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The majority of the world's ultra-poor live in conflict-affected environments. Poverty reduction efforts are increasingly attempting to target the most vulnerable inhabitants of these settings. Few studies have so far examined their impacts. Against the backdrop of one of the largest humanitarian crises in recent years, survey data from the Central African Republic demonstrates that a year after the conclusion of a large social safety net program, the poorest female participants did not benefit proportionately to other women and men. We draw on 257 in-depth qualitative interviews in extremely difficult-to-access conflict-affected sites across the country to explore the puzzle of why the most vulnerable inhabitants of conflict-affected settings may fail to benefit equally from poverty reduction programs. We demonstrate that conditions of social isolation—rather than poverty itself—create two specific barriers to long-term benefits. First, social isolation means that the poorest women recipients lack the social support networks that permit others to respond to conflict-related shocks without draining all their new income on emergency spending. Second, small social networks create a shortage of labor and higher start-up costs for new revenue-generating activities, thereby preventing spending on investment opportunities. These factors highlight the social barriers to poverty reduction, which are often intensified by shocks born from war, that material aid alone fails to redress. [ABSTRACT FROM AUTHOR]

This paper studies the association between caregiver--child interactions and early childhood development in literacy and numeracy in West and Central Africa. Data comes from Multiple Cluster Indicator Surveys (MICS) conducted in Central African Republic, Chad, Democratic Republic of the Congo, Gambia, Ghana, Guinea-Bissau, Sierra Leone, and Togo between 2017 and 2020. A multilevel logistic regression is used to estimate the likelihood of being developmentally on track for 35,752 children aged 3-4 years. The results indicate that cognitively stimulating interactions with caregivers such as reading and telling stories are correlated with a higher likelihood of being developmentally on track. Interactions with mothers are associated with significantly higher odds of being developmentally on track but not interactions with fathers.

In June 2015, the South African Parliament passed the long-awaited defence review (DR2015). The aim of the review was to stop the decline of the South African National Defence Force (SANDF) and to create an economical and sustainable force structure capable of continuing to fulfil its constitutional obligations and to support the country's foreign policy, primarily in relation to Africa. However, implementation of the DR2015 has turned out to be difficult. The major claim of this article is that the processes of demilitarisation and transition since the end of apartheid, combined with years of underfunding and the lack of a priority given to the SANDF has reduced the latter's professional military capabilities to such an extent that in the future it will find it difficult to function in the active international role it has played since the end of the 1990s. The reduced role of the SANDF is also an illustration of South Africa in general prioritising domestic developmental and security challenges, as well as its footstep in Africa. The study is based on extensive empirical data collection in South Africa and the Democratic Republic of Congo in the form of a string of semi-structured qualitative interviews, primary documentary research and an extensive academic literature review conducted from 2000 to 2017. [ABSTRACT FROM AUTHOR]

The recurrence of conflict and violence in the CAR in the 1990s and early 2000s underpinned the movement of people from this country to Cameroon. The avalanche of people fleeing war, atrocities perpetrated by politico-military groups and highwaymen along the eastern borders, constitutes a serious security threat. This threat can be understood in terms of its immediate effects and long-term impacts on East Cameroon. The dynamics of these cross-border migratory movements have had direct repercussions on the political, economic, social and physical life of the populations of Cameroon's eastern fringe. Based on empirical documentation in the form of books, articles, press clippings and newspapers, directive and semi-directive interviews, and field observations of various actors and protagonists, this article aims, in short, to show and highlight the impacts of cross-border mobility on security in East Cameroon, a geographical entity contiguous with the Central African Republic. [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]

Qualitative empirical enquiries into dynamics of security and insecurity often include a blind spot that bear theoretical ramifications because only those areas and respondents that allow for relatively safe fieldwork are studied. To transparently articulate the spheres of projection that creep into our knowledge production, we propose a distinction between inner and outer circles as highly fluid but separate geographical, socio-political and methodological spaces. Drawing on fieldwork in the Central African Republic and South Sudan, we discuss the risks posed by incomplete data and subsequently flawed inferences. We argue that the perceptions of fear projected onto the outer circle shape people's behaviour more than measurable insecurity incidents and that increased interaction between actors in both circles reduces the perceived threats coming from the outer circles. We demonstrate how studying insecurity from inner circles risks securitizing outer circles while further centralizing the inner ones. We thus urge transparency in data collection and the related inferences that underpin our knowledge production. [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]

