation science to systematically introduce and test the applicability of the adapted WHO ANC package in selected sites across four countries. Methods: Study design is a mixed methods stepped-wedge cluster randomized implementation trial with a nested cohort component (in India and Burkina Faso). The intervention is composed of two layers: (i) the country- (or state)-specific ANC package, including evidence-based interventions to improve maternal and newborn health outcomes, and (ii) the co-interventions (or implementation strategies) to help delivery and uptake of the adapted ANC package. Using COM-B model, co-interventions support behaviour change among health workers and pregnant women by (1) training health workers on the adapted ANC package and ultrasound (except in India), (2) providing supplies, (3) conducting mentoring and supervision and (4) implementing community mobilization strategies. In Rwanda and Zambia, a fifth strategy includes a digital health intervention. Qualitative data will be gathered from health workers, women and their families, to gauge acceptability of the adapted ANC package and its components, as well as experience of care. The implementation of the adapted ANC package of interventions, and their related costs, will be documented to understand to what extent the co-interventions were performed as intended, allowing for iteration. Discussion: Results from this study aim to build the global evidence base on how to implement quality ANC across different settings and inform pathways to scale, which will ultimately lead to stronger health systems with better maternal and perinatal outcomes. On the basis of the study results, governments will be able to adopt and plan for national scale-up, aiming to improve ANC nationally. This evidence will inform global guidance. Trial registration number: ISRCTN, ISRCTN16610902. Registered 27 May 2022. https://www.isrctn.com/ISRCTN16610902

The vulnerabilities of agricultural land and food production to future water scarcity

Rapidly increasing populations coupled with increased food demand requires either an expansion of agriculturalland or sufficient production gains from current resources. However, in a changing world, reduced wateravailability might undermine improvements in crop and grass productivity and may disproportionately affectdifferent parts of the world. Using multi-model studies, the potential trends, risks and uncertainties to land useand land availability that may arise from reductions in water availability are examined here. In addition, theimpacts of different policy interventions on pressures from emerging risks are examined.Results indicate that globally, approximately 11% and 10% of current crop- and grass-lands could be vul-nerable to reduction in water availability and may lose some productive capacity, with Africa and the MiddleEast, China, Europe and Asia particularly at risk. While uncertainties remain, reduction in agricultural land areaassociated with dietary changes (reduction of food waste and decreased meat consumption) offers the greatestbuffer against land loss and food insecurity

Evidence for the Contribution of the Hemozoin Synthesis Pathway of the Murine Plasmodium yoelii to the Resistance to Artemisinin-Related Drugs

Plasmodium falciparum malaria is a major global health problem, causing approximately 780,000 deaths each year. In response to the spreading of P. falciparum drug resistance, WHO recommended in 2001 to use artemisinin derivatives in combination with a partner drug (called ACT) as first-line treatment for uncomplicated falciparum malaria, and most malaria-endemic countries have since changed their treatment policies accordingly. Currently, ACT are often the last treatments that can effectively and rapidly cure P. falciparum infections permitting to significantly decrease the mortality and the morbidity due to malaria. However, alarming signs of emerging resistance to artemisinin derivatives along the Thai-Cambodian border are of major concern. Through long-term in vivo pressures, we have been able to select a murine malaria model resistant to artemisinins. We demonstrated that the resistance of Plasmodium to artemisinin-based compounds depends on alterations of heme metabolism and on a loss of hemozoin formation linked to the down-expression of the recently identified Heme Detoxification Protein (HDP). These artemisinins resistant strains could be able to detoxify the free heme by an alternative catabolism pathway involving glutathione (GSH)-mediation. Finally, we confirmed that artemisinins act also like quinolines against Plasmodium via hemozoin production inhibition. The work proposed here described the mechanism of action of this class of molecules and the resistance to artemisinins of this model. These results should help both to reinforce the artemisinins activity and avoid emergence and spread of endoperoxides resistance by focusing in adequate drug partners design. Such considerations appear crucial in the current context of early artemisinin resistance in Asia

Within-host competition does not select for virulence in malaria parasites; studies with Plasmodium yoelii

In endemic areas with high transmission intensities, malaria infections are very often composed of multiple genetically distinct strains of malaria parasites. It has been hypothesised that this leads to intra-host competition, in which parasite strains compete for resources such as space and nutrients. This competition may have repercussions for the host, the parasite, and the vector in terms of disease severity, vector fitness, and parasite transmission potential and fitness. It has also been argued that within-host competition could lead to selection for more virulent parasites. Here we use the rodent malaria parasite Plasmodium yoelii to assess the consequences of mixed strain infections on disease severity and parasite fitness. Three isogenic strains with dramatically different growth rates (and hence virulence) were maintained in mice in single infections or in mixed strain infections with a genetically distinct strain. We compared the virulence (defined as harm to the mammalian host) of mixed strain infections with that of single infections, and assessed whether competition impacted on parasite fitness, assessed by transmission potential. We found that mixed infections were associated with a higher degree of disease severity and a prolonged infection time. In the mixed infections, the strain with the slower growth rate was often responsible for the competitive exclusion of the faster growing strain, presumably through host immune-mediated mechanisms. Importantly, and in contrast to previous work conducted with Plasmodium chabaudi, we found no correlation between parasite virulence and transmission potential to mosquitoes, suggesting that within-host competition would not drive the evolution of parasite virulence in P. yoelii

Panorama de la maladie de Kaposi dans le service des maladies infectieuses et Tropicales du CHU Yalgado Ouédraogo de 2010 à 2015.

