Association of TP53 rs1042522 with cervical cancer in the sub-Saharan African population: a meta-analysis.

OBJECTIVE: TP53 plays a crucial role in preventing cancer development. Previous studies in sub-Saharan Africa (SSA) reported inconclusive findings for the association of the TP53 rs1042522 C > G variant with cervical cancer. We therefore performed a meta-analysis to summarise this association in the SSA population. METHODS: Online databases were searched to identify suitable articles according to the PRISMA guidelines. We included studies published in English or French that provided the sample sizes and genotype counts for both cases and controls and evaluated the association between TP53 rs1042522 and cervical cancer in the SSA population. A fixed-effect model was used to calculate the pooled odds ratio (OR) and 95% confidence intervals (95% CIs). RESULTS: A total of 699 cervical cancer cases and 1008 controls from eight studies in SSA were included in this meta-analysis. Women harbouring the variant G allele of the TP53 rs1042522 were at increased risk of cervical cancer in allelic (G vs. C; OR = 1.30, 95% Cl = 1.12-1.50), homozygous (GG vs. CC; OR = 1.62, 95% CI = 1.20-2.19) and recessive (GG vs. CG + GG; OR = 1.74, 95% CI = 1.34-2.25) genetic models. However, the dominant genetic model (CG + GG vs. CC; OR = 1.20, 95% CI = 0.96-1.48) was not significantly associated with cervical cancer. CONCLUSIONS: Our meta-analysis revealed that harbouring variant G allele of TP53 rs1042522 is associated with cervical cancer risk in the SSA population.

OBJECTIF: Le TP53 joue un rôle crucial dans la prévention du développement du cancer. Des études antérieures en Afrique subsaharienne (ASS) ont rapporté des résultats non concluants pour l'association de la variante TP53 rs1042522 C>G avec le cancer du col de l'utérus. Nous avons donc réalisé une méta-analyse pour résumer cette association dans la population SSA. MÉTHODES: Les bases de données en ligne ont été recherchées pour identifier les articles appropriés selon les directives PRISMA. Nous avons inclus des études publiées en anglais ou en français qui ont fourni la taille des échantillons et le nombre de génotypes pour les cas et les témoins et évalué l'association entre TP53 rs1042522 et le cancer du col de l'utérus dans la population SSA. Un modèle à effet fixe a été utilisé pour calculer le rapport de cotes combiné (OR) et les intervalles de confiance à 95% (IC95%). RÉSULTATS: Un total de 699 cas de cancer du col utérin et 1008 témoins de huit études en ASS ont été inclus dans cette méta-analyse. Les femmes hébergeant l'allèle variant G du TP53 rs1042522 présentaient un risque accru de cancer du col de l'utérus chez les modèles génétiques alléliques (G vs C; OR = 1,30, IC95%: 1,12-1,50), homozygotes (GG vs CC; OR = 1,62, IC95%: 1,20-2,19) et récessifs (GG vs.CG + GG; OR = 1,74, IC95%: 1,34-2,25). Cependant, le modèle génétique dominant (CG + GG vs CC; OR = 1,20, IC95%: 0,96-1,48) n'était pas significativement associé au cancer du col utérin. CONCLUSIONS: Notre méta-analyse a révélé que l'hébergement de l'allèle variant G de TP53 rs1042522 est associé au risque de cancer du col de l'utérus dans la population SSA.

[A Mythological Anamnesis: from AIDS Spiders to the Bats of Ebola or Covid-19 - Revised Version of the Paper Presented at the Colloquium "Cultural and Social Perspectives on Epidemics", musée du quai Branly-Jacques-Chirac, June 27, 2019]. / Une anamnèse mythologique : des araignées du sida aux chauves-souris d'Ebola ou de la Covid-19 ­ Version remaniée de la communication présentée au colloque Regards culturels et sociaux autour des épidémies, musée du quai Branly-Jacques-Chirac le 27 juin 2019.

This article focuses on some representations of the origin of AIDS and Ebola in Burkina Faso, against a new background of Covid-19 which began in early 2020 in connection with two animals: the spider and the bat. These are also, if not first and foremost, heroes of oral literature (from tales to myths) from this region of West Africa. It is up to anthropologists to explore the meandering symbolism and imagination of these liminal animals that move back and forth between the worlds inhabited by humans and the "bush" worlds of non-humans. Here arises a mythological anamnesis. These "trickster" animals challenge categories and understanding of both virologists and anthropologists.

Cet article porte sur quelques représentations de l'origine du sida et d'Ebola en pays lobi burkinabè, avec la Covid-19 en nouvel arrière-plan depuis le début de l'année 2020, en lien avec deux animaux : l'araignée et la chauve-souris. Ce sont aussi, voire d'abord, des héros de la littérature orale (des contes aux mythes) de cette région d'Afrique de l'Ouest. Des anthropologues ont exploré les méandres des symboliques et des imaginaires de ces animaux liminaires qui vont et viennent entre les mondes habités par les humains et les univers de « brousse ¼ des non-humains. Une anamnèse mythologique est mise à jour. Ces animaux rusés se jouent de nos catégories et de notre entendement, virologues et anthropologues ici confondus.

[Epidemiology of primitive digestive cancers in adult in three specialized health centers in Cotonou (Benin Republic)]. / Épidémiologie des cancers digestifs primitifs de l'adulte dans trois centres sanitaires spécialisés de Cotonou (République du Bénin).

