Relevance of a citizen participation technology platform to strengthen sub-Saharan health systems / Pertinence d'une plateforme technologique de participation citoyenne pour consolider les systèmes de santé subsahariens

Introduction: A citizen participation intervention using a toll-free number combined with an interactive voice server to collect citizens' opinions on their health systems was conducted in Burkina Faso, Benin, and the Democratic Republic of Congo between 2020 and 2021. Purpose of research: This paper aims to assess the effectiveness, sustainability, and transferability of this m-participation intervention to the health systems strengthening. Results: The analysis shows the relevance of the telephone to include citizens in the governance of sub-Saharan health systems. Conclusion: Information and communication technologies are an important support in the quest for better health democracy in sub-Saharan Africa.

Introduction: Une intervention de participation citoyenne par téléphone, via un numéro vert combiné à un serveur vocal interactif pour recueillir les opinions des citoyens sur leurs systèmes de santé a été déployée au Burkina Faso, au Bénin et en République démocratique du Congo entre 2020 et 2021. But de l'étude: Cet article évalue l'efficacité, la viabilité et la transférabilité de cette intervention participative pour consolider les systèmes de santé. Résultats: L'analyse montre une pertinence du téléphone pour impliquer les citoyens dans la gouvernance des systèmes de santé subsahariens. Conclusion: Les technologies de l'information et de la communication sont un soutien important dans la quête d'une meilleure démocratie sanitaire en Afrique subsaharienne.

Using Information and Communication Technologies to Engage Citizens in Health System Governance in Burkina Faso: Protocol for Action Research.

BACKGROUND: Health systems are complex systems involving a vast range of actors. In West Africa, they are often not accessible or responsive. Burkina Faso has widely expressed, in its public health policy, the need to improve both access to quality care and health system responsiveness. There is also a strong wish to give more voice to citizens. To support Burkinabè institutions in achieving these goals, we have developed an action research (AR) protocol. OBJECTIVE: This paper presents the protocol that will address citizens' participation in health policies and their empowerment through the expression of opinions, for accountability, as well as the strengthening of the health system using information and communication technologies (ICTs). METHODS: Our approach will consist of (1) enabling people to express their opinions on the health system by means of a toll-free (TF) service coupled with an interactive voice server (IVS); (2) building an information base with anonymous and reliable data; and (3) conducting information awareness-raising activities, including knowledge transfer (KT) and advocacy, social integration activities, development of OpenData platforms, and the capitalization and media coverage of governance issues. For this purpose, the AR project will be implemented in Burkina Faso. The design uses a concurrent mixed-methods approach. This AR project will evaluate the acceptability, process, effectiveness, and economic costs of the device's implementation. We will also analyze the potential for the data collected by the device to be used to improve practices. RESULTS: Data collection is in progress; the TF number was officially launched on July 1, 2020, and data collection is planned to continue throughout 2021. By using mixed methods, our AR will be approached from a variety of perspectives. Mixed methods will support us in combining the partial insights into sophisticated realities from qualitative inquiries with the data analyses produced by quantitative research. CONCLUSIONS: This AR is expected to add knowledge on how to increase the empowerment of the population, especially the most vulnerable, to participate in democratic processes and enjoy and exercise their human rights. This protocol recommends implementing a low-cost, contextually adapted technology, associated with an evidence-based approach and carried out on a significant scale. The originality of this approach lies in the fact that it introduces a real AR dimension with local communities and nongovernmental organizations (NGOs), combined with an integrated strategy of KT and application throughout the project for all stakeholders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/28780.

Environmental concentration of nonylphenol alters the development of urogenital and visceral organs in avian model.

Nonylphenol (NP) is an endocrine disruptor with harmful effects including feminization and carcinogenesis on various organisms. This substance is a degradation product of nonylphenol ethoxylates (NPEO) that is used in several industrial and agricultural processes. In this paper, we examined the assessment of NP exposure on chick embryo development, using a concentration consistent with the environmental concentrations of NP. With this aim, NP (between 0.1 and 50 µg/egg) was injected into the yolk of egg through a small needle hole in the shell. We report the effect of NP on chick reproductive system development although the effect we observed is lower than those observed by exposition to other endocrine disruptors. However, histological analysis highlighted a decrease of intraluminal seminiferous surface area in 64.12% of case (P=0.0086) and an heterogeneous organization of the renal tubules when 10 µg/egg were injected. Moreover, an impairment of liver development with an abnormal bile spillage was observed when higher concentration of NP was injected (50 µg/egg).

