Quality of Long-acting Reversible Contraception Provision in Lomé, Togo.

CONTEXT: Provision of high-quality contraceptive counseling and services is essential to ensure family planning (FP) programs are rights-based and voluntary. Togo's modern contraceptive use has steadily increased with almost a quarter of the method mix attributed to long-acting reversible contraceptives (LARC). The purpose of this study is to assess the quality of LARC provision in Togo. METHODS: Data for this study were collected in 2016 as part of a larger research study conducted in Lomé, Togo to assess the effectiveness of the ongoing FP service delivery model. Quality of FP service was assessed in terms of program capacity and program performance. Program capacity was measured with five individual variables and program performance was measured with the Method Information Index (MII). Descriptive statistics and mixed effects models were used to assess likelihood of LARC uptake. RESULTS: Of the 669 clients included in the study, 19.4% received a LARC method. Multivariable results show that LARC uptake is significantly associated with supervisory visit at the facility in the last three months (program capacity indicator) (OR 1.44; 95%CI 1.48-2.39) and is twice as likely for those with a positive MII score, even after controlling for provider and client characteristics (OR 2.1; 95%CI 1.61-2.51). CONCLUSION: This study identified supervisory visits and comprehensive contraceptive counseling as the key quality factors positively associated with uptake of LARC. Continued focus on quality of care and provider-client information exchange is necessary to ensure women's FP needs are met.

Epidemiological and clinical profile of intestinal parasitosis of children in rural areas in Central African Republic.

OBJECTIVE: To describe the epidemiological and clinical profile of intestinal parasites in children in rural Central African Republic. PATIENTS AND METHODS: We conducted a multicenter cross-sectional study in Central African Republic rural areas. Children seen as outpatients regardless of the reason for consultation were included in the study after parental consent. Each stool sample sent to the laboratory in a plastic pot was subjected to a direct co-examination with physiological water. RESULTS: A total of 102 children were included in the study, of whom 53 were boys (51.96%), the median age was 4 years (3 months; 15 years old). They had a primary level of education in 31.37% of cases, 76.47% came from Health Region 1. Drilling was the source of drinking water in 61.76% of cases and the backwater was used for bathing by 26.47% of children. Abdominal pain was observed in 55 children (53.92%). The prevalence of intestinal parasitosis was 88.23%. Of 122 identified parasites, 96 were helminths (78.69%) and 26 were protozoa (21.31%). Of the three protozoan species isolated, Entamoeba histolytica was found in 15 cases (14.70%). The most common helminthiasis was Ascaris lumbricoides (40.19%). The frequency of parasitic infection was 92% in children aged from 5 to 9 years. Mono-parasitism was observed in 52.94% versus 33.33% for poly-parasitism. CONCLUSION: Intestinal parasitosis is a public health problem in Central African Republic rural areas. Improving access to drinking water for populations could reduce the magnitude of these diseases.

Epidémie de rougeole en période post-conflit dans une zone rurale centrafricaine

Introduction : La rougeole est une maladie infectieuse très contagieuse. Les situations de conflit telles que le cas de la République centrafricaine (RCA), peuvent favoriser la survenue des épidémies. L'objectif de ce travail était de décrire l'épidémie de rougeole survenue dans la préfecture sanitaire de Sangha-Mbaéré en termes de temps, lieu et personnes. Patients et méthodes : Il s'agissait d'une étude rétrospective réalisée lors de l'investigation des cas de rougeole survenus à Nola, dans le sud-ouest de la RCA qui a couvert la période du 30 décembre 2015 au 20 avril 2016. La population cible était constituée d'enfants de moins de 15 ans. Nous avons inclus dans l'étude, après consentement éclairé des parents, tout enfant chez qui un agent de santé a suspecté la rougeole avec une fièvre supérieure ou égale à 38°C, une éruption maculo-papulaire généralisée (non vésiculaire) et un des signes suivants : toux, rhinorrhée ou conjonctivite. Les caractéristiques sociodémographiques et cliniques ont été recueillies à l'aide d'un questionnaire anonyme. La saisie et l'analyse des données ont été faites au logiciel Epi Info 7. Résultats : Au total, 31 malades ont été inclus dont 58% de sexe féminin soit un sex-ratio (F/H) de 1,38. L'âge moyen était de 1,9 ± 1,2 ans. Les enfants âgés entre 1 et 4 ans représentaient 74,19% des cas. Tous les enfants (100%) n'étaient pas vaccinés contre la rougeole. Ils provenaient de la commune de Salo dans 51,61% des cas et de Nola dans 48,39%. Le taux d'attaque était de 0,82‰. Dans la commune de Salo, le taux d'attaque était de 2,97‰ (16/5392) et de 0,46‰ (15/32401) à Nola. Le taux de létalité était de 9,68% (3/31). Ce taux était de 33,33% (1/3) avant l'âge d'un an, de 8,70% chez les enfants de 1 à 5 ans. Conclusion : L'épidémie de rougeole survenue à Nola serait liée à une faible couverture vaccinale. Le renforcement de la vaccination et de la surveillance épidémiologique pourrait contribuer au contrôle et à une prévention efficace de la rougeole ainsi que d'autres maladies à potentiel épidémique