Health research studies are increasingly focusing on digestive cancers because of their increasing frequency and severity. The objective of this work was to study the epidemiological aspects of primary digestive cancers in adults in three hospital centers in the commune of Cotonou. A total of 676 cases of digestive cancers were identified out of 25,093 patients received during the study period (2.7%). The mean age was 54 ± 14.1 years: [16-96] and the sex ratio was 2:1. The most frequent cancers were those of the liver (259; 38.3%) and colon-rectum (154; 22.8%). The next most common cancers in descending order were gastric cancer (12%), esophageal cancer (11.4%), pancreatic cancer (11.4%), anal cancer (1.9%), hail cancer (1.5%) and biliary cancer (0.7%). The average time to visit was 9 months. The main risk factors found were viral hepatitis B and C, alcoholism, diabetes, obesity, colonic polyps, smoking, excessive consumption of salt and dietary nitrates. Lethality was 58.4%, with cancers of the liver, colon-rectum, pancreas, and esophagus in descending order of mortality. The average overall survival was 10 months. Digestive cancers most often affect people in their fifties, who are usually men in Cotonou. They are dominated by liver cancer and colorectal cancer. Modifiable risk factors are often found. The control of these factors and early diagnosis could help improve the survival of patients affected.

L'objectif de ce travail était d'étudier les aspects épidémiologiques des cancers digestifs primitifs chez l'adulte dans trois centres hospitaliers de la commune de Cotonou. Il s'agissait d'une étude transversale descriptive et analytique, ayant comporté deux phases de recueil de données, l'une rétrospective sur neuf ans et l'autre prospective sur dix mois. Elle a porté sur les patients présentant un cancer digestif pris en charge dans trois centres hospitaliers de la commune de Cotonou au Bénin. Au total, 676 cas de cancers digestifs ont été répertoriés sur 25 093 patients reçus au cours de la période d'étude, soit 2,7 %. L'âge moyen était de 54 ± 14,1 ans : [16­96], et le sex-ratio était de 2:1. Les cancers les plus fréquents étaient ceux du foie (259 ; 38,3 %) et du côlon-rectum (154 ; 22,8 %). Venaient ensuite dans l'ordre décroissant le cancer gastrique (12 %), le cancer oesophagien (11,4 %), le cancer pancréatique (11,4 %), le cancer anal (1,9 %), le cancer grêlique (1,5 %) et le cancer biliaire (0,7 %). Le délai moyen de consultation était de neuf mois. Les principaux facteurs de risque trouvés étaient les hépatites virales B et C, l'alcoolisme, le diabète, l'obésité, les polypes coliques, le tabagisme, la consommation excessive de sel et nitrates alimentaires. La létalité était de 58,4 %, avec dans l'ordre décroissant de mortalité les cancers du foie, du côlonrectum, du pancréas et de l'oesophage. La moyenne de survie globale était de dix mois. Les cancers digestifs touchent le plus souvent des sujets de la cinquantaine, volontiers de sexe masculin à Cotonou. Ils sont dominés par le cancer du foie et le cancer colorectal. Des facteurs de risque modifiables sont souvent retrouvés. Le contrôle de ces facteurs et le diagnostic précoce pourraient contribuer à améliorer la survie des patients atteints.

Design and field methods of the ARISE Network Adolescent Health Study.

The ARISE Network Adolescent Health Study is an exploratory, community-based survey of 8075 adolescents aged 10-19 in 9 communities in 7 countries: Burkina Faso, Eswatini, Ethiopia, Ghana, Nigeria, Tanzania and Uganda. Communities were selected opportunistically and existing population cohorts maintained by health and demographic surveillance systems (HDSSs). The study is intended to serve as a first round of data collection for African adolescent cohorts, with the overarching goal of generating community-based data on health-related behaviours and associated risk factors in adolescents, to identify disease burdens and health intervention opportunities. Household-based sampling frames were used in each community to randomly select eligible adolescents (aged 10-19 years). Data were collected between July 2015 and December 2017. Consenting participants completed face-to-face interviews with trained research assistants using a standardised questionnaire, which covered physical activity, cigarette and tobacco use, substance and drug use, mental health, sexual behaviours and practices, sexually transmitted infections, pregnancy, food security and food diversity, teeth cleaning and hand washing, feelings and friendship, school and home activities, physical attacks and injuries, health care, health status assessment and life satisfaction, as well as media and cell phone use and socio-demographic and economic background characteristics. Results from this multi-community study serve to identify major adolescent health risks and disease burdens, as well as opportunities for interventions and improvements through policy changes.

L'étude ARISE du réseau sur la santé des adolescents est une étude exploratoire de surveillance basée sur la communauté portant sur 8.075 adolescents âgés de 10 à 19 ans dans 9 communautés de 7 pays: Burkina Faso, Eswatini, Ethiopie, Ghana, Nigéria, Tanzanie et Ouganda. Les communautés ont été sélectionnés de manière opportuniste et les cohortes de population existantes maintenues par des systèmes de surveillance de la santé et démographique (SSSD). L'étude est destinée à servir comme premier cycle de collecte de données pour les cohortes d'adolescents africains, dans le but primordial de générer des données communautaires sur les comportements liés à la santé et les facteurs de risque associés chez les adolescents, afin d'identifier la charge de morbidité et les opportunités d'intervention en matière de santé. Des cadres d'échantillonnage basés sur le ménage ont été utilisés dans chaque communauté pour sélectionner au hasard les adolescents admissibles (âgés de 10-19 ans). Les données ont été collectées entre juillet 2015 et décembre 2017. Les participants consentants ont participé à des entretiens de face à face avec des assistants de recherche formés, à l'aide d'un questionnaire standardisé couvrant l'activité physique, l'usage de la cigarette ou la consommation de tabac, l'usage de drogues et autres substances, la santé mentale, les comportements et pratiques sexuels, les infections sexuellement transmissibles, la grossesse, la sécurité et la diversité alimentaire, le nettoyage des dents et le lavage des mains, les sentiments et les amitiés, les activités scolaires et à domicile, les attaques et les blessures physiques, les soins de santé, l'évaluation de l'état de santé et la satisfaction à l'égard de la vie, l'utilisation des médias et du téléphone portable ainsi que les caractéristiques sociodémographiques et économiques. Les résultats de cette étude portant sur plusieurs communautés permettent d'identifier les principaux risques pour la santé des adolescents et les charges de morbidité, ainsi que les opportunités d'interventions et d'amélioration par le biais de changements de politiques.

