Using Total Cohort Fertility in Adolescence (TCFA) to analyse adolescent fertility trends and factors in Niger: Evidence from 1992 to 2012 demographic and health surveys.

Girls aged 10-19 currently represent 12% of Niger's population (2020). And this number continues to grow as the fertility rate is higher while mortality is declining faster. Using Niger's demographic and health surveys carried out between 1992 and 2012, the study investigated adolescent fertility, its trends and associated factors. It mobilised descriptive methods (Total cohort fertility in adolescence (TCFA) computation, distribution of the number of adolescent births, and computation of adolescent cohort childbearing mean age) and multivariate Logistic and Poisson models. The result shows the TCFA went from 1.29 in 1992 to 1.17 in 2012. Early sexual intercourse and marriage, infant mortality, the desire for a large family, and urbanisation are among the factors significantly associated with adolescent fertility in Niger. The study concludes that the high level of adolescent fertility in Niger does not seem to be changing.

Les adolescentes représentent 12 % de la population Nigerienne (2020). Ce chiffre continue de croître car la fécondité reste elevée alors que la mortalité diminue rapidement. Utilisant les enquêtes démographiques et de santé du Niger entre 1992 et 2012, cette étude s'est intéressée aux tendances et facteurs de la descendance finale à l'adolescence (DFA). Elle a mobilisé des méthodes descriptives (calcul de la DFA, distribution du nombre de naissances adolescentes, calcul de l'âge moyen à la maternité adolescente) et des modèles multivariés de régression logistique et de Poisson. Les résultats montrent que la DFA est passée de 1,29 en 1992 à 1,17 en 2012. Les rapports sexuels et le mariage précoces, la mortalité infantile, le désir d'une famille nombreuse et l'urbanisation sont parmi les facteurs significativement associés à la fécondité adolescente au Niger. L'étude conclut que le niveau élevé de la fécondité des adolescentes au Niger ne semble pas évoluer.

Facteurs associés à la surmortalité infanto-juvénile des jumeaux à Haïti.

Introduction : In Haiti, excess mortality among twins is an additional health burden, given that child mortality levels are already very high there. Haiti is the country in the Latin America and Caribbean region with the highest rate of twin births (about 17 ‰). However, there, the excess mortality among twins has been little studied. PURPOSE OF RESEARCH: To identify factors associated with excess mortality among twins. METHODS: With data from the Demographic and Health Surveys, calculation of under-five mortality rates (U5MR) and using a Cox regression to analyze factors associated with excess mortality among twins. RESULTS: Twins have U5MRs that are three times higher than those of singletons. However, these U5MRs fell sharply, but more sharply among twins than singletons. Indeed, between 1994 and 2016, the U5MR for twins decreased by about 53% (from 432 ‰ to 204‰), while for singletons, it was only 36% (from 121‰ to 77‰). The multivariate results show that all else being equal, twins have a 3.3 (2.86-3.87) times higher Hazard Ratio of death than singletons. They also show low birth weight, lack of prenatal visits, and lack of breastfeeding are independently associated with excess mortality among twins in Haiti.Conclusions : The health of twin children remains a major challenge for Haiti. To further reduce their excess mortality, the government has to develop accessible obstetric and pediatric services essential for the care of twin pregnancies.

Assessment of peri-urban livestock producers' willingness to pay for improved forages as cash crops.

Availability of quality feed is a major constraint for livestock production in Burkina Faso. Despite previous efforts to test improved forages at research stations to overcome the dry-season feed gap, little has been done to promote them as cash crops that can contribute to meeting the growing feed demand in the country. This study was undertaken to evaluate the willingness to pay (WTP) for improved forage by livestock producers in the peri-urban livestock production systems of Burkina Faso. A total of 202 livestock producers were interviewed using semi-structured questionnaires. The contingent valuation method and Tobit econometric model were used to analyze the survey data. Exactly 79% of the interviewed livestock producers were willing to pay for improved forages for their livestock. Key factors that significantly affect this decision were the price of cottonseed cakes used as supplemental feed (P = .001), farmers' knowledge about improved forage crops (P = .001), farmers' ethnicity (P = .05), and farmers' practice of daily grazing and transhumance (P = .01). The estimated WTP for improved forage as a cash crop was US$0.32 kg-1 for all livestock producers and $0.58 kg-1 for those who only expressed a positive WTP. The positive WTP for improved forages and factors affecting that decision suggest that producing improved forages is a viable alternative to expensive cottonseed cakes and the practice of transhumance to overcome the dry-season feed gap. Therefore, dissemination of improved forages is recommended to market-oriented crop farmers to meet the growing feed demand in Burkina Faso.