Relative performance of indoor vector control interventions in the Ifakara and the West African experimental huts.

BACKGROUND: West African and Ifakara experimental huts are used to evaluate indoor mosquito control interventions, including spatial repellents and insecticides. The two hut types differ in size and design, so a side-by-side comparison was performed to investigate the performance of indoor interventions in the two hut designs using standard entomological outcomes: relative indoor mosquito density (deterrence), exophily (induced exit), blood-feeding and mortality of mosquitoes. METHODS: Metofluthrin mosquito coils (0.00625% and 0.0097%) and Olyset® Net vs control nets (untreated, deliberately holed net) were evaluated against pyrethroid-resistant Culex quinquefasciatus in Benin. Four experimental huts were used: two West African hut designs and two Ifakara hut designs. Treatments were rotated among the huts every four nights until each treatment was tested in each hut 52 times. Volunteers rotated between huts nightly. RESULTS: The Ifakara huts caught a median of 37 Culex quinquefasciatus/ night, while the West African huts captured a median of 8/ night (rate ratio 3.37, 95% CI: 2.30-4.94, P < 0.0001) and this difference in mosquito entry was similar for Olyset® Net and more pronounced for spatial repellents. Exophily was greater in the Ifakara huts with > 4-fold higher mosquito exit relative to the West African huts (odds ratio 4.18, 95% CI: 3.18-5.51, P < 0.0001), regardless of treatment. While blood-feeding rates were significantly higher in the West African huts, mortality appeared significantly lower for all treatments. CONCLUSIONS: The Ifakara hut captured more Cx. quinquefasciatus that could more easily exit into windows and eave traps after failing to blood-feed, compared to the West African hut. The higher mortality rates recorded in the Ifakara huts could be attributable to the greater proportions of Culex mosquitoes exiting and probably dying from starvation, relative to the situation in the West African huts.

Intégration de la colposcopie comme méthode de dépistage des lésions précancéreuses et cancéreuses dans le paquet minimum d'activités dans une maternité niveau 3 sur une série de 569 cas. Exemple du CHU de Yopougon - Abidjan