Gender differences in nutritional status, diet and physical activity among adolescents in eight countries in sub-Saharan Africa.

OBJECTIVE: The objective of this study was to evaluate gender differences in nutritional status, dietary intake, physical activity and hand hygiene among adolescents from diverse geographical settings in sub-Saharan Africa. METHODS: This study utilised cross-sectional data from six countries (Burkina Faso, Ethiopia, Ghana, Nigeria, Tanzania and Uganda) within the ARISE Adolescent Health Survey (n = 7625). Body mass index (BMI) was calculated using measured heights and weights, and z-scores were calculated based on the 2007 WHO growth standards for age and sex. Information on demographics, diet and health behaviours was collected through face-to-face interviews using a standardised questionnaire. Site-specific and pooled prevalence ratios were determined. RESULTS: The prevalence of underweight, overweight and stunting pooled across sites was 14.3%, 6.8% and 18.1%, respectively. Female sex was associated with a lower risk of being underweight (pooled prevalence ratio 0.66, 95% 0.57, 0.77) and stunted (pooled PR 0.63, 95% CI 0.55, 0.71), but a higher risk of being overweight (pooled PR 1.60, 95% CI 1.26, 2.06). Females were also less likely to exercise for 1 h or more per day (pooled PR 0.77, 95% CI 0.67, 0.88), and more likely to wash hands after using toilets or latrines and to wash hands with soap (pooled PRs 1.13, 95% CI 1.05, 1.21 and 1.35, 95% CI 1.23, 1.45, respectively). CONCLUSION: Our results emphasise that sex is a key predictor of nutritional status among sub-Saharan African adolescents and suggest that gender-specific interventions may be required to reduce the double burden of under- and overnutrition.

OBJECTIF: L'objectif de cette étude était d'évaluer les différences entre les sexes en matière d'état nutritionnel, d'apport alimentaire, d'activité physique et d'hygiène des mains chez les adolescents de divers contextes géographiques en Afrique subsaharienne. MÉTHODES: Cette étude a utilisé des données transversales provenant de six pays (Burkina Faso, Ethiopie, Ghana, Nigeria, Tanzanie et Ouganda) dans le cadre de l'enquête sur la santé des adolescents ARISE (n = 7.625). L'indice de masse corporelle (IMC) a été calculé à l'aide des mesures de la taille et du poids et les scores z ont été calculés sur la base des normes de croissance de 2007 de l'OMS pour l'âge et le sexe. Les informations sur la démographie, les comportements diététiques et de santé ont été recueillies lors d'entretiens se face à face à l'aide d'un questionnaire standardisé. Les rapports de prévalences poolés et spécifiques au site ont été déterminés. RÉSULTATS: La prévalence de l'insuffisance pondérale, du surpoids et du retard de croissance, répartie entre les sites, était de 14,3%, 6,8% et 18,1%, respectivement. Le sexe féminin était associé à un risque plus faible d'avoir une insuffisance pondérale (rapport de prévalence poolée, RP: 0,66 ; 95%: 0,57 - 0,77) et d'avoir un retard de croissance (RP poolé: 0,63 ; IC95%: 0.55-0.71), mais un risque plus élevé de surpoids (PR poolé: 1.60; IC95%: 1.26-2.06). Les filles étaient également moins susceptibles de faire de l'exercice physique pendant au moins une heure par jour (RP poolé: 0,77 ; IC95%: 0.67-0.88) et plus susceptibles de se laver les mains après avoir utilisé des toilettes ou des latrines et de se laver les mains au savon (RP poolé: 13.1; IC95%: 1.05-1.21 et 1.35; IC95%: 1.23-1.45 respectivement). CONCLUSION: Nos résultats soulignent que le sexe est un facteur prédictif de l'état nutritionnel chez les adolescents africains subsahariens et suggèrent que des interventions spécifiques au genre pourraient être nécessaires pour réduire la double charge de la sous-nutrition et de la suralimentation.

Prevention of Mother-to-Child Transmission of HIV ­ an Update from Rural Africa. / Prävention der Übertragung von HIV von Mutter auf Kind - Update aus dem ländlichen Afrika

Sub-Saharan Africa is home of 85 % of pregnant women living with HIV and 90 % of HIV-infected children. WHO issued the first prevention of mother-to-child transmission of HIV (PMTCT) recommendations in 2000. These guidelines have been revised to incorporate new evidence and align with the goal of universal treatment access and zero infections among children. Currently, 82 % of HIV-infected pregnant women receive antiretroviral treatment, and infections among children have halved since 2010. However, in 2018, 160,000 children became infected. Reasons hindering the success of PMTCT are: a) non-universal HIV testing during pregnancy; b) low retention through the PMTCT cascade; and c) missed opportunities to diagnose women who acquire HIV while pregnant or breastfeeding. To address these gaps innovative strategies are needed.

Impact of the addition of azithromycin to antimalarials used for seasonal malaria chemoprevention on antimicrobial resistance of Streptococcus pneumoniae.

OBJECTIVE: A trial was conducted in Burkina Faso and Mali to investigate whether addition of azithromycin to the antimalarials used for seasonal malaria chemoprevention reduces mortality and hospital admissions of children. We tested the sensitivity of nasal isolates of Streptococcus pneumoniae obtained during this trial to azithromycin and other antibiotics. METHODS: Azithromycin or placebo was administered monthly, in combination with the antimalarials used for seasonal malaria chemoprevention, for four months, over the annual malaria transmission seasons of 2014, 2015, and 2016. Nasopharyngeal swabs were collected from 2773 Burkinabe and 2709 Malian children on seven occasions: in July and December each year prior to and after drug administration, and at a final survey in early 2018. Pneumococci were isolated from nasopharyngeal swabs and tested for sensitivity to azithromycin and other antibiotics. RESULTS: A total of 5482 samples were collected. In Burkina Faso, the percentage of pneumococcal isolates resistant to azithromycin among children who had received it increased from 4.9% (95% CI: 2.4%, 9.9%) before the intervention to 25.6% (95% CI: 17.6%, 35.7%) afterward. In Mali, the increase was from 7.6% (95% CI: 3.8%, 14.4%) to 68.5% (95% CI: 55.1%, 79.4%). The percentage of resistant isolates remained elevated (17.7% (95% CI: 11.1%, 27.1%) in Burkina Faso and 19.1% (95% CI: 13.5%, 26.3%) in Mali) among children who had received azithromycin 1 year after stopping the intervention. An increase in resistance to azithromycin was also observed in children who had received a placebo but it was less marked. CONCLUSION: Addition of azithromycin to the antimalarial combination used for seasonal malaria chemoprevention was associated with an increase in resistance of pneumococci to azithromycin and erythromycin, which persisted 1 year after the last administration of azithromycin.

