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Objectif : L’Objectif de cette étude était d’étudier les caractéristiques épidémiologiques, des parodontopathies (pathologies des tissus de soutien de la dent) observées chez la femme enceinte en consultation prénatale dans le service de Gynécologie obstétrique du CHU Gabriel Touré. Matériels et Méthode : Nous avons réalisé une étude transversale, analytique basée sur l’observation de l’état parodontal des femmes enceintes, sur une période de 2 mois (de Mai à Juillet 2013), sur 208 observations recensées en consultation prénatale. Les données ont été recueillies à partir des dossiers médicaux, saisies et analysées avec le logiciel SPSS 19.0 Résultats : Nous avons inclus 189/208 (90,90 % de maladies parodontales). La classe d’âge la plus atteinte a été celle des 20-29 ans (52,40%), avec une moyenne d’âge de 26,88 et des extrêmes allant de 14 à 49 ans. Les femmes mariées étaient les plus représentées (94,70 %), elles étaient multigestes dans 71,00 % des cas et les femmes au foyer (40,40 %). Les femmes séropositives représentaient 14,00 % de l’échantillon. L’indice CPITN correspondant au détartrage était plus important chez les patientes, entre la 11e semaine et la 41e semaine de gestation. Conclusion : Cette étude montre la fréquence élevée des parodontopathies chez la femme enceinte, d’où l’intérêt d’un partenariat entre professionnels de la santé de la reproduction, et ceux de la cavité buccale.

Abstract Background Our recent studies have shown headache disorders to be very common in the central and western sub-Saharan countries of Benin and Cameroon. Here we report headache in nearby Mali, a strife-torn country that differs topographically, culturally, politically and economically. The purposes were to estimate headache-attributed burden and need for headache care. Methods We used cluster-random sampling in seven of Mali’s eleven regions to obtain a nationally representative sample. During unannounced household visits by trained interviewers, one randomly selected adult member (18–65 years) from each household was interviewed using the structured HARDSHIP questionnaire, with enquiries into headache in the last year and, additionally, headache yesterday (HY). Headache on ≥ 15 days/month (H15+) was diagnosed as probable medication-overuse headache (pMOH) when associated with acute medication use on ≥ 15 days/month, and as “other H15+” when not. Episodic headache (on

Le tourisme rural intégré est un type de tourisme alternatif qui place la population locale au cœur des initiatives favorisant ainsi son développement et permettant de bénéficier des retombées économiques du secteur. Lancé dans les années 1970 en Basse Casamance, il offre diverses richesses naturelles et culturelles. L’objectif est de créer des coopératives autour des campements villageois afin de réduire la pauvreté. Cette étude analyse l’apport du tourisme rural intégré dans le village d’Affiniam, longtemps enclavé et difficile d’accès. Elle s’appuie sur une approche quantitative (enquête) et qualitative (entretien et observation) pour évaluer la perception de la population. Les résultats montrent un bilan satisfaisant dans la mesure où l’installation du campement villageois a permis à la population locale de bénéficier des retombées du tourisme et de porter le développement de sa localité. Cent pourcent des enquêtés affirment que le campement a permis le développement du village, et 94 % indiquent participer aux activités du campement. Cependant, 92 % des enquêtés notent également des effets négatifs. Parmi ceux-ci, 53 % mentionnent la dégradation des mœurs, 28 % parlent de la prostitution déguisée, 13 % évoquent la perversion sociale et 6 % citent d’autres effets (risque de maladie, marchandisation de la culture). Malgré ces effets négatifs, 83 % des enquêtés jugent le bilan positif, 16 % le trouvent moyen et 1 % le considèrent faible.

