Genetic insights of H9N2 avian influenza viruses circulating in Mali and phylogeographic patterns in Northern and Western Africa.

Avian influenza viruses (AIVs) of the H9N2 subtype have become widespread in Western Africa since their first detection in 2017 in Burkina Faso. However, the genetic characteristics and diffusion patterns of the H9N2 virus remain poorly understood in Western Africa, mainly due to limited surveillance activities. In addition, Mali, a country considered to play an important role in the epidemiology of AIVs in the region, lacks more comprehensive data on the genetic characteristics of these viruses, especially the H9N2 subtype. To better understand the genetic characteristics and spatio-temporal dynamics of H9N2 virus within this region, we carried out a comprehensive genetic characterization of H9N2 viruses collected through active surveillance in live bird markets in Mali between 2021 and 2022. We also performed a continuous phylogeographic analysis to unravel the dispersal history of H9N2 lineages between Northern and Western Africa. The identified Malian H9N2 virus belonged to the G1 lineage, similar to viruses circulating in both Western and Northern Africa, and possessed multiple molecular markers associated with an increased potential for zoonotic transmission and virulence. Notably, some Malian strains carried the R-S-N-R motif at their cleavage site, mainly observed in H9N2 strains in Asia. Our continuous phylogeographic analysis revealed a single and significant long-distance lineage dispersal event of the H9N2 virus to Western Africa, likely to have originated from Morocco in 2015, shaping the westward diffusion of the H9N2 virus. Our study highlights the need for long-term surveillance of H9N2 viruses in poultry populations in Western Africa, which is crucial for a better understanding of virus evolution and effective management against potential zoonotic AIV strain emergence.

Men Who Have Sex with Both Men and Women in West Africa: Factors Associated with a High Behavioral Risk of Acquiring HIV from Male Partners and Transmission to Women (CohMSM ANRS 12324-Expertise France).

HIV is highly prevalent in men who have sex with men (MSM) in West Africa. Many MSM in the region also have sex with women (MSMW). Accordingly, they are a potential bridge subpopulation for HIV transmission to women. We aimed to evaluate the proportions and characteristics of West African MSMW at high behavioral risk of acquiring HIV from male partners and transmitting it to female partners (HBRMF). The cohort ANRS-12324 CohMSM Study included 630 HIV-negative MSM in Burkina Faso, Cote d'Ivoire, Mali, and Togo. Among MSMW (i.e., with ≥ 1 female partner) in the cohort, HBRMF was identified using trajectory models based on seven at-risk sexual practices with male and female partners, including inconsistent condom use, multiple partnerships, and receptive same-sex anal intercourse. To assess the relevance of using trajectory models, we compared the proportions of participants who seroconverted during the cohort follow-up among those at HBRMF and those not at HBRMF. Factors associated with HBRMF were identified using a generalized estimation equation logistic regression model accounting for longitudinal data. Approximately half (47%) of the 304 MSMW (22% of all CohMSM study participants) were at HBRMF. This group accounted for 75% of the 28 HIV seroconversions observed during follow-up (p = 0.001). HBRMF was positively associated with being aged < 25 years (aOR 95% CI 1.67 [1.23-2.27]), being sexually attracted only to men (1.97 [1.38-2.78]), feelings of loneliness (1.92 [1.38-2.65]), and homonegative violence score (1.22 [1.05-1.41]). HBRMF was negatively associated with having had both stable and casual female partners in the previous 6 months (0.34 [0.20-0.60] vs. only a stable female partner). HBRMF tended to be negatively associated with having ≥ 4 sexual intercourses with female partners in the previous four weeks (0.54 [0.27-1.06] vs. no intercourse). Establishing official relationships with women might be a strategy for young and/or stigmatized MSMW to comply with social pressure to display a heterosexual lifestyle. However, this seems to increase the risk of HIV transmission to female partners. In the present study, almost half of MSMW were at HBRMF. This result stresses the need to adapt HIV research and prevention to MSMW and their female partners.

Increasing incidence of Plasmodium ovale and persistent reporting of Plasmodium vivax in imported malaria cases: an analysis of 9-year surveillance data in four areas of China.

