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Fruits and vegetables (F&Vs) are an essential food group for humans and prevent non-communicable diseases (NCDs). The objective of this study is to know the level of consumption of F&Vs by health professionals in Ouagadougou and their determinants. This is a descriptive cross-sectional study conducted from May to August 2016 in the Central Region of Burkina Faso. It included 442 health workers according to cluster sampling. Data collection tools consisted of frequency of food consumption of fruits and vegetables. The results showed that the level of F&Vs consumption among health professionals is very low. Only 11.5% of respondents consumed fruits every day and 21.8% did the same for vegetables and 1.4% of health professionals consumed more than five servings of F&Vs per day. Only 1.6% of health professionals surveyed had sufficient knowledge of the functions of F&Vs, and 85.8% were not aware of the recommendations of World Health Organizations regarding the consumption of F&Vs. Gender, distance from the fruit supply, and average monthly financial income were associated with the irregularity of the fruit consumption at the threshold of 5% in the univariate analysis. However, in the multivariate analysis, gender, profession, distance from fruit supply and average monthly financial income were predictive of irregular fruit consumption. The level of F&Vs consumption in health professionals is low, as is their level of knowledge of the functions of F&Vs. Key words: Burkina Faso, consumption, determinants, fruits and vegetables, health professionals.

Background: Influenza infection is a serious public health problem that causes an estimated 3 to 5 million cases and 250,000 deaths worldwide every year. The epidemiology of influenza is well-documented in high- and middle-income countries, however minimal effort had been made to understand the epidemiology, burden and seasonality of influenza in Africa. This study aims to assess the state of knowledge of seasonal influenza epidemiology in Africa and identify potential data gaps for policy formulation following the 2009 pandemic. Method: We reviewed articles from Africa published into four databases namely: MEDLINE (PubMed), Google Scholar, Cochrane Library and Scientific Research Publishing from 2010 to 2019. Results: We screened titles and abstracts of 2070 studies of which 311 were selected for full content evaluation and 199 studies were considered. Selected articles varied substantially on the basis of the topics they addressed covering the field of influenza surveillance (n=80); influenza risk factors and co-morbidities (n=15); influenza burden (n=37); influenza vaccina- tion (n=40); influenza and other respiratory pathogens (n=22) and influenza diagnosis (n=5). Conclusion: Significant progress has been made since the last pandemic in understanding the influenza epidemiology in Africa. However, efforts still remain for most countries to have sufficient data to allow countries to prioritize strategies for influenza prevention and control. Keywords: Influenza; epidemiology; review; Africa; post pandemic.

Rift Valley fever (RVF) is a mosquito‐borne viral zoonosis causing abortions and high mortality among animals, whereas in humans, the disease is usually mild or asymptomatic. In September 2016, the Republic of Niger declared the first RVF outbreak in the northern region of Tahoua near the Malian border. This study describes the outbreak and reports the results of serological and molecular investigations of the human and animal samples collected. Serum samples from both human and animal suspected cases have been confirmed at the Centre de Recherche Médicale et Sanitaire (CERMES) and the Laboratoire Centrale d'Elevage (LABOCEL) public health and animal reference laboratories, respectively. Techniques for biological confirmation were real time reverse transcription polymerase chain reaction (RT‐PCR) and enzyme linked immunosorbent assay (ELISA). Phylogenetic trees were established after genetic sequencing of the small and medium segments of the RVF virus (RVFV) genome. Out of the 399 human samples collected, 17 (4.3%) were confirmed positive for RVFV. Overall, 33 (8.3%) deaths occurred out of which five (29%) were among the 17 confirmed cases. Regarding animals, 45 samples were tested, three of which were RT‐PCR positive and 24 were IgG positive. The phylogenetic analyses showed that the Niger strains clustered with Senegal 2013 and Mauritania 2015 RVFV strains. This first outbreak of RVF was very challenging for public and animal health laboratories in Niger. Besides resulting in human deaths, important loss of cattle has been reported. Therefore, vigilance has to be strengthened emphasising vector control strategies and active surveillance among animals.

West Nile virus (WNV), belonging to the Flaviviridae family, causes a mosquito-borne disease and shows great genetic diversity, with at least eight different lineages. The Koutango lineage of WNV (WN-KOUTV), mostly associated with ticks and rodents in the wild, is exclusively present in Africa and shows evidence of infection in humans and high virulence in mice. In 2016, in a context of Rift Valley fever (RVF) outbreak in Niger, mosquitoes, biting midges and sandflies were collected for arbovirus isolation using cell culture, immunofluorescence and RT-PCR assays. Whole genome sequencing and in vivo replication studies using mice were later conducted on positive samples. The WN-KOUTV strain was detected in a sandfly pool. The sequence analyses and replication studies confirmed that this strain belonged to the WN-KOUTV lineage and caused 100% mortality of mice. Further studies should be done to assess what genetic traits of WN-KOUTV influence this very high virulence in mice. In addition, given the risk of WN-KOUTV to infect humans, the possibility of multiple vectors as well as birds as reservoirs of WNV, to spread the virus beyond Africa, and the increasing threats of flavivirus infections in the world, it is important to understand the potential of WN-KOUTV to emerge.