Contexte : Les techniques de dépistage des lésions précancéreuses les plus efficaces et rentables dans les pays africains comprennent les inspections visuelles à l'aide de tests d'acide acétique et lugol tels que recommandés par l'OMS car peu coûteuses, indolores, simples à réaliser, reproductibles, socialement et culturellement acceptables, sans effets secondaires avec des résultats immédiats.Objectifs : Déterminer le taux de participation des femmes et ses déterminants, la prévalence des lésions précancéreuses et leur prise en charge. Patientes et méthodes : De janvier 2011 à décembre 2013, 569 femmes volontaires âgées de 18 à 65 ans, ayant eu une activité sexuelle ou non, porteuse ou non d'une grossesse de moins de 15 semaines d'aménorrhée, après un passage en consultation ou aux urgences pendant lesquelles, un dépistage par la méthode visuelle a été proposé ont été incluses. La colposcopie a eu lieu au service de Gynécologie-Obstétrique du Centre Hospitalier Universitaire de Yopougon Abidjan. Les prélèvements biopsiques étaient acheminés au laboratoire d'anatomie pathologie du Centre Hospitalier Universitaire de Treichville Abidjan. Les données ont été recueillies et analysées en utilisant le logiciel Epi info version 3.4.5.Résultats : Le taux de participation des femmes était en général de 6,03%. L'âge moyen de la population était de 40,3 ans IC1-α [36,2-44,4]. La moitié de la population (52,4%) n'avait pas de revenus fixes, et 36,9% d'entre elles étaient non-instruites. 74,2% des femmes habitaient la commune et étaient situées dans un rayon de 10 km. 20,2% des patientes étaient ménopausées. Les lésions acidophiles et iodo-négatives étaient respectivement de 8 et 10%. La prévalence des lésions précancéreuses et cancéreuses à la colposcopie était de 9,3% des cas. Les néoplasies intra épithéliales (CIN) CIN 1 représentaient près de la moitié des cas prélevés (44,8%) quand les CIN 2 et + totalisaient 20,7%. Soixante-huit virgule neuf pour cent (68,9%) des transformations atypiques (TAG) avaient des néoplasies intra-épithéliales de tout grade confirmées histologiquement. L'hystérectomie simple et l'électro-conisation ont été effectué respectivement chez 5,7 et 11,3% des femmes toutes CIN 2 et +. La cryothérapie avait été faite chez les femmes jeunes avec une CIN 1 soit 24,5%. Conclusion : Intégrée dans le paquet minimum des activités des centres hospitaliers, la colposcopie pourrait contribuer à la réduction de l'incidence et la mortalité liée au cancer du col de l'utérus dans nos pays

World Health Organization's Innovative Direct Disbursement Mechanism for Payment of Grassroots Immunization Personnel and Operations in Nigeria: 2004-2015.

BACKGROUND: Following the 1988 World Health Assembly resolution to eradicate polio, the government of Nigeria, with support from partners, has been implementing several rounds of supplementary immunization activities (SIAs) each year. In addition to the technical requirements, the success of the polio eradication initiative depends on timely provision of adequate financial resources. Disbursement of funds for SIAs and payment of allowances to numerous vaccination personnel at the grassroots level are enormous operational challenges in a country the size of Nigeria. Upon donors' request for a transparent and effective payment mechanism, the World Health Organization (WHO), in consultation with national counterparts, created the innovative direct disbursement mechanism (DDM) in 2004. The objective of the DDM was to timely deploy operational funds at the field level and directly pay vaccination personnel allowances at the grassroots level. METHODS: A detailed operational guideline for funds disbursement was developed in close consultation with central and field stakeholders. Multiyear financial resource requirements and operational budgets for every campaign were produced by an interagency-coordinated finance subcommittee. The WHO engaged a bank and an accounting firm as DDM partners to support disbursement of and accounting for the SIA funds, respectively. The 37 WHO field offices were equipped with electronic financial systems to support the DDM process, and temporary payment sites were set up to facilitate payment to vaccination personnel at the grassroots level. Coordination meetings among DDM partners were held regularly to reconcile financial records and address operational challenges. RESULTS: Between 2004 and 2014, DDM supported 99 polio and nonpolio vaccination campaigns, disbursing more than $370 million to about 16 million beneficiaries across 280 temporary payment sites. To mitigate security risks and reduce operational costs, the WHO and DDM partners introduced mobile payment to vaccination personnel in May 2015 in compliance with national regulations. A total of 97% of the targeted 1871 beneficiaries in 2 pilot sites were successfully paid through mobile payment, although some challenges remain to be addressed. DISCUSSION: The DDM has met its objectives with a high rate of financial accountability and transparency, despite persistent operational and security challenges. With support from Nigeria, the Pakistan polio vaccination program successfully adopted the DDM. The DDM continues to play an important role in effective implementation of the polio endgame strategy and the national immunization strategic plan. As part of polio legacy planning, we recommend the DDM as a model for other opportunities that involve the engagement of large field-level teams as new vaccines are introduced in Nigeria and elsewhere.

