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Abstract Introduction As part of the implementation of its mission “to integrate hygiene activities into healthcare”, the general directorate of health conducted in 2018 with its technical structures, an evaluation of the implementation of Infection Prevention and Control (IPC) using the WHO IPCAF tool in 30 health-care facilities in the autonomous district of Abidjan. Materials and methods This were a cross-sectional survey with a conceptualized component considering the issue of injection safety and sanitary waste management, which was conducted in the named health-care facilities from March 20 to 28, 2018. The scores of the essential components of the IPC made it possible to assess the IPC level of each health-care facility evaluated and the overall IPCAF score of all facilities. Results The overall median IPCAF score of the health-care facilities was 242.5/800 and corresponded to an inadequate level overall. No facility reached the “advanced” level of performance, 5 facilities (17%) reached the “intermediate” level, 10 (33%) fell into the “basic” level, and 15 (50%) were at the “inadequate” level. Baseline institutions had much higher scores than first contact institutions. Conclusion IPC component activities were inadequate and fragmented in the under-resourced health facilities at the time of the assessment. It would be appropriate to provide adequate resources and develop expertise in IPC through strong political will and leadership. This will contribute to the achievement of universal health insurance objectives with safe health services for patients.

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Many U.S. colleges and universities are concerned with how best to prepare students to become globally competent citizens. Therefore, the need existed to examine the general global competence of students enrolling in international dimension (ID) courses at Oklahoma State University. This investigation was a census study; the target population included all undergraduate students (N = 147) enrolled in three ID courses offered in the College of Agricultural Sciences and Natural Resources (CASNR) during the fall semester of the 2010–2011 academic year. General knowledge instruments were used to gather pretest and posttest data to measure differences. Although students’ post-course scores were higher than pre-course scores, their overall performance was below 60%. This difference in knowledge gain connoting general global competence was statistically significant (p < .05), but the corresponding effect size was small, which signaled little practical significance. Whether ID courses are an efficacious way of achieving substantial change in students’ general global competence remains an open question. A more appropriate method to assess change in general global competence may be writing assignments. Faculty are encouraged to improve their ID courses by infusing learning experiences that stand to enhance students’ general global competence while complementing content-specific objectives.

One of the basic debates in African development is whether agriculture can be the instrument for the transformation of a rural economy. A common question is whether agricultural policies can provide the impetus to move agriculture in developing economies from subsistence to commercial agriculture. Senegal’s Plan Sénégal Emergent (PSE) provides a data point in this discussion. Senegal and international donors invested in agricultural supply chains starting in 2012 to facilitate the emergence of commercial agriculture for peanuts, rice, and vegetables. This study focuses on these investments in the Senegal River Valley of northern Senegal. The empirical results presented in this study provide evidence that farms in the Senegal River Valley impacted by PSE have moved away from subsistence agriculture by planting more hectares in commercial crops.

Food Deficiency in the Sangha Region - Congo. The problem of food shortage in Sangha region is accompanied by alarming paradoxes. The region offers extremely favorable conditions for the development of agriculture : equatorial climate with abundance of rains and sun, a lot of uncultivated areas, a lot rivers, etc. Despite these advantages, food crops production is insignificant in the light of the very high infant mortality in the area 17.5 % (6), a death rate which is often bound with malnutrition. Contrary to what is commonly admitted, this food shortage is caused neither by natural obstacles nor by a certain passivity or immobility among peasants but by bad agricultural politic in the region. This article investigates these paradoxes and suggests in the same way a frame of analyses and orientations which could help overcome the regions savers food shortage.

Some considerations on restraining the decline in the rural population in the Popular Republic of Congo. A review of the trend of demographie movement in the Congo since the independence shows a growing urbanization. The number of people involved in farm activites have kept decreasing. However in recent times there is a transition back to agriculture which has to be encouraged in order to put an end to the decline of the rural population.

