Factors Contributing to Non-Compliance with the Standard Antenatal Visits among Women in Nyaruguru District; Southern Province; Rwanda

Background: Non-compliance with at least four standard antenatal care (ANC) visits is a critical public health problem. In Rwanda; the proportion of pregnant women who follow the four ANC remains relatively low (43.9%) although it has relatively increased.Objectives: To assess the level of knowledge of selected pregnant women on the importance of using the ANC service; to determine the proportion of pregnant women attending the four ANC and to identify factors limiting the women to the four standards ANC compliance.Design: A descriptive; cross-sectional; quantitative study.Setting: Nyaruguru District.Subject: All women on term and those with child aged one year. They were randomly selected from each village until the sample size of the study (n = 367) was attained.Results: About 13.4% of pregnant women made at least four ANC visits. The low ANC attendance was significantly associated with the long walking distance from home to the health centre (p=0.05); insufficient knowledge on the importance of the use of the ANC service (p=0.01). Conclusion: There is a need to strengthen education and awareness on the importance of ANC in that community in order to reduce maternal and infant mortality in Nyaruguru District

[HIV risk practices and access to prevention in a men's prison in Burkina Faso]. / Pratiques à risque et accès à la prévention du VIH dans une prison pour hommes au Burkina Faso.

The aim of this survey was to assess the HIV risk practices of male prisoners and their access to prevention. This descriptive study took place at the House of Detention and Corrections in Ouagadougou from June through August 2012. In all, 165 prisoners (median age: 28 years, range: 18-65) were interviewed. A low proportion of the prisoners (16%) had accurate knowledge of the modes of HIV transmission. Before imprisonment, their sex lives featured multiple partners, occasional sex, and low condom use. Seven (4%) prisoners reported homosexual relations while in prison. The conditions of incarceration and the denial of homosexual practices at Ouagadougou aggravate prisoners' vulnerability to HIV/AIDS.

[Community organizations and fighting STDs, HIV and AIDS in Montreal: lessons for sub-Saharan Africa]. / Les organismes communautaires et la lutte contre les IST/VIH/sida à Montréal : quelles leçons pour les pays africains au sud du Sahara ?

UNLABELLED: The HIV/AIDS pandemic is one of the most important public health problems in the world. In Benin as elsewhere in Africa, the combination of some sociological and sociocultural factors with socio-economic realities have led this pandemic to progress faster in some farming regions than in urban areas. This survey was performed during a three-month internship researching community-based organizations in Montreal that care for HIV/AIDS patients. OBJECTIVES: to analyse the actions taken by community-based organisations to combat this pandemic and point out the strengths and weaknesses of this system; - to draw useful lessons to apply in Africa. METHOD: more than one hundred organisations play a direct or indirect role in the combat against HIV/AIDS in the city ofMontreal. The choice of organisations to visit was determined by their interest for HIV/AIDS prevention and treatment or for the struggle against social exclusion. After a visit and guided tour of the premises of each organisation, one of its officials was interviewed for 20 to 30 minutes (according to a semi-structured outline, appendix 2. The data were analysed manually. RESULTS: the survey showed that even in high-income countries, the same risk behaviors, equally influenced by poverty, social exclusion andvulnerability, lead to this disease. Further, its chronic nature, related to essentially permanent antiretroviral treatments makes it harder for vulnerable groups to maintain healthy behaviours. The concentration of disease in vulnerable groups gives a false sense of security to most of the population, which does not feel concerned, ignores messages intended to raise awareness, and does not participate in voluntary screening. The organisations and actors involved, with the support of public health facilities, battle this vulnerability while providing information and resources to the target groups to help them protect themselves better. This struggle thus remains too focused on these target groups. Efforts must be made to make the discourse on AIDS legible to broader populations, for the borderlines between these target groups and the rest of the population is very fuzzy. Discussion and lessons: This analysis of the process of fighting HIV/AIDS inMontreal identified some positive experiences that can inspire concrete actions in African setting. One is the experience of the Farha Foundation, an organisation specialized in community fund-raising, which puts its collections at the disposal of other community organisations, and is independent, receiving no funding from local, provincial or federal public authorities. Transposition of this experience to Africa would require contextualisation and would need to mobilize the resources of not only the local community but also the national and international communities. The "Ruban en route" organization provides useful awareness programs for the young, visiting primary and secondary schools to debate HIV/AIDS issues with students with games, and demonstrating condom use. In the African context, given the limited educational system and the extent of school quitting, such an organisation would need to find a means to reach young apprentices and young farmers in informal structures. Action Séro Zero and Stella target male homosexuals and sex workers, respectively, and work to have their rights recognized by the community. The application of their policies would not be possible in our societies, for sociocultural reasons. Instead efforts must be directed toward making the community understand the need to encourage and tolerate recognition and aid for prostitutes, for the good of all. To a lesser degree, the experience of "Spectre de rue" with the TAPAJ project (Travail Alternatif Payé A la Journée or alternative work paid daily) is also importable, although only in urban environments where "street kids" are an important phenomenon. In some cities, where their number is increasing, this activity can be connected to an organisation working on awareness campaigns among the young. Contact with these street children should help them to become more socialized and to find the means to earn their living more legally. Finally, the usefulness of providing anti-retroviral treatment to people living with HIV is the most important lesson we learned during our Montreal stay. This very useful experience will nonetheless be very difficult to undertake in a rural African environment. Indeed, making antiretroviral cocktails available to patients might risk consuming the quasi-totality of the budget available for prevention. Work on this aspect is possible only if the local, national and international community mobilizes to provide the resources necessary. The international community is, however, starting to do so, by means of the Global Fund, to fight malaria, HIV/AIDS and tuberculosis. This survey has thus allowed us to learn some useful means of combatting AIDS in Africa.

