From research to a political commitment to strengthen access to surgical, obstetric, and anesthesia care in Africa by 2030.

Objective: This study aimed to engage African leaders and key stakeholders to commit themselves toward the strengthening of surgical, obstetric, and anesthesia care systems by 2030 in Africa. Methods: From research to a political commitment, a baseline assessment was performed to foster the identification of the gaps in surgical care as a first step of an inclusive process. The preliminary findings were discussed during the International Symposium on Surgical, Obstetric, and Anesthesia Systems Strengthening by 2030 in Africa. The conclusions served to draft the Dakar Declaration and its Regional Action Plan 2022-2030 to improve access to surgical care by 2030 in Africa, endorsed by Heads of State. Results: The International Symposium was composed of two meetings that gathered (i) 85 scientific experts and (ii) 28 ministers of health or representatives from 28 sub-Saharan African countries. The 28 African countries represent (i) 51% of the continent's total population, (ii) 68% of the 47 African countries of the WHO Africa Region, (iii) 58% of all African Union countries, and (vi) 79% (3,371) of the WHO Africa Region's total (4,271) health districts. The International Symposium and the Heads of State Summit successfully produced the Dakar Declaration on access to equitable, affordable, and quality Surgical, Obstetric, and Anesthesia Care by 2030 in Africa and its Regional Actions Plan 2022-2030 which prioritizes 12 urgent actions needed to be implemented, six strategic priorities, 16 key indicators, and an annual dashboard to monitor progress. Conclusion: The Dakar Declaration and its Regional Action Plan 2022-2030 are a commitment to establish quality and sustainable surgical, obstetric, and anesthesia care in each African country within the ambitious framework of "The Africa we want" Agenda 2063.

Lassa fever in Benin: description of the 2014 and 2016 epidemics and genetic characterization of a new Lassa virus.

We report two outbreaks of Lassa fever that occurred in Benin in 2014 and 2016 with 20 confirmed cases and 50% (10/20) mortality. Benin was not previously considered to be an endemic country for Lassa fever, resulting in a delay to diagnose the disease and its human transmission. Molecular investigations showed the viral genomes to be similar to that of the Togo strain, which is genetically very different from other known strains and confirms the existence of a new lineage. Endemic circulation of Lassa virus in a new territory and the genetic diversity thus confirm that this virus represents a growing threat for West African people. Given the divergence of the Benin strain from the prototypic Josiah Sierra Leone strain frequently used to generate vaccine candidates, the efficacy of vaccine candidates should also be demonstrated with this strain.

Impact of AIDS on adult mortality: a morgue-based study in Pointe-Noire, Republic of Congo.

OBJECTIVE: To measure the impact of AIDS on adult mortality by systematically investigating all deaths during 3 months, in the city of Pointe-Noire where the HIV epidemic emerged 20 years ago and levelled-off around 5% among adults. DESIGN: : Exhaustive morgue-based study, in a city where by law all bodies should be registered at the morgue before they can be legally buried. METHODS: From 30 June to 19 October 2001, a clinical examination of all bodies registered at the morgue was performed by a physician, and blood samples were systematically drawn for HIV testing. Relatives were interviewed on circumstances of death. Additional information was gathered from hospital files for cases previously hospitalized. Age- and sex-specific mortality rates were calculated using the population at risk derived from the 2001 census. RESULTS: Overall, 1309 adult deaths were investigated and 96.5% of the bodies registered at the morgue were tested for HIV. Forty-five percent of the deaths (570) were due to AIDS. The HIV prevalence was higher in female than in male deaths (57.1 versus 44.8%; P < 0.001). The AIDS-mortality rate among adults was 6.3 per thousand for women and 4.9 per thousand for men. Among 1000 young adults aged 15 years, 442 girls and 482 boys will not reach age 60 years (45q15). Without AIDS these would have been 216 and 307, respectively. CONCLUSIONS: Our study provides a direct measure of the impact of AIDS on mortality relative to other causes. In the most productive age group, 25-44 years, mortality is tripled by AIDS.

Genetic subtypes of HIV type 1 based on the vpu/env sequences in the Republic of Congo.

To investigate the HIV-1 subtypes prevalent in the Republic of Congo, we isolated 28 HIV-1 strains from Congolese AIDS patients in 1996 and 1997, and analyzed them phylogenetically. Phylogenetic analysis based on part of the 5' tat-env (vpu) and env sequences revealed that only 13 (46.4%) of the 28 isolates belonged to the same subtype in the vpu tree as in the env tree; the remaining 15 (53.6%) strains showed discordant subtypes between vpu and env with 6 different profiles; that is, 1 A/A (vpu/env), 1 D/D, 5 G/G, 4 H/H, 2 unclassified (U)/U, 9 G/A, 2 G/H, 1 G/J, 1 H/G, 1 U/A, and 1 U/J. Thus, 9 of the 15 discordant HIV-1s were of the G/A (vpu/env) type, and did not form any subcluster within the subtype G lineage in the vpu-based phylogenetic tree. In addition, CRF02_AG (IbNG), which is a G/A (vpu/env) type, was not found in the Republic of Congo. These data suggest that the majority of HIV-1 subtypes circulating in the Republic of Congo have mosaic structures and may have been derived from independent recombinational events.