Time for Inclusion of Racial and Gender Discrimination in Routine Clinical Assessment.

Recently, there has been an increasing amount of scientific interest towards the broad theme of racial inequalities and their impact on human health, specifically exploring how ethnic discrimination affects the wellness of black people and the COVID-19 pandemic. Some of these conditions of inequity also affect black children. Discrimination and racism should be routinely considered as causative agents or triggers of disease and routinely included in clinical examination, during history collection and evaluation of vital signs. This will benefit child and family health, worldwide. We shared our recent experience by reporting a case of a 13-year-old black girl who came to Italy from Niger about 3 years earlier through the traumatizing migratory journey. She was evaluated in the Pediatric Emergency Department (PED) for sleepiness that had progressively worsened during the last days. We describe the case and how it was handled differently by pediatricians and pediatric trainees with equally different personal and professional backgrounds.We also report the preliminary results of a national survey aimed to assess discrimination and inequalities in Italian Paediatric Residency Schools. Medical ability has been allowing us to respond rapidly to a novel virus in order to save lives. The expertise of doctors and researchers must be used to evaluate this hidden crisis as well, to address racism and injustice and to protect vulnerable people from harm. Our case showed us how it is essential including racial and gender discrimination in a diagnostic process.

Determinants of dietary practices during pregnancy: A longitudinal qualitative study in Niger.

Undernutrition is associated with maternal morbidity and poor pregnancy outcomes. This qualitative study seeks to understand the multilevel factors influencing maternal dietary practices in Niger, including the impact of pregnancy illnesses on diet. Criterion-based, purposive sampling was used to select pregnant women and household members from 24 villages in a rural district of the Maradi Region in south-central Niger. Semistructured interviews (n = 153) and focus group discussions (n = 38) explored 4 primary themes: (a) perceptions of ideal diet during pregnancy, (b) barriers to consuming the ideal diet, (c) coping strategies including dietary responses related to pregnancy illnesses, and (d) changes in perceptions from early to late pregnancy. Longitudinal data collection allowed for repeated interviews of pregnant women to document changes in dietary practices throughout pregnancy. Transcripts were coded using an inductive approach informed by grounded theory methodology. Participants categorized foods into 4 primary dietary taxonomies when discussing ideal maternal diets but cited constraints related to accessibility and availability impeding routine consumption of these foods. Perceptions of "modern," urban foods as healthy, coupled with key structural barriers such as food costs, were identified. Maternal morbidity influenced food consumption, as women reported reducing food intake early in pregnancy in response to illness episodes. Although awareness of optimal foods for supporting healthy pregnancies was moderately high, some misconceptions were observed and multilevel barriers to food security restricted opportunities for consuming these foods. Nutrition-specific and nutrition-sensitive interventions could improve access and availability of acceptable foods for supporting increased dietary intake during pregnancy.

Detection of bacterial pathogens in clade E head lice collected from Niger's refugees in Algeria.

BACKGROUND: Head lice, Pediculus humanus capitis, are obligate blood-sucking parasites. Phylogenetically, they occur in five divergent mitochondrial clades (A, D, B, C and E), each having a particular geographical distribution. Recent studies have revealed that head lice, as is the case of body lice, can act as a vector for louse-borne diseases. Here, we aimed to study the genetic diversity of head lice collected from Niger's refugees (migrant population) arriving in Algeria, northern Africa, and to look for louse-borne pathogens. Comparative head lice samples collected from indigenous population of schoolchildren (non-immigrant) were also analyzed to frame the study. RESULTS: In this study, 37 head lice samples were collected from 31 Nigerien refugees, as well as 45 head lice from 27 schoolchildren. The collection was established in three localities of eastern Algiers, north Algeria. Quantitative real-time PCR screening of pathogens bacteria and the genetic characterisation of the head lice satut were performed. Through amplification and sequencing of the cytb gene, results showed that all head lice of Nigerien refugees 37/82 (45.12%) belonged to clade E with the presence of four new haplotypes, while, of the 45 head lice of schoolchildren, 34/82 lice (41.46%) belonged to clade A and 11/82 (13.41%) belonged to clade B. Our study is the first to report the existence of clade E haplogroup in Nigerien head lice. DNA of Coxiella burnetii was detected in 3/37 (8.10%) of the head lice collected from 3 of the 31 (9.67%) migrant population. We also revealed the presence of Acinetobacter DNA in 20/37 (54.05%) of head lice collected from 25/31 (80.64%) of the Nigerien refugees, and in 25/45 (55.55%) head lice collected from 15/27 (55.55%) schoolchildren. All positive Nigerien-head lice for Acinetobacter spp. were identified as A. baumannii, while positive schoolchildren-head lice were identified as A. johnsonii 15/25 (60%), A. variabilis 8/25 (32%) and A. baumannii 2/25 (8%). CONCLUSIONS: Based on these findings from head lice collected on migrant and non-migrant population, our results show, for the first time, that head lice from Niger belong to haplogroup E, and confirm that the clade E had a west African distribution. We also detected, for the first time, the presence of C. burnetii and A. baumannii in these Nigerien head lice. Nevertheless, further studies are needed to determine whether the head lice can transmit these pathogenic bacteria from one person to another.

Coping with a nutrient deficiency: cultural models of vitamin A deficiency in northern Niger.

