Effects of Five Years of Treatment of Onchocerciasis with Ivermectin under Community Guidelines in Resurgent Areas of Burkina Faso: A before-and-after Analysis.

BACKGROUND: Almost the entire country of Burkina Faso was endemic to onchocerciasis. Onchocerciasis control efforts thus brought the prevalence of O. volvulus to a level where the disease was no longer a public health problem in 2002. A resurgence of onchocerciasis cases has been observed in two regions (Cascades and the Southwest) located around several river basins in 2010-2011. In accordance with WHO guidelines for the management of resurgent cases, community-directed treatment with ivermectin (CDTI) was implemented in the affected areas. The aim of this study was to determine the effects of this intervention on parasitological indices of onchocerciasis, depending on the distance between villages and rivers. METHODOLOGY: We conducted a paired pre-post study using aggregated village-level data from two cross-sectional surveys conducted in each region. A Wilcoxon signed-rank test was used to compare the standardized microfilarodermia prevalence and community microfilarial load (CMFL). RESULTS: A total of 43 villages in 6 health districts, in the Southwest (18) and Cascades (25) regions were included in the study. The key findings were that standardized microfilaria prevalence and CMFL decreased significantly after the implementation of CDTI in both regions (p < 0.0001). The median standardized microfilaria prevalence was 2.8 [interquartile range (IQR): 0.2-6.6] before CDTI and 0.72 [IQR: 0.0-2.17] after CDTI. The results showed also a decline in standardized microfilaria prevalence and CMFL in all villages, regardless of the distance separating the village from the streams. However, the results were not statistically significant for the villages located 5 km or more from streams (p = 0.0816 and 0.0542 for standardized microfilaria prevalence and CMFL, respectively). CONCLUSION: Our results thus show that the implementation of effective CDTI could stop the transmission of O. volvulus in these two regions. The main challenge for stopping transmission could be the migration of populations to neighboring countries and migration of the vector from one country to another, as Burkina Faso shares some river basins with neighboring countries.

Health seeking behaviour associated with obstetric fistula care in Guinea: An analysis of the 2018 Demographic and Health survey.

This study aimed to analyze factors associated with obstetric fistula care-seeking behavior in Guinea, based on data from the 2018 Demographic and Health Survey. Women aged 15-49 years who reported having obstetric fistula constituted the study population, statistical analysis was using Stata 16.0 software. Multivariate logistic regression was used to identify the factors associated with fistula care-seeking behavior. Among women with obstetric fistula, 78.9% sought care; 21.1% of those who sought care underwent repair. Factors associated with care-seeking behavior were being divorced (AOR =8.08; 95% CI:1.56-41.84), having a job (AOR =3.23; 95% CI: 1.11-9.44), being a member of a poor household (AOR =6.49; 95% CI:1.21-34.82) and whose fistula had appeared 6 days or more after the occurrence of the causal circumstance (AOR =3.63 95% CI: 1.28-10.28). This study suggests that the foundations on which fistula prevention and treatment programs are built should be reviewed, taking into account the factors highlighted by this study.

Cette étude visait à analyser les facteurs associés aux comportements de recherche de soins pour la fistule obstétricale en Guinée, partant des données de l'enquête démographique et de santé de 2018. Les femmes âgées de 15 à 49 ans ayant déclaré avoir une fistule obstétricale ont constitué la population d'étude, l'analyse statistique a été réalisée à l'aide du logiciel Stata 16.0. La régression logistique multivariée a été utilisée pour identifier les facteurs associés aux comportements de recherche de soins pour la fistule. Parmi les femmes atteintes de fistule obstétricale, 78,9 % ont eu recours à des soins ; 21,1 % de celles qui ont recouru ont subi une réparation. Les facteurs associés aux comportements de recherche de soins étaient le fait d'être divorcée (ORA=8.08 ; 95% IC :1.56-41.84), d'avoir un travail (ORA =3.23 ; 95% IC : 1.11-9.44), d'être membre d'un ménage pauvre (ORA =6.49 ; 95% IC :1.21-34.82) et dont la fistule était apparue 6 jours ou plus après la survenue de la circonstance causale (ORA =3.63 95% IC : 1.28-10.28). Cette étude suggère de revoir les bases sur lesquelles les programmes de prévention et de traitement de la fistule sont construits, tout en prenant en compte les facteurs mis en évidence par cette étude.

