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Abstract Background The 2014–2016 Ebola virus disease outbreak in West Africa revealed weaknesses in the health systems of the three most heavily affected countries, including a shortage of public health professionals at the local level trained in surveillance and outbreak investigation. In response, the Frontline Field Epidemiology Training Program (FETP) was created by CDC in 2015 as a 3-month, accelerated training program in field epidemiology that specifically targets the district level. In Guinea, the first two FETP-Frontline cohorts were held from January to May, and from June to September 2017. Here, we report the results of a cross-sectional evaluation of these first two cohorts of FETP-Frontline in Guinea. Methods The evaluation was conducted in April 2018 and consisted of interviews with graduates, their supervisors, and directors of nearby health facilities, as well as direct observation of data reports and surveillance tools at health facilities. Interviews and site visits were conducted using standardized questionnaires and checklists. Qualitative data were coded under common themes and analyzed using descriptive statistics. Results The evaluation revealed a significant perception of improvement in all assessed skills by the graduates, as well as high levels of self-reported involvement in key activities related to data collection, analysis, and reporting. Supervisors highlighted improvements to systematic and quality case and summary reporting as key benefits of the FETP-Frontline program. At the health facility level, staff reported the training had resulted in improvements to information sharing and case notifications. Reported barriers included lack of transportation, available support personnel, and other resources. Graduates and supervisors both emphasized the importance of continued and additional training to solidify and retain skills. Conclusions The evaluation demonstrated a strongly positive perceived benefit of the FETP-Frontline training on the professional activities of graduates as well as the overall surveillance system. However, efforts are needed to ensure greater gender equity and to recruit more junior trainee candidates for future cohorts. Moreover, although improvements to the surveillance system were observed concurrent with the completion of the two cohorts, the evaluation was not designed to directly measure impact on surveillance or response functions. Combined with the rapid implementation of FETP-Frontline around the world, this suggests an opportunity to develop standardized evaluation toolkits, which could incorporate metrics that would directly assess the impact of equitable field epidemiology workforce development on countries’ abilities to prevent, detect, and respond to public health threats.

Abstract Background Schistosomiasis is still a public health issue in certain areas of developing countries (especially in sub-saharan Africa). Schistosoma haematobium is a proven carcinogenic agent that causes mainly bladder squamous cell carcinoma. This type of cancer has characteristic epidemiological, clinical and histopathological features with poor prognosis as compared to other urinary bladder cancers not associated with this parasite. Cases presentation We report two fatal cases of advanced-stage bladder squamous cell carcinoma associated with Schistosoma haematobium in a sub-saharan developing African country (Niger), illustrating the devastating complications of this tropical neglected disease. The two cases were a 38-year-old woman and a 37-year-old male. They presented with chronic pelvic pain and hematuria. The clinical and radiological work-up revealed invasive urivary bladder tumor extended to the pelvis, that was histopathologically proven to be an invasive squamous cell carcinoma associated with Schistosoma haematobium. The two patients died shortly after the diagnosis before chemotherapy prescription. Conclusion Schistosoma-associated bladder squamous cell carcinoma has characteristic features with dismal prognosis. Eradication of this parasite remains the only efficient way to prevent the devastating consequences of this particular cancer.

The 2014–2016 Ebola outbreak in Guinea revealed systematic weaknesses in the existing disease surveillance system, which contributed to delayed detection, underreporting of cases, widespread transmission in Guinea and cross-border transmission to neighboring Sierra Leone and Liberia, leading to the largest Ebola epidemic ever recorded. Efforts to understand the epidemic's scale and distribution were hindered by problems with data completeness, accuracy, and reliability. In 2017, recognizing the importance and usefulness of surveillance data in making evidence-based decisions for the control of epidemic-prone diseases, the Guinean Ministry of Health (MoH) included surveillance strengthening as a priority activity in their post-Ebola transition plan and requested the support of partners to attain its objectives. The U.S. Centers for Disease Control and Prevention (US CDC) and four of its implementing partners—International Medical Corps, the International Organization for Migration, RTI International, and the World Health Organization—worked in collaboration with the Government of Guinea to strengthen the country's surveillance capacity, in alignment with the Global Health Security Agenda and International Health Regulations 2005 objectives for surveillance and reporting. This paper describes the main surveillance activities supported by US CDC and its partners between 2015 and 2019 and provides information on the strategies used and the impact of activities. It also discusses lessons learned for building sustainable capacity and infrastructure for disease surveillance and reporting in similar resource-limited settings.

