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Resume Objectif L’objectif de cette etude etait de determiner le portrait des troubles musculosquelettiques chez les tisseuses de pagnes traditionnels au Burkina Faso. Methodes Il s’agit d’une etude de type descriptive et transversale sur 213 tisseuses de pagnes traditionnels burkinabees exercant dans la ville de Ouagadougou. Les analyses statistiques des donnees recueillies ont ete faites a l’aide du logiciel SPSS Statistics 22. Resultats Durant les 12 derniers mois, 98,1 % (n = 209) des personnes incluses ont eu au moins un trouble musculosquelettique et 56,3 % durant les 7 derniers jours (n = 120). Presque toutes les zones corporelles identifiees dans le questionnaire etaient affectees avec, en moyenne, 4,18 ± 2,3 et 1,5 ± 0,5 zones par personne, respectivement pour les 12 derniers mois et les 7 derniers jours. Les parties les plus touchees etaient le bas du dos (76,5 %) et les epaules (70,4 %) pendant les 12 derniers mois, tandis que les chevilles (24,9 %) et les genoux (23 %) etaient les plus affectes au cours des 7 derniers jours. Des correlations de Spearman (moyenne r ≈ 0,30 [p Conclusion Ces resultats revelent que les troubles musculosquelettiques chez les tisseuses constituent une realite et interpellent par rapport a une reflexion sur la sante physique des tisseuses. Niveau de preuve 5.

As of 4 April 2021, a total of 169 cases of cerebral venous sinus thrombosis (CVST) and 53 cases of splanchnic vein thrombosis were reported to EudraVigilance among around 34 million people vaccinated in the European Economic Area and United Kingdom with COVID-19 Vaccine AstraZeneca, a chimpanzee adenoviral vector (ChAdOx1) encoding the spike protein antigen of the SARS-CoV-2 virus. The first report of the European Medicines Agency gathering data on 20 million people vaccinated with Vaxzevria® in the UK and the EEA concluded that the number of post-vaccination cases with thromboembolic events as a whole reported to EudraVigilance in relation to the number of people vaccinated was lower than the estimated rate of such events in the general population. However, the EMA's Pharmacovigilance Risk Assessment Committee concluded that unusual thromboses with low blood platelets should be listed as very rare side effects of Vaxzevria®, pointing to a possible link. The same issue was identified with the COVID-19 Vaccine Janssen (Ad26.COV2.S). Currently, there is still a sharp contrast between the clinical or experimental data reported in the literature on COVID-19 and the scarcity of data on the unusual thrombotic events observed after the vaccination with these vaccines. Different hypotheses might support these observations and should trigger further in vitro and ex vivo investigations. Specialized studies were needed to fully understand the potential relationship between vaccination and possible risk factors in order to implement risk minimization strategies.

Purpose Accurate measures of violence are difficult to obtain from self-reported data because of stigmatization and social undesirability of the topic. Most methods that attempt to reduce such biases require literacy and either remove the benefits of interviewer guidance or do not give individual-level results. We tested a low-tech nonverbal response card that avoids revealing interviewees' responses to interviewers while retaining interviewer support among adolescents in communities with very low educational attainment. Methods As part of a broader health questionnaire, we asked a sample of 1,644 adolescents, aged 12–20 years, in northwestern Burkina Faso about their experiences of physical and sexual violence. We randomized participants to either a conventional verbal response arm or a nonverbal response card arm where respondents' answers were unspoken and not displayed to interviewers. We first evaluated response validity and reliability in each arm, then compared prevalence rates across arms and evaluated whether any differences varied by respondent characteristics using regression models. Results The level of internal reliability of responses among nonverbal respondents was similar to or greater than that of verbal respondents. Nonverbal respondents reported similar patterns of physical assault and sexual debut as verbal respondents but significantly higher levels of sexual assault and forced sex. These differences were broadly similar across sample subgroups defined by age, gender, proneness to social desirability, and mental health. Conclusions Nonverbal response cards offer a practical and beneficial method for reducing underreporting of stigmatized and traumatic experiences while maintaining data quality in low-literacy populations.

