Strengthening equitable health systems in West Africa: The regional project on governance research for equity in health systems

The West African Health Organization (WAHO) supported an innovative regional initiative that contributes to building effective decision making, community and researcher partnerships to strengthen equitable health systems and influence local programmes and policies. Four projects were funded in Nigeria, Sierra Leone, Burkina Faso and Senegal, supported by a Regional Advisory Committee of experts and local Steering Committees. Based on a framework drawn from WAHO objectives, we reviewed documents, conducted 56 project stakeholder interviews and undertook thematic analysis. A diverse range of stakeholders perceived that the projects were in line with national priorities, were well managed and were equitably implemented. The projects generated evidence that could increase access to and improve quality maternal health services. Sustainable partnerships were formed and stakeholder and research team capacity were strengthened. Our study provides insight into project implementation in West Africa, bearing in mind context-specific issues. (Afr J Reprod Health 2022; 26[5]: 81-89).

The first year of the COVID-19 pandemic in the ECOWAS region

Objective: to analyse the pandemic after one year in terms of the evolution of morbidity and mortality and factors that may contribute to this evolution Design: This is a secondary analysis of data gathered to respond to the COVID-19 pandemic. The number of cases, incidence rate, cumulative incidence rate, number of deaths, case fatality rate and their trends were analysed during the first year of the pandemic. Testing and other public health measures were also described according to the information available. Settings: The 15 States members of the Economic Community of West African States (ECOWAS) were considered. Results: As of 31st March 2021, the ECOWAS region reported 429,760 COVID-19 cases and 5,620 deaths. In the first year, 1,110.75 persons were infected per million, while 1.31% of the confirmed patients died. The ECOWAS region represents 30% of the African population. One year after the start of COVID-19 in ECOWAS, this region reported 10% of the cases and 10% of the deaths in the continent. Cumulatively, the region has had two major epidemic waves; however, countries show different patterns. The case fatality rate presented a fast growth in the first months and then decreased to a plateau. Conclusion: We learn that the context of COVID-19 is specific to each country. This analysis shows the importance of better understanding each country's response. During this first year of the pandemic, the problem of variants of concern and the vaccination were not posed.

Xerodermapigmentosum : difficulté diagnostique en Afrique occidentale

Le Xéroderma pigmentosum (XP) est lié à un défaut des enzymes impliquées dans la réparation des effets oncogènes de l'exposition aux ultraviolets. L'affection se rencontre dans le monde entier, dans toutes les ethnies et races. Cette génodermatose rare est souvent méconnue dans les pays en manque de spécialiste en dermatologie. Cette rareté de Xeroderma pigmentosum et l'insuffisance de personnel qualifié engendrent des difficultés diagnostiques de cette pathologie surtout en Afrique Occidentale où le XP est diagnostiqué à tort pour d'autres pathologies. Objectif: Partager avec les confrères la problématique de diagnostic de Xéroderma pigmentosum dans les pays en insuffisance de dermatologues et de plateau technique. Observation: il s'agissait d'un patient de 21 ans, sexe masculin, sans antécédents pathologique de dermatoses, issu d'un mariage consanguin qui a consulté pour sècheresse cutanée et photophobie après un long parcours dans beaucoup des centres de santé de la place sans diagnostic et sans amélioration notable, chez qui l'interrogatoire a retrouvé la notion de consanguinité (son père et sa mère sont des cousins, et provenaient du même clan Dogon),l'absence de troubles pigmentaires cutanées à la naissance et l'apparition des troubles pigmentaires cutanées à l'âge de 16ans. L'examen physique a objectivé la photophobie en plus des signes cliniques et paracliniques specifiques ce qui a permis de retenir le diagnostic de Xéroderma pigmentosum, forme variante. Conclusion: en Afrique Occidentale, la difficulté diagnostique de Xéroderma pigmentosum est sans doute en rapport avec un manque de personnel qualifié et des moyens techniques de diagnostic, ce qui rend sa fréquence sous-estimée

Emergence of colorectal cancer in West Africa : accepting the inevitable - review