A new Afrotropical genus (Ifrika gen. n.) and three new species (Ifrika mnyamasp. n., Ifrika nyigusp. n. and Ifrika wadudusp. n.) are described and illustrated. A fourth species, Ifrika pauculihirtacomb. n., is transferred from Dissomphalus. The males of this genus are easily recognised among the other genera of Pristocerinae by having the following combination of characteristics: the median clypeal lobe indistinct from the lateral ones, the dorsal pronotal area very short, the hypopygium with an inner membrane and a posterior margin deeply excavated, the genitalia with the harpe strongly incurved, almost fully divided, the aedeagus with a basal cover plate, the mediodorsal fold, and the median projection ventrally curved and apodeme dorsally curved. A key to all species and some comments on the Afrotropical Bethylidae fauna are also provided. [ABSTRACT FROM AUTHOR]

Heavy episodic drinking (HED) is associated with negative health consequences. The goal of the study was to assess HED among the general adult population in Central African Republic (CAR). In a cross-sectional survey in CAR (Bangui city and Ombella M'Poko region), 3 301 people (range = 25 - 64 years) completed structured interview questions, including on alcohol use, and anthropometric and blood pressure measurements were taken. Logistic regression was used to assess associations between sociodemographic indicators, health factors, and past-month HED. Results indicated that 33.0% of participants reported HED (26.4% in women and 44.4% in men), and among past 12-month drinkers 63.1% reported HED. In the final logistic regression model, male sex, aged 35 to 44 years, ten or more years of education, current tobacco smoking, current smokeless tobacco use, second-hand smoke exposure, and having four or more meals outside the home in the past week increased the odds of HED. One-third of the study population reported HED, suggesting a need for population-level interventions to reduce HED. [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]

Scholarly attention to the militarization of conservation efforts globally is now being further explored through attention to the specific dynamics around "green militarization" in places where violent conflict is endemic, as in this special issue. Scholars have tracked the governance and economic effects of these developments. In this paper we look at a different level of political effect, namely that of individual tracker-guards as they navigate their careers in arms-carrying work. Existing research on tracker-guards focuses on them in their capacity as anti-poachers and looks at one site only. In contrast, we take a biographical, historical, and regional approach to show how anti-poaching jobs play into broader markets for arms-carrying work and the ways that men navigate them in search of social status and employment stability. The paper spans two adjacent but nationally distinct sites: eastern Chad (primarily in and around Zakouma National Park) and northeastern Central African Republic (primarily in and around Bamingui-Bangoran and Manovo-Gounda St. Floris National Parks). Focusing on the lives of three tracker-guards, we show that even within the same region the status and relational opportunities associated with anti-poaching vary depending on wider contexts encompassing evolving demands for skilled men in arms, and as a result so do the trajectories of people trying to make their way professionally in these realms. This finding demonstrates the usefulness of understanding the personal politics (social and relational factors and what counts as success) into which anti-poaching work plays. [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]

"Leaving no one behind" (LNOB) constitutes one of the core principles underpinning the 2030 Agenda for Sustainable Development. We propose a complementary fuzzy logic approach to identify countries left behind in human development and each of its dimensions. We find that the countries left furthest behind at the beginning of the century were those that most reduced gaps with respect to better performing countries after two decades. Nevertheless, we cannot clearly speak of convergence in human development. There are notable exceptions, such as the Central African Republic, Liberia, Yemen, Haiti or Venezuela, which despite the improvement in their Human Development Index worryingly increased their gaps in human development dimensions relative to the rest of the world. Our analysis highlights significant advantages of using the proposed fuzzy-based LNOB approach to incorporate the moral imperative of leaving no country behind in the measurement of human development. [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]

Rebel governance assumes a symbiotic relationship between coercion and public goods provision. However, in the rebel-held town of Ndélé, Central African Republic, we find that governance happens in rebel-held territory, but rarely by rebels. Rebels allowed other actors to provide services for the people only when this did not hinder rebels extracting political clout and economic benefit from the people and their lands. We show how rebels' extractive ambitions and governance discourses evolved during successive stages of rebellion through a diachronic comparison rooted in multimethod fieldwork from 2018 to 2022. We ask, why were rebel groups able to set up their rule, then rule for seven years, before ultimately losing power? Rebels evoked public goods at the onset of rebellion to justify the use of coercive means. After rebel rule was established, rebels outsourced public goods to international and state actors allowing for governance in rebel-held territory while focussing their own efforts on extraction. When their rule was challenged, rebels targeted governance actors and spaces in their territory in pursuit of economic gain and political dominance. Our findings call for a re-evaluation of existing rebel governance studies and the ways in which rebel groups are engaged with. [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]

