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The paper analyses the normative and empirical capacity of elections to function as a peace mechanism in the early stages of the recovery period. Accordingly, the analysis is based on a theoretical framework that draws attention to the timing of elections in postconflict societies. Moreover, in order to operationalize such theoretical aspects, the paper focuses on two relevant case studies: the 1997 elections in Liberia (perceived as postconflict) and the 2020-2021 elections in The Central African Republic (early peace process - not void of conflict). Accordingly, the paper poses the following research questions: How was the prospect of organizing these rounds of election received by the parties involved in the conflict? How did these rounds of election relate to the peace process? Do elections represent an adequate mechanism to achieve positive peace in post-conflict societies. [ABSTRACT FROM AUTHOR]

Abstract: The Central African Republic (CAR) has been a theater of hostilities for decades, in- cluding the Seleka rebellion in December 2012, which caused religious-based discrimination, especially between the Muslim minority and Christian majority. Opportunistic political leaders and armed groups have misused religion for political and egocentric gains in the CAR. The pur- pose of this qualitative content analysis research is to investigate the use of religion for political motives in the CAR and how such actions impact conflict and sectarian divides in the so-called phantom state. The paper recommends ways to mitigate political influence and the misuse of religion by political and armed group actors in the CAR. Very little or no literature on conflict in the CAR has specifically addressed the influence of politics on religion and how it contributes to fueling conflict in the country. This study fills the gaps in the literature by investigating the historical narratives of the CAR conflict while highlighting instances of political abuse of religion. A review of existing literature on the political manipulation of religion establishes the basis for a critical analysis of the influence of politics on religion in the CAR and its impact on conflict. [ABSTRACT FROM AUTHOR]

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While preventive maintenance services have emerged as promising interventions to improve the continuity of water service delivery, the operational and contextual requirements for sustained functionality within maintenance models are not well understood. This paper uses data analysis to better understand factors influencing the success of rural water service delivery within the circuit rider maintenance model in fragile contexts. Incorporating operational data from a large scale circuit rider hand-pump maintenance program in the Central African Republic, mixed-effect logistic regression models were used to identify determinants of water point functionality and payment compliance. Models were informed by data from over 16,000 maintenance visits across nine years. Faster response time, proximity to urban centers, and proximity to other hand-pumps emerged as significant factors for improving water point functionality, while proximity to maintenance program headquarters, pump functionality, and frequency of maintenance visits significantly influenced payment compliance. The observed high functionality rates of hand-pumps serviced by the maintenance program indicates the potential benefits of professionalized maintenance through the circuit rider model at promoting water system reliability in fragile contexts. Despite adaptability and resilience in implementation of the circuit rider model, insecurity and conflict remain barriers to sustaining service delivery in the Central African Republic. [ABSTRACT FROM AUTHOR]

Treatment of acute malnutrition requires novel approaches to improve coverage, reduce costs and improve the efficiency of standard protocols that separate the management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of simplified, combined protocols to treat both MAM and SAM has drawn research and policy interest among global, regional and national stakeholders. However, the perspectives of local communities and health care workers regarding the use of protocols to treat acute malnutrition in a routine health care system are generally lacking. This was a cross‐sectional mixed‐methods study aimed at assessing the perceptions of different stakeholders on the use of a simplified, combined protocol in two districts in the Central African Republic. Most of the respondents preferred the simplified, combined protocol over the standard protocol. They generally agreed that the protocol was easy to understand, allowed more children to receive treatment and was effective in treating acute malnutrition. The protocol modifications were well received, including the expanded admission criteria, use of mid‐upper arm circumference (MUAC) only for admission and discharge criteria and reduced and simplified ready‐to‐use therapeutic food quantity to treat MAM and SAM. Some caregivers expressed concern with the use of MUAC only to declare recovery, flagging that underlying illnesses could still be present. The caregivers recommended the provision of other food basket interventions to improve the treatment. The support by caregivers and health care workers on the idea of training community health volunteers to treat acute malnutrition points to the potential of scaling up decentralized treatment to increase coverage in remote areas. Key messages: The use of the simplified, combined protocol to treat acute malnutrition received overwhelming support from most stakeholders involved in implementation.Stakeholders were supportive of the use of the protocol to provide care for both severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) children with a shorter length of stay in treatment.Most stakeholders supported the use of mid‐upper arm circumference only for the admission and discharge of children.The majority of stakeholders reported that the ready‐to‐use therapeutic food given for MAM and SAM was sufficient for the child's recovery.The idea of training and equipping community health volunteers to treat acute malnutrition was well supported by caregivers and health care workers and should be explored further. [ABSTRACT FROM AUTHOR]

Background: The use of medical abortion using either a combination of mifepristone and misoprostol, or misoprostol alone has contributed to increased safety and decreased mortality and morbidity. The availability of quality medical abortion medicines is an essential component in the provision of quality abortion care. Understanding the factors that influence the availability of medical abortion medicines is important to help in-country policymakers, program planners, and providers improve availability and use of medical abortion. Methods: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines across five elements (Registration & Quality Assurance, Policy & Financing, Procurement & Distribution, Provider Knowledge, and End-user Knowledge) in eight countries: Botswana, Burkina Faso, Central African Republic, Democratic Republic of the Congo, Eswatini, Lesotho, Namibia and Uganda between November 2020 and November 2021. The assessment included an online desk review and virtual or telephone-based key informant interviews. Results: Registration of medical abortion medicines—misoprostol or co-packaged mifepristone and misoprostol products (combi-pack)—was established in all countries, except the Central African Republic. In Lesotho and Eswatini, the national regulatory agency is still in development and importation of Cytotec™ misoprostol is permitted for off-label use in obstetrics/gynecology. Misoprostol was included in all countries' essential medicines lists, except Botswana. Burkina Faso and Democratic Republic of the Congo also include mifepristone on their essential medicines list and medical abortion regimens in national abortion care service and delivery guidelines. Additionally, guidelines clarified health worker roles in the provision of abortion care specific to the legal context of each country and permitted task-shifting of abortion service provision. Where guidelines did not exist, medical abortion medicines and their use were not well integrated into the public health care system. Community awareness activities on abortion rights and services have been limited in scope across the countries assessed, however, end-users' awareness of misoprostol as a medical abortion medicine was reported. Conclusion: The national landscape assessments identified several cross-cutting opportunities to improve availability of medical abortion medicines, including importing quality-assured medical abortion medicines; developing nationally approved abortion service and delivery guidelines that optimize healthcare worker roles; and expanding communication strategies to reach end-users and pharmacists. [ABSTRACT FROM AUTHOR]

This research paper is based on living material belonging to the genus Euphaedra, collected over the last 10 years in Bangui, as well as a neighbouring South West area in Central African Republic (CAR). There are four rare species of Euphaedra confirmed in CAR, and three others are reported for the first time in this country. Some comments are included relating to species abundance and distribution. [ABSTRACT FROM AUTHOR]