Background: This study aimed at exploring the epidemiological pattern of imported malaria in China before malaria elimination in 2021, to provide evidence-based data for preventing malaria re-establishment in China. Methods: Nine-year surveillance data on imported malaria in four provincial-level administrative divisions (PLADs) (Anhui, Chongqing, Guangxi, and Zhejiang) between 2011 and 2019 were thoroughly collected and analyzed. Results: A quite stable trend in imported malaria cases between 2011 and 2019 was observed. In total, 6,064 imported patients were included. Plasmodium falciparum was the most frequently reported species (4,575, 75.6%). Cases of malaria were most frequently imported from Western Africa (54.4%). We identified an increasing trend in P. ovale and a persistence of P. vivax infections among the cases of malaria imported from Western Africa. Most patients (97.5%) were 20-50 years old. Among imported malaria infections, the main purposes for traveling abroad were labor export (4,914/6,064, 81.0%) and business trips (649, 10.7%). Most patients (2,008/6,064, 33.1%) first visited county-level medical institutions when they sought medical help in China. More patients were diagnosed within 3 days after visiting Centers for Disease Control and Prevention (CDCs) or entry-exit quarantine facilities (EQFs) (1,147/1609, 71.3%) than after visiting medical institutions (2,182/3993, 54.6%). Conclusion: Imported malaria still poses a threat to the malaria-free status of China. County-level institutions are the primary targets in China to improve the sensitivity of the surveillance system and prevent the re-establishment of malaria. Health education should focus on exported labors, especially to Western and Central Africa. Increasing trend in P. ovale and persistence of P. vivax infections indicated their underestimations in Western Africa. Efficient diagnostic tools and sensitive monitoring systems are required to identify Plasmodium species in Africa.

Study on the use and effectiveness of malaria preventive measures reported by employees of chinese construction companies in Western Africa in 2021.

BACKGROUND: As malaria continues to be a significant global public health concern, especially in Sub-Saharan Africa, Chinese workers in Africa are at increased risk of malaria. The effectiveness of malaria prevention measures implemented by Chinese companies and workers is a question that may correlate with the malaria infection rate in this population. This study explored the use and effectiveness of malaria prevention measures for Chinese employees in West Africa to provide a reference for companies and individuals on improving malaria prevention and control. METHODS: Using a cross-sectional approach, we surveyed 256 participants in 2021, mainly from Nigeria, Mali, Côte d'Ivoire, Ghana, Guinea, Sierra Leone, and Senegal in West Africa. The survey duration is from July to the end of September 2021. We selected two companies from the 2020 ENR "World's Largest 250 International Contractors" list, which featured 6 Chinese companies, all of which are state-owned and have a 61.9% market share in Africa. The participants were Chinese workers with more than a year of work experience in construction companies in Africa. A 20-minute WeChat-based structured online questionnaire was used to obtain information on malaria infection status and malaria prevention measures. Descriptive statistical analysis, chi-square test, principal components analysis, and ordinal logistic regression analysis are used to analyze the data obtained. The difference in Statistical significance was set at P < 0.05. RESULTS: Ninety six (37.5%) participants contracted malaria more than once within a year. The principal components analysis found a low correlation between public and individual preventive measures. No significant correlation was found between public preventive measures and malaria infection (p > 0.05), while standardized use of mosquito nets (P = 0.016) and pesticide spraying (P = 0.047) contributed significantly to fewer malaria infections at the individual level, but the removal of vegetation around houses (P = 0.028) at the individual level related to higher malaria infection. CONCLUSIONS: In our sample of Chinese construction workers going to Africa, some individual preventive measures had a stronger association with malaria prevention than a variety of public environmental measures. Furthermore, individual and public preventive measures were not associated with each other. Both of these findings are surprising and require further investigation in larger and more diverse samples. This- study provides important clues about the challenges that risk reduction programs face for migrant workers from China and elsewhere.

Prevalence of SARS-CoV-2 and co-infection with malaria during the first wave of the pandemic (the Burkina Faso case).