The monthly trends of malaria cases in children under 5 years of age in Guinea: comparative analysis between a seasonal malaria chemoprevention (SMC) and a non-SMC health district.

BACKGROUND: The Republic of Guinea, where malaria represents the leading cause of morbidity and mortality among children, the seasonal malaria chemoprevention (SMC) is deployed only in areas with very seasonal modes of transmission. It should target children at the highest risk of serious illness. The objective of the study was to prevent uncomplicated and serious cases of malaria in the target population. This study aimed to analyse the monthly trends in malaria-related morbidity among children under the age of 5 in Guinea. METHODS: This was a quasi-experimental study with routine data from the National Health Information System (SNIS). The two districts Mamou (the SMC intervention site) and Kindia (the control site) were selected to compare the monthly trends in malaria cases among children under the age of 5, from July to October, covering the years from 2015 to 2020. The statistical analysis used interrupted time series to estimate the effects of the SMC. RESULTS: The SMC programme contributed to a significant average reduction in the number of malaria cases of 225 cases per month in the intervention district (95% CI - 362 to - 88; p = 0.002), compared to the control district. However, the study also revealed that the effect of SMC varied between cycles, presenting different monthly malaria cases. CONCLUSION: The SMC contributed to a significant reduction in malaria cases among children under the age of 5 in the health district of Mamou from 2018 to 2020. However, this reduction varied by monthly SMC cycle. This study suggests extending the SMC in other areas with high perennial seasonal transmission respecting the World Health Organization SMC eligibility criteria, as a strategy in the dynamic of reducing malaria cases in children under the age of 5 in Guinea.

Prevalence and factors associated with unskilled childbirth attendance in Guinea: Analysis of the 2018 Demographic and Health Survey.

This study aimed to analyze the prevalence and factors associated with the unassisted delivery by qualified health personnel in the Republic of Guinea, based on data from the 2018 demographic and health survey. Multivariate logistic regression was used to identify the associated factors. The prevalence of unassisted delivery was 40.8%; it was 38.4% in rural areas and 2.3% in urban areas. Factors associated with this type of delivery included the performance of no ANC (ORa = 6.19 IC95%: [4.86 - 7.87], p<0.001) and those who had performed one to three ANC (ORa =1.75 IC95%: [1.49 - 2.05], p<0.001) the perception of the distance to the health institution as a problem (ORa =1.28 IC95%: [1.10 - 1.48], p<0.001), belonging to the poor wealth index (ORa = 2.77 IC 95%: [2.19 - 3.50], p<0.001) and average (ORa = 2.01 IC95%: [1.57 - 2.57], p<0.001), the fact of residing in the region of Faranah (ORa = 2.24 IC95%: [1.37 - 3.65], p<0.001) and rural areas (ORa = 4.15 IC95%: [3.10 - 5.56], p<0.001). Strengthening community awareness, making functional ambulances available to rural health centers and making prenatal care inputs available in health institutions would help to reduce the scale of unassisted deliveries in the Republic of Guinea.

Cette étude visait à analyser la prévalence et les facteurs associés à l'accouchement non assisté par un personnel de santé qualifié en Guinée, partant des données de l'enquête démographique et de santé de 2018. La régression logistique multivariée a servi à identifier les facteurs associés. La fréquence de l'accouchement non assisté était de 40.8% ; elle était de 38.4% en milieu rural et 2.3% en milieu urbain. Les facteurs associés à ce type d'accouchement comprenaient la réalisation d'aucune CPN (ORa =6.19 IC95% : [4.86 - 7.87], p<0.001) et celles qui avaient réalisées une à trois CPN (ORa =1.75 IC95% : [1.49 - 2.05], p<0.001) la perception de la distance pour la structure de santé comme un problème (ORa =1.28 IC95% : [1.10 - 1.48], p<0.001), l'appartenance à l'indice de richesse pauvre (ORa =2.77 IC95% : [2.19 - 3.50], p<0.001) et moyenne (ORa =2.01 IC 95% : [1.57 - 2.57], p<0.001), le fait de résider dans la région de Faranah (ORa =2.24 IC95% : [1.37 - 3.65], p<0.001) et rurale (ORa =4,15 IC 95% : [3,10 - 5,56], p<0,001). Le renforcement de la sensibilisation communautaire, la mise d'ambulances fonctionnelles à la disposition des centres de santé ruraux et rendre disponible les intrants de soins prénatals dans les structures sanitaires contribueraient serte à réduire l'ampleur des accouchements non assistés en Guinée.