Background In endemic areas, children develop slowly and naturally anti-Plasmodium antibodies and become semi-immune. Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine + amodiaquine (SPAQ) is a new strategy to reduce malaria morbidity in West African young children. However, SMC may impact on the natural acquisition of anti-Plasmodium immunity. This paper evaluates the effect of SMC with SPAQ on antibody concentration in young children from Niger. Methods This research was conducted in areas benefitting from SMC since 2014 (Zinder district), without SMC (Dosso district), and with 1 year of SMC since 2016 (Gaya district). To assess the relationship between SMC and Plasmodium falciparum IgG antibody responses, the total antibody concentrations against two P. falciparum asexual stage vaccine candidate antigens, circumsporozoite protein (CSP) and glutamate-rich protein R2 (GLURP-R2), in children aged 3 to 59 months across the three areas were compared. Antibody concentrations are quantified using an enzyme-linked immunosorbent assay on the elution extracted from positive and negative malaria Rapid Diagnostic Test cassettes. Results The analysis concerns two hundred and twenty-nine children aged from 3 to 59 months: 71 in Zinder, 77 in Dosso, and 81 in Gaya. In Zinder (CSP = 17.5 µg/ml and GLURP-R2 = 14.3 µg/ml) median antibody concentration observed are higher than in Gaya (CSP = 7.7 µg/ml and GLURP-R2 = 6.5 µg/ml) and Dosso (CSP = 4.5 µg/ml and GLURP-R2 = 3.6 µg/ml) (p Conclusion The research reveals some evidences which show that seasonal malaria chemoprevention with SPAQ has an effect on blood stage antibody responses and pre-erythrocytic stage of P. falciparum infections in Niger. Increased antibody titres with increased SMC/SPAQ implementation. This contradicts hypothesis that SMC/SPAQ could reduce immunity to erythrocyte and liver-stage antigens. Further studies are necessary to provide better understanding of the SMC effect on malaria immunity.

Background: The alcohol consumption level is rising in Burkina Faso, which has the highest prevalence of heavy drinking in West Africa. This study used daily alcohol intake levels to explore drinking behaviors in regard to the days of the week and associations with dependence signs.Methods: We operated variables from the past 12-month drinkers reported by the 2013 Stepwise survey, which provided information on daily drinking and symptoms of alcohol dependence. We performed student tests, principal component analyses and logistic regression.Results: Data from 1,139 past 12-month drinkers was analyzed, and 15.9% (95%; CI: 13.8–18.1) of users had at least one sign of alcohol dependence. Both drinkers without and with dependence symptoms had a common behavior for higher intake on Thursday, Saturday and Sunday, while lower intake behavior was observed on Tuesday. Only drinkers with dependence signs had high intake behavior, especially on Monday and Friday. In multivariate analysis, alcohol dependence signs were associated with increased drinking only on Monday [adjusted odds ratio (aOR) =1.24, p=0.0001)] or Friday (aOR=1.15, p=0.003).Conclusion: For drinkers without any dependence sympoms, behaviors for higher intake were limited to Thursday, Saturday and Sunday in accordance with the “social events schedule” and the “weekly administrative time-off”, but those with dependence signs extended this kind of behavior to Monday or Friday, likely due to the increased and persistent craving triggered by the high intake the previous day.

Background: In endemic areas, children develop slowly and naturally develop anti-Plasmodium antibodies and become semi-immune. Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine + amodiaquine (SPAQ) is a new strategy to reduce malaria morbidity in young children in West Africa. However, SMC may impact on the natural acquisition of anti-Plasmodium immunity. We evaluated the effect of SMC with SPAQ on malaria antibody concentration in Niger.Methods: This survey was conducted in areas targeted with SMC since 2014 (Zinder district), without SMC (Dosso district), and with one year SMC 2016 (Gaya district). To assess the relationship between SMC and P. falciparum IgG antibody responses, we compared total antibody concentrations against two P. falciparum asexual stage vaccine candidate antigens, circumsporozoite protein (CSP) and glutamate-rich protein R2 (GLURP-R2), in children aged 3-59 months across the three sites. Antibody concentrations were quantified using an enzyme-linked immunosorbent assay (ELISA) on the elution extracted from positive and negative RDT cassettes.Results: A total of 229 children aged 3-59 months were included in the analysis: 71 in Zinder, 77 in Dosso, and 81 in Gaya. In Zinder (CSP=17.5µg/ml and GLURP-R2=14.3µg/ml) median antibody concentration observed were higher than in Gaya (CSP=7.7 µg/ml and GLURP-R2=6.5 µg/ml) and Dosso (CSP=4.5 µg/ml and GLURP-R2=3.6 µg/ml) (pConclusion: We have some evidence that seasonal malaria chemoprevention with SPAQ has an effect on blood stage antibody responses and pre-erythrocytic stage of Plasmodium falciparum infections in Niger. Future studies are necessary to provide better understanding of the effect of on malaria immunity.

Background In limited resources countries, HBsAg-rapid diagnostic test (RDT) represents a good alternative for the diagnosis of hepatitis B virus (HBV) infection. Due to many factors that can influence their analytical performances, an evaluation with local biological samples before using on a large scale is recommended. Objectives The aims of the study were: (i) to evaluate the analytical performance of eight commercial RDTs used in Burkina Faso for the detection of HBsAg using serum from blood donors, and (ii) to propose an algorithm using these RDTs based on their analytical performance. Study design 109 HBsAg-positive and 216 HBsAg-negative samples were included in this evaluation. A modified version of the World Health Organization (WHO) algorithm for the detection of HBsAg was used as the gold standard. A pairwise combination of RDTs performance was done to choose the best diagnostic algorithm. Results All RDTs presented an excellent specificity (Sp) (≥99.0 %) except Accucare HBsAg® test. Sensitivity (Se) ranged from 90.8 % (95 % CI: 87.9−93.7) for Rapid Signal™ HBsAg to 92.8 % (95 % CI: 90.3−95.5) for SD BioLine® HBsAg and Artron® HBsAg. The pairwise combinations of the Se and Sp of RDTs showed no improvement in diagnostic performance. Conclusion The RDTs evaluated in this study have good sensitivities and excellent specificities indicating their use in clinical practice and for HBV mass screening in Burkina Faso. However, their use should be monitored in the context of blood transfusion. Furthermore, according to our algorithm, each positive sample should be confirmed by another RDT of good Se.