Les littoraux sont des zones de concentration de différentes activités socio-économiques qui sont parfois difficiles à concilier. Le tourisme balnéaire par exemple, exige une plage de qualité et des eaux de baignade propres, ce qui peut entrer en conflit avec d'autres activités comme la pêche et la transformation des produits marins. Cet article vise à examiner comment l'occupation désordonnée des zones côtières par différentes activités socio-économiques impacte le tourisme côtier, et à proposer des solutions pour une gestion plus rationnelle de ces espaces. L’étude s’est focalisée sur le littoral de l’axe Abéné-Kafountine, au sud Sénégal. Une première évaluation de l'occupation des zones côtières entre Abéné et Kafountine a été effectuée pour analyser les conflits d'utilisation et leurs effets sur le tourisme. La méthodologie combine la cartographie des activités et une approche qualitative basée sur des entretiens et des observations. Les résultats de la cartographie de ces installations montrent une occupation anarchique du littoral, avec une centralisation des quais de pêche à Kafountine et à Abéné et la répartition de part et d’autre des aménagements touristiques. Cette situation combinée à un problème d’aménagement entraîne l’insalubrité de la plage. Les résultats des enquêtes qualitatives permettent de constater la frustration des hôteliers et des touristes qui déplorent la prolifération des ordures et la fumée sur la plage, ce qui pénalise le secteur touristique. Des pistes sont enfin explorées pour envisager une gestion durable et concertée de ces territoires.

Abstract Background Lockdown measures of COVID-19 have had different repercussions on the well-being of households in West Africa depending on their resilience capacity. This study compares the dynamic of households’ food insecurity during COVID-19 pandemic according to their membership in different types of agricultural cooperatives in four West African countries, namely Ghana, Mali, Ivory Coast, and Senegal. Methodology We used data collected from 1270 members of agricultural cooperatives and regression analyses, to understand the link between the nature of their cooperatives and the food insecurity dynamic of their household, while controlling for other sociodemographic characteristics. Cooperative were categorized either “active” or “poorly/not active” depending on their capacity to conduct initiatives that address the needs of their members, to maintain communication between leaders and members, the participation of members to decisions, and their possession of a good understanding of business management. Food insecurity is measured using the Food Insecurity Experience Scale (FIES) and the Coping Strategy Index (CSI). Respondents were asked to answer questions related to their food security status for the period before and during the pandemic. Results The COVID-19 pandemic has adversely affected respondents' food security status. These effects varied according to the severity of sanitary measures implemented and to the dynamism of cooperatives. Households of poorly or not active cooperatives have experienced more food insecurity in Ivory Coast and Senegal than those who were members of active cooperatives; in Ghana the effects were significant but similar in both types of cooperatives. Members of both cooperatives in Mali appear to have been less affected than members in other countries. Furthermore, households of poorly/not active cooperatives have used more severe coping strategies in Ivory Coast, Ghana, and Senegal during the pandemic. Conclusions Strong collaboration and support provided by cooperatives can contribute to increase the resilience capacity of their members to shocks such as the COVID-19 pandemic.

Au Québec, l’insécurité alimentaire est un enjeu de santé publique. Malgré le soutien de plusieurs ministères aux organisations communautaires et privées qui luttent contre l’insécurité alimentaire, elle perdure et s’est aggravée avec la pandémie de COVID-19. Cet article analyse la cohérence des politiques et interventions gouvernementales de lutte contre l’insécurité alimentaire au Québec et interroge leur capacité à la prévenir. Un cadre théorique basé sur les déterminants de la sécurité alimentaire et sur le concept de cohérence des politiques publiques est mobilisé. La plupart des interventions de lutte contre l’insécurité alimentaire en 2021 étaient réparties dans trois politiques gouvernementales, le Plan d’action gouvernemental pour l’inclusion économique et la participation sociale 2017-2023; la Politique gouvernementale de prévention en santé 2017-2021 et la Politique bioalimentaire 2018-2023, auxquelles s’ajoutent d’autres interventions provinciales et fédérales. En revanche, aucune stratégie d’ensemble officielle ne vise directement la lutte contre l’insécurité alimentaire, ce qui permettrait de coordonner les interventions gouvernementales et de la société civile (milieux communautaires et privés) et de créer des ponts entre les politiques sociales, de santé publique et bioalimentaires. La mise en place d’une telle stratégie permettrait de mieux agir sur l’ensemble des déterminants (individuels ou collectifs) et de mieux prévenir l’insécurité alimentaire. Cela faciliterait le développement de parcours intégrant plusieurs types d’interventions, adaptés aux différentes populations vulnérables. Une vision commune, des cibles à atteindre ainsi que des mécanismes de suivi et d’évaluation des effets réels des interventions, individuels et croisés, pourraient être mis en place, en collaboration avec les acteurs concernés.