SummaryContextIn the current context of residual plasmodium transmission where zoophagic proclivities of Anopheles intervene, we propose to treat peridomestic animals using the endectocide Ivermectin as a complementary approach to bednets. As Ivermectin remanence with classic veterinary compounds is insufficient to induce a significant decrease in vectors’ populations, we developed a long-lasting injectable formulation of ivermectin from the BEPO® technology designed to release insecticidal concentrations of the molecule for 6 months. The work reported here is a proof of concept that using this new technology could help decrease field Anopheles populations.MethodsEight calves were injected with Ivermectin therapeutic doses of 1.2 mg/kg body weight using 2 long lasting formulations (A and B). Efficacy of the product at killing wild derived An. coluzzii has been evaluated by direct-skin feeding assays from 1 to 210 days after injection (DAI). Efficacy on survival was estimated with Cox proportional hazards mixed models and Kaplan meier estimates. To predict efficacy in field-based scenarii, we used a transmission model fed with an entomological model considering different levels for the Anopheles’ zoophagic preference, calves vs humans ratios, and bed net use variables.ResultsThe release at mosquitocidal plasmatic concentrations of Ivermectin during 6 months is confirmed for both formulations (Hazard ratios > 1 for both formulations against their vehicle for 210 days). The Ivermectin concentration allowing to kill 90% of the mosquitoes before the extrinsic incubation period of the parasite is achieved (10 days) are 11 and 9 ng/ml for formulations A and B if the blood meal is taken before the infectious one, and 15 and 13 ng/ml if it was taken after. Modeling showed that Ivermectin treatment of calves using BEPO® technology would reduce infectious vector populations, from at least 35% for most anthropophagic Anopheles in villages where cattle to human ratio is the lowest, to more than 75% if vectors were zoophagic and calves numbers superior to humans’.ConclusionOur study gives the proof of concept that a long-lasting formulation of Ivermectin administered to calves could help decrease field malaria vectors’ populations, which may, ultimately, have an impact at the epidemiological level.

Le Groupe d’intérêt en hémostase périopératoire (GIHP) et le Groupe français d’études sur l’hémostase et la thrombose (GFHT), en collaboration avec la Société française d’anesthésie et de réanimation (SFAR) ont fait des propositions de gestion des agents antiplaquettaires (AAP) pour une procédure invasive programmée. Ces propositions ont été discutées et validées par vote ; toutes sauf une ont fait l’objet d’un accord fort. La gestion des AAP dépend de leur indication et de la procédure considérée. Le risque hémorragique lié à la procédure invasive peut être divisé en bas, intermédiaire ou élevé, selon la possibilité ou non de réaliser la procédure sous traitement (sous respectivement bithérapie antiplaquettaire, aspirine en monothérapie ou aucun AAP). Si une interruption des AAP est indiquée avant la procédure, une dernière prise d’aspirine, clopidogrel, ticagrélor et prasugrel 3, 5, 5 et 7 jours avant la procédure est proposée. Le risque thrombotique associé à l’interruption des AAP doit être évalué en fonction de l’indication des AAP. Il est plus élevé chez les patients traités par bithérapie pour un stent coronaire que chez ceux traités par monothérapie pour une prévention cardiovasculaire, un antécédent d’accident vasculaire cérébral ischémique ou une artériopathie oblitérante des membres inférieurs. Ces propositions concernent aussi le rôle potentiel des tests fonctionnels plaquettaires, la gestion des AAP pour l’anesthésie locorégionale, centrale et périphérique, et pour la chirurgie cardiaque coronaire.

