Health transformation toward universal healthcare coverage amidst conflict: examining the impact of international cooperation in Niger.

Background: Approximately 70% of Sub-Saharan African countries have experienced armed conflicts with significant battle-related fatalities in the past two decades. Niger has witnessed a substantial rise in conflict-affected populations in recent years. In response, international cooperation has aimed to support health transformation in Niger's conflict zones and other conflict-affected areas in Sub-Saharan Africa. This study seeks to review the available evidence on health interventions facilitated by international cooperation in conflict zones, with a focus on Niger. Methods: We conducted a systematic literature review (SLR) adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted from 2000 to 4 September 2022 using MeSH terms and keywords to identify relevant studies and reports in Sub-Saharan Africa and specifically in Niger. Databases such as PubMed (Medline), Google Scholar, Google, and gray literature were utilized. The findings were presented both narratively and through tables and a conceptual framework. Results: Overall, 24 records (10 studies and 14 reports) that highlighted the significant role of international cooperation in promoting health transformation in conflict zones across Sub-Saharan Africa, including Niger, were identified. Major multilateral donors identified were the World Health Organization (WHO), United Nations Children's Fund (UNICEF), United Nations Fund for Population Activities (UNFPA), World Bank, United States Agency for International Development (USAID), European Union, European Commission Humanitarian Aid (ECHO), Global Fund, and Global Alliance for Vaccines and Immunization (GAVI). Most supports targeted maternal, newborn, child, adolescent, and youth health, nutrition, and psycho-social services. Furthermore, interventions were in the form of public health initiatives, mobile clinic implementation, data management, human resource capacity building, health information systems, health logistics, and research funding in conflict zones. Conclusion: This literature review underscores the significant engagement of international cooperation in strengthening and transforming health services in conflict-affected areas across Sub-Saharan Africa, with a particular focus on Niger. However, to optimize the effectiveness of healthcare activities from short- and long-term perspectives, international partners and the Ministry of Public Health need to re-evaluate and reshape their approach to health intervention in conflict zones.

Lassa fever outcomes and prognostic factors in Nigeria (LASCOPE): a prospective cohort study.

BACKGROUND: Lassa fever is a viral haemorrhagic fever endemic in parts of west Africa. New treatments are needed to decrease mortality, but pretrial reference data on the disease characteristics are scarce. We aimed to document baseline characteristics and outcomes for patients hospitalised with Lassa fever in Nigeria. METHODS: We did a prospective cohort study (LASCOPE) at the Federal Medical Centre in Owo, Nigeria. All patients admitted with confirmed Lassa fever were invited to participate and asked to give informed consent. Patients of all ages, including newborn infants, were eligible for inclusion, as were pregnant women. All participants received standard supportive care and intravenous ribavirin according to Nigeria Centre for Disease Control guidelines and underwent systematic biological monitoring for 30 days. Patients' characteristics, care received, mortality, and associated factors were recorded using standard WHO forms. We used univariable and multivariable logistic regression models to investigate an association between baseline characteristics and mortality at day 30. FINDINGS: Between April 5, 2018, and March 15, 2020, 534 patients with confirmed Lassa fever were admitted to hospital, of whom 510 (96%) gave consent and were included in the analysis. The cohort included 258 (51%) male patients, 252 (49%) female patients, 426 (84%) adults, and 84 (16%) children (younger than 18 years). The median time between first symptoms and hospital admission was 8 days (IQR 7-13). At baseline, 176 (38%) of 466 patients had a Lassa fever RT-PCR cycle threshold (Ct) lower than 30. From admission to end of follow-up, 120 (25%) of 484 reached a National Early Warning Score (second version; NEWS2) of 7 or higher, 67 (14%) of 495 reached a Kidney Disease-Improving Global Outcome (KDIGO) stage of 2 or higher, and 41 (8%) of 510 underwent dialysis. All patients received ribavirin for a median of 10 days (IQR 9-13). 62 (12%) patients died (57 [13%] adults and five [6%] children). The median time to death was 3 days (1-6). The baseline factors independently associated with mortality were the following: age 45 years or older (adjusted odds ratio 16·30, 95% CI 5·31-50·30), NEWS2 of 7 or higher (4·79, 1·75-13·10), KDIGO grade 2 or higher (7·52, 2·66-21·20), plasma alanine aminotransferase 3 or more times the upper limit of normal (4·96, 1·69-14·60), and Lassa fever RT-PCR Ct value lower than 30 (4·65, 1·50-14·50). INTERPRETATION: Our findings comprehensively document clinical and biological characteristics of patients with Lassa fever and their relationship with mortality, providing prospective estimates that could be useful for designing future therapeutic trials. Such trials comparing new Lassa fever treatments to a standard of care should take no more than 15% as the reference mortality rate and consider adopting a combination of mortality and need for dialysis as the primary endpoint. FUNDING: Institut National de la Santé et de la Recherche Médicale, University of Oxford, EU, UK Department for International Development, Wellcome Trust, French Ministry of Foreign Affairs, Agence Nationale de Recherches sur le SIDA et les hépatites virales, French National Research Institute for Sustainable Development.