Caractéristiques épidémiologiques cliniques et endoscopiques des œsophagites peptiques en République Centrafricaine : prédominance des lésions modérées chez les patients symptomatiques

Objectif : Décrire les aspects épidémiologiques, cliniques et endoscopiques des œsophagites peptiques en République Centrafricaine.Patients et méthodes : Cette étude prospective descriptive, menée pendant 18 mois dans le service d'hépato-gastroentérologie et de médecine interne de l'Hôpital Universitaire de l'Amitié de Bangui, a concerné 1376 patients ayant eu une Endoscopie Oeso-Gastro-Duodénale (EOGD) pour une symptomatologie digestive haute. La classification de Savary-Miller a été utilisée pour décrire les œsophagites peptiques.Résultats : Une œsophagite peptique a été observée chez 410 patients (29,8%) (sex-ratio Femme/Homme = 1,4). L'âge moyen des patients était de 40,3 ans (extrêmes : 16 et 86 ans). Des épigastralgies, un pyrosis et des régurgitations acides étaient signalés par les patients dans respectivement 57,3%, 53,9% et 48,3% des cas. Parmi les facteurs de risque connus d'œsophagite, la consommation d'alcool a été déclarée par 266 patients (65%), de tabac par 58 (14,1%) et la prise d'anti-inflammatoires non-stéroïdiens par 126 (30,7%). Un surpoids a été noté chez 78 patients (19%), et une obésité chez 57 (14%) tandis que 89 étaient considérés comme maigres (21,7%). Les œsophagites peptiques étaient en général modérées : stade I (n = 123, 30%), stade II (n = 256, 62,4%), stade III (n = 31, 7,6%), stade IV (n = 0). Les principales lésions associées étaient une hernie hiatale (n = 148, 36%), une gastrite congestive (n = 45, 11%) et des érosions gastroduodénales liées à la prise d'anti-inflammatoires non-stéroïdiens (n = 50, 12,2%). Conclusion : Une œsophagite peptique était mise en évidence chez près d'un tiers des patients symptomatiques ayant eu une EOGD, le plus souvent modérée. Il n'a pas été observé de sténose peptique, ni d'endo-brachyœsophage. Parmi les facteurs de risque, une surcharge pondérale, la prise d'AINS et une hernie hiatale étaient notées chacun dans environ un tiers des cas

[Influence of care pathways on the time of initiation of TB treatment]. / Influence du parcours de soins sur le délai d'initiation du traitement antituberculeux.

INTRODUCTION: Untreated positive pulmonary TB smear has both individual implications, increasing morbidity and mortality, and collective implications, increasing the contagiousness of the disease. The present study aims to identify the course of patient care and the influence of care pathway on the time of initiation of TB treatment in Abidjan. METHODS: We conducted a prospective and comparative study between two groups with pulmonary smear-positive: 38 with a conventional course (use of only the health facilities) and 198 with mixed driving (combining health facilities, self-medication and traditional medicine). RESULTS: The average time between onset of symptoms and initiation of treatment for patients with conventional path was significantly different from that observed in patients with mixed course (4.28 weeks versus 8.57 weeks, P < 0.001). Multivariate analysis mixed route was related to level of education (OR=2.728 [1.165-6.386]; P=0.02), the district of residence (OR=2.690 [1.168-6.195]; P=0.02), the mode of onset of symptoms (OR=0.33 [0.101-0.6607]; P=0.013) and weight loss (OR=0.259 [0.139-0.798]; P=0.004). CONCLUSIONS: The course of patients are multiple and can induce delays in starting treatment for tuberculosis. The sensitization of the population and the involvement of traditional healers in TB screening may contribute to the early therapeutic management.

