La bibliothèque des étudiants en santé

9415 ressources

• Article libreArticleEn anglais

  Adiposity Phenotypes and Subclinical Atherosclerosis in Adults from Sub–Saharan Africa: An H3Africa AWI–Gen Study

  Engelbert A. Nonterah, Michiel L. Bots, Abraham Oduro, Godfred Agongo, Cassandra C. Soo, Lisa K. Micklesfield, Felistas Mashinya, Palwendé R. Boua, Shukri F. Mohamed, Alisha N. Wade, Catherine Kyobutungi, Halidou Tinto, Shane A. Norris, Stephen M. Tollman, Michèle Ramsay, Diederick E. Grobbee, Kerstin Klipstein–Grobusch, Nigel J. Crowther

  Background:Obesity and adipose tissue distribution contribute to an increased risk of cardiovascular disease (CVD) by promoting atherosclerosis. This association has been poorly studied in sub–Saharan Africa (SSA) despite the rising prevalence of cardiovascular disease.Objectives:We determined the association between various adiposity phenotypes and carotid intima–media thickness (CIMT), a proxy of subclinical atherosclerosis, in a large SSA population.Methods:A population–based cross–sectional study was performed from 2013–2016 in Burkina Faso, Ghana, Kenya and South Africa. Body mass index (BMI), waist (WC), hip circumferences (HC), visceral (VAT) and subcutaneous adipose tissue (SCAT) using B-mode ultrasound were measured. Ultrasonography of left and right far wall CIMT of the common carotid artery was used as an indicator of subclinical atherosclerosis. Individual participant data meta–analyses were used to determine the associations between adiposity phenotypes and CIMT in the pooled sample while adjusted multivariable linear regression analyses were used for site specific analyses.Results:Data were obtained from 9,010 adults (50.3% women and a mean age of 50± 6years). Men had higher levels of visceral fat than women while women had higher BMI, waist and hip circumference and subcutaneous fat than men at all sites except Burkina Faso. In the pooled analyses, BMI (β–value [95% CIs]: 19.5 [16.8, 22.3] μm) showed the strongest relationship with CIMT followed by VAT (5.86 [4.65, 7.07] μm), SCAT (5.00 [2.85, 7.15] μm), WC (1.27 [1.09, 1.44] μm) and HC (1.23 [1.04, 1.42] μm). Stronger associations were observed in men than in women.Conclusion:Obesity within SSA will likely result in higher levels of atherosclerosis and promote the occurrence of cardio- and cerebrovascular events, especially in males, unless addressed through primary prevention of obesity in both rural and urban communities across Africa. The inverse association of VAT with CIMT in Burkina Faso and Gh

  Biostatistiques et épidémiologieMédecine interne (cardiologie, endocrinologie, néphrologie…)Santé publiqueLicence : http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Adolescent health and well‐being in sub‐Saharan Africa: Strengthening knowledge base and research capacity through a collaborative multi‐country school‐based study

  Sachin Shinde, Ramadhani Abdallah Noor, Mary Mwanyika‐Sando, Mosa Moshabela, Amare W. Tadesse, Huda Sherfi, Alain Vandormael, Tara Young, Amani Tinkasimile, Roisin Drysdale, Till Baernighausen, Deepika Sharma, Wafaie W. Fawzi

  AbstractIn Sub‐Saharan Africa (SSA), adolescents make up around one‐quarter of the population who are growing up in a rapidly urbanizing environment, with its associated risks and benefits, including impacts on health, psychosocial development, nutrition, and education. However, research on adolescents' health and well‐being in SSA is limited. The ARISE (African Research, Implementation Science and Education) Network's Adolescent Health and Nutrition Study is an exploratory, school‐based study of 4988 urban adolescents from five countries: Burkina Faso, Ethiopia, South Africa, Sudan, and Tanzania. A multistage random sampling strategy was used to select the schools and adolescents. Adolescent boys and girls aged 10–15 years were interviewed using a standardized questionnaire by trained enumerators. The questionnaire covered multiple domains including demographic and socioeconomic characteristics, water, sanitation and hygiene practices, antimicrobial resistance, physical activity, dietary behaviours, socioemotional development, educational outcomes, media use, mental health, and menstrual hygiene (only for girls). Additionally, a desk review of health and school meal policies and programs and a qualitative investigation into health and food environments in schools were conducted with students, administrators, and food vendors. In this paper, we describe the study design and questionnaire, present profiles of young adolescents who participated in the study, and share field experiences and lessons learned for future studies. We expect that this study along with other ARISE Network projects will be a first step toward understanding young people's health risks and disease burdens, identifying opportunities for interventions and improving policies, as well as developing potential research capacities on adolescent health and well‐being in the SSA region. Key messages Several global initiatives recommend greater investment in adolescents' health and well‐being as key to su

  Microbiologie (bactériologie, virologie)PharmacologieSanté publiqueLicence : http://creativecommons.org/licenses/by/4.0/ This is an open access article under the terms of theLicense, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Adolescent mental health services in West Africa: a comparative analysis of Burkina Faso, Ghana, and Niger

  Michel Adurayi Amenah, Nassirou Ibrahim, Ludovic Deo Gracias Tapsoba, Jacob Novignon, Ama Pokuaa Fenny, Irene A. Agyepong, Roxane Borges da Silva, Tim Ensor

