Risk factors associated with congenital central nervous system abnormalities in the National Hospital of Zinder, Niger.

INTRODUCTION: Congenital malformations of the central nervous system (CNS) are morphological abnormalities of the brain and spinal cord that occur during fetal development. They constitute the second most common congenital disability, after congenital cardiac defects. Many risk factors have been identified; however, these studies included various types of congenital abnormality. Furthermore, there is a lack of information on risk factors for congenital CNS malformation, and notably in the Zinder region of Niger. OBJECTIVE: This study aimed to identify the risk factors associated with congenital CNS malformations in the Zinder region. METHODS: In a case-control design, patients with congenital CNS malformation were enrolled between June 2022 and April 2023 in the Department of Neurosurgery of the National Hospital of Zinder. RESULTS: Family history of malformation (aOR:3.31, 95% CI:1.25-8.78) and consanguine marriage (aOR:2.28, 95% CI:1.23-4.20) were significantly associated with congenital CNS malformation. In contrast, folic acid supplementation (aOR:0.34, 95% CI:0.13, 0.89), multiparity (aOR:0.34, 95% CI:0.13, 0.89), and grand multiparity (aOR, 0.47; 95% CI:0.23, 0.97) had a protective effect. CONCLUSION: Risk factors such as family malformation history and consanguine marriage increased the risk of developing congenital malformations of the central nervous system. In contrast, folic acid supplementation in the index period and multiparity had a significant protective effect.

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.

Family with recurrent cases of neural tube defects in Niamey (Niger).

A series of patients affected by neural tube defects have been studied in Niamey (Niger). This population is highly consanguineous and we try estimating the number of cases in which a previous identical malformation has been reported in the family. We found only 4 families indicating that the percentage of such families is not increased in our population. However, we think that studying genetic factors in this specific population could allow to demonstrate susceptibility genes that can act on this pathology.

Epidemiological behaviour and interventions of malaria in Niger, 2010-2019: a time-series analysis of national surveillance data.

BACKGROUND: Malaria remains a significant public health concern in Niger, with the number of cases increasing from 592,334 in 2000 to 3,138,696 in 2010. In response, a concerted campaign against the disease has been initiated. However, the implementation of these malaria interventions and their association with epidemiological behaviour remains unclear. METHODS: A time-series study was conducted in Niger from 2010 to 2019. Multiple data sources concerning malaria were integrated, encompassing national surveillance data, Statistic Yearbook, targeted malaria control interventions, and meteorological data. Incidence rate, mortality rate, and case fatality ratio (CFR) by different regions and age groups were analysed. Joinpoint regression models were used to estimate annual changes in malaria. The changes in coverage of malaria interventions were evaluated. RESULTS: Between 2010 to 2019, the incidence rate of malaria decreased from 249.43 to 187.00 cases per 1,000 population in Niger. Niamey had a high annual mean incidence rate and the lowest CFR, while Agadez was on the contrary. Joinpoint regression analysis revealed a declining trend in malaria incidence for all age groups except the 10-24 years group, and the mortality rate and the CFR initially decreased followed by an increase in all age groups. Niger has implemented a series of malaria interventions, with the major ones being scaled up to larger populations during the study period. CONCLUSIONS: The scale-up of multi-interventions in Niger has significantly reduced malaria incidence, but the rise in mortality rate and CFR addresses the challenges in malaria control and elimination. Malaria endemic countries should enhance surveillance of malaria cases and drug resistance in Plasmodium, improve diagnosis and treatment, expand the population coverage of insecticide-treated bed nets and seasonal malaria chemoprevention, and strengthen the management of severe malaria cases.

First identification of Microsporidia MB in Anopheles coluzzii from Zinder City, Niger.