Les abcès amibiens du foie dans le service de gastroentérologie à l'hôpital de l'Amitié de Bangui : aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs

Objectif : Décrire les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs desabcès amibiens du foie.Patients et Méthodes : ll s'agissait d'une étude rétrospective des patients hospitalisés du 1er Janvier 2001 au 31 Décembre 2010, pour abcès amibien du foie, dans le service de Gastroentérologie et de Médecine Interne à l'Hôpital de l'Amitié de Bangui.Résultats : 47 cas d'abcès amibiens du foie avaient été colligés, composés de 35 hommes et 12femmes. L'âge moyen était de 31 ans (extrêmes 21 et 65 ans). 34 patients (72,3%) avaient unniveau socioéconomique bas. 45 cas (95,8%) avaient une hépatomégalie douloureuse et une fièvrefaisant évoquer la classique triade de Fontan. L'hémogramme avait mis en évidence une leucocytosesupérieure à 10000/mm3 dans 19 cas (52%). La sérologie amibienne était positive chez la quasi totalité des patients (45 soit 95,7%). L'échographie abdominale avait montrée des abcès unifocauxdans 21 cas (44,6%) et multifocaux dans 6cas (12,7%) dont la dimension variait de 20 mm à 130mm.Le traitement était médical dans 44 cas (93,62%) et médico-chirurgical : 3 cas (6,38%).Tous lespatients avaient eu le métronidazole et de la Ciprofloxacine ou de l'amoxicilline plus l'acideclavulanique). La guérison a été effective chez 43 malades (89,3% des cas). Les critères en sont la normalisation de la température dans les 72 heures suivant le début du traitement, l'amendement sensible des douleurs dans le même délai, la disparition des signes digestifs

African Programme For Onchocerciasis Control 1995-2015: model-estimated health impact and cost.

BACKGROUND: Onchocerciasis causes a considerable disease burden in Africa, mainly through skin and eye disease. Since 1995, the African Programme for Onchocerciasis Control (APOC) has coordinated annual mass treatment with ivermectin in 16 countries. In this study, we estimate the health impact of APOC and the associated costs from a program perspective up to 2010 and provide expected trends up to 2015. METHODS AND FINDINGS: With data on pre-control prevalence of infection and population coverage of mass treatment, we simulated trends in infection, blindness, visual impairment, and severe itch using the micro-simulation model ONCHOSIM, and estimated disability-adjusted life years (DALYs) lost due to onchocerciasis. We assessed financial costs for APOC, beneficiary governments, and non-governmental development organizations, excluding cost of donated drugs. We estimated that between 1995 and 2010, mass treatment with ivermectin averted 8.2 million DALYs due to onchocerciasis in APOC areas, at a nominal cost of about US$257 million. We expect that APOC will avert another 9.2 million DALYs between 2011 and 2015, at a nominal cost of US$221 million. CONCLUSIONS: Our simulations suggest that APOC has had a remarkable impact on population health in Africa between 1995 and 2010. This health impact is predicted to double during the subsequent five years of the program, through to 2015. APOC is a highly cost-effective public health program. Given the anticipated elimination of onchocerciasis from some APOC areas, we expect even more health gains and a more favorable cost-effectiveness of mass treatment with ivermectin in the near future.

Prevalence of cardiac dyssynchrony and correlation with atrio-ventricular block and QRS width in dilated cardiomyopathy: an echocardiographic study.

INTRODUCTION: Cardiac dyssynchrony causes disorganised cardiac contraction, delayed wall contraction and reduced pumping efficiency. We aimed to assess the prevalence of different types of dyssynchrony in patients with dilated cardiomyopathy (DCM), and to establish the correlation between atrio-ventricular block and atrio-ventricular dyssynchrony (AVD), and between impaired intra-ventricular conduction and the existence of inter-ventricular dyssynchrony (inter-VD) and intra-left ventricular dyssynchrony (intra-LVD). METHODS: We included 40 patients in New York Heart Association stage III or IV, admitted consecutively with DCM with severe left ventricular dysfunction (left ventricular end-diastolic diameter ≥ 60 mm and/or ≥ 30 mm/m(2)) and left ventricular ejection fraction < 35%. Electrocardiographic and echocardiographic data were evaluated in all patients. Patients were divided into two groups: group 1: eight patients, with a QRS duration ≥ 120 ms, and all presented with left bundle branch block; group 2: 32 patients with a narrow QRS < 120 ms. RESULTS: Overall, the mean age was 54.7 ± 16.8 years and patients in group 1 were older (67.2 ± 13.6 vs 51.5 ± 15.8 years, p = 0.01). The prevalence of atrio-ventricular dyssynchrony (AVD), inter-VD and intra-LVD was respectively 40, 47.5 and 70%. Two patients (5%) did not exhibit dyssynchrony. AVD was present with a similar frequency in the two groups (37.5% in group 1 vs 40.6% in group 2, p = 0.8). There was no correlation of the magnitude of AVD with the duration of the PR interval (from the beginning of the P wave to the beginning of the QRS complex) (r(2) = 0.02, p = 0.37) or the QRS width (r(2) = 0.01, p = 0.38). A greater proportion of patients with inter-VD was observed in group 1 (87.5 vs 60%, p = 0.03). There was a trend towards a more important inter-ventricular mechanical delay according to QRS width (r(2) = 0.009, p = 0.06). The proportion of intra-LVD was similar in all groups, with a high prevalence (87.5% in group 1 and 65.6% in group 2, p = 0.39). CONCLUSION: The assessment of cardiac dyssynchrony is possible in our country. Intra-ventricular mechanical dyssynchrony had a high prevalence in patients with DCM, irrespective of the QRS width. These data emphasise the usefulness of echocardiography in the screening of patients.