Lacrimal gland chondroid syringoma is a very rare tumor with classic clinico-radiological symptoms that should be familiar to clinicians for appropriate patients’ management as the tumor has potential for recurrence and malignant transformation. We report herein a case of chondroid syringoma in a 35-year-old patient presenting with progressive painless proptosis for 2 years. He underwent complete surgical removal of the tumor, with subsequent clinical improvement of his symptoms.

A robust epidemic-prone disease surveillance system is a critical component of public health infrastructure and supports compliance with the International Health Regulations (IHR). One digital health platform that has been implemented in numerous low- and middle-income countries is the District Health Information System Version 2 (DHIS2). In 2015, in the wake of the Ebola epidemic, the Ministry of Health in Guinea established a strategic plan to strengthen its surveillance system, including adoption of DHIS2 as a health information system that could also capture surveillance data. In 2017, the DHIS2 platform for disease surveillance was piloted in two regions, with the aim of ensuring the timely availability of quality surveillance data for better prevention, detection, and response to epidemic-prone diseases. The success of the pilot prompted the national roll-out of DHIS2 for weekly aggregate disease surveillance starting in January 2018. In 2019, the country started to also use the DHIS2 Tracker to capture individual cases of epidemic-prone diseases. As of February 2020, for aggregate data, the national average timeliness of reporting was 72.2%, and average completeness 98.5%; however, the proportion of individual case reports filed was overall low and varied widely between diseases. While substantial progress has been made in implementation of DHIS2 in Guinea for use in surveillance of epidemic-prone diseases, much remains to be done to ensure long-term sustainability of the system. This paper describes the implementation and outcomes of DHIS2 as a digital health platform for disease surveillance in Guinea between 2015 and early 2020, highlighting lessons learned and recommendations related to the processes of planning and adoption, pilot testing in two regions, and scale up to national level.

Climate services favor adopting strategies to increase agricultural productivity, enhance sustainable development, and adapt to unavoidable climate variability and change. However, for climates services to be effective, they must be accessible and suitable to user needs. This study investigated the effects of customized climate services (CCS) on land and labor productivity. Portraying the case of CCS delivered in the districts of Bolgatanga (Northern Ghana), Dano and Ouahigouya (western and northern Burkina Faso) in West Africa, it used: i) historical panel data of daily rainfall, yields, agricultural input, and output prices; ii) cost statements of farm operations and iii) other survey data from beneficiaries of on-farm demonstrations (pilot sites). Different results were found across farmers on the demonstrator sites, with Dano and Bolgatanga recording the best land and labor productivity. Strong and positive effects were observed in Dano, where land productivity increased by 200% and labor productivity doubled despite consecutive pluviometric extremes such as heavy rain events and prolonged dry spells in the 2017 and 2018 cropping seasons. Further investigation showed that CCS was particularly favorable to land and labor productivity of farmers who were committed to the advisory given by the CCS providers. Therefore, as perishable goods, the success of CCS applications would require thorough co-production, delivery, and monitoring for their effectiveness in improving land and labor productivity for agriculture in semi-arid regions of West Africa.