Background: Mortality from physical inactivity-related non-communicable diseases (NCDs) is projected to surpass deaths from communicable diseases by 2030 in Africa. Monitoring physical activity (PA) is important for planning public health interventions addressing NCDS and planetary health, but there is a dearth of evidence on PA trends in Africa. This study explored the secular trends in overall and domains of PA (leisure, occupation, and transport), and examined the gender, age, and education disparities in PA trends across African countries. Methods: We utilized data from the STEPwise approach to NCDs risk factor surveillance in eleven African countries (Algeria, Benin, Botswana, Cabo Verde, Eritrea, Eswatini, Malawi, Mali, Central Africa Republic, Sao Tome and Principe, and Zambia) with at least two surveys conducted between 2003/2010 (first-wave) and 2010/2020 (second-waves). A total of 29,282 and 40,147 adults (18–69 years) in the first and second waves, respectively, completed PA interviews using the Global Physical Activity Questionnaire. Gender, age, and education status were self-reported. Weighted individual-country PA prevalence and 95% confidence interval (95%CI) were obtained. Random-effect meta-analysis was conducted to assess pooled estimates of PA trends across countries. Gender, age, and education disparities in PA trends were also investigated. Results: Country-specific results showed significant upward trends in total PA in eight countries. Seven countries showed significant increasing trends in some leisure-time PA (2.0% − 13.9% increase) and ≥ 150 min/week transport PA (4.0% − 24.5% increase), while five countries recorded significant increasing trends in occupational PA (6.6% − 56.9% increase). Gender, age and education disparities in meeting the WHO PA guidelines remained relatively stable over time, but disparities in leisure, transport and occupational PA increased in most countries. Conclusions: The prevalence of overall PA among African adults has marginally increased over 17 years. There are still many adults, especially women and people with lower education, not doing well in domain specific PA. Policy and environmental interventions are needed to improve PA and to reduce gender, age, and education disparities in leisure, transport, and occupational PA in African countries. [ABSTRACT FROM AUTHOR]

A simplified, combined protocol admitting children with a mid‐upper‐arm circumference (MUAC) of <125 mm or oedema to malnutrition treatment with ready‐to‐use therapeutic food (RUTF) uses two sachets of RUTF per day of those with MUAC < 115 mm and/or oedema and one sachet of RUTF per day for those with MUAC 115–<125 mm. This treatment previously demonstrated noninferior programmatic outcomes compared with standard treatment and high recovery in a routine setting. We aimed to observe the protocol's effectiveness in a routine setting at scale, in two health districts of the Central African Republic through an observational cohort study. The pilot enrolled children for 1 year in consortium by the Ministry of Health and nongovernmental partners. A total of 7909 children were admitted to the simplified, combined treatment. Treatment resulted in an 81.2% overall recovery, with a mean length of stay (LOS) of 38.7 days and a mean RUTF consumption of 43.4 sachets per child treated. Among children admitted with MUAC < 115 mm or oedema, 67.9% recovered with a mean LOS of 48.1 days and consumed an average of 70.9 RUTF sachets. Programme performance differed between the two districts, with an overall defaulting rate of 31.1% in the Kouango‐Grimari health district, compared to 8.2% in Kemo. Response to treatment by children admitted with severe acute malnutrition (SAM) by MUAC and SAM by oedema was similar. The simplified, combined protocol resulted in a satisfactory overall recovery and low RUTF consumption per child treated, with further need to understand defaulting in the context. Key messages: The simplified, combined protocol with a mid‐upper‐arm circumference (MUAC)‐based ready‐to‐use therapeutic food (RUTF) resulted in a recovery rate that reached SPHERE standards, low length of stay and low RUTF consumption per child among all children treated.Response to treatment was similar among children admitted with severe acute malnutrition (SAM) by oedema and those admitted SAM by MUAC.Contextual factors such as insecurity and stockouts in treatment products affect programme outcomes by increasing defaulting and decreasing recovery rates.The simplified, combined protocol might present an opportunity to treat more children with less product; decentralised delivery should continue to be explored. [ABSTRACT FROM AUTHOR]

Background: Ongoing conflict between multiple armed groups, including pastoralist herders in the Central African Republic (CAR) causes frequent population displacements, food insecurity and scarcity of healthcare services. The inaccessibility and insecurity of many areas of CAR limit data collection and assessments from national nutritional surveys. Community health workers (CHWs) trained by an international non-governmental organisation, The MENTOR Initiative, deliver basic healthcare to children under 5 years old living in hard-to-reach and conflict-affected areas in eight subprefectures of north-west CAR. Their nutritional status and its associations with geography, malaria, season and conflict are unknown. Methods: CHW monthly records (October 2015–August 2021), Armed Conflict Location and Event Data project conflict data and The World Bank Group meteorological data for eight subprefectures of north-west CAR were analysed. Associations between counts of global acute malnutrition (GAM) assessed by mid-upper arm circumference and malaria, season and conflict were investigated using negative binomial regression. Results: Of the 457,325 consultations with children aged 6–59 months, 6.2% and 0.4% were classified as moderately or severely malnourished, respectively. The negative binomial model demonstrated differences in counts of GAM by subprefecture. Counts of GAM were positively associated with the case rate of severe malaria (IRR = 1.045; 95% CI: 1.04–1.06) and the rainy season (July–September) (IRR = 1.10; 95% CI: 1.03–1.17). Conflict events coded as Battles in ACLED were associated with lower counts of GAM (IRR = 0.78; 95% CI: 0.62–0.97). Conclusions: This analysis shows geographical differences in levels of malnutrition in north-west CAR and demonstrates clear associations between malnutrition, season and malaria. It provides evidence that levels of GAM may be underestimated in north-west CAR in areas experiencing conflict. These findings highlight the need for targeted nutritional support to reach children most at risk of malnutrition. CHWs are a proven effective means of delivering essential primary healthcare services in hard-to-reach, conflict-affected areas. [ABSTRACT FROM AUTHOR]

This paper analyses the declining importance of political parties in the Central African Republic (CAR). The country can be considered an extreme example of the lack of viability of a state in general, and democracy in particular. However, the quality of elections has exceeded the average in the sub-region over a substantial time-span. Hopes for a democratic future only faded in recent years. The paper hypothesises that both political parties and rebel movements are failing to adequately represent (ethnoregional) interests, but that parties are suffering more in the course of the enduring war and the peace process. Patterns of elite behaviour are presented as the main explanation for the resulting crisis of representation, with international actors' preference for inclusionary power-sharing deals seen as the main aggravating factor. [ABSTRACT FROM PUBLISHER]

Background: Hepatitis B virus (HBV) is the major cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. The global epidemiological scenario of HBV infection has been changing rapidly over the last two decades due to an effective immunization programme initiated by the World Health Organization. The objective of this study is to estimate the prevalence of HBV in apparently healthy young people and to identify the risk factors of transmission of the HBV among this population in Bangui. Methods: Dried blood Spots from 801 adolescent high school and young adult university students were prepared by spotting a drop of whole blood (4 spots) from the same fingerprick onto Whatman filter paper. A blood sample aliquot eluted from DBS was then processed with commercial ELISA tests (Abbott Murex, Dartfort, UK) to detect HBsAg antigen, Anti-HBc and Anti-HBs antibodies). Results: The overall prevalence was 42.3% for antibody to hepatitis B core antigen, 15.5% for HBsAg of which 1.3% of HBsAg alone. HBV familial antecedents, sexual activity and socioeconomic conditions were the main risk factors of HBV infection encountered in the adolescents and young adults. Conclusion: These results show for the first time the high prevalence of HBV in apparently healthy young people in Bangui. This high prevalence is age- and sex-independent. Transmission risk factors were a familial antecedent of HBV, no utilisation of condoms and public scholarship. To lower HBV prevalence, an adequate program of active screening and vaccination for adolescents and young adults should be implemented, along with a universal immunization program. [ABSTRACT FROM AUTHOR]

The growing population of young people in the world today makes them an indispensable factor in international, regional, national and local development today. The UN World Programme of Action for Youth (WPAY) and the African Union's African Youth Charter all attest to the concern development stakeholders pay to youth development. This paper analysis youth policy within 9 member states of the Central African Sub region, showcasing the vital, yet significant role that polities are creating in fostering an enabling environment for youth participation. It explores the tenets of youth policy within this sub region by depicting how the participation of youths in societal activities and decision making instances should be an asset and a prerequisite for sustainable economic growth and social development. It also expresses abysmal concern about the magnitude of youth unemployment and underemployment throughout in Africa and its profound implications for the future of our societies, particularly those residing in the Central African sub region. The study is descriptive and applies a qualitative approach based on expert interviews and desk research. It employs the explanatory case study approach, and the combined anthropological research techniques through the use of key informant interview, written records and non-participant observations. The authors also conducted research in major databases like google scholar, PUB Med with the search phrase being youth policies, participation and youth governance. The 2016 Youth Development Index Report indicates that all 9 Central African countries have a low index, and 4 of the 9 countries are ranked in the bottom 10 of the classification. The findings also reveal that conflicts, underdevelopment and lack of political willingness are customarily accountable for the lagging of this Sub region in youth policy matters. The paper also proposes indicators to monitor and evaluate Youth Policies in the Central African Sub region, using the model proposed by Tanya BASARAB, develop initiatives to promote youth participation, and encourage networking among youth organizations and institutions with the Central African Sub region.

