Diagnostic capacity for cutaneous fungal diseases in the African continent.

BACKGROUND: Cutaneous fungal infections are very common, especially in poorer communities and with intercurrent HIV infection. Determining the fungal pathogen in skin-related fungal neglected tropical diseases (NTDs) determines optimal therapy. We undertook a country survey across many African countries to determine the diagnostic capacity for skin fungal diseases. METHODS: A detailed questionnaire was delivered to country contacts to collect data on availability, frequency, and location of testing for key diagnostic procedures and followed up with 2 rounds of validation by video call and by confirmation of individual country data confirmation by email. RESULTS: Of 47 countries with data, seven (15%) and 21 (45%) do not offer skin biopsy in the public or private sector, respectively, but 22 (46%) countries do it regularly, mostly in university hospitals. Direct microscopy is often performed in 20 of 48 (42%) countries in the public sector and not done in 10 (21%). Fungal cultures are often performed in 21 of 48 (44%) countries in the public sector but not done in nine (20%) or 21 (44%) in either public or private facilities. Histopathological examination of tissue is frequently used in 19 of 48 (40%) countries but not in nine (20%) countries in the public sector. The cost of diagnostics to patients was a major limiting factor in usage. CONCLUSION: Major improvements in the availability and use of diagnostic tests for skin, hair, and nail fungal disease are urgently needed across Africa.

Trends in health surveillance and joint service delivery for pastoralists in West and Central Africa.

In most sub-Saharan African countries, pastoralism represents an important economic resource and contributes significantly to national growth; however, challenges remain, particularly in providing social services to pastoralists (especially health and education) and in avoiding conflict with local sedentary communities and local authorities. All of this takes place while pastoralists try to maintain their mobile lifestyle within a rapidly changing ecosystem. Transdisciplinary approaches, such as 'One Health', which covers both human and animal health, have proven effective in delivering services and reaching mobile pastoralists in remote areas. The pastoralist way of life could be described as being linked to both their livestock and their environment, which makes social science an important element when researching the delivery and adaptation of social services to pastoralists. Early or pre-diagnostic detection of emerging and endemic infectious disease remains a vital aspect of health surveillance targeted at preventing further transmission and spread. Community-based syndromic surveillance, coupled with visual mobile phone technology, adapted to the high levels of illiteracy among nomads, could offer an alternative to existing health surveillance systems. Such an approach could contribute to accelerated reporting, which could in turn lead to targeted intervention among mobile pastoralists in sub-Saharan Africa. Although considerable efforts have been made towards integrating mobile pastoralists into social services, obstacles remain to the adoption of a clear, specific and sustainable policy on pastoralism in sub-Saharan Africa.

Bien que le pastoralisme constitue une ressource économique majeure dans la plupart des pays d'Afrique subsaharienne et qu'il contribue significativement à la croissance des économies nationales, il se heurte encore à de nombreuses difficultés liées notamment à l'accès aux services sociaux, en particulier dans les domaines de la santé et de l'éducation, et à la prévention des conflits avec les communautés sédentaires et les autorités locales. Ce constat intervient à un moment où les pasteurs eux-mêmes essayent de préserver leur mode de vie nomade au sein d'un écosystème soumis à de rapides transformations. Les approches transdisciplinaires, en particulier celles relevant du concept « Une seule santé ¼ qui recouvre à la fois la santé humaine et la santé animale ont fait leurs preuves pour améliorer la fourniture de services et la couverture des pasteurs nomades dans les régions éloignées. Le mode de vie des pasteurs pouvant se définir comme entretenant à la fois des relations avec le bétail et avec leur environnement, les sciences sociales ont un rôle important à jouer pour étudier les modalités de fourniture de services sociaux et leur adaptation aux communautés pastorales. La capacité de procéder à la détection précoce (pré-diagnostic) des maladies émergentes ou endémiques demeure un aspect crucial de la surveillance sanitaire visant à prévenir les risques de transmission et de propagation. L'exercice d'une surveillance syndromique par les communautés, en recourant aux technologies de l'imagerie transmise par téléphonie mobile selon des modalités adaptées à cette population majoritairement illettrée constitue une alternative prometteuse aux systèmes actuels de surveillance sanitaire. Une telle approche permettrait d'accélérer le rythme des notifications et donc de cibler les interventions à destination des pasteurs nomades en Afrique subsaharienne. Bien que des efforts considérables aient été déployés pour faire bénéficier les pasteurs nomades des services sociaux, nombre d'obstacles s'opposent encore à la mise en place d'une politique claire, spécifique et durable en faveur du pastoralisme en Afrique subsaharienne.

