Using a multiplex serological assay to estimate time since SARS-CoV-2 infection and past clinical presentation in malagasy patients.

Background: The world is facing a 2019 coronavirus (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this context, efficient serological assays are needed to accurately describe the humoral responses against the virus. These tools could potentially provide temporal and clinical characteristics and are thus paramount in developing-countries lacking sufficient ongoing COVID-19 epidemic descriptions. Methods: We developed and validated a Luminex xMAP® multiplex serological assay targeting specific IgM and IgG antibodies against the SARS-CoV-2 Spike subunit 1 (S1), Spike subunit 2 (S2), Spike Receptor Binding Domain (RBD) and the Nucleocapsid protein (N). Blood samples collected periodically for 12 months from 43 patients diagnosed with COVID-19 in Madagascar were tested for these antibodies. A random forest algorithm was used to build a predictive model of time since infection and symptom presentation. Findings: The performance of the multiplex serological assay was evaluated for the detection of SARS-CoV-2 anti-IgG and anti-IgM antibodies. Both sensitivity and specificity were equal to 100% (89.85-100) for S1, RBD and N (S2 had a lower specificity = 95%) for IgG at day 14 after enrolment. This multiplex assay compared with two commercialized ELISA kits, showed a higher sensitivity. Principal Component Analysis was performed on serologic data to group patients according to time of sample collection and clinical presentations. The random forest algorithm built by this approach predicted symptom presentation and time since infection with an accuracy of 87.1% (95% CI = 70.17-96.37, p-value = 0.0016), and 80% (95% CI = 61.43-92.29, p-value = 0.0001) respectively. Interpretation: This study demonstrates that the statistical model predicts time since infection and previous symptom presentation using IgM and IgG response to SARS-CoV2. This tool may be useful for global surveillance, discriminating recent- and past- SARS-CoV-2 infection, and assessing disease severity. Fundings: This study was funded by the French Ministry for Europe and Foreign Affairs through the REPAIR COVID-19-Africa project coordinated by the Pasteur International Network association. WANTAI reagents were provided by WHO AFRO as part of a Sero-epidemiological "Unity" Study Grant/Award Number: 2020/1,019,828-0 P·O 202546047 and Initiative 5% grant n°AP-5PC-2018-03-RO.

One Health: navigating plague in Madagascar amidst COVID-19.

BACKGROUND: Africa sees the surge of plague cases in recent decades, with hotspots in the Democratic Republic of Congo, Madagascar, and Peru. A rodent-borne scourge, the bacterial infection known as plague is transmitted to humans via the sneaky bites of fleas, caused by Yersinia pestis. Bubonic plague has a case fatality rate of 20.8% with treatment, but in places such as Madagascar the mortality rate can increase to 40-70% without treatment. MAIN TEXT: Tragedy strikes in the Ambohidratrimo district as three lives are claimed by the plague outbreak and three more fight for survival in the hospitals, including one man in critical condition, from the Ambohimiadana, Antsaharasty, and Ampanotokana communes, bringing the total plague victims in the area to a grim to five. Presently, the biggest concern is the potential plague spread among humans during the ongoing COVID-19 pandemic. Effective disease control can be achieved through training and empowering local leaders and healthcare providers in rural areas, implementing strategies to reduce human-rodent interactions, promoting water, sanitation and hygiene practices (WASH) practices, and carrying out robust vector, reservoir and pest control, diversified animal surveillance along with human surveillance should be done to more extensively to fill the lacunae of knowledge regarding the animal to human transmission. The lack of diagnostic laboratories equipped represents a major hurdle in the early detection of plague in rural areas. To effectively combat plague, these tests must be made more widely available. Additionally, raising awareness among the general population through various means such as campaigns, posters and social media about the signs, symptoms, prevention, and infection control during funerals would greatly decrease the number of cases. Furthermore, healthcare professionals should be trained on the latest methods of identifying cases, controlling infections and protecting themselves from the disease. CONCLUSIONS: Despite being endemic to Madagascar, the outbreak's pace is unparalleled, and it may spread to non-endemic areas. The utilization of a One Health strategy that encompasses various disciplines is crucial for minimizing catastrophe risk, antibiotic resistance, and outbreak readiness. Collaboration across sectors and proper planning ensures efficient and consistent communication, risk management, and credibility during disease outbreaks.