  BackgroundAdolescent mental health (AMH) is a critical issue worldwide, particularly in West Africa, where it is intensified by socio-economic, cultural, and security challenges. Insecurity and the presence of mining sites expose adolescents to hazardous environments, substance abuse, and adulterated alcohol, further aggravating their mental health. Despite these severe issues, research on AMH in this region remains limited. This study aims to analyze the provision of AMH services in Burkina Faso, Ghana, and Niger, highlighting the unique challenges these countries face within the broader West African healthcare context.MethodsThe study adopted a multi-stage, stratified sampling design to collect data from primary healthcare centers (PHCs) in the three countries. Using STATA.17, Descriptive analysis was conducted on the data related to availability of AMH services, types of mental health disorders treated, resources available, and OPD attendance rates. The analysis also incorporated factors such as the rural-urban divide and the presence of national guidelines for AMH services.ResultsThe findings reveal a significant shortfall in the provision of AMH services across the region, with less than 30% of PHCs across all the countries offering these services. The study also highlights a pronounced rural-urban disparity in AMH service availability, a general absence of national guidelines for AMH care, and low OPD attendance rates.ConclusionThe study highlights the urgent need for comprehensive policy reform and targeted interventions to enhance AMH services in West Africa. Key policy reforms should include the development and implementation of national guidelines for AMH care and integration of AMH services into primary healthcare. Additionally, efforts should focus on capacity building through the training of mental health professionals, increasing public awareness to reduce stigma, and ensuring equitable resource allocation across rural and urban areas. Improving AMH ca

  Santé publiqueLicence : Open Access http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/publicdomain/zero/1.0/ This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as

  Lire dans MyLaafi
• Lien vers la sourceMémoire

  Adrénaline versus corticoïdes dans le traitement de l'anaphylaxie : quel pronostic à 1 mois de la prise en charge ?

  Tracy Charles

  Introduction : l'anaphylaxie représente un motif de consultation de plus en plus fréquent aux urgences. Malgré les recommandations de prise en charge qui prônent l’utilisation de l’adrénaline en première ligne de traitement, en pratique les corticoïdes restent la première thérapeutique administrée en cas d’anaphylaxie. L’objectif de notre étude est de comparer le pronostic des patients qui ont reçu de l’adrénaline ou des corticoïdes à la suite d’une consultation pour anaphylaxie aux urgences du CHU d’Amiens. Matériel et méthode : il s’agit d’une étude de cohorte rétrospective pendant la période de janvier 2019 à janvier 2022. Les patients inclus avaient tous reçu des corticoïdes et/ou de l’adrénaline. Le but était d’établir le pronostic des patients dans le mois qui suivait la prise en charge selon les caractéristiques suivantes : présence d’une réaction biphasique, apparition ou absence d’effets indésirables secondaires cardio-vasculaires. Résultats : 127 cas d’anaphylaxie ont été inclus. L’âge moyen était de 49 ans. 18,1% des patients étaient atopiques. Les patients aux antécédents cardio-vasculaires représentaient 37% de la cohorte. Il n’y avait pas de différence significative entre la présence d’effets indésirables cardio-vasculaire et l’administration de corticoïdes ou d’adrénaline ni entre la présence d’antécédent ou de traitement cardio-vasculaire et la présence d’effets indésirables. Cependant, les patients qui présentaient une réaction biphasique après la sortie des urgences n’avaient pas bénéficié d’adrénaline (p=0.05). Nos résultats montraient une tendance d’effets indésirables plus importante chez les patients qui avaient une cardiopathie ischémique, sans que ce résultat soit significatif. Conclusion : il n’y avait pas de différence en termes d’effets indésirables chez les patients qui recevaient de l’adrénaline et/ou des corticoïdes. Cependant, les patients qui avaient présenté une réaction biphasique n’avaient pas reçu d’adrénaline. Ce traitement sembl

  Biostatistiques et épidémiologiePharmacologieSémiologieLicence : https://creativecommons.org/licenses/by/4.0/

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Advances and Gaps in Global Newborn Screening for Sickle Cell Disease

  Newborn screening (NBS) for sickle cell disease (SCD) has been performed in the United States (US) for decades, significantly reducing infant morbidity and mortality. A landmark clinical trial demonstrated that early identification of SCD enabled timely and life-saving prophylactic penicillin; this led to recommendations for universal NBS across the US. Early use of hydroxyurea as a safe and effective treatment for SCD further improved clinical outcomes by preventing acute and chronic disease complications. These advances add to the importance of early diagnosis through NBS, providing an opportunity for early treatment intervention. In recent years, high-resource countries—including those in Europe, the UK, and Canada—have adopted NBS for SCD using diverse strategies. Simultaneously, pilot programs in lower-resource settings such as Africa, Brazil, and India have demonstrated local feasibility and impact through implementation efforts. An overarching equity gap for achieving global NBS for SCD is the variable access to simple, accurate, and affordable testing. Other challenges include timing of NBS testing, targeted populations, laboratory methods, and parental education with genetic counseling. Questions remain about the equitable enrollment of affected infants worldwide into comprehensive care to ensure early treatment. These challenges raise concerns about sustainability, underscore the need for long-term funding and a strategic plan, and highlight persistent inequities from the lack of global NBS standards.