Background: Age estimation by invasive dental methods is a destructive, costly and time-consuming approach, whereas, age estimation methods using dental radiographs are simple, non-destructive and provide reliable information. Age estimation by the Kvaal radiographic method has proven to be a reliable method, but possible ethnic variations may limit its uses in other populations. The objective of this study was to reproduce the original Kvaal method with CBCT for the estimation of the age of the adult melano-African subject in Côte d'Ivoire, in order to propose an age estimation formula, specific to our study population, by taking into account the measurements of tooth and pulp ratios., Methods: A cross-sectional study used 102 radiographic data from a CBCT Planmeca® examination in a private dental clinic in Abidjan. It was data from subjects of at least 18 years of age. Dental measurements in length and width of the entire tooth, root and pulp were performed on maxillary central incisors and the different ratios were calculated according to the Kvaal method. The correlation between age and ratios was also assessed. Age estimated using the Kvaal formula was compared to the chronological age. A linear regression equation was developed using ratios and age predictive factors to evaluate the accuracy of the Kvaal formula., Results: In all, a total of 102 radiographs of 102 subjects, of whom 55 (53.9%) were females, were analyzed. The median age was 51 years (inter-quartile range [IQR] 41- 58). Using the Kvaal formula, the Standard error of the estimated age was higher in the African melanoderma population compared to the Kvaal population. The new formula derived from that of the Kvaal formula was developed and applied to our study population (Age = 84.7- 114.2 (M) - 29.4 (W - L) gave more than double the standard error of estimated age by Kvaal (26.03)., Conclusion: Our study showed that the measurements made by Kvaal are reproducible with CBCT and there is a correlation between age and the dental parameters studied. However, the age estimation formula determined by Kvaal et al. is not valid for African melanoderma subjects living in Côte d'Ivoire.

Objectives: Discriminatory attitudes (DA) of dental surgeons towards PLWHIV may hinder their access to oral health care. The objective of this study was to identify the factors associated with the discriminatory attitudes of dentists towards PLHIV in C&#244;te d&#8217;Ivoire., Methods: This was a cross-sectional study conducted on a randomly selected sample of dentists in Abidjan. The data collected were: their socio-professional characteristics, their knowledge of HIV/AIDS, their perceptions and attitudes towards PLWHIV, and whether they had received continuing education or sensitization on HIV/AIDS. Discriminatory attitudes was a binary variable, defined from the combination of four criteria. Numbers and percentages were calculated for all variables. The risk of having DA was estimated by the odds ratio., Results: A total of 120 dentists were surveyed, 43.3% of whom were women and 39.2% from the private sector. They did not know the routes of transmission (29.2%) and the oral pathologies associated with HIV (62.5%). Their perceptions were dominated by the fear of being contaminated during care (69.2%). The frequency of DA was estimated at 69.2%. The main associated factors were: female gender; lack of knowledge of HIV/AIDS-related oral pathologies, lack of the risk of HIV transmission after blood exposure accident, and ignorance of the existence of a law on the protection of PLWHA; and fear of being contaminated., Conclusion: This study reveals that the DA of dental surgeons with regard to PLWHIV in C&#244;te d&#8217;Ivoire are mainly the result of poor knowledge of the disease.

Background: Health information systems are crucial to provide data for decision-making and demand for data is constantly growing. However, the link between data and decisions is not always rational or linear and the management of data ends up overloading frontline health workers, which may compromise quality of healthcare delivery. Despite limited evidence, there is an increasing push for the digitalization of health information systems, which poses enormous challenges, particularly in remote, rural settings in low- and middle-income countries. Paper-based tools will continue to be used in combination with digital solutions and this calls for efforts to make them more responsive to local needs. Paper-based Health Information Systems in Comprehensive Care (PHISICC) is a transdisciplinary, multi-country research initiative to create and test innovative paper-based health information systems in three sub-Saharan African countries., Methods/design: The PHISICC initiative is being carried out in remote, rural settings in Côte d'Ivoire, Mozambique and Nigeria through partnership with ministries of health and research institutions. We began with research syntheses to acquire the most up-to-date knowledge on health information systems. These were coupled with fieldwork in the three countries to understand the current design, patterns and contexts of use, and healthcare worker perspectives. Frontline health workers, with designers and researchers, used co-creation methods to produce the new PHISICC tools. This suite of tools is being tested in the three countries in three cluster-randomized controlled trials. Throughout the project, we have engaged with a wide range of stakeholders and have maintained the highest scientific standards to ensure that results are relevant to the realities in the three countries., Discussion: We have deployed a comprehensive research approach to ensure the robustness and future policy uptake of findings. Besides the innovative PHISICC paper-based tools, our process is in itself innovative. Rather than emphasizing the technical dimensions of data management, we focused instead on frontline health workers' data use and decision-making. By tackling the whole scope of primary healthcare areas rather than a subset of them, we have developed an entirely new design and visual language for a suite of tools across healthcare areas. The initiative is being tested in remote, rural areas where the most vulnerable live., (© 2021. The Author(s).)