An overdue catalyst: Limitations imposed by COVID-19 improved capacity building in community-led environmental education in Madagascar.

The COVID-19 pandemic caused by the SARS-CoV-2 virus brought many primatology research programs and conservation efforts to a halt. After Madagascar closed its borders during March 2020, many on-site international project leaders and researchers returned to their home countries when their programs were delayed or canceled. Madagascar remained closed to travelers until November 2021, when it reopened to international flights. The 20-month absence of international researchers allowed many local Malagasy program staff, wildlife professionals, and community leaders to step into new leadership roles and responsibilities. Many programs that already had strong Malagasy leadership and meaningful collaborations with local communities flourished, while others either swiftly strengthened these attributes or faced challenges from pandemic-related travel restrictions. Here, we describe how the coronavirus pandemic events of 2020-2021 initiated long-overdue shifts in outdated models of internationally led primate research and education projects in communities living alongside primates at risk of extinction. We discuss the benefits and challenges of pandemic-induced changes within five primatological outreach projects, as well as how we can use these experiences to improve community-led environmental education and conservation awareness in the future.

A historical review of pandemics with a dermatological perspective

We present a literature review of dermatology features in historical pandemics. A pandemic is an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and affecting a large number of people. Smallpox was the first documented pandemic, around 10 000 BC, spread by the inhalation of airborne droplets. A few days after an initial high fever, headache and fatigue, a mucocutaneous maculopapular eruption appeared, which then developed pustules and erosions. The last outbreak occurred in the USA in 1949. Smallpox was eradicated in 1980, following a vaccination programme. Mycobacterium tuberculosis is the causative agent of tuberculosis (TB), an ongoing global pandemic. The earliest documentations were 3300 years ago. In 2020, the World Health Organization (WHO) provisionally estimated 1.5 million deaths globally. Most commonly affecting the lungs, cutaneous TB may present with inflammatory papules, plaques, suppurative nodules and chronic ulcers. Requiring long, complex antibiotic regimens, multidrug resistant TB is an increasing problem. Now extremely rare, yet still with recent outbreaks in 2021 in Madagascar, bubonic plague arrived in Europe in 1346 causing 75-200 million deaths. It is caused by the bacterium Yersinia pestis, transmitted through fleas that have fed on infected rodents. Clinical features include papules, pustules, ulcers and eschars, tender lymphadenopathy and systemic symptoms, and it responds to antibiotics. Syphilis, caused by the bacterium Treponema pallidum, is sexually transmitted. The first known outbreak was during warfare in 1494-5 in Naples, Italy. In 2020, the WHO estimated that, globally, seven million people had new infections. Primary syphilis typically produces a painless, genital ulcer (or chancre). Secondary syphilis presents with a nonitchy, maculopapular erythema over the trunk, palms and soles. Early recognition and antibiotic treatment usually lead to good outcomes. Estimated by the WHO to affect 37.7 million people in 2020, HIV is thought to have mutated from simian immunodeficiency virus by the 1960s in sub-Saharan Africa, spreading to the Caribbean and USA by the late 1960s. Initial symptoms include a fever, headache and lymphadenopathy. Dermatological features are common, including opportunistic cutaneous infections, nonspecific exanthemas, seborrhoeic dermatitis and Kaposi sarcoma. Advances in antiretroviral therapies mean people with HIV can have an excellent prognosis, although the WHO estimated in 2020 that more than 200 000 people with HIV died from concomitant TB. Since 2019, COVID-19 has had a considerable global impact on healthcare. With more than 300 million cases and 5.5 million deaths to date, some services have been overwhelmed owing to large case numbers, variable vaccine uptake, workplace changes to reduce transmission and staff shortages. Cutaneous features include perniosis, urticarial, purpuric, vesicular or maculopapular eruptions. Pandemics throughout history have been repeatedly shown to present with an element of skin involvement. We can utilize this to promote education and early recognition of these features, to facilitate diagnosis and raise awareness of the potential complications of serious diseases.