  Biologie cellulaire et moléculaireGénétiqueHématologieLicence : Creative Commons Attribution (CC BY) license Published by MDPI on behalf of the International Society for Neonatal Screening. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Advancing the use of evidence in bouillon fortification policy discussions: Burkina Faso, Nigeria, and Senegal

  Ann Tarini, Jérome W. Somé, Maguette Beye, Faith Ishaya, Karim Koudougou, Augustine Okoruwa, Stephen A. Vosti

  AbstractPolicy changes require stakeholder buy‐in, therefore, the timely delivery of tailored evidence provided to all stakeholders involved in policy discussions is important. This paper reports the evidence generation and delivery processes undertaken in Burkina Faso, Nigeria, and Senegal in support of bouillon fortification discussions. We identified stakeholder‐specific evidence needs, tapped existing data and new data to generate that evidence, and packaged and delivered it to stakeholders. Evidence needs included the levels of micronutrient inadequacy (with/without existing and other hypothetical fortification programs), the potential contributions of bouillon fortification to reduce micronutrient inadequacy and (for some micronutrients) child mortality, the cost and cost‐effectiveness of bouillon fortification programs, and the contribution of bouillon to total sodium intake. Evidence on technical and commercial issues was also required. Stakeholder‐specific understanding and ownership of evidence was essential; achieving both required continual interaction and trust. New bouillon evidence delivery channels were developed in each country and linked to existing decision‐making bodies. A shared vocabulary and understanding of issues and evidence, and the continual innovative redelivery of evidence, were critical to success; persistence and innovations in evidence delivery paid dividends. Concrete policy changes regarding bouillon fortification were secured in Nigeria; policy discussions continue in Burkina Faso and Senegal. Nutrition policy landscapes are comprised of a large number of stakeholders and vary by country depending on the policy issues being discussed. Launching a bouillon fortification program required mapping and strategically engaging with selected entities and individuals in these landscapes, discovering their evidence needs regarding specific questions, generating the needed evidence, and devising ways to deliver compelling evidence in innovat

  PédiatrieSanté publiqueLicence : http://creativecommons.org/licenses/by/4.0/ This is an open access article under the terms of theLicense, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Adverse selection in a community-based health insurance scheme in rural Africa: Implications for introducing targeted subsidies

  Divya Parmar, Aurélia Souares, Manuela de Allegri, Germain Savadogo, Rainer Sauerborn

  BackgroundAlthough most community-based health insurance (CBHI) schemes are voluntary, problem of adverse selection is hardly studied. Evidence on the impact of targeted subsidies on adverse selection is completely missing. This paper investigates adverse selection in a CBHI scheme in Burkina Faso. First, we studied the change in adverse selection over a period of 4 years. Second, we studied the effect of targeted subsidies on adverse selection.MethodsThe study area, covering 41 villages and 1 town, was divided into 33 clusters and CBHI was randomly offered to these clusters during 2004–06. In 2007, premium subsidies were offered to the poor households. The data was collected by a household panel survey 2004–2007 from randomly selected households in these 33 clusters (n = 6795). We applied fixed effect models.ResultsWe found weak evidence of adverse selection before the implementation of subsidies. Adverse selection significantly increased the next year and targeted subsidies largely explained this increase.ConclusionsAdverse selection is an important concern for any voluntary health insurance scheme. Targeted subsidies are often used as a tool to pursue the vision of universal coverage. At the same time targeted subsidies are also associated with increased adverse selection as found in this study. Therefore, it’s essential that targeted subsidies for poor (or other high-risk groups) must be accompanied with a sound plan to bridge the financial gap due to adverse selection so that these schemes can continue to serve these populations.

  Biostatistiques et épidémiologieSanté publiqueLicence : http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Aedes aegypti mosquitoes from Burkina Faso can transmit the chikungunya virus and Zika virus of the African lineage, but not the Zika virus of the Asian lineage

  Aboubakar Sanon, Lanjiao Wang, Athanase Badolo, Leen Delang

  AbstractAedes aegypti is the primary vector for the transmission of dengue virus (DENV), Zika virus (ZIKV), and chikungunya virus (CHIKV). While Burkina Faso has been facing an increase in DENV epidemics, no ZIKV or CHIKV outbreaks have been reported. Here, we, therefore, assessed the vector competence of Ae. aegypti mosquitoes from Burkina Faso for ZIKV and CHIKV transmission. Ae. aegypti mosquitoes from urban and peri-urban sites of Ouagadougou were orally infected via blood meal with different titres of a West African CHIKV strain and ZIKV strains of the Asian and African lineage. The infection rate for mosquitoes from both sites was ~65% for CHIKV, whereas the dissemination was 85% and 45%, respectively, in urban and peri-urban mosquitoes. The CHIKV transmission rates ranged between 14 and 18%. For the African lineage of ZIKV, the infection rate was higher for urban mosquitoes than peri-urban mosquitoes (100% vs. 80%), whereas the dissemination rate was 100% in mosquitoes from both sites. The transmission rates for African ZIKV ranged between 12 and 18% for both urban and peri-urban mosquitoes. In contrast to ZIKV of the African lineage, low infection rates (10–30%) and dissemination rates (14–50%) were observed with the Asian lineage of ZIKV. Additionally, mosquitoes from both sites could not transmit the ZIKV strain of the Asian lineage. This study demonstrates, for the first time, the capability of Ae. aegypti mosquitoes from Burkina Faso to transmit chikungunya virus and the pre-epidemic strain of Zika virus in their saliva, highlighting the importance of establishing surveillance for these viruses in Burkina Faso.