OBJECTIF: Un essai a été mené au Burkina Faso et au Mali pour investiguer si l'addition d'azithromycine aux antipaludéens utilisés dans le cadre de la chimioprévention du paludisme saisonnier réduisait la mortalité et les hospitalisations d'enfants. Nous avons testé la sensibilité à l'azithromycine et à d'autres antibiotiques pour les isolats nasaux de Streptococcus pneumoniae obtenus lors de cet essai. MÉTHODES: L'azithromycine ou un placebo a été administré mensuellement, en association avec les antipaludéens utilisés pour la chimioprévention du paludisme saisonnier, pendant 4 mois, durant les saisons de transmission annuelle du paludisme de 2014, 2015 et 2016. Des échantillons nasopharyngés ont été prélevés sur écouvillons chez 2.773 enfants burkinabés et 2.709 enfants maliens lors de 7 occasions: en juillet et en décembre chaque année avant et après l'administration du médicament, ainsi que lors d'une surveillance finale au début de 2018. Les pneumocoques ont été isolés à partir d'écouvillons nasopharyngés et soumis à des tests de sensibilité à l'azithromycine et à d'autres antibiotiques. RÉSULTATS: 5.482 échantillons ont été collectés. Au Burkina Faso, le pourcentage d'isolats de pneumocoque résistants à l'azithromycine chez les enfants qui l'avaient reçu était passé de 4,9% (IC95%: 2,4%, 9,9%) avant l'intervention à 25,6% (IC95%: 17,6-35,7%) après. Au Mali, l'augmentation est passée de 7,6% (IC95%: 3,8-14,4%) à 68,5% (IC95%: 55,1-79,4%). Le pourcentage d'isolats résistants est resté élevé (17,7% (IC95%: 11,1-27,1%) au Burkina Faso et 19,1% (IC95%: 13,5-26,3%) au Mali) chez les enfants ayant reçu l'azithromycine un an après arrêter l'intervention. Une augmentation de la résistance à l'azithromycine a également été observée chez les enfants ayant reçu un placebo, mais elle était moins marquée. CONCLUSION: L'ajout d'azithromycine à la combinaison antipaludique utilisée pour la chimioprévention du paludisme saisonnier était associé à une augmentation de la résistance du pneumocoque à l'azithromycine et à l'érythromycine, qui persistait un an après la dernière administration d'azithromycine.

Population-based prevalence of human T-lymphotropic virus type 1 in sub-Saharan Africa: a systematic review and meta-analysis.

BACKGROUND: Human T-cell lymphotropic virus type 1 (HTLV-1), the causative agent of adult T-cell leukaemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), is endemic in sub-Saharan Africa (SSA) and poses a high morbidity and mortality risk. Its prevalence in the general population is poorly understood. The potential for prevention motivated us to do a systematic review and meta-analysis of population-based studies to estimate the prevalence of HTLV-1 in SSA. METHODS: A comprehensive, no-limit search was conducted in EMBASE, PubMed, Web of Science and the Cochrane Library from their inception dates to March 2019. Population-based studies presenting data on HTLV-1 in sub-Saharan Africa were included. Pooled prevalence was estimated using a random-effects meta-analysis. RESULTS: A total of 21 studies were included, representing 42 297 participants. The pooled HTLV-1 seroprevalence was 3.19% (95% CI 2.36-4.12%) with variations across year of study. Prevalence of HTLV-1 positively correlated with year of study (ß = 0.0036, P = 0.007). Participants from Central, Western and Southern Africa had a seroprevalence of 4.16% (95% CI 2.43-6.31%), 2.66% (95% CI 1.80-3.68%) and 1.56% (95% CI 0.48-3.15%), respectively. CONCLUSIONS: Our findings suggest that HTLV-1 infection is a public health concern in SSA and highlight the need to implement effective preventive programmes and interventions aimed at reducing the burden of this common yet neglected infection.

PRÉVALENCE DANS LA POPULATION DU VIRUS T-LYMPHOTROPIQUE HUMAIN DE TYPE 1 (HTLV-1) EN AFRIQUE SUBSAHARIENNE: OBJECTIF: Le virus lymphotropique T humain 1 (HTLV-1), l'agent causal de la leucémie T de l'adulte/lymphome (ATL) et la myélopathie associée à HTLV-1/paraparésie spastique tropicale (HAM/TSP), est endémique en Afrique subsaharienne (ASS) et présente un risque élevé de morbidité et de mortalité. Sa prévalence dans la population générale est mal comprise. Le potentiel de prévention nous a incité à procéder à une revue systématique et à une méta-analyse des études basées sur la population afin d'estimer la prévalence du HTLV- 1 en ASS. MÉTHODES: Une recherche approfondie et sans limite a été effectuée dans EMBASE, PUBMED, Web of Science et dans la Cochrane Library, depuis leur création jusqu'à mars 2019. Des études basées sur la population présentant des données sur HTLV-1 en ASS ont été incluses. La prévalence poolée a été estimée à l'aide d'une méta-analyse à effet aléatoire. RÉSULTATS: Un total de 21 études ont été incluses, représentant 42.297 participants. La séroprévalence poolée du HTLV-1 était de 3,19% (IC95%: 2,36% à 4,12%), avec des variations au cours de l'année de l'étude. La prévalence du HTLV-1 était corrélée positivement avec l'année d'étude (bêta = 0,0037, p = 0,007). Les participants d'Afrique centrale, de l'Ouest et Australe présentaient une séroprévalence de 4,16% (IC95%: 2,43% à 6,31%), de 2,66% (IC95%: 1,80% à 3,68%) et 1,56% (IC95%: 0,48% à 3,15%), respectivement. CONCLUSIONS: Nos résultats suggèrent que l'infection au HTLV-1 est une préoccupation de santé publique en ASS et soulignent la nécessité de mettre en œuvre des programmes et des interventions préventives efficaces visant à réduire la charge de cette infection commune mais négligée.