Aunque en la mayoría de los países del África subsahariana el pastoreo constituye un importante recurso económico y contribuye sensiblemente al crecimiento nacional, quedan aún problemas por resolver, sobre todo a la hora de prestar servicios sociales a las comunidades de pastores, en particular de salud y educación, y de evitar situaciones de conflicto con las comunidades sedentarias y administraciones locales. Todo ello sucede mientras las sociedades pastorales tratan de preservar su modo de vida nómada dentro de un ecosistema sujeto a rápidas transformaciones. Se ha comprobado que los planteamientos transdisciplinares, como el de «Una sola salud¼, que abarca a la vez la salud humana y la sanidad animal, resultan eficaces para prestar servicios y llegar a las comunidades de pastores nómadas de zonas aisladas. Cabría describir el pastoreo como un modo de vida vinculado a la vez al ganado y al medio natural, lo que hace de las ciencias sociales un elemento importante a la hora de investigar la prestación y adaptación de servicios sociales a estas poblaciones. La detección pronta o previa al diagnóstico de enfermedades infecciosas emergentes o endémicas sigue siendo un aspecto central de la vigilancia sanitaria, destinado a impedir que el agente pueda transmitirse o propagarse. La vigilancia sindrómica a escala comunitaria, combinada con la tecnología de la telefonía móvil visual, perfectamente adaptada a los elevados niveles de analfabetismo existentes entre los nómadas, podría ofrecer una alternativa a los sistemas vigentes de vigilancia sanitaria. Semejante método podría ayudar a comunicar con mayor presteza episodios sanitarios, lo que a su vez podría traducirse en intervenciones específicas entre los pastores nómadas del África subsahariana. Aunque se han hecho considerables esfuerzos para integrar en los servicios sociales a las comunidades pastorales móviles, subsisten obstáculos que dificultan la adopción en el África subsahariana de una política clara, específica y sostenible con respecto al pastoreo.

[Plasmodium falciparum chloroquine and pyrimethamine resistance monitoring network with molecular tools in the Niger River valley, Republic of Niger]. / Réseau de surveillance moléculaire de la chimioré- sistance de Plasmodium falciparum a la chloroquine et a la pyriméthamine dans la vallée du fleuve Niger, au Niger.

Plasmodium falciparum resistance to chloroquine first arose in Africa 25 years ago. Nowadays most of African malaria control programmes have switched their first-line treatment of uncomplicated malaria cases towards artemisinin derivatives combination. After WHO guidelines, a survey network for malaria treatment resistance has been set up in the Niger valley around Niamey since December 2004. The association of the Niger national malaria control programme with the CERMES research center allowed collecting of samples from both health centers and hospitals of this region. Blood finger-pricks on filter papers were tested for detection of plasmodial antigen in health center without biological diagnosis capacity. Specimens found positive either in hospital laboratory or by using antigen method were tested by PCR/RFLP to detect K76T mutations on the pfcrt gene and S108N mutation on the pfdhfr gene. This simple procedure allows the screening of a large number of specimens. Moreover, a spatial distribution of mutations and evidence of resistance clusters were searched integrating the data in a geographic information system. The 76T mutation of pfcrt and 108N of pfdhfr were respectively found in 50.8% and 57% of the specimens tested. No statistically significant difference was found according to the level of sanitary formations or the age of the patients. No resistance cluster was identified and the prevalence of mutation seems homogeneous in the zone. By completing the clinical efficacy studies we think that our simple method for collecting and testing blood samples associated with clinical efficacy studies may be useful for building a network of malaria drug resistance in Africa.

Mycobacterium bovis isolates from tuberculous lesions in Chadian zebu carcasses.

This slaughterhouse study in Chad shows higher proportions of Mycobacterium bovis isolates among Mbororo than Arabe zebu cattle. Spoligotyping shows a homogenetic population structure for M. bovis and lack of spacer 30, as were found in neighboring Cameroon and Nigeria. This finding suggests transborder and ongoing transmission between cattle.

Molecular characterization and drug resistance testing of Mycobacterium tuberculosis isolates from Chad.

The molecular characterizations of the first 40 Mycobacterium tuberculosis isolates from Chad revealed a high proportion of isolates of the Cameroon family (33%), of which one isolate showed a monodrug resistance. In total, 9/33 (27%) isolates were resistant to isoniazid. The implications of these findings are discussed.