  Santé publiqueLicence : This is an open-access article distributed under the terms of the Creative Commons Attribution License.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Aetiological agents of cerebrospinal meningitis: a retrospective study from a teaching hospital in Ghana

  Michael Owusu, Samuel Blay Nguah, Yaw Agyekum Boaitey, Ernest Badu-Boateng, Abdul-Raman Abubakr, Robert Awuley Lartey, Yaw Adu-Sarkodie

  AbstractsBackgroundMeningitis is an important cause of morbidity and mortality in low-resource settings. In sub-Saharan Africa, the meningitis belt has been characterized by particularly high and seasonal incidences of bacterial meningitis extending throughout life. Despite the progress being made in treating the condition, the mortality rates continue to be high, ranging between 2% and 30% globally. In Ghana, the mortality rate of meningitis has been estimated to range from 36% to 50%. However little information is available on the pathogens contributing to meningitis and their antimicrobial susceptibilities. Updated information is essential to adjust the recommendations for empirical treatment or prevention of meningitis which could have immense implications for local and global health.MethodsWe retrospectively reviewed laboratory records of all patients suspected of bacterial meningitis who underwent a lumbar puncture from January 1, 2008 to December 31, 2010. Data were retrieved from laboratory record books and double entered into a Microsoft® excel spreadsheet.ResultsRecords of 4,955 cerebrospinal fluid samples were analysed. Of these, 163 (3.3%, 95%CI: 2.8% to 3.8%) were confirmed meningitis and 106 (2.1%, 95%CI: 1.7% to 2.6%) were probable meningitis cases. Confirmed meningitis cases were made up of 117 (71.8%) culture positive bacteria, 19 (11.7%) culture positive Cryptococcus neoformans and 27(16.6%) Gram positive bacteria with negative culture. The most prevalent bacteria was Streptococcus pneumoniae 91 (77.7%), followed by E.coli 4 (3.4%), Salmonella species 4 (3.4%), Neisseria meningitidis 3 (2.5%), Pseudomonas species 3(2.5%) and others. Pneumococcal isolates susceptibility to penicillin, chloramphenicol and ceftriaxone were 98.9% (95%CI: 94.0% to 100.0%), 83.0% (95%CI: 73.4% to 90.1%) and 100.0% (95%CI: 95.8% to 100.0%) respectively.ConclusionStreptococcus pneumoniae is an important cause of meningitis among all age groups and its susceptibility to pen

  Microbiologie (bactériologie, virologie)ImmunologiePharmacologieLicence : http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Lien vers la sourceArticle

  Affections ostéo-articulaires des membres supérieurs dues aux vibrations - Histo-anatomie et physiopathologie

  F.X. Ley

  Les affections ostéo-articulaires des membres supérieurs, dues aux vibrations, procèdent de deux mécanismes physiopathologiques. - Un mécanisme vasculaire artéritique, aggravé par l'anatomie vasculaire précaire du semi-lunaire, qui, dans 30 % des cas, se présente comme ayant une vascularisation de type terminal? Ce mécanisme abouti à une nécrose puis à une fibrose cicatricielle de cet os. Le scaphoïde quant à lui possède une riche vascularisation anastomotique interne et externe ; cela explique la relative rareté de la maladie de KOHLER qui serait plutôt liée à la traumatologie de cet os. - Un mécanisme lié à l'histo-anatomie fonctionnelle : les tissus de soutien (os, cartilage, muscle, ligaments...), dérivés du mésenchyme primitif, conservent, lors de leur évolution, leur parenté ainsi que leurs potentialités structurelles, dès lors que leurs conditions d'utilisation de modifient sous l'effet des forces de pression, de traction ou de glissement. L'ostéophytose péri-articulaire décrite dans les lésions du coude attribuées aux vibrations procède d'une transformation cartilagineuse des fibrocytes des ligaments, des tendons ou de la capsule articulaire qui, au point de convergence des forces générées par les vibrations, laissent apparaître une ossification desmale.

  SémiologieMaladies infectieuses et tropicalesMédecine interne (cardiologie, endocrinologie, néphrologie…)Licence : https://creativecommons.org/publicdomain/zero/1.0/

  Lire dans MyLaafi
• Article libreArticle

  Affects de la mère pendant la grossesse, relation mère-bébé, santé et développement du nourrisson à Kinshasa

  Daniel Okitundu Luwa E-Andjafono, Brigitte Imbula Essam, Adelin N´situ Mankubu, Ally Ndjukendi Omba, Timothée Kamanga Mbuyi

  Introductionle rôle de l´affectivité maternelle prénatale dans le développement du nourrisson est peu documenté dans notre milieu. L´objectif de cette étude était de déterminer les liens entre les sentiments de la mère à la connaissance de la grossesse, la peur de l´accouchement, la relation mère-bébé et le développement du nourrisson.Méthodesen consultations préscolaires à Kinshasa, 120 mères âgées de 28,4 ans (± 12,18 ans), portant des bébés de 1 à 10 mois, ont participé à une étude transversale, par entretien et questionnaire, sur la relation mère-bébé, le comportement, la santé et le développement du bébé et l´affectivité maternelle. Les échelles de dépression maternelle postnatale d´Edimbourg (l´EPDS), de dépression et anxiété de Goldberg et les critères DSM-IV de dépression ont été utilisées. Il y a eu recours aux tests de Khi-carré et Mann-Whitney dans l´analyse statistique.Résultatsl´absence de joie relative à la grossesse était associée à la grossesse non désirée (p<0,001), l´absence du soutien du père de l´enfant (p=0,011), l´ennui au portage du bébé frustré (p=0,046), la conso labilité difficile du bébé (p<0,001), le comportement non affiliatif du bébé né d´une grossesse désirée (p=0 ,034), la santé infantile moins bonne (p=0 ,010) et la dépression maternelle (EPDS) (p=0,043). La peur de l´accouchement était associée au déficit de réponses aux signaux du bébé (p=0 ,002) et la tension au portage du bébé frustré (p=0,02).Conclusionles affects négatifs pendant la grossesse prédiraient des troubles de la relation mère-bébé, de la santé et du développement du nourrisson.

