Health workforce strategies during COVID-19 response: insights from 15 countries in the WHO Africa Region.

INTRODUCTION: The COVID-19 pandemic unveiled huge challenges in health workforce governance in the context of public health emergencies in Africa. Several countries applied several measures to ensure access to qualified and skilled health workers to respond to the pandemic and provide essential health services. However, there has been limited documentation of these measures. This study was undertaken to examine the health workforce governance strategies applied by 15 countries in the World Health Organization (WHO) Africa Region in responding to the COVID-19 pandemic. METHODS: We extracted data from country case studies developed from national policy documents, reports and grey literature obtained from the Ministries of Health and other service delivery agencies. This study was conducted from October 2020 to January 2021 in 15 countries - Angola, Burkina Faso, Chad, Eswatini, Ghana, Guinea, Guinea Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal and Togo. RESULTS: All 15 countries had national multi-sectoral bodies to manage the COVID-19 response and a costed national COVID-19 response plan. All the countries also reflected human resources for health (HRH) activities along the different response pillars. These activities included training for health workers, and budget for the recruitment or mobilization of additional health workers to support the response, and for provision of financial and non-financial incentives for health workers. Nine countries recruited additional 35,812 health workers either on a permanent or temporary basis to respond to the COVID-19 with an abridged process of recruitment implemented to ensure needed health workers are in place on time. Six countries redeployed 3671 health workers to respond to the COVID-19. The redeployment of existing health workers was reported to have impacted negatively on essential health service provision. CONCLUSION: Strengthening multi-sector engagement in the development of public health emergency plans is critical as this promotes the development of holistic interventions needed to improve health workforce availability, retention, incentivization, and coordination. It also ensures optimized utilization based on competencies, especially for the existing health workers.

Efficient adsorption of selenium (Se(IV) and Se(VI)) from water using Acacia senegal polysaccharide with multiple amine groups: Synthesis and application.

In this study, an amine-rich gel (ARAS) was prepared by chemically altering Acacia senegal (AS). ARAS acts as an adsorbent for selenium. Owing to the introduction of amino functional groups and a remarkable specific surface area (91.89 g/m2), ARAS shows maximum adsorption capacities at 75 and 130 mg g-1 for Se(IV) and Se(VI), respectively. The removal efficiency of ARAS is higher (ωSeIV = 98.2 % and ωSeVI = 98.6 %) at lower concentrations (CSeIV = 100 ppm and CSeVI = 95 ppm) and the adsorption equilibrium is achieved within 60 min. The adsorption process of Se (IV) and Se (VI) via ARAS is elucidated using the Quasi-Second-Order kinetic and Langmuir models. The enhanced adsorption capacity of the adsorbent could be attributed to the synergistic effects of electrostatic attraction, hydrogen bonding, and specific physicochemical properties. Thermodynamic studies reveal that the surface adsorption process is spontaneous and exothermic. Notably, ARAS maintains remarkable adsorption stability under a variety of solution conditions, including variable pH (4-11), NaCl concentrations (0-1 M), and the presence of organic solvents. It retains approximately 60 % of its initial adsorption capacity for Se(IV) and Se(VI) after three adsorption cycles. Therefore, ARAS with its cost-effectiveness and exceptional performance shows considerable potential for applications in water treatment.

[Dr Jean Languillon (1912-2003), a major unrecognized leprologist]. / Le Dr Jean Languillon (1912-2003), un léprologue majeur trop méconnu.

Languillon's contribution to the control of leprosy cannot be reduced to the manual of leprology which remains the reference for anyone working on this disease in sub-Saharan Africa. This would mean forgetting his works that established the immunological origin of leprosy and its cutaneous, adverse and neurological complications.Another major aspect, the importance of his contribution to the treatment of the disease, in particular through the development of polychimiotherapy (PCT), which has made Institut Marchoux in Bamako one of the five WHO's collaborating centers in the field of clinical research in leprosy.Languillon was also involved in a holistic approach of the disease by creating the first leprosy surgery unit and implementing physiotherapy, orthopedic care with appropriate equipment, and social rehabilitation… without forgetting preventive aspects of complications through the necessary regular administration of treatments, and control of patients spread over wide territories, by creating a corps of leprosy nurse monitors and leprosy specialists. These will provide essential support to the doctor most often in charge of a huge sector where the need of assistance was obvious.Languillon ended his African career by creating the ILAD, Institute of Applied Leprology in Dakar, which offers the full range of care, as he always advocated.Finally, he did not resist the call of Order of Malta which offered him to share his expertise in the different countries where the Order was involved.