High-density peptide arrays are an excellent means to profile anti-plasmodial antibody responses. Different protein intrinsic epitopes can be distinguished, and additional insights are gained, when compared with assays involving the full-length protein. Distinct reactivities to specific epitopes within one protein may explain differences in published results, regarding immunity or susceptibility to malaria. We pursued three approaches to find specific epitopes within important plasmodial proteins, (1) twelve leading vaccine candidates were mapped as overlapping 15-mer peptides, (2) a bioinformatical approach served to predict immunogenic malaria epitopes which were subsequently validated in the assay, and (3) randomly selected peptides from the malaria proteome were screened as a control. Several peptide array replicas were prepared, employing particle-based laser printing, and were used to screen 27 serum samples from a malaria-endemic area in Burkina Faso, West Africa. The immunological status of the individuals was classified as “protected” or “unprotected” based on clinical symptoms, parasite density, and age. The vaccine candidate screening approach resulted in significant hits in all twelve proteins and allowed us (1) to verify many known immunogenic structures, (2) to map B-cell epitopes across the entire sequence of each antigen and (3) to uncover novel immunogenic epitopes. Predicting immunogenic regions in the proteome of the human malaria parasite Plasmodium falciparum, via the bioinformatics approach and subsequent array screening, confirmed known immunogenic sequences, such as in the leading malaria vaccine candidate CSP and discovered immunogenic epitopes derived from hypothetical or unknown proteins.

Introduction Previous studies in African countries have been suggestive of non-specific effects (NSE) of vaccination on child survival. Live vaccines (e.g. measles, MV) have been found to reduce child mortality while inactivated vaccines (e.g. diphtheria-tetanus-pertussis, DTP) have been associated with increased mortality; NSE were often found to be sex-specific. Methods A case-control study nested into the Health and Demographic Surveillance System (HDSS) cohort of the Centre de Recherche en Sante de Nouna (CRSN) was conducted in northwestern Burkina Faso. A total of 3,010 children born in 2009–11, were included in the study, 375 cases and 2635 age and village matched controls. The main outcome measures were the mortality odds ratios for vaccinated versus unvaccinated children by antigen. The main outcome measures were the mortality odds ratios for vaccinated versus unvaccinated children by antigen. Results Most deaths occurred in late infancy, and there were significantly more deaths in males as compared to females (OR 1.29, CI 1.04–1.60). Overall, there was no statistically significant association between vaccine status and mortality. However, among children in the age group 2–8 months, there was a consistent sex-differential pattern for all doses of oral polio vaccine combined with pentavalent vaccine (OPV + Penta), with the vaccines being associated with lower mortality in boys, but not in girls. Routine MV + yellow fever vaccine was associated with reduced mortality, but only before mass vaccination campaigns with meningitis and measles vaccines took place. Conclusions The findings of this study provide further support on the existence of NSE of childhood vaccinations in a large population of rural Burkina Faso. More randomized controlled trials are needed to confirm these observations.

A large share of the buildings in Europe are old and in need of renovation, both in terms of functional repairs and energy efficiency. While many studies have addressed energy renovation of buildin ...

Resume Depuis 2011, l’experience et les donnees concernant les patients traites par anticoagulants oraux directs (AOD) et beneficiant d’un acte invasif programme se sont enrichies. Dans le meme temps, un accroissement du risque hemorragique lors de la realisation de relais anticoagulants preoperatoires a ete mis en evidence, sans reduction du risque thrombotique. Ces donnees nouvelles conduisent a adapter les propositions emises par le GIHP en 2011. Pour les actes programmes a risque hemorragique faible, il est propose de ne pas prendre d’AOD la veille au soir ni le matin de l’intervention, quel que soit le schema therapeutique du patient ; et de reprendre le traitement selon le schema habituel du patient et au moins 6 heures apres la fin du geste invasif. Pour les actes invasifs a risque hemorragique eleve, il est propose une derniere prise a j–3 pour le rivaroxaban, l’apixaban et l’edoxaban ; une derniere prise de dabigatran a j–4 si la clairance de la creatinine est superieure a 50 mL/min, a j–5 si la clairance est comprise entre 30 et 50 mL/min. Dans le cas de la neurochirurgie intracrânienne et de l’anesthesie neuraxiale, des delais plus longs sont conseilles. Il n’y a plus de place pour les relais anticoagulants ni pour la mesure des concentrations d’AOD sauf situations exceptionnelles.