The Central African Republic (CAR) became independent in August 1960. Since then, political instability, characterized by coups, mutinies, demonstrations, strikes, riots and civil wars, has been part of the political landscape of this landlocked country in Central Africa. The deadliest rebellion of this seemingly permanent political unrest is the sectarian conflict between Christians and Muslims that began after a coalition of rebel groups called Seleka (alliance) overthrew President François Bozizé in May 2013. Using a process-tracing qualitative method, this paper argues that the politics of exclusion provides the best explanation for political unrest in the CAR, as the excluded elites from northeastern poor regions attempted to re-insert themselves in the political process dominated by the elites from well-endowed southern regions. However, this exclusion seems to emerge as the result of interaction between elements of continuity and elements of change. [ABSTRACT FROM AUTHOR]

The Central African Republic, located in the central part of Africa, has been known for decades of conflict between the communities. Citizens of local communities first influenced the solution to the conflict. However, the mentioned country cannot solve it, and external actors must contribute to these processes. International organisations (United Nations, European Union, and African Union) and the powered world countries (the United States of America, China, and France) were also significant, active, and influential in this process. Russia obtained a unique position in the process. The present study attempted to critically evaluate this country's historical background, current conflict situation, and perspectives. The study aimed to answer the essential question of the external players, activities, and roles in the Central African Republic and asserted their interests in the mentioned region by the complex of general theoretical methods. Special attention was paid to Russian activities in this country. It is obvious that the mutual relations of external actors fundamentally influence the situation in the mentioned country. The conflict situation in the country was affected, is affected, and will be affected not only by inside processes but also by outside processes. [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]

The greater part of the semi-deciduous moist forests of the Congo basin has been given to logging companies for exploitation. In the next decades, very few of these forests will remain intact. In this paper, we aimed to identify large-scale variations in the structure, composition and functioning of African moist forests that could serve as a baseline for both management and conservation purposes. Commercial forest inventory data were assembled for 49,711 0.5-ha plots, covering an area of more than six million hectares, crossing the borders of Cameroon, Central African Republic and Republic of Congo. Floristic composition was analyzed for a subset of 176 genera reliably identified in the field. Three key functional traits of tropical trees: regeneration guild, leaf phenology, and wood specific gravity, were collected at the species level from various sources, and assigned at the genus level. We first investigated the main variations in forest structure and composition, and identified seven forest types based on these variations. Differences in the percentage of pioneer and deciduous stems, and mean wood specific gravity were tested between forest types. Most of the study area was composed of a mosaic of the structural variations of the forests characterized by the occurrence of Celtis (Ulmaceae) species, which are mostly composed of frequent and abundant genera that formed the common floristic pool of the region. Secondary Musanga (Moraceae) forest is located in repeatedly disturbed areas, along roads and around main cities; mixed Manilkara (Sapotaceae) forest covers a huge area in the southern Central African Republic and in the northern Republic of Congo; and monodominant Gilbertiodendron (Fabaceae) forest is sparsely distributed along rivers. The contrasted structure, composition, and functioning of the forest types imply pronounced differences in population and ecosystem processes, and call for adapted management and conservation strategies. [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]

This article is about a young farmer named Linga and his encounter with a water spirit in Oubangui-Chari (present-day Central African Republic) in 1930. It is also about the telling and re-telling of Linga's encounter as the story was transcribed into Banda, translated into French, and rewritten as an ethnographic folktale. Responsible for these transformations were two Banda interpreters and a colonial administrator from the Caribbean. In the last two decades, historians of colonialism have turned increasingly to interpreters and other intermediaries. Often missing from this scholarship, however, are analyses of the granular details—of how colonial intermediaries used transcription, translation, and other methods to create new words, texts, and ideas. Linguistic anthropologists refer to such interventions as "entextualization," the process by which fragments of discourse are extracted from their immediate settings and rendered into detached texts. Drawing on this scholarship, I argue that tracing the granular processes of entextualization opens up new vantage points from which to study the role of colonial intermediaries in the production of knowledge. The article also illuminates a methodology for mapping otherwise invisible constellations of language, meaning, and colonial power. [ABSTRACT FROM AUTHOR]