Optimising geographical accessibility to primary health care: a geospatial analysis of community health posts and community health workers in Niger.

BACKGROUND: Little is known about the contribution of community health posts and community health workers (CHWs) to geographical accessibility of primary healthcare (PHC) services at community level and strategies for optimising geographical accessibility to these services. METHODS: Using a complete georeferenced census of community health posts and CHWs in Niger and other high-resolution spatial datasets, we modelled travel times to community health posts and CHWs between 2000 and 2013, accounting for training, commodities and maximum population capacity. We estimated additional CHWs needed to optimise geographical accessibility of the population beyond the reach of the existing community health post network. We assessed the efficiency of geographical targeting of the existing community health post network compared with networks designed to optimise geographical targeting of the estimated population, under-5 deaths and Plasmodium falciparum malaria cases. RESULTS: The per cent of the population within 60-minute walking to the nearest community health post with a CHW increased from 0.0% to 17.5% between 2000 and 2013. An estimated 10.4 million people (58.5%) remained beyond a 60-minute catchment of community health posts. Optimal deployment of 7741 additional CHWs could increase geographical coverage from 41.5% to 82.9%. Geographical targeting of the existing community health post network was inefficient but optimised networks could improve efficiency by 32.3%-47.1%, depending on targeting metric. INTERPRETATIONS: We provide the first estimates of geographical accessibility to community health posts and CHWs at national scale in Niger, highlighting improvements between 2000 and 2013, geographies where gaps remained and approaches for optimising geographical accessibility to PHC services at community level.

Aspects épidémiologiques et cliniques des accidents du travail avec incapacité permanente partielle : à propos de 221 cas colligés

Les accidents du travail (AT) sont fréquents et s'accompagnent souvent de lourdes conséquences pour l'individu, la communauté et l'employeur, occasionnant dans certains cas des séquelles dont il faut déterminer le taux d'incapacité permanente partielle (IPP). L'étude était transversale et analytique. Elle s'est déroulée sur une période de cinq années allant de 2012 à 2016, et a concerné tous les dossiers complets d'accidents du travail avec Incapacité Permanente Partielle AT/IPP enregistrés à la Direction régionale de Ouagadougou de la Caisse Nationale de Sécurité Sociale. Les résultats descriptifs ont été présentés sous forme univariée et bivariée. L'échantillon était constitué de 221 cas d'AT/IPP extraits parmi les dossiers d'AT déclarés à Ouagadougou, soit un taux de 4,49 % (221/4922). L'échantillon était constitué de 54 femmes (24,4 3%) et 167 hommes (75,57 %). L'âge moyen était de 40,09 ± 8,8 ans (16 - 62 ans), avec une sinistralité plus fréquente dans le secteur des « services fournis à la collectivité, services sociaux et services personnels » (38,46 %). Plus de 2/3 des cas étaient des « employés » (67,42 %). Les accidents de trajet constituaient la majorité des sinistres (62 %). Ils survenaient en matinée entre 6 heures et 8 heures (45,25 %) et le véhicule de transport était le principal élément agent matériel causal (64,71 %). Les AT/IPP ont causé des fractures des membres (48,88 %) et entrainé 110 cas d'impotence fonctionnelle (49 %) et en moyenne 103 journées de travail perdues (3 - 848 jours). La prévention des AT/IPP devra intégrer des modules sur la sécurité routière

Consommation d'alcool chez les travailleurs à Ouagadougou (Burkina Faso)