Background In 2010, Niger and other meningitis belt countries introduced a meningococcal serogroup A conjugate vaccine (MACV). We describe the epidemiology of bacterial meningitis in Niger from 2010 to 2018. Methods Suspected and confirmed meningitis cases from January 1, 2010 to July 15, 2018 were obtained from national aggregate and laboratory surveillance. Cerebrospinal fluid specimens were analyzed by culture and/or polymerase chain reaction. Annual incidence was calculated as cases per 100 000 population. Selected isolates obtained during 2016–2017 were characterized by whole-genome sequencing. Results Of the 21 142 suspected cases of meningitis, 5590 were confirmed: Neisseria meningitidis ([Nm] 85%), Streptococcus pneumoniae ([Sp] 13%), and Haemophilus influenzae ([Hi] 2%). No NmA cases occurred after 2011. Annual incidence per 100 000 population was more dynamic for Nm (0.06–7.71) than for Sp (0.18–0.70) and Hi (0.01–0.23). The predominant Nm serogroups varied over time (NmW in 2010–2011, NmC in 2015–2018, and both NmC and NmX in 2017–2018). Meningococcal meningitis incidence was highest in the regions of Niamey, Tillabery, Dosso, Tahoua, and Maradi. The NmW isolates were clonal complex (CC)11, NmX were CC181, and NmC were CC10217. Conclusions After MACV introduction, we observed an absence of NmA, the emergence and continuing burden of NmC, and an increase in NmX. Niger’s dynamic Nm serogroup distribution highlights the need for strong surveillance programs to inform vaccine policy.

Resume But/objectif Les problemes nutritionnels chez les personnes vivant avec le VIH (PvVIH) sont frequents dans les pays en developpement. Les deficits nutritionnels aggravent l’immunodepression qui accentue en retour la denutrition, accelerant l’evolution de l’infection. L’alimentation des PvVIH en Afrique subsaharienne est peu decrite. Notre etude visait a evaluer la consommation alimentaire des PvVIH suivie a la file active d’un hopital de district du Burkina Faso. Materiels et methodes Nous avons mene une etude transversale quantitative dans l’hopital de district de Do a Bobo-Dioulasso en juin–juillet 2014 chez des adultes infectes de 18 ans et plus. L’etat nutritionnel sur la base de l’IMC et la consommation par des questionnaires de frequence alimentaire ont ete evalues. Resultats Un echantillon de 124 PvVIH ont ete interviewees dont 75,8 % de femmes. L’âge moyen etait de 39,0 ans ± 8,7. L’insuffisance ponderale existait dans 18,5 % des cas. Au total, 77,4 % des patients prenaient trois repas journaliers. La consommation alimentaire quotidienne incluait de la pâte de farine (« To ») dans 40,3 % des cas, du pain dans 33,9 % des cas, du riz dans 33,1 % des cas, des legumes prepares en sauce et quelques fruits, des huiles et graisses dans 74,2 % des cas, des sucres dans 61,3 % des cas, de la viande dans 33,1 % des cas, du poisson dans 19,4 % des cas et du lait dans 13,7 % des cas. L’eau courante etait utilisee en boisson chez 80,7 % des individus. Conclusion Dans la population etudiee, la consommation des aliments sources d’energie est habituelle, alors que celles des aliments sources de micronutriments est faible. Les principales causes probables de ce desequilibre sont les difficultes d’acces a certains aliments, et un defaut d’information. Des programmes educationnels nutritionnels devraient etre developpes dans la lutte contre le VIH.

Background: In endemic areas, children develop slowly and naturally anti-Plasmodium antibodies and become semi-immune. Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine + amodiaquine (SPAQ) is a new strategy to reduce malaria morbidity in young children in West Africa. However, SMC may impact on the natural acquisition of anti-Plasmodium immunity. We evaluated the effect of SMC with SPAQ on malaria antibodies levels in Niger. Methods: This survey was conducted in areas with SMC since 2014 (Zinder district), without SMC (Dosso district) and with one year SMC 2016 (Gaya district). To assess the relationship between SMC and total Ig G Ab against P. falciparum antigens, we measured antibodies levels of two P.falciparum asexual stage vaccine candidate antigens (Circum Sporozoid Protein and Glutamate-rich Protein R2) in children aged 3–59 months and compared these levels in Zinder, Dosso and Gaya by enzyme-linked immune-sorbent assay (ELISA) on the elution extracted from the RDTs positive and negative cassette. Results: A total of 229 children aged 3-59 months were included in the analysis: 71 in Zinder, 77 in Dosso, and 81 in Gaya. In Zinder (CSP=17.5 and GLURP-R2=14.3) median antibodies levels observed were higher than in Gaya (CSP=7.7 and GLURP-R2=6.5) and Dosso (CSP=4.5 and GLURP-R2=3.6) (p

International audience; Background and Aims: In Niger, acute respiratory infections (ARIs) are the second most common cause of death in children aged younger than 5 years. However, the etiology of ARI is poorly understood in the country. This study aims to describe viral and bacterial infections among children aged younger than 5 years hospitalized with febrile ARI at two hospitals in Niamey, Niger's capital city, and the reported clinical procedures.Methods: We conducted a prospective study among children aged younger than 5 years hospitalized with febrile ARI at two national hospitals in Niamey between January and December 2015. Clinical presentation and procedures during admission were documented using a standardized case investigation form. Nasopharyngeal specimens collected from each patient were tested for a panel of respiratory viruses and bacteria using the Fast Track Diagnostic 21 Plus kit.Results: We enrolled and tested 638 children aged younger than 5 years, of whom 411 (64.4%) were aged younger than 1 year, and 15 (2.4%) died during the study period. Overall, 496/638 (77.7%) specimens tested positive for at least one respiratory virus or bacterium; of these, 195 (39.3%) tested positive for respiratory viruses, 126 (25.4%) tested positive for respiratory bacteria, and 175 (35.3%) tested positive for both respiratory viruses and bacteria. The predominant viruses detected were respiratory syncytial virus (RSV) (149/638; 23.3%), human parainfluenza virus (HPIV) types 1 to 4 (78/638; 12.2%), human rhinovirus (HRV) (62/638; 9.4%), human adenovirus (HAV) (60/638; 9.4%), and influenza virus (INF) (52/638; 8.1%). Streptococcus pneumoniae (249/638; 39.0%) was the most frequently detected bacterium, followed by Staphylococcus aureus (112/638; 12.2%) and Haemophilus influenzae type B (16/638; 2.5%). Chest X-rays were performed at the discretion of the attending physician on 301 (47.2%) case patients. Of these patients, 231 (76.7%) had abnormal radiological findings. A total of 135/638 (21.2%) and 572/638 (89.7%) children received antibiotic treatment prior to admission and during admission, respectively.Conclusion: A high proportion of respiratory viruses was detected among children aged younger than 5 years with febrile ARI, raising concerns about excessive use of antibiotics in Niger.