Acacia senegal Budmunchiamines as a Potential Adjuvant for Rejuvenating Phenicol Activities towards Escherichia coli-Resistant Strains.

The continuous emergence of bacterial resistance alters the activities of different antibiotic families and requires appropriate strategies to solve therapeutic impasses. Medicinal plants are an attractive source for researching alternative and original therapeutic molecules. In this study, the fractionation of natural extracts from A. senegal and the determination of antibacterial activities are associated with molecular networking and tandem mass spectrometry (MS/MS) data used to characterize active molecule(s). The activities of the combinations, which included various fractions plus an antibiotic, were investigated using the "chessboard" test. Bio-guided fractionation allowed the authors to obtain individually active or synergistic fractions with chloramphenicol activity. An LC-MS/MS analysis of the fraction of interest and molecular array reorganization showed that most identified compounds are Budmunchiamines (macrocyclic alkaloids). This study describes an interesting source of bioactive secondary metabolites structurally related to Budmunchiamines that are able to rejuvenate a significant chloramphenicol activity in strains that produce an AcrB efflux pump. They will pave the way for researching new active molecules for restoring the activity of antibiotics that are substrates of efflux pumps in enterobacterial-resistant strains.

Nutrient Profiles of Commercially Produced Complementary Foods Available in Burkina Faso, Cameroon, Ghana, Nigeria and Senegal.

The nutritional quality of commercially produced complementary food (CPCF) varies widely, with CPCF in high-income settings often containing excessive levels of sugar and sodium. Little is known about the nutritional quality of CPCF available in the West Africa region, despite their potential to improve the nutrition of infants and young children (IYC). This study evaluated the nutritional quality of CPCF available in five West African countries using the WHO Europe nutrient profiling model (NPM) and assessed their suitability for IYC based on label information. The proportion that would necessitate a "high sugar" warning was also determined, and the micronutrient (iron, calcium, and zinc) content was assessed against IYC-recommended nutrient intakes. Of the 666 products assessed, only 15.9% were classified as nutritionally suitable for promotion for IYC. The presence of added sugar and excessive sodium levels were the most common reasons for a product to fail the nutrient profiling assessment. Dry/instant cereals contributed the highest percentage of recommended nutrient intake (RNI) per serving. This highlights the need for policies to improve the nutritional quality of CPCF in West Africa, including labeling standards and the use of front-of-pack warning signs to promote product reformulation and clearly communicate nutritional quality to caregivers.

Accuracy of declared nutrient content on labels of commercial complementary food products in Cambodia, Indonesia and Senegal.

Commercially produced complementary foods (CPCF) have the potential to fill nutritional gaps in the diets of older infants and young children. This study evaluated the accuracy of nutrient declarations on labels of 43 commonly available CPCF in three peri-urban/urban locations: Khsach Kandal district, Cambodia (n = 11); Bandung, Indonesia (n = 11) and Guédiawaye and Dakar departments, Senegal (n = 21). Label values (LV) from product nutrient declarations were compared to analytical values (AV) derived from laboratory nutrient analysis for macronutrients (carbohydrate, protein and total fat), nutrients of public health concern (saturated fat, total sugar and sodium), and micronutrients of interest (calcium, iron and zinc). European Union guidance for nutrition label accuracy was used to set tolerance ranges for each nutrient LV relative to AV. LV were missing for one or more nutrients in 88.4% (n = 38) of the CPCF products and no CPCF met EU tolerance thresholds for all nine nutrients assessed. Over half of products with LV for key micronutrients (55.6%, n = 10/18) and macronutrients (54.8%, n = 23/42) met tolerances for LV accuracy. Eighty-five percent (n = 11/13) of products with LV for nutrients of public health concern were determined to be accurate. Nutrient content claims for iron appeared on 19 (44.2%) of the 43 products. Of the products which made an iron content claim, 26.3% had inaccurate LV with the majority of these containing less iron than declared. Regulatory action is needed to ensure that CPCF labelling communicates complete and accurate nutrient content information that enables caregivers to make informed decisions for feeding older infants and young children.