BACKGROUND: Malaria, a disease transmitted by Anopheles mosquitoes, is a major public health problem causing millions of deaths worldwide, mostly among children under the age of 5 years. Biotechnological interventions targeting parasite-vector interactions have shown that the microsporidian symbiont Microsporidia MB has the potential to disrupt and block Plasmodium transmission. METHODS: A prospective cross-sectional survey was conducted in Zinder City (Zinder), Niger, from August to September 2022, using the CDC light trap technique to collect adult mosquitoes belonging to the Anopheles gambiae complex. The survey focused on collecting mosquitoes from three neighborhoods of Zinder (Birni, Kangna and Garin Malan, located in communes I, II and IV, respectively). Collected mosquitoes were sorted and preserved in 70% ethanol. PCR was used to identify host species and detect the presence of Microsporidia MB and Plasmodium falciparum infection. RESULTS: Of the 257 Anopheles mosquitoes collected and identified by PCR, Anopheles coluzzii was the most prevalent species, accounting for 97.7% of the total. Microsporidia MB was exclusively detected in A. coluzzii, with a prevalence of 6.8% (17/251) among the samples. No significant difference in prevalence was found among the three neighborhoods. Only one An. coluzzii mosquito tested PCR-positive for P. falciparum. CONCLUSIONS: The results confirm the presence of Microsporidia MB in Anopheles mosquitoes in Zinder, Niger, indicating its potential use as a biotechnological intervention against malaria transmission. However, further studies are needed to determine the efficacy of Microsporidia MB to disrupt Plasmodium transmission as well as its impact on vector fitness.

Successful completion of onchocerciasis elimination mapping (OEM) in Niger, West Africa.

BACKGROUND: By 1987, onchocerciasis in Niger had been successfully controlled in the six endemic river basins. In 2017, onchocerciasis elimination mapping (OEM) was carried out to determine if there was any ongoing transmission in the country as a whole. METHODS: The recommended OEM procedures were implemented. RESULTS: Ten districts, that included 35 villages, required field investigation as sites of possible transmission. None of these were found capable of supporting black fly breeding, nor was there any evidence of the presence of Simulium sp. flies. CONCLUSIONS: The implementation of OEM indicates that there is no transmission of onchocerciasis currently taking place in these newly assessed sites in Niger.

Climate shocks and nutrition: The role of food security policies and programs in enhancing maternal and neonatal survival in Niger.

Niger is afflicted with high rates of poverty, high fertility rates, frequent environmental crises, and climate change. Recurrent droughts and floods have led to chronic food insecurity linked to poor maternal and neonatal nutrition outcomes in vulnerable regions. We analyzed maternal and neonatal nutrition trends and subnational variability between 2000 and 2021 with a focus on the implementation of policies and programs surrounding two acute climate shocks in 2005 and 2010. We used four sources of data: (a) national household surveys for maternal and newborn nutritional indicators allowing computation of trends and differences at national and regional levels; (b) document review of food security reports; (c) 30 key informant interviews and; (d) one focus group discussion. Many food security policies and nutrition programs were enacted from 2000 to 2020. Gains in maternal and neonatal nutrition indicators were more significant in targeted vulnerable regions of Maradi, Zinder, Tahoua and Tillabéri, from 2006 to 2021. However, poor access to financial resources for policy execution and suboptimal implementation of plans have hindered progress. In response to the chronic climate crisis over the last 20 years, the Nigerien government and program implementers have demonstrated their commitment to reducing food insecurity and enhancing resilience to climate shocks by adopting a deliberate multisectoral effort. However, there is more that can be achieved with a continued focus on vulnerable regions to build resilience, targeting high risk populations, and investing in infrastructure to improve health systems, food systems, agriculture systems, education systems, and social protection.

Clinical Outreach Training and Supportive Supervision Quality-of-Care Analysis: Impact of Readiness Factors on Health Worker Competencies in Malaria Case Management in Cameroon, Mali, and Niger.

Improving the quality of malaria clinical case management in health facilities is key to improving health outcomes in patients. The U.S. President's Malaria Initiative Impact Malaria Project has supported implementation of the Outreach Training and Supportive Supervision (OTSS) approach in 11 African countries to improve the quality of malaria care in health facilities through the collection and analysis of observation-based data on health facility readiness and health provider competency in malaria case management. We conducted a secondary analysis of longitudinal data collected during routine supervision in Cameroon (April 2021-March 2022), Mali (October 2020-December 2021), and Niger (November 2020-September 2021) using digitized checklists to assess how service readiness affects health worker competencies in managing patients with fever correctly and providing those with confirmed uncomplicated malaria cases with appropriate treatment and referral. Linear or logistic regression analyses were conducted to assess the effect of facility readiness and its components on observed health worker competencies. All countries demonstrated significant associations between health facility readiness and malaria case management competencies. Data from three rounds of OTSS visits in Cameroon, Mali, and Niger showed a statistically significant positive association between greater facility readiness scores (including the availability of commodities, materials, and trained staff) and health worker competency in case management. These findings provide evidence that health worker performance is likely affected by the tools and training available to them. These results reinforce the need for necessary tools and properly trained staff if high-quality malaria case management services are to be delivered at health facilities.