Background: In 2020, during the COVID-19 pandemic, Médecins Sans Frontières (MSF) initiated three cycles of dihydroartemisin-piperaquine (DHA-PQ) mass drug administration (MDA) for children aged three months to 15 years within Bossangoa sub-prefecture, Central African Republic. Coverage, clinical impact, and community members perspectives were evaluated to inform the use of MDAs in humanitarian emergencies. Methods: A household survey was undertaken after the MDA focusing on participation, recent illness among eligible children, and household satisfaction. Using routine surveillance data, the reduction during the MDA period compared to the same period of preceding two years in consultations, malaria diagnoses, malaria rapid diagnostic test (RDT) positivity in three MSF community healthcare facilities (HFs), and the reduction in severe malaria admissions at the regional hospital were estimated. Twenty-seven focus groups discussions (FGDs) with community members were conducted. Results: Overall coverage based on the MDA card or verbal report was 94.3% (95% confidence interval (CI): 86.3–97.8%). Among participants of the household survey, 2.6% (95% CI 1.6–40.3%) of round 3 MDA participants experienced illness in the preceding four weeks compared to 30.6% (95% CI 22.1–40.8%) of MDA non-participants. One community HF experienced a 54.5% (95% CI 50.8–57.9) reduction in consultations, a 73.7% (95% CI 70.5–76.5) reduction in malaria diagnoses, and 42.9% (95% CI 36.0–49.0) reduction in the proportion of positive RDTs among children under five. A second community HF experienced an increase in consultations (+ 15.1% (− 23.3 to 7.5)) and stable malaria diagnoses (4.2% (3.9–11.6)). A third community HF experienced an increase in consultations (+ 41.1% (95% CI 51.2–31.8) and malaria diagnoses (+ 37.3% (95% CI 47.4–27.9)). There were a 25.2% (95% CI 2.0–42.8) reduction in hospital admissions with severe malaria among children under five from the MDA area. FGDs revealed community members perceived less illness among children because of the MDA, as well as fewer hospitalizations. Other indirect benefits such as reduced household expenditure on healthcare were also described. Conclusion: The MDA achieved high coverage and community acceptance. While some positive health impact was observed, it was resource intensive, particularly in this rural context. The priority for malaria control in humanitarian contexts should remain diagnosis and treatment. MDA may be additional tool where the context supports its implementation. [ABSTRACT FROM AUTHOR]

Background: Monkeypox is a viral zoonotic disease commonly reported in humans in parts of Central and West Africa. This protocol is for an Expanded Access Programme (EAP) to be implemented in the Central African Republic, where Clade I monkeypox virus diseases is primarily responsible for most monkeypox infections. The objective of the programme is to provide patients with confirmed monkeypox with access to tecovirimat, a novel antiviral targeting orthopoxviruses, and collect data on clinical and virological outcomes of patients to inform future research. Methods: The study will be conducted at participating hospitals in the Central African Republic. All patients who provide informed consent to enrol in the programme will receive tecovirimat. Patients will remain in hospital for the duration of treatment. Data on clinical signs and symptoms will be collected every day while the patient is hospitalised. Blood, throat and lesion samples will be collected at baseline and then on days 4, 8, 14 and 28. Patient outcomes will be assessed on Day 14 –end of treatment–and at Day 28. Adverse event and serious adverse event data will be collected from the point of consent until Day 28. Discussion: This EAP is the first protocolised treatment programme in Clade I MPXV. The data generated under this protocol aims to describe the use of tecovirimat for Clade I disease in a monkeypox endemic region of Central Africa. It is hoped that this data can inform the definition of outcome measures used in future research and contribute to the academic literature around the use of tecovirimat for the treatment of monkeypox. The EAP also aims to bolster research capacity in the region in order for robust randomised controlled trials to take place for monkeypox and other diseases. Trial registration: {2a & 2b}: ISRCTN43307947. [ABSTRACT FROM AUTHOR]

The paper deals with an operation of Italian engineers in Central African Republic (CAR). The aim of the operation was to construct the temporary bridge. This operation was supported by 15th Engineering Regiment and the University of Defence. Two soldiers from the 15th Engineering Regiment were sent to CAR to help Italian engineers. During this operation REACH-BACK concept between University of Defence and 15th Engineer Regiment was used. Communication and cooperation between these units was supported by Information Portal of Engineer Corps. The portal works as a support element for REACH-BACK concept. [ABSTRACT FROM AUTHOR]

Beginning in 2013, the Central African Republic has been engulfed in a civil war pitting successive governments against a substantial number of armed groups who also compete against each other for control over territory, population and resources. Some of these groups are claiming to be defenders of religious groups in the country, with the Séléka militias fighting for the Muslim communities and the anti-Balaka groups claiming Christian roots and inclinations. Other religiously inspired armed groups such as the Lord's Resistance Army are also present in the country. The following study is an attempt to understand how the "religious" label can be applied to such armed groups and whether it can influence their behavior, thus bringing into light a valuable, albeit lesser known example on how AGs and religion are connected in contemporary Africa. [ABSTRACT FROM AUTHOR]

The Central African Republic is one of the world’s most vulnerable countries, suffering from chronic poverty, violent conflicts and weak disaster resilience. In collaboration with Doctors without Borders/Médecins Sans Frontières (MSF), this study presents a novel approach to collect information about socio-economic vulnerabilities related to malnutrition, access to resources and coping capacities. The first technical test was carried out in the North of the country (sub-prefecture Kabo) in May 2015. All activities were aimed at the investigation of technical feasibility, not at operational data collection, which requires a random sampling strategy. At the core of the study is an open-source Android application named SATIDA COLLECT that facilitates rapid and simple data collection. All assessments were carried out by local MSF staff after they had been trained for one day. Once a mobile network is available, all assessments can easily be uploaded to a database for further processing and trend analysis via MSF in-house software. On one hand, regularly updated food security assessments can complement traditional large-scale surveys, whose completion can take up to eight months. Ideally, this leads to a gain in time for disaster logistics. On the other hand, recording the location of every assessment via the smart phones’ GPS receiver helps to analyze and display the coupling between drought risk and impacts over many years. Although the current situation in the Central African Republic is mostly related to violent conflict it is necessary to consider information about drought risk, because climatic shocks can further disrupt the already vulnerable system. SATIDA COLLECT can easily be adapted to local conditions or other applications, such as the evaluation of vaccination campaigns. Most importantly, it facilitates the standardized collection of information without pen and paper, as well as straightforward sharing of collected data with the MSF headquarters or other aid organizations. [ABSTRACT FROM AUTHOR]