Capacity building in operational research on obstetric fistula: Experience in the Democratic Republic of Congo, 2017-2021.

OBJECTIVE: To implement a Flexible Operational Research Training (FORT) course within the Fistula Care Plus Project, Democratic Republic of Congo, from 2017 to 2021. METHODS: A descriptive study using design and implementation (process and outcome) data. Two to four members of medical teams from three supported sites were selected for the training based on their research interests and level of involvement in the program. RESULTS: Two courses (13-14 months each) involving nine facilitators and 17 participants overall were conducted between 2017 and 2021. Most participants in both courses were medical doctors (67% and 71%, respectively) from the supported hospitals (83% and 77%, respectively). About half were women. In addition to classic face-to-face didactic modules, the courses integrated online platforms to cope with the changing contexts (Ebola virus and COVID-19). Most participants reported having gained new skills in developing research protocols, collecting, managing, and analyzing data, and developing research manuscripts. The two courses resulted in six scientific manuscripts and three presentations at international conferences. Participants subsequently published five papers from their research after the first course. The total direct costs for both courses were representing a cost of $3669 per participant trained. CONCLUSION: The FORT model proved feasible, efficient, and successful. However, scaling up will require more adaptation efforts from programs and participating sites.

Knowledge, attitudes, and practices of health providers regarding access to and use of contraceptive methods among adolescents and youth in urban Guinea.

Introduction: The objective of this study was to analyze providers' knowledge, attitudes, and practices regarding access to and use of contraception by urban adolescents and youth. Methods: This is a cross-sectional study of 1,707 health care providers in 173 selected private and public health facilities in the capital city of Conakry and the seven administrative regions of Guinea. Factors associated with health care providers' attitudes and practices were then analyzed using logistic regression. Results: Among the 1,707 health providers, 71% had a good level of Knowledge about modern contraceptive use among adolescents and youth. In addition, 62% had positive attitudes, and 41% had good prescribing practices toward using modern contraceptive methods by adolescents and youth. Being a midwife (aOR: 1.39, 95%CI: 1.02-1.89), Being aged 25-34 years (aOR: 1.7, 95%CI: 1.2-2.3), 35-44 years (aOR: 2.1, 95%CI: 1.4-3.0), and 45 years, and older (aOR: 2.4, 95%CI: 1.3-4.2), an increase of years in professional experience (aOR:1.05; 95%CI: 1.02-1.08) were factors significantly associated with provider positive attitudes. However, being a medical doctor (aOR: 2.37, 95%CI: 1.04-4.42), an increase of years in professional experience (aOR: 1.07; 95%CI: 1.04-1.10) and a positive attitude (aOR: 3.16. 95%CI: 2.48-4.01) were factors associated with good practice in delivering modern contraceptive methods to adolescents and youth. Conclusion: Positive attitudes and good practices toward the use of contraceptive services by adolescents and youth were found among providers. However, many health care providers still have unfavorable attitudes and practices toward delivering FP services to urban adolescents and youth. Therefore, future intervention programs should focus on training health care providers in youth- and adolescent-friendly reproductive health services and promoting contraception among adolescents.

Unmet need for contraception and its associated factors among adolescent and young women in Guinea: A multilevel analysis of the 2018 Demographic and Health Surveys.