  PédiatrieGynécologie-obstétriqueLicence : https://creativecommons.org/licenses/by/4.0/ The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (), which permits unrestricted use, distribution, and reproduction in any medium, p

  Lire dans MyLaafi
• Article libreArticle

  Afibrinogénémie congénitale: à propos d’une observation

  Karim Assani, Lamya Karboubi, Badr Sououd Benjelloun Dakhama

  L’afibrinogénémie est une dyscrasie rare caractérisée par un déficit constitutionnel en fibrinogène. Elle se transmet sur un mode autosomique récessif. Les manifestations hémorragiques sont variables et peuvent mettre en jeu le pronostic vital. Un peu plus de 250 cas ont été publiés à nos jours. Nous rapportons un nouveau cas d’afibrinogénémie congénitale chez une enfant de 3 ans et demi hospitalisée pour hématémèse de moyenne abondance. A travers ce cas, nous rappelons les différents aspects de cette affection sur les plans clinique, biologique, génétique ainsi que thérapeutique.

  Biologie cellulaire et moléculaireGénétiquePédiatrieLicence : The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Aflatoxin Contamination of Maize, Groundnut, and Sorghum Grown in Burkina Faso, Mali, and Niger and Aflatoxin Exposure Assessment

  Titilayo D. O. Falade, Adama Neya, Saïdou Bonkoungou, Karim Dagno, Adamou Basso, Amadou Lamine Senghor, Joseph Atehnkeng, Alejandro Ortega-Beltran, Ranajit Bandyopadhyay

  Aflatoxin contamination of staple crops by Aspergillus flavus and closely related fungi is common across the Sahel region of Africa. Aflatoxins in maize, groundnut, and sorghum collected at harvest or from farmers’ stores within two weeks of harvest from Burkina Faso, Mali, and Niger were quantified. Thereafter, aflatoxin exposure values were assessed using per capita consumption rates of those crops. Mean aflatoxin concentrations in maize were high, 128, 517, and 659 µg/kg in Mali, Burkina Faso, and Niger, respectively. The estimated probable daily intake (PDI) of aflatoxins from maize ranged from 6 to 69, 29 to 432, and 310 to 2100 ng/kg bw/day in Mali, Burkina Faso, and Niger, respectively. Similarly, mean aflatoxin concentrations in sorghum were high, 76 and 259 µg/kg in Mali and Niger, respectively, with an estimated PDI of 2–133 and 706–2221. For groundnut, mean aflatoxin concentrations were 115, 277, and 628 µg/kg in Mali, Burkina Faso, and Niger, respectively. Aflatoxin exposure values were high with an estimated 9, 28, and 126 liver cancer cases/100,000 persons/year in Mali, Burkina Faso, and Niger, respectively. Several samples were extremely unsafe, exceeding manyfold regulatory levels of diverse countries (up to 2000 times more). Urgent attention is needed across the Sahel for integrated aflatoxin management for public health protection, food and nutrition security, and access to trade opportunities.

  Santé publiqueLicence : https://creativecommons.org/licenses/by/4.0/ Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ().

  Lire dans MyLaafi
• Article libreArticleEn anglais

  African isolates show a high proportion of multiple copies of the Plasmodium falciparum plasmepsin-2 gene, a piperaquine resistance marker

  Didier Leroy, Fiona Macintyre, Yeka Adoke, Serge Ouoba, Aissata Barry, Ghyslain Mombo-Ngoma, Jacques Mari Ndong Ngomo, Rosauro Varo, Yannelle Dossou, Antoinette Kitoto Tshefu, Tran Thanh Duong, Bui Quang Phuc, Bart Laurijssens, Roland Klopper, Nimol Khim, Eric Legrand, Didier Ménard

  BackgroundToday, the development of new and well-tolerated anti-malarial drugs is strongly justified by the emergence of Plasmodium falciparum resistance. In 2014–2015, a phase 2b clinical study was conducted to evaluate the efficacy of a single oral dose of Artefenomel (OZ439)–piperaquine (PPQ) in Asian and African patients presenting with uncomplicated falciparum malaria.MethodsBlood samples collected before treatment offered the opportunity to investigate the proportion of multidrug resistant parasite genotypes, including P. falciparum kelch13 mutations and copy number variation of both P. falciparum plasmepsin 2 (Pfpm2) and P. falciparum multidrug resistance 1 (Pfmdr1) genes.ResultsValidated kelch13 resistance mutations including C580Y, I543T, P553L and V568G were only detected in parasites from Vietnamese patients. In Africa, isolates with multiple copies of the Pfmdr1 gene were shown to be more frequent than previously reported (21.1%, range from 12.4% in Burkina Faso to 27.4% in Uganda). More strikingly, high proportions of isolates with multiple copies of the Pfpm2 gene, associated with piperaquine (PPQ) resistance, were frequently observed in the African sites, especially in Burkina Faso and Uganda (> 30%).ConclusionsThese findings were considered to sharply contrast with the recent description of increased sensitivity to PPQ of Ugandan parasite isolates. This emphasizes the necessity to investigate in vitro susceptibility profiles to PPQ of African isolates with multiple copies of the Pfpm2 gene and estimate the risk of development of PPQ resistance in Africa.Trial registration Clinicaltrials.gov reference: NCT02083380. Study title: Phase II efficacy study of artefenomel and piperaquine in adults and children with P. falciparum malaria. https://clinicaltrials.gov/ct2/results?cond=&term=NCT02083380&cntry=&state=&city=&dist=. FSFV: 23-Jul-2014; LSLV: 09-Oct-2015

  Microbiologie (bactériologie, virologie)Parasitologie et mycologiePharmacologieLicence : Open Access http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/publicdomain/zero/1.0/ This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (), which permits unrestricted use, distribution, and reproduction in any medium, provid

  Lire dans MyLaafi
• Lien vers la sourceBase de donnéesEn anglais

  African Journals Online (AJOL)

  AJOL

  La plus grande plateforme de revues scientifiques publiées en Afrique, dont de nombreuses revues de santé en accès libre.

