Blood Biochemical Reference Intervals of Black Caimans (Melanosuchus niger) and Spectacled Caimans (Caiman crocodilus) in the Brazilian Amazon Region.

Reference intervals for physiologic parameters, crucial for assessing the health status of animals, have been documented for various crocodilian species across the globe. Nonetheless, the establishment of plasma biochemical reference intervals specific to Amazonian crocodilians remains incomplete. In an effort to address this gap, we procured blood samples from 65 black caimans (Melanosuchus niger) and 58 spectacled caimans (Caiman crocodilus) during the period of September-December 2019 within the Anavilhanas National Park in the Brazilian Amazon region We aimed to define reference intervals for 11 key plasma variables measured, namely glucose, triglycerides, total cholesterol, calcium, magnesium, sodium, potassium, albumin, total protein, uric acid, and urea. In general, the determined blood reference intervals aligned closely with those established for other crocodilian species. Some specific measurements, such as total cholesterol, sodium, and magnesium, exhibited distinct variations based on the species. Furthermore, female black caimans showcased elevated cholesterol levels compared with their male counterparts. Within the spectacled caimans, disparities related to sex were evident solely in the case of electrolytes sodium and potassium, with males demonstrating higher levels compared with females. These reference intervals not only provide data for assessing potential fluctuations in the health of wild or captive Amazonian crocodilians but also hold value for veterinary management.

A New Species of Unibarra (Monogenoidea, Dactylogyridae) Parasite of Oxydoras niger From Juruá River, State of Acre, Brazil and New Data for U. paranoplatensis.

Monogenoids are ectoparasites that have a simple one-host lifecycle, high species diversity, and a relatively high host specificity. During studies on the helminth fauna of fishes from the Jurua River, in Acre State, Brazil, a new species of the monotypic genus Unibarra Suriano & Incorvaia, 1995 was found parasitizing Oxydoras niger Valenciennes, 1821. Unibarra juruaensis n. sp. is allocated in the genus based on the presence of a single haptoral bar, marginal hooks similar in shape and size, gonads partially overlapping, and a conspicuous filament which connects the base of the male copulatory organ with the accessory piece. The new species differs from the only species of the genus by the smaller size of the body and of the structures, by the morphology of copulatory complex, with an accessory piece thinner than that of U. paranoplatensis Suriano & Incorvaia, 1995 and by the presence of two eyespots. The type species, U. paranoplatensis, is referred in a new host, Pimelodus blochii Valenciennes, 1840, with new morphological data. A table of measurements of the new species and previous and the present reports of U. paranoplatensis is presented.

An investigation on protein and amino acid contents in scales and muscles of pomfret Parastromateus niger (Bloch, 1795) and Pampus argenteus (Eupharasen, 1788).

The present investigation was aimed to examine the percentage quantity of protein and amino acids in scales and muscles of Pampus argenteus and Parastromateus niger gathered from the local fish market of district Quetta of Balochistan. About 80 specimens of these two species, i.e., Pampus argenteus (N=40) and Parastromateus niger (N = 40), were collected from April 2017 to May 2018. In general, crude protein content was high in scales, that is, 71.03% in Parastromateus niger and 52.11% in Pampus argenteus, as well as in muscles of two Pomfret species of fishes i.e., 63.44% in Pampus argenteus and 60.99% in Parastromateus niger on a dry-weight basis, respectively. Likewise, the muscles and scales of Parastromateus niger reveal well compositions of amino acids that include proline was found to be high, and methionine was less than other amino acids, whereas threonine was found high in the scales of Pampus argenteus, but methionine was observed in lesser amount. However, the amino acids found in Pampus argenteus muscles also showed different compositions, such as lysine was found to be high, but histidine was less, respectively. In comparison, amino acids like tryptophan and cysteine were not detected in both scales and muscles of these Pomfret species of fishes. Thus, this study was based on analyzing the utilization of both Pomfret species of scales and meat whether they could have values as good supplements of both protein and certain kinds of essential amino acids in animal diets.

Modeling the effect of lockdown timing as a COVID-19 control measure in countries with differing social contacts.