The 2014-2016 Ebola virus disease outbreak revealed the fragility of the Guinean public health infrastructure. As a result, the Guinean Ministry of Health is collaborating with international partners to improve compliance with the International Health Regulations and work toward the Global Health Security Agenda goals, including enhanced case- and community-based disease surveillance. We assessed the case-based disease surveillance system during October 1, 2015-March 31, 2016, in the Boffa prefecture of Guinea. We conducted onsite interviews with public health staff at the peripheral (health center), middle (prefectural), and central (Ministry of Health) levels of the public health system to document leadership structure; methods for maintaining case registers and submitting weekly case reports; disease surveillance feedback; data analysis; and baseline surveillance information on four epidemic-prone diseases (cholera, meningococcal meningitis, measles, and yellow fever). The surveillance system was simple and paper-based at health centers and computer spreadsheet-based at the prefectural and central levels. Surveillance feedback to stakeholders at all levels was infrequent. Data analysis activities were minimal at the peripheral levels and progressively more robust at the prefectural and central levels. Reviewing the surveillance reports from Boffa during the study period, we observed zero reported cases of the four epidemic-prone diseases in the weekly reporting from the peripheral to the central level. Similarly, the national District Health Information System 2 had no reported cases of the four diseases in Boffa but did indicate reported cases among all four neighboring prefectures. Based on the assessment findings, which suggest low sensitivity of the case-based disease surveillance system in Boffa, we recommend additional training and support to improve surveillance data quality and enhance Guinean public health workforce capacity to use these data.

Water scarcity for smallholder farming in West Africa has led to the shift of cultivation from uplands to inland valleys. This study investigates the impacts of climate and land use/land cover (LULC) change on water resources in an intensively instrumented inland valley catchment in Southwestern Burkina Faso. An ensemble of five regional climate models (RCMs) and two climate scenarios (RCP 4.5 and RCP 8.5) was utilized to drive a physically-based hydrological model WaSiM after calibration and validation. The impact of climate change was quantified by comparing the projected period (2021–2050) and a reference period (1971–2000). The result showed a large uncertainty in the future change of runoff between the RCMs. Three models projected an increase in the total runoff from +12% to +95%, whereas two models predicted a decrease from −44% to −24%. Surface runoff was projected to show the highest relative change compared to the other runoff components. The projected LULC 2019, 2025, and 2030 were estimated based on historical LULC change (1990–2013) using the Land Change Modeler (LCM). A gradual conversion of savanna to cropland was shown, with annual rates rom 1 to 3.3%. WaSiM was used to simulate a gradual increase in runoff with time caused by this land use change. The combined climate and land use change was estimated using LULC-2013 in the reference period and LULC-2030 as future land use. The results suggest that land use change exacerbates the increase in total runoff. The increase in runoff was found to be +158% compared to the reference period but only +52% without land use change impacts. This stresses the fact that land use change impact is not negligible in this area, and climate change impact assessments without land use change analysis might be misleading. The results of this study can be used as input to water management models in order to derive strategies to cope with present and future water scarcities for smallholder farming in the investigated area.

Many studies have been undertaken on climate variability in West Africa since the drastic drought of 1970s. These studies rely in many cases on different baseline periods chosen with regard to the reference periods defined by the World Meteorological Organization. A method is developed in this study to determine a stationary baseline period for rainfall variability analysis. The method is based on an application of three statistic tests (on deviation and trend) and a test of shifts detection in rainfall time series. The application of this method on six different gridded rainfall data and observations from 1901 to 2018 shows that the 1917–1946 period is the longest stationary period. An assessment of the significance of the difference between the mean annual rainfall amount during this baseline period and the annual rainfall amount during the other years shows that the “Normal” annual rainfall amount is defined by an interval delineated by ±the standard deviation (STD). With regard to this interval, a very wet/dry year is defined with a surplus/gap over/below the STD. Overall the 1901–2018 period, the 1950–1970 period presents the most important number of significant wet years and the 1971–1990 period presents the most important number of significant dry years.