Introduction: Front-line health workers in remote health facilities are the first contact of the formal health sector and are confronted with life-saving decisions. Health information systems (HIS) support the collection and use of health related data. However, HIS focus on reporting and are unfit to support decisions. Since data tools are paper-based in most primary healthcare settings, we have produced an innovative Paper-based Health Information System in Comprehensive Care (PHISICC) using a human-centred design approach. We are carrying out a cluster randomised controlled trial in three African countries to assess the effects of PHISICC compared with the current systems., Methods and Analysis: Study areas are in rural zones of Côte d'Ivoire, Mozambique and Nigeria. Seventy health facilities in each country have been randomly allocated to using PHISICC tools or to continuing to use the regular HIS tools. We have randomly selected households in the catchment areas of each health facility to collect outcomes' data (household surveys have been carried out in two of the three countries and the end-line data collection is planned for mid-2021). Primary outcomes include data quality and use, coverage of health services and health workers satisfaction; secondary outcomes are additional data quality and use parameters, childhood mortality and additional health workers and clients experience with the system. Just prior to the implementation of the trial, we had to relocate the study site in Mozambique due to unforeseen logistical issues. The effects of the intervention will be estimated using regression models and accounting for clustering using random effects., Ethics and Dissemination: Ethics committees in Côte d'Ivoire, Mozambique and Nigeria approved the trials. We plan to disseminate our findings, data and research materials among researchers and policy-makers. We aim at having our findings included in systematic reviews on health systems interventions and future guidance development on HIS., Trial Registration Number: PACTR201904664660639; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

The objective of this cross-sectional study was to determine the type of care that can be achieved and the epidemiological profile of patients attending the 3 public dental practices in the Haut-Sassandra region, in Côte d'Ivoire. The data collection concerned socio-demographic characteristics, reason for consultation, oral hygiene, dental condition, malocclusions and the availability of equipment for the performance of procedures. The 400 patients observed (51.5% male) were aged 16.0 to 86.0 years (mean=35.5 years; SD=13.1 years). The main reasons for consultation were pain (91.5%) and aesthetics (23.5%). Oral hygiene was insufficient for 36.8% of subjects. Oral conditions were malocclusions (12.8%), caries (98.7%) and edentulous (65.7%) with only 11.8% with prosthesis. The average DMFT index was 9.3. Only extractions and resin attached prostheses were possible in all 3 health facilities. Preventive dentistry (sealent, fluoridation), dentofacial orthopedics and implantology were not available in any dental practice. The most frequently performed acts were extractions (74.5%). The results of this study highlight the need for oral health planning with service equipment and awareness among populations who shouldn't wait until they are in pain to consult., Competing Interests: Conflict of interest: the authors declare no potential conflict of interests., (©Copyright: the Author(s), 2019.)

Background: In Côte d'Ivoire, maternal health service utilization indicators remain low despite improvements in health coverage and the availability of free health care for pregnant women. The objective of the study was to identify the determinants associated with the use of maternal health services in the department of Bloléquin, in western Côte d'Ivoire., Methods: We conducted a cross-sectional study with an analytical focus. The study sample size was 400 women. Study participants were selected through a two-stage cluster survey. The data were collected using a standardized questionnaire whose items concerned socio-demographic data, the different uses of maternal health services, namely childbirth assisted by a health professional, use of family planning, prenatal consultation and postnatal consultation. Logistic regression was used to investigate factors associated with the use of maternal health services. The significance of the statistical tests was set at 5%. The odds ratios and 95% confidence intervals were calculated and interpreted., Results: The results showed that women made less use of family planning services (OR = 0.4), prenatal consultation (OR = 0.2) and assisted childbirth (OR = 0.2) when they provided the funding for care themselves. Women with monthly incomes above $26.8 used family planning services 4 times more than those with lower incomes. Married women used prenatal consultations 3 times more often than unmarried women (CI 95%  = 1.4-7.3). Desiring pregnancy increased the use of post-natal consultations by 3 times (CI 95%  = 1.5-6.1)., Conclusion: Improving the use of maternal health services in western Côte d'Ivoire requires taking into account women's socio-cultural and economic challenges. In initiatives related to the financial empowerment of women, efforts must be made at the level of emotional considerations related to pregnancy.