Despite the recent repositioning efforts to increase the use of modern contraceptives, the prevalence of unmet need for contraception remains high among adolescent and young women in Guinea. This study analyzed the individual and contextual factors associated with the unmet need for contraception among adolescent and young women in 2018 in Guinea. We conducted a secondary analysis of the 2018 Demographic and Health Survey data. Multilevel mixed-effects logistic regression models were used to assess the association between individual and contextual characteristics and unmet need for contraception among adolescents and young women. Adjusted odds ratios (AORs) with their 95% confidence intervals (CIs) were calculated, with statistical significance set at p < 0.05. The prevalence of total unmet need for contraception was 22.6% (95% CI, 18.1-27.8). Being an adolescent aged 15-19 years (AOR = 1.44; 95% CI, 1.01-2.05), unmarried (AOR = 5.19; 95% CI, 3.51-7.67), having one or two children (AOR = 3.04; 95% CI, 2.18-4.25), or more than two children (AOR = 4.79; 95% CI, 3.00-7.62) were individual factors associated with the unmet need for contraception. As for community factors, only living in Labé (AOR = 2.54; 95% CI, 1.24-5.18) or Mamou (AOR = 1.73; 95% CI, 1.21-2.48) was significantly associated with the unmet need for contraception. In conclusion, both individual and community characteristics were significantly associated with the unmet need for contraception. This highlights the need to focus and strengthen communication and counseling strategies targeting adolescents and young women and aiming to increase the uptake of family planning in Guinea.

A rapid assessment of health system preparedness and response to the COVID-19 pandemic in Guinea.

Epidemic-prone diseases have high adverse impacts and pose important threats to global health security. This study aimed to assess levels of health facility preparedness and response to the COVID-19 pandemic in Guinea. This was a cross-sectional study in public and private health facilities/services across 13 Guinean health districts. Managers and healthcare workers (HCWs) from departments in each facility/service were interviewed. Descriptive statistics and comparisons were presented using Pearson's Chi-Squared Test or Fischer exact test. Totally, 197 managers and 1020 HCWs participated in the study. Guidance documents and dedicated spaces for management/isolation of suspected COVID-19 cases were available only in 29% and 26% of facilities, respectively. Capacities to collect (9%) and safely transport (14%) samples were low. Intensive care units (5%), dedicated patient beds (3%), oxygenators (2%), and respirators (0.6%) were almost lacking. While 36% of facilities/services had received infection prevention and control supplies, only 20% had supplies sufficient for 30 days. Moreover, only 9% of HCWs had received formal training on COVID-19. The main sources of information for HCWs were the media (90%) and the internet (58%). Only 30% of HCWs had received personal protective equipment, more in the public sector (p<0.001) and in Conakry (p=0.022). This study showed low levels of preparedness of health facilities/services in Guinea and highlighted a lack of confidence among HCWs who felt unsafe at their workplace. Better governance to improve and maintain the capacity of the Guinean health system to respond to current and future epidemics is needed.

Distribution of snake species and snakebites in hotspots of Ethiopia.

INTRODUCTION: In Sub-Saharan Africa, snakebites are a public health problem. In Ethiopia, clinical cases have been described, but little information exists on snakebites burden and its geographical distribution. The aim of this study was to document the spatial distribution of venomous snakes and snakebites in Ethiopia. METHODOLOGY: In a cross-sectional observational study, venomous snakes were collected during snake catching activities in six Ethiopian hotspot areas between April 2015 and September 2020. Species and habitat were described. In the hotspot areas, routine health information data on reported snakebites was collected in 78 districts and subsequently used to map annual incidence per district. RESULTS: A total of 333 snakes were collected and 14 species were identified. The most prevalent species were Bitis arietans, Bitis arietanus somalica, Echis pyramidum, known as vipers, and Naja pallida, known as cobra. The highest number of snakes (75) was observed in the Northwest and Eastern parts of Ethiopia, mostly in cultivation and man-made farm land, wooded and moist dry savanna. In each hotspot a wide variety of species was observed, although composition was different. The highest snakebite incidence overlapped with the high snakes densities in Northwest Ethiopia. The snakebite annual average incidence at district level was very heterogeneous and ranged from < 15 cases/100,000 inhabitants (44% of the districts) to 309.2 cases/100,000 inhabitants. CONCLUSIONS: Snake diversity and distribution, linked to high incidence of snakebites in the hotspots, suggests a close interconnection between human, animal and environmental systems and could inform the need for antivenoms per geographical locality.

Evaluation of Three Blended Learning Courses to Strengthen Health Professionals' Capacity in Primary Health Care, Management of Sexual and Reproductive Health Services and Research Methods in Guinea.