Living with rodent pests: Unifying stakeholder interests to prioritise pest management in rural Madagascar

Rodent pests can have major social, economic, and environmental impacts. Their management, therefore, represents a complex socio-ecological problem involving a network of stakeholders from across different sectors, with diverging and sometimes competing interests. Failure to incorporate stakeholder interests can result in ineffective or unsustainable management programmes, with unintended negative consequences for people and nature.Participatory approaches to decision-making have been proposed as suitable strategies to tackle complex problems, yet, these processes are often considered too difficult, costly, or time-consuming to implement.To facilitate a participatory approach to rodent control in Madagascar, we identified and mapped key stakeholders and developed a multisector framework for guiding rodent management programmes based on current literature and expert recommendations. We then carried out interviews and focus groups with stakeholders and end-users to validate the final framework.The final framework unifies stakeholder interests around the dimensions of People, Resources, Knowledge and Power. Combined application of the stakeholder map and framework provides decision-makers with the tools to identify stakeholder interests;to explore areas of conflict, as well as areas of agreement;and to ensure that these are addressed within the design of control programmes. As an assessment tool, the framework can also be used to evaluate the responsiveness of programmes to the needs of different stakeholders and assess whether objectives are being reached.We recommend the application of the stakeholder map and framework to encourage and strengthen participatory approaches aimed at rodent pest control. Due to the inclusive and interdisciplinary nature of the framework, it can be applied to address numerous complex social, environmental, and economic issues across scales, sectors, and systems.Read the free Plain Language Summary for this article on the Journal blog.

Diagnostic challenge of dyspnea in the context of the COVID-19 pandemic wave: a case report.

Background: Since its discovery, COVID-19 has often been the first diagnosis of dyspnea and asthenia, especially during the pandemic waves. However, it is not always COVID-19. We report a particular case of a late-diagnosed HIV-positive patient in Madagascar. Case presentation: A 21-year-old male patient was admitted to a hospital center in Antananarivo for dyspnea and poor general condition. Physical examination revealed hypoxemia of 85% on room air. His chest X-ray showed bilateral reticular-micronodular opacities. He was suspected and treated for COVID-19. On the 15th day of hospitalization, HIV-1 infection complicated by probable pneumocystis was diagnosed. On the other hand, a multimetastatic testicular cancer was also suspected. The patient died after a few hours of hospitalization in the intensive care unit. Conclusion: This was a case of an HIV-positive patient belatedly diagnosed in the complications stage during the COVID-19 pandemic wave. The investigation of the differential diagnoses remains crucial to avoid serial misdiagnosis and to adjust therapeutic management.

Idiopathic Granulomatous Mastitis as an Unusual Cause of Erythema Nodosum in a Malagasy Woman.

Introduction: Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease. Neoplastic and infectious etiologies must be ruled out. IGM is a diagnostic challenge for countries with high tuberculosis endemicity like Madagascar since it may clinically and radiologically mimic breast tuberculosis. We report a case of IGM associated with erythema nodosum in a Malagasy. Case Report: A 29-year-old primiparous woman came to a dermatological consultation for typical erythema nodosum lesions that appeared one month after a breast swelling. She had no particular medical history. Examination revealed typical erythema nodosum lesions on the legs, voluminous tender mass in the right breast. Bacteriological samples and tuberculosis test were negative. Imaging showed mastitis on the right breast with no evidence of malignancy. Histology revealed a non-caseating granulomas on the lobule of the right breast. As part of an etiological work-up, COVID-19 serology was performed with a positive IgG antibody. The diagnosis of IGM associated with erythema nodosum was evocated. The evolution was favorable under systemic corticosteroid therapy. Discussion: The cause of this uncommon lesion remains obscure. The extramammary localizations such as erythema nodosum and arthralgia suggest an autoimmune origin. This pathogenesis is also reinforced by a good response to systemic immunosuppression. In our patient, the etiological assessment of the mastitis revealed a chronic infection with SARS-CoV-2. Histopathology is the gold standard for the IGM diagnosis which demonstrates a lobulocentric granulomas without caseous necrosis. Oral corticosteroid therapy is the initial choice of treatment. Conclusion: Now, with several cases of concomitant IGM and EN reported, dermatologists should be aware that erythema nodosum can be one of the presenting signs of IGM, since the two conditions appear to be associated. The particularity of our case lies in the incidental discovery of SARS-CoV-2 infection. Is a chronic granulomatous disease associated with SARS-CoV-2 infection, a coincidence?