Plain Language Summary A labor companion is a person who supports a woman throughout labor and birth, typically a woman’s spouse/partner, family member, or friend. We were interested to explore if a labor companion throughout labor and birth was acceptable to women and health workers, and feasible to start doing for women in Burkina Faso. To achieve this objective, we interviewed 77 women, companions, and health workers about their beliefs and opinions about labor companions, and what might help or be a challenge to having companions. We also visited eight hospitals to understand what the labor ward looks like, and any policies about companions. We found that hospitals were allowing a ‘traditional model’ of companionship, allowing companions to accompany women only in the waiting and postnatal rooms (not during labor or birth). Both women and health workers believed that companionship during labor and birth would be helpful and desired, which might help to make it a reality for all women. We also identified some challenges, due to crowded labor rooms with limited privacy, and hospital rules that did not allow companionship. We found that sometimes a woman’s family would choose the companion, instead of the woman herself, which may mean the woman does not want this person present. We plan to use these findings to help us to develop a program that allows any woman to have a companion present during labor and birth, in a way that ensures that she chooses the companion, and the companion can support her well.

Introduction In high mortality settings, prophylactic azithromycin has been shown to improve birth weight and gestational age at birth when administered antenatally, to reduce the incidence of neonatal infections when administered intrapartum, and to improve survival when administered in infancy. Questions remain regarding whether azithromycin can prevent stillbirths, and regarding the optimal strategy for the delivery of azithromycin to pregnant women and their infants.Methods and analysis Sauver avec l’Azithromycine en Traitant les Femmes Enceintes et les Enfants (SANTE) is a 2×2 factorial, individually randomised, placebo-controlled, double-masked trial in rural Mali. The primary aims are: (1A) to assess the efficacy of antenatal and intrapartum azithromycin on a composite outcome of stillbirths and infant mortality through 6–12 months and (1B) to assess the efficacy of azithromycin administered concurrently with the first and third doses of pentavalent vaccines (Penta-1/3) on infant mortality through 6–12 months. Pregnant participants (n=49 600) and their infants are randomised 1:1:1:1 to one of four treatment arms: (1) mother and infant receive azithromycin, (2) mother and infant receive placebo, (3) mother receives azithromycin and infant receives placebo or (4) mother receives placebo and infant receives azithromycin. Pregnant participants receive three single 2 g doses: two antepartum and one intrapartum. Infants receive a single 20 mg/kg dose at the Penta-1 and 3 visits. An additional cohort of 12 000 infants is recruited at the Penta-1 visit and randomised 1:1 to receive azithromycin or placebo at the same time points. The SANTE trial will inform guidelines and policies regarding the administration of antenatal and infant azithromycin using routine healthcare delivery platforms.Ethics and dissemination This trial was approved by the Institutional Review Board at the University of Maryland School of Medicine (Protocol #HP-00084242) and the Faculté de Médecine et d’Odonto-Stomatologie in Mali. The findings of this trial will be published in open access peer-reviewed journals.Trial registration number NCT03909737.

Abstract 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.

Background The WHO recommends use of the RTS,S/AS01E (RTS,S) malaria vaccine for young children living in areas of moderate to high Plasmodium falciparum malaria transmission and suggests countries consider seasonal vaccination in areas with highly seasonal malaria. Seasonal vaccination is uncommon and may require adaptations with potential cost consequences. This study prospectively estimates cost of seasonal malaria vaccine delivery in Mali and Burkina Faso.Methods Three scenarios for seasonal vaccine delivery are costed (1) mass campaign only, (2) routine Expanded Programme on Immunisation (EPI) and (3) mixed delivery (mass campaign and routine EPI)), from the government’s perspective. Resource use data are informed by previous new vaccine introductions, supplemented with primary data from a sample of health facilities and administrative units.Findings At an assumed vaccine price of US $5 per dose, the economic cost per dose administered ranges between $7.73 and $8.68 (mass campaign), $7.04 and $7.38 (routine EPI) and $7.26 and $7.93 (mixed delivery). Excluding commodities, the cost ranges between $1.17 and $2.12 (mass campaign), $0.48 and $0.82 (routine EPI) and $0.70 and $1.37 (mixed delivery). The financial non-commodity cost per dose administered ranges between $0.99 and $1.99 (mass campaign), $0.39 and $0.76 (routine EPI) and $0.58 and $1.28 (mixed delivery). Excluding commodity costs, service delivery is the main cost driver under the mass campaign scenario, accounting for 36% to 55% of the financial cost. Service delivery accounts for 2%–8% and 12%–23% of the total financial cost under routine EPI and mixed delivery scenarios, respectively.Conclusion Vaccine delivery using the mass campaign approach is most costly followed by mixed delivery and routine EPI delivery approaches, in both countries. Our cost estimates provide useful insights for decisions regarding delivery approaches, as countries plan the malaria vaccine rollout.