Background: Three blended courses on Primary Health Care (eSSP), Management of Sexual and Reproductive Health Services (eSSR), and Research Methods (eMR) were developed and implemented between 2017 and 2021 by the Maferinyah National Training and Research Center in Rural Health, a training and research institution of the Ministry of Health in Guinea. The study objectives were to evaluate the reasons for dropout and abstention, the learners' work behavior following the training, and the impact of the behavior change on the achievements of learners' organizations or services. Methods: We evaluated the three implemented courses in 2021, focusing on levels 3 and 4 of the Kirkpatrick training evaluation model. Quantitative and qualitative data were collected through an open learning platform (Moodle), via an electronic questionnaire, during the face-to-face component of the courses (workshops), and at learners' workplaces. Descriptive statistics and thematic analysis were performed for quantitative and qualitative data, respectively. Results: Out of 1,016 applicants, 543 including 137 (25%) women were enrolled in the three courses. Over the three courses, the completion rates were similar (67-69%) along with 20-29% dropout rates. Successful completion rates were 72% for eSSP, 83% for eMR and 85% for eSSR. Overall success rate (among all enrollees) ranged from 50% (eSSP) to 58% (eSSR). The majority (87%) of the learners reported applying the knowledge and skills they acquired during the courses through activities such as supervision (22%), service delivery (20%), and training workshops (14%). A positive impact of the training on utilization/coverage of services and increased revenues for their health facilities were also reported by some trainees. Conclusion: These findings showed fair success rates and a positive impact of the training on learners' work behavior and the achievements of their organizations.

The direct cost of dialysis supported by families for patients with chronic renal failure in Ouagadougou (Burkina Faso).

BACKGROUND: Chronic renal failure can lead to dialysis and/or a kidney transplant in the final stage. The number of patients under dialysis has increased considerably in the world and particularly in sub-Saharan Africa. Dialysis is a very expensive care. This is the reason why this study on the costs of dialysis management was initiated in Burkina Faso. The objective of the study is to determine the direct medical and non-medical costs of managing chronic renal failure among dialysis patients in Ouagadougou in 2020. METHODS: An analytical cross-sectional study was conducted. Data were collected in the hemodialysis department of three public university hospitals in Ouagadougou, Burkina Faso. All dialysis patients with chronic renal failure were included in the study. Linear regression was used to investigate the determinants of the direct medical and non-medical cost of hemodialysis. RESULTS: A total of 290 patients participated in this study, including children, adults, and the elderly with extremes of 12 and 82 years. Almost half of the patients (47.5%) had no income. The average monthly total direct cost across all patients was 75842 CFA or US$134.41.The average direct medical cost was 51315 CFA or US$90.94 and the average direct non-medical cost was 24 527 CFA or US$43.47. Most of the patients (45.2%) funded their hemodialysis by their own source. The multivariate analysis showed that the presence of an accompanying person during treatment, residing in a rural area, ambulatory care, use of personal cars, and treatment at the dialysis center of Yalgado Teaching Hospital were associated with higher direct costs. CONCLUSION: The average cost of dialysis services borne by the patient and his family is very high in Burkina Faso, since it is 2.1 times higher than the country's minimum interprofessional wage (34664 CFA or US$61.4). It appears that the precariousness of the means of subsistence increases strongly with the onset of chronic renal failure requiring dialysis. Thus, to alleviate the expenses borne by dialysis patients, it would be important to extend the government subsidy scheme to the cost of drugs and to promote health insurance to ensure equitable care for these patients.

Management of febrile illness in rural Guinea over a seven-year period: A retrospective study.

