Cost of pediatric hospitalizations in Burkina Faso: A cross-sectional study of children aged <5 years enrolled through an acute gastroenteritis surveillance program.

INTRODUCTION: Diarrheal illness is a leading cause of hospitalizations among children <5 years. We estimated the costs of inpatient care for rotavirus and all-cause acute gastroenteritis (AGE) in two Burkina Faso hospitals. METHODS: We conducted a cross-sectional study among children <5 years from December 2017 to June 2018 in one urban and one rural pediatric hospital. Costs were ascertained through caregiver interview and chart abstraction. Direct medical, non-medical, and indirect costs per child incurred are reported. Costs were stratified by rotavirus results. RESULTS: 211 children <5 years were included. AGE hospitalizations cost 161USD (IQR 117-239); 180USD (IQR 121-242) at the urban and 154USD (IQR 116-235) at the rural site. Direct medical costs were higher in the urban compared to the rural site (140USD (IQR 102-182) vs. 90USD (IQR 71-108), respectively). Direct non-medical costs were higher at the rural versus urban site (15USD (IQR 10, 15) vs. 11USD (IQR 5-20), respectively). Indirect costs were higher at the rural versus urban site (35USD (IQR 8-91) vs. 0USD (IQR 0-26), respectively). Rotavirus hospitalizations incurred less direct medical costs as compared to non-rotavirus hospitalizations at the rural site (79USD (IQR 64-103) vs. 95USD (IQR 80-118)). No other differences by rotavirus testing status were observed. The total median cost of a hospitalization incurred by households was 24USD (IQR 12-49) compared to 75USD for government (IQR 59-97). Direct medical costs for households were higher in the urban site (median 49USD (IQR 31-81) versus rural (median 14USD (IQR 8-25)). Households in the lowest wealth quintiles at the urban site expended 149% of their monthly income on the child's hospitalization, compared to 96% at the rural site. CONCLUSIONS: AGE hospitalization costs differed between the urban and rural hospitals and were most burdensome to the lowest income households. Rotavirus positivity was not associated with greater household costs.

Dedicated cone-beam breast CT using laterally-shifted detector geometry: Quantitative analysis of feasibility for clinical translation.

BACKGROUND: High-resolution, low-noise detectors with minimal dead-space at chest-wall could improve posterior coverage and microcalcification visibility in the dedicated cone-beam breast CT (CBBCT). However, the smaller field-of-view necessitates laterally-shifted detector geometry to enable optimizing the air-gap for x-ray scatter rejection. OBJECTIVE: To evaluate laterally-shifted detector geometry for CBBCT with clinical projection datasets that provide for anatomical structures and lesions. METHODS: CBBCT projection datasets (n = 17 breasts) acquired with a 40×30 cm detector (1024×768-pixels, 0.388-mm pixels) were truncated along the fan-angle to emulate 20.3×30 cm, 22.2×30 cm and 24.1×30 cm detector formats and correspond to 20, 120, 220 pixels overlap in conjugate views, respectively. Feldkamp-Davis-Kress (FDK) algorithm with 3 different weighting schemes were used for reconstruction. Visual analysis for artifacts and quantitative analysis of root-mean-squared-error (RMSE), absolute difference between truncated and 40×30 cm reconstructions (Diff), and its power spectrum (PSDiff) were performed. RESULTS: Artifacts were observed for 20.3×30 cm, but not for other formats. The 24.1×30 cm provided the best quantitative results with RMSE and Diff (both in units of µ, cm-1) of 4.39×10-3±1.98×10-3 and 4.95×10-4±1.34×10-4, respectively. The PSDiff (>0.3 cycles/mm) was in the order of 10-14µ2mm3 and was spatial-frequency independent. CONCLUSIONS: Laterally-shifted detector CBBCT with at least 220 pixels overlap in conjugate views (24.1×30 cm detector format) provides quantitatively accurate and artifact-free image reconstruction.

Dynamic relationship of traditional soil restoration practices and climate change adaptation in semi-arid Niger.

Climate change increases the vulnerability of agrosystems to soil degradation and reduces the effectiveness of traditional soil restoration options. The implementation of some practices need to be readjusted due to steadily increasing temperature and lowering precipitation. For farmers, the best practice found, should have the potential to achieve maximum sustainable levels of soil productivity in the context of climate change. A study was conducted in South-West Niger to investigate the use of the suitable practice, through (i) a meta-analysis of case studies, (ii) using field survey and (iii) by using AquaCrop model. Results showed that the effects of the association zaï + mulch on crop yield was up to 2 times higher than control plots depending on climate projections scenario RCP 8.5 under which carbon dioxide (CO2) concentrations are projected to reach 936 ppm by 2100. The practice appeared to be an interesting option for enhancing crop productivity in a context of climate change. Concerning its ability, it offers the best prospects to reverse soil degradation in the study area. In addition, the simulation showed that this strategy was suitable for timely sowing and therefore confirmed scholars and farmers views. Furthermore, this practice is relatively more effective compared to the others practices. These results show that association zaï + mulch could be considered as the best practice that can participate to a successful adaptation to reduce risk from climate change at the same time by reducing the vulnerability of farmers in Southwest of Niger for now and even for the future.