This present research explores a progressive repurposing of Virtual Reality technology, Virtual Immersive Contact (VIC), in a real-world setting to; explore viability to reduce prejudice and investigate the role of empathy in motivating prosocial behavior. The study employed a between-subjects repeated-measures experimental design of a randomized sample (n = 113) split into two conditions to reduce prejudice and discrimination in the active conflict area of the Central African Republic (CAR). In line with the study's hypotheses, VIC produced a significant increase in empathic concern for the Muslim outgroup and intentions to donate to a Muslim family, while also showing that the relationship between empathy and helping behaviours was mostly explained by confounding variables. This research provides both the first evidence of its kind that VIC could be a new form of fostering positive intergroup contact in an active conflict setting, crating a new facet of intergroup contact theory, and further evolving the literature on the empathy, prosocial behaviour relationship. [ABSTRACT FROM AUTHOR]

This paper examines the employment of religious differences in escalating political crises in the Central African Republic (CAR) with threats of separatism in the country based on this. When Michel Am Nondroko Djotodia seized power through the Séléka rebellion in March 2013 and then abdicated the 'hot potato,' the crises during and after his abdication became intensely religious and on a scale unknown in the history of the country. From then on, there have been repeated threats of separation of Muslims from the predominantly Christian population. The Séléka rebels and fighters who also have some non-Muslims have been associated with Islam, and the anti-balaka is constituted of mainly Christian and non-Christian militias. The tussle for leadership and control of the CAR between the Séléka and anti-balaka rival movements has been motivated by religion. This has contributed in making the CAR a failed state with recurrent scenes of violence, killings, and displacements. Through a content analysis of the literature on the religious dimension of the crisis, we will examine the reasons for and threats of a split in a country with xenophobic religious differences and political volatility. [ABSTRACT FROM AUTHOR]

Background: Hookworms are important pathogens of humans. To date, Necator americanus is the sole, known species of the genus Necator infecting humans. In contrast, several Necator species have been described in African great apes and other primates. It has not yet been determined whether primate-originating Necator species are also parasitic in humans. Methodology/Principal Findings: The infective larvae of Necator spp. were developed using modified Harada-Mori filter-paper cultures from faeces of humans and great apes inhabiting Dzanga-Sangha Protected Areas, Central African Republic. The first and second internal transcribed spacers (ITS-1 and ITS-2) of nuclear ribosomal DNA and partial cytochrome c oxidase subunit 1 (cox1) gene of mtDNA obtained from the hookworm larvae were sequenced and compared. Three sequence types (I–III) were recognized in the ITS region, and 34 cox1 haplotypes represented three phylogenetic groups (A–C). The combinations determined were I-A, II-B, II-C, III-B and III-C. Combination I-A, corresponding to N. americanus, was demonstrated in humans and western lowland gorillas; II-B and II-C were observed in humans, western lowland gorillas and chimpanzees; III-B and III-C were found only in humans. Pairwise nucleotide difference in the cox1 haplotypes between the groups was more than 8%, while the difference within each group was less than 2.1%. Conclusions/Significance: The distinctness of ITS sequence variants and high number of pairwise nucleotide differences among cox1 variants indicate the possible presence of several species of Necator in both humans and great apes. We conclude that Necator hookworms are shared by humans and great apes co-habiting the same tropical forest ecosystems. Author Summary: We conducted analyses of DNA sequences obtained from the infective larvae of Necator spp. from humans and great apes inhabiting Dzanga-Sangha Protected Areas, Central African Republic. Three sequence types (I–III) were recognized in the in the ITS region, and 34 cox1 haplotypes represented three phylogenetic groups (A–C). I-A, II-B, II-C, III-B, III-C combinations were determined. Combination I-A, corresponding to Necator americanus, was demonstrated in humans and western lowland gorillas; II-B and II-C were observed in humans (local inhabitants and researchers), western lowland gorillas and chimpanzees; III-B and III-C were found only in humans. Pairwise nucleotide difference in the cox1 haplotypes between the groups was more than 8%, while the difference within each group was less than 2.1%, suggesting that each type represents a distinct species. This is the first molecular evidence that Necator species found in great apes can infect humans and vice versa. [ABSTRACT FROM AUTHOR]

Background: A randomized controlled trial in South Africa found a beneficial effect of acyclovir on genital ulcer healing, but no effect was seen in trials in Ghana, Central African Republic and Malawi. The aim of this paper is to assess whether the variation in impact of acyclovir on ulcer healing in these trials can be explained by differences in the characteristics of the study populations. Methodology/Principal Findings: Pooled data were analysed to estimate the impact of acyclovir on the proportion of ulcers healed seven days after randomisation by HIV/CD4 status, ulcer aetiology, size and duration before presentation; and impact on lesional HIV-1. Risk ratios (RR) were estimated using Poisson regression with robust standard errors. Of 1478 patients with genital ulcer, most (63%) had herpetic ulcers (16% first episode HSV-2 ulcers), and a further 3% chancroid, 2% syphilis, 0.7% lymphogranuloma venereum and 31% undetermined aetiology. Over half (58%) of patients were HIV-1 seropositive. The median duration of symptoms before presentation was 6 days. Patients on acyclovir were more likely to have a healed ulcer on day 7 (63% vs 57%, RR = 1.08, 95% CI 0.98-1.18), shorter time to healing (p = 0.04) and less lesional HIV-1 RNA (p = 0.03). Small ulcers (<50 mm2), HSV-2 ulcers, first episode HSV-2 ulcers, and ulcers in HIV-1 seropositive individuals responded best but the better effectiveness in South Africa was not explained by differences in these factors. Conclusions/Significance: There may be slight benefit in adding acyclovir to syndromic management in settings where most ulcers are genital herpes. The stronger effect among HIV-1 infected individuals suggests that acyclovir may be beneficial for GUD/HIV-1 co-infected patients. The high prevalence in this population highlights that genital ulceration in patients with unknown HIV status provides a potential entry point for provider-initiated HIV testing. [ABSTRACT FROM AUTHOR]

Objective: We sought to evaluate the relationship between onchocerciasis prevalence and that of epilepsy using available data collected at community level. Design: We conducted a systematic review and meta-regression of available data. Data Sources: Electronic and paper records on subject area ever produced up to February 2008. Review Methods: We searched for population-based studies reporting on the prevalence of epilepsy in communities for which onchocerciasis prevalence was available or could be estimated. Two authors independently assessed eligibility and study quality and extracted data. The estimation of point prevalence of onchocerciasis was standardized across studies using appropriate correction factors. Variation in epilepsy prevalence was then analyzed as a function of onchocerciasis endemicity using random-effect logistic models. Results: Eight studies from west (Benin and Nigeria), central (Cameroon and Central African Republic) and east Africa (Uganda, Tanzania and Burundi) met the criteria for inclusion and analysis. Ninety-one communities with a total population of 79,270 individuals screened for epilepsy were included in the analysis. The prevalence of epilepsy ranged from 0 to 8.7% whereas that of onchocerciasis ranged from 5.2 to 100%. Variation in epilepsy prevalence was consistent with a logistic function of onchocerciasis prevalence, with epilepsy prevalence being increased, on average, by 0.4% for each 10% increase in onchocerciasis prevalence. Conclusion: These results give further evidence that onchocerciasis is associated with epilepsy and that the disease burden of onchocerciasis might have to be re-estimated by taking into account this relationship. Author Summary: Epilepsy is particularly common in tropical areas. One main reason is that many endemic infections have neurological consequences. In addition, the medical, social and demographic burden of epilepsy remains substantial in these countries where it is often seen as a contagious condition and where the aetiology is often undetermined. For several decades, field researchers had reported some overlapping between the geographical distributions of epilepsy and onchocerciasis, a parasitic disease caused by the filarial worm Onchocerca volvulus which afflicts some 40 million persons worldwide. Here, we conducted a statistical analysis of all the data available on the relationship between the two conditions to determine whether the proportion of people suffering from epilepsy in a community could be related to the frequency of onchocerciasis. The combined results of the eight studies carried out in west, central and east Africa indicate a close epidemiological association between the two diseases. Should a causative relationship be demonstrated, onchocerciasis, which is known as "river blindness" because of its most serious sequela and the distribution of its vectors, could thus also be called "river epilepsy". More research is needed to determine the mechanisms explaining this association and to assess the burden of onchocerciasis-associated epilepsy. [ABSTRACT FROM AUTHOR]