Abstract Background Chronic renal failure can lead to dialysis and/or a kidney transplant in the final stage. The number of patients under dialysis has increased considerably in the world and particularly in sub-Saharan Africa. Dialysis is a very expensive care. This is the reason why this study on the costs of dialysis management was initiated in Burkina Faso. The objective of the study is to determine the direct medical and non-medical costs of managing chronic renal failure among dialysis patients in Ouagadougou in 2020. Methods An analytical cross-sectional study was conducted. Data were collected in the hemodialysis department of three public university hospitals in Ouagadougou, Burkina Faso. All dialysis patients with chronic renal failure were included in the study. Linear regression was used to investigate the determinants of the direct medical and non-medical cost of hemodialysis. Results A total of 290 patients participated in this study, including children, adults, and the elderly with extremes of 12 and 82 years. Almost half of the patients (47.5%) had no income. The average monthly total direct cost across all patients was 75842 CFA or US$134.41.The average direct medical cost was 51315 CFA or US$90.94 and the average direct non-medical cost was 24 527 CFA or US$43.47. Most of the patients (45.2%) funded their hemodialysis by their own source. The multivariate analysis showed that the presence of an accompanying person during treatment, residing in a rural area, ambulatory care, use of personal cars, and treatment at the dialysis center of Yalgado Teaching Hospital were associated with higher direct costs. Conclusion The average cost of dialysis services borne by the patient and his family is very high in Burkina Faso, since it is 2.1 times higher than the country's minimum interprofessional wage (34664 CFA or US$61.4). It appears that the precariousness of the means of subsistence increases strongly with the onset of chronic renal failure requiring dialysis. Thus, to alleviate the expenses borne by dialysis patients, it would be important to extend the government subsidy scheme to the cost of drugs and to promote health insurance to ensure equitable care for these patients.

The objective of this article is to present the contribution of migrant fishers to the supply of fishmeal factories in Senegal, The Gambia and Mauritania. The method consisted first of identifying migrant fishers and then quantifying the volumes of small pelagic fish they catch in the three countries studied. Then, an interview guide was submitted to more than 250 actors (migrant fishers and fishmongers) met in Banjul and Serrekunda in the Gambia, in Nouakchott and Nouadhibou in Mauritania, and in the fishing, centers located on the small Senegalese coast. These individual and collective interviews made it possible to estimate and determine the share of migrant fishers’ catches allocated to the fishmeal industry. Overall, the four groups of migrant fishers (3 Senegalese and 1 Guinean) identified in Mauritania and The Gambia catch on average more than 305,000 tonnes of pelagic fish per year over the period 2015 - 2018. Analysis of the marketing of their catches shows that almost 63% of the 305,000 tonnes, i.e. 192,000 tonnes of pelagic fish, are destined to supply the fishmeal factories of the three countries studied, while only 113,000 tonnes are distributed on the national consumer markets (fresh and artisanal processed). Of the 192,000 tonnes destined for fishmeal factories, two-thirds are sent to Mauritanian factories, with Senegal and The Gambia sharing the remaining third. Thus, important collaborations have been established in recent years between migrant fishers and the fishmeal industries. Indeed, the fishmeal industries improve the operating accounts of migrant fishers by ensuring the sale of their catches at more remunerative prices than on the local market at the micro level. However, when analyzed on a large scale, fishmeal industries exert a real pressure on the nutritional security of West African countries, as pelagic fish are the main source of animal protein in Senegal and The Gambia and have been over exploited in recent years. In addition, they prevent access to artisanal processing of their raw material. All these elements raise the question of the urgency of regulating migrant fishers catches on a regional scale and drastically reducing the share allocated to fishmeal processing in favor of local consumption.

