Improving postpartum care for mothers and newborns in Niger and Mali: a case study of an integrated maternal and newborn improvement programme.

Despite appropriate guidelines, healthcare services worldwide often fail to deliver high-impact evidence-based care. This case study describes a large-scale programme to improve integrated postpartum care for mothers and newborns in Niger and Mali. As a result of an improvement effort based on common objectives, local ownership and shared learning to accelerate implementation of best practices, 78 facilities demonstrated rapid improvement in compliance with standards for post-partum haemorrhage prevention and Essential Newborn Care as well as a reduction in estimated postpartum haemorrhage. This approach yields rapid results and can be efficiently spread to improve care in low-resource settings.

Photochemically-induced fluorescence properties of two benzoyl- and phenylurea pesticides and determination in natural waters.

A photo-induced fluorescence (PIF) method was developed for the determination of two benzoyl- and phenylurea pesticides, namely diflubenzuron (DFB) and fenuron (FEN). The photoconversion under UV irradiation of both pesticides into strongly fluorescent photoproducts was performed in several media (methanol, ethanol, acetonitrile, pH4 aqueous solution and pH4 water-methanol (30:70, v/v) mixture). PIF parameters were optimized. Analytical figures of merit for the PIF determination of DFB and FEN were satisfactory, with rather wide linear dynamic range (LDR) values of one to two orders of magnitude, relatively low limit of detection (LOD) values of, respectively, 9-24 ng/mL for DFB and 1-28 ng/mL for FEN, and limit of quantification (LOQ) values of, respectively, 30-80 ng/mL for DFB and 4-95 ng/mL for FEN, according to the medium. Relative standard deviation (RSD) values were in the range 1.7-5.6%. PIF was validated by comparing its analytical performances to those of a standard UV absorption spectrophotometric method. The optimized PIF method was applied to the quantitative analysis of both pesticides in various spiked natural water samples collected in a Senegal agricultural area by the standard addition procedure prior to extraction steps in dichloromethane, with satisfactory mean recovery percentage values (97.0-105.3 for DFB and 98.3-102.8% for FEN). An interference study of foreign species, including pesticides and inorganic ions, likely to be present in natural waters, was also carried out.

Application of flow injection analysis--photo-induced fluorescence (FIA-PIF) for the determination of α-cypermethrin pesticide residues in natural waters.

Flow injection analysis combined with photo-induced fluorescence (FIA-PIF) has been applied for the determination of α-cypermethrin pesticide residues in Senegalese natural waters, using organic solutions and cyclodextrin (ß-cyclodextrin and 2-hydroxypropyl-ß-cyclodextrin) aqueous media. The α-cypermethrin insecticide has a very weak natural fluorescence, but it is converted into strongly fluorescent photoproduct(s) by UV irradiation. Cyclodextrins were found to enhance the PIF signal. FIA parameters, including mobile phase flow rate, injected volume, and reactor length, were optimized. Analytical performances of the FIA-PIF method for the determination of α-cypermethrin were satisfactory, with concentration linear dynamic ranges over one to two orders of magnitude and with rather low limits of detection and limits of quantification, in the ng mL(-1) range, and relative standard deviations comprised between 1.2% and 3.8%. Application of FIA-PIF for the analysis of fortified natural water samples collected from Senegal yielded good recovery values (84-112%). Because of its high sampling rate, the FIA-PIF method constitutes a rapid analytical tool, useful for quantification of α-cypermethrin residues in natural waters.

Development of a new automatic on-site detector of pesticides in natural waters by photo induced fluorescence, application to three phenylurea and benzoylurea herbicide.

Prototypes of on-site automatic photo induced fluorescence detectors of pesticide in natural waters are set up and applied for the determination of the benzoyl- and phenylurea pesticides, namely fluometuron, monolinuron and diflubenzuron. As these pesticides present no native fluorescence the set up system use the photo conversion under UV irradiation of these pesticides into highly fluorescent photoproducts. A first system, called AUTOPIF, (evolution the commercial AQUAPOD system) is develop using a detection via a diode array spectrometer. To improve the sensitivity of the method, a second system, called AUTOPIF+, is developed with a more resolute spectrometer and an intensified CCD camera detection. Analytical applications were carried out in aqueous solution and detected on line with the AUTOPIF and AUTOPIF+ system. The calibration curves are linear over one order of magnitude, and the limits of detection are in the µg mL-1 range. The analytical performances of these methods for the determination of the three pesticides are satisfactory in comparison to other classical PIF methods published for the determination of phenylurea pesticides in aqueous solutions. Our results show that the AUTOPIF and AUTOPIF+ methods are versatile, sensible and can be easily applied as an alert system to detect pollutant residues in naturals waters over a threshold value.