While the ridde constitutes a game that challenges the intellectual adroitness of the riddler's peers, it is a metaphor that confronts the apparently impossible with what is. If Harold Scheub is correct in affirming in his book The Poem in the Story (Madison: U of Wisconsin P, 2002) that the riddle is ‘a model for all oral art,’ then the dynamics of riddle change are significant for the entire gamut of literary art. This paper presents the Gbaya riddle of Cameroon and the Central African Republic in its historical context with mutation, replacement, and creation of new riddles. By remembering and retaining from the past, borrowing from the present, and creating anew in the midst of constant change, the Gbaya riddle maintains its life of entertainment and instruction. The vicissitudes of change are made friendly through the metaphor of the riddle. [ABSTRACT FROM AUTHOR]

While “Pygmy” hunter-gatherers have generally been assumed to be the original inhabitants of the central African rainforest, recent studies dispute the viability of subsistence in tropical rainforests through foraging alone. There are, however, few studies that are based on sound data of actual long-term foraging. This paper examines the viability of “pure” foraging in tropical rainforests, based on data from participant observation of a long-term foraging expedition among the Baka in the northwestern Congo Basin. The group was observed to subsist solely on wild food resources, particularly wild yams, for two-and-half months. The study was carried out during the dry season when food resources are generally thought to be scarce in tropical rainforests. [ABSTRACT FROM AUTHOR]

Background The objectives of this study were to determine the association between the vulnerability factors linked to human immunodeficiency virus (HIV) and other sexually transmitted infection among the young women who sell sex (YWSS) group (15–24 years) and adult sex workers, engaged in consensual sex for money (AFSW). Methods A cross-sectional study was conducted among AFSW involved in commercial sex transactions. Prevalence ratios (PR) analysis was carried out using log-binomial regression model. Results The prevalence of HIV-1 was 29.4% among YWSS compared to 19.6% among female sex worker (PR = 1.43 [1.07–1.91]). Consistent condoms use last 3 months were very low at 22.3% and 41.2%, respectively (PR = 0.52 [0.37–0.74]), the low education level among YWSS versus AFSW (PR = 0.55 [0.40–0.76]); YWSS having been a victim of sexual violence in the last 12 months (PR = 2.00 [1.52–2.63]), were also more likely to be HIV positive. Conclusions The YWSS had a high prevalence of HIV, experienced other socioeconomic vulnerabilities and remain a key population for comprehensive HIV programs. To reach all YWSS, programs need to consider many outreach programs and address the shared determinants of HIV risk. [ABSTRACT FROM AUTHOR]

Identifying and quantifying factors that influence tree growth are crucial issues to ensure sustainable forest management, particularly in moist tropical forests. Tree growth depends on several factors comprising ontogenic stage, competition by neighbours and environmental conditions. Several studies have focused on one or two of them, but very few have considered all three, especially in Central Africa. We investigated the effects of diameter and competition on tree growth, in four Central African sites characterized by their soil physicochemical properties, at both tree community and population levels.We calibrated growth models using diameter data collected on 29,741 trees between 2015 and 2018, on twelve 4 or 9‐ha plots spread over the four sites. These models included diameter, wood density, competition indices and site effect as explainable variables at the community level and excluded wood density at the population level.At the community level, the best models explained 11% of growth variability with a decreasing effect of species wood density, diameter, site and competition. Our results show that even if low, site effect can result from different soil nutrients depending on both tree size and species wood density. We observed higher tree growth on sites with (i) high exchangeable K, organic C, total N and total P for low wood density species; (ii) high available P and C:N for small trees, high exchangeable Ca and Mg for medium to large trees, all belonging to medium and hard wood density species. At the population level, the best models explained between 0 to 43% of growth variability, with significant competition effect (resp. site effect) for 21 (resp. 9) of the 43 species studied. Site ranking varied greatly between the 9 species concerned, probably reflecting different sensitivities to the scarcity of particular soil nutrients.Synthesis. Our study provides original results on the factors influencing tree growth in Central Africa, showing that the potential effect of soil nutrients depends on tree size and species wood density. Remaining highly unpredictable at the population level, this effect makes it essential to increase the number of dynamics monitoring systems in logging concessions. [ABSTRACT FROM AUTHOR]

(1) Background: Bacillus cereus biovar anthracis (Bcbva) was the causative agent of an anthrax-like fatal disease among wild chimpanzees in 2001 in Côte d'Ivoire. Before this, there had not been any description of an anthrax-like disease caused by typically avirulent Bacillus cereus. Genetic analysis found that B. cereus had acquired two anthrax-like plasmids, one a pXO1-like toxin producing plasmid and the other a pXO2-like plasmid encoding capsule. Bcbva caused animal fatalities in Cameroon, Democratic Republic of Congo, and the Central African Republic between 2004 and 2012. (2) Methods: The pathogen had acquired plasmids in the wild and that was discovered as the cause of widespread animal fatalities in the early 2000s. Primate bones had been shipped out of the endemic zone for anthropological studies prior to the realized danger of contamination with Bcbva. Spores were isolated from the bone fragments and positively identified as Bcbva. Strains were characterized by classical microbiological methods and qPCR. Four new Bcbva isolates were whole-genome sequenced. Chromosomal and plasmid phylogenomic analysis was performed to provide temporal and spatial context to these new strains and previously sequenced Bcbva. Tau and principal component analyses were utilized to identify genetic and spatial case patterns in the Taï National Park anthrax zone. (3) Results: Preliminary studies positively identified Bcbva presence in several archival bone fragments. The animals in question died between 1994 and 2010. Previously, the earliest archival strains of Bcbva were identified in 1996. Though the pathogen has a homogeneous genome, spatial analyses of a subset of mappable isolates from Taï National Park revealed strains found closer together were generally more similar, with strains from chimpanzees and duikers having the widest distribution. Ancestral strains were located mostly in the west of the park and had lower spatial clustering compared to more recent isolates, indicating a local increase in genetic diversity of Bcbva in the park over space and time. Global clustering analysis indicates patterns of genetic diversity and distance are shared between the ancestral and more recently isolated type strains. (4) Conclusions: Our strains have the potential to unveil historical genomic information not available elsewhere. This information sheds light on the evolution and emergence of a dangerous anthrax-causing pathogen. [ABSTRACT FROM AUTHOR]

Background: Despite increasing evidence on COVID-19, few studies have been conducted in humanitarian settings and none have investigated the direct and indirect effects of the pandemic in the Central African Republic. We studied the COVID-19 epidemiology, health service utilization, and health care seeking behavior in the first year of the pandemic in Bangui and surrounding areas. Methods: This mixed-methods study encompasses four components: descriptive epidemiological analysis of reported COVID-19 cases data; interrupted time series analysis of health service utilization using routine health service data; qualitative analysis of health care workers' perceptions of how health services were affected; and health care seeking behavior of community members with a household survey and focus group discussions. Results: The COVID-19 epidemiology in CAR aligns with that of most other countries with males representing most of the tested people and positive cases. Testing capacity was mainly concentrated in Bangui and skewed towards symptomatic cases, travelers, and certain professions. Test positivity was high, and many cases went undiagnosed. Decreases in outpatient department consultations, consultations for respiratory tract infections, and antenatal care were found in most study districts. Cumulative differences in districts ranged from − 46,000 outpatient department consultations in Begoua to + 7000 in Bangui 3; − 9337 respiratory tract infections consultations in Begoua to + 301 in Bangui 1; and from − 2895 antenatal care consultations in Bimbo to + 702 in Bangui 2. Consultations for suspected malaria showed mixed results while delivery of BCG vaccine doses increased. Fewer community members reported seeking care at the beginning of the pandemic compared to summer 2021, especially in urban areas. The fear of testing positive and complying with related restrictions were the main obstacles to seeking care. Conclusions: A large underestimation of infections and decreased health care utilization characterized the first year of the COVID-19 pandemic in Bangui and surrounding area. Improved decentralized testing capacity and enhanced efforts to maintain health service utilization will be crucial for future epidemics. A better understanding of health care access is needed, which will require strengthening the national health information system to ensure reliable and complete data. Further research on how public health measures interact with security constraints is needed. [ABSTRACT FROM AUTHOR]