Introduction et but de l’etude Les troubles de la deglutition (TD) sont frequents dans les centres de soins de sante primaires (CSSP) et la qualite de prise en charge des l’admission influence fortement l’etat nutritionnel des patients et leur pronostic global. Les maladies neurologiques sont les plus pourvoyeuses de TD, avec une frequence d’environ un tiers chez les patients hemiplegiques. Dans les CSSP au Burkina Faso, les infirmiers sont les premiers a evaluer ces patients mais il n’existe pas de donnees relatives aux modalites de prise en charge des TD. L’objectif de cette etude etait d’estimer les connaissances, attitudes et pratiques des infirmiers concernant les TD des patients hemiplegiques accueillis dans les CSSP de Bobo-Dioulasso, dont le centre de reference accueille le plus de patients hemiplegiques dans ce pays. Materiel et methodes Une enquete transversale a ete realisee du 1 er aout au 15 septembre 2014 aupres des infirmiers des CSSP des districts sanitaires urbains de Bobo-Dioulasso. Elle a utilise un questionnaire standardise explorant leurs connaissances et pratiques concernant les TD chez le sujet hemiplegique. Resultats et analyse statistique Sur 125 infirmiers enquetes (83,3 % des personnels vises), 82,4 % avaient deja recu un patient hemiplegique. Le role du cerveau dans la survenue d’une hemiplegie et d’un TD etait connu par 56,8 % des infirmiers, 42,3 % savaient qu’un TD peut entrainer une pneumopathie de deglutition, 36,0 % connaissaient une manœuvre de sauvetage en cas de fausse route. Ils evaluaient correctement le retentissement du TD sur l’etat nutritionnel dans 39,2 % des cas. Sur ce point, leurs connaissances etaient meilleures s’ils etaient plus recemment sortis de l’ecole de formation. Respectivement 65,6 % et 1,6 % des infirmiers connaissaient le benefice des adaptations posturales et l’influence des caracteristiques des aliments sur la capacite a deglutir. Chez les 103 infirmiers ayant deja recu un hemiplegique, 68,0 % estimaient pouvoir detecter un TD par l’entretien clinique, et 30,1 % ne donnaient aucun conseil au patient. En multivariee, depister un TD etait associe a de bonnes connaissances sur la valeur de la voix (OR = 3,5 ; IC 95 = 1,4–8,1 ; p = 0,005). Conclusion Peu d’infirmiers etaient avertis de la liaison entre TD et hemiplegie, des enjeux et complications classiques lies aux TD. Ils avaient des pratiques variables souvent non conformes aux bonnes strategies sur le depistage et la prise en charge des TD. Dans un but d’amelioration des soins des patients hemiplegiques, l’enseignement neurologique et celui de la nutrition devrait s’accompagner de formations portant sur les TD, en insistant sur le depistage et la prise en charge simple.

Hepatitis E virus (HEV) infection in developing countries is associated with poor hygiene, lack of clean drinking water, and inadequate sanitation. In this study, we report the first case investigation and describe the present situation of HEV outbreak within displaced persons camps in the Diffa region, Republic of Niger. The investigation showed the outbreak to be closely linked to unclean water supply, low hygiene, and sanitation facility standards. Between January and September 2017, a total of 1,917 HEV suspect cases were recorded from which 736 (38.4%) have been confirmed positive for HEV by reverse transcription polymerase chain reaction and enzyme linked immunosorbent assay. Overall, 38 (1.9%) deaths were recorded, including 17 (44.7%) pregnant women. The ongoing outbreak highlights poor drinking water quality and sanitation conditions in displaced persons camps in the Diffa region. Disease containment and patient care activities, particularly for pregnant women, may have resulted in decreased transmission of infection and deaths.

Introduction: Bacterial meningitis (BM) is one of the most severe infectious disease in Niger republic. To best describe the trends of BM disease, meningitis surveillance data from the Centre de Recherche Medicale et Sanitaire (CERMES) and the Direction of Surveillance and Response to Epidemics (DSRE) were reviewed and analyzed. Methods: Data on number of notified cases of BM and on pathogens were analyzed during 2003-2015. Excel 2013 was used for trend analysis on the etiology of BM prevalence and incidence. Results: A total of 10051 cerebrospinal fluid (CSF) samples collected were confirmed by laboratory methods. The main etiologies of meningitis detected were N. meningitidis (82.1%), S. pneumonia (12.1%) and H. influenza (3.4%). N. meningitidis mostly affected children in the age groups of 5-9 years (32.9%) and 10-14 years (24.9%) with respective mean incidence of 14.9 and 11.3. The percentage estimate of N. meningitidis serogroup A (NmA) meningitis fell to 0% in 2015 while during the same year that of N. meningitidis serogroup C (NmC) and N. meningitidis serogroup W (NmW) reached 82.9% and 17% respectively. Conclusion: Overall, the epidemiological trends of the BM in Niger were dynamic. The emergence of NmC strains suggests that there may be an urgent need for serogroup C containing vaccines in Niger in the coming years. Keywords : Niger, epidemiology, bacterial meningitis, surveillance

Objective To study the involvement of variations in 4 genes associated with susceptibility and/or protection against HIV-1 in serodiscordant couples in Burkina Faso, namely, genes encoding HLA-B57, interferon regulatory factor 1 (IRF1), dendritic cell-specific ICAM3-grabbing nonintegrin (DC-SIGN) and CCR5 delta 32 (CCR5Δ32). Methods Two DC-SIGN and two IRF1 single nucleotide polymorphisms (SNPs) as well as HLA-B57*01 and CCR5 Δ 32 alleles were genotyped in 51 serodiscordant couples in Burkina Faso. DC-SIGN, IRF1 and HLA-B57*01 genotyping was carried out by real time PCR using TaqMan assays (Applied Biosystems, USA and Sacace Biotechnologies, Italy). CCR5 Δ 32 deletion was investigated by PCR. Results The two SNPs of DC-SIGN promoter showed a significant genotypic difference in serodiscordant couples. After multivariate analysis, only the association between DC-SIGN rs2287886 and HIV-1 remained significant ( P IRF1 SNPs and HIV-1 infection. CCR5 Δ 32 wild type allele was found in 100% of serodiscordant couples. A high frequency of HLA-B57*01 allele was found in the HIV-positive (78%) compared with HIV-negative group (51%), however this difference was no longer significant after the correction of the sex confounding effect in the logistic regression model. Conclusions Our study suggests a protective role of a variation of DC-SIGN promoter and genetic resistance to HIV-1 in serodiscordant couples in Burkina Faso.