Phytogeographical and sociolinguistical patterns of the diversity, distribution, and uses of wild mushrooms in Côte d'Ivoire, West Africa.

BACKGROUND: Many fungal species in tropical Africa are useful, with high added value, and play essential roles in the structure and dynamic of ecosystems. However, the diversity, distribution, and uses by local populations of these non-timber forest products (NTFPs) and their respective habitats are still very poorly understood in sub-Saharan Africa in general and more specifically in Côte d'Ivoire. This study aims at (i) inventorying the wild useful mushrooms of Côte d'Ivoire within its major protected areas and their respective surrounding sociolinguistical groups, according to climatic and phytogeographical gradients, and (ii) recording ethnomycological knowledge and considerations of these local people. METHODS: Field and ethnomycological surveys were conducted in the main and highest protected areas of Côte d'Ivoire (Comoé, Marahoué, and Taï national parks) and a set of their respective surrounding villages, along climatic and phytogeographical gradients. Standardized methods (permanent plots and opportunistic searches) were used for field surveys. In addition, a total 748 respondents belonging to 13 ethnic groups were interviewed at a rate of 300 interviewees during the preliminary investigations and 448 persons during the proper ethnomycological surveys. RESULTS: Sixty-eight useful wild fungal species, belonging to 17 families and 23 genera, were listed and collected. Four categories of usage were reported by the rural people (food, medicinal, belief and recreational), with a dominance of food and medicinal uses. Fifty-six species were reported to be used as food and 16 species as medicinal fungi. These uses varied not only from one sociolinguistical group to another but also from a visited village to another. The high number (41) of the reported useful species was found in the Sudano-Guinean savanna zone while 28 species were collected in the forest zone and 22 species in the forest-savanna mosaic zone. These mushrooms were either saprotrophic or symbiotic (ectomycorrhizal or termitophilic). Auricularia sp3, Psathyrella tuberculata, and Termitomyces spp. were found as the most commonly used mushrooms. CONCLUSIONS: These national scale field and ethnomycological surveys give one of the more complete but non-exhaustive list of useful mushrooms of Côte d'Ivoire. Mushrooms are relatively well known and used by the Ivorian people within the main phytogeographical zone of the country. These people also have an interest in all the functional groups with an important phytogeographical zone-fungal-specific used species. However, protected areas of the visited zones seem to represent the last sanctuaries of these organisms due to high rate of loss of natural habitats.

Snow Storms and Vulnerable Populations: Local Public Health Activities in Response to the 2014-2015 Severe Winter Weather.

ABSTRACTThe Northeastern United States experienced some of its coldest and snowiest conditions ever recorded during the winter of 2014-2015. The snowfall and extreme temperatures created significant challenges for local health departments attempting to continue critical services and respond to storm-related needs of the community. This report from the field aims to describe the impact of the severe weather on local health departments' operations, to examine the disruption to public health services, and to document public health support provided to vulnerable populations during the 2014-2015 winter season. Our findings show that the severe weather exposed major challenges in continuity of public health operations across health departments of various sizes and highlighted some key issues as well as effective strategies, such as collaborations with community-based organizations, to identify and address the needs of the most vulnerable during the winter storms. (Disaster Med Public Health Preparedness. 2019;13:647-649).

Determinants of Termite Assemblages' Characteristics within Natural Habitats of a Sudano-Guinean Savanna (Comoe National Park, Côte d'Ivoire).