Development of indicators for integrated antenatal care service provision: a feasibility study in Burkina Faso, Kenya, Malawi, Senegal and Sierra Leone.

OBJECTIVES: While service integration has gained prominence as an objective of many global initiatives, there is no widely recognised single definition of integration nor a clear understanding of how programmes are integrated into health systems to achieve improved health outcomes. This study aims to review measurement approaches for integrated antenatal care (ANC) services, propose and operationalise indicators for measuring ANC service integration and inform an integrated ANC indicator recommendation for use in low-income and middle-income countries (LMICs). DESIGN: Feasibility study. SETTING: Burkina Faso, Kenya, Malawi, Senegal and Sierra Leone. METHODS: Our six-step approach included: (1) conceptualise ANC service integration models; (2) conduct a targeted literature review on measurement of ANC service integration; (3) develop criteria for ANC service integration indicators; (4) propose indicators for ANC service integration; (5) use extant data to operationalise the indicators; and (6) synthesise information to make an integrated ANC indicator recommendation for use in LMICs. RESULTS: Given the multidimensionality of integration, we outlined three models for conceptualising ANC service integration: integrated health systems, continuity of care and coordinated care. Looking across ANC service integration estimates, there were large differences between estimates for ANC service integration depending on the model used, and in some countries, the ANC integration indicator definition within a model. No one integrated ANC indicator was consistently the highest estimate for ANC service integration. However, continuity of care was consistently the lowest estimate for ANC service integration. CONCLUSIONS: Integrated ANC services are foundational to ensuring universal health coverage. However, our findings demonstrate the complexities in monitoring indicators of ANC service quality using extant data in LMICs. Given the challenges, it is recommended that countries focus on monitoring measures of service quality. In addition, efforts should be made to improve data collection tools and routine health information systems to better capture measures of service integration.

Analysis of the social acceptability of a humanized childbirth intervention in Senegal: A qualitative study.

BACKGROUND: In efforts to improve the quality of women's care and enhance related experiences in Senegal, the Senegalese government implemented an intervention named "humanized childbirth" in their health facilities. AIM: To analyze the social acceptability of humanized childbirth as well as its relevance given the social values in Senegal. METHODS: A multiple-case study was conducted within four health facilities in Dakar. Breastfeeding mothers (n = 20), pregnant women (n = 4), midwives (n = 8), Bajenu Gox (n = 4), members of the Health Development Committee (n = 4), and men from the community (n = 4) were interviewed individually, and a documentary analysis was done. The thematic analysis was performed using the acceptability theoretical framework. FINDINGS: The results show that most participants agreed with the idea of humanized childbirth. However, participants display varying viewpoints as to the social acceptability of various components of the intervention. While there is an overall agreement concerning the benefits of motivated and attentive health professionals focused on prevention, restoring dignity for the parturient woman, freedom to eat and drink, massages and relaxation, the same cannot be said about the freedom of choice for birth positions and companionship. DISCUSSION: The contrasting viewpoints as to the acceptability of humanized childbirth can be explained by the perception of risk and lack of experience with free birthing positions, as well as structural and cultural barriers surrounding the notion of companionship. CONCLUSION: Education and awareness of the benefits of free birthing positions and companionship would be required among Senegalese women to enable a cultural shift in maternity wards in Senegal.

Evaluation of gum Arabic (Acacia Senegal) as a natural prebiotic to improve growth performance and health status of broiler chickens.