Socio-demographic variables can guide prioritized testing strategies for epidemic control in resource-limited contexts.

BACKGROUND: Targeted surveillance allows public health authorities to implement testing and isolation strategies when diagnostic resources are limited, and can be implemented via the consideration of social network topologies. Yet, it remains unclear how to implement such surveillance and control when network data are unavailable. METHODS: We evaluated the ability of socio-demographic proxies of degree centrality to guide prioritized testing of infected individuals compared to known degree centrality. Proxies were estimated via readily-available socio-demographic variables (age, gender, marital status, educational attainment, and household size). We simulated SARS-CoV-2 epidemics via a SEIR individual-based model on two contact networks from rural Madagascar to further test the applicability of these findings to low-resource contexts. RESULTS: Targeted testing using socio-demographic proxies performed similarly to targeted testing using known degree centralities. At a low testing capacity, using the proxies reduced the infection burden by 22-33% while using 20% fewer tests, compared to random testing. By comparison, using known degree centrality reduced the infection burden by 31-44% while using 26-29% fewer tests. CONCLUSIONS: We demonstrate that incorporating social network information into epidemic control strategies is an effective countermeasure to low testing capacity and can be implemented via socio-demographic proxies when social network data are unavailable.

Galenic preparations for the prevention of the spread of COVID-19

Background: A.P.P.A. Project is the main activity of the nonprofit organisation Aid Progress Pharmacist Agreement (A.P.P.A.) which is the result of the cooperation between the University of Turin and Italian Pharmacists and it operates in the field of International Health Cooperation. The objective of the Project is the realisation of Galenic laboratories within healthcare facilities located in Developing Countries. Seven Projects are currently on-going in Madagascar, Angola, Chad and Haiti. Purpose(s): In view of the pandemic caused by COVID19, and to reduce its spread as much as possible in the hospitals where the Project is active, the goal was to implement specific procedures on site for the production of alcoholic solutions, liquid soaps and disinfectant gels in accordance with WHO guidelines. Method(s): The A.P.P.A. labs have been promptly equipped with standard procedures for the preparation of disinfectant formulations. The procedures have been developed in a very simple way to allow their introduction on site even remotely and without a specific training path that requires to be carried out in person. Result(s): Since the manual skills have been acquired during the preparation of Galenic formulations over time, local operators had no difficulty with the new formulations;if necessary specific indications are given by email or by phone calls. In the labs where these formulations had already been introduced in the past for the prevention of nosocomial infections, the setting up has been enhanced by the reorganisation of the production activities. Conclusion(s): The Galenic preparation, also in these contexts, resulted a good strategy for healthcare personnel and for hospitalised patients.

Epidemiological Patterns of Seasonal Respiratory Viruses during the COVID-19 Pandemic in Madagascar, March 2020-May 2022.

Three epidemic waves of coronavirus disease-19 (COVID-19) occurred in Madagascar from March 2020 to May 2022, with a positivity rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of 21% to 33%. Our study aimed to identify the impact of COVID-19 on the epidemiology of seasonal respiratory viruses (RVs) in Madagascar. We used two different specimen sources (SpS). First, 2987 nasopharyngeal (NP) specimens were randomly selected from symptomatic patients between March 2020 and May 2022 who tested negative for SARS-CoV-2 and were tested for 14 RVs by multiplex real-time PCR. Second, 6297 NP specimens were collected between March 2020 and May 2022 from patients visiting our sentinel sites of the influenza sentinel network. The samples were tested for influenza, respiratory syncytial virus (RSV), and SARS-CoV-2. From SpS-1, 19% (569/2987) of samples tested positive for at least one RV. Rhinovirus (6.3%, 187/2987) was the most frequently detected virus during the first two waves, whereas influenza predominated during the third. From SpS-2, influenza, SARS-CoV-2, and RSV accounted for 5.4%, 24.5%, and 39.4% of the detected viruses, respectively. During the study period, we observed three different RV circulation profiles. Certain viruses circulated sporadically, with increased activity in between waves of SARS-CoV-2. Other viruses continued to circulate regardless of the COVID-19 situation. Certain viruses were severely disrupted by the spread of SARS-CoV-2. Our findings underline the importance and necessity of maintaining an integrated disease surveillance system for the surveillance and monitoring of RVs of public health interest.