Predicting completion of treatment among foreign-born adolescents treated for latent tuberculosis infection in Los Angeles.

SETTING: Two health clinics in Los Angeles County, California. OBJECTIVE: To identify factors associated with completion of care among foreign-born adolescents treated for latent tuberculosis infection (LTBI). DESIGN: A total of 766 low-income adolescents (79% participation rate), including 610 foreign-born, were recruited. In prospective face-to-face interviews, data were obtained on socio-demographic and lifestyle characteristics, psychosocial factors and clinic-related variables. Medical chart data were abstracted regarding clinic appointment keeping and completion of treatment. Univariate and multivariate logistic regression analyses were performed to identify factors associated with completion of care. RESULTS: Foreign-born adolescents were more likely to complete care than US-born adolescents, with 82% completion of care rate. In logistic regression analyses after controlling for age, medication taking behavior (OR 1.26, 95%CI 1.15-1.39), living with both parents (OR 1.74, 95%CI 1.02-2.97), sexual intercourse (OR 0.66, 95%CI 0.36-1.19) and speaking mostly or only English with parents (OR 0.39, 95%CI 0.15-1.03) were independently associated with completion of care. CONCLUSION: These findings contribute to our understanding of the factors that may explain why some adolescents complete care whereas others do not. They provide supportive evidence that tailored intervention programs should be developed to support the screening and completion of treatment of foreign-born adolescents.

Fluorimetric determination of aromatic pesticides in technical formulations. Effects of solvent and of ultraviolet photolysis.

The effects of solvent and of ultraviolet (UV) photolysis on the fluorescence intensity of several aromatic pesticides including bendiocarb, chlorophacinone, coumatetralyl and pirimiphos-methyl were investigated. The type and polarity of solvent (acetonitrile, dimethylsulfoxide, methanol, ethanol and 2-propanol) were shown to play an important role in the limits of detection (LOD) of the method. UV photolysis provoked a decrease of the fluorescence signal more or less marked, depending of the structure of the pesticide. Analytical figures of merit were evaluated for the determination of pesticides under optimal conditions. The method exhibited satisfactory analytical performances. The linear dynamic ranges were obtained over more than two orders of magnitude. The LOD ranged from 0.03 to 20 ng/ml, according to the compound. The relative standard deviations were between 5.5 and 6.1%. Examples of application to the determination of pesticides in technical formulations are presented. The mean recoveries ranged from 86 to 116%. It shows the usefulness of this technique for pesticide analysis.

Fluorimetric analysis of pesticides: Methods, recent developments and applications.

The fluorimetric analysis of pesticides is reviewed with emphasis on the description of direct and indirect fluorimetric methods, including chemical derivatization, fluorogenic labelling, and photochemically-induced fluorescence. The use of fluorescence detection in TLC, HPLC and FIA as well as applications to environmental samples are discussed in detail.

Photochemically-induced fluorescence determination of sulfonylurea herbicides using micellar media.

An analytical method based on the use of UV irradiation to produce fluorescent derivatives from four non-fluorescent sulfonylurea herbicides, including chlorsulfuron, metsulfuron methyl, 3-rimsulfuron and sulfometuron methyl is described. Their photochemically-induced fluorescence (PIF) properties in several solvents (water, dimethyl sulfoxide (DMSO), dimethyl formamide (DMF), acetonitrile, methanol, ethanol, propan-2-ol and their binary mixtures with water) and micellar solutions of sodium dodecyl sulfate (SDS), and cetyltrimethylammonium chloride (CTAC) are reported. Physicochemical variable influencing the sensitivity of the method have been optimized. A PIF method is developed for the determination of the four herbicides under study. Micellar media are found to provide the best analytical figures of merits. Linear dynamic ranges are established over about two orders of magnitude. The limit of detection (LOD) range from 0.2 to 6 ng ml(-1) according to the compound, with relative standard deviation (RSD) between 1.2 and 3.9%. Examples of applications to the analysis of these herbicides in spiked river water samples are given. The mean recoveries range from 80 to 104%.

Behavioral interventions for the control of tuberculosis among adolescents.