Africa accounts for 1.5% of the global coronavirus disease 2019 (COVID-19) cases and 2.7% of deaths, but this low incidence has been partly attributed to the limited testing capacity in most countries. In addition, the population in many African countries is at high risk of infection with endemic infectious diseases such as malaria. Our aim is to determine the prevalence and circulation of SARS-CoV-2 variants, and the frequency of co-infection with the malaria parasite. We conducted serological tests and microscopy examinations on 998 volunteers of different ages and sexes in a random and stratified population sample in Burkina-Faso. In addition, nasopharyngeal samples were taken for RT-qPCR of SARS-CoV-2 and for whole viral genome sequencing. Our results show a 3.2 and a 2.5% of SARS-CoV-2 seroprevalence and PCR positivity; and 22% of malaria incidence, over the sampling period, with marked differences linked to age. Importantly, we found 8 cases of confirmed co-infection and 11 cases of suspected co-infection mostly in children and teenagers. Finally, we report the genome sequences of 13 SARS-CoV-2 isolates circulating in Burkina Faso at the time of analysis, assigned to lineages A.19, A.21, B.1.1.404, B.1.1.118, B.1 and grouped into clades; 19B, 20A, and 20B. This is the first population-based study about SARS-CoV-2 and malaria in Burkina Faso during the first wave of the pandemic, providing a relevant estimation of the real prevalence of SARS-CoV-2 and variants circulating in this Western African country. Besides, it highlights the non-negligible frequency of co-infection with malaria in African communities.

Individual- and Neighborhood-Level Factors of Measles Vaccination Coverage in Niamey, Niger: A Multilevel Analysis.

Vaccination is a proven equitable intervention if people take advantage of the opportunity to get vaccinated. Niger is a low-income country in West Africa, with a 76% measles 1 vaccination coverage rate in 2016. This study was conducted to identify individual- and neighborhood-level factors that could improve measles 1 vaccination coverage in Niamey, the capital. In October 2016, 460 mothers with children aged 12-23 months were surveyed. The outcome was to determine whether the mother's child had been vaccinated against measles 1 or not. For individual-level variables of measles 1 vaccination status, the following were included: mother's age group, mother tongue, maternal education level, husband's job, where the mother gave birth (at home or at a health center) and whether the mother discussed vaccination with friends. Neighborhood-level factors were access time to the health center, household access to electricity, and a grand-mean-centered wealth score. Multilevel logistic regression analysis was performed. At the individual-level, primary and secondary-educated mothers were more likely to vaccinate their children against measles 1 (aOR 1.97, 95% CI 1.11-3.51). At the neighborhood-level, no factors were identified. Therefore, a strengthened focus on equity-based, individual factors is recommended, including individual motivation, prompts and ability to access vaccination services.

Primary Healthcare Quality in Conflict and Fragility: a subnational analysis of disparities using Population Health surveys.

BACKGROUND: Recent global reports highlighted the importance of addressing the quality of care in all settings including fragile and conflict-affected situations (FCS), as a central strategy for the attainment of sustainable development goals and universal health coverage. Increased mortality burden in FCS reflects the inability to provide routine services of good quality. There is also paucity of research documenting the impact of conflict on the quality of care within fragile states including disparities in service delivery. This study addresses this measurement gap by examining disparities in the quality of primary healthcare services in four conflict-affected fragile states using proxy indicators. METHODS: A secondary analysis of publicly available data sources was performed in four conflict-affected fragile states: Cameroon, the Democratic Republic of Congo, Mali, and Nigeria. Two main databases were utilized: the Demographic Health Survey and the Uppsala Conflict Data Program for information on components of care and conflict events, respectively. Three equity measures were computed for each country: absolute difference, concentration index, and coefficients of mixed-effects logistic regression. Each computed measure was then compared according to the intensity of organized violence events at the neighborhood level. RESULTS: Overall, the four studied countries had poor quality of PHC services, with considerable subnational variation in the quality index. Poor quality of PHC services was not only limited to neighborhoods where medium or high intensity conflict was recorded but was also likely to be observed in neighborhoods with no or low intensity conflict. Both economic and educational disparities were observed in individual quality components in both categories of conflict intensity. CONCLUSION: Each of the four conflict-affected countries had an overall poor quality of PHC services with both economic and educational disparities in the individual components of the quality index, regardless of conflict intensity. Multi-sectoral efforts are needed to improve the quality of care and disparities in these settings, without a limited focus on sub-national areas where medium or high intensity conflict is recorded.

Review of the ecology and behaviour of Aedes aegypti and Aedes albopictus in Western Africa and implications for vector control.