This study investigates the robustness of the physically-based hydrological model WaSiM (water balance and flow simulation model) for simulating hydrological processes in two data sparse small-scale inland valley catchments (Bankandi-Loffing and Mebar) in Burkina Faso. An intensive instrumentation with two weather stations, three rain recorders, 43 piezometers, and one soil moisture station was part of the general effort to reduce the scarcity of hydrological data in West Africa. The data allowed us to successfully parameterize, calibrate (2014–2015), and validate (2016) WaSiM for the Bankandi-Loffing catchment. Good model performance concerning discharge in the calibration period (R2 = 0.91, NSE = 0.88, and KGE = 0.82) and validation period (R2 = 0.82, NSE = 0.77, and KGE = 0.57) was obtained. The soil moisture (R2 = 0.7, NSE = 0.7, and KGE = 0.8) and the groundwater table (R2 = 0.3, NSE = 0.2, and KGE = 0.5) were well simulated, although not explicitly calibrated. The spatial transposability of the model parameters from the Bankandi-Loffing model was investigated by applying the best parameter-set to the Mebar catchment without any recalibration. This resulted in good model performance in 2014–2015 (R2 = 0.93, NSE = 0.92, and KGE = 0.84) and in 2016 (R2 = 0.65, NSE = 0.64, and KGE = 0.59). This suggests that the parameter-set achieved in this study can be useful for modeling ungauged inland valley catchments in the region. The water balance shows that evaporation is more important than transpiration (76% and 24%, respectively, of evapotranspiration losses) and the surface flow is very sensitive to the observed high interannual variability of rainfall. Interflow dominates the uplands, but base flow is the major component of stream flow in inland valleys. This study provides useful information for the better management of soil and scarce water resources for smallholder farming in the area.

Rationale: Uterine carcinosarcomas (UCS) are rare aggressive biphasic tumors classified as a subtype of high-grade uterine carcinomas. However, these tumors have particular histopathological features and clinical behavior with worse prognosis than high-grade uterine carcinomas., Patient Concerns: The incidence of UCS is increasing and more studies are required to elucidate their clinical and histopathological characteristics. Herein, we report clinicopathological features of 9 cases of UCS in a low-income country., Diagnoses: We retrospectively collected all cases of UCS at our Pathology Department over a period of 4 years. The diagnosis was performed on formalin-fixed, paraffin-embedded and hematoxylin and eosin-stained surgical specimens., Interventions: Nine surgically treated cases of UCS have been registered, representing 12.67% of all uterine malignancies with a mean age of 58.88 years (range: 50-65 years). Abdominal pain and metrorrhagia were the main clinical presentations. The epithelial component of UCS was often a serous carcinoma (66.66%) and patients presented with large tumors (mean size of 9.24 cm, range of 5-19 cm), with advanced FIGO stages (stages III-IV) in 5/9 patients (55.55%)., Outcomes: Follow-up data were available in 5/9 patients among which only 2 were alive 2 and 25 months after the surgical treatment (overall survival of 40%)., Lessons: UCS are rare and aggressive uterine tumors with very poor prognosis especially in low-income countries., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Poroid neoplasms (PN) are a heterogeneous group of tumors deriving from sweat glands and folliculo-sebaceous units. Their histological classification and clinical features are challenging. Our aim was to report clinicopathological features of poroid neoplasms., Methods: It is a retrospective study including all cases of poroid neoplasms registered at our Pathology laboratory of Niamey National Hospital (February 2020-February 2024)., Results: We registered 13 cases of benign poroid neoplasms: 10 classic poromas (CP) (76.9%), 2 poroid hidradenomas (PH) (15.4%) and 1 dermal duct tumor (DDT) (7.7%). Nine cases (69.2%) had preoperative clinical diagnosis of malignancy. The mean age was 41.1 years (range of 12-70 years) with a slight female predominance. Only 4/13 cases (30.8%) had classical palmoplantar locations. The tumors mean size was 3.7 cm (range of 0.4-8 cm). Clear cells were present in 7 cases (53.8%), apocrine ductal differentiation (mixed or pure) in 6 cases (46.2%), keratin horns in 2 cases (15.4%), squamous eddies in 6 cases (46.2%), melanin pigments in 1 case (7.7%) and sebaceous differentiation in 2 cases (15.4%)., Conclusions: Unlike what is classically reported, our study shows that apocrine ductal differentiation, younger age and non-palmoplantar locations are common in poroid neoplasms., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Splenic lymphangiomas (SL) are very rare benign cystic lesions found in pediatric population. Their occurrence in adults is exceptional. Splenectomy is the common management of splenic lesions for diagnostic and/or therapeutic purpose. Our aim is to report additional cases of SL diagnosed on splenectomy specimens at our Pathology laboratory with literature review., Methods: This is a retrospective study including all cases of splenectomy recorded at our Pathology laboratory (June 2020-August 2022). We performed a comparison of clinicopathological features between patients with SL and those with other benign splenic diseases., Results: Sixteen cases of splenectomy were included. The mean age was 30.25 years (range of 6-70 years). The final histopathological diagnoses were congestive spleens in all cases of sickle cell disease (SCD) (5/16 patients, 31.25%), splenic cystic lymphangiomas (4/16 patients, 25%), capsular splenic infiltration by gastric and colic cancers (3/16 cases, 18.75%), splenic abscess (2/16 cases, 12.5%) and splenic rupture with subcapsular hematoma (1/16 patients, 6.25%). 12/16 patients (75%) had benign splenic conditions (4/12 with SL, 5/12 with SCD, 2/12 with abscess and 1/12 with splenic trauma). Patients with SL were older than those with other benign splenic conditions (mean age of 28.27 years versus 20.87 years). Also patients with SL presented with massive splenomegaly (mean splenic weight of 1675 g versus 418.75 g, mean splenic size of 19.62 cm versus 14.63 cm). Open surgery was performed in 15/16 patients (93.75%)., Conclusion: Unlike previous studies, our series shows that SL are a common indication for splenectomy and occur in older patients with massive cystic splenomegaly. Open splenectomy is still an usual surgical practice in our country., (© 2022. The Author(s).)