The differential impact of HIV and antiretroviral therapy on gender-specific tuberculosis rates.

OBJECTIVE: To assess the impact of the HIV epidemic and the rollout of antiretroviral therapy (ART) from 2004 on the gender-specific TB burden in Cape Town, we investigated temporal changes in TB notification rates, the HIV-associated relative risk of TB and the population attributable risk fraction (PAF) of HIV by gender. METHODS: Annual TB notifications, mid-year population and HIV prevalence estimates were used to calculate rates per 100 000 population stratified by gender and HIV. Annual rate ratios (RR) of TB associated with HIV and PAF were calculated by gender. RESULTS: Pre-HIV TB notification rates were lower among women than men (146/100 000 vs. 247/100 000). With the onset of the HIV, epidemic rates increased 5.3-fold in women (to 778/100 000) and 3.7-fold in men (to 917/100 000) to a peak in 2008, after which they declined by 25% in women (to 634/100 000) and 18% in men (to 755/100 000) by 2014. The HIV-associated RR of TB was 25% higher in women than in men in 2006 (25 vs. 20), but decreased to the same level in 2014. HIV PAF declined between 2008 and 2014 from 56% to 50% and from 40% to 38% in women and men, respectively. CONCLUSIONS: The HIV epidemic led to greater relative increases in TB rates among women than men. The increased HIV-associated TB risk in women could be compatible with removal of the biological protection of female gender by HIV infection. The decline in RR and PAF in HIV-positive women could be explained by increasing ART usage reversing female gender-related susceptibility.

OBJECTIF: Afin d'évaluer l'impact de l'épidémie du VIH et le déploiement du traitement antirétroviral (ART depuis 2004) sur la charge de la tuberculose (TB) spécifique au sexe, à Cape Town, nous avons examiné les changements temporels dans les taux de notification de la TB, le risque relatif de TB associé au VIH et la fraction de risque attribuable à la population (FAP) du VIH par sexe. MÉTHODES: Les notifications annuelles de la TB, les estimations de la population en milieu d'année et de la prévalence du VIH ont été utilisées pour calculer les taux par 100.000 habitants stratifiés par sexe et VIH. Les rapports de risque (RR) annuels de TB associé au VIH et la FAP ont été calculés par sexe. RÉSULTATS: Les taux de notification de la TB avant le VIH étaient plus faibles chez les femmes que chez les hommes (146 sur 100.000 contre 247 sur 100.000). Avec le début de l'épidémie de VIH, les taux ont augmenté de 5,3 fois chez les femmes (à 778/100.000) et de 3,7 fois chez les hommes (à 917/100.000) pour atteindre un pic en 2008. Puis, ils ont diminué de 25% chez les femmes (à 634/100.000) et de 18% chez les hommes (à 755/100.000) en 2014. Les RR de TB associés au VIH étaient 25% plus élevés chez les femmes que chez les hommes en 2006 (25 contre 20), mais ont diminué au même niveau en 2014. La FAP du VIH a diminué entre 2008 et 2014, passant de 56% à 50% et de 40% à 38% chez les femmes et les hommes, respectivement. CONCLUSIONS: L'épidémie du VIH a entraîné une augmentation relative du taux de TB chez les femmes supérieure à celle des hommes. L'augmentation du risque de TB associé au VIH chez les femmes pourrait être compatible avec la suppression de la protection biologique du sexe féminin par l'infection au VIH. La baisse des RR et de la FAP chez les femmes VIH positives pourrait être expliquée par une augmentation de l'utilisation de l'ART inversant la sensibilité liée au sexe féminin.

Effect of a 'diagonal' intervention on uptake of HIV and reproductive health services by female sex workers in three sub-Saharan African cities.

OBJECTIVES: To enhance uptake of sexual and reproductive health (SRH) services by female sex workers (FSWs), we conducted an implementation study in which we piloted and tested context-specific 'diagonal' interventions, combining vertical, targeted interventions with horizontally improved access to the general health services, in three cities in sub-Saharan Africa. METHODS: We collected indicators of SRH service uptake through face-to-face interviews with approximately 400 FSWs, pre- and post-intervention, in Durban, South Africa; Tete, Mozambique; and Mombasa, Kenya, recruited by respondent-driven sampling. Changes in uptake were tested for their statistical significance using multivariate logistic regression models. RESULTS: In all cities, overall uptake of services increased. Having used all services for contraception, STI care, HIV testing, HIV care, cervical cancer screening and sexual violence, if needed, increased from 12.5% to 41.5% in Durban, 25.0% to 40.1% in Tete and 44.9% to 69.1% in Mombasa. Across cities, the effect was greatest in having been tested for HIV in the past six months which increased from 40.9% to 83.2% in Durban, 56.0% to 76.6% in Tete and 70.9% to 87.6% in Mombasa. In Tete and Mombasa, rise in SRH service use was almost entirely due to a greater uptake of targeted services. Only in Durban was there additionally an increase in the utilisation of general health services. CONCLUSION: SRH service utilisation improved in the short-term in three different sub-Saharan African contexts, primarily through vertical, targeted components. The long-term effectiveness of diagonal approaches, in particular on the use of general, horizontal health services, needs further investigation.