Genetic polymorphism of merozoite surface protein 1 and antifolate-resistant genes in Plasmodium falciparum from Mali and Niger.

Since 2015, countries in the Sahel region have implemented large-scale seasonal malaria chemoprevention (SMC). However, the mass use of sulfadoxine-pyrimethamine (SP) plus amodiaquine impacts the genetic diversity of malaria parasites and their sensitivity to antimalarials. This study aimed to describe and compare the genetic diversity and SP resistance of Plasmodium falciparum strains in Mali and Niger. We collected 400 blood samples in Mali and Niger from children aged 3-59 months suspected of malaria. Of them, 201 tested positive (Niger, 111, 55.2%; Mali, 90, 44.8%). Polymorphism of merozoite surface protein 1 (msp1) genetic marker showed 201 allotypes. The frequency of the RO33 allotype was significantly higher in Niger (63.6%) than in Mali (39.3%). There was no significant difference in the frequency of the K1 and MAD20 allotypes between the 2 countries. The multiplicity of infection was 2 allotypes per patient in Mali and one allotype per patient in Niger. The prevalence of strains with the triple mutants Pfdhfr51I/Pfdhfr59R/Pfdhps436A/F/H and Pfdhfr51I/Pfdhfr59R/Pfdhps437G was 18.1% and 30.2%, respectively, and 7.7% carried the quadruple mutant Pfdhfr51I/Pfdhfr59R/Pfdhps436A/F/H/Pfdhps437G. Despite the significant genetic diversity of parasite populations, the level of SP resistance was comparable between Mali and Niger. The frequency of mutations conferring resistance to SP still allows its effective use in intermittent preventive treatment in pregnant women and in SMC.

Distance to Health Centers and Effectiveness of Azithromycin Mass Administration for Children in Niger: A Secondary Analysis of the MORDOR Cluster Randomized Trial.

Importance: The MORDOR (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) trial demonstrated that mass azithromycin administration reduced mortality by 18% among children aged 1 to 59 months in Niger. The identification of high-risk subgroups to target with this intervention could reduce the risk of antimicrobial resistance. Objective: To evaluate whether distance to the nearest primary health center modifies the effect of azithromycin administration to children aged 1 to 59 months on child mortality. Design, Setting, and Participants: The MORDOR cluster randomized trial was conducted from December 1, 2014, to July 31, 2017; this post hoc secondary analysis was conducted in 2023 among 594 clusters (communities or grappes) in the Boboye and Loga departments in Niger. All children aged 1 to 59 months in eligible communities were evaluated. Interventions: Biannual (twice-yearly) administration of a single dose of oral azithromycin or matching placebo over 2 years. Main Outcomes and Measures: A population-based census was used to monitor mortality and person-time at risk (trial primary outcome). Community distance to a primary health center was calculated as kilometers between the center of each community and the nearest health center. Negative binomial regression was used to evaluate the interaction between distance and the effect of azithromycin on the incidence of all-cause mortality among children aged 1 to 59 months. Results: Between December 1, 2014, and July 31, 2017, a total of 594 communities were enrolled, with 76 092 children (mean [SD] age, 31 [2] months; 39 022 [51.3%] male) included at baseline, for a mean (SD) of 128 (91) children per community. Median (IQR) distance to the nearest primary health center was 5.0 (3.2-7.1) km. Over 2 years, 145 693 person-years at risk were monitored and 3615 deaths were recorded. Overall, mortality rates were 27.5 deaths (95% CI, 26.2-28.7 deaths) per 1000 person-years at risk in the placebo arm and 22.5 deaths (95% CI, 21.4-23.5 deaths) per 1000 person-years at risk in the azithromycin arm. For each kilometer increase in distance in the placebo arm, mortality increased by 5% (adjusted incidence rate ratio, 1.05; 95% CI, 1.03-1.07; P < .001). The effect of azithromycin on mortality varied significantly by distance (interaction P = .02). Mortality reduction with azithromycin compared with placebo was 0% at 0 km from the health center (95% CI, -19% to 17%), 4% at 1 km (95% CI, -12% to 17%), 16% at 5 km (95% CI, 7% to 23%), and 28% at 10 km (95% CI, 17% to 38%). Conclusions and Relevance: In this secondary analysis of a cluster randomized trial of mass azithromycin administration for child mortality, children younger than 5 years who lived farthest from health facilities appeared to benefit the most from azithromycin administration. These findings may help guide the allocation of resources to ensure that those with the least access to existing health resources are prioritized in program implementation. Trial Registration: ClinicalTrials.gov Identifier: NCT02047981.