Western Africa is vulnerable to arboviral disease transmission, having recently experienced major outbreaks of chikungunya, dengue, yellow fever and Zika. However, there have been relatively few studies on the natural history of the two major human arbovirus vectors in this region, Aedes aegypti and Ae. albopictus, potentially limiting the implementation of effective vector control. We systematically searched for and reviewed relevant studies on the behaviour and ecology of Ae. aegypti and Ae. albopictus in Western Africa, published over the last 40 years. We identified 73 relevant studies, over half of which were conducted in Nigeria, Senegal, or Côte d'Ivoire. Most studies investigated the ecology of Ae. aegypti and Ae. albopictus, exploring the impact of seasonality and land cover on mosquito populations and identifying aquatic habitats. This review highlights the adaptation of Ae. albopictus to urban environments and its invasive potential, and the year-round maintenance of Ae. aegypti populations in water storage containers. However, important gaps were identified in the literature on the behaviour of both species, particularly Ae. albopictus. In Western Africa, Ae. aegypti and Ae. albopictus appear to be mainly anthropophilic and to bite predominantly during the day, but further research is needed to confirm this to inform planning of effective vector control strategies. We discuss the public health implications of these findings and comment on the suitability of existing and novel options for control in Western Africa.

Prevalence, awareness, treatment, and control of hypertension in Bissau, Western Africa.

Hypertension is the leading preventable risk factor for cardiovascular diseases. In Guinea-Bissau there are no previous population-based hypertension surveys. Therefore, the authors aimed to estimate the prevalence, awareness, treatment, and control of high blood pressure among adults living in Bissau. A sample (n = 973) of dwellers in Bissau, aged 18-69 years, was assembled through stratified and cluster sampling. Patients underwent face-to-face interviews and blood pressure measurements following the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance. The prevalence of hypertension was 26.9%, and 51.4% of hypertensive individuals were aware of their condition, of whom 51.8% reported having received pharmacological treatment in the previous 2 weeks. Among the latter, 49.9% had blood pressure values below 140/90 mm Hg. These findings show that hypertension has become a major public health problem in Guinea-Bissau, emphasizing the urgent need to develop and implement national strategies for the prevention and management of hypertension.

Phylogeny and Cryptic Diversity of Diopatra (Onuphidae, Annelida) in the East Atlantic.

Diopatra Audouin & Milne-Edwards, 1833 is a species rich genus that is common in tropical and subtropical regions. The genus is readily identified by its striking, spiral branchiae, but species identification has historically been challenging due to a high variation in diagnostic characters used. This study aims to reconstruct the phylogeny of Diopatra with molecular markers and assess the species diversity of West African Diopatra with the species delimitation programs bPTP and BPP. Specimens were collected from Morocco to Angola, and the markers COI, 16S and 28S were sequenced from 76 specimens. The constructed phylogeny retrieved Diopatra as monophyletic, as well as five well supported clades within the genus. All clades were defined by morphological characters, some of which have previously not been considered to have high phylogenetic or taxonomical value. Species delimitation analyses recovered 17 new species, several of which were not readily identified morphologically. One species complex comprising between one and 12 species was left unresolved due to incongruence between the species delimitation methods and challenging morphology. Our results indicate that the diversity of Diopatra is significantly underestimated, where this regional study near to doubled the number ofknown species from the East Atlantic.

Access to primary healthcare Services in Conflict-Affected Fragile States: a subnational descriptive analysis of educational and wealth disparities in Cameroon, Democratic Republic of Congo, Mali, and Nigeria.

BACKGROUND: Measuring and improving equitable access to care is a necessity to achieve universal health coverage. Pre-pandemic estimates showed that most conflict-affected and fragile situations were off-track to meet the Sustainable Development Goals on health and equity by 2030. Yet, there is a paucity of studies examining health inequalities in these settings. This study addresses the literature gap by applying a conflict intensity lens to the analysis of disparities in access to essential Primary Health Care (PHC) services in four conflict-affected fragile states: Cameroon, Democratic Republic of Congo, Mali and Nigeria. METHODS: For each studied country, disparities in geographic and financial access to care were compared across education and wealth strata in areas with differing levels of conflict intensity. The Demographic Health Survey (DHS) and the Uppsala Conflict Data Program were the main sources of information on access to PHC and conflict events, respectively. To define conflict intensity, household clusters were linked to conflict events within a 50-km distance. A cut-off of more than two conflict-related deaths per 100,000 population was used to differentiate medium or high intensity conflict from no or low intensity conflict. We utilized three measures to assess inequalities: an absolute difference, a concentration index, and a multivariate logistic regression coefficient. Each disparity measure was compared based on the intensity of conflict the year the DHS data was collected. RESULTS: We found that PHC access varied across subnational regions in the four countries studied; with more prevalent financial than geographic barriers to care. The magnitude of both educational and wealth disparities in access to care was higher with geographic proximity to medium or high intensity conflict. A higher magnitude of wealth rather than educational disparities was also likely to be observed in the four studied contexts. Meanwhile, only Nigeria showed statistically significant interaction between conflict intensity and educational disparities in access to care. CONCLUSION: Both educational and wealth disparities in access to PHC services can be exacerbated by geographic proximity to organized violence. This paper provides additional evidence that, despite limitations, household surveys can contribute to healthcare assessment in conflict-affected and fragile settings.