Is home-based HIV testing universally acceptable? Findings from a case-control study nested within the HPTN 071 (PopART) trial.

OBJECTIVE: The HPTN 071 (PopART) trial is examining the impact of a package including universal testing and treatment on community-level HIV incidence in Zambia and South Africa. We conducted a nested case-control study to examine factors associated with acceptance of home-based HIV testing and counselling (HB-HTC) delivered by community HIV-care providers (CHiPs) in PopART intervention communities. METHODS: Of 295 447 individuals who were offered testing, random samples of individuals who declined HB-HTC (cases) and accepted HB-HTC (controls), stratified by gender and community, were selected. Odds ratios comparing cases and controls were estimated using multivariable logistic regression. RESULTS: Data from 642 participants (313 cases, 329 controls) were analysed. There were no differences between cases and controls by demographic or behavioural characteristics including age, marital or socio-economic position. Participants who felt they could be open with CHiPs (AOR: 0.46, 95% CI: 0.30-0.71, P < 0.001); self-reported as not previously tested (AOR: 0.64; 95% CI: 0.43-0.95, P = 0.03); considered HTC at home to be convenient (AOR: 0.38, 95% CI: 0.27-0.54, P = 0.001); knowing others who had accepted HB-HTC from the CHiPs (AOR: 0.49, 95% CI: 0.31-0.77, P = 0.002); or were motivated to get treatment without delay (AOR: 0.60, 95% CI: 0.43-0.85, P = 0.004) were less likely to decline the offer of HB-HCT. Those who self-reported high-risk sexual behaviour were also less likely to decline HB-HCT (AOR: 0.61, 95% CI: 0.39-0.93, P = 0.02). Having stigmatising attitudes about HB-HTC was not an important barrier to HB-HCT uptake. Men who reported fear of HIV were more likely to decline HB-HCT (AOR: 2.68, 95% CI: 1.33-5.38, P = 0.005). CONCLUSION: Acceptance of HB-HTC was associated with lack of previous HIV testing, positive attitudes about HIV services/treatment and perception of high sexual risk. Uptake of HB-HCT among those offered it was similar across a range of demographic and behavioural subgroups suggesting it was 'universally' acceptable.

[Spontaneous coronary artery dissection: An exceptional cause of acute coronary syndrome]. / Dissection spontanée des artères coronaires : une cause rare de syndrome coronarien aigu.

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS) or sudden death, which typically affects young women. We reported two cases of black Africans patients, aged 56 and 52 years old, who presented to Abidjan Heart Institute for ACS. Coronary angiography showed spontaneous dissection of the right coronary artery in the first case, and dissection of the distal left anterior descending artery in the second. A conservative approach was preferred. Both patients received antiplatelet agents, beta-blockers, angiotensin converting enzyme inhibitors and statins, with a favorable in-hospital course. These cases highlight SCAD as a possible cause of ACS. Implementation of interventional cardiology in Sub-Saharan Africa will help identify this uncommon cause of ACS.

Changes in viral hepatitis B screening practices over time in West African HIV clinics.

BACKGROUND: We aimed to describe changes in hepatitis B screening practices over a 3-year period among HIV-infected patients in West Africa. METHODS: A medical chart review was conducted in urban HIV treatment centers in Ivory Coast (3 sites), Benin, Burkina Faso, Senegal, and Togo (1 site each). Among patients who started antiretroviral treatment between 2010 and 2012, 100 per year were randomly selected from each clinic. Demographic, clinical, and laboratory data was collected using a standardized questionnaire. We assessed changes in the proportion of patients screened over time and identified predictors of screening in a multivariable logistic regression. RESULTS: A total of 2097 patients were included (median age: 37 years, 65.4% of women). Overall, 313 (14.9%) patients had been screened for hepatitis B, with an increase from 10.6% in 2010 to 18.9% in 2012 (P<0.001) and substantial differences across countries. In multivariable analysis, being aged over 45 years (adjusted odds ratio: 1.34 [1.01-1.77]) and having an income-generating activity (adjusted odds ratio: 1.82 [1.09-3.03]) were associated with screening for hepatitis B infection. Overall, 62 HIV-infected patients (19.8%, 95% confidence interval: 15.5-24.7) were HBsAg-positive and 82.3% of them received a tenofovir-containing drug regimen. CONCLUSION: Hepatitis B screening among HIV-infected patients was low between 2010 and 2012. The increasing availability of HBsAg rapid tests and tenofovir in first-line antiretroviral regimen should improve the rates of hepatitis B screening.

Independent and combined effects of maternal smoking and solid fuel on infant and child mortality in sub-Saharan Africa.

OBJECTIVE: To estimate the independent and combined risks of infant and child mortality associated with maternal smoking and use of solid fuel in sub-Saharan Africa. METHODS: Pooled weighted data on 143 602 under-five children in the most recent demographic and health surveys for 15 sub-Saharan African countries were analysed. The synthetic cohort life table technique and Cox proportional hazard models were employed to investigate the effect of maternal smoking and solid cooking fuel on infant (age 0-11 months) and child (age 12-59 months) mortality. Socio-economic and other confounding variables were included as controls. RESULTS: The distribution of the main explanatory variable in households was as follows: smoking + solid fuel - 4.6%; smoking + non-solid fuel - 0.22%; no smoking + solid fuel - 86.9%; and no smoking + non-solid fuel - 8.2%. The highest infant mortality rate was recorded among children exposed to maternal smoking + solid fuel (72 per 1000 live births); the child mortality rate was estimated to be 54 per 1000 for this group. In full multivariate models, the risk of infant death was 71% higher among those exposed to maternal smoking + solid fuel (HR = 1.71, CI: 1.29-2.28). For ages 12 to 59 months, the risk of death was 99% higher (HR = 1.99, CI: 1.28-3.08). CONCLUSIONS: Combined exposures to cigarette smoke and solid fuel increase the risks of infant and child mortality. Mothers of under-five children need to be educated about the danger of smoking while innovative approaches are needed to reduce the mortality risks associated with solid cooking fuel.