INTRODUCTION: Febrile illnesses constitute a major clinical challenge in tropical settings. We aimed to assess the frequency, presentation and management of febrile illness at two health facilities in Forécariah, Guinea, with a focus on appropriateness of antibiotic prescription. MATERIALS AND METHODS: This was a retrospective study conducted in patient files in a health center and a district hospital. Proportions of antibiotic prescription were determined by age group and syndromes as well as appropriateness of antibiotic prescription using the WHO model list (2019). RESULTS: From 2014 to 2020, 23,583 of 62,185 (38.0%) visits were related to febrile illness. Most patients with fever were female (56.1%) and evaluated at the health center (81.0%). Gastrointestinal (40.6%) and respiratory syndromes (36.8%), and undifferentiated fever (30.0%) were the most common presentations. Malaria was confirmed in 61.3% of the cohort. Overall, the rate of antibiotic prescription was high (14,834/23,583, 62.9%), mostly among patients aged <5 years (5,285/7,566, 69.9%), those with respiratory (7,577/8,684, 87.3%) and gastrointestinal (6,324/9,585, 66.0%) syndromes. Moreover, 7,432/14,465 (51.4%) patients with malaria were also prescribed an antibiotic. Penicillin (42.0%), cotrimoxazole (26.3%) and quinolones (18.7%) were the most frequently prescribed antibiotics. Overall, appropriateness of antibiotic prescription was low (38.3%), and even more so in patients with respiratory (29.1%) and gastrointestinal (25.8%) syndromes. CONCLUSIONS: Febrile illness is a major cause of consultation in rural Guinea. Rate of antibiotic prescription was high, even in confirmed malaria and was often considered inappropriate. There is a pressing need to investigate the etiological spectrum and improve the diagnostic approach of febrile illness in Guinea.

SELECTION OF PFCRT 76T AND PFMDR1 86Y MUTANT PLASMODIUM FALCIPARUM AFTER TREATMENT OF UNCOMPLICATED MALARIA WITH ARTESUNATE-AMODIAQUINE IN REPUBLIC OF GUINEA.

The use of Amodiaquine monotherapy is associated with the selection of molecular markers of Plasmodium falciparum resistance to chloroquine (pfcrt and pfmdr1). The decrease in sensitivity and the emergence of P. falciparum resistant to artemisinin-based combination therapy have been reported. Therefore, it is important to assess the impact of treatment of uncomplicated malaria with Artesunate-Amodiaquine (AS+AQ) on molecular markers of antimalarial resistance. We used standard World Health Organization (WHO) protocols to determine the in vivo efficacy of the combination (AS+AQ). In total, 170 subjects were included in the study. The molecular analysis focused on 168 dried blood spots. The aims were to determine the frequency of pfcrt 76T and pfmdr1 86Y mutations and the rates of reinfection using polymorphism markers msp1, msp2, and microsatellite markers (CA1, Ta87, TA99). Nested-PCR was used, followed in some cases by a restriction digestion. The level of P. falciparum clinical response was 92.9% (156/168) of Adequate Clinical and Parasitological Response (ACPR) before molecular correction and 97.0% (163/168) after molecular correction (P = 0.089). The frequency of mutation point pfcrt 76T was 76.2% (128/168) before treatment and 100% (7/7) after treatment (P = 0.1423). For the pfmdr1 mutation, the frequency was 28% (47/168) before treatment and 60% (6/10) after treatment (P = 0.1124). The rate of pfcrt 76T + pfmdr1 86Y was 22% (37/168) before and 50% (6/12) after treatment (P = 0.1465). Despite the presence of AS in the combination, AS+AQ selects for pfcrt 76T and pfmdr1 86Y mutant P. falciparum in Guinea.

PREVALENCE OF PARASITIC INFECTIONS IN CHILDREN OF BOKE, GUINEA.

Helminthic and intestinal protozoan infections and malaria infections are common in children less than 15 yr old in sub-Saharan Africa, but little is known about these infections in Guinea. The aim of this study was to determine the prevalence of parasitic infections in children aged less than 15 yr and the relationship of these infections with anemia. The cross-sectional study was done in Dabbis sub-prefecture in the Boke region of Guinea from 18 to 26 March 2017. A simple random sampling at the household level was performed, and 1 child under the age of 15 was included per eligible household. A total of 392 children were included in the analysis. Clinical and parasitological information were assessed, including anthropometric measures (weight and height), disease symptoms, hemoglobin level, and malaria parasitemia. Helminthic and protozoan intestinal infections were present in 59.7% of the children surveyed. Malaria infection prevalence was 45.5% when assessed by microscopy and 43.6% when assessed by a rapid diagnostic test. Plasmodium falciparum, accounting for 84.2% of malaria infections, was the main malaria species infection. Gastrointestinal parasites were present in 19.1% of children. The main gastrointestinal parasites present included Entamoeba coli (5.4%) and Giardia intestinalis (5.1%). There was no association between the presence of anemia and the parasitic status of the children. Parasitic screening and mass treatment in this age group, as well as household awareness raising, would reduce cases of parasitic infections in rural Guinea.