  Santé publiqueMéthodologie de la recherche et thèseLicence : variable

  Lire dans MyLaafi
• Article libreArticleEn anglais

  African meningitis belt pneumococcal disease epidemiology indicates a need for an effective serotype 1 containing vaccine, including for older children and adults

  Bradford D Gessner, Judith E Mueller, Seydou Yaro

  BackgroundPneumococcal conjugate vaccine strategies in GAVI-eligible countries are focusing on infant immunization but this strategy may not be optimal in all settings. We aimed to collect all available population based data on pneumococcal meningitis throughout life in the African meningitis belt and then to model overall meningitis risk to help inform vaccine policy.MethodsAfter a systematic review of literature published from 1970 through the present, we found robust population-based Streptococcus pneumoniae (Sp) meningitis data across age strata for four African meningitis belt countries that included 35 surveillance years spanning from 1970 to 2005. Using these data we modeled disease risk for a hypothetical cohort of 100,000 persons followed throughout life.ResultsSimilar to meningococcal meningitis, laboratory-confirmed pneumococcal meningitis was seasonal, occurring primarily in the dry season. The mean annual Sp meningitis incidence rates were 98, 7.8 to 14, and 5.8 to 12 per 100,000 among persons <1, 1 through 19, and 20 to 99 years of age, respectively, which (in the absence of major epidemics) were higher than meningococcal meningitis incidences for persons less than 1 and over 20 years of age. Mean Sp meningitis case fatality ratios (CFR) among hospitalized patients ranged from 36-66% depending on the age group, with CFR exceeding 60% for all age groups beyond 40 years; depending on the age group, Sp meningitis mortality incidences were 2 to 12-fold greater than those for meningococcal meningitis. The lifetime risks of pneumococcal meningitis disease and death were 0.6% (1 in 170) and 0.3% (1 in 304), respectively. The incidences of these outcomes were highest among children age <1 year. However, the cumulative risk was highest among persons age 5 to 59 years who experienced 59% of pneumococcal meningitis outcomes. After age 5 years and depending on the country, 59-79% of meningitis cases were caused by serotype 1.ConclusionsIn the African meningitis be

  Biostatistiques et épidémiologieMicrobiologie (bactériologie, virologie)ImmunologieLicence : http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  African-specific polymorphisms in Plasmodium falciparum serine repeat antigen 5 in Uganda and Burkina Faso clinical samples do not interfere with antibody response to BK-SE36 vaccination

  Nobuko Arisue, Nirianne Marie Q. Palacpac, Edward H. Ntege, Adoke Yeka, Betty Balikagala, Bernard N. Kanoi, Edith Christiane Bougouma, Alfred B. Tiono, Issa Nebie, Amidou Diarra, Sophie Houard, Flavia D’Alessio, Odile Leroy, Sodiomon B. Sirima, Thomas G. Egwang, Toshihiro Horii

  BK-SE36, based on Plasmodium falciparum serine repeat antigen 5 (SERA5), is a blood-stage malaria vaccine candidate currently being evaluated in clinical trials. Phase 1 trials in Uganda and Burkina Faso have demonstrated promising safety and immunogenicity profiles. However, the genetic diversity of sera5 in Africa and the role of allele/variant-specific immunity remain a major concern. Here, sequence analyses were done on 226 strains collected from the two clinical trial/follow-up studies and 88 strains from two cross-sectional studies in Africa. Compared to other highly polymorphic vaccine candidate antigens, polymorphisms in sera5 were largely confined to the repeat regions of the gene. Results also confirmed a SERA5 consensus sequence with African-specific polymorphisms. Mismatches with the vaccine-type SE36 (BK-SE36) in the octamer repeat, serine repeat, and flanking regions, and single-nucleotide polymorphisms in non-repeat regions could compromise vaccine response and efficacy. However, the haplotype diversity of SERA5 was similar between vaccinated and control participants. There was no marked bias or difference in the patterns of distribution of the SE36 haplotype and no statistically significant genetic differentiation among parasites infecting BK-SE36 vaccinees and controls. Results indicate that BK-SE36 does not elicit an allele-specific immune response.

  Biologie cellulaire et moléculaireGénétiqueParasitologie et mycologieLicence : This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journa

  Lire dans MyLaafi
• Article libreArticleEn anglais

  After surgery: the effects of life-saving caesarean sections in Burkina Faso

  Véronique Filippi, Rasmané Ganaba, Clara Calvert, Susan F. Murray, Katerini T. Storeng

  BackgroundIn African countries, caesarean sections are usually performed to save mothers and babies’ lives, sometimes in extremis and at considerable costs. Little is known about the health and lives of women once discharged after such surgery. We investigated the long-term effects of life-saving caesarean section on health, economic and social outcomes in Burkina Faso.MethodsWe conducted a 4 year prospective cohort study of women and their babies using mixed methods. The quantitative sample was selected in seven hospitals and included 950 women: 100 women with a caesarean section associated with near-miss complication (life-saving caesareans); 173 women with a vaginal birth associated with near-miss complication; and 677 women with uncomplicated vaginal childbirth. Structured interviews were conducted at 3 months, 6 months, 12 months and 3 and 4 years postpartum. These were supplemented by medical record data on delivery and physical examinations at 6 and 12 months postpartum. The lives and experiences of 21 women were documented ethnographically. Data were analysed with multivariable logistic regressions, using survival analysis and thematic analysis.ResultsThe physical effects of life-saving caesareans appeared to be similar to women who had an uncomplicated childbirth, although 55 % of women with life-saving caesareans had another caesarean in their next pregnancy. The negative effects were generally economic, social and reproductive when compared to vaginal births, including increased debts (AOR = 3.91 (1.46–10.48) and sexual violence (AOR = 4.71 (1.04–21.3)) and lower fertility (AOR = 0.44 (0.24–0.80)) 4 years after life-saving caesareans. In the short and medium term, women with life-saving caesareans appeared to suffer increased psychological distress compared to uncomplicated births. They were more likely to use contraceptives (AOR = 5.95 (1.53–23.06); 3 months). Mortality of the index child was increased in both near-miss groups, independent of delivery mo

