Chapitre 2. L'autonomisation des comités nationaux d'éthique de la recherche en Afrique : perspective historique et enjeux actuels.

Since the 60s, and particularly after various scandals in the 90s, national research ethics committees in Africa have established themselves as key players in the field of international clinical research. Notably based on the principle of double ethical review, their existence has historically been aimed at preventing a form of ethical dumping, a temptation that still exists today on the part of some research promoters. While the international framework of “soft” law has favored their emergence and legitimacy, a legal and regulatory framework of “hard” law is also necessary at local level for each national research ethics committee, to ensure its proper functioning and the optimal fulfillment of its missions. The aim of this article is to analyze the similarities and differences between three national ethics committees in Africa, specifically the CNERS of Guinea, the CNERS of Benin and the CNESVS of Côte d’Ivoire, in terms of status, missions, legal or regulatory ground and, more generally, autonomy. This analysis will enable us, on the one hand, to take account of common logistical difficulties and, on the other, to go beyond differences in legal status and missions to define what enables this type of committee to fully exercise its role(s). Finally, this article proposes to model the various elements that contribute to the autonomy and resilience of a national research ethics committee, around a notion proposed on this occasion: the “circles of autonomy”.

Traditional treatment of human and animal salmonelloses in Southern Benin: Knowledge of farmers and traditherapists.

AIM: This study aimed to report medicinal plants that are likely to be used in the control of salmonellosis. MATERIALS AND METHODS: A cross-sectional study was conducted in Southern Benin. Semi-structured questionnaires were administered to 150 farmers and 100 traditional therapists in seven high municipalities. This step helped to collect plants that are used in the treatment of animal salmonellosis and typhoid fever in human. RESULTS: The results revealed a low level of use of medicinal plants among breeders who prefer antibiotics such as oxytetracycline (53.55%), tylosine + sulfadimerazine (15.30%), and alphaceryl (19.13%). However, plants such as Moringa oleifera (leaves), Carica papaya (leaves and seeds), and Vernonia amygdalina (leaves) were mostly used by some farmers. From traditional therapists, 57 plant species of 32 families were identified as typhoid fever cures; among which Leguminosae, Asteraceae, and Euphorbiaceae were predominant. Persea americana (22.72%), V. amygdalina (7.57%), and Corchorus olitorius (7.57%) were the most cited by traditherapists for the treatment of typhoid fever in human. CONCLUSION: This study provides a database for further studies on the in vitro and in vivo efficacy of Benin plant species on Salmonellaspp. These evaluations will guarantee the availability of new therapeutic solutions for populations.

Sanitary Risks Connected to the Consumption of Infusion from Senna rotundifolia L. Contaminated with Lead and Cadmium in Cotonou (Benin).

This study carried out an assessment of sanitary risks connected to the consumption of Senna rotundifolia Linn. contaminated with lead and cadmium. This plant was collected and analyzed by atomic absorption spectrophotometry. The results revealed a contamination of plants from markets of Dantokpa, Vossa, and Godomey with heavy metals. Senna from Vossa was higher in cadmium and lead levels (Pb: 2.733 mg/kg ± 0.356 mg/kg; Cd: 0.58 mg/kg ± 0.044 mg/kg) compared to the two other places (Pb: 1.825 mg/kg ± 0.133 mg/kg, Cd: 0.062 mg/kg ± 0.015 mg/kg and Pb: 1.902 mg/kg ± 0.265 mg/kg, Cd: 0.328 mg/kg ± 0.024 mg/kg), respectively, for Dantokpa and Godomey. In terms of risk assessment through the consumption of Senna, the values recorded for lead were nine times higher with children and six times higher with adults than the daily permissive intake (Pb: 3.376 × 10(-2) mg/kg/day for children and 2.105 × 10(-2) mg/kg/day for adults versus 3.6 × 10(-3) mg/kg/day for DPI). With respect to cadmium, there was no significant difference between the recorded values and the DPI (Cd: 1 × 14 10(-3) mg/ kg/day for children and Cd: 0.71 × 10(-3) mg/ kg/day for adults versus Cd: 1 × 10(-3) mg/kg/day for adults). This exposure of the population to lead and cadmium through the consumption of antimalarial healing plants could pose public health problems.

[Distribution of Buruli ulcer in the Zè district of Benin]. / Distribution spatiale de l'ulcère de Buruli dans la commune de Zê (Bénin).