Gum Arabic (GA) is a natural product containing soluble fiber that is indigestible in the gastrointestinal tract and has been used as a traditional medicine to treat many diseases such as intestinal inflammation, kidney disease, and liver disorders, which may be reflected in the improved performance of broiler chickens when used. Therefore, the main objective of the current study was to evaluate the effects of GA on the performance, immune system, visceral organs, functional tests, and histological changes of the ileum, liver, and kidneys of broilers. A total of 432 1-day-old male broilers were allocated to six dietary treatments (0.0, 0.12, 0.25, 0.5, 0.75, and 1.0% GA) for 35 days. Performance, internal organs, and blood biochemical indices were measured. Morphology and histometry of the intestine were also performed. Meanwhile, tissues of the ileum, liver, and kidney were examined and evaluated microscopically to observe histological changes. All levels of GA (0.12 to 1.0%) had a positive effect on growth performance and feed conversion ratio. In addition, GA had no effect on the relative weight of lymphoid and visceral organs, except for a linear response in the bursa and liver. The levels of GA (0.12 and 0.25%) showed the potential to decrease serum uric acid, creatinine, and alanine aminotransferase. The remarkable increase in small intestinal morphology of chickens fed GA and an increase in all histometric values of the ileum. All histological changes in the intestine, liver, and kidneys improved in chickens fed the basal diet containing 0.12 to 0.50% GA. These results provide useful evidence for the potential use of GA powder (Acacia senegal) as a natural prebiotic to improve performance and intestinal, liver, and kidney health in broiler chickens.

Chemical Composition and Anti-Urolithiatic Activity of Extracts from Argania spinosa (L.) Skeels Press-Cake and Acacia senegal (L.) Willd.

Ethnobotanical studies have reported the traditional medicinal uses of Acacia senegal (L.) Willd. and Argania spinosa (L.) Skeels against kidney stone formation and other chronic kidney diseases. The present work is undertaken to study the litholytic activity and the inhibiting activity of calcium oxalate crystallization by bioactive compounds identified in Argania spinosa (L.) Skeels press-cake (residue of Argan oil) and in Acacia senegal (L.) Willd. The litholytic activity was studied in vitro on cystine and uric acid stones using a porous bag and an Erlenmeyer glass. The study of the inhibiting activity of calcium oxalate crystallization, was based on temporal measurements of the optical density, registered at a 620 nm wavelength for 30 min using an ultraviolet−visible spectrophotometer. The silylation method was performed to identify phytochemicals, followed by gas chromatography coupled with mass spectrophotometry (GC/MS) analysis. The results show significant litholytic activity of Argania Spinosa press-cake hydro-ethanolic extract on uric acid and cystine stones, respectively, with dissolution rates (DR) of 86.38% and 60.42% versus 3.23% and 9.48% for the hydro-ethanolic extract of Acacia senegal exudate. Furthermore, the percentages of nucleation inhibition are 83.78% and 43.77% (p ˂ 0.05) for Argania spinosa and Acacia senegal, respectively. The results point to the detection of 17 phytochemicals in Argania spinosa press-cake extract, the majority of which are phenolic acids and have potent anti-urolithiatic action.

Applying the health capability profile to empirically study chronic hepatitis B in rural Senegal: a social justice mixed-methods study protocol.