Comprehensive Profile of Pathogens and Antimicrobial Resistance in Conjunctivitis Cases from Niger.

Infectious conjunctivitis outbreaks remain a public health burden. This study focuses on the pathogen and antimicrobial resistance (AMR) profiles identified in Niger. Sixty-two patients with acute infectious conjunctivitis who presented to health posts were enrolled from December 2021 to May 2022. Nasal and conjunctival swabs were obtained from each patient. Unbiased RNA deep sequencing (RNA-seq) was used to identify associated pathogens. A pathogen was identified in 39 patients (63%; 95% CI, 50-74). Of those, an RNA virus was detected in 23 patients (59%; 95% CI, 43-73). RNA viruses were diverse and included human coronaviruses (HCoVs): SARS-CoV-2, HCoV-229E, HCoV-HKU1, and HCoV-OC43. A DNA virus was identified in 11 patients (28%; 95% CI, 17-44). Of those, four patients had a coinfection with an RNA virus and two patients had a coinfection with both an RNA virus and a bacterium. DNA viruses were predominantly human herpesvirus (cytomegalovirus, Epstein-Barr virus, human herpesvirus 8) and human adenovirus species B, C, and F. Eighteen patients (46%; 95% CI, 32-61) had a bacteria-associated infection that included Haemophilus influenza, Haemophilus aegyptius, Staphylococcus aureus, Streptococcus pneumoniae, and Moraxella spp. Antimicrobial resistance determinants were detected in either the conjunctiva or nasal samples of 20 patients (32%; 95% CI, 22-45) and were found to be more diverse in the nose (Shannon alpha diversity, 1.12 [95% CI, 1.05-1.26] versus 1.02 [95% CI, 1.00-1.05], P = 0.01). These results suggest the potential utility of leveraging RNA-seq to surveil pathogens and AMR for ocular infections.

Trends in malnutrition among children under 5 in Niger: a retrospective analysis of demographic and nutrition surveys comparing 2008-2014 with 2015-2021.

OBJECTIVES: For decades, Niger, a Sahelian country in Africa, has faced serious food and nutrition crises. Policies and strategies have been implemented by the Government, with the support of its partners, to address this public health problem. The current study was conducted to assess trends in malnutrition among children under 5 years of age. By comparing results from 2008 to 2014 with results from 2015 to 2021, this study aimed to check the efficacy of strategies and policies that were implemented to combat malnutrition. STUDY DESIGN: Retrospective study. METHODS: Data from the annual nutrition survey Standardized Monitoring and Assessment of Relief and Transitions and the Demographic and Health and Multiple Indicator Surveys were used. Meta-analyses were performed on the data as a whole and in each age group by time period. For analysis of age groups, the 95% confidence interval (CI) data were missing, thus an estimate was made from the 'design effect' calculated based on existing CIs. RESULTS: Institutional arrangements had not changed from 2008 to 2014 to 2015-2021, and there were very few changes to existing strategies and policies. The prevalence of Global Acute Malnutrition and Global Chronic Malnutrition (GCM) both remained above critical thresholds for each year in both periods. GCM was above the emergency threshold for both periods, indicating that all regions of the country were affected by malnutrition. The most populated regions (40%) of Maradi and Zinder were the most affected by malnutrition. These two regions also had highest incidence of poverty and the least health service coverage. CONCLUSIONS: Despite the implementation of various policies and strategies, the nutritional status of children under 5 remains an important public health problem.

Postabortion care availability, readiness, and accessibility in Niger in 2022: results from linked facility-female cross-sectional data.