[Frequency of tuberculosis and the impact of immunosuppression in people living with HIV (PLHIV) followed at the Regional Hospital Center of Maradi, Niger]. / Frequence de la tuberculose et l'impact de l'immunodepression chez les personnes vivant avec le VIH (PVVIH) suivies au Centre Hospitalier Regional de Maradi, Niger.

OBJECTIVE: Objective of this study was to determine the frequency of tuberculosis (TB) and the impact of immunosuppression in patients living with HIV (PvVIH) monitored at the Regional Hospital Center (CHR) of Maradi. METHODS: That was a retrospective study based on the medical records of PvVIH followed in the infectious diseases department of the CHR of Maradi. All HIV-positive adults were included in regular consultations between January 2013 and September 2018. RESULTS: A total of 872 patients were included. The average age of the cohort was 36.10 years ± 11,53. Of these patients, 15 had tuberculosis infection with a frequency of 1.72% (95% CI: 1.05 - 2.82) and 429 a CD4 T cell count of less than 200 / mm3. Of the 15 co-infected HIV / TB patients, 60% had a CD4 T cell count of less than 200 / mm3 (p = 0.78). HIV1 was tested in 98.73% of cases, HIV2 in 0.69% and both types of virus in 0.58% of cases. All patients who had a TB infection were HIV1 +. CONCLUSION: Knowledge about the prevalence and impact of TB in people living with HIV is needed to establish a mechanism for controlling this disease. It is more than necessary to prevent TB among PLWHIV when CD4 counts begin to decline.

OBJECTIF: L'objectif de cette étude était de déterminer la fréquence de la tuberculose (TB) et l'impact de l'immunodépression chez les personnes vivants avec le VIH (PvVIH) suivies au Centre Hospitalier Régional (CHR) de Maradi. MÉTHODES: Nous avons mené une étude rétrospective à partir des dossiers médicaux de PvVIH suivies dans le service des maladies infectieuses du CHR de Maradi. Ont été inclus tous les adultes séropositifs au VIH vus en consultation régulière entre Janvier 2013 et Septembre 2018. RÉSULTATS: Au total, 872 patients avaient été inclus dans notre étude. L'âge moyen de la cohorte était de 36,10 ans ± 11,53. Parmi ces patients, 15 avaient présenté une infection tuberculeuse soit une fréquence de 1,72% (IC 95% : 1,05 - 2,82) et 429 avaient un taux de Lymphocytes TCD4 inférieur à 200/mm3. Sur les 15 patients co-infectés VIH/TB, 60% avaient un taux de Lymphocytes T CD4 inférieur à 200/mm3 (P=0,78). Le VIH1 était impliqué dans 98,73% des cas, le VIH2 dans 0,69% et les deux types de virus à la fois dans 0,58% des cas. Tous les patients qui avaient présenté une infection tuberculeuse étaient VIH1+. CONCLUSION: Les connaissances sur les fréquences et l'impact sur l'immunodépression de la tuberculose chez les PvVIH sont nécessaires pour la mise en place d'un mécanisme de lutte efficace contre cette maladie. Il est plus que nécessaire de prévenir la tuberculose chez les PvVIH lorsque le taux de CD4 commence à régresser.

Perioperative management of gastrointestinal surgery in a resource-limited hospital in Niger: Cross-sectional study.

BACKGROUND: Perioperative management in digestive surgery is a challenge in sub-Saharan Africa. Objective: To describe the process and outcomes of perioperative management in gastrointestinal surgery. MATERIALS AND METHODS: This was a single center cross-sectional study over a 4-month period from June 1 to September 30, 2017, in a Nigerien hospital (West Africa). This study included caregivers and patients operated on gastrointestinal surgery. RESULTS: We collected data for 56 caregivers and 253 patients underwent gastrointestinal surgery. The average age of caregivers was 38.6 ± 8.7. The median length of professional practice was 9 years. Almost 52% of caregivers (n = 29) did not know the standards of perioperative care. The median age of patients was 24 years, and male gender constituted 70% of cases (n = 177) with a sex ratio of 2.32. Patients came from rural areas in 78.2% (n = 198). Emergency surgery accounted for 60% (n = 152). The most surgical procedure was digestive ostomies performed in 28.9% (n = 73), followed by hernia repair and appendectomy in 24.5% (n = 62) and 13.9% (n = 35) respectively. The postoperative course was complicated in 28.1% (n = 71) among which 13 deaths. In the group of caregivers, the poor practice of perioperative management was associated with poor professional qualification, insufficient equipment, insufficient motivation (p < 0.05). The ASA3&ASA4 score, undernutrition, emergency surgery, poor postoperative monitoring, and poor psychological preparation were associated with complicated postoperative outcomes (p < 0.05). CONCLUSION: The inadequacy of the technical platform and the lack of continuous training for healthcare staff represented the main dysfunctions of our hospital. The risk factors for complications found in this study need appropriate perioperative management to improve prognosis in gastrointestinal surgery.