The application, timing, and duration of lockdown strategies during a pandemic remain poorly quantified with regards to expected public health outcomes. Previous projection models have reached conflicting conclusions about the effect of complete lockdowns on COVID-19 outcomes. We developed a stochastic continuous-time Markov chain (CTMC) model with eight states including the environment (SEAMHQRD-V), and derived a formula for the basic reproduction number, R0, for that model. Applying the [Formula: see text] formula as a function in previously-published social contact matrices from 152 countries, we produced the distribution and four categories of possible [Formula: see text] for the 152 countries and chose one country from each quarter as a representative for four social contact categories (Canada, China, Mexico, and Niger). The model was then used to predict the effects of lockdown timing in those four categories through the representative countries. The analysis for the effect of a lockdown was performed without the influence of the other control measures, like social distancing and mask wearing, to quantify its absolute effect. Hypothetical lockdown timing was shown to be the critical parameter in ameliorating pandemic peak incidence. More importantly, we found that well-timed lockdowns can split the peak of hospitalizations into two smaller distant peaks while extending the overall pandemic duration. The timing of lockdowns reveals that a "tunneling" effect on incidence can be achieved to bypass the peak and prevent pandemic caseloads from exceeding hospital capacity.

Influence of sex, size and trophic level on blood Hg concentrations in Black caiman, Melanosuchus niger (Spix, 1825) in French Guiana.

Mercury (Hg) is a contaminant that is impacting ecosystems worldwide. Its toxicity is threatening wildlife and human populations, leading to the necessity of identifying the most affected ecosystems. Therefore, it is essential to identify pertinent bioindicator organisms to monitor Hg contamination. In this study, we determined the stable carbon (δ13C) and nitrogen (δ15N) isotope ratios in the red blood cells (RBCs), and the total Hg concentration in total blood of 72 Melanosuchus niger in French Guiana. The goals of our study were to assess the level of Hg contamination in total blood of Black caimans and to further investigate the influence of individual traits (i.e., sex, size/age, diet) on Hg concentrations. Mercury concentration in total blood of Black caimans ranged from 0.572 to 3.408 µg g-1 dw (mean ± SD is 1.284 ± 0.672 µg g-1 dw) and was positively correlated to individual body size and trophic position (δ15N). We did not find any sexual or seasonal effects on Hg concentrations in the blood. The use of blood of M. niger is relevant to determine Hg concentrations within the population and suggests that this species can be used as a bioindicator for environmental contamination. In addition, our results emphasize trophic position as a major source of Hg variation and further suggest that it is essential to take trophic position (δ15N) into account for future studies.

Contributions to the knowledge of Neotropical ant-like spiders: Myrmecotypus tahyinandu sp. n. from Bolivian Chiquitano forest, a new country record for M. niger, and indirect evidence for species-specific mimicry (Araneae: Corinnidae: Castianeirinae).

Myrmecotypus tahyinandu sp. n. is described from the Bolivian Chiquitano forest, and M. niger Chickering, 1937 is recorded from Bolivia for the first time. The morphological differentiation among the closely related M. tahyinandu sp. n. and M. iguazu Rubio Arbino, 2009 is likely attributable to the selection for specific ant mimicry. Adults of M. tahyinandu sp. n. are accurate mimics of the ant Camponotus crassus Mayr, 1862, M. iguazu of C. sericeiventris (Guérin-Méneville, 1838), and M. niger of Dolichoderus bispinosus (Olivier, 1792). This study is the first to identify ant models for morphologically closely related Castianeirinae, providing a promising starting point for future research on ant mimicry.

Allaeotes niger, a weevil introduced to Cuba and the only known New World Stromboscerini (Coleoptera: Curculionidae: Dryophthorinae).

Allaeotes niger He, Zhang and Pelsue, a weevil hitherto known only from the type series collected in China, is for the first time reported from Cuba. In addition to three historical Cuban specimens, approximately one hundred adults were observed in 2018 under bark of fallen logs at a plantation of (likely non-native) pines in westernmost Pinar del Río province. This is the only New World record of a member of the monophyletic core of the tribe Stromboscerini, otherwise distributed in a triangle delimited by Japan, Sri Lanka and northern Australia (plus a single mysterious record from Uganda). Phylogenetic analysis of one mitochondrial (COI) and two nuclear (ITS2 and 28S) markers recovered the Cuban specimens nested within the tribe, but not in a clade with two unnamed congeners from Vietnam. Adults of all four known Allaeotes species are illustrated, including both named ones. Remarkably, both Cuban and Ugandan records of extraterritorial Stromboscerini pertain to species associated with dead wood, a biological trait possibly facilitating human-assisted transoceanic dispersal. Cuban populations of A. niger are interpreted as a pre-1990 human-mediated introduction. Two additional specimens of A. niger intercepted at US ports of entry arriving from China and the Dominican Republic, respectively, corroborate this hypothesis and suggest China as a likely origin of the Cuban introduction. All data used herein (specimen images, geographical localities, DNA sequences) are available online in a public dataset dx.doi.org/10.5883/DS-VGDS012.