[Neuronal death: potential role of the nuclear enzyme, poly (ADP-ribose) polymerase]. / Mort neuronale: rôle potentiel d'une enzyme nucléaire, la poly(ADP-ribose) polymérase.

Poly(ADP-ribose) polymerase (PARP, EC 2.4.2.30) is known as a nuclear enzyme that is activated by DNA strand breaks to participate in DNA repair. It is also called poly(ADP-ribose) synthase (PARS) or poly(ADP-ribose) transferase (PADRT). In physiological conditions, PARP plays an important role in maintaining genomic stability. However, for several pathological situations, which include massive DNA injury (brain ischemia for example), excessive activation of PARP can deplete stores of nicotinamide adenine dinucleotide (NAD+), the PARP substrate, which, with the subsequent ATP depletion, leads to cell death. PARP activation appears to play a major role in neuronal death induced by cerebral ischemia, traumatic brain injury, Parkinson disease and other pathologies. PARP inhibitors (3-aminobenzamide and other compounds) and PARP gene deletion induced dramatic neuroprotection in experimental animals (rats, mice). Accordingly, these data suggest that PARP inhibitors could provide a novel therapeutic approach in a wide range of neurodegenerative disorders including cerebral ischemia and traumatic brain injury.

Protective effect of melatonin in a model of traumatic brain injury in mice.

The pineal hormone melatonin has recently been shown to exert neuroprotective activity in a variety of experimental neuropathologies in which free radicals are involved. This neuroprotective effect has been attributed to the antioxidant properties of melatonin. Considering that free radicals also play a deleterious role in traumatic brain injury (TBI), the purpose of the present study was to determine whether melatonin would have a beneficial effect in this pathology. Head injury was induced in mice and the neurological deficit was evaluated at 24 hr by a grip test. In this model, the free radical scavenger, alpha-phenyl-tert-butyl-nitrone (2 x 100 mg/kg, i.p.) given 5 min and repeated at 4 hr after TBI was neuroprotective. Melatonin (1.25 mg/kg, i.p.) given 5 min and repeated at 1, 2, and 3 hr after head trauma also significantly reduced the neurological deficit. This beneficial effect was not due to melatonin-induced hypothermia since repeated treatment with melatonin did not modify the colonic temperature of mice. This study shows that melatonin exerts a beneficial effect on the neurological deficit induced by traumatic brain injury in mice. The mechanisms of this neuroprotection remains to be established, and more particularly, the contribution of the antioxidant activity of melatonin.

Reduction of tyrosine nitration after N(omega)-nitro-L-arginine-methylester treatment of mice with traumatic brain injury.

Oxygen free radicals and nitric oxide (NO) have been proposed to be involved in the cascade of injury elicited by traumatic brain injury. However, the mechanism(s) of injury remain to be explored. Since superoxide generation is triggered by traumatic brain injury, the cytotoxic peroxynitrite could be formed, but it is not known if this actually occurs. Dot blot and immunohistochemistry studies were performed to quantify tyrosine nitration and identify cell types in which such reactions occur in the brain of mice submitted to traumatic brain injury. Nitrotyrosine formation increased from 4 to 24 h after traumatic brain injury and was primarily observed in degenerating neurons, in areas corresponding to the sites of direct impact (frontal cortex) and diffuse impact (frontoparietal cortex and ventromedial hypothalamic nucleus). Furthermore, N omega-nitro-L-arginine-methylester (L-NAME), a NO-synthase inhibitor which has previously been shown to promote neurological recovery in traumatic brain injury, reduced nitrotyrosine formation and the number of nitrotyrosine-positive neurons. These results indicate that traumatic brain injury induces peroxynitrite formation which may contribute to cell damage.

Reduction of the neurological deficit in mice with traumatic brain injury by nitric oxide synthase inhibitors.

This study investigates the effect of the NO synthase inhibitors, NG-nitro-L-arginine methyl ester (L-NAME) and 7-nitroindazole (7-NI), on the neurological deficit 24 h after a moderate closed head injury in mice. Low doses of L-NAME or 7-NI given soon after the injury significantly reduced the neurological deficit compared to the vehicle-treated group. L-Arginine (300 mg/kg) did not alter the neurological deficit, but reversed the protective effects of both L-NAME and 7-NI when given at the same time. Both L-NAME and 7-NI had dose-related effects. The neuroprotective effects of L-NAME and 7-NI occurred when the drugs were given 5, 30, or 60 min after brain injury, but not when treatment was begun 2 h after brain injury, suggesting a short therapeutic window for both drugs. These results suggest that NO synthesis by neuronal NO synthase plays an important role in the early neurotoxic cascade leading to neurological deficit following traumatic brain injury.

Reduction of the neurological deficit in mice with traumatic brain injury by nitric oxide synthase inhibitors.

This study investigates the effect of the NO synthase inhibitors, NG-nitro L-arginine methyl ester (L-NAME) and 7-nitro indazole (7-NI), on the neurological deficit 24 h after a moderate closed head injury in mice. Low doses of L-NAME or 7-NI given soon after the injury significantly reduced the neurological deficit compared to the vehicle-treated group. L-Arginine (300 mg/kg) did not alter the neurological deficit, but reversed the protective effects of both L-NAME and 7-NI when given at the same time. Both L-NAME and 7-NI had dose-related effects. The neuroprotective effects of L-NAME and 7-NI occurred when the drugs were given 5, 30, or 60 min after brain injury, but not when treatment was begun 2 h after brain injury, suggesting a short therapeutic window for both drugs. These results suggest that NO synthesis by neuronal NO synthase plays an important role in the early neurotoxic cascade leading to neurological deficit following traumatic brain injury.