Background: Aggressive angiomyxoma (AAM) is a locally infiltrative mesenchymal tumour that most commonly affects the pelvis and/or perineum in adult women. AAM is very rare in males, especially in infancy., Case Presentation: A 10-month-old fulani (African) male infant was referred to our department for a large painless mass in the right testicule. The mass was detected during the neonatal period and gradually increased in size. Ultrasound examination revealed a large heterogeneous lesion; computed tomography results led to the conclusion that the mass was a mesenteric hernia. An inguinal and scrotal surgical approach was adopted. Exploratory surgery found a normal right testicle displaced upwardly and a large scrotal mass. Radical excision of the mass and orchidopexy were performed. Subsequent histology and immunohistochemstry studies indicated that the mass was a scrotal angiomyxoma. The postoperative course was uneventful. No recurrence occurred during the 6-month follow-up., Conclusion: To the best of our knowledge, this is the youngest patient with AAM reported to date. Angiomyxoma should be included in the differential diagnosis of scrotal masses, for which radical excision is justifiable to prevent recurrence., (© 2022. The Author(s).)

This article describes two datasets generated from various sources in south western Burkina Faso to identify the key climate and environmental drivers that cause farmers to migrate. The survey sampling is random but reasoned and rational. The first dataset from 367 farm households contains data on farmers' perception of climate change risks or hazards, their impacts on farmland productivity and farm households' risk management strategies. The second dataset from 58 farm households contains data on agricultural practices, environmental changes, and environmental migration. Three supplemental Excel sheets show the results of the surveys. Details on the sample as well as further interpretation and discussion of the surveys are available in the associated research article ('Field Facts for Crop Insurance Design: Empirical Evidence from South Western Burkina Faso' (W. M. Fonta, S. Sanfo, B. Ibrahim, B. Barry, 2015) [1]).