Polycyclic aromatic hydrocarbon-emulsifier protein produced by Aspergillus brasiliensis (niger) in an airlift bioreactor following an electrochemical pretreatment.

An emulsifier protein (EP) was produced and easily separated from oil-contaminated water as an economical substrate when Aspergillus brasiliensis, pretreated in a solid state culture with a controlled electric field, was used in an airlift bioreactor. The hydrocarbon-EP comprised 19.5% of the total protein, its purification enhanced the specific emulsifying activity (EA) seven times. The influence of operational conditions (pH and salt concentration) on the EA were assessed to characterise the emulsion stability. The EA was increased by 19% in alkaline environments (pH 7-11), but it was not affected by the presence of salt (0-35 g L-1). On the other hand, preheating the EP samples (60 °C) enhanced the EA by 2.5 times. Based on analysis of its EA, this EP can be applied as a bioremediation enhancer in contaminated soils.

Unconditional cash transfers for assistance in humanitarian disasters: effect on use of health services and health outcomes in low- and middle-income countries.

BACKGROUND: Unconditional cash transfers (UCTs) are a common social protection intervention that increases income, a key social determinant of health, in disaster contexts in low- and middle-income countries (LMICs). OBJECTIVES: To assess the effects of UCTs in improving health services use, health outcomes, social determinants of health, health care expenditure, and local markets and infrastructure in LMICs. We also compared the relative effectiveness of UCTs delivered in-hand with in-kind transfers, conditional cash transfers, and UCTs paid through other mechanisms. SEARCH METHODS: We searched 17 academic databases, including the Cochrane Public Health Group Specialised Register, the Cochrane Database of Systematic Reviews (The Cochrane Library 2014, Issue 7), MEDLINE, and EMBASE between May and July 2014 for any records published up until 4 May 2014. We also searched grey literature databases, organisational websites, reference lists of included records, and academic journals, as well as seeking expert advice. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials (RCTs), as well as cohort, interrupted time series, and controlled before-and-after studies (CBAs) on UCTs in LMICs. Primary outcomes were the use of health services and health outcomes. DATA COLLECTION AND ANALYSIS: Two authors independently screened all potentially relevant records for inclusion criteria, extracted the data, and assessed the included studies' risk of bias. We requested missing information from the study authors. MAIN RESULTS: Three studies (one cluster-RCT and two CBAs) comprising a total of 13,885 participants (9640 children and 4245 adults) as well as 1200 households in two LMICs (Nicaragua and Niger) met the inclusion criteria. They examined five UCTs between USD 145 and USD 250 (or more, depending on household characteristics) that were provided by governmental, non-governmental or research organisations during experiments or pilot programmes in response to droughts. Two studies examined the effectiveness of UCTs, and one study examined the relative effectiveness of in-hand UCTs compared with in-kind transfers and UCTs paid via mobile phone. Due to the methodologic limitations of the retrieved records, which carried a high risk of bias and very serious indirectness, we considered the body of evidence to be of very low overall quality and thus very uncertain across all outcomes.Depending on the specific health services use and health outcomes examined, the included studies either reported no evidence that UCTs had impacted the outcome, or they reported that UCTs improved the outcome. No single outcome was reported by more than one study. There was a very small increase in the proportion of children who received vitamin or iron supplements (mean difference (MD) 0.10 standard deviations (SDs), 95% confidence interval (CI) 0.06 to 0.14) and on the child's home environment, as well as clinically meaningful, very large reductions in the chance of child death (hazard ratio (HR) 0.26, 95% CI 0.10 to 0.66) and the incidence of severe acute malnutrition (HR 0.44, 95% CI 0.24 to 0.80). There was also a moderate reduction in the number of days children spent sick in bed (MD - 0.36 SDs, 95% CI - 0.62 to - 0.10). There was no evidence for any effect on the proportion of children receiving deworming drugs, height for age among children, adults' level of depression, or the quality of parenting behaviour. No adverse effects were identified. The included comparisons did not examine several important outcomes, including food security and equity impacts.With regard to the relative effectiveness of UCTs compared with a food transfer providing a relatively high total caloric value, there was no evidence that a UCT had any effect on the chance of child death (HR 2.27, 95% CI 0.69 to 7.44) or severe acute malnutrition (HR 1.15, 95% CI 0.67 to 1.99). A UCT paid in-hand led to a clinically meaningful, moderate increase in the household dietary diversity score, compared with the same UCT paid via mobile phone (difference-in-differences estimator 0.43 scores, 95% CI 0.06 to 0.80), but there was no evidence for an effect on social determinants of health, health service expenditure, or local markets and infrastructure. AUTHORS' CONCLUSIONS: Additional high-quality evidence (especially RCTs of humanitarian disaster contexts other than droughts) is required to reach clear conclusions regarding the effectiveness and relative effectiveness of UCTs for improving health services use and health outcomes in humanitarian disasters in LMICs.