Counseling Techniques Supporting West African Children With Adverse Childhood Experiences: A Systematic Review.

Using a meta-synthesis approach, through the review of current literature, five published and peer reviewed qualitative research reports were studied. The intention was to identify interventions being used with West African children who have endured adverse childhood experiences. These results were found through matching inclusionary criteria and all studies were screened for appropriateness and relevance to the topic matter. The literature was analyzed across five online databases including Proquest, PsychInfo, Scopus, Wiley, and Springer from January 2005 to June 2020. The authors found minimal evidence indicating interventions used in West Africa for adverse experiences related specifically to children, but found themes related to interventions that serve West African families that include children. Findings were thematically analyzed through meta-synthesis and identified four themes used in the interventions, which include western, spiritual, expressive arts, and cultural approaches. West African children endure adverse experiences such as terrorism, abuse, and war violence that contribute to an increasing the need for mental health interventions. These experiences approached from western, spiritual, expressive arts, and cultural vantage points were identified but limited in information about delivery and efficacy, thus providing little guidance regarding further exploratory research.

Preservative chemicals as a new health risk related to traditional medicine markets in western Africa.

Health risks associated to the use of tropical wildlife have so far been envisioned through the lens of zoonotic pathogens spread by the bushmeat trade, putting aside the equally vibrant network of traditional medicine markets (TMMs). We collected information on the preservative techniques used for animal body parts from TMMs in Benin through a semi-structured questionnaire addressed to 45 sellers. We show that a recent shift from traditional preservative techniques using harmless treatments towards modern techniques -involving the recurrent use of hazardous chemicals (such as Sniper)- is likely to pose a serious health risk to practitioners and consumers of animal parts from TMMs in Benin. We conclude that the non-regulation of the TMM activities represents a critical risk to both biodiversity conservation and human health in western Africa.

[Management of breast cancer in Abidjan: A single center experience]. / Expérience africaine monocentrique de la prise en charge personnalisée des cancers du sein à Abidjan : défis et perspectives.

AIM: To present the results of the personalized care of Ivorian women suffering from breast cancer since the advent of immunohistochemistry in Côte d'Ivoire. METHODS: We carried out a single-center retrospective study at the Yopougon university hospital from January 2014 to December 2018. All women's breast cancer with complementary immunohistochemistry and treated at the Yopougon hospital center were selected. Standard descriptive statistical tests were used to describe patient and tumor characteristics, and univariate and multivariate analyzes were performed with a statistical significance set at a P-value of 0.05 using SPSS version 20.0. RESULTS: The mean age of women is 48.27 years, SD (11.92). 50.88 % of the tumors were hormone-dependent. The triple negative subgroup was the most represented (43.28 %) followed by luminal A (35.42 %). Conservative treatment represented 18.51 % of cases. In the univariate analysis, the risk of developing a hormone-dependent cancer is statistically significant respectively in women with an education level removed OR=1.98 (P˂0.015) and with a wealthy salary OR=1.85 (P˂0.009). On the other hand, the high level of education (OR=0.44; P˂0.005), and the well-off salary condition (OR=0.59; P˂0.024) would be protective factors for the development of triple negative breast cancer. All these factors are not significant in multivariate analysis, whether for hormone-dependent or triple negative tumors. CONCLUSION: The personalized care of breast cancer in our African context remains difficult and must take into account several medical and extra-medical parameters.

Hymenopteran Parasitoids of Hard Ticks in Western Africa and the Russian Far East.