Dans le monde du travail, l'alcoolisation de certains travailleurs est une préoccupation aussi bien de l'employeur que des autres salariés. En effet, l'alcool est un facteur démultiplicateur du risque professionnel. Cependant très peu de données sont disponibles dans les pays de la sous-région. L'objectif était d'étudier l'ampleur de la consommation d'alcool chez les travailleurs à Ouagadougou. Nous avons procédé à un échantillonnage stratifié simple. Le questionnaire AUDIT a été administré aux travailleurs ayant donné leur consentement. Les résultats ont été présentés sous formes univariées. L'échantillon était constitué de 350 travailleurs avec un taux de participation de 100 %. La prévalence de la consommation d'alcool était de 65,14 % avec une fréquence de consommation inférieure ou égale à 4 fois par mois chez 50 % des travailleurs. La quantité d'alcool consommée un jour typique de consommation était inférieure ou égale à 4 verres chez 57,02 %. Les travailleurs qui avaient une consommation à faible risque étaient les plus représentés avec 39,43 %. Le sexe masculin, la confession religieuse non musulmane et le niveau d'instruction supérieur étaient les facteurs associés à la consommation d'alcool chez les travailleurs. La consommation d'alcool chez les travailleurs dans la ville de Ouagadougou est importante. Cela interpelle les acteurs de la prévention quant à la nécessité d'en tenir compte dans la politique santé et sécurité au travail en entreprise

Niger's Child Survival Success, Contributing Factors and Challenges to Sustainability: A Retrospective Analysis.

BACKGROUND: Household surveys undertaken in Niger since 1998 have revealed steady declines in under-5 mortality which have placed the country 'on track' to reach the fourth Millennium Development goal (MDG). This paper explores Niger's mortality and health coverage data for children under-5 years of age up to 2012 to describe trends in high impact interventions and the resulting impact on childhood deaths averted. The sustainability of these trends are also considered. METHODS AND FINDINGS: Estimates of child mortality using the 2012 Demographic and Health Survey were developed and maternal and child health coverage indicators were calculated over four time periods. Child survival policies and programmes were documented through a review of documents and key informant interviews. The Lives Saved Tool (LiST) was used to estimate the number of child lives saved and identify which interventions had the largest impact on deaths averted. The national mortality rate in children under-5 decreased from 286 child deaths per 1000 live births (95% confidence interval 177 to 394) in the period 1989-1990 to 128 child deaths per 1000 live births in the period 2011-2012 (101 to 155), corresponding to an annual rate of decline of 3.6%, with significant declines taking place after 1998. Improvements in the coverage of maternal and child health interventions between 2006 and 2012 include one and four or more antenatal visits, maternal Fansidar and tetanus toxoid vaccination, measles and DPT3 vaccinations, early and exclusive breastfeeding, oral rehydration salts (ORS) and proportion of children sleeping under an insecticide-treated bed net (ITN). Approximately 26,000 deaths of children under-5 were averted in 2012 due to decreases in stunting rates (27%), increases in ORS (14%), the Hib vaccine (14%), and breastfeeding (11%). Increases in wasting and decreases in vitamin A supplementation negated some of those gains. Care seeking at the community level was responsible for an estimated 7,800 additional deaths averted in 2012. A major policy change occurred in 2006 enabling free health care provision for women and children, and in 2008 the establishment of a community health worker programme. CONCLUSION: Increases in access and coverage of care for mothers and children have averted a considerable number of childhood deaths. The 2006 free health care policy and health post expansion were paramount in reducing barriers to care. However the sustainability of this policy and health service provision is precarious in light of persistently high fertility rates, unpredictable GDP growth, a high dependence on donor support and increasing pressures on government funding.

Homozygous deletion of an EGR2 enhancer in congenital amyelinating neuropathy.

The transcription factor EGR2 is expressed in Schwann cells, where it controls peripheral nerve myelination. Mutations of EGR2 have been found in patients with congenital hypomyelinating neuropathy or Charcot-Marie-Tooth disease type 1D. In a patient with congenital amyelinating neuropathy, we observed pathological abnormalities recapitulating the peripheral nervous system phenotype of homozygous Egr2-null mice. This patient, born from consanguineous parents, showed no EGR2 immunoreactivity in Schwann cells and harbored a homozygous 10.7-kilobase-long deletion encompassing a myelin-specific enhancer of EGR2. This regulatory mutation is the first genetic abnormality associated with congenital amyelinating neuropathy in humans.