It seems not too long ago that colon and rectal cancer was called a 'rare' disease in rural Africa, however over the last 30 years in West Africa, published evidence has shown decade by decade increases in the incidence of Colorectal cancer (CRC). Therefore CRC should now be accepted as a recognized disease in native Africans; nevertheless we must acknowledge that the incidence is a fraction of what obtains in the developed countries of Europe and America. This presentation will attempt to examine the emergence of CRC within the West African axis over the last 4 decades

Stigmate immunologique de la circulation des Orthopoxvirus chez des sujets nés après l'éradication de la variole en Côte d'ivoire Afrique de l'ouest

Justification : Depuis l'éradication du virus de la variole, on note une émergence des autres Orthopoxvirus surtout le Monkeypoxvirus en Afrique centrale. A ce jour aucun cas d'infection humaine à Orthopoxvirus n'a été notifié en Côte d'Ivoire. Cependant, l'activité humaine en milieu rural, la présence des réservoirs potentiels et le climat sont des facteurs favorables à la circulation de ce groupe de virus. Objectif : Mettre en évidence la circulation des Orthopoxvirus en Côte d'Ivoire en situation post éradication de la variole dans la population non vaccinée contre cette maladie. Matériel et méthode : 385 sérums de sujets non vaccinés contre la variole, choisis parmi 1353 sérums collectés lors d'une surveillance nationale de la fièvre jaune, ont été analysés. La méthode ELISA a été utilisée pour rechercher les IgG anti Orthopoxvirus. Résultats : l'âge moyen des patients était de 11 ans et le sex-ratio était de 1,97. Les IgG anti-Orthopoxvirus ont été détectées dans 4,95% des sérums ; seuls 0,78% de ces sérums avaient un titre ≥ 400. La majorité des sérums contenant ces IgG (84,16%) provenaient d'individus habitant la moitié sud de la Côte d'Ivoire. Conclusion : le niveau d'exposition aux Orhopoxvirus reste faible chez les sujets non vaccinés contre la variole. Cependant, vu le nombre croissant de sujets susceptibles à ces virus, il est nécessaire de mettre en place des sites sentinelles de surveillance, particulièrement du Monkeypoxvirus

Un cas de condylome géant vulvaire du nourrisson traité avec succès par électrocoagulation au Bénin

Nous rapportons ici un cas de condylome géant vulvaire chez un nourrisson de 02 ans contaminé par sa « baby-sitter » qui présentait les mêmes lésions. Traité par exérèse chirurgicale couplée à une électrocoagulation, l'évolution a été marquée par une récidive deux semaines après le traitement ; ce qui a nécessité une deuxième séance d'électrocoagulation. Plus d'un an après, plus aucune lésion n'a été notée témoignant ainsi d'un succès thérapeutique. La non disponibilité de l'imiquimod dans notre zone géographique, impose un recours systématique à un traitement invasif quelque soit l'âge du patient

Ebola virus disease control in West Africa: an ecological, one health approach

The 2013-2015 Ebola Virus Disease outbreak in West Africa had similar nuances with the 1976 outbreaks in Central Africa; both were caused by the Zaire Ebola Virus strain and originated from rural forested communities. The definitive reservoir host of Ebola virus still remains unknown till date. However; from ecological perspective; it is known that the virus first emerged from forest ecotypes interfacing with human activities. As at March 2015; the outbreak has claimed over 9000 lives; which is unprecedented. Though it remains unproved; the primary sources of infection for past and present outbreaks are forest dwelling; human-hunted fauna. Understanding the ecological factors at play in these forest ecotypes where wild fauna interface with human and causing pathogen spill over is important. A broad based One Health approach incorporating these ecological concepts in the control of Ebola Virus Disease caneffectively ameliorate or forestall infection now and in the future