Some parasitoids of the genus Ixodiphagus (Hymenoptera, Chalcidoidea: Encyrtidae) are well-known natural enemies of ticks. In this study, we investigate the occurrence of parasitoid wasps in adult hard ticks from Western Africa (Côte d'Ivoire and Senegal) and Far Eastern Europe (Russia) using molecular methods. The morphological identification allowed the classification of 785 collected specimens of six species of ticks: Rhipicephalus (Boophilus) microplus (41%), Ixodes persulcatus (33%), Dermacentor silvarum (11%), Haemaphysalis concinna (7%), Amblyomma variegatum (5%), and Haemaphysalis japonica (3%). The newly developed MALDI-TOF MS protocol identified tick species in spite of their different storage (dried or in 70% ethanol) conditions for a long period. Molecular screening of ticks by a new standard PCR system developed in this study revealed the presence of parasitoid wasp DNA in 3% (28/785) of analyzed ticks. Ixodiphagus hookeri was detected in 86% (24/28) of infested ticks, including 13 I. persulcatus, 9 R (B) microplus, and one H. concinna and D. silvarum. While an unidentified parasitoid wasp species from the subfamily Aphidiinae and Braconidae family was detected in the remaining 14% (4/28) infested ticks. These infested ticks were identified as I. persulcatus. Our findings highlight the need for further studies to clarify the species diversity of parasitoid infesting ticks by combining molecular and morphological features. The novel molecular and MALDI-TOF MS protocols could be effective tools for the surveillance and characterization of these potential bio-control agents of ticks.

Maternal mortality risk indicators: Case-control study at a referral hospital in Guinea.

OBJECTIVE: This study aimed to describe intrapartum and postpartum exposures possibly associated with the risk of in-hospital maternal mortality in Guinea. STUDY DESIGN: Data were collected in the Western Sub-Saharan Africa setting at the university hospital in Conakry, Guinea, during 2016-2017. Case-control study design was applied. The cases comprised all intrapartum and postpartum maternal deaths recorded during the study period. The controls were selected by random sampling from patients discharged alive following hospitalization due to vaginal delivery or cesarean section. Maternal mortality ratio (MMR) was defined as a quotient of the number of maternal deaths per 100,000 live births. Multivariable logistic regression was applied to generate odds ratios (OR) and 95 % confidence intervals (95 %CI). RESULTS: A total of 10,208 live births and 144 maternal deaths were recorded. The MMR was at 1411 per 100,000 live births. The main causes of maternal death included postpartum hemorrhage (56 %), retroplacental hematoma (10 %), and eclampsia (9%). The ORs of maternal death were significantly elevated in case of transfer from another hospital (OR 24.60, 95 %CI 11.32-53.46), misoprostol-induced labor (OR 4.26, 95 %CI 2.51-7.91), non-use of partogram (OR 3.70, 95 %CI 1.31-5.20), duration of labor ≥24 h (OR 2.87, 95 %CI 1.35-5.29), and positive history of cesarean section (OR 2.54, 95 %CI 1.12-6.19). CONCLUSION: To stop preventable maternal mortality in Sub-Saharan Africa, continued efforts are needed to provide perinatal monitoring, to reorganize the obstetric reference system, and to decrease the number of avoidable cesarean sections. Furthermore, the internal supervision of misoprostol doses used for labor induction should be a priority.

Feasibility of manual white blood cell counts as a predictor of neonatal sepsis in a low-resource setting.

BACKGROUND: Manual white blood cell (WBC) differential counts as a predictor for neonatal sepsis development in a low-resource setting have not been thoroughly evaluated. We hypothesized that manual differentiation (specifically immature:total [I:T] neutrophil ratios) would be feasible and useful as an adjunct to predict early-onset neonatal sepsis (EONS). Secondarily, we hypothesized that vaccination with bacillus Calmette-Guérin (BCG) and oral polio vaccine (OPV) could alter WBC differential counts and thus might reduce its predictive performance. METHODS: We performed a prospective cohort study within a randomized trial, randomizing healthy, high-risk newborns admitted to the nursery at the national hospital in Guinea-Bissau 1:1 to BCG+OPV at admission or at discharge (usual practice). Thin capillary blood films were prepared at 2 d of age in a subset of 268 neonates. WBC counts were assessed by microscopy and neonates were followed up for sepsis development within 2 weeks. RESULTS: Ninety-eight percent (264/268) of smears provided interpretable reads. Of the 264 children, 136 had been randomized to receive BCG+OPV prior to sampling; the remaining 128 were vaccinated at discharge. The I:T ratio (average 0.017) was lower among children who did not develop clinical sepsis but did not predict sepsis (p=0.70). Only three children had an I:T ratio >0.2 (associated with a higher probability of clinical sepsis in previous studies) but did not develop sepsis. Immunization did not alter WBC composition. CONCLUSIONS: Manual WBC differentials are feasible in low-resource settings. WBC differentials are not affected by standard newborn immunization. However, the I:T ratio had no value in predicting subsequent development of sepsis.

