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We describe in this first series of lupus documented in Niger, the epidemiological, diagnostic, therapeutic and prognostic aspects.This is a prospective study in internal medicine at the National Hospital of Niamey during 10 years. ACR criteria were used as diagnostic criteria.We identified only 9 cases with a frequency of 0.05 % (7 women, 2 men) with a mean age of 36.7 years [range, (26, 48)]. Frequent manifestations were prolonged fever (8 cases), malar rash (6 cases), arthritis (6 cases), alopecia (5 cases), discoid lupus (3 cases), haematological disorders (7 cases), serositis (4 cases) and renal failure (4 cases). All patients had at least 4 ACR criteria with an average of 6.11 criteria. ANA were positive in 8 patients with an average of 1/568, 68 [extremes (1/1280-1/160)]. The most commonly molecules used were Prednisone, Azathioprine and Hydroxychloroquine. The Mycofénolate Mofétil, Cyclophosphamide and Rituximab were used in a single patient. The outcome was favorable in 8 patients and we deplore the death of one patient.Under diagnosis would be the basis of the low prevalence of lupus in Niger. Diagnostic means are necessary for epidemiological studies in order to have more representative data.

Introduction. Kaposi varicelliform eruption (KVE) is a widespread cutaneous viral infection, most commonly herpes simplex virus, which affects patients with underlying dermatosis. When KVE occurs in a patient with a history of psoriasis, it is referred to as psoriasis herpeticum, a rare subtype of KVE with only a handful of cases reported in the literature. To the authors’ knowledge, we report for the first time a case of psoriasis herpeticum in pregnancy. Case Presentation. A 23-year-old woman in her third pregnancy presented at 26-week gestation with a 10-year history of psoriasis. Cutaneous examination revealed diffuse psoriatic plaques with scattered ~1 cm erosions. Punch biopsy of the skin revealed herpes simplex virus (HSV) infection within a psoriatic plaque, necessitating dermatological treatment. The patient experienced premature rupture of membranes at 37-week gestation. Pelvic exam showed no evidence of herpetic lesions. After labor augmentation, the patient delivered a healthy female infant with no evidence of HSV infection. Discussion. Psoriasis herpeticum is a rare and potentially devastating complication of an underlying dermatosis. With a paucity of data available to guide pregnancy-specific issues, the general management of this condition is controversial and requires a multidisciplinary care approach. Concerns for systemic infection in the mother and vertical transmission to the neonate are of critical importance.

In Niger, the tuberculosis (TB) screening among people living with human immunodeficiency virus (HIV) (PLHIV) is nonsystematic and the use of additional tests is very often limited. The objective of this research is to evaluate the performance and the cost-effectiveness of various paraclinical testing strategies of TB among adult patients with HIV, using available tests in routine for patients cared in Niamey. This is a multicentric prospective intervention study performed in Niamey between 2010 and 2013. TB screening has been sought in newly diagnosed PLHIV, before ART treatment, performing consistently: a sputum examination by MZN (Ziehl-Nielsen staining) and microscopy fluorescence (MIF), chest radiography (CR), and abdominal ultrasound. The performance of these different tests was calculated using sputum culture as a gold standard. The various examinations were then combined in different algorithms. The cost-effectiveness of different algorithms was assessed by calculating the money needed to prevent a patient, put on ART, dying of TB. Between November 2010 and November 2012, 509 PLHIV were included. TB was diagnosed in 78 patients (15.3%), including 35 pulmonary forms, 24 ganglion, and 19 multifocal. The sensitivity of the evaluated algorithms varied between 0.35 and 0.85. The specificity ranged from 0.85 to 0.97. The most costeffective algorithm was the one involving MIF and CR. We recommend implementing a systematic and free direct examination of sputum by MIF and a CR for the detection of TB among newly diagnosed PLHIV in Niger.