International audience; BACKGROUND:Low- and middle-income countries are currently facing the massive public health challenge of road traffic injuries. The lack of effective surveillance systems hinders proper assessment of epidemiologic status and intervention priorities. The objective of our study was to estimate the mortality and morbidity attributable to road crashes in Bamako, Mali using the capture-recapture method.METHODS:During the 1 January, 2012-31 April, 2012 period, we collected data on road traffic crashes from the road accident registers of the police forces of Bamako, Mali on the one hand, and from a register kept by health facilities in the same area. An automatic, then manual matching procedure was performed to find pairs of records related to the same crash victims. The number of victims and the number of fatalities were estimated by the capture-recapture method using the Chapman estimator.RESULTS:The health facility and the police registries included 3587 and 1432 records, respectively. The matching procedure identified 603 common records, 31 of which were fatalities. The annual incidence estimate for road victims was 1038 in 100 000 and the annual incidence estimate for road fatalities was 12 in 100 000. Victims from both sources were more likely to be male, in the 15-34 age group, and almost half of all injured road users and two in three fatalities were using motorized two-wheelers. One victim out of five was a pedestrian.CONCLUSION:Our estimates are in line with available literature data from low-income countries. While more cases were reported by health facilities than by police forces, we believe that an effective surveillance system should not be based solely on medical reports as much would be missing as regards the crash circumstances and characteristics.

Resume Objectif Il est de plus en plus evident que l’ocytocine, qui regule l’appetit, joue un role dans le remodelage osseux et ameliore l’osteoporose. Nous avons deja montre une diminution significative des taux d’ocytocine circulante au cours de l’osteoporose post-menopausique de la femme en comparaison a des sujets sains. Cependant, des facteurs impliques dans la physiopathologie de l’osteoporose, comme les œstrogenes et la leptine, sont connus pour reguler la secretion d’ocytocine. Ci-apres, nous avons etudie les relations entre l’ocytocine et d’autres facteurs hormonaux connus pour reguler le remodelage osseux et la composition corporelle dans l’osteoporose post-menopausique de la femme, en comparaison a des sujets sains. Methodes Chez 20 femmes post-menopausees avec osteoporose severe comparees a 16 sujets sains controles, nous avons mesure les taux seriques d’ocytocine, d’œstradiol par dosage hautement sensible, de testosterone, Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), Sex Hormone Binding Globulin (SHBG), Thyroid Stimulating Hormone (TSH), osteocalcine, telopeptide N terminal du collagene de type I, leptine. La densite minerale osseuse et la composition corporelle etaient egalement determinees par absorptiometrie biphotonique a rayons X (DXA). Resultats Les femmes osteoporotiques ont des taux seriques significativement plus faibles d’ocytocine, de leptine et de LH et des taux plus eleves de CTX et de SHBG ; tous les autres parametres biologiques etaient similaires dans les deux groupes. La masse graisseuse et la masse maigre etaient significativement diminuees chez les femmes osteoporotiques. Les taux seriques d’ocytocine etaient significativement correles a la densite minerale osseuse mais avec aucun autre parametre mesure, y compris la leptine, l’œstradiol et l’âge. Dans une analyse de regression logistique, l’osteoporose demeurait significativement correlee a l’ocytocine, independamment de l’âge. Conclusions De faibles taux seriques d’ocytocine semblent etre associes a une osteoporose severe, independamment d’autres facteurs associes a l’osteoporose ou connus pour reguler les taux seriques d’ocytocine, comme l’œstradiol ou la leptine, renforcant le concept selon lequel l’ocytocine peut etre impliquee dans la physiopathologie de l’osteoporose post-menopausique.

Resume Objectifs Notre but a ete de decrire les caracteristiques des fractures osteoporotiques de la ceinture pelvienne et leur evolution. Methodes Nous avons recueilli les donnees cliniques et biologiques de 60 patients, ayant eu une fracture osteoporotique de la ceinture pelvienne et ayant ete hospitalises dans notre service de rhumatologie. Nous avons evalue l’evolution chez 51 d’entre eux, a l’aide d’un questionnaire rempli par telephone. Resultats Notre population etait composee principalement de femmes âgees (femmes 81,6 %, âge moyen : 79 ans) qui presentaient dans plus de la moitie des cas un antecedent d’osteoporose, de fracture ou de maladie cardiovasculaire. Dans 89 % des cas, la fracture etait survenue apres une chute consequence. Les branches pubiennes constituaient le principal siege de la fracture (65 %). Nous avons observe un pourcentage eleve de carence en vitamine D (80,6 %) associe a une hyperparathyroidie secondaire (51,6 %). Avant la survenue de la fracture, tous les patients vivaient a leur domicile et 84,1 % etaient autonomes. Au cours de l’hospitalisation, 52,5 % des patients ont eu une complication et dans la majorite des cas, une infection urinaire ou une escarre. A la sortie du service seulement 31 % des patients sont retournes a leur domicile. Au moment de l’evaluation finale (en moyenne, 29 mois apres la fracture), 11 patients sont decedes (en moyenne, 190 jours apres la fracture). Parmi les survivants, 74,5 % vivent a leur domicile, 60 % necessitent une assistance pour au moins une activite de la vie quotidienne et 18,6 % ont eu une nouvelle fracture. Seulement 63,2 % sont toujours traites pour osteoporose. Conclusion Les fractures de la ceinture pelvienne necessitant une hospitalisation initiale possedent des caracteristiques communes avec les fractures de l’extremite superieure du femur : population âgee a predominance feminine, carence en vitamine D, chute a l’origine de la fracture et, aussi, severite pronostique avec un taux eleve de morbidite et de mortalite et une perte d’autonomie.