International audience

In subsistence farming populations of sub-Saharan Africa reliant on rainfed agriculture, years of low crop yields result in poorer child nutrition and survival. Estimates of such impacts are critical for their reduction and prevention. We developed a model to quantify such health impacts, and the degree to which they are attributable to weather variations, for a subsistence farming population in the Nouna district of Burkina Faso (89,000 people in 2010). The method combines data from a new weather-crop yield model with empirical epidemiological risk functions. We quantify the child mortality impacts for 1984-2012 using observed weather data and estimate potential future burdens in 2050 and 2100 using daily weather data generated by global climate models parameterized to simulate global warming of 1.5°C above pre-industrial levels. For 1984-2012, crop yields below 90% of the period average were estimated to result in the total of 109.8 deaths per 10,000 children

Background: Malaria remains one of the most important causes of morbidity and death in Sub-Saharan Africa. Along with early diagnosis and treatment of malaria cases and intermittent preventive treatment in pregnancy (IPTp), vector control is an important tool in the reduction of new cases. Alongside the use of long lasting insecticide treated bed nets (LLINs) and indoor residual spraying (IRS), targeting the vector larvae with biological larvicides such as Bacillus thuringiensis israelensis (Bti) is gaining importance as a means of reducing the number of mosquito larvae before they emerge to their adult stage. With this study, we present data corroborating the entomological impact of such an intervention in a rural African environment. Methods: The study extended over two years and researched the impact of biological larviciding with Bti on malaria mosquitoes that were caught indoors and outdoors of houses using light traps. We calculated the achieved reductions in female Anopheles mosquitoes for two different larviciding choices using a regression model. Findings: In villages that received selective treatment of the most productive breeding sites, the number of female Anopheles spp. dropped by 61% (95% CI: 54%-66%) compared to the pre-intervention period. In villages in which all breeding sites were treated, the number of female Anopheles spp. was reduced by 70% (95% CI: 64%-74%) compared to the pre-intervention period. Interpretation: We showed that malaria vector abundance can be dramatically reduced through larviciding of breeding habitats and that, in many geographical settings, they are a viable addition to current malaria control measures. Trial Registration Information: The study was registered under the trial id PACTR201611001721299 on the Pan African Clinical Trials Registry.. Funding Statement: This work was financed by Manfred Lautenschlager foundation, Wiesloch, Germany. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the ethics committees of the University of Heidelberg under the certificate number S-438/2013 and additionally presented to and granted by the national ethics board of Burkina Faso in Ouagadougou and the local ethics committee at the research site in Nouna. We collected aggregated collective informed consent for the spraying activities for each village.

The process of implementing successful franchise system has received limited attention in the literature. The purpose of our paper is to replicate in France a franchise development model developed in New Zealand that identifies significant sequentially activities in the franchising process. Using a case study approach franchisors in ten French start-up franchisees were interviewed in order to determine how they applied the franchising process identified in the New Zealand study. A quantitative measure is derived as the basis of comparison for different approaches in the two countries. Our findings lend some support for the model, while revealing interesting differences between franchise development in the New Zealand study and the franchising start-up environment in France.