BACKGROUND: Postabortion care (PAC), which is an essential element of emergency obstetric care, is underresearched in Niger. The study aims to assess the availability, readiness, and accessibility of facility-based PAC services in Niger. METHODS: This study uses female and facility data from Performance Monitoring for Action Niger. The female data include a nationally representative sample of women aged 15-49 (n = 3,696). Using GPS coordinates, these female data were linked to a sample of public and private facilities (n = 258) that are expected to provide PAC. We assessed PAC availability and facility readiness to provide basic and comprehensive PAC using the signal functions framework, overall and by facility type. We then calculated the distance between women and their closest facility and estimated the proportion of women living within five kilometers (5 km) of a facility providing any PAC, basic PAC, and comprehensive PAC, overall and by women's background characteristics. RESULTS: Only 36.4% and 14% of eligible facilities had all basic and comprehensive PAC signal functions, respectively. Oxytocics and laparotomy were the most missing signal function for basic and comprehensive PAC, respectively. Private facilities were the least ready to provide the full range of PAC services. While 47% of women lived within 5 km of a facility providing any PAC services, only 33.4% and 7.9% lived within 5 km of a facility providing all basic and all comprehensive PAC signal functions, respectively. Women who were divorced/widowed, had higher levels of education, and were living in urban areas had increased odds of living within 5 km of a facility with any or basic PAC. Women who were never married had increased odds of living within 5 km of a facility with comprehensive PAC, while urban residence was fully predictive of living within 5 km of a facility with comprehensive PAC. CONCLUSIONS: This study found PAC availability and readiness to be insufficient in Niger, with inadequate and disparate accessibility to facilities providing PAC services. We recommended stakeholders ensure stock of essential commodities and availability of PAC services at primary facilities in order to mitigate the negative maternal health repercussions of unsafe abortion in this setting.

Comparison of Population-Based Census versus Birth History for the Estimation of Under-5 Mortality in Niger.

The WHO guidelines on mass distribution of azithromycin for child survival recommend monitoring of mortality to evaluate effectiveness. Trials that contributed evidence to these guidelines used a population-based census to monitor vital status, requiring census workers to visit each household biannually (twice yearly). Birth history is an alternative to the census approach that may be more feasible because it decreases the time and labor needed for mortality monitoring. This study aimed to compare the population-based census (reference standard) and birth history (index test) approaches to estimating mortality among children 1 to 59 months old using data from the Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) trial. Sixteen communities that received 5 years of biannual census in the MORDOR trial were selected randomly also to receive birth history surveys. The census approach recorded more participants and households than birth history, with correlations more than 0.94 for each. The correlation between number of deaths in each community was 0.84 (95% CI, 0.59-0.94). A comparison of the mortality incidence rate estimated from the census against the under-5 mortality rate estimated from the birth history resulted in a correlation of 0.60 (95% CI, 0.15-0.84). Of the 47% of children who were linked individually to compare vital status from each method, the death status of children had a sensitivity of 80% (95% CI, 73-89) and a specificity of 98% (95% CI, 98-99), comparing birth history to census. Overall birth histories were found to be a reasonable alternative to biannual census for tracking vital status.

Temporal Trends in Phenotypic Macrolide and Nonmacrolide Resistance for Streptococcus pneumoniae Nasopharyngeal Samples Up to 36 Months after Mass Azithromycin Administration in a Cluster-Randomized Trial in Niger.

Azithromycin mass drug administration decreases child mortality but also selects for antibiotic resistance. Herein, we evaluate macrolide resistance of nasopharyngeal Streptococcus pneumoniae after azithromycin MDA. In a cluster-randomized trial, children 1-59 months received azithromycin or placebo biannually. Fifteen villages from each arm were randomly selected for antimicrobial resistance testing, and 10-15 randomly selected swabs from enrolled children at each village were processed for S. pneumoniae isolation and resistance testing. The primary prespecified outcome was macrolide resistance fraction for azithromycin versus placebo villages at 36 months. Secondary non-prespecified outcomes were comparisons of azithromycin and placebo for: 1) macrolide resistance at 12, 24, and 36 months; 2) nonmacrolide resistance at 36 months; and 3) suspected-erm mutation. At 36 months, 423 swabs were obtained and 322 grew S. pneumoniae, (azithromycin: 146/202, placebo: 176/221). Mean resistance prevalence was non-significantly higher in treatment than placebo (mixed-effects model: 14.6% vs. 8.9%; OR = 2.0, 95% CI: 0.99-3.97). However, when all time points were evaluated, macrolide resistance prevalence was significantly higher in the azithromycin group (ß = 0.102, 95% CI: 0.04-0.167). For all nonmacrolides, resistance prevalence at 36 months was not different between the two groups. Azithromycin and placebo were not different for suspected-erm mutation prevalence. Macrolide resistance was higher in the azithromycin group over all time points, but not at 36 months. Although this suggests resistance may not continue to increase after biannual MDA, more studies are needed to clarify when MDA can safely decrease mortality and morbidity in lower- and middle-income countries.