The aim is to describe the characteristics of osteoporotic pelvic fractures and their outcome. We recorded clinical and biological characteristics of 60 osteoporotic pelvic fractures hospitalized in our Department of Rheumatology and assessed their outcome in 51 cases, using a questionnaire administrated by phone call. In our population, pelvic fractures mainly affected elderly women (81.6% of women, mean age 79 years), presenting, in more than 50% of the cases, a past medical history of osteoporosis, previous fracture and cardiovascular disease. The fractures were triggered by a fall in 89% of the cases and mainly located at the pubic rami (65%). There was a high rate of vitamin D deficiency (80.6%) associated with a secondary hyperparathyroidism (51.6%). Before the pelvic fracture, all patients lived at their personal home and 84.1% were autonomous. During hospitalization, 52.5% of the patients experienced an adverse event, mostly related to urinary tract infection and bedsore. At time to discharge, only 31% directly returned to their own home. At the final assessment (mean delay from the fracture: 29 months), 11 patients were dead (mean delay: 190 days). Among living patients, 74.5% lived at home, 60% required assistance for at least one daily life activity and 18.6% experienced a new fracture. Only 63.2% were still treated for osteoporosis. Osteoporotic pelvic fractures requiring initial hospitalization share most characteristics of hip fracture: elderly people, women predominance, vitamin D insufficiency, fall triggering the fracture, and also the severity assessed by a high morbidity and mortality and loss of autonomy.

Background Malaria intermittent preventive treatment of malaria in infant with sulphadoxine-pyrimethamine (IPTi-SP) reduced the incidence of malaria and anaemia by 30% and 20% respectively. The strategy is now a recommended policy for malaria control. However, there was no published study on the impact of the strategy on mortality. The present study assessed the impact of the implementation of IPTi-SP in health services in Mali on all-cause mortality. Methods The 22 health sub-districts of the district of Kolokani were randomized at a 1:1 ratio to either receive IPTi-SP or to serve as a control. The IPTi-SP was implemented for two years starting December 2006. Information on births and deaths through 31 March, 2009 was collected on all children who reached four months of age on 1 December, 2006, likely to be exposed to the intervention in 75 localities randomly selected in each zone. Results A total of 5,882 children (2,869 from the intervention zone and 3,013 from the nonintervention zone) who reached four months of age between 1 December, 2006 and 1 December, 2008 were surveyed between the age of four months to the age of 18 months from 1 December, 2006 to 31 March, 2009. In the cohort of four to 18 months of age, the mortality rate per 1,000 children was 2.53 in the intervention zone compared to 3.46 in the nonintervention zone, gender and season adjusted mortality rate ratio (MRR) = 0.73 (95% CI 0.55-0.97, p = 0.029). In the cohort of the four to 12 months of age, mortality rates per 1,000 children were 2.22 in the intervention zone and 3.13 in the non-intervention zone, MRR = 0.71 (95% CI 0.49-1.02, p = 0.064) adjusted for gender and season. Conclusion The implementation of the IPTi-SP resulted in a substantial reduction in all-cause mortality in children. The results of this study support the adoption and the implementation of IPTi-SP as malaria control strategy. Trial Registration ClinicalTrials.govNCT00766662

International audience; PURPOSE: There is growing evidence that oxytocin, which regulates appetite, plays a role in bone remodelling and improves osteoporosis. We previously showed a significant decrease in circulating oxytocin levels in postmenopausal osteoporotic women compared to healthy controls. However, factors involved in the pathophysiology of osteoporosis, such as estrogens and leptin, are known to regulate oxytocin secretion. Herein, we evaluated the relationships between oxytocin and other hormonal factors known to regulate bone remodeling and body composition in postmenopausal osteoporotic women, compared to healthy controls. METHODS: In 20 postmenopausal women with severe osteoporosis compared to 16 healthy controls, we measured serum levels of oxytocin, high sensitive estradiol, testosterone, FSH, LH, SHBG, TSH, osteocalcin, serum type I collagen carboxy-terminal telopeptide, leptin. Bone mineral density and body composition were also measured with DXA. RESULTS: Osteoporotic women had significantly lower oxytocin, leptin and LH serum levels and higher CTX and SHBG; all other biological parameters were similar in both groups. Fat mass and lean mass were significantly decreased in osteoporotic women. Oxytocin serum levels were significantly correlated to bone mineral density but not to any other measured parameter, including leptin, estradiol and age. In a logistic regression analysis, osteoporosis remained significantly correlated to oxytocin, regardless of age. CONCLUSIONS: Low oxytocin serum levels appeared to be associated with severe osteoporosis, independently of other factors associated with osteoporosis or known to regulate oxytocin serum levels, such as estradiol or leptin, reinforcing the concept that oxytocin may be involved in the pathophysiology of postmenopausal osteoporosis.