Female genital cutting: current practices and beliefs in western Africa

Objective To conduct a cross-national comparative study of the prevalence and correlates of female genital cutting (FGC) practices and beliefs in western Africa. Methods Data from women who responded to the Multiple Indicator Cluster Surveys between 2005 and 2007 were used to estimate the frequencies of ever having been circumcised; having had a daughter circumcised; and believing that FGC practices should continue. Weighted logistic regression using data for each country was performed to determine the independent correlates of each outcome. Findings The prevalence of FGC was high overall but varied substantially across countries in western Africa. In Sierra Leone; Gambia; Burkina Faso and Mauritania; the prevalence of FGC was 94; 79; 74and 72; respectively; whereas in Ghana; Niger and Togo prevalence was less than 6. Older age and being Muslim were generally associated with increased odds of FGC; and higher education was associated with lower odds of FGC. The association between FGC and wealth varied considerably. Burkina Faso was the only country in our study that experienced a dramatic reduction in FGC prevalence from women (74) to their daughters (25); only 14.2of the women surveyed in that country said that they believe the practice should continue. Conclusion The prevalence of FGC in western Africa remains high overall but varies substantially across countries. Given the broad range of experiences; successful strategies from countries where FGC is declining may provide useful examples for high-prevalence countries seeking to reduce their own FGC practices

Insecticide resistance in the Simulium damnosum S. L. vectors of human onchocerciasis: distributional, cytotaxonomic and genetical studies

Human onchocerciasis is a debilitating disease caused by the filarial parasite Onchocerca volvulus (Leukart). The parasite is transmitted by dipterous insects of the family Simuliidae. ln West Africa, transmission is by members of lhe Simulium damnosum (Theobald) species complex. The manifestations of the disease are mainly dermal, lymphatic and ocular, the most severe of which is blindness hence the common name 'river blindness'. The disease is found in parts of Latin America, the Yemen and Sub-Sahara Africa. lt affects some 17.7 million people world-wide with 500,000 severely visually disabled and some 27O,00O blind. ln West Af rica, which is the most affected area, there are over 5 million infected with onchocerciasis and about 148,000 blind. ln view of this, the Onchocerciasis Control Programme in West Africa (OCP), one of the biggest vector control operations covering parts of 11 countries was started in 1975 by the World Health Organization to control onchocerciasis as a disease of public health and socio-economic importance. The initial strategy of the OCP was the application of insecticides to the breeding sites of the insect vectors. ln the OCP, temephos an organophosphate insecticide (OP) was the only chemical used for the initial five years due to its selective mode of action. Resistance to temephos first appeared in 1980 in a population of S. soubrense/S.sanctipauli on the Bandama river in Southern Côte d'lvoire. Later, similar resistant populations of the same species were identified in other river basins in the C6te d'lvoire. ln 1981 Chlorphoxim, also an OP, was used as a replacement for temephos in areas where resistance to temephos had been detected but a similar pattern of resistance was soon detected against chlorphoxim Careful monitoring of resistance to temephos has shown that it has spread to all river basins and different species of the S. damnosum complex at one time or another within the OCP area. Resistance to insecticides demands that large quantities and more novel and toxic chemicals have to be used in the fight against insects and other arthropod pests. This has important economic, operational and environmental demands. ln the West African vector control programme mentioned above, a rotation of 6 insecticides is used to manage insecticide resistance. This strategy places a major constraint on the operations of the Programme (OCP) due to the logistic need of stocking insecticides in the field

Some aspects of blood transfusion practice in West Africa

It is agreed that safe blood transfusion is achieved only through the joint implementation of safe donation; quality in testing and processing and transfusion only when essential. The article throws light on current transfusion practice in West Africa and suggests ways to implement the above three components which together make blood transfusion safe

Measles in a West African nomadic community

A serological survey was conducted among Tuareg nomads to determine their level of immunity to measles. More than half (57.9%) of the children under 10 years of age did not have detectable antibodies to measles, suggesting that transmission of the disease is low in this mobile population. Mothers' reports of their children's history of measles were accurate (positive predictive value 93.9% for under-5-year-olds). Nomads are a reservoir of susceptible individuals who require immunization strategies adapted to their particular life-styles. These can be implemented at relatively low cost