Termites are one of the major components of tropical ecosystems. However, the ecological and biological variables determining the structure of their communities within natural habitats are less documented in general and especially in the Comoe National Park, a Sudano-Guinean savanna zone located in the north-eastern part of Côte d'Ivoire (West Africa). Using a standardized method of belt transects, the structure of termite's communities was estimated within habitats differing in the structure of their vegetation, soil characteristics, and the disturbance level caused by annual occurrences of bushfires. The effect of a set of environmental variables (habitat type, occurrence of annual bushfire, woody plant density, woody plant species richness, and soil physicochemical parameters) was tested on the habitat-specific recorded termite species. Sixty species of termites belonging to 19 genera, seven subfamilies and two families, namely Rhinotermitidae (Coptotermitinae and Rhinotermitinae) and Termitidae (Apicotermitinae, Cubitermitinae, Macrotermitinae, Nasutitermitinae, and Termitinae) were sampled. These species were assigned to the four feeding groups of termites: fungus growers (18 species), wood feeders (17 species), soil feeders (19 species) and the grass feeders (6 species). The highest diversity of termites was encountered in forest habitats, with 37 and 34, respectively, for the gallery forest and the forest island. Among savanna habitats, the woodland savanna was identified as the most diversified habitat with 32 recorded species, followed by the tree savanna (28 species) and the grassy savanna (17 species). The distribution of termite species and their respective feedings groups was determined by the habitat type and a set of environmental variables such as Woody Plant Diversity (WPD), Woody plant Families Diversity (WPFD), and Organic Carbon (OC). The annual Fire Occurrence (FO) was found to indirectly impact the characteristics of termite assemblages within natural habitats via their respective Herbaceous Species Richness (HSR) and Woody Plant Species Richness (WPSR). In summary, the spatial heterogeneity of the Comoe National Park, modeled by the uncontrolled annual bushfire, offers a diversified natural habitat with an important variety of termite-habitat-specific species, probably due to the food preference of these organisms and its relatively good conservation status.

Diversity, phenology and distribution of Termitomyces species in Côte d'Ivoire.

The mutualistic symbiosis between termites of the Macrotermitinae subfamily (Isoptera: Termitidae) and fungi of the genus Termitomyces (Basidiomycota: Lyophyllaceae) is of great ecological and socio-economic importance. Seasonal fruit bodies of the symbiotic fungi are regularly collected and sold in Côte d'Ivoire. However, there are very few studies on their diversity, phenology, distribution and especially the socio-economic scope of the fruit bodies of these fungi at a national scale. This study aims at (i) assessing the diversity of Termitomyces fruit bodies in Côte d'Ivoire and (ii) mapping their fructification areas through a determination of their spatiotemporal distribution according to a climatic and phytogeographic gradients. Using ethnomycological surveys all over the Ivorian territory, information was collected from rural populations on the fructification of Termitomyces and their socio-economic importance. Based on these surveys, sampling efforts of these fungi were properly structured and oriented. The results revealed a diversity of 16 species of Termitomyces, including 9 species new to Côte d'Ivoire and 2 probably new to science. Five species were found in the forest zone, nine in theGuinean savannah zone and four in the Sudano-Guinean zone. Termitomyces's fructifications were observed throughout the year, with specific period for each species. All listed species are regularly consumed by populations. However, only Termitomyces letestui (Pat.) R. Heim and Termitomyces schimperi (Pat.) R. Heim are marketed on a relatively large scale.

Impact of human disturbance on bee pollinator communities in savanna and agricultural sites in Burkina Faso, West Africa.

All over the world, pollinators are threatened by land-use change involving degradation of seminatural habitats or conversion into agricultural land. Such disturbance often leads to lowered pollinator abundance and/or diversity, which might reduce crop yield in adjacent agricultural areas. For West Africa, changes in bee communities across disturbance gradients from savanna to agricultural land are mainly unknown. In this study, we monitored for the impact of human disturbance on bee communities in savanna and crop fields. We chose three savanna areas of varying disturbance intensity (low, medium, and high) in the South Sudanian zone of Burkina Faso, based on land-use/land cover data via Landsat images, and selected nearby cotton and sesame fields. During 21 months covering two rainy and two dry seasons in 2014 and 2015, we captured bees using pan traps. Spatial and temporal patterns of bee species abundance, richness, evenness and community structure were assessed. In total, 35,469 bee specimens were caught on 12 savanna sites and 22 fields, comprising 97 species of 32 genera. Bee abundance was highest at intermediate disturbance in the rainy season. Species richness and evenness did not differ significantly. Bee communities at medium and highly disturbed savanna sites comprised only subsets of those at low disturbed sites. An across-habitat spillover of bees (mostly abundant social bee species) from savanna into crop fields was observed during the rainy season when crops are mass-flowering, whereas most savanna plants are not in bloom. Despite disturbance intensification, our findings suggest that wild bee communities can persist in anthropogenic landscapes and that some species even benefitted disproportionally. West African areas of crop production such as for cotton and sesame may serve as important food resources for bee species in times when resources in the savanna are scarce and receive at the same time considerable pollination service.

Impact and effectiveness of pentavalent rotavirus vaccine in children <5 years of age in Burkina Faso.