Taxonomic revision of the Square-tailed Drongo species complex (Passeriformes: Dicruridae) with description of a new species from western Africa.

We describe a new species of drongo in the Square-tailed Drongo (Dicrurus ludwigii) complex using a combination of biometric and genetic data. The new species differs from previously described taxa in the Square-tailed Drongo complex by possessing a significantly heavier bill and via substantial genetic divergence (6.7%) from its sister-species D. sharpei. The new species is distributed across the gallery forests of coastal Guinea, extending to the Niger and Benue Rivers of Nigeria. We suspect that this taxon was overlooked by previous avian systematists because they either lacked comparative material from western Africa or because the key diagnostic morphological character (bill characteristics) was not measured. We provide an updated taxonomy of the Square-tailed Drongo species complex.

Facility-Based Maternal Death in Western Africa: A Systematic Review.

BACKGROUND: For exploring maternal death, supply and demand-side factors can be characterized by the three delays model developed by Thaddeus and Maine (1994). The model comprises delay in deciding to seek care (delay 1), delay in reaching the health facility (delay 2), and delay in receiving quality care once at the health facility (delay 3). Few studies have comprehensively dealt with the health systems delays that prevent the receipt of timely and appropriate obstetric care once a woman reaches a health facility (phase III delays). The objective of the present study was to identify facility-level barriers in West African health facilities. METHODS: Electronic databases (Medline, cumulative index to nursing and allied health literature, Centre for Agriculture and Biosciences International Global Health, EMBASE) were searched to identify original research articles from 1996 to 2016. Search terms (and synonyms) related to (1) maternal health care (e.g., obstetric care, perinatal care, maternal health services); (2) facility level (e.g., maternity unit, health facility, phase III, hospital); and (3) Western Africa (e.g., Nigeria, Burkina Faso) were combined. This review followed the preferred reporting items for systematic reviews and meta-analyses. RESULTS: Of the 2103 citations identified, 13 studies were eligible. Studies were conducted in Nigeria, Burkina Faso, Gambia, Guinea, Senegal, and Sierra Leone. 30 facility-level barriers were identified and grouped into 6 themes (human resources, supply and equipment, referral-related, infrastructure, cost-related, patient-related). The most obvious barriers included staff shortages, lack of maternal health services and procedures offered to patients, and lack of necessary medical equipment and supplies in the health-care facilities. CONCLUSION: This review emphasizes that phase I and phase II barriers are not the only factors preventing women from accessing proper emergency obstetric care. Health-care facilities in Western Africa are inadequately equipped to handle the obstetric needs of patients. Supply-side barriers must be addressed to reduce maternal mortality in the region.

EBOLA Ag K-SeT rapid test: field evaluation in Sierra Leone.

OBJECTIVES: Efficient interruption of Ebola virus disease (EVD) transmission chains critically depends on reliable and fast laboratory diagnosis. We evaluated the performance of the EBOLA Virus Antigen Detection K-SeT (EBOLA Ag K-SeT), a new rapid diagnostic antigen test in field settings. METHODS: The study was conducted in a field laboratory located in Freetown (Sierra Leone) by the Italian National Institute for Infectious Diseases 'L. Spallanzani' and the EMERGENCY Onlus NGO. The EBOLA Ag K-SeT was tested on 210 residual plasma samples (EVD prevalence 50%) from patients hospitalized at the EMERGENCY Ebola treatment center in Goderich (Freetown), comparing the results with quantitative real-time PCR. RESULTS: Overall, the sensitivity of EBOLA Ag K-SeT was 88.6% (95% confidence interval (CI), 82.5-94.7), and the corresponding specificity was 98.1% (95% CI, 95.5-100.7). The positive and negative predictive values were 97.9% (95% CI, 95.0-100.8) and 89.6% (95% CI, 84-95.2), respectively. The sensitivity strongly increased up to 98.7% (95% CI, 96.1-101.2) for those samples with high virus load (≥6.2 log RNA copies/mL). CONCLUSIONS: Our results suggest that EBOLA Ag K-SeT could represent a new effective diagnostic tool for EVD, meeting a need for resource-poor settings and rapid diagnosis for individuals with suspected EVD.