  Biologie cellulaire et moléculaireGénétiqueBiostatistiques et épidémiologieLicence : Open Access http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/publicdomain/zero/1.0/ This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (), which permits unrestricted use, distribution, and reproduction in any medium, provid

  Lire dans MyLaafi
• Article libreArticle

  Age de début de la presbytie chez le sujet noir camerounais

  Stève Robert Ebana Mvogo, Viola Andin Dohvoma, José Stéphanie Ngassam Fangwa, Caroline Mvilongo Tsimi, Marie Evodie Akono Zoua, Marie Blanche Nguena, Epee Emilienne, Ellong Augustin, Ebana Mvogo Côme

  IntroductionLa prescription d'une addition dans notre pratique n'est pas rare chez les patients de moins de 40 ans. Nous avons recherché le besoin d'une addition après étude objective de la réfraction et partant déterminer l'âge moyen de début de la presbytie.MéthodesNous avons mené une étude transversale et descriptive à l'Hôpital Central de Yaoundé durant trois mois chez les patients âgés de 35 à 45 ans. Ils ont tous bénéficié d'une étude objective de la réfraction sous cycloplégie. La correction de la vision de loin était faite sous cycloplégie, alors que l'addition en vison de près était évaluée deux jours plus tard lorsque la cycloplégie n'était plus effective. La prescription probable d'une addition à la correction de loin devait être réalisée 2 jours après la cycloplégie. L'analyse statistique a été faite avec le logiciel IBM SPSS 20.0.RésultatsNous avons examiné 55 patients soit 110 yeux. L'âge moyen des patients était de 41,87±2,5 ans, avec un sex-ratio de 0,28 en faveur des femmes. L'astigmatisme hypermétropique était l'amétropie la plus fréquente avec 58,2% de cas suivi de l'hypermétropie avec 24,6%. Nous n'avons retrouvé aucun sujet myope. L'âge moyen de début de la presbytie dans cette tranche d'âge était de 43,2±1,7 ans. Après correction objective en vision de loin, aucun patient n'avait besoin d'une addition avant 40 ans. Par ailleurs, 4 patients sur 10 avec une amétropie hypermétropique n'ont pas besoin d'addition avant 45 ans. La prescription d'une addition était liée de façon significative à l'âge.ConclusionL'âge moyen de début de la presbytie est de 43,2±1,7 ans. Avant 45 ans, toute prescription d'une addition doit être précédée d'une étude objective de la réfraction.

  Licence : The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Lien vers la sourceArticle

  Âge et taux de létalité des maladies infectieuses.

  Gabriele Sorci, Bruno Faivre

  SémiologieMaladies infectieuses et tropicalesMédecine interne (cardiologie, endocrinologie, néphrologie…)Licence : https://creativecommons.org/licenses/by/4.0/

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Age-modified factors associated with placental malaria in rural Burkina Faso

  Biébo Bihoun, Serge Henri Zango, Maminata Traoré-Coulibaly, Innocent Valea, Raffaella Ravinetto, Jean Pierre Van Geertruyden, Umberto D’Alessandro, Halidou Tinto, Annie Robert

  BackgroundMalaria in pregnancy can result in placental infection with fetal implications. This study aimed at assessing placental malaria (PM) prevalence and its associated factors in a cohort of pregnant women with peripheral malaria and their offspring.MethodThe data were collected in the framework of a clinical trial on treatments for malaria in pregnant women . Placental malaria (PM) was diagnosed by histopathological detection of parasites and/or malaria pigment on placenta biopsies taken at delivery. Factors associated with PM were assessed using logistic regression.ResultsOut of 745 biopsies examined, PM was diagnosed in 86.8 % of women. Acute, chronic and past PM were retrieved in 11 (1.5 %), 170 (22.8 %), and 466 (62.6 %) women, respectively. A modifying effect was observed in the association of gravidity or anemia at the study start with pooled PM (presence of parasites and/or malaria pigment). In women under 30, gravidity ≤ 2 was associated with an increased prevalence of pooled PM but in women aged 30 years or more, gravidity was no more associated with pooled PM (OR 6.81, 95 % CI 3.18 – 14.60; and OR 0.52, 95 % CI 0.10 – 2.76, respectively). Anemia was associated with pooled PM in women under 30 (OR 1.96, 95 % CI 1.03 – 3.72) but not in women aged 30 years or more (OR 0.68, 95 % CI 0.31 – 1.49). Similarly, the association of gravidity with past-chronic PM depended also on age. A higher prevalence of active PM was observed in women under 30 presenting with symptomatic malaria (OR 3.79, 95 % CI 1.55 – 9.27), while there was no significant increase in the prevalence of active PM (presence of parasites only) in women with symptomatic malaria when aged 30 years or more (OR 0.42, 95 % CI 0.10 – 1.75). In women with chronic PM, the prevalence of low birth weight or prematurity was the highest (31.2 %) as compared with past PM or no PM.ConclusionDespite the rapid diagnosis and efficacious treatment of peripheral infection, the prevalence of placental malaria re