Introduction: Do health facilities (HF) have basic resources needed to manage malaria? The purpose of our study was to analyze the operational capacity (OC) of first-line health facilities in Ivory Coast in the management of malaria., Methods: SARA methodology was used to conduct a descriptive cross-sectional study from 10 to 30 July 2016. The operational capacity in the management showed an average availability of 9 identification tracers divided in 3 areas: (i) staff and guidelines; (ii) capacity of diagnosis; (iii) drugs and products. This operational capacity was assessed through the calculation of an index and then compared with the health facilities according to the management authority and the geographical area using Chi-square test with p-values α fixed at 0.05., Results: Out of 818 HFs, 651(79.6%) were in the public sector and 487(59.5%) were located in the rural area. The operational capacity of first line health facilities was 74.5%. This OC was higher in the public sector (81.3%) than in the private sector (48.8%) (p < 10 -3 ) as well as in the rural area (82.7%) compared to the urban area (62.9%) (p < 10 -3 )., Conclusion: In 2016, first line health facilities in Ivory Coast had basic resources needed to manage malaria. It is necessary to focus on the need to strengthen health facility services in addition to prevention., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts., (© David Guanga Meless et al.)

The title compound, C 17 H 18 N 2 O 3 , is constructed from a benzodiazepine ring system linked to a pendant di-hydro-pyran ring, where the benzene and pendant di-hydro-pyran rings are oriented at a dihedral angle of 15.14 (4)°. Intra-molecular N-H Diazp ⋯O Dhydp and C-H Diazp ⋯O Dhydp (Diazp = diazepine and Dhydp = di-hydro-pyran) hydrogen bonds link the seven-membered diazepine ring to the pendant di-hydro-pyran ring, enclosing S (6) ring motifs. In the crystal, N-H Diazp ⋯O Dhydp hydrogen bonds link the mol-ecules into infinite chains along [10]. These chains are further linked via C-H Bnz ⋯O Dhydp , C-H Dhydp ⋯O Dhydp and C-H Mth ⋯O Dhydp (Bnz = benzene and Mth = meth-yl) hydrogen bonds, forming a three-dimensional network. The observed weak C-H Diazp ⋯ π inter-action may further stabilize the structure. Hirshfeld surface analysis of the crystal structure indicates that the most important contributions for the crystal packing are from H⋯H (51.1%), H⋯C/C⋯H (25.3%) and H⋯O/O⋯H (20.3%) inter-actions. Hydrogen bonding and van der Waals inter-actions are the dominant inter-actions in the crystal packing.

During infection and inflammation, circulating monocytes leave the bloodstream and migrate into tissues, where they differentiate into macrophages. Macrophages express surface Toll-like receptors (TLRs), which recognize molecular patterns conserved through evolution in a wide range of microorganisms. TLRs play a central role in macrophage activation which is usually associated with gene expression alteration. Macrophages are critical in many diseases and have emerged as attractive targets for therapy. In the following protocol, we describe a procedure to isolate murine peritoneal macrophages using Brewer's thioglycollate medium. The latter will boost monocyte migration into the peritoneum, accordingly this will raise macrophage yield by 10-fold. Several studies have been carried out using bone marrow, spleen or peritoneal derived macrophages. However, peritoneal macrophages were shown to be more mature upon isolation and are more stable in their functionality and phenotype. Thus, macrophages isolated from murine peritoneal cavity present an important cell population that can serve in different immunological and metabolic studies. Once isolated, macrophages were stimulated with different TLR ligands and consequently gene expression was evaluated.

Objectives: The aims of this study were to describe adults' oral health behaviour and identify the sociodemographic determinants that influence people to seek oral care in Côte d'Ivoire, in a context of promoting a more accessible health care system., Methods: The design was a cross-sectional pilot survey undertaken in the department of Dabou, Côte d'Ivoire. A stratified sampling procedure with proportional allocation size was used, based on four different criteria: place of residence; type of dwelling; distance between the chosen locality and the dental clinic; and, the presence of a medical centre in the locality. The sample consisted of 927 people (18 years or older) who were interviewed by questionnaire. Data were collected at face to face interviews, using the method of itineraries., Results: 34% of the population had not accessed a dental practitioner during the past 12 months. The reasons for not seeking care were: self-medication, lack of money and a perception of not needing care. A dentist or a traditional healer had been sought by 33%. The choice of therapy was influenced by educational level and having health insurance (p < 0.05). The main reasons for attending a traditional healer were linked to educational level, the type of dwelling and the participants' place of residence (p < 0.05). Choosing to see a dentist was associated with age, the type of dwelling and the distance between the chosen locality and the dental clinic (p < 0.05, Conclusion: The socioeconomic situation of the participants was a determining factor for seeking care. Improving access to health care should be part of the global fight against poverty and the reduction of social inequalities.