INTRODUCTION: Despite the early implementation of hepatitis B vaccination and the ongoing decentralisation of chronic hepatitis B (CHB) care, over 10% of the Senegalese adult population lives with CHB and liver cancer remains a main cause of death. Investigating factors associated with CHB infection, prevention of CHB-related morbidity, and prevention and treatment of mortality secondary to CHB calls for a holistic and multidimensional approach. This paper presents the adaptation of the health capability profile (HCP) to a specific epidemiological issue and empirical setting: it seeks to identify and analyse inter-related abilities and conditions (health capabilities) in relation to the CHB epidemic in the rural area of Niakhar, Senegal. METHODS AND ANALYSIS: This ongoing study relies on a sequential social justice mixed-methods design. The HCP is comprehensively adapted to CHB in rural Senegal and guides the design and conduct of the study. Objective and subjective data are collected at the individual level following a mixed-methods explanatory core design. The quantitative module, embedded in the ANRS12356 AmBASS cross-sectional survey (exhaustive sampling), is used to select a purposeful sampling of participants invited for one-on-one qualitative interviews. Additional data are collected at the institutional and community level through health facility surveys and an ethnography (in-depth interviews) of local and national CHB stakeholders. Data analysis adopts a synergistic approach to produce a multilayered analysis of individual HCPs and crosscutting analysis of the 15 health capabilities. The data integration strategy relies on a mixed-methods convergent core design, and will use 0-100 health capability scores as well as flow diagrams to measure and characterise levels of development and interactions among health capabilities, respectively. ETHICS AND DISSEMINATION: This study was approved by Senegalese and French authorities. Results dissemination through local workshops and scientific publications aim at fuelling effective policy change towards CHB-related health capability.

Ameliorations in dyslipidemia and atherosclerotic plaque by the inhibition of HMG-CoA reductase and antioxidant potential of phytoconstituents of an aqueous seed extract of Acacia senegal (L.) Willd in rabbits.

The assigned work was aimed to examine the capability of phytoconstituents of an aqueous seed extract of Acacia senegal (L.) Willd to inhibit HMG-CoA reductase and regression of the atherosclerotic plaque. The chemical fingerprinting of the test extract was assessed by LC-MS/MS. Consequently, the analyses of in-vitro, in-vivo, and in-silico were executed by using the standard protocols. The in-vitro assessment of the test extract revealed 74.1% inhibition of HMG-CoA reductase. In-vivo assessments of the test extract indicated that treated hypercholesterolemic rabbits exhibited a significant (P≤0.001) amelioration in the biomarker indices of the dyslipidaemia i.e., atherogenic index, Castelli risk index(I&II), atherogenic coefficient along with lipid profile. Subsequently, significant reductions were observed in the atherosclerotic plaque and antioxidant levels. The in-silico study of molecular docking shown interactions capabilities of the leading phytoconstituents of the test extract i.e., eicosanoic acid, linoleic acid, and flavan-3-ol with target protein of HMG-CoA reductase. The values of RSMF and potential energy of top docked complexes were show significant interactions. Accordingly, the free energy of solvation, interaction angle, radius of gyration and SASA were shown significant stabilities of top docked complex. The cumulative data of results indicate phytoconstituents of an aqueous seed extract of Acacia senegal have capabilities to inhibit the HMG-CoA reductase and improve the levels of antioxidants.

Ethnobotanical study of cowpea (Vigna unguiculata (L.) Walp.) in Senegal.

Cowpea (Vigna unguiculata) plays a key role in family farming systems in Senegal. It makes an essential contribution to economic, nutritional and food security. Although it is crucial, little is known about how farmers classify the diversity of local varieties or about the social practices associated with them. The aim of this study is to characterize the farming practices associated with growing cowpea in Senegal. Surveys were conducted involving 335 rural farmers living in 37 villages, spread across seven regions that produce cowpea. An average of ten farmers were randomly selected in each village. The results reveal that cowpea is a key feature of cropping systems in the studied area. Our findings highlight the high diversity of local cowpea varieties with 59 local names inventoried. In 75% of cases, the name refers to the seed's morphology or color. Cowpea production is more diverse in Diourbel and Louga and less diverse in the south. More than half the farmers (57%) acquired their cowpea seeds (early, semi-early and late maturity varieties) outside their village, either from markets, seed suppliers or NGOs. This new understanding of farmers' expertize in the management of cowpea and its local variability will help to valorize local diversity in breeding programs.

Cultivated and wild pearl millet display contrasting patterns of abundance and co-occurrence in their root mycobiome.