Extant forest plantations as a potential bridge between social needs and ecological management: a comparative case study analysis.

In the face of global deforestation, there is a challenge to balance the management of areas of high conservation concern and social interests. As a response to the growing human-environment interface and the use of forests for subsistence, plantations became a management tool to provide for wood harvesting during the 1970s. Some plantations were subsequently protected from harvest as conservation of all forests increased. Plantations that are now illegal to harvest can cause local animosities toward forest protection to increase and may also result in concentrated harvesting impacts on surrounding natural forests. In this article, we analyzed case studies of plantations from El Salvador and Niger. By utilizing distinctly disparate case studies, commonalities between the two can illuminate possible management lessons. In the comparison of El Salvador and Niger forest plantations we found the following commonalities: utilizing plantations for sustainable harvest has the to potential to reduce animosity between managers and stakeholders; plantations can serve as a risk-averse testing ground for novel managerial practices; and the sustainable harvest of plantations can reduce deforestation and impacts on biodiversity in natural remnant forests. We argue that extant plantations currently under illegal harvesting legislation could become the epicenters of social and ecological conservation through a management shift to sustainable harvesting. By focusing on these relics, managers could work with stakeholders to change unduly burdening restrictions and promote cooperation between conservationists and local populations.

Toxoplasmosis seroprevalence in urban rodents: a survey in Niamey, Niger.

A serological survey of Toxoplasma gondii was conducted on 766 domestic and peridomestic rodents from 46 trapping sites throughout the city of Niamey, Niger. A low seroprevalence was found over the whole town with only 1.96% of the rodents found seropositive. However, differences between species were important, ranging from less than 2% in truly commensal Mastomys natalensis, Rattus rattus and Mus musculus, while garden-associated Arvicanthis niloticus displayed 9.1% of seropositive individuals. This is in line with previous studies on tropical rodents--that we reviewed here--which altogether show that Toxoplasma seroprevalence in rodent is highly variable, depending on many factors such as locality and/or species. Moreover, although we were not able to decipher statistically between habitat or species effect, such a contrast between Nile grass rats and the other rodent species points towards a potentially important role of environmental toxoplasmic infection. This would deserve to be further scrutinised since intra-city irrigated cultures are extending in Niamey, thus potentially increasing Toxoplasma circulation in this yet semi-arid region. As far as we are aware of, our study is one of the rare surveys of its kind performed in Sub-Saharan Africa and the first one ever conducted in the Sahel.

Toxoplasmosis seroprevalence in urban rodents: a survey in Niamey, Niger

A serological survey of Toxoplasma gondii was conducted on 766 domestic and peridomestic rodents from 46 trapping sites throughout the city of Niamey, Niger. A low seroprevalence was found over the whole town with only 1.96% of the rodents found seropositive. However, differences between species were important, ranging from less than 2% in truly commensal Mastomys natalensis, Rattus rattus and Mus musculus, while garden-associated Arvicanthis niloticus displayed 9.1% of seropositive individuals. This is in line with previous studies on tropical rodents - that we reviewed here - which altogether show that Toxoplasma seroprevalence in rodent is highly variable, depending on many factors such as locality and/or species. Moreover, although we were not able to decipher statistically between habitat or species effect, such a contrast between Nile grass rats and the other rodent species points towards a potentially important role of environmental toxoplasmic infection. This would deserve to be further scrutinised since intra-city irrigated cultures are extending in Niamey, thus potentially increasing Toxoplasma circulation in this yet semi-arid region. As far as we are aware of, our study is one of the rare surveys of its kind performed in Sub-Saharan Africa and the first one ever conducted in the Sahel.

Treatment of severe acute malnutrition in infants aged <6 months in Niger.