When conflicts emerge the media often become, intended or not, a key actor. It is through media that every party within a conflict attempts to convey its own narrative, contributing to a complex reality that affects journalists' work in many different ways. This article aims to reflect on Bläsi's (2004) factors of influence on conflict coverage in the context of media development in Burkina Faso and the Central African Republic. Developed from a western standpoint on war reporters covering foreign conflicts, we propose to adapt this model to 'local' contexts in order to provide a more holistic analysis of journalism in conflict settings, but also to propose entry points for constructive coordination among multiple media development actors. In this article, we discuss the audience dimension, the pressure put through lobbies, the journalists' personal features, the situation on-site, structural factors referring to the broader media and information system, and the political climate. We strive to offer a critique so as to adapt to the relevance of 'local' journalists living and reporting in conflict-affected areas, in which media development assistance often takes place, in opposition to international foreign correspondents that are deployed to cover far-away violent conflicts. [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]

In this paper we present a cross-cultural study of toddler interactions with other juveniles (1-15 years of age) in two small-scale societies, the Bofi farmers and foragers of Central Africa. This paper provides a unique perspective because child development studies have predominantly been conducted in Western industrialized settings. Most studies of juvenile interactions among non-Western small-scale cultures have focused either on sibling caretaking or the functional value of juvenile play-groups, while little attention has been given to various types of juvenile interactions. In this study we utilized naturalistic observations of 21 Bofi farmer and 22 Bofi forager toddlers to examine the role of cultural group and age in how toddlers interact with other juveniles, specifically with respect to caretaking, social, and conflict interactions. Toddler-juvenile caretaking interactions were quite similar among the Bofi foragers and farmers despite differing parental ethno-theories about juvenile caretaking, and age effects were apparent only among the farmers. Toddler-juvenile social interactions were predicted by both age and cultural group: Toddlers engaged socially with juveniles more as they grew older in both groups, but farmer toddlers interacted with juveniles more than did forager toddlers overall. Bofi farmer and forager toddler conflicts appeared quite infrequent by Western standards, although cultural group differences were apparent: Farmer toddler engaged in more conflict with juveniles than forager toddlers did. Lastly, the topics of conflicts varied according to cultural group, but not age: Farmer toddler conflicts were more often related to disagreements over objects and responses to physical aggression than were forager toddler conflicts.

This article evaluates the military operation of the European Union in Chad and the Central African Republic in 2008-09. Despite a promising conceptual approach and close cooperation with the United Nations (UN), the operation created significant political problems between member states. It led to a split - France arguing that it carried too much of the burden and Germany and the United Kingdom sensing that they were sponsoring a pet project. When the UN failed to achieve its ambitious promises to establish a parallel presence and follow-on force, tensions arose with the UN as well. This type of operation is therefore unlikely to be repeated in the near future. [ABSTRACT FROM AUTHOR]

Abstract: Zooarchaeological analyses often draw inferences on socioeconomic status from the composition of bone assemblages associated with houses and other structures in residential sites. In this paper, we test how well faunal assemblages reflect socioeconomic differences among contemporary farmer households in two rural villages in the Central African Republic. Independent measures of wealth are tallied and ranked for six households in each village, including complete inventories of the types and numbers of material goods and the sizes of residential structures and agricultural fields. These data are compared against the associated food bones collected from household trash middens and activity areas, including skeletal abundances, large mammal body part representation, and taxonomic diversity. In most instances larger and more taxonomically diverse faunal assemblages are associated with houses of means and the faunas do, in fact, reflect differences in socioeconomic status. However, faunal “wealth” may be linked to factors unrelated to social or economic inequalities, notably the presence of active hunters. Our analyses suggest that small animals provide useful and important data in assessing socioeconomic means, and comparative studies of wealth in archaeological contexts should not be based on bones alone. [Copyright &y& Elsevier]

This article covers the past two years of the activity of the International Criminal Court. Ten years after the signature of the Rome Statute, the Court has continued investigating situations in four countries (Democratic Republic of Congo, Uganda, the Sudan and the Central African Republic). The activity of the Court has accelerated, with four indictees in custody in the DRC situation, one public arrest warrant in the CAR situation and two in the Sudan situation. The Court has developed its case law on victim participation and refined its procedural framework, through constant debate between the Prosecutor and the pre-trial chambers. It has also pursued its goal of increasing cooperation with State parties, and raising awareness of the Court through outreach programs. The Court faces difficult challenges in establishing itself as a credible court, balancing the necessary requirements of fairness in a criminal trial and the high expectations of victims and the international community. The recent stay of proceedings and granting of release in the Lubanga case, which is supposed to be the first trial of the Court, is an illustration of this challenge and the difficulty in finding this balance. [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 article discusses the establishment of the General Agreement on Trade in Services (GATS) to be administered by the World Trade Organization. The objective of GATS is to ensure that key parts of the audiovisual service sector are progressively liberalized and privatized. The United States and the Central African Republic have made preliminary commitments in all subcategories of the audiovisual sector. A major criticism of the GATS is the secrecy and lack of transparency of the process.