Summary Background Artemisinin-based combination therapies (ACTs) are the recommended first-line treatment for uncomplicated Plasmodium falciparum malaria. Ferroquine is a new combination partner for fast-acting ACTs such as artesunate. We aimed to assess different doses of ferroquine in combination with artesunate against uncomplicated P falciparum malaria in a heterogeneous population in Africa. Methods We did a phase 2, multicentre, parallel-group, double-blind, randomised, dose-ranging non-inferiority trial at eight African hospitals (two in Gabon, three in Burkina Faso, one in Benin, and two in Kenya). We recruited patients presenting with acute P falciparum monoinfection (1000–200 000 parasites per μL), and a central body temperature of at least 37·5°C or history of fever in the past 24 h. We assessed patients in two sequential cohorts: cohort 1 contained adults (bodyweight >50 kg) and adolescents (aged ≥14 years, >30 kg), and cohort 2 contained children (aged 2–13 years, 15–30 kg). We randomly assigned patients (1:1:1:1) to receive artesunate 4 mg/kg per day plus ferroquine 2 mg/kg, 4 mg/kg, or 6 mg/kg, given double-blind once per day for 3 days, or ferroquine monotherapy 4 mg/kg per day given single-blind (ie, allocation was only masked from the patient) once per day for 3 days. We did 14 patient visits (screening, 3 treatment days and 48 h post-treatment surveillance, a visit on day 7, then one follow-up visit per week until day 63). The primary endpoint was non-inferiority of treatment in terms of PCR-corrected cure rate against a reference value of 90%, with a 10% non-inferiority margin, assessed in patients treated without major protocol deviations for parasitologically confirmed malaria. We assessed safety in all treated patients. This study is registered with ClinicalTrials.gov, number NCT00988507, and is closed. Findings Between Oct 16, 2009, and Sept 22, 2010, we randomly assigned 326 eligible patients to treatment groups, with last follow-up visit on Dec 1, 2010. 284 patients (87%) were available for per-protocol analyses. At day 28, PCR-confirmed cure was noted in 68 (97%, 95% CI 90–100) of 70 patients treated with ferroquine 2 mg/kg plus artesunate, 73 (99%, 93–100) of 74 with ferroquine 4 mg/kg plus artesunate, 71 (99%, 93–100) of 72 with ferroquine 6 mg/kg plus artesunate, and 54 (79%, 68–88) of 68 with ferroquine 4 mg/kg monotherapy. The three dose groups of ferroquine plus artesunate met the non-inferiority hypothesis. The most common adverse events were headache in cohort 1 (30 [19%] of 162 patients) and worsening malaria in cohort 2 (23 [14%] of 164 patients); occurrences were similar between treatment groups. Interpretation Ferroquine combined with artesunate was associated with high cure rates and was safe at all doses tested, and could be a promising new drug combination for the treatment of P falciparum malaria. Ferroquine could also partner other drugs to establish a new generation of antimalarial combinations, especially in regions that have developed resistance to ACTs. Funding Sanofi.

Background: Over the past 15 years, scaling up of cost effective interventions resulted in a remarkable decline of under-five mortality rates (U5MR) in sub-Saharan Africa. However, the reduction shows considerable heterogeneity. We assessed the effects of child, maternal, and household interventions on U5MR in Burkina Faso at national and subnational levels and identified the regions with least effective interventions. Methods: Data on health-related interventions and U5MR were extracted from the Burkina Faso Demographic and Health Survey (DHS) 2010. Bayesian geostatistical proportional hazards models with a Weibull baseline hazard were fitted on the mortality outcome. Spatially varying coefficients were considered to assess the geographical variation of the intervention effects. The analyses were adjusted for child, maternal, and household characteristics, as well as climatic and environmental factors. Findings: The average U5MR was as high as 128 per 1000 ranging from 81 (region of Centre-Est) to 223 (region of Sahel). At national level, DPT3, immunization, and baby postnatal check within 24 hours after birth had the most important effect on U5MR (hazard ratio (HR)=0·89, 95% Bayesian credible interval (BCI): 0·86-0·98 and HR=0·89, 95% BCI: 0·86-0·92, respectively). At sub-national level, the most effective interventions are the skilled birth attendance, and improved drinking water, followed by baby post-natal check within 24 hours after birth, vitamin A supplementation, antenatal care visit, and all-antigens immunization (including BCG, Polio3, DPT3, and measles immunization). Centre-Est, Sahel, and Sud-Ouest were the regions with the highest number of effective interventions. There was no intervention with statistically important effect on child survival in the Hauts Bassins region. Interpretation: The spatial variation of health interventions having the strongest effect on changes of U5MR raises the need to deliver and reinforce health interventions at a more granular level. Priority interventions are DPT3 immunization, skilled birth attendance, baby post-natal visits in the regions of Sud-Ouest, Sahel, and Hauts Bassins, respectively. Our methodology could be applied to other national surveys, as it allows an incisive, data-driven and specific decision-making approach to optimize the allocation of health interventions at subnational level. Funding: Swiss National Science Foundation (SNSF; Bern, Switzerland) and Swiss Development Cooperation (SDC; Bern, Switzerland). Declaration of Interest: We declare no competing interests.