OBJECTIVE: To report a nutritional rehabilitation program in Niger for the management of severe acute malnutrition in infants aged <6 months. STUDY DESIGN: This is a presentation of a case series (n = 632) of young infants who were admitted to a nutrition rehabilitation program in 2010-2011. The main characteristics of the inpatient treatment protocol where the use of diluted F-100 milk via a supplementary suckling technique until exclusive breastfeeding was reinitialized, coaching of mothers on infant feeding, and intensive antibiotic therapy as indicated during the stabilization phase. Semistructured interviews were conducted with 103 mothers. RESULTS: Rates of recovery, mortality, and default were 85% (537 of 632), 6% (37 of 632), and 9% (55 of 632), respectively. The majority of infants had an infectious disease at study entry (81%), particularly acute watery diarrhea and respiratory tract infections. Infection on admission was a predictor of death during treatment (OR, 3.9; 95% CI, 1.6-9.2). Anorexia at entry was a risk factor for treatment failure (OR, 4.4; 95% CI, 1.71-11.1). Interviews revealed a very low rate of exclusive breastfeeding (3%), with delayed initiation in 68% of cases. Traditional beliefs, perceived insufficiency of breast milk, and psychological problems played important roles in feeding choices. CONCLUSION: Severe acute malnutrition in infants aged <6 months can be successfully treated by managing cases as inpatients with an adapted protocol, intensive clinical supervision, and intensive drug treatment if indicated. Whether similar outcomes are achievable in community-based programs remains to be verified. Effective interventions for improving breastfeeding practices are needed.

Estimates of HIV incidence from household-based prevalence surveys.

OBJECTIVE: To estimate HIV incidence in the general population in countries where there have been two recent household-based HIV prevalence surveys (the Dominican Republic, Mali, Niger, Tanzania, and Zambia). METHODS: We applied a validated method to estimate HIV incidence using HIV prevalence measurement in two surveys. RESULTS: We estimate incidence among men and women aged 15-44 years to be: 0.5/1000 person-years at risk in the Dominican Republic 2002-2007, 1.1/1000 in Mali 2001-2006, 0.6/1000 in Niger 2002-2006, 3.4/1000 in Tanzania 2004-2008, and 11.2/1000 in Zambia 2002-2007. The groups most at risk in these epidemics are typically 15-24-year-old women and 25-39-year-old men. Incidence appears to have declined in recent years in all countries, but only significantly among men in the Dominican Republic and Tanzania and women in Zambia. CONCLUSION: Using prevalence measurements to estimate incidence reveals the current level and age distribution of new infections and the trajectory of the HIV epidemic. This information is more useful than prevalence data alone and should be used to help determine priorities for interventions.

The human right to the highest attainable standard of health: new opportunities and challenges.

The health and human rights communities have much in common. Recently, the international community has begun to devote more attention to the right to the highest attainable standard of health ("the right to health"). Today, this human right presents health and human rights professionals with a range of new opportunities and challenges. The right to health is enshrined in binding international treaties and constitutions. It has numerous elements, including the right to health care and the underlying determinants of health, such as adequate sanitation and safe water. It empowers disadvantaged individuals and communities. If integrated into national and international policies, it can help to establish policies that are meaningful to those living in poverty. The author introduces his work as the UN Special Rapporteur on the right to health. By way of illustration, he briefly considers his interventions on Niger's Poverty Reduction Strategy, Uganda's neglected (or tropical or poverty-related) diseases, and the recent US-Peru trade negotiations. With the maturing of human rights, health professionals have become an indispensable part of the global human rights movement. While human rights do not provide magic solutions, they have a constructive contribution to make. The failure to use them is a missed opportunity of major proportions.

Reliability of data on caesarean sections in developing countries.

OBJECTIVE: To examine the reliability of reported rates of caesarean sections from developing countries and make recommendations on how data collection for surveys and health facility-based studies could be improved. METHODS: Population-based rates for caesarean section obtained from two sources: Demographic and Health Surveys (DHS) and health facility-based records of caesarean sections from the Unmet Obstetric Need Network, together with estimates of the number of live births, were compared for six developing countries. Sensitivity analyses were conducted using several different definitions of the caesarean section rate, and the rates obtained from the two data sources were compared. FINDINGS: The DHS rates for caesarean section were consistently higher than the facility-based rates. However, in three quarters of the cases, the facility-based rates for caesarean sections fell within the 95% confidence intervals for the DHS estimate. CONCLUSION: The importance of the differences between these two series of rates depends on the analyst's perspective. For national and global monitoring, DHS data on caesarean sections would suffice, although the imprecision of the rates would make the monitoring of trends difficult. However, the imprecision of DHS data on caesarean sections precludes their use for the purposes of programme evaluation at the regional level.