Aetiologies of non-malaria febrile episodes in children under 5 years in sub-Saharan Africa.

OBJECTIVES: To provide an overview of the most frequent aetiologies found in febrile episodes of children under 5 years from sub-Saharan Africa. METHODS: MEDLINE and EMBASE were searched for publications in English and French on non-malaria fever episodes in African children under 5 years of age, which were published between January 1990 and July 2015. Case reports and conference abstracts were excluded. RESULTS: In total, 3851 titles and abstracts were reviewed, and 153 were selected for full screening of which 18 were included in the present review. Bloodstream infection (BSI) was most commonly investigated (nine of 18) followed by urinary tract infection (UTI) (four of 18) and respiratory tract infection (RTI) (two of 18). Few studies investigated BSI and UTI in the same children (two of 18), or BSI and gastrointestinal infection (GII) (one of 18). As for BSI, the most frequently isolated bacteria were E. coli (four of 12), Streptococcus pneumonia (four of 12), Salmonella spp (three of 12) and Staphylococcus aureus (two of 12) with a positive identification rate of 19.7-33.3%, 5.2-27.6%, 11.7-65.4% and 23.5-42.0%, respectively. As for UTI, the main bacteria isolated were E. coli (six of six) and Klebsiella spp (six of six) with a positive rate of 20.0-72.3% and 10.0-28.5%, respectively. No bacterium was isolated in RTI group, but Human influenzae A and B were frequently found, with the highest positive identification rate in Tanzania (75.3%). Dengue virus (two of 12) was the most frequently reported viral infection with a positive identification rate of 16.7-30.8%. Finally, only rotavirus/adenovirus (69.2% positive identification rate) was found in GII and no bacterium was isolated in this group. CONCLUSIONS: The high prevalence of treatable causes of non-malaria fever episodes requires a proper diagnosis of the origin of fever followed by an appropriate treatment, thereby reducing the under-5 mortality in sub-Saharan Africa and preventing the overprescription of antibiotics and thus circumventing the rise of antibiotic resistance.

[Residual pleural opacity in patients treated for pleural tuberculosis in Yaounde]. / Opacité pleurale résiduelle en fin de traitement pour tuberculose pleurale à Yaoundé.

INTRODUCTION: The aim of this study was to evaluate the incidence and risk factors of residual pleural opacity (RPO) at the end and after 6 months (M12) of antituberculosis treatment (ATT) in adults with pleural tuberculosis. METHODS: In this prospective cohort study, all patients admitted for pleural tuberculosis between September 2010 and August 2012 in the pneumology A unit of Yaounde Jamot Hospital were included. Each patient was then followed up for 12 months. RPO was considered significant if it was measured 10mm or more on standard chest X-ray. The logistic regression model was used to investigate the risk factors of significant RPO at the end of antituberculosis treatment. RESULTS: Of the 193 patients included, median (interquartile range) age of 33 (25-42) years, 115 (59.6%) were men. The incidence (95% CI) of significant RPO was 22.0% (14.9-29.1) and 11.0% (4.9-17.1) at the end of ATT and at M12 respectively. In multivariate analysis, the risk factors of the occurrence of a significant RPO at the end of ATT and at M12 were smoking, associated parenchymal lesions, and hypoglycopleuria. CONCLUSION: Cumulative incidence of RPO ≥ 10 mm was 22% at the end of ATT and 11% after 12 months from the beginning of treatment. Patients with risk factors of RPO ≥ 10 mm should benefit from greater surveillance and appropriate management.

[Presumption of sleep apnea in a black African hypertensive population: Importance of the Epworth sleepiness scale in the diagnostic approach]. / Présomption d'apnées du sommeil dans une population d'hypertendus Noirs africains : intérêt de l'échelle de somnolence diurne d'Epworth dans l'approche diagnostique.

INTRODUCTION: Sleep apnea syndrome (SAS) is very little described in the hypertensive black African. PURPOSE: To screen sleep apnea syndrome using the rating scale of Epworth daytime sleepiness, and to investigate the determinant factors and to infer therapeutic consequences. METHOD: This is a retrospective and prospective study with descriptive and analytical purpose that focused on 200 hypertensive outpatients of the Cardiology Institute of Abidjan. The primary endpoint studied was the SAS. The diagnostic approach of SAS was performed using the rating scale of Epworth daytime sleepiness. RESULTS: The prevalence of sleep apnea was 45%. The average age of sleep apnea carriers was 56.1 years, with a male predominance (60%). The determinant factors of sleep apnea syndrome were male gender (60% versus 40%, P=0.021), obesity (77.8% versus 62.7%, P<0.0001), diabetes (26.7% versus 15.5%, P=0.5) and dyslipidemia (54.4% versus 27.3%, P=0.0009). Life in urban areas, occupation and smoking were not correlated with SAS in our series. The control of hypertension was better in non-apneic patients compared to apneic patients (63.6% versus 38.9%, P=0.04). The visceral impact of hypertension in apneic patients was highly significant (77.8% versus 41.7%, P=0.014). Therapeutically, it was noted the preferential prescription of combination therapy in apneic patients compared to non-apneic patients (82.3% versus 74.4%).

Du travail aux papiers et des papiers au travail. l'expérience du travail et de la régularisation des sans-papiers / Do trabalho aos documentos e dos documentos ao trabalho. a experiência do trabalho e de regularização dos trabalhadores irregulares / From work to documents and from documents to work. working experience and regularization processes of irregular workers / Del trabajo a los documentos y de los documentos al trabajo. la experiencia del trabajo y de la regularización de los trabajadores irregulares

À l'heure où les médias s'emparent des questions de gouvernance et de gestion des migrations irrégulières, de plus en plus d'études sociologiques et anthropologiques tentent de déconstruire les idées reçues, notamment sur l'emploi. Nous examinerons ici les manières dont des migrants sans-papiers, originaires de l’Afrique Subsaharienne, trouvent du travail en France. Il s'agira de démontrer comment les "identités de papiers", définissant un individu comme "protégé", "étranger" ou "national", témoignent d'un espace économique dédié à ces travailleurs, au travers d'interstices de jeux favorisant la négociation des différentes relations en jeu au sein du marché du travail. En s'inspirant de la notion de "jeux de vérité", au sens de Michel Foucault, nous essayerons alors de dévoiler, de manière originale, comment les niveaux interstitiels de jeux amènent à soulever la question des nombreux rapports de force opérationnels dans la définition des situations de travail et dans la régularisation des sans-papiers.