Copyright of Politics & Policy is the property of Wiley-Blackwell 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.)

This article critiques the prescription of joint security units called for by civil war peace agreements as a means to integrate armed forces previously in conflict. Drawing on cases from Sudan, South Sudan, and the Central African Republic, this article offers a comparative assessment of the joint security units attempted in each country. As negotiators and mediators often employ templates from other contexts, the deficits exemplified by these cases call for rethinking the practice of establishing joint units in the doctrine of military integration, as well as in the wider practice of negotiating security arrangements in peace processes. [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 article aims at investigating how do mechanisms of bureaucratic politics contribute to the decision of deploying troops and in so doing to mold the national motivations underscoring the deployment. The text takes Brazil as a case and researches the decision-making process in the country, using past cases of deployments that actually happened. The bulk of the analysis, however, is dedicated to the negative case where Brazil decided not to contribute to the United Nations Multidimensional Integrated Stabilization Mission in the Central African Republic (MINUSCA). The analysis provides a breakdown of the 2017–2018 domestic political and bureaucratic decision-making process in Brazil as regards the possibility of deploying troops to MINUSCA and traces the mechanisms in action that resulted in the negative decision by the government. Based on the case of Brazil, considerations are made on the importance of investigating negative scenarios to better understanding how developing countries, such as the BRICS, value the motivations and ultimately decide to contribute to a UN mission. [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]

Background: The term Nodding Syndrome (NS) refers to an atypical and severe form of childhood epilepsy characterized by a repetitive head nodding (HN). The disease has been for a long time limited to East Africa, and the cause is still unknown. The objective of this study was to confirm the existence of NS cases in Central African Republic (CAR). Methodology/Principal findings: This was a cross-sectional descriptive study in the general population. The identification of NS cases was conducted through a door-to-door survey in a village near Bangui along the Ubangui River. Based on Winkler's 2008 and the World Health Organization (WHO)'s 2012 classifications, the confirmation of cases was done by a neurologist who also performed the electroencephalograms. No laboratory tests were done during this investigation. Treatment was offered to all patients. A total of 6,175 individuals was surveyed in 799 households. After reviewing the cases, we identified 5 NS cases in girls aged between 8 and 16. The age of onset of the seizures was between 5 and 12 years of age. Two cases were classified as "HN plus" according to Winkler's 2008 classification. Four NS cases were classified as probable and one as confirmed according to the WHO's 2012 classification. Three of them presented with developmental delay and cognitive decline, and one had an abnormally low height-for-age z-score. Electroencephalographic abnormalities were found in four patients. Conclusions/Significance: Nodding Syndrome cases were described in CAR for the first time. Despite certain peculiarities, these cases are similar to those described elsewhere. Given that only a small part of the affected area was investigated, the study area along the Ubangui River needs to be expanded in order to investigate the association between Onchocerca volvulus and NS and also evaluate the real burden of NS in CAR. Author summary: Nodding Syndrome (NS) is a form of severe epilepsy that affects children in Africa. Thousands of children have been affected since its first description 60 years ago in East Africa, particularly Tanzania, South Sudan, and Uganda. Its evolution is marked by the appearance of many serious complications such as stunting, wasting, delayed sexual development, and psychiatric illness that can lead to death in some cases. Both the future of the affected children and the present of the adults in charge of them are hampered by an intolerable level of social and economic harm. Here, we describe new cases of NS that emerged in a context of extreme poverty in the Central African Republic (CAR). Because the area at risk of NS was partially investigated in this study, we urge to carry out a larger-scale study in order to assess the real burden of NS in CAR and draw the attention of public authorities. [ABSTRACT FROM AUTHOR]