The interactions between the geophysical processes and geodynamics of the lithosphere play a crucial role in the geologic structure of the Earth's crust. The Bangui magnetic anomaly is a notable feature in the lithospheric structure of the Central African Republic (CAR) resulting from a complex tectonic evolution. This study reports on the coherence in the geophysical data and magnetic anomaly field analysed from a series of maps. The data used here include raster grids on free-air altimetric gravity, magnetic EMAG2 maps, geoid EGM2008 model and topographic SRTM/ETOPO1 relief. The data were processed to analyse the correspondence between the geophysical and geologic setting in the CAR region. Histogram equalization of the topographic grids was implemented by partition of the raster grids into equal-area patches of data ranged by the segments with relative highs and lows of the relief. The original data were compared with the equalized, normalized and quadratic models. The scripts used for cartographic data processing are presented and commented. The consistency and equalization of topography, gravity and geoid data were based using GMT modules 'grdfft' and 'grdhisteq' modules. Using GMT scripts for mapping the geophysical and gravity data over CAR shows an advanced approach to multi-source data visualization to reveal the relationships in the geophysical and topographic processes in central Africa. The results highlighted the correlation between the distribution of rocks with high magnetism in the central part of the Bangui anomaly, and distribution of granites, greenstone belts, and metamorphosed basalts as rock exposure. The correspondence between the negative Bouguer anomaly (<−80 mGal), low geoid values (<−12 m) and the extent of the magnetic anomaly with extreme negative values ranging from −1000 to −200 nT is identified. The integration of the multi-source data provides new insights into the analysis of crustal thicknesses and the average density of the Earth in CAR, as well as the magnitude of the magnetic fields with notable deviations caused by the magnetic flux density in the Bangui area related to the distribution of mineral resources in CAR. [ABSTRACT FROM AUTHOR]

Background: CAR is one of the poorest countries in the world. While UN statistics suggest that there is no health emergency in the country, two recently published mortality surveys contradict this. Moreover, recent accusations of massive scale human rights abuses by mercenaries suggested the need for a nationwide mortality survey. Methods: Two stage cluster surveys were conducted in two different strata: one in the roughly half of the country within the Government's control, and one in the areas mostly outside of the Government's control. We randomly selected 40 clusters of 10 households in each stratum. The survey included questions on vital events with open-ended questions about health and household challenges at the beginning and end of each interview. Results: 70 of 80 selected clusters were successfully visited. We interviewed 699 households, containing 5070 people. 11 households (1.6%) refused to be interviewed and approximately 18.3% of households were absent at the time of visitation, mainly in the safer Government controlled areas. Interviewed households had a birth rate of 42.6 /1000 / year (95%CI 35.4–59.7) and a crude mortality rate (CMR) of 1.57 /10,000/day (95%CI: 1.36–1.78). The birth rate was lower and the death rate markedly higher in the strata outside of Government control. Families described malaria or fever, and diarrhea as the primary reported causes of death with violence accounting for 6% of all deaths. Conclusions: CAR is experiencing a severe health emergency, with the highest measured nationwide mortality in the world to our knowledge. UN published death rate estimates appear to be less than one fourth of reality. There is a desperate need for food aid in the form of general distributions in CAR, along with the accompanying work programs, seed and tool distributions needed to restart local economies. This is of particular importance in rural areas outside of the Government control. While some humanitarian actors are doing their best to respond, the crisis level mortality rate suggests that the needs in CAR are being largely unmet. [ABSTRACT FROM AUTHOR]

Introduction: In the Central African Republic (CAR), HIV/AIDS is the main cause of death in women aged 15–49 years. Increased testing coverage is essential in prevention of HIV/AIDS, especially in areas where conflict hinders access to health care. Socio-economic status (SES) has been shown to be associated with HIV testing uptake. We investigated whether "Provider-initiated HIV testing and counselling" (PITC) could be implemented in a family planning clinic in an active conflict zone in the Central African Republic to reach women of reproductive age and assessed whether socioeconomic status was associated with testing uptake. Methods: Women aged 15–49 years were recruited from a free family planning clinic run by Médecins Sans Frontières in the capital Bangui. An asset-based measurement tool was created based on analysis of qualitative in-depth interviews. Measures of socioeconomic status were constructed from the tool, also by using factor analysis. Logistic regression was used to quantify the association between SES and HIV testing uptake (yes/no), while controlling for potential confounders: age, marital status, number of children, education level and head of household. Results: A total of 1419 women were recruited during the study period, where 87.7% consented to HIV testing, and 95.5% consented to contraception use. A total of 11.9% had never been tested for HIV previously. Factors negatively associated with HIV testing uptake were: being married (OR = 0.4, 95% CI 0.3–0.5); living in a household headed by the husband as opposed to by another person (OR = 0.4, 95% CI 0.3–0.6), and lower age (OR = 0.96, 95% CI 0.93–0.99). Higher level of education (OR = 1.0, 95% CI 0.97–1.1) and having more children aged under 15 (OR = 0.92, 95% CI 0.81–1.1) was not associated with testing uptake. In multivariable regression, testing uptake was lower in the higher SES groups, but the differences were not significant (OR = 0.80, 95% CI 0.55–1.18). Conclusions: The findings show that PITC can be successfully implemented in the patient flow in a family planning clinic, without compromising contraception uptake. Within the PITC framework in a conflict setting, socioeconomic status was not found to be associated with testing uptake in women of reproductive age. [ABSTRACT FROM AUTHOR]

Background: Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR). Methods: We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records' reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity. Results: We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%). Conclusion: Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings. [ABSTRACT FROM AUTHOR]

Diamond and gold mining has been practiced by artisanal miners in the Central African Republic (CAR) for decades. The recent introduction of riverine dredges indicates a transition from artisanal/manual digging and sorting techniques to small-scale mining methods. This study implements a remote sensing analysis of Synthetic Aperture Radar (SAR) data to map gold and diamond dredges operating on the Kadéï (Sangha) river in the CAR. Riverine vessels are identified in Sentinel-1 SAR data between 2015 and 2019, and their activity levels are mapped over time. The number of active dredges identified on the river increased over the five years studied, with the largest increase occurring between 2016 and 2017. Detailing a method for mapping and monitoring riverine diamond and gold dredge mining is an important step in keeping up with evolving technologies and new areas of mineral exploitation and in helping address concerns over resource governance in remote and conflict-prone terrain. The use of SAR technology, with its weather-independence, broad coverage, and available wavelength combinations, allows for higher temporal resolution and improved vessel detection in the monitoring of small-scale mining (SSM) dredges. [ABSTRACT FROM AUTHOR]

The article discusses the mapping of political economy of roadblocks in the Central African Republic. It mentions roadblocks as a manifestation of control over trade routes and a formidable source of funding for all parties. Information through a graph on concentration of roadblocks around distinct and overlapping trade circuits is also given.