Cultural explanations and management strategies for specific signs and symptoms of vitamin A deficiency are explored in a Hausa-speaking community in northern Niger. Their interpretations of the etiology of nightblindness in young children and pregnant women focus on food-related causes, in which "lack of good food" is central. In parallel with the significance of food in the etiology of nightblindness, the recommended treatments are home food remedies, primarily involving liver, meat, or green leaves. The locally attributed etiology for the more severe manifestation of vitamin A deficiency, xerophthalmia, stands in sharp contrast to this. People believe the primary cause is "heat" produced by acute infectious disease (particularly measles). A trip to the medical dispensary or a reliance upon home remedies are the preferred treatment options for this condition. We explore the striking correspondence between local interpretations of nightblindness and contemporary medical knowledge and treatment in relation to the very different explanations and curative measures offered for more serious manifestations of vitamin A deficiency.

[Brain cysticercosis: review and case report]. / Cisticercosi cerebrale: rassegna e descrizione di un caso clinico.

After thorough biological, epidemiological and clinical analysis as well as diagnosis and therapy of neurocysticercosis, the Authors describe a case they have encountered. Given the increase in the emigration rate from developing countries, the epidemiological nature of this case indicates that brain parasitosis due to helminths requires more attention. As seen in the last 20 years in the United States, these pathologies might increase significantly in Italy in the near future.

From childbearers to culture-bearers: transition to postchildbearing among Tuareg women.

This essay presents an analysis of women's lived experience of the transition from childbearing to postchildbearing among a division of the Tuareg in Niger, West Africa. The analysis suggests that biological realities associated with the end of fertility are interwined with local notions of qualities of ritual and social elderhood among women. It shows how changes in ritual and social roles, associated with increasing devotion to Islam and becoming a mother-in-law, are salient criteria for assuming the role and status of post-menopausal woman. The implication of this is very significant for biocultural reasons: menstruation and its cessation are not always literally the most important markers in female aging, in cross-cultural perspective.

mtDNA sequence diversity in Africa.

mtDNA sequences were determined from 241 individuals from nine ethnic groups in Africa. When they were compared with published data from other groups, it was found that the !Kung, Mbuti, and Biaka show on the order of 10 times more sequence differences between the three groups, as well as between those and the other groups (the Fulbe, Hausa, Tuareg, Songhai, Kanuri, Yoruba, Mandenka, Somali, Tukana, and Kikuyu), than these other groups do between one other. Furthermore, the pairwise sequence distributions, patterns of coalescence events, and numbers of variable positions relative to the mean sequence difference indicate that the former three groups have been of constant size over time, whereas the latter have expanded in size. We suggest that this reflects subsistence patterns in that the populations that have expanded in size are food producers whereas those that have not are hunters and gatherers.

Polymorphism of class I alcohol dehydrogenase in French, Vietnamese and Niger populations: genotyping by PCR amplification and RFLP analysis on dried blood spots.

The polymorphism of human alcohol dehydrogenase (ADH) can contribute to the explanation of the important ethnic differences towards alcohol metabolism. Its assessment at the genomic DNA level with a procedure, excluding labelled probes, consisting of PCR (Polymerase chain reaction) amplification on dried blood spots and analysis of allele-specific RFLP (Restriction fragment length polymorphism) profiles, is well adapted to extensive studies in population samples. It can emphasize the importance of ADH as a genetic marker of population. Three ethnic groups (French Caucasians, Vietnamese Orientals, Black Africans from Niger) were studied. ADH2 and ADH3 genotypes were in equilibrium according to the Hardy-Weinberg law. Important differences were noted in the distribution of ADH2 and ADH3 alleles.

What health system for nomadic populations?

In Niger, independent mobile health units intended to meet the needs of nomadic populations have proved ineffectual and excessively costly. Primary health care services should be based on fixed structures with a reasonably wide radius of coverage and sufficient flexibility and mobile capacity to fulfil their obligations to all sectors of the population.

PIP: In Niger, mobile health teams provided the first health services for nomadic populations, but these services have proved ineffective and costly. Since 1971, many dispensaries have been established in the rural areas to perform immunization. A 1990 evaluation of the Agadez region, in the northeast showed poor returns on investments. Immunization has been carried out by the mobile medical service since 1968 using 2 teams, each comprising 2 nurses, 2 vaccinators, and a driver/guide. The Expanded Program on Immunization (EPI) was launched in 1988 with both mobile teams and fixed health services. By the end of the year the region had achieved coverages of 40% for BCG (bacillus Calmette-Guerin) in children 1 year of age, 54% for 3rd dose of diphtheria-pertussis-tetanus (DPT3) immunization, 35% for children protected against tetanus, and 47% for 2nd dose of tetanus toxoid. The mobile medical service provided less than 10% of first dose DPT (DPT1) and measles immunizations and under 5% of DPT3 coverage which continued in the first 6 months of 1991. A survey in Mali during 1974 showed that the per capita cost of immunization by mobile units was 11 times higher than that performed by fixed units. The health district consists of the rural dispensaries, the first point of contact for patients who may have to travel up to 30 kilometers; and medical posts, which are intermediate referral facilities usually with an ambulance vehicle. These 2 types of health services cannot cover the rural areas effectively and do not involve the community. Fixed health facilities should not be limited to a radius of 5 kilometers, they should establish seasonal circuits as the population moves, and 1 or more areas should be served by an intermediate fed health post. Health teams should carry out immunization and family planning, as well as the education and the supervision of first level workers. In the nomadic areas, every health district should have at least 1 health post.