Gastrointestinal defects of the Gas1 mutant involve dysregulated Hedgehog and Ret signaling.

The gastrointestinal (GI) tract defines the digestive system and is composed of the stomach, intestine and colon. Among the major cell types lining radially along the GI tract are the epithelium, mucosa, smooth muscles and enteric neurons. The Hedgehog (Hh) pathway has been implicated in directing various aspects of the developing GI tract, notably the mucosa and smooth muscle growth, and enteric neuron patterning, while the Ret signaling pathway is selectively required for enteric neuron migration, proliferation, and differentiation. The growth arrest specific gene 1 (Gas1) encodes a GPI-anchored membrane protein known to bind to Sonic Hh (Shh), Indian Hh (Ihh), and Ret. However, its role in the GI tract has not been examined. Here we show that the Gas1 mutant GI tract, compared to the control, is shorter, has thinner smooth muscles, and contains more enteric progenitors that are abnormally distributed. These phenotypes are similar to those of the Shh mutant, supporting that Gas1 mediates most of the Shh activity in the GI tract. Because Gas1 has been shown to inhibit Ret signaling elicited by Glial cell line-derived neurotrophic factor (Gdnf), we explored whether Gas1 mutant enteric neurons displayed any alteration of Ret signaling levels. Indeed, isolated mutant enteric progenitors not only showed increased levels of phospho-Ret and its downstream effectors, phospho-Akt and phospho-Erk, but also displayed altered responses to Gdnf and Shh. We therefore conclude that phenotypes observed in the Gas1 mutant are due to a combination of reduced Hh signaling and increased Ret signaling.

The chick embryo: an animal model for detection of the effects of hormonal compounds.

Hormonal compounds are a class of pharmaceutical product that disrupt the endocrine system of animals and humans. Exposure to these molecules, even at low concentrations, can have severely damaging effects on the environment, to organisms, and to humans. The cumulative presence of these compounds is also characterized by synergistic effects which are difficult to estimate. They are an underestimated danger to the environment and to the human population. This paper presents an in-vivo model enabling to assessment of the real impact of exposure to hormonal compounds and the synergistic effect which can be involved. The anatomical effects of in-ovo exposure to two natural estrogen compounds (estrone and estriol, at 600 ng g(-1)) and a synthetic estrogen (ethynylestradiol, at 20 ng g(-1)) have been investigated. Estrone and estriol lead to morphological defects, mainly in the urogenital system of the developing chick embryo, whereas ethynylestradiol has fewer effects. Estriol caused persistence of Müllerian ducts in 50% of male embryos and hypertrophic oviducts in 71% of females. Estrone had the same effects but at the percentages were lower. Kidney dysfunction was also observed, but only with estrone, in both males and females. We also tested estrogenic compounds in two types of cell line which are estrogen sensitive (BG1 and MCF7) then completed and confirmed our previous in-vivo results. Seven pharmaceutical-like compounds--estrone (E1), estradiol (E2), estriol (E3), ethynylestradiol (EE(2)), carbamazepine (C), genistein (G), and bisphenol-A (BPA)--were tested alone or in mixtures. Different effects on the two cell lines were observed, indicating that endocrine compounds can act differently on this organism. Experiments also showed that these molecules have synergistic action and induce more severe effects when they are in mixtures.

SOX9 specifies the pyloric sphincter epithelium through mesenchymal-epithelial signals.

Gastrointestinal (GI) development is highly conserved across vertebrates. Although several transcription factors and morphogenic proteins are involved in the molecular controls of GI development, the interplay between these factors is not fully understood. We report herein the expression pattern of Sox9 during GI development, and provide evidence that it functions, in part, to define the pyloric sphincter epithelium. SOX9 is expressed in the endoderm of the GI tract (with the exclusion of the gizzard) and its derivate organs, the lung and pancreas. Moreover, SOX9 is also expressed at the mesoderm of the pyloric sphincter, a structure that demarcates the gizzard from the duodenum. Using retroviral misexpression technique, we show that Sox9 expression in the pyloric sphincter is under the control of the BMP signaling pathway, known to play a key role in the development of this structure. By misexpressing SOX9 in the mesoderm of the gizzard, we show that SOX9 is able to transdifferentiate the adjacent gizzard epithelium into pyloric sphincter-like epithelium through the control of mesodermal-epithelial signals mediated in part by Gremlin (a modulator of the BMP pathway). Our results suggest that SOX9 is necessary and sufficient to specify the pyloric sphincter epithelial properties.