Resurgence of Ebola virus in 2021 in Guinea suggests a new paradigm for outbreaks.

Seven years after the declaration of the first epidemic of Ebola virus disease in Guinea, the country faced a new outbreak-between 14 February and 19 June 2021-near the epicentre of the previous epidemic1,2. Here we use next-generation sequencing to generate complete or near-complete genomes of Zaire ebolavirus from samples obtained from 12 different patients. These genomes form a well-supported phylogenetic cluster with genomes from the previous outbreak, which indicates that the new outbreak was not the result of a new spillover event from an animal reservoir. The 2021 lineage shows considerably lower divergence than would be expected during sustained human-to-human transmission, which suggests a persistent infection with reduced replication or a period of latency. The resurgence of Zaire ebolavirus from humans five years after the end of the previous outbreak of Ebola virus disease reinforces the need for long-term medical and social care for patients who survive the disease, to reduce the risk of re-emergence and to prevent further stigmatization.

Outcomes of blended learning for capacity strengthening of health professionals in Guinea.

BACKGROUND: Quality human resources constitute an essential pillar of an effective health system. This paper analyzes the outcomes of blended learning for post-Ebola capacity strengthening of health professionals in Guinea. METHODS: Two courses lasting 3 months each (7-8 modules) were developed and implemented: one in Primary Health Care (eSSP) and the other in Sexual and Reproductive Health Services Management (eSSR). Both eSSP and eSSR courses were offered online on the Moodle platform, followed by a face-to-face capacity-building workshop. A cross-sectional study using a mixed-methods approach was conducted in 2018-19. As outcomes, we described learners' sociodemographic characteristics, course completion and success, and perceptions of the courses and support from the instructors, analyzed the factors associated with learners' successful completion and reported on learners' feedback on their blended learning experience. Quantitative data were analyzed using the STATA 15 software, and qualitative data were analyzed through content analysis. RESULTS: Overall, 282 health professionals were enrolled for both eSSP and eSSR courses. The completion rate was 69.5% (196/282). The success rate for learners who completed the courses was 80% (156/196), and the overall success rate for enrollees was 55% (156/282). The dropout and abstention rates were 22 and 9%, respectively. On both eSSP and eSSR courses, the success rate of women enrolled was higher than or equal to men's. The success rate of medical doctors enrolled (53% for eSSP and 67% for eSSR) was higher than for other health professionals, in particular nurses (9% for eSSP) and midwives (40% for eSSR). Course type was associated with success (AOR = 1.93; 95% CI = 1.15-3.24). Most learners strongly agreed that the courses are relevant for targeted health professionals (81 to 150/150), pdf course materials are well-structured and useful (105/150), the content of the modules is relevant, comprehensible, and clear (90/150), self-assessment quizzes are helpful (105/150), summative assessment assignments are relevant (90/150), the course administrators and IT manager were responsive to learners' concerns (90/150), they will recommend the courses to colleagues and friends (120/150). CONCLUSION: Two blended courses for capacity strengthening of health professionals were successfully developed and implemented in Guinea.

Approche eLearning pour le renforcement des capacités des professionnels de santé en Guinée : une expérience post-Ebola.

INTRODUCTION: The development of quality human resources for health is an essential pillar of an effective health system. The objective of this study was to describe the implementation process and the results of an eLearning approach for capacity strengthening of health professionals in Guinea. METHOD: A descriptive cross-sectional study using a mixed research method was conducted from January 15, 2018 to January 15, 2019. RESULTS: A team from the National Training and Research Centre in Rural Health of Maferinyah in Guinea has been trained in the development of online courses. Two courses lasting three months each (7 to 8 modules), entirely offered online on the Moodle platform, have been developed, one on Primary Health Care (eSSP) and the other on the Management of Sexual and Reproductive Health Services (eSSR). Overall, 282 health professionals have been enrolled for both courses, with a completion rate of 69.5%. The success rate for learners who completed the courses was 79.6% and the success rate for enrollees was 55.3%. The dropout and abstention rates were 21.6% and 8.9%, respectively. The strengths, weaknesses and challenges of the organization and the success of such a training were reported. CONCLUSIONS: The eLearning approach for capacity strengthening of health professionals is feasible and gives good findings in low-income contexts like that of Guinea.