  Biostatistiques et épidémiologieParasitologie et mycologieHématologieLicence : Open Access http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/publicdomain/zero/1.0/ This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Age-related patterns of early childhood development practices amongst rural families in Burkina Faso: findings from a nationwide survey of mothers of children aged 0-3 years

  Jennifer Hollowell, Mireille Belem, Tessa Swigart, Joanna Murray, Zelee Hill

  ABSTRACTBackgroundAround two thirds of children in Sub-Saharan Africa are at risk of not meeting their developmental potential. Scalable interventions, based on an understanding of local contexts, that promote nurturing care in children’s early years are needed.ObjectivesTo investigate age-related patterns of Early Childhood Development (ECD) practices amongst caretakers of children aged 0–3 years in rural households in Burkina Faso, in order to inform the design of a mass media campaign to be evaluated through a randomized controlled trial.MethodsA household survey using a structured questionnaire was used to collect data from 960 rural mothers of children aged 0–3 years in a regionally stratified random sample of 130 villages.ResultsThe mother was the main caretaker and engaged most in ECD-related activities at all ages (0–3 years). The father, grandmother and older children also engaged in ECD-related activities with older children (aged 1–3 years). Singing and playing occurred moderately frequently. Singing in the last three days: 36% at age 0–5 months increasing to 84% at age 3 years; playing in the last three days: 26% at age 0–5 months, increasing to 65% at age 3 years. Activities such as reading, counting, drawing, ‘showing and naming’ and ‘chatting’ were limited, particularly in the child’s first year. Reasons for not engaging in these activities include lack of literacy, lack of books and toys or playthings and a belief that the child was too young.ConclusionOpportunities for learning, especially through verbal interactions, appeared to be limited during the developmentally crucial first three years, most notably in the first year of life. The challenge for ECD intervention development in Burkina Faso will be finding ways to promote more responsive interactions at an early age and finding ways of mobilizing other family members to become more engaged in stimulating activities in the child’s early years.

  Biostatistiques et épidémiologiePédiatrieSanté publiqueLicence : http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Age-structured non-pharmaceutical interventions for optimal control of COVID-19 epidemic

  In an epidemic, individuals can widely differ in the way they spread the infection depending on their age or on the number of days they have been infected for. In the absence of pharmaceutical interventions such as a vaccine or treatment, non-pharmaceutical interventions (e.g. physical or social distancing) are essential to mitigate the pandemic. We develop an original approach to identify the optimal age-stratified control strategy to implement as a function of the time since the onset of the epidemic. This is based on a model with a double continuous structure in terms of host age and time since infection. By applying optimal control theory to this model, we identify a solution that minimizes deaths and costs associated with the implementation of the control strategy itself. We also implement this strategy for three countries with contrasted age distributions (Burkina-Faso, France, and Vietnam). Overall, the optimal strategy varies throughout the epidemic, with a more intense control early on, and depending on host age, with a stronger control for the older population, except in the scenario where the cost associated with the control is low. In the latter scenario, we find strong differences across countries because the control extends to the younger population for France and Vietnam 2 to 3 months after the onset of the epidemic, but not for Burkina Faso. Finally, we show that the optimal control strategy strongly outperforms a constant uniform control exerted over the whole population or over its younger fraction. This improved understanding of the effect of age-based control interventions opens new perspectives for the field, especially for age-based contact tracing. Author summaryCOVID-19 infected individuals differ in the way they spread the infection depending on their age or on the number of days elapsed since the contamination. This individual heterogeneity can impact the design of public health control measures to contain epidemics. Using optimal control t

  ImmunologieSanté publiqueLicence : Creative Commons Attribution License This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  Lire dans MyLaafi
• Article libreArticleEn anglais

  Age, Weight, and CYP2D6 Genotype Are Major Determinants of Primaquine Pharmacokinetics in African Children

  Bronner P. Gonçalves, Helmi Pett, Alfred B. Tiono, Daryl Murry, Sodiomon B. Sirima, Mikko Niemi, Teun Bousema, Chris Drakeley, Rob ter Heine

  ABSTRACTLow-dose primaquine is recommended to prevent Plasmodium falciparum malaria transmission in areas threatened by artemisinin resistance and areas aiming for malaria elimination. Community treatment campaigns with artemisinin-based combination therapy in combination with the gametocytocidal primaquine dose target all age groups, but no studies thus far have assessed the pharmacokinetics of this gametocytocidal drug in African children. We recruited 40 children participating in a primaquine efficacy trial in Burkina Faso to study primaquine pharmacokinetics. These children received artemether-lumefantrine and either a 0.25- or a 0.40-mg/kg primaquine dose. Seven blood samples were collected from each participant for primaquine and carboxy-primaquine plasma levels determinations: one sample was collected before primaquine administration and six after primaquine administration according to partially overlapping sampling schedules. Physiological population pharmacokinetic modeling was used to assess the impact of weight, age, and CYP2D6 genotype on primaquine and carboxy-primaquine pharmacokinetics. Despite linear weight normalized dosing, the areas under the plasma concentration-time curves and the peak concentrations for both primaquine and carboxy-primaquine increased with age and body weight. Children who were CYP2D6 poor metabolizers had higher levels of the parent compound, indicating a lower primaquine CYP2D6-mediated metabolism. Our data indicate that primaquine and carboxy-primaquine pharmacokinetics are influenced by age, weight, and CYP2D6 genotype and suggest that dosing strategies may have to be reconsidered to maximize the transmission-blocking properties of primaquine. (This study has been registered at ClinicalTrials.gov under registration no. NCT01935882.)

  Microbiologie (bactériologie, virologie)Parasitologie et mycologiePharmacologieLicence : Creative Commons Attribution 4.0 International license This is an open-access article distributed under the terms of the.

  Lire dans MyLaafi