Neste momento em que a midia tem tem tratado das questões de governança e da gestão das migrações irregulares, cada vez mais estudos sociológicos e antropológicos buscam desconstruir o senso comum, sobretudo em relação ao emprego. Nos examinaremos aqui as maneiras pelas quais os migrantes irregulares, originários da África Subsahariana, encontram trabalho na França. Trata-se de demonstrar como as "identidades de documento", definem um indivíduo como "protegido", "estrangeiro" ou "nacional", elas falam de um espaço econômico destinado a estes trabalhadores, mediante os interstícios do jogo que favorecem a negociação de diferentes relações em jogo no seio do mercado de trabalho. Inspirados na noção de "jogo de verdade", no sentido de Michel Foucault, nós buscaremos desvelar, de maneira original, como os níveis instersticiais do jogo trazem a tona a questão das numerosas relações de força que operam na configuração das relações de trabalho e na regularização dos trabalhadores irregulares.

At the moment when the media seems to control matters concerning governance and illegal migration, sociological and anthropological studies try to deconstruct some longlasting ideas, especially those about employment. In this article we will examine the different ways through which irregular Sub-Saharan African immigrants find a job in France. We will try to show how an “identity document” defining an individual as being “protected”, “foreign” or “national”, can witness the economic space reserved to these workers by virtue of interstitial games favoring the negotiation of different working relationships being played on the work market. Being inspired by the “truth games”, in the sense of Foucault, we try to reveal, in an original way, how the various levels of interstitial games raise the question of many different power relations which are operational in the definition of the working conditions and the regularization of irregular workers.

En este momento en que la media tiene tratado de las cuestiones de gobernanza e de la gestión de las migraciones irregulares, cada vez más estudios sociológicos y antropológicos buscan deconstruir el sentido común, sobre todo en relación al empleo. Nosotros examinaremos aquí las maneras por las que los migrantes irregulares, originarias de África Subsahariana, encuentran trabajo en Francia. Se trata de demostrar como las "identidades de documento", definen un individuo como "protegido", "extranjero" ou "nacional", ellas hablan de un espacio económico destinado a estos trabajadores, mediante los intersticios del juego que favorecen la negociación de diferentes relaciones en juego dentro del mercado de trabajo. Inspirados en la noción de "juego de verdad", en el sentido de Michel Foucault, nosotros buscaremos desvelar, de manera original, como los niveles instersticiales del juego traen a la vista la cuestión de las numerosas relaciones de fuerza que operan en la configuración de las relaciones de trabajo y en la regulación de los trabajadores irregulares.

[Emergency vascular access conversion to native arterio veinous fistula: a prospective study of 37 hemodialysis patients in Rwanda]. / Conversion des abords vasculaires d'urgence pour hémodialyse en fistules natives au Rwanda : à propos de 37 cas.

UNLABELLED: Chronic hemodialysis in Rwanda is relatively recent and most of patients are treated with catheters. SUMMARY: Thirty-seven patients who require chronic hemodialysis with catheters were evaluated during a 3-years period in order to facilitate the creation of a permanent vascular access for hemodialysis (AVF). Patient selection were made during a multi-disciplinary consultation. The sex-ratio was 1.5 and the main cause of the nephropathy was arterial hypertension. RESULTS: Thirty-one patients benefited from the creation of an arterioveinous fistula. All of the interventions were performed using local or loco-regional anesthesia. Sixty percent of these AVF were radio-cephalic, 35.4% were humero-cephalic. Sixty-four percent of the operations were performed on ambulatory patients, with a primary function for 90% of them. CONCLUSION: This work proves the feasibility of the creation of AVF in Rwanda, thus allowing to preclude the various complications that arise with the prolonged use of a catheter. This experience was made possible by the pooling of the resources of 4 of Rwanda's leading hospitals. In an early future, the development of vascular surgery will assure the permanence of this care.

Osteoprotegerin is not a determinant of metabolic syndrome in sub-Saharan Africans after age adjustment.

OBJECTIVES: Osteoprotegerin (OPG), a soluble member of tumor necrosis factor receptor superfamily that inhibits bone resorption, has been suggested as a cardiovascular risk factor in humans. In this study, we aim to investigate the potential relationship between OPG and MetS (MetS) in a sub-Saharan African population. METHODS: Four hundred and eleven volunteers (152 men, 259 women) aged ≥18 years recruited from the general population in Douala and Edea, Cameroon participated in this study. Anthropometric parameters measured and blood samples were collected for glucose, serum lipids and OPG concentrations measurements. Mean differences of the variables in different groups were compared using Students' t test. We performed logistic regressions to analyze the impact of independent factors on the relation between OPG and MetS outcome. MetS was defined using the Joint Interim Statement 2009. RESULTS: OPG levels did not vary significantly between both men and women with and without MetS (both P>0.05). However, with high fasting blood glucose (≥5.6 mmol/L) had a significantly higher OPG level than those with lower glucose level (P=0.014). In multiple logistic regression analysis, MetS did not show any significant association with serum OPG levels in men and women after adjusting for age, physical activity, alcohol consumption and menopausal status in women (P=0.720 and P=0.930 respectively). CONCLUSION: This study failed to demonstrate any relationship between OPG and MetS. Nevertheless, the positive association between blood glucose and OPG levels reveals that OPG might be involved in cardiovascular risk development in this sub-Saharan African population.