Fréquence des grossesses en milieu scolaire et profil des adolescentes concernées à Conakry, Guinée.

INTRODUCTION: Pregnancy in schools is an obstacle to the development and education of young girls, especially in developing countries. The purpose of this study was to assess the frequency of pregnancies within a school setting and the profile of adolescent girls who have had the experience in Conakry, Guinea. METHOD: We conducted a cross-sectional study covering the period from January 1 to June 30, 2017 in 16 schools. RESULTS: A total of 2,419 adolescent girls consented to participate in the study. The mean age was 16.48±0.04 years with extremes of 10 and 19 years. Students aged 15 to 19 (93.0%), those in college (53.3%) and single (69.8%) were the most likely to have been pregnant in school (P<0.05). The factors statistically significantly associated with the occurrence of teenage pregnancies in a school environment were age (Adjusted odds ratio (AOR)=1.5; 95%CI=1.3-1.7; P<0.001), school level (AOR=0.6; 95%CI=0.4-0.8; P=0.003 for Lycée), the place of residence (AOR=0.5; 95%CI=0.4-0.9; P=0.002 for Matam, AOR=0.4; 95%CI=0.3-0.8; P<0.001 for Dixinn, AOR=0,3; 95%CI=0.2-0.8; P=0.010 for Ratoma), marital status (AOR=8.7; 95%CI=3.4-7.0; P<0.001), information on reproductive health (AOR=2.4; 95%CI=1.1-3.0; P=0.015), knowledge of the benefits of family planning (AOR=2.2; 95%CI=1.0-2.2; P=0.030) and the difficulty of accessing sexual and reproductive health services (AOR=3.4; 95%CI=1.4-3,7; P<0.01). CONCLUSIONS: The occurrence of school pregnancies remains a worrying reality among adolescent girls in Guinea. Factors associated with the occurrence of pregnancy in the school are age, school level, place of residence, marital status, knowledge of sexual health information, knowledge of the benefits of family planning, and related difficulties access to sexual and reproductive health services.

Motorcycle Accidents and Their Outcomes amongst Victims Admitted to Health Facilities in Guinea: A Cross-Sectional Study.

BACKGROUND: Motorcycle road traffic accidents (RTA) constitute an increasing public health challenge with victims more likely to sustain fatal injuries compared with other types of RTA. The aim of this study was to analyze motorcycle RTA-related morbidity and mortality among victims admitted to hospitals in Guinea from 2015 to 2017. MATERIALS AND METHODS: This was a cross-sectional study based on hospital records from six districts (Boké, Kindia, Mamou, Faranah, N'Zérékoré, and Siguiri) from January 1, 2015, to December 31, 2017. Bivariate analysis and multivariate logistic regression were used to explore associations between RTA types and mortality. RESULTS: There were 14,962 RTA victims with motorcycle RTA accounting for 58.3% and other RTA 45.3% of hospital admissions. Overall, motorcycle RTA accounted for 77.7%, with young adults (96.2%) and males (73.5%) more affected when compared to victims of other types of RTA. Median age of motorcycle RTA victims was 23 years (IQR: 17-33 years). Students (29.7%), employees (23.6%), and farmers/housewives (23.3%) were the commonest groups affected by motorcycle RTA. The highest burden of motorcycle RTA occurred in the mining zones (Boké and Siguiri). Wounds (39.2% and 27.3%) and multiple injuries (43.8% and 43.8%) were the commonest types of injury sustained by victims of both motorcycle and other types of RTA, respectively. Motorcycle RTA accounted for 54% of overall deaths. Using multivariate logistic regression analysis, sustaining a motorcycle RTA in N'Zérékoré (AOR: 4.2; 95% CI: 1.6-11.2) and being admitted with mild (AOR: 7.4; 95% CI 2.1-25.8) and heavy or deep coma (AOR: 776.1; 95% CI: 340.2-1770.7) were significantly associated with mortality. CONCLUSIONS: Motorcycle RTA are an important cause of morbidity and mortality in Guinea. Males, young adult users, students, employees, and people from mining zones are the most affected. Better law enforcement and awareness raising among Guinean young adults are promising prevention strategies.