Assessment of variability in PM2.5 and its impact on human health in a West African country.

PM2.5 has become a global challenge threatening human health, climate, and the environment. PM2.5 is ranked as the most common cause of premature mortality and morbidity. Therefore, the current study endeavors to probe the spatiodynamic characteristics of PM2.5 in the Republic of Niger and its impacts on human health from 1998 to 2019. Based on remotely sensed satellite datasets, the study found that the concentration of PM2.5 continued to rise in Niger from 68.85 µg/m3 in 1998 to 70.47 µg/m3 in 2019. During the study period, the annual average PM2.5 concentration is far above the WHO guidelines and the interim target-1 (35 µg/m3). The overall annual growth rate of PM2.5 concentration in Niger is 0.02 µg/m3/year. The health risk (HR) due to PM2.5 exposure is also escalated in Niger, particularly, in Southern Niger. The extent of the extremely high-risk areas corresponding to 1 × 104-9.4 × 105 µg.persons/m3 is increased from 0.9% (2000) to 2.8% (2019). Niamey, southern Dakoro, Mayahi, Tessaoua, Mirriah, Magaria, Matameye, Aguié, Madarounfa, Groumdji, Madaoua, Bouza, Keita, eastern Tahoua, eastern Illéla, Bkomnni, southern Dogon-Doutchi, Gaya, eastern Boboye, central Kollo, and western Tillabéry are experienced high HR due to long-term exposure to PM2.5. These findings indicate that PM2.5 causes a serious health risk across Niger. There is an immediate need to carry out its regional control. Therefore, policymakers and the Nigerien government should make conscious efforts to identify the priority target areas with radically innovative appropriate mitigation interventions.

Cost of Acute Malnutrition Treatment Using a Simplified or Standard Protocol in Diffa, Niger.

Evidence on the cost of acute malnutrition treatment, particularly with regards to simplified approaches, is limited. The objective of this study was to determine the cost of acute malnutrition treatment and how it is influenced by treatment protocol and programme size. We conducted a costing study in Kabléwa and N'Guigmi, Diffa region, where children with acute malnutrition aged 6-59 months were treated either with a standard or simplified protocol, respectively. Cost data were collected from accountancy records and through key informant interviews. Programme data were extracted from health centre records. In Kabléwa, where 355 children were treated, the cost per child treated was USD 187.3 (95% CI: USD 171.4; USD 203.2). In N'Guigmi, where 889 children were treated, the cost per child treated was USD 110.2 (95% CI: USD 100.0; USD 120.3). Treatment of moderate acute malnutrition was cheaper than treatment of severe acute malnutrition. In a modelled scenario sensitivity analysis with an equal number of children in both areas, the difference in costs between the two locations was reduced from USD 77 to USD 11. Our study highlighted the significant impact of programme size and coverage on treatment costs, that cost can differ significantly between neighbouring locations, and that it can be reduced by using a simplified protocol.

Predictors of Anaemia among Pregnant Women Booking for Antenatal Care at Federal Medical Centre, Bida, Niger State, Nigeria.

BACKGROUND: Maternal anaemia results in morbidity and mortality in both the mother and the unborn child. INTRODUCTION: Several factors have been found to determine anaemia among pregnant women but vary from place to place depending on the population and setting of the study. We thus set out to determine predictors of anaemia among pregnant women at booking in FMC, Bida. METHODS: This is a descriptive cross-sectional study carried out over a period of three (3) months among 248 pregnant women booking for Antenatal Care (ANC) at the ANC Clinic of the Federal Medical Centre (FMC), Bida, Niger state. RESULTS: The mean haemoglobin concentration was 10.2 ±1.0g/dl and 72.6% of all the women were anaemic (haemoglobin concentration < 11g/dl). Anaemia was significantly related to Religion (Islam) (p <0.001), Ethnicity (Yoruba) (p <0.001), the Gestational age (second trimester) at booking (p= 0.013), Interpregnancy interval (< 2 years) (p <0.001), microcytic red blood cell (p <0.001) and hypochromic red blood cell (p <0.001) morphology and absence of fever (p = 0.043) in index pregnancy. In the final analysis at the multivariate level hypochromic red blood cells (OR = 0.049, p = 0.001, CI = 0.008-0.307), Gestational age (second trimester) at booking (OR = 3.465, p = 0.011, CI = 1.323-9.077) and Religion (Islam) (OR = 4.309, p = 0.006, CI = 1.520-12.215) remained significant independent predictors of anaemia. CONCLUSION: Anaemia in pregnancy is still a frequent finding, and it's linked to diets poor in iron and folate, booking in the second trimester, and religion. The prevalence and severity of anaemia in pregnancy will be considerably reduced by early booking, and iron/folate nutritional interventions.