Fungal communities associated with roots play a key role in nutrient uptake and in mitigating the abiotic and biotic stress of their host. In this study, we characterized the roots mycobiome of wild and cultivated pearl millet [Pennisetum glaucum (L.) R. Br., synonym: Cenchrus americanus (L.) Morrone] in three agro-ecological areas of Senegal following a rainfall gradient. We hypothesized that wild pearl millet could serve as a reservoir of endophytes for cultivated pearl millet. We therefore analyzed the soil factors influencing fungal community structure and whether cultivated and wild millet shared the same fungal communities. The fungal communities associated with pearl millet were significantly structured according to sites and plant type (wild vs cultivated). Besides, soil pH and phosphorus were the main factors influencing the fungal community structure. We observed a higher fungal diversity in cultivated compared to wild pearl millet. Interestingly, we detected higher relative abundance of putative pathotrophs, especially plant pathogen, in cultivated than in wild millet in semi-arid and semi-humid zones, and higher relative abundance of saprotrophs in wild millet in arid and semi-humid zones. A network analysis based on taxa co-occurrence patterns in the core mycobiome revealed that cultivated millet and wild relatives had dissimilar groups of hub taxa. The identification of the core mycobiome and hub taxa of cultivated and wild pearl millet could be an important step in developing microbiome engineering approaches for more sustainable management practices in pearl millet agroecosystems.

'We like things tangible:' A critical analysis of menstrual hygiene and health policy-making in India, Kenya, Senegal and the United States.

Over the last decade, many countries have adopted policies addressing menstrual needs. Our research explores the opportunities and challenges that have shaped these initiatives and critically examines their scope and substantive focus. Our study analyses developments in four countries: India, Kenya, Senegal, and the United States. It is based on an analysis of 34 policy documents and interviews with 85 participants active in policy-making or advocacy. Across countries, we found a predominant policy focus on tangible and material outcomes, such as menstrual products and facilities, that is informed by a narrow perception of menstrual needs as the management of bleeding. A number of drivers influenced policy-makers to keep this focus, especially the key narrative around menstrual pads as a perceived solution to school absenteeism combined with sensationalisation in the media and the quest for quantifiable results. Menstrual stigma is so ingrained that it continues to constrain policy-makers and advocates themselves by perceiving and presenting menstruation as a problem to be fixed, managed, and hidden. When considering new policy directions, we need to create capacity for a holistic menstrual policy landscape that overcomes systemic barriers to addressing the needs of menstruators that are largely rooted in menstrual stigma.

Transforming social norms to improve girl-child health and well-being: a realist evaluation of the Girls' Holistic Development program in rural Senegal.

BACKGROUND: Early adolescence is a critical period where social norms, attitudes, and behaviors around gender equality form. Social norms influence adolescent choices and behaviors and are reinforced by caregivers and community members, affecting girls' reproductive health and educational opportunities. Understanding how to shift these often-interconnected norms to delay child marriage, pregnancy and keep girls in school requires understanding of the structure and dynamics of family and community systems. The Senegalese and American non-governmental organization, the Grandmothers Project-Change through Culture, seeks to address these intertwined factors through innovative community change strategies that build on the specific structure and values of West African collectivist cultures. METHODS: The Girls' Holistic Development approach in rural Vélingara, Senegal posits that by increasing recognition, knowledge and empowerment of elder community women and reinforcing intergenerational communication and decision-making, community members including girls will support and advocate on behalf of girls' interests and desires. We assessed the Girls Holistic Development approach using Realist Evaluation with a mixed-method, quasi-experimental design with a comparison population. We examined differences in intergenerational communication, decision-making and descriptive and injunctive norms related to early marriage, pregnancy and schooling. RESULTS: After 18 months, intergenerational communication was more likely, grandmothers felt more valued in their communities, adolescent girls felt more supported with improved agency, and norms were shifting to support delayed marriage and pregnancy and keeping girls in school. Grandmothers in intervention villages were statistically significantly more likely to be perceived as influential decision-makers by both VYA girls and caregivers for marriage and schooling decisions compared to girls and caregivers in comparison villages. CONCLUSIONS: This realist evaluation demonstrated shift in social norms, particularly for VYA girls, in intervention villages favoring delaying girls' marriage, preventing early pregnancy and keeping girls in school along with increased support for and action by grandmothers to support girls and their well-being related to these same outcomes. These shifts represent greater community social cohesion on girl-child issues. This research helps explain the linkage between social norms and girls' reproductive health and education outcomes and demonstrates that normative shifts can lead to behavior change via collective community action mechanisms.