International audience; The phenotypic and functional characteristics of immune cells of osteoporotic women compared to healthy controls similar for age and estrogen level showed for the first time significant changes in several B lymphocytes populations in postmenopausal osteoporosis, related to bone mineral density (BMD) and fractures, and a significant lower basal secretion of interferon-gamma (IFN-gamma) by CD4(+). INTRODUCTION: To investigate the interactions between bone and immune system, we studied the phenotypic and functional characteristics of immune cells of 26 postmenopausal women with osteoporotic (OP) fractures compared to 24 healthy controls. METHODS: We analyzed surface markers of peripheral B, CD4(+) and CD8(+) lymphocytes and cytokine secretion in supernatants of these cells cultured with or without stimulation. Body composition was assessed by dual energy X-ray absorptiometry. RESULTS: The two groups were similar for age and estrogen level. OP women had a significantly lower body mass index, fat mass, and lean mass. The number of CD19(+), CD19(+)/CD27(+), CD19(+)/CD27(+)/CD5(-)/CD38(+) and CD19(+)/CD27(+)/RANK(+), CD4(+)/CD27(+)/CD45RA(-)/RANK(+), and CD4(+)/CD27(+)/CD45RA(-)/CD28(+) was lower in OP women and positively correlated to BMD. In OP women, under basal conditions, CD4(+) secreted less IFN-gamma and B lymphocytes more granulocyte macrophage colony-stimulating factor (GM-CSF). GM-CSF was positively correlated to fracture rate and negatively to BMD. CONCLUSIONS: Our results suggest that, regardless of age and estrogen status, postmenopausal OP is associated with immune changes, highlighting a possible role of IFN-gamma in the pathophysiology of OP and reporting, for the first time, changes in several B lymphocyte populations. These alterations may reflect the frailty observed after fracture, providing new insight into the mechanisms of morbidity and mortality associated with OP fractures.

International audience

The prevalence of malnutrition in Benin has been estimated at 29% and infant-juvenile mortality rate at 156% per hundred. Because there is no specific data on the prevalence of malnutrition in Cotonou, a transverse descriptive study was undertaken to determine the rate and features of malnutrition. Anthropometric measurements were performed in African children who were between 0 and 36 months of age and had been living in Cotonou for at least 6 months. A questionnaire was administered to the mothers of all children including study of risk factors and assessment of food intake for the last 24 hours. A semi-assisted interview was carried out with the mothers of undernourished children to determine awareness of their child's condition. A total of 1085 children were included in the study. The prevalence of malnutrition according to type was 20.6% for stunting (Inadequate height for age or chronic malnutrition), 14.6% for underweight (inadequate weight for age) and 3.6% for wasting (inadequate weight for height or acute malnutrition) including severe cases in 6.4%, 2%, and 9.6% respectively. Our data did not demonstrate a significant correlation between malnutrition and any of the following factors: profession of the father, education of the mother, use of contraception, ongoing pregnancy, number of brothers and sisters, number of siblings, or sleeping under a bed net. Conversely malnutrition was significantly correlated with the following factors: history of malnutrition in siblings, soclo-economic level, inadequate food Intake in the last 24 hours, and regularity of medical surveillance of children (although a significant relationship was not found between malnutrition and activity at health care centers). Findings from the 81 interviews carried out with mothers of undernourished children showed that 35% were unaware of the nutritional status of their child. Only 6.1% of mothers who recognized a development problem attributed it to food intake. Only one third of the mothers of the 75 undernourished children that had been examined in a health care centers had been informed by a health care worker that their child was undernourished and one third of mothers had undertaken no action to Improve the condition of their child.

We investigated placental malaria infection and blood chloroquine concentration in pregnant women to assess a new method of monitoring the chloroquine resistance (CQ-R) of Plasmodium falciparum. We studied two groups of women: 96 women taking the usual prophylactic treatment of 300 mg chloroquine per week and 108 controls given no treatment. We carried out placental apposition, a thick smear and determination of blood chloroquine concentration after delivery. Malarial infection of the placenta was more frequent and the density of parasites higher in controls than in women given prophylaxis. Blood chloroquine concentrations were adequate in all women given prophylaxis (above 200 ng/ml, with a mean of 500 ng/ml). Twenty-six per cent of placentas in the treated group and 51% of placentas in the control group were infected. The placental infection rates for the two groups were compared. The frequency of chloroquine-resistant strains was about 50% (2 or 3 times higher than the CQ-R frequencies obtained in studies using in vivo tests). The simplicity of placental apposition makes this technique potentially valuable. However, determination of blood chloroquine concentration is also required and can only be carried out in a reference center.

A multi-centre enquiry in 12 of 30 provinces of Burkina Faso was carried out to study smoking in pupils at secondary schools. The prevalence of smoking was 13.6 per cent. Amongst the smokers, occasional smoking was the most common, involving 62 per cent. Boys smoked more than girls. The average age of starting smoking was early, at 13.4 years. The majority of smokers consumed less than five cigarettes a day and the favourite place for consumption was the home of their parents or guardian and at school. The determinants of school smokers were above all environmental: the influence of friends and advertising. The students showed a good knowledge of the harmful effects of smoking. This knowledge was linked to their educational level and to their status as a smoker or non-smoker. The proportion of pupils who had obtained good results in the term which preceded the enquiry was more significant amongst the non-smokers than amongst the smokers. An awareness of the significance of smoking amongst pupils by their parents, guardians and teachers involves health education and rigorous legislative measures on advertising and these would contribute to some reduction in the extent of the phenomenon in educational establishments.

The quality of medical care was studied in the gyneco-obstetrical department of the National Hospital Center of Ouagadougou, Burkina Faso. Evaluation covered not only facilities, procedures and results, but also patient satisfaction using standardized criteria. The results showed an apparent contradiction between poor facilities and high maternal and prenatal mortality rate on the one hand and proper use of procedures and good patient satisfaction on the other. Installation of a computerized medical record system should allow continuous monitoring of the quality of care in the context of a sub-Saharan hospital by providing ready access to simple standardized indicators especially of maternal and prenatal mortality.

In Bangui (Central African Republic) an epidemiological survey making use of cluster sampling has been performed. Prevalence rate is not very high in Bangui (3.4%). Boys are more infected than girls. Both in rural and urban area prevalence rates are decreasing with age. Microsporum langeronii has been identified in 98% of case.

In Central African Republic, the first cases of resistant P. falciparum to chloroquine occurred in 1983 in non immune expatriate residents on regular chemoprophylaxis. From 1984 to 1991, 950 in vivo tests with a seven days observation period were performed in semi-immune autochtonous children living in seven towns of the country. Chloroquine treatments were given at 25 mg/kg over 3 days period to children with P. falciparum parasitaemia500 (634 simplified methods) or1000/mm3 (316 WHO standard field tests), usually asymptomatic. Until 1988, the surveys show an absence or a low frequency of chloroquine resistance (usually below 10%) according to the town; since 1989, the resistance has been present in all towns but everywhere with a frequency under 20%. None cases of R III level resistance was observed and all children became or remained asymptomatic at day 7. Until further surveys demonstrate a decreased efficacity of chloroquine, it is advised that chloroquine be used at 25 mg/kg over 3 days period as the treatment of choice in uncomplicated acute malaria in the Central African Republic.