Lassa fever clinical course and setting a standard of care for future randomized trials: A protocol for a cohort study of Lassa-infected patients in Nigeria (LASCOPE).

BACKGROUND: Lassa Fever (LF), is a severe viral disease prevalent in Western Africa. It is classified as a priority disease by the World Health Organization (WHO). Ribavirin is the recommended therapy despite weak evidence of its efficacy. Promising therapeutic agents are becoming available for evaluation in human. Before launching therapeutic trials, we need data on the evolution of the disease under the best possible conditions of care. METHODS: We have initiated a prospective study in Nigeria to better understand the clinical course and prognostic factors of LF while implementing high quality standardized care. Inclusion criteria are: suspected or confirmed LF and informed consent. Participants are followed 60 days from admission and receive free of charge standardized supportive care and biological monitoring, as well as intravenous ribavirin for those with confirmed LF. Data are collected using standardized case report forms (CRF). Primary and secondary outcomes are fatality and severe morbidity, with special focus on acute kidney dysfunction and pregnancy complications. Factors associated with outcomes will be investigated. RESULTS: The cohort is planned for 3 years. Inclusions started in April 2018 at the Federal Medical Center Owo in Ondo State. A second site will open in Nigeria in 2020 and discussions are underway to open a site in Benin. 150 to 200 new participants are expected per year. CONCLUSIONS: This cohort will: provide evidence to standardize LF case management; provide key inputs to design future clinical trials of novel therapeutics; and establish clinical research teams capable of conducting such trials in LF-endemic areas. STUDY REGISTRATION: The LASCOPE study was registered on ClinicalTrial.gov (NCT03655561).

[Malaria infection during pregnancy in Niamey, Niger]. / Infection palustre de la femme enceinte à Niamey au Niger.

INTRODUCTION: malaria during pregnancy is a major public health problem in Africa. It can have serious consequences for mother, fetus and newborn. It is associated with high maternal and infant mortality rate. The purpose of our study was to determine the prevalence of plasmodium infection in pregnant women, describe their clinical signs and potential complications, analyze associated factors, and propose preventive measures. METHODS: we conducted a cross-sectional study at the Issaka Gazobi Maternity Ward (MIG), Niamey, from 1 June to 30 November 2017. Diagnosis was based on microscopic examination. RESULTS: two hundred and forty-nine (249) women were included in this study. The prevalence of plasmodium infection was 36.5% (IC95%; [30.6; 42.9]). Mean parasite density was 177 P/µl (SD: 121; [40; 800]). All infections were due to P. falciparum. Seventy-three point six percent (67/91) of infected women were asymptomatic. Only 26.4% (24/91) of them had uncomplicated malaria; 9.6% (6/91) had miscarriage; 38.4% of newborns were low birthweight; 26.51% (66/249) developed congenital malaria. Mortality rate was 1.1% (1/ 91). Intermittent preventive treatment (IPT) significantly protected patients against gestational malaria (p=0.01). CONCLUSION: in Niger, P. falciparum infection very commonly affects pregnant women. It is most often asymptomatic but it can lead to uncomplicated or even severe malaria. Main consequences include abortion, low birth weight, intrauterine growth retardation, congenital malaria and maternal death. IPT and the use of long-lasting insecticide-treated mosquito nets (LLINs) can prevent infection.

Surgical management of pyelo-ureteral junction syndrome in a resource-limited setting: case of Zinder National Hospital, Niger.