IntroductionIn Burkina Faso, the first cases of COVID-19 were reported in March 2020. Health personnel are on the front line of COVID-19 control, and it is important to understand their perceptions and knowledge of the disease. The objective was to determine the knowledge and perceptions of healthcare personnel of COVID-19 in the city of Ouagadougou.MethodThe study was conducted in five plots in the city of Ouagadougou. A total of 20 health workers from public and private health centers in the city of Ouagadougou were selected during May 2020. In-depth individual interviews were conducted, and a thematic analysis was performed using NVIVO.Results and discussionThe routes of transmission identified were promiscuity, respiratory tract, and physical contact. Various symptoms have been noted, such as fever, cough, and runny nose. However, they recognize that these symptoms are not sufficient to make a diagnosis of COVID-19. Similarly, the treatments mentioned are modern medicine and phytomedicine.ConclusionThe research has generated information on healthcare workers' knowledge and perceptions of COVID-19. Therefore, they are useful for decision-making regarding protective measures for health workers in the management of COVID-19.

Abstract Background In Senegal, studies focusing specifically on vaccination coverage with the Bacille de Calmette et Guérin (BCG) vaccine, the birth dose of oral polio vaccine (OPV zero dose) and the birth dose of hepatitis B (HepB-BD) vaccine are insufficient. This study aimed to highlight vaccination coverages with birth doses and factors associated with timely vaccination in Podor health district. Methods A cross-sectional study was carried out from June 19 to 22, 2020. The study population consisted of children aged 12 to 23 months of which 832 were included. A stratified two-stage cluster survey was carried out. The sources of data were home-based records (HBR), health facility registries (HFR) and parental recalls. Timely vaccination refers to any vaccination that has taken place within 24 h after birth. Descriptive analyzes, the chi-square test and logistic regression were performed. Results The crude vaccination coverages with BCG, OPV zero dose and HepB-BD were 95.2%, 88.3% and 88.1%, respectively. Vaccination coverages within 24 h after birth were estimated at 13.9%, 30% and 42.1%, respectively. The factors associated with timely HepB-BD are delivery in a health facility (AOR = 1.55; 95% CI = 1.02–2.40), access to television (AOR = 1.63; 95% CI = 1.16–2.29), weighing (AOR = 3.92; 95% CI = 1.97–8.53) and hospitalization of the newborn immediately after birth (AOR = 0.42; 95% CI = 0.28–0.62). Conclusion Timely administration of birth doses is a challenge in the Podor health district. The solutions would be improving geographic access to health facilities, involving community health workers, raising awareness and integrating health services.

Abstract Background Plasmodium falciparum malaria remains a major public health concern in sub-Sahara Africa. Seasonal malaria chemoprevention (SMC) with amodiaquine + sulfadoxine-pyrimethamine is one of the most important preventive interventions. Despite its implementation, the burden of malaria is still very high in children under five years old in Burkina Faso, suggesting that the expected impact of this promising strategy might not be attained. Development of innovative strategies to improve the efficacy of these existing malaria control measures is essential. In such context, we postulate that screening and treatment of malaria in household members of children receiving SMC could greatly improve the impact of SMC intervention and reduce malaria transmission in endemic settings. Methods This randomized superiority trial will be carried out in the Nanoro health district, Burkina Faso. The unit of randomisation will be the household and all eligible children from a household will be allocated to the same study group. Households with 3–59 months old children will be assigned to either (i) control group (SMC alone) or (ii) intervention (SMC+ screening of household members with standard Histidin Rich Protein Rapid Diagnostic Test (HRP2-RDT) and treatment if positive). The sample size will be 526 isolated households per arm, i.e., around 1052 children under SMC coverage and an expected 1315 household members. Included children will be followed-up for 24 months to fully cover two consecutive malaria transmission seasons and two SMC cycles. Children will be actively followed-up during the malaria transmission seasons while in the dry seasons the follow-up will be passive. Conclusion The study will respond to a major public health concern by providing evidence of the efficacy of an innovative strategy to boost the impact of SMC intervention.