CONTEXTE: L'anémie maternelle entraîne la morbidité et lamortalité de la mère et de l'enfant à naître. INTRODUCTION: Plusieurs facteurs ont été trouvés pour déterminer l'anémie chez les femmes enceintes, mais ils varient d'un endroit à l'autre en fonction de la population et du cadre de l'étude. Nous avons donc entrepris de déterminer les facteurs prédictifs de l'anémie chez les femmes enceintes au moment de la réservation dans le FMC de Bida. MÉTHODES: Il s'agit d'une étude transversale descriptive menée sur une période de trois (3) mois auprès de 248 femmes enceintes qui ont pris rendez-vous pour des soins prénataux (ANC) à la clinique ANC du Federal Medical Centre (FMC), Bida, dans l'État du Niger. RESULTATS: La concentration moyenne d'hémoglobine était de 10,2 ± 1,0g/dl et 72,6% de toutes les femmes étaient anémiques (concentration d'hémoglobine < 11g/dl). L'anémie était significativement liée à la religion (Islam) (p <0.001), à l'ethnie (Yoruba) (p <0.001), à l'âge gestationnel (deuxième trimestre) lors de la réservation (p= 0.013), à l'intervalle entre les grossesses (< 2 ans) (p <0.001), à la morphologie des globules rouges microcytaires (p <0.001) et hypochromes (p <0.001) et à l'absence de fièvre (p= 0.043) au cours de la grossesse de référence. Dans l'analyse finale au niveau multivarié, les globules rouges hypochromes (OR = 0.049, p = 0.001, CI = 0.008-0.307), l'âge gestationnel (deuxième trimestre) lors de la réservation (OR = 3.465, p = 0.011, CI = 1.323-9.077) et la religion (Islam) (OR= 4.309, p = 0.006, CI = 1.520-12.215) sont restés des prédicteurs indépendants significatifs de l'anémie. CONCLUSION: L'anémie pendant la grossesse est encore fréquente, et elle est liée à des régimes pauvres en fer et en folate, à la réservation au cours du deuxième trimestre, et à la religion. La prévalence et la gravité de l'anémie pendant la grossesse seront considérablement réduites par une prise en charge précoce et des interventions nutritionnelles à base de fer et de folate. Mots clés: Anémie, Anc, Grossesse, Prédicteurs.

Wastewater-Based Surveillance of Antimicrobial Resistance in Niger: An Exploratory Study.

Wastewater-based surveillance is increasingly recognized as an important approach to monitoring population-level antimicrobial resistance (AMR). In this exploratory study, we examined the use of metagenomics to evaluate AMR using untreated wastewater samples routinely collected by the Niger national polio surveillance program. Forty-eight stored samples from two seasons each year over 4 years (2016-2019) in three regions were selected for inclusion in this study and processed using unbiased DNA deep sequencing. Normalized number of reads of genetic determinants for different antibiotic classes were compared over time, by season, and by location. Correlations in resistance were examined among classes. Changes in reads per million per year were demonstrated for several classes, including decreases over time in resistance determinants for phenicols (-3.3, 95% CI: -8.7 to -0.1, P = 0.029) and increases over time for aminocoumarins (3.8, 95% CI: 0.0 to 11.4, P = 0.043), fluoroquinolones (6.8, 95% CI: 0.0 to 20.5, P = 0.048), and beta-lactams (0.85, 95% CI: 0.1 to 1.7, P = 0.006). Sulfonamide resistance was higher in the post-rainy season compared with the dry season (5.2-fold change, 95% CI: 3.4 to 7.9, P < 0.001). No differences were detected when comparing other classes by season or by site for any antibiotic class. Positive correlations were identified in genetic determinants of resistance among several antibiotic classes. These results demonstrate the potential utility of leveraging existing wastewater sample collection in this setting for AMR surveillance.