During adolescence in Senegal, as elsewhere, decisions on whether to keep girls in school and at what age to marry girls are made by their caregivers and influenced by family and community members. Early pregnancy occurs at these ages, either before or during marriage. These social influences, called social norms, set expectations for parents and girls.The Grandmothers Project­Change through Culture developed an intervention to shift social norms and change these three outcomes­early pregnancy, early marriage and keeping girls in school. The project, called Girls Holistic Development (GHD), builds on local relationships between girls, grandmothers, parents and community leaders and local values to facilitate discussion, reflection, collaboration and advocacy.This study used realist evaluation methods, including qualitative and quantitative interview and focus group discussions, to understand whether these shifts in norms and behaviors took place. Research took place with girls, grandmothers and male and female caregivers 18 months after GHD started. Quantitative survey included 7 intervention and 7 comparison villages.Results supported GHDs' expectations and strategy. In intervention villages, grandmothers and girls reported closer relationships; parents considered grandmothers important sources of advice. Girls, grandmothers and caregivers described social expectations as favoring girl's education, marriage at older ages and development of strategies to prevent girl's pregnancy in intervention villages.This evaluation provided strong support for GHDs' ability to shift social norms to improve girls' outcomes. By working with local relationships and values, GHD created more communication between community and family members and facilitated increased social bonds within the community.

Vitamin A Supplementation in Children in Guédiawaye Health District, Senegal.

To assess the coverage rate of routine vitamin A supplementa tion, a descriptive study was carried out in the Guédiawaye Health District. The coverage rate for vitamin A supplementation was 48.6%. Age over 24 months, uneducated father, maternal age over 25, and lack of disease-related knowledge were factors associated with delayed vitamin A supplementation.

[Ankylosing spondylitis in Senegal: epidemiological, diagnostic, therapeutic and evolutionary features at the Hospital Center University Aristide Le Dantec, Dakar]. / Spondylarthrite ankylosante au Sénégal: aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs au Centre Hospitalier Universitaire Aristide LeDantec de Dakar.

INTRODUCTION: ankylosing spondylitis (AS) is a progressive disease, which can result in disability. The purpose of this study is to describe the epidemiological, diagnostic, therapeutic and evolutionary features of AS in the Department of Rheumatology of the Hospital Center University Aristide Le Dantec, Dakar. METHODS: we conducted a descriptive and analytical cross-sectional study. Data were collected on a prospective and retrospective basis over a period of 8 years, between January 2012 and December 2020. Patients were diagnosed with AS on the basis of ESSG (European Seronegative Spondylarthropathy Group) and Amor diagnostic criteria, ASAS (Assessment of Spondyloarthritis International Society) criteria and modified New York criteria. Data were collected by a structured questionnaire and analyzed using the SPSS25 (Statistical Package for the Social Sciences) software. RESULTS: six hundred forty-seven patients met the inclusion criteria (414 women and 233 men) with a sex ratio of 1.77F/1M. Different symptomatic cases were found: axial disease (55.65%), mixed disease (44.35%) and systemic disease with extra-articular manifestations including uveitis (12.21%), aortic insufficiency (5.71%) and fibrobullous lung disease (3.86%). Sixty percent of patients were receiving non-steroidal anti-inflammatory drugs (NSAIDs), 47% methotrexate, and 0.92% biotherapy. Disease activity index, functional index and quality of life index enabled disease monitoring. CONCLUSION: our results show that there was predominance in women. Patients were mostly affected by axial spondyloarthritis. More than half of our patients were treated with anti-inflammatory, 47% with methotrexate and 0.92% with biotherapy. This study highlights that the features of ankylosing spondylitis (AS) are a burden to the patient with spondyloarthritis and disease progression over time.