BACKGROUND: Pyelo-ureteral junction syndrome (PUJS) is a frequent congenital malformation. We report the surgical management of PUJS by pyeloplasty according to Anderson-Hyne-Kuss's procedure at the Zinder National Hospital.. METHODS: This was a retrospective study from January 2013 to December 2016 (4 years), including patients who have undergone surgery for PUJS. RESULTS: Twelve (12) cases of PUJS had a surgery among which 66.7% were men with an average age of 32.5 ± 7.6 years. The clinical symptomatology was lumbar pain or renal colic in 92.3% of cases. This pain had evolved for more than 2 years for 58.3% of the cases. Ultrasound coupled with intravenous urography or CT-scan was performed to confirm the diagnosis of PUJS in 58.3 and 41.7% of cases. The average serum creatinine level at admission was 181.25 ± 67.3 µmol/L [Lab reference range: 53-97 µmol/L]. The Anderson-Hynes non dismembered pyeloplasty is used for all the patients. The release of a crossing lower pole vessel was performed in 25%, pyelolithotomy in 16.7%. The average surgery time was 118.3 ± 20.7 min. The average hospital length of stay was 10.8 ± 3 days. Immediate postoperative complications were recorded in 33.3% (n = 4). Postoperative outcomes were considered good by disappearance of clinical, biological and radiological signs. CONCLUSION: The Anderson-Hynes non dismembered pyeloplasty gives good results and provides a successful alternative in an environment where laparoscopy and robotic surgery are not developed.

Transfusional Malaria and Associated Factors at the National Blood Transfusion Center of Niamey-Niger.

SUMMARY: Problem. Transfusional malaria is an accidental transmission of Plasmodium via a blood transfusion. Its magnitude is underestimated and very little data on the assessment of this risk are available in Niger. OBJECTIVE: This study aimed to determine the prevalence of plasmodial infection of blood bags at the National Blood Transfusion Center of Niamey (NBTC). METHODOLOGY: A cross-sectional study to diagnose Plasmodium infection by microscopy and Rapid Diagnostic Test (RDT) was carried out during the rainy season (September to November 2015). Blood grouping was performed by the BETH-VINCENT technique. RESULTS: One thousand three hundred and fifty-seven (1357) blood bags were collected. One hundred and fifty-seven (11.6%) of the donors were infected with Plasmodium by microscopy and 2.4% (9/369) by rapid diagnostic test. All infections were with P. falciparum (100%). The mean parasite density was 197 parasites/µL (SD=281; [80: 2000]). There were no significant differences in infection prevalence between the ABO blood groups (p = 0.3) or the rhesus positivity (p=08). There is also no significant difference in temporal (p = 0.1) and spatial (p = 0.6) distribution. CONCLUSION: The transmission of transfusional malaria during the rainy season is a fact in Niger. Such risks were independent of the ABO blood type and positivity for the rhesus antigen. Pretransfusion diagnosis or posttransfusion therapy should be instituted to prevent it.

Changing trends in the epidemiology of vertebral osteomyelitis in Marseille, France.

The incidence and significant morbidity of vertebral osteomyelitis are increasing despite the progress of diagnosis competences. Among the 50 cases of vertebral osteomyelitis managed in our centers over the past 5 years, 84% of the cases were in men. The mean age was 55 years. Sixty-two percent of patients had comorbidities and risk factors: diabetes mellitus (24%), malignancy (16%), intravenous drug use (10%) and alcoholism (4%). A source of infection was identified in 66% of cases, including postvertebral surgery infection (18%) and hematogenous infection (48%). The mean time to diagnosis was 36 days. Back pain were occurred in 90% of cases, fever (70%), neurologic deficits (40%), epidural abscesses (32%), completed vertebral bone destruction (26%) and psoas abscess (12%). A single organism was isolated in 92% of cases. Gram-positive bacteria were identified in 76% of cases, while Gram-negative bacilli (GNB) were found in 18% of cases. The presence of GNB was significantly associated with malignancy (p 0.041). The mean duration of antibiotic therapy was 123 days. Surgical treatment was performed in 41 cases: spinal stabilization (26%), drainage of abscesses (32%) and relief of compression (40%). Residual pain was found in 24% of cases, and neurologic sequelae in 22%. Cervical or thoracic localization was a risk factor for neurologic compromise (p 0.042). The epidemiology of vertebral osteomyelitis has changed; an increase in malignancy that was significantly associated with vertebral osteomyelitis due to GNB has been observed. Our study shows that the rate of neurologic complications remains high despite improved diagnostic capabilities and optimal treatment.

Protective measures against acute respiratory symptoms in French pilgrims participating in the Hajj of 2009.

Among a cohort of 274 French pilgrims participating in the 2009 Hajj, 77.4% used hand disinfectant, 89.8% used disposable handkerchiefs, and 79.6% used face masks; 97.4% were vaccinated against seasonal flu, 5.8% against H1N1, and 31.4% against pneumococcus. Influenza vaccine and face mask use did not significantly reduce respiratory symptoms.