Conferences

First he examined the interactions between the lingering effects of the COVID-19 pandemic and current economic and social transformations. In light of the session in his honour, Dr George Harlow (American Museum of Natural History, New York, USA) chronicled the history of his career, in which he built collections, organised exhibitions and performed geological fieldwork around the world while researching jade, ruby, etc. Pamir rubies formed at unusually low pressures (minimum of 1–1.2 kbar) and a temperature of approximately 760°C. Wim Vertriest (Gemological Institute of America [GIA], Bangkok, Thailand) and co-authors reviewed the identification of low-temperature heat treatment of gem corundum (i.e. up to about 1200°C, which starts causing damage to rutile ‘silk’ inclusions). In another presentation, Dr Dutrow and co-authors investigated the origin determination of Cu-bearing tourmaline using statistical analyses of LIBS and electron microprobe data.

Africa ‘not on track to reach 2030 HIV/AIDS targets’

Speed read Researchers estimated the likelihood of 38 African countries reaching 2030 HIV/AIDS targets The chances of reaching HIV testing or condom use targets are less than 30 per cent As COVID-19 takes centre stage, Africa cannot afford to not fight HIV/AIDS, says an expert [NAIROBI] The likelihood of African countries reaching HIV testing and condom use targets by 2030 is only 12.1 per cent and 28.5 per cent respectively, making the need for more testing and treatment a priority, a modelling study suggests. The Joint United Nations Programme on HIV/AIDS (UNAIDS) launched ambitious targets in 2014 to end the AIDS epidemic by 2030 by achieving 95 per cent diagnosis and 95 per cent of people with HIV taking medications against the disease. Stuart Gilmour, St. Luke’s International University In 2019, there were 690,000 AIDS-related deaths and 1.7 million new infections, with young women and adolescent girls accounting for about 25 per cent of new infections in Sub-Saharan Africa despite making up about ten per cent of the population, according to UNAIDS.

Complex social and political factors threaten the world's smallest primate with extinction

We highlight current problems, challenges and dilemmas of conservation action in Madagascar, which is one of the poorest countries, but also the hottest global biodiversity hotspot. Consequences of climate change and the COVID‐19 pandemic exacerbate an already dramatic situation for many protected areas that are under pressure from illegal logging and habitat clearance for agriculture. The example of Madame Berthe's mouse lemur (Microcebus berthae), the world's smallest primate, illustrates how conservation efforts are failing because this “critically endangered” lemur species (Markolf et al. 2020) is feared to be extinct only 30 years after its discovery, even though its entire global range is situated inside a protected area. Numerous other lemurs, who have a higher percentage of CR/EN/VU species than any other group of mammals, are facing very similar prospects, despite this globally most endangered group of mammals enjoying particular attention from conservation policy makers and activists for decades because their endemic populations have been rapidly declining in shrinking habitats. [ FROM AUTHOR] Copyright of Conservation Science & Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

SARS-CoV-2 infection rate in Antananarivo frontline health care workers, Madagascar.

BACKGROUND: Health care workers (HCWs) represent a vulnerable population during epidemic periods. Our cohort study aimed to estimate the risk of infection and associated factors among HCWs during the first wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Madagascar. METHODS: A prospective cohort study was carried out in three hospitals that oversaw the first cases of COVID-19. Monthly ELISA-based serological tests were conducted, and nasopharyngeal swabs were collected in the case of symptoms linked to COVID-19 for RT-PCR analysis. Survival analyses were used to determine factors associated with SARS-CoV-2 infection. RESULTS: The study lasted 7 months from May 2020. We included 122 HCWs, 61.5% of whom were women. The median age was 31.9 years (IQR: 26.4-42.3). In total, 42 (34.4%) had SARS-CoV-2 infections, of which 20 were asymptomatic (47.6%). The incidence of SARS-CoV-2 infection was 9.3% (95% CI [6.5-13.2]) person-months. Sixty-five HCWs presented symptoms, of which 19 were positive by RT-PCR. When adjusted for exposure to deceased cases, infection was more frequent in HCWs younger than 30 years of age (RR = 4.9, 95% CI [1.4-17.2]). CONCLUSION: Our results indicate a high incidence of infection with SARS-CoV-2 among HCWs, with a high proportion of asymptomatic cases. Young HCWs are more likely to be at risk than others. Greater awareness among young people is necessary to reduce the threat of infection among HCWs.