Isolation and Biological Characterization of Homoisoflavanoids and the Alkylamide N-p-Coumaroyltyramine from Crinum biflorum Rottb., an Amaryllidaceae Species Collected in Senegal.

Crinum biflorum Rottb. (syn. Crinum distichum) is an Amaryllidaceae plant used in African traditional medicine but very few studies have been performed on this species from a chemical and applicative point of view. Bulbs of C. biflorum, collected in Senegal, were extracted with ethanol by Soxhlet and the corresponding organic extract was purified using chromatographic methods. The pure compounds were chemically characterized by spectroscopic techniques (1D and 2D 1H and 13C NMR, HR MS and ECD) and X-ray analysis. Four homoisoflavonoids (1-4) and one alkylamide (5) were isolated and characterized as 5,6,7-trimethoxy-3-(4-hydroxybenzyl)chroman-4-one (1), as 3-hydroxy-5,6,7-trimethoxy-3-(4-hydroxybenzyl)chroman-4-one (2), as 3-hydroxy-5,6,7-trimethoxy-3-(4-methoxybenzyl)chroman-4-one (3) and as 5,6,7-trimethoxy-3-(4-methoxybenzyl)chroman-4-one (4), and the alkylamide as (E)-N-(4-hydroxyphenethyl)-3-(4-hydroxyphenyl)acrylamide (5), commonly named N-p-coumaroyltyramine. The relative configuration of compound 1 was verified thanks to the X-ray analysis which also allowed us to confirm its racemic nature. The absolute configurations of compounds 2 and 3 were assigned by comparing their ECD spectra with those previously reported for urgineanins A and B. Flavanoids 1, 3 and 4 showed promising anticancer properties being cytotoxic at low micromolar concentrations towards HeLa and A431 human cancer cell lines. The N-p-coumaroyltyramine (5) was selectively toxic to A431 and HeLa cancer cells while it protected immortalized HaCaT cells against oxidative stress induced by hydrogen peroxide. Compounds 1-4 also inhibited acetylcholinesterase activity with compound 3 being the most potent. The anti-amylase and the strong anti-glucosidase activity of compound 5 were confirmed. Our results show that C. biflorum produces compounds of therapeutic interest with anti-diabetic, anti-tumoral and anti-acetylcholinesterase properties.

Impact of Traditional Healers on the HIV Care Cascade in Senegal, West Africa: A Longitudinal Study.

Consultation with traditional healers (THs) is common among people living with HIV in sub-Saharan Africa. We conducted a prospective longitudinal study to determine the association between consultation with THs and HIV outcomes following 12 months of antiretroviral therapy (ART). HIV-infected individuals presenting for care and initiation of ART in Dakar and Ziguinchor, Senegal were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart reviews at enrollment, 6 months after ART initiation, and 12 months after ART initiation. Among the 186 participants, 35.5% consulted a TH. The most common reason for consulting a TH was "mystical" concerns (18%). Those who consulted a TH before ART initiation were more likely to present with a CD4 count < 200 cells/mm3 (44% versus 28%; P = 0.04) and WHO stage 3 or 4 disease (64% versus 46%; P = 0.03), and they were less likely to disclose their HIV status (44% versus 65%; P = 0.04). Those who consulted a TH more than 6 months after ART initiation were more likely to report poor adherence to ART (57% versus 4%; P < 0.01). The strongest predictor of virologic failure was consulting a TH more than 6 months after ART initiation (odd ratio [OR], 7.43; 95% CI, 1.22-45.24). The strongest predictors of mortality were consulting a TH before ART initiation (OR, 3.53; 95% CI, 1.25-9.94) and baseline CD4 count < 200 cells/mm3 (OR, 3.15; 95% CI, 1.12-8.89). Our findings reveal multiple opportunities to strengthen the HIV care cascade through partnerships between THs and biomedical providers. Future studies to evaluate the impact of these strategies on HIV outcomes are warranted.