Antenatal care service delivery and factors affecting effective tetanus vaccine coverage in low- and middle-income countries: Results of the Maternal Immunisation and Antenatal Care Situational analysis (MIACSA) project.

OBJECTIVES: To map the integration of existing maternal tetanus immunization programmes within antenatal care (ANC) services for pregnant women in low- and middle-income countries (LMICs) and to identify and understand the challenges, barriers and facilitators associated with high performance maternal vaccine service delivery. DESIGN: A mixed methods, cross sectional study with four data collection phases including a desk review, online survey, telephone and face-to-face interviews and in country visits was undertaken between 2016 and 2018. Associations of different service delivery process components with protection at birth (PAB) and with country groups were established. PAB was defined as the proportion of neonates protected at birth against neonatal tetanus. Regression analysis and structural equation modelling was used to assess associations of different variables with maternal tetanus immunization coverage. Latent class analysis (LCA), was used to group country performance for maternal immunization, and to address the problem of multicollinearity. SETTING: LMICs. RESULTS: The majority of LMICs had a policy on recommended number of ANC visits, however most were yet to implement the WHO guidelines recommending eight ANC contacts. Countries that recommended > 4 ANC contacts were more likely to have high PAB > 90%. Passive disease surveillance was the most common form of disease surveillance performed but the maternal and neonatal morbidity and mortality indicators recorded differed between countries. The presence of user fees for antenatal care and maternal immunization was significantly associated with lower PAB (<90%). CONCLUSIONS: Recommendations include implementing the current WHO ANC guideline to facilitate increased opportunities for vaccination during each pregnancy. Improved utilisation of ANC services by increasing the demand side by increasing the quality of services, reducing any associated costs and supporting user fee exemptions, or the supply side can also enhance utilisation of ANC services which are positioned as an ideal platform for delivery of maternal vaccines.

New Genetic Insights into Pearl Millet Diversity As Revealed by Characterization of Early- and Late-Flowering Landraces from Senegal.

Pearl millet (Pennisetum glaucum (L.) R. Br.) is a staple food and a drought-tolerant cereal well adapted to Sub-Saharan Africa agro-ecosystems. An important diversity of pearl millet landraces has been widely conserved by farmers and therefore could help copping with climate changes and contribute to future food security. Hence, characterizing its genetic diversity and population structure can contribute to better assist breeding programs for a sustainable agricultural productivity enhancement. Toward this goal, a comprehensive panel of 404 accessions were used that correspond to 12 improved varieties, 306 early flowering and 86 late-flowering cultivated landraces from Senegal. Twelve highly polymorphic SSR markers were used to study diversity and population structure. Two genes, PgMADS11 and PgPHYC, were genotyped to assess their association to flowering phenotypic difference in landraces. Results indicate a large diversity and untapped potential of Senegalese pearl millet germplasm as well as a genetic differentiation between early- and late-flowering landraces. Further, a fine-scale genetic difference of PgPHYC and PgMADS11 (SNP and indel, respectively) and co-variation of their alleles with flowering time were found among landraces. These findings highlight new genetic insights of pearl millet useful to define heterotic populations for breeding, genomic association panel, or crosses for trait-specific mapping.

Anatomy of the pineal region applied to its surgical approach.

INTRODUCTION: The pineal region is situated in the posterior part of the incisural space. This region includes the pineal body inside the quadrigeminal arachnoidal cistern. This article reviews the anatomic features of this region, with particular emphasis on those aspects of importance for surgical access to the pineal region. MATERIAL & METHODS: Five cadaver heads fixed in 10% formalin and injected with colored latex were used for anatomic dissection (five other specimens were also prepared and dissected to illustrate the articles on surgical techniques and approaches presented elsewhere in this issue). RESULTS: The pineal body is surrounded by several important structures such as: posterior part of the third ventricle, tectum, the complex of the great cerebral vein of Galen, pulvinar nuclei of the thalamus and splenium of corpus callosum. CONCLUSION: The surgical approach of the pineal body, whatever the route or the technique used (microsurgical, endoscopic or stereotactic), creates a great challenge for the neurosurgeons due to its location in the deep part of the brain and its close relationships with complex surrounded vascular structures.

Les goitres nodulaires toxiques

Introduction : Jusqu'ici; aucune etude dans notre pays n'avait porte specifiquement sur les goitres nodulaires toxiques. Elles n'ont ete citees que dans des etudes generales des hyperthyroidies. Methodes : Il s'agit d'une etude retrospective de 62cas de goitres nodulaires toxiques colliges entre 1979 et 1999 a la clinique medicale 2 du CHU de Dakar. Le diagnostic de nodule toxique a ete retenu sur les criteres suivants : la coexistence d'un ou plusieurs nodules thyroidiens et de signes de thyrotoxicose; l'existence d'un nodule hyperfixiant a la scintigraphie thyroidienne a l'iode 131; l'elevation des hormones thyroidiennes T3 et/ou T4. Nous nous sommes interesses aux aspects epidemiologiques; cliniques; aux complications et aux aspects therapeutiques et evolutifs. Resultats : Il s'agissait de 49 nodules uniques (79;03) et de 13 goitres multi nodulaires (20;97). Dans les cas de nodules uniques; l'age moyen etait de 40 ans; le sexe ratio de 0;04 (47 femmes; 2 hommes). Le nodule etait cliniquement decelable dans 47 cas (95;9) et extinctif dans73;5; La cardiothyreose existait dans 34;6des cas. En cas de goitre multi nodulaire; l'age moyen etait de 45ans; le sexe feminin dans tous les cas. Le goitre etait cliniquement decelable chez 12 patients (95;3). La cardiothyreose existait dans 46;15des cas. 62des patients ont ete perdus de vue en cours de traitement d'equilibration de l'hyperthyroidie. Sur les 37adresses en chirurgie; seuls deux ont ete revus apres thyroidectomie. Conclusion : Cette etude confirme la predominance du goitre nodulaire toxique chez la femme jeune; sa gravite par la frequence de la cardiothyreose et souligne les difficultes liees a la prise en charge therapeutique