El Médico de Familia cubano y su contribución en la lucha contra el SIDA en África / The Cuban family physician and his/her contribution in the fight against AIDS in Africa

El propósito de este trabajo es brindar una experiencia de un colectivo de médicos combatientes internacionalistas cubanos que prestamos nuestra cooperación médica en uno de los países más pobres del mundo, Níger. Exponemos cómo el Médico de Familia cubano está contribuyendo a la lucha contra el SIDA en África, cómo realiza la identificación del problema, cómo define los factores que lo provocan y se hace un esbozo de cuáles son las actividades fundamentales que se realizan en el combate contra el SIDA. Se define como logro fundamental la sensibilización que se obtiene de las autoridades de la salud pública nigeriana, así como también del gobierno, en relación con el SIDA, gracias al trabajo realizado entre otros por los médicos cubanos

The evaluation of quality assurance: developing and testing practical methods for managers.

OBJECTIVE OF THE STUDY: To develop an approach for evaluating quality assurance (QA) activities and programs in health care settings and to test different evaluation methods. DESIGN: This was not a formal scientific study, but rather a research and development (R&D) study, which followed the following steps: (1) reviewing the literature; (2) clarifying critical issues for all key aspects of QA activities; (3) drafting a guide to provide a flexible vehicle for different approaches; (4) testing and adapting the guide as it evolved in three countries; and (5) testing two evaluation tools (self-assessment and appreciative evaluation) in Chile. SETTING AND STUDY PARTICIPANTS: The evaluation guide was tested by evaluating QA structures, activities, and programs at the country, regional, and facility levels in Zambia, Niger, and Chile. RESULTS: The study resulted in an evaluation guide, which includes an implementation outline, an evaluation matrix, and an appendix of evaluation tools and methods. The guide helps evaluators: agree on a proposed evaluation's scope and design; develop an evaluation methods plan; and address QA history, advocacy, culture, and structure, as well as QA activities and accomplishments. Specific results of the country evaluations in Zambia, Niger, and Chile are presented in separate articles in this supplement. CONCLUSION: The QA programs in which the evaluation guide was tested differed in many ways, such as health system structure, decision to focus on particular services, political level implementing QA, policy environment, leadership, and program evolution. The implementation guide presents an outline of the key implementation steps for an evaluation, and includes checklists and model forms (e.g. sample agenda for a team planning meeting, sample list of questions to focus the evaluation). The evaluation matrix presents indicators by QA component and key question, and it enables evaluators to build an approach and select methods. The appendix describes the various tools and methods presented in the first two sections of the evaluation guide.

[Molecular tools in the epidemiology of tick-borne bacterial diseases]. / Approche moléculaire de l'épidémiologie des maladies bactériennes transmises par les tiques.

Molecular tools have been used to detect rickettsiae in ticks. In Ixodes ricinus ticks collected in France, we detected for the first time there an emerging pathogen, Rickettsia helvetica, and an Ehrlichia sp, closely related to the agent of human granulocytic ehrlichiosis. In Guadeloupe (French West Indies), we described the occurrence of African tick-bite fever due to Rickettsia africae, which had been previously reported in sub-Saharan Africa only. In Africa, we completed our knowledge about the distribution of R. africae (Mali, Niger, Sudan, Burundi), and detected for the first time Rickettsia mongolotimonae, an emerging pathogen. Anaplasma marginale the agent of bovine anaplasmosis was detected in Mali. Rickettsiae of unknown pathogenicity were detected in Mali and Niger.

Client satisfaction. Operations research activities and results.

PIP: Operations research (OR) is a major component of the Quality Assurance Project's (QAP) strategy for improving the quality of health care delivery worldwide. QAP's Operations Research Program aims to improve the feasibility, utility, and cost-effectiveness of quality assurance strategies in developing countries. QAP and its field partners work to maximize the utility of each field study's findings. As such, the project hopes to disseminate information on all aspects of important OR projects, from the initial design to implementation and results. Over the course of the project, QAP's staff and their partners will develop studies in 16 technical areas. One key area of interest is the study of client satisfaction with health care delivery. The project currently has two major studies on client satisfaction underway in Niger and Peru. Phase one results from the Niger research and QAP and the Max Salud Institute in Peru are discussed.^ieng