Plasmodium falciparum and P. malariae epidemiology in a West African village

Transmission of Plasmodium falciparum and P. malariae was studied in a village in Burkina Faso. Consecutive captures of mosquitos were organized twice a month over a year and the species of the mosquitos identified. Also, the prevalences and densities of Plasmodium spp. were determined every 2 months in a sample of children who lived in the village. Anopheles gambiae, A. funestus, and A. nili were the local vectors, but only the first two played a predominant role in both P. falciparum and P. malariae transmission. The parasitological sporozoite index (SI) was 4.48% for A. gambiae and 4.22% for A. funestus. The immunological SIs were higher: 5.82% of A. gambiae were infected with P. falciparum and only 0.16% with P. malariae; the corresponding proportions for A. funestus were 6.45% and 0.41%. Transmission of Plasmodium spp. by A. gambiae was important during the rainy season (July-October) and by A. funestus at the beginning of the dry season (September-November). Each child in the study village could receive about 396 P. falciparum-infected bites per year but only 22 of P. malariae. The P. falciparum parasite indices were maximum during the middle of the rainy season (August), while those for P. malariae reached a peak during the dry season (February)

The predicted and observed decline in onchocerciasis infection during 14 years of successful control of Simulium spp. in West Africa

In 55 villages from the well-protected central area of the Onchocerciasis Control Programme in West Africa (OCP), skin snip surveys have been carried out at regular intervals since the programme started, and the latest round of surveys was undertaken after 12-14 years of successful vector control. The observed trends in the prevalence and intensity of onchocerciasis infection in cohorts of adults were compared with the trends predicted using a host-parasite model. After 12-14 years of control the community microfilarial load (CMFL) was close to zero in all villages. During the last few years of control, the prevalence of infection declined at an accelerated rate, and this was predicted by the model. There was generally good agreement between observed and predicted trends. The predictions were based on an estimated average duration of infection of 10.4 years, which corresponds to a mean reproductive lifespan for Onchocerca volvulus of 9-9.5 years, and an upper limit of 15 years for 95% of the infections. Differences between the observed and predicted data included the trend in CMFL between the first and second surveys, which in 18 villages did not show the predicted decline. Furthermore, the observed final decline in prevalence was faster than predicted in the north-eastern part of the central OCP area. After 14 years of vector control, the level of onchocerciasis has fallen to such a low level that consideration is being given to ending larviciding

Application of multiple methods to study the immunization programme in an urban area of Guinea

During 1988-89, studies were conducted to evaluate the immunization system in Conakry, Guinea. The first, a health facility survey, found that health staff screened the vaccination status of only 30% of children who presented for curative care. A sterile syringe and needle were used for less than half of the injections. In the second survey, key informant interviews with vaccinators and health centre chiefs showed that there were minimal lines of communication between health workers and the community, but that health workers did not perceive this to be a problem. Focus group discussions in the community revealed a high level of general knowledge about vaccine-preventable diseases. However, mothers did not know how many vaccinations their children should receive or by what age they should be completed. They complained of long waiting times in health centres, the high costs of vaccination, poor rapport with health workers, and the occurrence of abscesses after vaccination. The final study, a "knowledge, attitudes, and practice" community survey, showed that missed immunization opportunities and inappropriately timed vaccinations reduced potential vaccine coverage by almost 30% among children with vaccination cards. Higher socioeconomic status, delivery in hospital, and whether mothers perceived the vaccinations to be affordable affected whether the child began the immunization series. Once a child had entered the immunization system, completion of the series was determined by the mother's education level, employment status, and experience with vaccination services

La lutte contre l'onchocercose en Afrique de l'Ouest: : un bilan

Nous présentons le vaste programme de lutte contre I'onchocercose en Afrique de l'Ouest qui intéresse onze Etats et couvre plus d'un million de kilomètres carrés' Nous réalisons une importante mise au point sur les aspects épidémiologiques' cliniques et thérapeutiques de I 'onchocercose mais aussi sur I 'impact socioéconomique de cette filariose dans les grandes zones bioclimatiques de savane et de forêt de I 'Afrique tropicale' Nous analysons les problèmes très particuliers que pose la lutte antivectorielle contre la simulie. Nous évoquons les nouvelles perspectives de lutte apportées par I'apparition de l' ivermectine. Ce travail est également l'occasion d'une vaste revue bibliographique actualisée'