OBJECTIVES: Activation of latent tuberculosis infection into tuberculosis disease (TB), the primary killer among infectious diseases worldwide, can be prevented with six months of anti-TB medication. A large percentage of adolescents started on medication, however, fail to complete their treatment. The authors developed and tested the effects of innovative educational strategies on infected adolescents at two health centers serving ethnically diverse populations. METHODS: The authors used a randomized experimental four-group design to assess the independent and combined effects of peer counseling and a participant-parent contingency contract intervention. RESULTS: A total of 794 adolescents were recruited into the study, for a 79% participation rate. The overall rate of treatment completion was 79.8%. Self-efficacy for medication-taking behavior at post-test correlated strongly with completion of care (R = 0.367, p = 0.002). Participants randomized to the peer counseling groups demonstrated significantly greater improvements in self-efficacy and mastery than the usual care control group. Based on the study results, continuing education seminars and workshops were implemented for TB control staff at the two health clinics and for all TB Control Division staff at the Los Angeles County Health Department. Educational materials and a training manual for enhancing completion of treatment of latent TB infection through tailored educational approaches were developed and disseminated to the clinics. CONCLUSIONS: Health education and incentives are helpful adjuncts to the completion of treatment for latent tuberculosis infection in adolescents.

Simultaneous determination of binary mixtures of sulfonylurea herbicides in water by first-derivative photochemically induced spectrofluorimetry.

First-derivative photochemically induced spectrofluorimetry (PIF-1D) is applied to the simultaneous determination of binary mixtures of 4 sulfonylurea herbicides in aqueous micellar samples. Synthetic binary mixtures of sulfometuronmethyl with chlorsulfuron, metsulfuron-methyl, and 3-rimsulfuron, respectively, are well resolved by using the zero-crossing point procedure. PIF-1D allows the determination of binary mixtures of these herbicides with linear dynamic ranges over about 2 orders of magnitude, limits of detection between 0.5 and 52 ng/mL, and relative standard deviations within 0.3-2.9%. Application to the determination of binary mixtures of these herbicides in spiked tap water samples yielded satisfactory recoveries (90-117%).

[Surgical treatment of clitoral cysts complicating female genital mutilation]. / Traitement chirurgical des kystes clitoridiens compliquant des mutilations génitales féminines.

We report the surgical management of eight vulvar tumors occurred at the waning of female genital mutilation practiced in childhood. Patients were aged 19 to 38 years. It was essentially excision type 2. Surgical excision of the labia minora with a refund without clitoral plasty gave satisfactory aesthetic and functional results. Histological examination of these tumors showed a single cyst containing keratin without inflammatory reaction.

Determination of phenylurea pesticides by direct laser photo-induced fluorescence.

A direct Laser Photo-Induced Fluorescence (DL-PIF) method is developed for the determination of two phenylurea pesticides, namely fenuron and diflubenzuron. The DL-PIF method uses a tunable Nd:YAG-OPO Laser to obtain the photoproduct(s) and to simultaneously analyse their fluorescence in a short acquisition time on an intensified CCD camera. Compared to classical PIF methods, the use of a tunable laser improves the selectivity (by choosing the suitable excitation wavelength), increases the sensitivity (due to the high energy of the beam) and also reduces the time of analysis. The analytical performances of this method for the determination of both pesticides are satisfactory in comparison to other classical PIF methods published for the determination of phenylurea pesticides. The calibration curves were linear over one order of magnitude and the limits of detection were in the ng mL(-1) range. Satisfactory recoveries were obtained in the analysis of both pesticides in river and sea water spiked samples.

Anthropometric characteristics and cardiometabolic risk factors in a sample of urban-dwelling adults in Senegal.

AIM: The aim of this study was to analyze the relationship between anthropometric characteristics and cardiometabolic risk factors in urban-dwelling adults in Senegal to evaluate future threats to the public health in terms of chronic diseases. METHODS: Age- and gender-matched control subjects for a study on the prevalence of lipodystrophy in HIV+ patients were selected between June and September 2006 from the general population through systematic home visits guided by area of residence of cases. After consenting to participate, these subjects underwent anthropometric, clinical and biological examinations in their homes. RESULTS: The sample included 60 men and 106 women, mean age of 43.2 ± 9.4 years. Although the prevalence of overweight and obesity was much higher in women (30.2 and 29.2%, respectively) vs. 23.3 and 3.4%, respectively, in men (P<0.001), the women had lower waist-to-hip ratios (mean [95% CI]: 0.78 [0.77-0.80] vs. 0.86 [0.84-0.88] in men; P<10(-4)) and better systolic blood pressure, triglyceride and high-density lipoprotein (HDL)-cholesterol levels. However, their insulin levels were significantly higher (32.1 [28.2-36.5] pmol/l vs. 25.5 [21.0-30.8] in men; P<0.04). Principal component analysis showed that glucose and insulin correlated with subcutaneous fat, whereas blood pressure correlated with central fat distribution. Lipids were distributed between these two factors. CONCLUSION: Obesity still appears to be rare in Senegalese urban-dwelling men, whereas women, despite their overweight, have no untoward cardiometabolic profiles. However, the observed correlations between cardiometabolic risk factors and the amount and/or distribution of body fat suggest that obesity prevention should not be overlooked in the public health agenda for sub-Saharan Africa.