The function of the law in shaping social values is exposed in the article. Thispaper considers whether certain practices penalised in the surveyed countries (carrying our rituals with the use of human remains) could be classified as intangible cultural heritage and, thus, whether these practices should be legally protected. The main conclusion of the analysis is the statement that criminal law as a response to shamanism is inconsistent with the basic principles of a democratic state oflaw, including the right to expression and self-determination. Assuming that described social phenomenon exists in a society, and at the same time, this practice does not threaten other members of this society and is commonly accepted, the legislator should avoid creating regulations that are inconsistent with the current axiological system in a given community. The elimination of certain practices should take place by creating civilisation awareness inside a community. Criminal law does not fulfil this function. On the contrary, it contributes to the deepening and consolidation of the existence of certain pathological phenomena, as well as to the disappearance of indigenous cultures. [ABSTRACT FROM AUTHOR]

The study aimed to estimate the prevalence and associated factors of undiagnosed hypertension (HTN) among adults in the Central African Republic (CAR). In the cross-sectional 2017 CAR (Bangui and Ombella M'Poko) STEPS survey, 3265 persons aged 25 to 64 years (non-pregnant and with complete blood pressure measurement), responded to an interview, biomedical and physical, including blood pressure, measurements. Undiagnosed HTN was classified as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg among adults who had never been told by a doctor or other health worker that they had raised blood pressure or hypertension and had not been taking antihypertensive medication. Binary logistic regressions are used to estimate factors associated with undiagnosed HTN. Among those with HTN (N = 1373), the proportion of undiagnosed HTN was 69.8% and 30.2% diagnosed HTN. In the adjusted logistic regression analysis, male sex (AOR: 2.12, 95% CI 1.39–3.23), current tobacco use (AOR: 1.58, 95% CI 1.03–2.42), and high physical activity (AOR: 1.93, 95% CI 1.00–3.71) were positively associated, and age (AOR: 0.75, 95% CI 0.59–0.96), and underweight (AOR: 0.58, 95% CI 0.37–0.90) were inversely associated with undiagnosed HTN. In addition, among men, ever screened for glucose (AOR: 0.07, 95% CI 0.02–0.27) was negatively associated with undiagnosed HTN, and among women, married or cohabiting (AOR: 1.20, 95% CI 1.00–1.44), current heavy drinking (AOR: 1.41, 95% CI 1.04–1.91) were positively associated with undiagnosed HTN. Seven in ten of the adult population with HTN had undiagnosed HTN in CAR. Efforts should be reinforced to screen for HTN in the general population. [ABSTRACT FROM AUTHOR]

Introduction: the Exacto® Triplex HIV/HCV/HBsAg (Biosynex, Strasbourg, France) consists in lateral flow, immunochromatographic rapid diagnostic test simultaneously detecting human immunodeficiency virus (HIV)-1 and HIV-2 and hepatitis C virus (HCV)- specific antibodies (IgG and IgM) and hepatitis B virus (HBV) surface antigen (HBsAg) in serum, plasma and whole blood. We herein evaluated its diagnostic performances in the Central African Republic (CAR). Methods: crosssectional study was conducted on prospectively collected panel of 550 sera from adult inpatients living in Bangui, including 200 HIV-positive, 100 HBsAg-positive, 50 HCV-positive, 200 negatives to three viruses according to reference immunoenzymatic serological tests including Murex HCV (Diasorin, Saluggia, Italy) for HCV, Murex HBsAg (Diasorin) for HBV, Genscreen ULTRA HIV Ag-Ab HIV-1/2 Version 2 (Bio-Rad, Marnes-la-Coquette, France) and Murex HIV 1.2.0 Ag/Ab Combination (Diasorin), the 2 tests associated in the parallel algorithm for the reference strategy for the diagnosis of HIV in CAR. Serum samples were tested blindly in duplicate. The findings are reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: the Exacto® Triplex showed 99.5% (95% CI; 98.5-100.0), 96.0% [90.6-100.0] and 99.0% [97.1-100.0] sensitivities for HIV, HCV and HBsAg, respectively. The specificity, positive and negative predictive values (PPV and NPV) were 100.0% for all three viruses. The Youden's J index and Cohen's κ coefficient were 0.99 for HIV and HBsAg. For HCV, Youden's J and Cohen's κ coefficient were 0.96 and 0.98, respectively. In the epidemiological context of the CAR, the PPV and NPV for all three viral infections were high (≥99.0% to 100%). Conclusion: taken together, our STROBEcompliant study demonstrates that the Exacto® Triplex HIV/HCV/HBsAg showed high sensitivity and specificity for HIV and HBsAg (≥99.0%), and relatively high sensitivity (96.0%) and high specificity (100%) for HCV. These analytical performances are within the limits required by the WHO (i.e. sensitivity ≥99.0% and specificity ≥98.0%) for HIV and HBV. The Exacto® Triplex HIV/HCV/HBsAg is user-friendly at low cost, and appears highly desirable for routine use in the CAR, and likely other Central African countries. [ABSTRACT FROM AUTHOR]

Background: Unstable settings present challenges for the effective provision of antiretroviral treatment (ART). In this paper, we summarize the experience and results of providing ART and implementing contingency plans during acute instability in the Central African Republic (CAR) and Yemen. Case presentation: In CAR, MSF has provided HIV care in three conflict-affected rural regions; these were put on hold throughout the acute phase of violence. "Run-away bags" containing 3 or 4 months of ART were distributed to patients at MSF facilities. Among 1820 HIV patients enrolled into care, 1440 (79%) initiated ART. By December 2016, 782 (54%) patients were still under ART, 354 (25%) have been lost to follow up and 182 (13%) had died. In 2013, when violence disrupted services, 683 patients were receiving ART. Between September–December 2013, 594 (87%) patients received runaway bags and by February 2014, 313 (53%) of these patients returned to the clinic. In Yemen, when violence erupted, patients received a health card that included a helpline to call in case of drug shortages in admission to emergency stocks; this was not possible in CAR due to lack of a functioning telephone network. One thousand six hundred fifty-five PLWHA have been enrolled in care and 1470 (89%) initiated ART; 1056 (72%) are still followed on ART, 126 (9%) were lost to follow up, and 288 (20%) died. In January 2011 clashes began and by April 2011 MSF medical activities were interrupted. Of the 363 patients receiving ART, 363 (100%) received emergency bags to cover 9 months and by February 2012, 354 (98%) patients returned to care. In March 2015 a new wave of conflict affected Yemen, forcing HIV activities to revert to contingency planning. Conclusions: This experience provides further evidence that provision of HIV treatment and emergency drug stocks can be successfully provided to most patients in both conflict-affected settings. [ABSTRACT FROM AUTHOR]

Malaria control interventions target nocturnal feeding of the Anopheles vectors indoors to reduce parasite transmission. Mass deployment of insecticidal bed nets and indoor residual spraying with insecticides, however, may induce mosquitoes to blood-feed at places and at times when humans are not protected. These changes can set a ceiling to the efficacy of these control interventions, resulting in residual malaria transmission. Despite its relevance for disease transmission, the daily rhythmicity of Anopheles biting behavior is poorly documented, most investigations focusing on crepuscular hours and nighttime. By performing mosquito collections 48-h around the clock, both indoors and outdoors, and by modeling biting events using circular statistics, we evaluated the full daily rhythmicity of biting in urban Bangui, Central African Republic. While the bulk of biting by Anopheles gambiae, Anopheles coluzzii, Anopheles funestus, and Anopheles pharoensis occurred from sunset to sunrise outdoors, unexpectedly ~20 to 30% of indoor biting occurred during daytime. As biting events did not fully conform to any family of circular distributions, we fitted mixtures of von Mises distributions and found that observations were consistent with three compartments, corresponding indoors to populations of early-night, late-night, and daytime-biting events. It is not known whether these populations of biting events correspond to spatiotemporal heterogeneities or also to distinct mosquito genotypes/phenotypes belonging consistently to each compartment. Prevalence of Plasmodium falciparum in nighttime- and daytime-biting mosquitoes was the same. As >50% of biting occurs in Bangui when people are unprotected, malaria control interventions outside the domiciliary environment should be envisaged. [ABSTRACT FROM AUTHOR]