Background: African trypanosomes are parasites mainly transmitted by tsetse flies. They cause trypanosomiasis in humans (HAT) and animals (AAT). In Chad, HAT/AAT are endemic. This study investigates the diversity and distribution of trypanosomes in Mandoul, an isolated area where a tsetse control campaign is ongoing, and Maro, an area bordering the Central African Republic (CAR) where the control had not started. Methods: 717 human and 540 cattle blood samples were collected, and 177 tsetse flies were caught. Trypanosomal DNA was detected using PCR targeting internal transcribed spacer 1 (ITS1) and glycosomal glyceraldehyde-3 phosphate dehydrogenase (gGAPDH), followed by amplicon sequencing. Results: Trypanosomal DNA was identified in 14 human samples, 227 cattle samples, and in tsetse. Besides T. b. gambiense, T. congolense was detected in human in Maro. In Mandoul, DNA from an unknown Trypanosoma sp.-129-H was detected in a human with a history of a cured HAT infection and persisting symptoms. In cattle and tsetse samples from Maro, T. godfreyi and T. grayi were detected besides the known animal pathogens, in addition to T. theileri (in cattle) and T. simiae (in tsetse). Furthermore, in Maro, evidence for additional unknown trypanosomes was obtained in tsetse. In contrast, in the Mandoul area, only T. theileri, T. simiae, and T. vivax DNA was identified in cattle. Genetic diversity was most prominent in T. vivax and T. theileri. Conclusion: Tsetse control activities in Mandoul reduced the tsetse population and thus the pathogenic parasites. Nevertheless, T. theileri, T. vivax, and T. simiae are frequent in cattle suggesting transmission by other insect vectors. In contrast, in Maro, transhumance to/from Central African Republic and no tsetse control may have led to the high diversity and frequency of trypanosomes observed including HAT/AAT pathogenic species. Active HAT infections stress the need to enforce monitoring and control campaigns. Additionally, the diverse trypanosome species in humans and cattle indicate the necessity to investigate the infectivity of the unknown trypanosomes regarding their zoonotic potential. Finally, this study should be widened to other trypanosome hosts to capture the whole diversity of circulating trypanosomes. Author summary: Sleeping sickness (HAT) is a public health problem in 36 African countries. In Chad, 5 active foci are present in the Southern part. It is caused by trypanosomes, parasites causing disease in humans and livestock. Tsetse flies, the vectors of trypanosomes, declined in the Mandoul focus due to the impact of vector control coupled with active/passive screening and treatment campaigns. In the Maro focus, where such campaigns were absent during these surveys, HAT cases were reported recently. We carried out a study on circulating trypanosomes in humans, cattle and tsetse in these two foci. The results confirmed a reduction of the tsetse population and pathogenic trypanosomes of human and cattle in Mandoul. However, an unknown trypanosome was identified in a human and high frequency of T. theileri (known as non-pathogenic) was found in cattle. In contrast, in Maro, a high diversity of trypanosomes was observed, including T. b. gambiense and T. congolense in humans and several unknown trypanosomes in tsetse. These observations provide evidence of the circulating trypanosomes in the area that recommend widening the investigation to other mammalian hosts and mechanical vectors and considering and monitoring a possible zoonotic potential with the unknown trypanosome and T. congolense in humans. [ABSTRACT FROM AUTHOR]

Background: Thyroid cancer (TC) is the most prevalent malignancy of the endocrine system. Over the past decades, TC incidence rates have been increasing. TC quality of care (QOC) has yet to be well understood. We aimed to assess the quality of TC care and its disparities. Methods: We retrieved primary epidemiologic indices from the Global Burden of Disease (GBD) 1990–2017 database. We calculated four secondary indices of mortality to incidence ratio, disability‐adjusted life years (DALYs) to prevalence ratio, prevalence to incidence ratio, and years of life lost (YLLs) to years lived with disability (YLD) ratio and summarized them by the principal component analysis (PCA) to produce one unique index presented as the quality of care index (QCI) ranged between 0 and 100, to compare different scales. The gender disparity ratio (GDR), defined as the QCI for females divided by QCI for males, was applied to show gender inequity. Results: In 2017, there were 255,489 new TC incident cases (95% uncertainty interval [UI]: 245,709–272,470) globally, which resulted in 41,235 deaths (39,911–44,139). The estimated global QCI was 84.39. The highest QCI was observed in the European region (93.84), with Italy having the highest score (99.77). Conversely, the lowest QCI was seen in the African region (55.09), where the Central African Republic scored the lowest (13.64). The highest and lowest socio‐demographic index (SDI) regions scored 97.27 and 53.85, respectively. Globally, gender disparity was higher after the age of 40 years and in favor of better care in women. Conclusion: TC QOC is better among those countries of higher socioeconomic status, possibly due to better healthcare access and early detection in these regions. Overall, the quality of TC care was higher in women and younger adults. Countries could adopt the introduced index of QOC to investigate the quality of provided care for different diseases and conditions. [ABSTRACT FROM AUTHOR]