BACKGROUND: Nigers low-burden sex-work-driven HIV epidemic is situated in a context of high economic and demographic growth. Resource availability of HIV/AIDS has been decreasing recently. In 2007-2012 only 1% of HIV expenditure was for sex work interventions but an estimated 37% of HIV incidence was directly linked to sex work in 2012. The Government of Niger requested assistance to determine an efficient allocation of its HIV resources and to strengthen HIV programming for sex workers. METHODS: Optima an integrated epidemiologic and optimization tool was applied using local HIV epidemic demographic programmatic expenditure and cost data. A mathematical optimization algorithm was used to determine the best resource allocation for minimizing HIV incidence and disability-adjusted life years (DALYs) over 10 years. RESULTS: Efficient allocation of the available HIV resources to minimize incidence and DALYs would increase expenditure for sex work interventions from 1% to 4%-5% almost double expenditure for antiretroviral treatment and for the prevention of mother-to-child transmission and reduce expenditure for HIV programs focusing on the general population. Such an investment could prevent an additional 12% of new infections despite a budget of less than half of the 2012 reference year. Most averted infections would arise from increased funding for sex work interventions. CONCLUSIONS: This allocative efficiency analysis makes the case for increased investment in sex work interventions to minimize future HIV incidence and DALYs. Optimal HIV resource allocation combined with improved program implementation could have even greater HIV impact. Technical assistance is being provided to make the money invested in sex work programs work better and help Niger to achieve a cost-effective and sustainable HIV response.

Spirulina is a micro algae used for thousands of years due to its healing properties. We supplemented children suffering from sickle cell anemia in order to appreciate its impact on the anthropometrical and clinical parameters. It consisted of a randomized clinical double blind test which was carried during a period of 9 months. The study concerned 53 homozygotes children suffering from sickle cell anemia aged 6 months to 15 years. Also, they were visiting the National Hospital of Niamey for follow up. One group (28 children) received 5 g of spirulina daily, and the other group (25 children) received placebo. The aspects studied were: the number of hospitalizations and transfusions, the vaso-occlusive crisis, the body mass index, and the splenomegalia. We found that 84.90% of patients were hospitalized at least once and 45.3% of them have already been transfused. The average number of crisis has greatly decreased in the spirulina group from 2.75 before the study to 1.18 at the end of the study. This, thus, was observed when compared to 2.44 to 1.6 in the placebo group. We also noticed a decrease of the number of hospitalizations and the number of transfusions which is less important in the group supplemented with spirulina. In conclusion, this study showed that supplementation in spirulina had a significant impact on children suffering from sickle cell anemia. This is even despite the fact that the difference between the two groups is not significant in some cases.

Chapitre de l’ouvrage collectif Penser une démocratie alimentaire Volume II – Proposition Lascaux entre ressources naturelles et besoins fondamentaux, F. Collart Dutilleul et T. Bréger (dir), Inida, San José, 2014, pp. 357-364; International audience; La sécurité alimentaire des pays du Nord n’est pas celle des pays du Sud. Aux objectifs de diversité, de qualité des produits, d’information et de santé des consommateurs des premiers, répondent des préoccupations vitales d’autosuffisance alimentaire des seconds, traversant la propriété des terres, leurs cultures, l’approvisionnement en produits agroalimentaires et en intrants. Dès lors, les échanges commerciaux et les investissements internationaux dont les objets sont ces biens particuliers que sont la terre agricole et l’aliment, répondent à des objectifs inéluctablement différents, dont on sait qu’ils ne permettent pas pour l’essentiel, d’assurer l’effectivité du droit à l’alimentation, droit subjectif pourtant fondamental. Par ailleurs, au-delà de cette préoccupation essentielle, il peut s’avérer intéressant de s’interroger sur les outils contractuels qui régissent ces rapports économiques. S’il est bien un domaine dans lequel le sacro-saint principe de sécurité juridique n’est pas ébranlé, c’est celui des échanges agroalimentaires internationaux. Cependant, c’est paradoxalement à cet endroit qu’il est utile d’engager quelques réflexions.

8 pages; International audience; Le respect du droit à l'eau et la sécurité alimentaire entretiennent des liens étroits. Aussi, aucune politique ne peut atteindre l'objectif de sécurité alimentaire sans une meilleure articulation entre le droit à l'eau et la politique de sécurité alimentaire. Sous le bénéfice de ces observations qu'en est-il du respect du droit à l'eau et de la sécurité alimentaire au Mali ?

work in progress; Parmi les nombreuses interrogations liées aux pratiques BoP, cette proposition de communication a pour objectif de montrer que le produit, seul, ne fait pas la stratégie " BoP ", que l'intérêt et la force de ces stratégies sont dans les processus de mise en place qui accompagnent les plus démunis. En d'autres termes, le point de départ de la réflexion est d'affirmer que tous les produits qui s'adressent à la population du bas de la pyramide économique mondiale, ne sont pas des stratégies BoP au sens de Prahalad (2004). Le terme " BoP " désignant à la fois une population, un marché, des produits, des stratégies, un amalgame se crée. Il est donc important de distinguer les produits à destination des consommateurs émergents des produits issus de stratégies BoP. En s'appuyant sur des exemples de Nestlé au Cameroun, Procter et Gamble en Egypte et Danone en Egypte, nous proposons une taxonomie des produits à destination des plus démunis.