Language documentation faces challenges of data preservation and accessibility. Data can be lost due to physical deterioration (e.g. field notes or tape recordings) or outdated format (e.g. Microsoft Word 3.0). Archived data is typically difficult to access, and it is sometimes found that the archived information is inadequate for research purposes. Increased interest in language documentation has coincided with advancements in digital technologies, offering hope for meeting these challenges. This paper discusses the archiving of a 204-item wordlist of Ngbugu, an Ubangian language spoken in Central African Republic, employing best practice recommendations. Our solution includes: TIFF digital imaging of the original handwritten transcription, WAV digital recording of the wordlist, descriptive markup encoding of the wordlist in XML employing Unicode transcription, viewing and playback via an XSLT style sheet that renders the information in HTML, publishing metadata for resource discovery with the Open Language Archives Community (OLAC), and depositing the original materials and digital representations in an institutional archive committed to long-term preservation and access. [ABSTRACT FROM AUTHOR]

The Semliki Forest Virus (SFV) is an RNA virus with a positive-strand that belongs to the Togaviridae family's Alphavirus genus. An epidemic was observed among French troops stationed in the Central African Republic, most likely caused by the SFV virus. The two transmembrane proteins El and E2 and the peripheral protein E3 make up the viral spike protein. The virus binds to the host cell and is internalized via endocytosis; endosome acidification causes the E1/E2 heterodimer to dissociate and the E1 subunits to trimerize. Lupenone was evaluated against the E1 spike protein of SFV in this study based on state-of-the-art cheminformatics approaches, including molecular docking, molecular dynamics simulation, and binding free energy calculation. The molecular docking study envisaged major interactions of Lupenone with binding cavity residues involved non-bonded van der Waal's and Pi-alkyl interactions. Molecular dynamic simulation of a time scale 200 ns corroborated interaction pattern with molecular docking studies between Lupenone and E1 spike protein. Nevertheless, Lupenone intearcation with the E1 spike protein conforming into a stable complex substantiated by free energy landscape (FEL), PCA analysis. Free energy decomposition of the binding cavity resdiues of E1 spike protein also ensured the efficient non-bonded van der Waal's interaction contributing most energy to interact with the Lupenone. Therefore, Lupenone interacted strongly at the active site conforming into higher structural stability throughout the dynamic evolution of the complex. Thus, this study perhaps comprehend the efficiency of Lupenone as lead molecule against SFV E1 spike protein for future therapeutic purpose. [ABSTRACT FROM AUTHOR]

The Central African Republic (CAR) is one of the world's poorest and most fragile countries. Maybe there is no nation on the planet where the official health statistics are so poor. Evidence presented in this Conflict and Health themed collection to document humanitarian needs in CAR, suggests that UN statistics dramatically under-estimate the birth and death rates in conflict settings. To be current and valid, health indicator data in violent settings require more frequent measurement, more triangulation and granular exploration, and creative approaches based on few assumptions. In a world increasingly dependent on model driven data—data often inaccurate in conflict settings—we hope that this collection will allow those service providers and researchers operating in CAR to share their work and help us better learn how to learn. We particularly invite research from professionals working in CAR that documents humanitarian needs and presents indicators of population health where official estimates might not articulate the true extent of the health crisis. [ABSTRACT FROM AUTHOR]

This study was carried out in the Lom series in Cameroon, at the border with Central African Republic, located between the latitudes 5 ∘ 30 ′ –6 ∘ N and the longitudes 13 ∘ 30 ′ –14 ∘ 45 ′ E. A multi-scale analysis of aeromagnetic data combining tilt derivative, Euler deconvolution, upward continuation, and 2.75D modelling was used. The following conclusions were drawn. (1) Several major families of faults were mapped. Their orientations are ENE–WSW, E–W, NW–SE, and N–S with a NE–SW prevalence. The latter are predominantly sub-vertical with NW and SW dips and appear to be prospective for future mining investigations. (2) The evidence of compression, folding, and shearing axis was concluded from superposition of null contours of the tilt derivative and Euler deconvolution. The principal evidence of the local tectonics was due to several deformation episodes (D1, D2, and D4) associated with NE–SW, E–W, and NW–SE events, respectively. (3) Depths of interpreted faults range from 1000 to 3400 m. (4) Several linear structures correlating with known mylonitic veins were identified. These are associated with the Lom faults and represent the contacts between the Lom series and the granito-gneissic rocks; we concluded the intense folding was caused by senestral and dextral NE–SW and NW–SE stumps. (5) We propose a structural model of the top of the crust (schists, gneisses, granites) that delineates principal intrusions (porphyroid granite, garnet gneiss, syenites, micaschists, graphite, and garnet gneiss) responsible for the observed anomalies. The 2.75D modelling revealed many faults with a depth greater than 1200 m and confirmed the observations from reduced-to-Equator total magnetic intensity (RTE-TMI), tilt derivative, and Euler deconvolution. (6) We developed a lithologic profile of the Bétaré-Oya basin. [ABSTRACT FROM AUTHOR]

Copyright of Ankara Review of European Studies (ARES) / Ankara Avrupa Çalışmaları Dergisi (AAÇD) is the property of Ankara University European Union Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Paz y Conflictos is the property of Revista de Paz y Confilictos and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The Central African Republic (CAR) suffers a protracted conflict and has the second lowest human development index in the world. Available mortality estimates vary and differ in methodology. We undertook a retrospective mortality study in the Ouaka prefecture to obtain reliable mortality data. Methods: We conducted a population-based two-stage cluster survey from 9 March to 9 April, 2020 in Ouaka prefecture. We aimed to include 64 clusters of 12 households for a required sample size of 3636 persons. We assigned clusters to communes proportional to population size and then used systematic random sampling to identify cluster starting points from a dataset of buildings in each commune. In addition to the mortality survey questions, we included an open question on challenges faced by the household. Results: We completed 50 clusters with 591 participating households including 4000 household members on the interview day. The median household size was 7 (interquartile range (IQR): 4—9). The median age was 12 (IQR: 5—27). The birth rate was 59.0/1000 population (95% confidence interval (95%-CI): 51.7—67.4). The crude and under-five mortality rates (CMR & U5MR) were 1.33 (95%-CI: 1.09—1.61) and 1.87 (95%-CI: 1.37–2.54) deaths/10,000 persons/day, respectively. The most common specified causes of death were malaria/fever (16.0%; 95%-CI: 11.0–22.7), violence (13.2%; 95%-CI: 6.3–25.5), diarrhoea/vomiting (10.6%; 95%-CI: 6.2–17.5), and respiratory infections (8.4%; 95%-CI: 4.6–14.8). The maternal mortality ratio (MMR) was 2525/100,000 live births (95%-CI: 825—5794). Challenges reported by households included health problems and access to healthcare, high number of deaths, lack of potable water, insufficient means of subsistence, food insecurity and violence. Conclusions: The CMR, U5MR and MMR exceed previous estimates, and the CMR exceeds the humanitarian emergency threshold. Violence is a major threat to life, and to physical and mental wellbeing. Other causes of death speak to poor living conditions and poor access to healthcare and preventive measures, corroborated by the challenges reported by households. Many areas of CAR face similar challenges to Ouaka. If these results were generalisable across CAR, the country would suffer one of the highest mortality rates in the world, a reminder that the longstanding "silent crisis" continues. [ABSTRACT FROM AUTHOR]