L’incidence de la maladie de Kaposi à l’ère de la multithérapie aux antirétroviraux est en croissance. Elle se manifeste couramment par des lésions papulo-nodulaires angiomateuses se localisant fréquemment au niveau des membres inférieurs. Sa gravité réside dans ses possibilités de dissémination locorégionale. A partir de cinq cas, les auteurs rappellent la diversité clinique de la maladie, la difficulté de confirmation du diagnostic dans notre contexte, et la gravité de certaines formes cliniques. La maladie concernait trois hommes et deux femmes dont l’âge variait entre 30 et 43 ans. Il s’agissait de trois cas de Kaposi cutané, un cas de kaposi œsophagien et un cas de Kaposi ulcéro bourgeonnante de jambe avec atteinte pleurale. La confirmation anatomopathologique a été faite chez un seul patient et deux cas étaient décédés en cours d’hospitalisation.  La maladie de Kaposi était la circonstance de dépistage de l’infection à VIH dans deux cas, elle est  survenue au cours du traitement antirétroviral dans trois cas. La maladie de Kaposi est une pathologie classant Sida. Son diagnostic chez le sujet vivant avec le VIH justifie l’instauration rapide d’un traitement antirétroviral efficace quel que soit la valeur des lymphocytes TCD4. Sa prise en charge requiert une collaboration pluridisciplinaire.  Mots clés : Maladie de Kaposi, VIH, Sida.

Drugs that reduce transmission of falciparum malaria

Substantial gains have been made in reducing the global burden of malaria, much of which can be attributed to greater access to prompt diagnosis and highly effective treatment. However, as endemic countries commit to eliminating malaria, more aggressive interventions are needed to target the large number of apparently healthy individuals who harbour transmissible malaria parasites. Although most national antimalarial guidelines recommend artemisinin combination therapy for the management of uncomplicated falciparum malaria, chemopreventive strategies have generally adopted non-artemisinin combination therapy regimens such as sulfadoxinepyrimethamine and amodiaquine. Artemisinin and its derivatives reduce carriage of sexual stages of the malaria parasites (gametocytes) that are infectious to the mosquito vector, but neither artemisinin combination therapies nor sulfadoxine-pyrimethamine and amodiaquine prevent transmission from fully mature Plasmodium falciparum gametocytes that might be present at the time of treatment

Prise en charge post exposition des victimes d’agression par un animal à Ouagadougou

Le nombre de victimes d’agression par un animal ne cessent de croître au Burkina Faso. Chaque année plus de 5 000 cas  d’agressions par un animal sont notifiés dans le pays par les centres nationaux de traitement anti rabiques (CNTAR) du pays. L’étude se propose de décrire la prise en charge post agression des victimes d’agression par un animal de la commune de  Ouagadougou. Il s’est agi d’une étude rétrospective descriptive des victimes d’agression par animal, reçues au CNTAR de Ouagadougou, entre le 1er janvier et le 31 décembre 2009. Les données ont été collectées à partir du registre de consultation des victimes. Les données ont été analysées avec Epi-info 2000 version 3.5.3. La plupart des victimes d’agression provenaient de la commune de Ouagadougou (98,5 %) et l’âge médian était de 15 ans à prédominance masculine. L’animal agresseur était un chien domestique non immunisé contre la rage. Les victimes dans 25,48 % ont bénéficié d’une prophylaxie vaccinale anti rabique ; 30,70 % étaient agressées par un chien errant ou enragé avec une prophylaxie antirabique incomplète dans 22,54 % des cas. La rage a une issue toujours fatale ; le seul traitement reste la prévention primaire et surtout secondaire qui doivent être  renforcées.Mots-cles : Morsure, chien, rage, prévention, Ouagadougou.The number of victims of aggression by an animal are growing in Burkina. Each year more than 5000 cases of attacks by animals are notified by the anti rabies  treatment centers in the country. The study is to describe the post aggression management of victims of the town of Ouagadougou. It is a retrospective descriptive study of attack victims by animal received at the anti-rabies national processing center in Ouagadougou between 01st January and 31st December 2009. Data were collected from the  victims consultation register. The data analysis were performed with Epi-Info version 2000 3.5.3. Most victims of aggression came from  Ouagadougou city (98.5%). The median age was 15 years predominantly male (60%); 95% of the animal were  domestic dog and unvaccinated against rabies. The most common form of aggression was the bite (99%). After exposure, 25.48 % of the victims have received anti rabies vaccine prophylaxis, of which 30.70 % were attacked by a rabid stray dog, whose rabies prophylaxis was incomplete in 22.54 % of cases. Rabies having always fatal issue, the only treatment is primary   prevention, specially secondary prevention which should be strengthened.Keywords: bite, dog, rabies, prevention, Ouagadougou