The goals of this cross-sectional study conducted in the Zè district of Benin were to determine the overall distribution and prevalence of Buruli ulcer (BU) and to identify environmental and behavioral risk factors. A total of 425 current or previous BU patients from the study district were included. Data was obtained by direct observation, semi-structured interviews, and document review. The main findings can be summarized as follows. The overall prevalence of BU in the Zè district in 2006 was 52 cases per 10000 inhabitants. The prevalence of current and previous cases was 28.1 and 23.9 per 10 000 inhabitants respectively. The distribution of BU within the district was highly variable from one subdistrict to another and from one village to another within the same subdistrict. The subdistricts showing the highest and lowest endemicity were Djigbé with 265 cases per 10 000 inhabitants and Koundokpoé with 3 cases per 10 000 inhabitants respectively. Proximity of the hamlets to water bodies was a risk factor for the disease.

[Distribution of Mycobacterium ulcerans (Buruli ulcer) in the district of Lalo in Benin]. / Distribution de l'infection a Mycobacterium ulcerans (Ulcere de Buruli dans la commune de Lalo au Benin.

This study aimed to determine the distribution of Buruli ulcer (BU) in Lalo, one of the endemic districts of the Couffo department in Bénin. A total of 752 BU patients were detected in this district with 160 active and 592 inactive cases. The overall prevalence of BU in this district is 86.6 per 10,000 inhabitants, varying from 0 to 249/10,000 between sub-districts. At village level the prevalence varies between 0 and 561 cases per 10,000 inhabitants. Our findings confirm the large variation of distribution of the disease at the village level in endemic area. Children under 15 years are frequently affected. We also found a significant association between age and location of Buruli lesions. Further epidemiological and environmental studies are needed to identify the reasons for the extraordinary variation in BU distribution between villages from the same sub-district, and to confirm if it is associated with temporal variations.

[Traditional treatment for Buruli ulcer in Benin]. / Le traitement traditionnel de l'ulcère de Buruli au Bénin.

The purpose of this transversve qualitative study on traditional treatment for Buruli ulcer in Benin was to track the treatment itinerary of patients, the main phases of traditional treatment, cost and efficacy of such treatment, and the knowledge and skills of traditional practitioners. A total of 20 traditional practitioners, 35 patients treated by traditional therapy, and 35 patients treated by surgery were included. Findings showed that both traditional and surgical treatment was sought at a late stage. Reasons determining the type of treatment chosen included religion, access to adequate care facilities, constraints involved in surgical treatment, duration of hospitalization, and fear of scarring. The four main steps in traditional treatment were diagnosis, removal of necrotic tissue, wound care, and exorcism. The cost of traditional treatment was high not only in currency but also by payment in kind (eg., livestock and land). Although it is performed with patient consent, traditional treatment presents a number of risks. Information campaigns are necessary to inform populations about available treatments and the possible risks associated with each modality. Care centers must do more to lessen the constraints involved in surgical treatment both in terms of duration of hospitalization and cosmetic outcome.

Le traitement traditionnel de l'ulcere de Buruli au Benin

The purpose of this tra n s ve rs ve qualitat ive study on traditional treatment for Buruli ulcer in Benin was to track the tre atment itinera ry of pat i e n s ; the main phases of traditional treatment; cost and effi c a cy of such tre atment ; and the knowledge and skills of traditional practitioners. A total of 20 traditional practitioners; 35 patients treated by traditional therapy; and 35 patients treated by surgery were included. Findings showed that both traditional and surgical treatment was sought at a late stage. Reasons determining the type of tre atment chosen included religion; access to adequate care facilities; constraints involved in surgical treatment; duration of hospitalization; and fear of scarring. The four main steps in traditional treatment were diagnosis; removal of necrotic tissue; wound care; and exorcism. The cost of traditional treatment was high not only in c u rre n cy but also by payment in kind (e.g.; live s t o ck and land). Although it is perfo rmed with patient consent; t raditional tre atment presents a number of risks. Information campaigns are necessary to inform populations about available treatments and the possible risks associated with each modality. Care centers must do more to lessen the constraints involved in surgical treatment both in terms of duration of hospitalization and cosmetic outcome

Weather conditions and cerebrospinal meningitis in Benin (Gulf of Guinea, West Africa).

Over a 28-year period cerebrospinal meningitis, in sporadic as well as epidemic situations, mainly affected the Beninese territory from November to March, April or sometimes May. On the average, the acme occurred in February-March. A regression analysis confirmed that 14 to 34.5% of the temporal variability of the disease was due to the northern trade wind (harmattan) and a low absolute humidity in the northern areas, which constitute the main epidemiological pole of the country. On the contrary, cerebrospinal meningitis and climate turned out to be fully independent one from the other in the southernmost areas, where the harmattan is seldom experienced although the meningitis belt is at the present time spreading southwards. But the case-fatality ratio was especially high in the coastal region and during the off season, i.e. when endemic meningitis predominantly affected small children aged under one year. In any way, the climate-meningitis relationship proved to be weaker than is sometimes assumed, perhaps because this relationship is partly overshadowed by both anthropic effects (vaccination campaigns) and latency before disease outbreak.