De par leur richesse en ressources naturelles renouvelables, les zones inondables tropicales revetent un interet social et economique majeur pour les pays en developpement. Cependant, les fleuves tropicaux sont aujourd'hui de plus en plus amenages pour satisfaire les besoins lies a de nouvelles activites. Les zones jusque-la regulierement inondees par la crue annuelle se reduisent ou alors les rythmes de leur inondation sont profondement modifies. Les impacts de tels changements sont nombreux et portent atteinte a la biodiversite et a la durabilite des systemes d'exploitation. Il s'avere alors necessaire de definir de nouvelles approches de la gestion de l'eau, des espaces et des ressources vivantes, qui tout a la fois preservent les ecosystemes et prennent en consideration les besoins des differents usagers. Tel est l'objectif de cet ouvrage qui pose, dans un premier temps, la problematique societale autour de laquelle cette gestion doit etre repensee, en faisant apparaitre la diversite d'acteurs et d'institutions concernes. Il presente ensuite les acquis les plus recents de la recherche sur le fonctionnement de ces ecosystemes ainsi que sur les pratiques et strategies deployees par les populations qui les exploitent. Enfin est abordee la question des instruments a mettre en place pour assurer l'effectivite d'une gestion durable des zones inondables tropicales : apres avoir fait le point sur les apports de la recherche concernant les outils de traitement et de partage de l'information environnementale, l'ouvrage se termine par un debat sur les conditions de creation et de fonctionnement des institutions de suivi, de concertation et de decision. (Resume d'auteur)

Dracunculiasis, commonly known as guinea worm disease, is a nematode infection transmitted to humans exclusively via contaminated drinking water. The disease prevails in the most deprived areas of the world. No vaccine or medicine is available against the disease: eradication is being achieved by implementing preventive measures. These include behavioural change in patients and communities—such as self-reporting suspected cases to health workers or volunteers, filtering drinking water and accessing water from improved sources and preventing infected individuals from wading or swimming in drinking-water sources—supplemented by active surveillance and case containment, vector control and provision of improved water sources. Efforts to eradicate dracunculiasis began in the early 1980s. By the end of 2012, the disease had reached its lowest levels ever. This paper reviews the progress made in eradicating dracunculiasis since the eradication campaign began, the factors influencing progress and the difficulties in controlling the pathogen that requires behavioural change, especially when the threat becomes rare. The challenges of intensifying surveillance are discussed, particularly in insecure areas containing the last foci of the disease. It also summarizes the broader benefits uniquely linked to interventions against dracunculiasis.

Doctorat en Sciences, info:eu-repo/semantics/nonPublished

Background This study evaluated the performance of a new weight estimation strategy (Mercy Method) with four existing weight-estimation methods (APLS, ARC, Broselow, and Nelson) in children from Ouelessebougou, Mali. Methods Otherwise healthy children, 2 mos to 16 yrs, were enrolled and weight, height, humeral length (HL) and mid-upper arm circumference (MUAC) obtained by trained raters. Weight estimation was performed as described for each method. Predicted weights were regressed against actual weights. Agreement between estimated and actual weight was determined using Bland-Altman plots with log-transformation. Predictive performance of each method was assessed using residual error (RE), percentage error (PE), root mean square error (RMSE), and percent predicted within 10, 20 and 30% of actual weight. Results 473 children (8.1 ± 4.8 yr, 25.1 ± 14.5 kg, 120.9 ± 29.5 cm) participated in this study. The Mercy Method (MM) offered the best correlation between actual and estimated weight when compared with the other methods (r2 = 0.97 vs. 0.80-0.94). The MM also demonstrated the lowest ME (0.06 vs. 0.92-4.1 kg), MPE (1.6 vs. 7.8-19.8%) and RMSE (2.6 vs. 3.0-6.7). Finally, the MM estimated weight within 20% of actual for nearly all children (97%) as opposed to the other methods for which these values ranged from 50-69%. Conclusions The MM performed extremely well in Malian children with performance characteristics comparable to those observed for U.S and India and could be used in sub-Saharan African children without modification extending the utility of this weight estimation strategy.