Locating Indian Ocean Island States in India's Foreign Policy

The six Indian Ocean island states are located near key waterways, and are emerging as important actors in the geopolitics of the Indian Ocean. For India, outreach towards these island states is emerging as a key element of its Indian Ocean strategy. In fact, India's SAGAR (Security and Growth for All in the Region) Vision was launched in Mauritius in 2015. In the context of China's growing strategic and economic presence in the region, it is imperative for India to deepen its engagements with the smaller yet strategically important island states of the Indian Ocean. This paper locates the Indian Ocean island states in India's foreign policy broadly, and its maritime strategy specifically.

COVID-19 Induced Acute Pancreatitis in a Malagasy Woman Patient: Case Report and Literature Review.

Background: SARS-CoV-2 has been described as a respiratory tropic virus since its emergence in December 2019. During the course of the disease, other extra-pulmonary manifestations have been reported in the literature including pancreatic involvement such as acute pancreatitis. This phenomenon linking COVID-19 and acute pancreatitis has been reported by several case reports and cohort studies. No cases had been reported in sub-Saharan Africa and Madagascar. We report one more case Of COVID-19 induced acute pancreatitis in a Malagasy woman patient without risk factors, further consolidating the existing evidence. Case Presentation: A 44-year-old woman was diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and had a favorable course under home isolation and drug treatments. One week later, the patient was admitted to hospital with severe acute abdominal pain. Acute pancreatitis was considered according to the revised Atlanta criteria with the presence of the three criteria. Other etiologies of acute pancreatitis (lithiasis, alcohol, hypercalcemia, hypertriglyceridemia, tumor, trauma, surgery) were excluded. Ultimately, a COVID-19 induced acute pancreatitis was retained. The outcome was favorable under symptomatic medical treatment (fluid resuscitation, bowel rest, management of pain and vomiting, and early oral feeding). The patient was discharged after one week of hospitalization. Conclusion: COVID-19 is a possible etiology of acute pancreatitis. Acute pancreatitis should be routinely ruled out in a patient with COVID-19 infection with acute abdominal pain.

Early effects of the COVID-19 outbreak on the African dairy industry: cases of Burkina Faso, Kenya, Madagascar, and Senegal. (Agriculture et syst..mes alimentaires face .. la Covid-19.)

This paper provides an early assessment of the effects of the COVID-19 outbreak and of subsequent response measures on milk production, collection, processing, marketing and consumption in Africa. The researchers focus on the period surrounding the first wave of the outbreak (from February to June 2020), during which the number of cases surged and many steps were taken to curb the epidemic. The paper is based on reports from four countries covered by the Africa-Milk Research Project: Burkina Faso, Kenya, Madagascar and Senegal. Data was collected primarily from nine dairy processors located in those countries. Major conclusions of the study are: (1) Dairy farmers were negatively affected by COVID-19 measures when the health crisis coincided with the peak of the milk production season, and when governments did not take steps to support milk production. (2) Small and informal milk collectors were also affected by traffic restrictions as they could not obtain traffic permits. (3) Milk powder importation remained unaffected during the outbreak. (4) Dairy processors (particularly small ones) faced many challenges restricting their operation. Travel restrictions led to temporary interruptions of milk supply, and because of employee protection and safety measures, processing costs increased. (5) Many small retailers were affected by bans on public transport and reduced their purchases of artisanal dairy products;meanwhile, spoilage of dairy products increased during long curfews coupled with poor storage conditions. Supermarkets were able to increase their market share during the pandemic thanks to their connections with industrial dairy processors and wholesalers. (6) A majority of consumers decreased their consumption of dairy products due to a decrease of purchasing power. In some cases, an increase in consumption occurred (due to Ramadan month and dry season high temperatures) and consumption shifted towards long-life dairy products. (7) Overall, the consequences of the health crisis affected more small and informal dairy supply chains than the larger ones, which are more formal, better organised and finally more resilient to face this kind of global crisis.