A leprosy survey was conducted from 1982 to 1985 among 2650 semi-sedentarized Pygmies in two camp-villages in the Central African Republic. Leprosy is endemic there, with an estimated prevalence rate of 1.05% and an annual detection rate of 0.2%. In view of its close relations with other neighbouring ethnic groups this Pygmy community can be considered as a target population the study of which provides indications on the transmission and typical course of leprosy in the region and also as a potential focus of contamination. However, the concurrent presence of endemic tuberculosis made it necessary during the survey to look for clinical associations of leprosy and tuberculosis in patients so that the standard multidrug treatment schedules comprising rifampicin could be adjusted accordingly.

Three studies about relation between pregnancy and malaria have been conducted in CAR. The comparative study between plasmodic indexes (PI) et placental appositions (PAP) had shown that PAP offers biggest sensibility in the diagnosis of malaria infection (37.1% for PAP versus 17.1% for PI). The comparison of the PAP with placental anatomopathological study (PAN) revealed the same sensibility of both technics but the PAP's realization is very easy, at the opposite PAN's realization is long and requires sophisticated equipment. Moreover, PAP allows the differentiation between recent and post-malaria infection. The simultaneous realization of the PAP and chloroquinaemia had allowed to develop a surveillance of chloroquine resistance level of Plasmodium falciparum to amino-4-quinolines.

In order to evaluate the predictivity of neurological signs and symptoms in african patients, in Bangui's National Hospital Center (Central African Republic), 79 inpatients (aged 15-65 years) presenting with neurological manifestations (vascular attack, proved metabolic coma, or neuro-paludism excluded), and 64 age and sex matched controls in the same ward, without neurological or AIDS-related symptoms, were tested for the presence of HIV1-antibodies. 51/79 (65%) patients with neurological manifestations were HIV1-seropositive, and 10 (16%) of 64 controls (P less than 0.001). The positive predictive value (PPV) for HIV1 was 100% for patients with cutaneous zona (9 cases), Bell's palsy (4 cases) or cryptococcal meningitis (8 cases). The PPV for HIV1 was less important for the other neurological disorders: 43% for purulent meningitis (21 cases), 62% for major involvements of the central nervous system, without diagnosed etiology (32 cases; in which 13 were meningo-encephalitis, 16 focal deficits and 3 possible meningeal tuberculosis). In central Africa, the predictivity of neurological manifestations is high for HIV1 infection that emphasises the need for including neurological signs in clinical case definitions of AIDS in Africa.

The therapeutic strategy in chronic myeloid leukemia (CML) has been totally modified with the development of Imatinib Mesylate (Gleevec®), a specific inhibitor of Bcr/Abl tyrosine kinase activity. However, many side-effects are reported with Gleevec, generally low grade. We report a new side-effect in patients treated with Glevec® for CML: hypophosphatemia. Between September 2001 and February 2005, 38 patients with CML were treated with Gleevec®. Thirty-four patients (18 males, 16 females) had a complete clinical and biological follow-up including into bone metabolism. Fifteen patients presenting a low level of serum phosphorus. Hyphosphatemia appeared within a median of 15 months (range: 1–47). Comparison of normal and hypophosphatemic patients did not show any statistically significant difference regarding age, treatment duration and dose of Gleevec®. Moreover, in 17 patients, we investigated the plasma level of Gleevec® as described by Mahon FX et coll. And did not find a correlation between the phosphorus level and concentration of Gleevec® (1). We next investigated phosphorus metabolism starting with digestive excretion because Gleevec® is known to induce gastro-intestinal side-effects. A multivariate analysis showed a correlation between hypophosphatemia and diarrhea (p Interestingly, we observed a low cross-laps serum level in all patients, independently of their phosphatemia status. A similar observation was recently reported by Berman E and coll in 16 patients treated for gastrointestinal stromal tumors and CML (2). They suggested inhibition of the platelet-derived growth factor (PDGF) receptor b. Parathyroid hormone levels were similar in both groups and the low levels in the phosphorus group tended to correlate with an increased level of serum 1,25-dihydroxyvitamin D, but did not reach significance. This is could be in favour of an inhibition of bone remodelling by Gleevec® independently of hypophosphatemia. This suggests a possible implication of FGF23, a major regulator of phosphorus metabolism, that need to be further investigated.

Since August 1983, several cases of chloroquine resistant malaria have been observed in caucasian adults living in the Central African Republic (CAR) despite an antimalarial prophylaxis. Between 1984 and 1985, several studies including both in vitro and in vivo tests have been undertaken in cohorts of children to determine antimalaria drug sensitivity of P. falciparum in two towns of the CAR. In Bangui, out of 60 asymptomatic schoolchildren with asexual parasite count per mm3 of blood equal (or more than) 1,000, treated using a single intake of chloroquine at a dose of 10 mg/kg, three had asexual parasites at day 7 after drug administration. Alternatively, out of 57 other children with clinical malaria treated using a total dose of 25 mg/kg of chloroquine daily distributed within a 3 day period, only one exhibited a RII resistance. In vitro tests performed in a limited cohort of 15 school children showed a high sensitivity to chloroquine, amodiaquine, quinine and mefloquine in P. falciparum malaria. In Bouar, a group of 80 preschool children attending pediatric clinic were treated using either a single dose of 10 mg/kg of chloroquine (25 children) or 25 mg/kg of amodiaquine (21 cases) or 25 mg/kg of chloroquine (34 cases) within a three days period. Asymptomatic parasitaemia persisted or reappeared in 6 children all treated with 10 mg/kg of chloroquine. Therapeutic response to amino-4-quinolines in central african children is up to now satisfactory as compared to that observed in surrounding countries. Further surveys including other rural and urban areas are needed to appreciate the evolution of the phenomenon.