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Background: In Sub-Saharan Africa (SSA), febrile illnesses remain a major public health problem in children. However, the persistence of hrp2 antigen and the low sensitivity of pLDH RDT negatively affect antimalarials and antibiotics prescription practices. These limitations lead to poor management of febrile diseases and antimicrobial resistance (AMR). To improve the diagnosis of these febrile diseases and subsequent prescription of antimicrobials, it is hypothesized that the implementation of an algorithm including a two-step malaria RDT PfHRP2/pLDH supported by point-of-care (PoC) tests for bacterial infections could significantly improve the management of febrile diseases and thereby tackling AMR.Methods: To assess the value of the proposed algorithm, an open-label randomized controlled trial with three arms, enrolling febrile children from 6 to 59 months is proposed. In the control arm, febrile children will be managed according to the Integrated Management of Childhood Illnesses (IMCI), which is part of the standard of care in Burkina Faso. Treatment will be done according to national guidelines. In the RDT decisional algorithm (RDT-DA) arm (intervention), the clinical examination based on IMIC will be supported by a two-step malaria RDT and bacterial infections RDTs. Prescription will be left to the discretion of the healthcare workers based on clinical examination and PoC test results. In the e-algorithm arm (intervention), artificial intelligence integrating multiple layers of clinical information such as clinical examination, signs/symptoms and medical history, and biological information such as biomarkers (CRP and WBC) and pathogen-specific PoC tests, and oximetry will be developed. The e-algorithm will serve to guide the diagnostic and management of febrile infections in children. In the 3 arms, the case report forms will be digitalized. A final follow-up visit (day 7) will be scheduled for all participants. Patients will be asked to come back to the health facilities before the scheduled visit if the symptoms persist or in case of health condition worsening.Discussion: If successful, this study could contribute to improve the management of febrile diseases and reduce inappropriate use of antimicrobials.Trial Registration: The trial is registered at ClinicalTrial.gov, NCT05285657. Enrolment started on 4 March 2022 with long-term outcome being assessed completely by 2023. [ABSTRACT FROM AUTHOR]

Background: Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder caused by mutation in the HTT gene and characterized by involuntary movements as well as cognitive and behavioral impairment. Since its first description 150 years ago, studies have been reported worldwide. However, genetically confirmed cases have been scarce in Africa. Objective: To describe the clinical and genetic aspects of HD in the Malian population. Methods: Patients with HD phenotype and their relatives were enrolled after obtaining consent. Symptoms were assessed using the Total Motor Scale (TMS) of the United Huntington's Disease Rating Scale (UHDRS) and the Mini-Mental State Examination (MMSE). Brain imaging and blood tests were performed to exclude other causes. DNA was extracted for HTT sequencing. Results: Eighteen patients (13 families) with a HD phenotype were evaluated. A familial history of the disease was found in 84.6% with 55.5% of maternal transmission. The average length of the HTT CAG repeat was 43.6±11.5 (39–56) CAGs. The mean age at onset was 43.1±9.7years. Choreic movements were the predominant symptoms (100% of the cases) with an average TMS of 49.4±30.8, followed by cognitive impairment (average MMSE score: 23.0±12.0) and psychiatric symptoms with 22.2% and 44.4%, respectively. Conclusion: This is one of the largest HD cohorts reported in Africa. Increasing access to genetic testing could uncover many other HD cases and disease-modifying genetic variants. Future haplotype and psychosocial studies may inform the origin of the Malian mutation and the impact of the disease on patients and their relatives. [ABSTRACT FROM AUTHOR]

Background: Malaria remains a major cause of burden of illness in sub-Saharan Africa. The objectives of this study were to measure the costs of a malaria case in terms of costs borne by households affected and healthcare systems (either ambulatory or hospitalized) comprehensively in a number of countries in Sub- Saharan Africa, collecting data prospectively and retrospectively using a common protocol, which included data on lost productivity and unpaid time of caregivers. Methods: We conducted community-based and health care facility-based studies on disease burden and cost of malaria disease in four sub-Sahara Africa (SSA), namely: Burkina-Faso, Ghana, Nigeria and Uganda. These were both prospective and retrospective studies that used a common protocol. The study population included children under five years old with febrile illness that met the World Health Organization's clinical case definition for malaria. To standardize measurements of economic impact across countries and facilitate comparisons and interpretations, we expressed all direct and indirect costs in 2019. The study incorporated empirical values for most of the components of health services used, and most of their unit costs. Furthermore, it examined actual medical practices, rather than the more expensive setting of a formal prospective clinical study of laboratory confirmed malaria disease. We used the unit costs are they were in 2010 and 2011, when the field work was conducted, but then discounted them to the current year of 2019. Findings: The total household costs were highest in Ghana and lowest in Uganda. Health systems costs are significantly higher in Nigeria. As opposed to the three other countries, indirect costs in Ghana are lower than direct costs. It was found that in general richer households tended to spend more on treating OPD and IPD cases in the four countries and a majority of Ghana respondents were insured (67%) while in the three other countries, out of pockets spending were high (from different sources), followed by subsidies from social institutions. Conclusion: Malaria remains a major contributor the high economic burden of disease in SSA. The reasons that our estimates are higher than previous estimates could be the fact that we included as much as possible costs incurred by households before arriving at the facility where they were interviewed, comprising informal sector payment. Malaria endemic countries should not relent, but should rather redouble efforts to control and eliminate malaria as a major public health burden in SSA. [ABSTRACT FROM AUTHOR]

This article discusses the development and evaluation of a PCR-RFLP test for the detection of trypanocidal drug resistance in Trypanosoma congolense, a parasite that causes animal African trypanosomiasis (AAT) in sub-Saharan Africa. AAT affects livestock production and endangers the food supply of rural communities. The test, which detects a single point mutation in the parasite's DNA, was found to be more sensitive than the gold standard test. The use of blood spots or buffy coats on filter paper for sample collection and storage was also explored, offering logistical and economic advantages for large-scale surveys. [Extracted from the article]

• Hereditary spastic paraplegia type 11 is a rare complex neurodegenerative disease. • A novel homozygote deletion variant in the spatacsin gene in a Malian patient. • Although SPG11 is not reported in sub-Saharan Africa, it may not be uncommon. • While infectious and traumatic causes of spinal injury are most common in sub-Saharan Africa, genetic causes should also be investigated. [ABSTRACT FROM AUTHOR]