P5 Caractérisation des erreurs médicamenteuses survenues au Centre de néonatologie du Centre Hospitalier Universitaire Charles de Gaulle en avril 2023

Introduction : Les erreurs médicamenteuses sont fréquentes en néonatologie. Elles sont parfois critiques en situation de prématurité. Le but de la présente étude était de caractériser les erreurs médicamenteuses commises de la prescription à l’administration des traitements des patients admis au centre de néonatologie du CHU pédiatrique Charles de GAULLE.   Matériel et méthodes : il s’est agi d’une étude observationnelle à visée descriptive. Elle s’est déroulée durant le mois d’avril 2023 au centre de néonatologie du Centre Hospitalier Universitaire Charles de Gaulle (CHUP-CDG). La population d’étude était constituée des nouveau-nés admis pour soins au centre. Résultats : Au total 38 nouveau-nés ont été inclus dans l’étude. Deux cent quatorze (214) prescriptions, 36 préparations ou reconstitutions de médicaments, 54 administrations et 102 délivrances de traitement médicamenteux aux patients ont été analysées. Au total 179 erreurs médicamenteuses ont été identifiées. La prescription et l’administration des médicaments étaient les étapes qui comptaient le plus grand nombre d’erreur avec des proportions de 53,07 % et 40,78 %. La préparation/reconstitution des médicaments et la dispensation des traitements ont été sources d’erreurs médicamenteuses dans des proportions de 1,2% et 5,03%. Les erreurs de dose ont représenté 53,14 % des interventions pharmaceutiques. Selon le degré de réalisation, 41,90 % étaient des erreurs potentielles et la totalité des erreurs médicamenteuses n’avaient pas de conséquences significatives sur la santé des patients. Conclusion : Cette étude a permis détecter et de caractériser les erreurs survenues lors de processus du circuit clinique du médicament au centre de néonatologie du CHUP-CDG. Des renforcements de capacités des acteurs permettront de corriger les insuffisances relevées

Uptake of prevention of mother-to-child transmission cascade services in Burkina Faso between 2013 and 2020: are we on the right track?

The use of services to prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) remains a serious challenge in sub-Saharan Africa. In the last decade, Burkina Faso has implemented numerous policies to increase the use of PMTCT services by pregnant women and their partners, as well as children. This study assesses trends in the uptake of PMTCT services in Burkina Faso from 2013 to 2020 in order to study the progress and gaps in achieving the national and international targets set for 2020.info:eu-repo/semantics/publishe

TDF and quantitative ultrasound bone quality in African patients on second line ART, ANRS 12169 2LADY sub-study

Background Bone demineralization, which leads to osteoporosis and increased fracture risk, is a common metabolic disorder in HIV-infected individuals. In this study, we aimed to assess the change in bone quality using quantitative ultrasound (QUS) over 96 weeks of follow-up after initiation of second-line treatment, and to identify factors associated with change in bone quality. Methods and findings In a randomized trial (ANRS 12169), TDF and PI-na ve participants failing standard first-line treatment, from Burkina Faso, Cameroon, and Senegal were randomized to receive either TDF/FTC/LPVr, ABC/ddl/LPVr or TDF/FTC/DRVr. Their bone quality was assessed using calcaneal QUS at baseline and every 24 weeks until week 96. Stiffness index (SI) was used to measure bone quality. Out of 228 participants, 168 (74%) were women. At baseline, median age was 37 years (IQR: 33-46 years) and median T-CD4 count was 199 cells/mu l (IQR: 113-319 cells/mu l). The median duration of first-line antiretroviral treatment (ART) was 52 months (IQR: 36-72 months) and the median baseline SI was 101 (IQR: 87-116). In multivariable analysis, factors associated with baseline SI were sex ([beta = -10.8 [-18.1,-3.5] for women), age ([beta = -8.7 [-12.4,-5.1] per 10 years), body mass index (BMI) ((beta = +0.8 [0.1,1.5] per unit of BMI), and study site ((beta = +12.8 [6.5,19.1] for Cameroon). After 96 weeks of second-line therapy, a reduction of 7.1% in mean SI was observed, as compared with baseline. Factors associated with SI during the follow-up were similar to those found at baseline. Exposure to TDF was not associated with a greater loss of bone quality over time. Conclusion Bone quality decreased after second-line ART initiation in African patients independently of TDF exposure. Factors associated with bone quality include age, sex, baseline BMI, study site, and duration of follow-up