[Dynamic of respiratory pathology in a service of pneumology in black Africa in the context of HIV infection from 1998 to 2007]. / Dynamique de la pathologie respiratoire dans un service de pneumologie en Afrique noire dans le contexte de l'infection à VIH de 1998 à 2007.

INTRODUCTION: The pneumology in developing countries is practiced in a singular context: population mostly younger, endemic tuberculosis, high prevalence of HIV infection and growing pollution. OBJECTIVE: The aim of this study is to present respiratory pathology evolution in hospitalization of pneumology department in black Africa. METHODOLOGY: Our study is retrospective and descriptive. We consulted the register of hospitalization activities from January 1998 to December 2007. RESULTS: The age group of 20-49 years represents 78.36% of all patients. Tuberculosis (TB) remains the first affection from 1998 to 2007 with a frequency varying between 38.2% and 45.2%. The cases of pneumonia are in regression since 2001, but cases of febrile alveolar interstitial pneumonia (FAIP) increase. The pathologies bound to tobacco addiction are rare. HIV infection is associated to TB (82.86%), to pneumonia (77.22%), to FAIP (92.23%). On 832 cases of death recorded, 46.15% of deaths are assigned to TB, 15.98% to pneumonia and 14.66% to FAIP. The global lethality of the TB and the pneumonia is respectively 20.1% and 17.6%. The one of FAIP is 32.5%. Mortality attributable to TB and pneumonia decreases progressively but the one attributable to FAIP remains important. CONCLUSION: Respiratory pathology is dominated by TB, pneumonia and FAIP. These pathologies associated to HIV infection cause a strong mortality.

[Predictive factors of lost to follow-up status during tuberculosis treatment]. / Facteurs prédictifs du statut « perdus de vue ¼ au cours du traitement de la tuberculose.

INTRODUCTION: Patients with contagious tuberculosis who are lost to follow-up risk sowing the disease among their circle of acquaintances. Moreover, a history of inadequate anti-tuberculous treatment is an important risk factor for the development of drug-resistant organisms. The purpose of this study was to identify risk factors for loss to follow-up among patients undergoing treatment for tuberculosis. METHODOLOGY: We performed a prospective cohort study among patients with contagious tuberculosis, beginning with anti-tuberculous treatment followed during six months, after initial education-information about their condition. We compared the characteristics of 152 patients lost to follow-up from tuberculosis treatment against those of 492 patients who were not lost to follow-up. RESULTS: Independent factors associated with a reduction in the risk of being lost to follow-up were: the presence of night-sweats (OR=0.46 [0.24-0.88]; P=0.018), the presence of thoracic pain (OR=0.27 [0.14-0.54]; P<0.001), screening for HIV (OR=0.41 [0.17-0.98]; P=0.045), fact to inform a person of its disease (OR=0.06 [0.01-0.41]; P=0.004), the application of directly observed treatment in the community (OR=0.34 [0.17-0.66]; P<0.001). CONCLUSION: Reducing loss to follow-up during treatment for tuberculosis requires the development of a "good attitude" through education-information about tuberculosis.