Traditional medicine of which is a part traditional odontology occupies an important place within the African societies. It often constitutes the first appeal (80 % of the population) because of the high cost of the care, the incapacity of the human and material resources but also the faiths of the populations. This reality makes valuation of the traditional odontology a necessity. This study comes within this framework. It's a contribution for a better knowledge of practices and plants used in traditional odontology in Ivory Coast. So, after a presentation of some traditional knowledge's and their fields of application, the authors review studies made on the efficiency of plants in the prevention of tooth decay and the treatment of some oral diseases. The objective of these researches is to elaborate effective and financially affordable traditional improved drugs.

A systemic-pulmonary artery shunt in neonates with decreased pulmonary blood flow is technically demanding. We describe our surgical technique, postoperative management, and results in 19 neonates who underwent a modified Blalock-Taussig shunt between April 2003 and March 2006. Prostaglandin infusion was required in 8 patients who were critically cyanosed, and 5 were on inotropic support preoperatively. A 3.5 or 4.0-mm polytetrafluoroethylene graft was anastomosed with 8/0 polypropylene suture. Postoperatively, systemic pressure was kept slightly higher than normal, and heparin was started early. One patient required revision of the shunt, and one was reexplored for bleeding. There were 2 hospital deaths (mortality, 11%) in patients with preoperative hemodynamic instability. The mean follow-up period was 12 months, with no late postoperative shunt blockage or death. Meticulous surgical technique and judicious use of heparin and inotropic agents improved the outcome and reduced the incidence of shunt blockage and reexploration for bleeding.

Abidjan, the economical capital of Ivory Coast has a CAO of 2.7 with index O practically nil. The professional density is one surgeon for 12.000 inhabitants. Abidjan population, despite the requirements in increasing care has not recourse to the dental surgeons for their assumption of responsibility. The general objective of our study is to describe the therapeutic itinerary in odonto-stomatology of the Abidjan population. We have realised a questionnaire survey beside of population sample. The results show that 25 per cent of our population gives up care despite the presence of pain or embarrassment. Our study has allowed highlighting all the other recourses to the care. Indeed, the people who give up the care have much other recourse which has be identified in order of importance: the modern and traditional self-medication. Let us note in our study, that the choice of dental surgeon knows a constant evolution from the first to the third recourse. The lack of financial means constitutes however the first obstacle at the accessibility to the oral care in Ivory Coast.

In Africa, particularly in Ivory-Coast, dental patients present late with life threatening complications. The authors designed a questionnaire to be filled by each patient who presented with serious dental pathology whose only remedy was tooth extraction. Causes of late consultation including financial deprivation, fear of dentist, self medication are some of the factors identified by the authors as the most frequent factors. Dental health education and a comprehensive, social policy are advanced as possible ways of prevention.

In industrialized countries, the prevalence of antibodies to Mycoplasma penetrans is higher among human immunodeficiency virus (HIV)-seropositive homosexuals than other HIV-seropositive and HIV-seronegative groups. In an African heterosexual population, we found a higher prevalence of M. penetrans antibodies in HIV-seronegative blood donors (15.5%) than in France (0.9%) or the United States (0.3%) and a prevalence of 13.4% in HIV-seropositive individuals. HIV-seropositive individuals with less than 5% CD4 cells had a higher prevalence of M. penetrans antibodies than individuals with 5% or more CD4 cells (25.0 versus 8.5%).

A cluster sample survey on tuberculosis has been carried out in Bangui in February 1988. The bimodal distribution of the diameters of IDR on children aged between 5 to 9, gives evidence of a circulation of some non typical mycobacteriae and enables to fix the limit of positivity at 14 mm. The prevalence rate of the tuberculotic infection is 7.9 +/- 1.7% in the surveyed children population at school. The annual risk of infection is evaluated at 1.09% that ranks the Centrafrican Republic in the countries with a low prevalence rate.