Strategies to reduce maternal mortality in Central African Republic

Le Problème  Mortalité maternelle est un grave problème de santé publique en RCA avec un taux de 1355 décès pour 100.000 naissances vivantes.  Quatre principales difficultés sont à la base de ce problème : o Difficultés liées à l'accès aux soins o Difficultés liées à l'insuffisance et à la répartition inégale du personnel de santé o Difficultés liées à la prise en charge des urgences obstétricales et au système de référence o Difficultés liées à l'utilisation des services de santé  La réduction de la mortalité maternelle peut utiliser un certain nombre de stratégies efficaces et réalisables en Centrafrique. Cependant, le manque d'un guide clair et explicite limite la mise en oeuvre et la coordination de ces stratégies. Les Options Politiques Trois options politiques complémentaires ont été définies dans l'objectif de réduire la mortalité maternelle en Centrafrique:  Renforcement des capacités nationales en matière de la santé de la reproduction : o Renforcement des ressources humaines dans le domaine des soins obstétricaux d'urgence o Relèvement de plateau technique  Renforcement de la prise en charge des urgences obstétricales : o Prévention des grossesses non désirées o Prise en charge des urgences obstétricales o Sécurisation des produits de la santé de la reproduction o Audit des décès maternels  Mobilisation des différentes ressources en faveur de la lutte contre la mortalité maternelle : o Développement des systèmes de financement alternatif aux soins o Amélioration du niveau des connaissances des communautés sur les urgences obstétricales et les avortements à risque o Promotion de l'alphabétisation fonctionnelle des femmes o Amélioration des connaissances des décideurs sur les urgences obstétricales et les avortements à risque Stratégies de mise en oeuvre La combinaison des stratégies de mise en oeuvre est effective pour les trois (3) options choisies pour la réduction de la mortalité maternelle dont :  Le renforcement des ressources humaines par des formations de courte durée destinées aux agents itinérants ainsi qu'aux matrones.  Le développement des mesures incitatives pour amener les cadres à travailler dans les provinces  L'incitation du gouvernement à augmenter le nombre des formations sanitaires  La sensibilisation de la communauté pour la mise en place des mutuelles d'assurance  L'intensification d'un partenariat technique et financier avec les partenaires au développement

[Cervical dysplasia in women with human immunodeficiency virus (HIV) in areas of high prevalence of infection]. / Dysplasies cervicales chez les femmes séropositives pour le VIH en zone de forte prévalence de l'infection.

OBJECTIVES: To determine the prevalence of cervical squamous intraepithelial lesions among HIV-positive women, compared to that of HIV-negative women and identify the different types of lesions in both groups. PATIENTS AND METHODS: Cross-sectional study conducted in 16 months in two facilities and the service of pathological anatomy of Bangui. The sample consisted of 250 HIV-positive women matched to 250 HIV-negative women. The parameters studied were the HIV status, the result of cervical smear screening, the rates of CD4 and the data of the interview. RESULTS: The smears were inflammatory in 54.4% of HIV-negative and 46.4% of HIV-positive. Epidermoid intraepithelial lesions of the cervix were more frequent among HIV-positive women than among HIV-negative women with respectively 34.8% and 16.4% (P<0.0001). The low-grade lesions were more common regardless of HIV status of patients. The median age of onset of the LEI was lower among HIV-positive whatever the grade of the lesion. Koïlocytosis was found in 27.2% of HIV-positive women against 9.2% among HIV-negative (P<0.001). DISCUSSION AND CONCLUSION: The prevention of infection by HIV and HPV and the monitoring of precancerous lesions would allow to prevent their evolution towards invasive cancer.

Swift sympatric adaptation of a species of cattle tick to a new deer host in New Caledonia.

The occurrence and frequency of sympatric speciation in natural systems continue to be hotly debated issues in evolutionary biology. This might reflect the timescale over which evolution occurs resulting in there being few compelling observations of the phenomenon (lake fishes, phytophagous insects and Island trees). Despite predictions, few examples of sympatric speciation have been recorded in animal parasites, at least widely accepted as such. Here we show that, in New Caledonia, the monophasic (exploiting one individual host per generation) cattle tick Rhipicephalus microplus has evolved in contact with two sympatric host species into two differentiated genetic pools: on the cattle, its original host and on rusa deer, a new host for this tick. This sympatric isolation has occurred over a relative short period of time (i.e. less than 244 tick generations) as a consequence of differential selection pressure imposed by hosts. It is most likely that this phenomenon has occurred in many other places across the globe where this tick has come in contact with different host species in sympatry with cattle.

[Etiopathological factors of hepatocellular carcinoma in Bangui, Central African Republic: clinical, biological characteristics and virological aspects of patients]. / Etiopathologie du carcinome hépatocellulaire à Bangui, République centrafricaine : caractéristiques cliniques, biologiques et aspects virologiques des patients.

OBJECTIVES: To describe clinical, biological characteristics and virological aspects of patients with hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Sera obtained from consent patients with clinical suspicion of HCC. Routine biochemical tests and serological markers of hepatitis B virus (HBV), hepatitis D virus (HDV) and hepatitis C virus (HCV) were searched. A hepatic ultrasound scan was realized and, when a suspected mass lesion was observed, ultrasonographic-guided fine needle aspiration of the hepatic mass lesion was made to ascertain the diagnosis of HCC. RESULTS: One hundred and seventy-five sera were collected from 99 men and 76 women. Approximately 96.6% (169/175) of them had previous contact with HBV. HBs surface antigen was positive in 41% (69/169) of whom 53.6% (37/69) were co-infected by the HDV. Three patients (1.71%=3/175) were positive for anti-HCV antibodies. The other three patients (1.71%=3/175) did not present any markers for HBV or HCV. At the time of diagnosis, right upper quadrant pain, hepatomegaly, cachexia, were present in all patients. An increase in serum transaminases (70%), high bilirubin concentrations (40%), high AFP levels (40%) and low prothrombin levels (52%) were the most frequent biological abnormalities. Only 17 guided fine needle aspirations of mass lesions were realized. The diagnosis of HCC was confirmed by cytopathological examination for 14 of them. CONCLUSIONS: HCC is a frequent pathology in the Central African Republic (CAR). According to the ultrasound imaging data, patients consult at terminal stage of the disease. This study confirms also the association between HBV and HCC in CAR. Moreover, in 26.5% of patients HDV is associated with severe forms of the disease.

Etude epidemiologique de 150 cas de neoplasies cervicales depistees par le frottis cervico-vaginal a Bangui

Une etude transversale prospective de 14 mois; portant sur 150 frottis a ete realisee chez des femmes vues en consultation en gynecologie obstetrique a l'hopital communautaire de Bangui. Les prelevements ainsi effectues ont ete colores selon la technique de Harris Schoor et les resultats etaient rendus selon la classification de Bethesda couplee a celle de Richart ou celle de l'OMS. Nous avons enregistre : 71;3 pour cent de lesions de bas grade. 20 pour cent de lesions de haut grade et 8;6 de carcinome invasif. Les lesions condylomateuses virales ont representee 40;7 pour cent. Les facteurs de risque identifies etaient : grossesse multiple rapprochee (p=0;03); antecedents d'infections sexuellement transmissibles (p0;001). Comme cela a deja etait demontre anterieurement l'education sanitaire et le depistage systematique constituent les meilleurs moyens de lutte contre le cancer du col uterin

[Report of a case of ovarian pregnancy observed at the Gynecolgy-Obstetrics Service in Bangui (Central African Republic)]. / A propos d'un cas de grossesse ovarienne observée dans le service de Gynécologie-Obstétrique à Bangui (Centrafrique).

The case report was the first observed in Central African Republic. The patient was a thirty years woman who comes from a small-townish for dead fetus retained. She had not point out abdominal pain or bleeding and had presented a satisfied clinical state. The investigations had confirm a dead abdominal pregnancy. During the laparotomy, it was uncovered a regular mass developed on the right annex. Those annex mass hasn't presented adherences with other abdominal organs. The ablation of the mass and the right annex had been done without difficulty. The holing of operated mass had permit to uncover a macerated dead male fetus weighted 1650 grams. The following of operation was normal The histological analysis had determined the nature of that ovarian pregnancy. Hour attention was be retain by that case who had prolonged development and almost non-existence complications.