BACKGROUND: Burkina Faso was one of the first African nations to introduce pentavalent rotavirus vaccine (RV5, RotaTeq) into its national immunization program in October 2013. We describe the impact and effectiveness of rotavirus vaccine on acute gastroenteritis (AGE) hospitalizations among Burkinabe children. METHODS: Sentinel hospital-based surveillance for AGE was conducted at four hospitals during December 2013 - February 2017. Demographic, clinical, and vaccination information was collected and stool specimens were tested by EIA. Trends in rotavirus AGE hospitalizations and changes in the proportion of AGE hospitalizations due to rotavirus were examined at two sentinel sites from January 2014 - December 2016. Unconditional logistic regression models using data from all 4 surveillance sites were used to calculate vaccine effectiveness (VE, defined as 1-odds ratio) by comparing the odds of vaccination among rotavirus AGE (cases) and non-rotavirus AGE (controls) patients, controlling for age, season, hospital site and socioeconomic factors. RESULTS: The proportion of AGE hospitalizations that tested positive for rotavirus declined significantly among children <5 years of age, from 36% (154/422) in 2014 to 22% (71/323, 40% reduction, p < .01) in 2015 and 20% (61/298, 44% reduction, p < .01) in 2016. Among infants, the percentage of AGE admissions due to rotavirus fell significantly from 38% (94/250) in 2014 to 21% (32/153, 44% reduction, p < .01) in 2015 and 17% (26/149, 54% reduction, p < .01) in 2016. The adjusted VE for full 3-dose series of RV5 against rotavirus hospitalization was 58% (95% [CI], 10%, 81%) in children 6-11 months of age and 19% (-78%, 63%) in children ≥12 months. CONCLUSION: Rotavirus hospitalizations declined after introduction of pentavalent rotavirus vaccine in children, particularly among infants. RV5 significantly protected against severe rotavirus gastroenteritis in infants, but effectiveness decreased in older children.

Bee pollination increases yield quantity and quality of cash crops in Burkina Faso, West Africa.

Mutualistic biotic interactions as among flowering plants and their animal pollinators are a key component of biodiversity. Pollination, especially by insects, is a key element in ecosystem functioning, and hence constitutes an ecosystem service of global importance. Not only sexual reproduction of plants is ensured, but also yields are stabilized and genetic variability of crops is maintained, counteracting inbreeding depression and facilitating system resilience. While experiencing rapid environmental change, there is an increased demand for food and income security, especially in sub-Saharan communities, which are highly dependent on small scale agriculture. By combining exclusion experiments, pollinator surveys and field manipulations, this study for the first time quantifies the contribution of bee pollinators to smallholders' production of the major cash crops, cotton and sesame, in Burkina Faso. Pollination by honeybees and wild bees significantly increased yield quantity and quality on average up to 62%, while exclusion of pollinators caused an average yield gap of 37% in cotton and 59% in sesame. Self-pollination revealed inbreeding depression effects on fruit set and low germination rates in the F1-generation. Our results highlight potential negative consequences of any pollinator decline, provoking risks to agriculture and compromising crop yields in sub-Saharan West Africa.

Allocation strategies of savanna and forest tree seedlings in response to fire and shading: outcomes of a field experiment.

The forest-savanna ecotone may be very sharp in fire-prone areas. Fire and competition for light play key roles in its maintenance, as forest and savanna tree seedlings are quickly excluded from the other ecosystem. We hypothesized a tradeoff between seedling traits linked to fire resistance and to competition for light to explain these exclusions. We compared growth- and survival-related traits of two savanna and two forest species in response to shading and fire in a field experiment. To interpret the results, we decomposed our broad hypothesis into elementary tradeoffs linked to three constraints, biomass allocation, plant architecture, and shade tolerance, that characterize both savanna and adjacent forest ecosystems. All seedlings reached similar biomasses, but forest seedlings grew taller. Savanna seedlings better survived fire after topkill and required ten times less biomass than forest seedlings to survive. Finally, only savanna seedlings responded to shading. Although results were consistent with the classification of our species as mostly adapted to shade tolerance, competition for light in the open, and fire tolerance, they raised new questions: how could savanna seedlings survive better with a 10-times lower biomass than forest seedlings? Is their shade intolerance sufficient to exclude them from forest understory?

Importance of protected areas for biodiversity conservation in central Côte D'ivoire: comparison of termite assemblages between two neighboring areas under differing levels of disturbance.

To highlight human impact on biodiversity in the Lamto region, termites were studied with regard to their use as bio-indicators of habitat change in the tropics. Using a standardized method, termites were sampled in the three most common habitat types, i.e., in semi-deciduous forest, savanna woodland, and annually burned savanna, all inside Lamto Reserve and its surrounding rural domain. Termite species richness fell from 25 species in the Lamto forest to 13 species in the rural area, involving strong modification in the species composition (species turnover = 59 %). In contrast, no significant change in diversity was found between the Lamto savannas and the rural ones. In addition, the relative abundance of termites showed a significantly greater decline in the rural domain, even in the species Ancistrotermes cavithorax (Sjöstedt) (Isoptera: Termitidae), which is known to be ecologically especially versatile. Overall, the findings of this study suggest further investigation around Lamto Reserve on the impact of human activities on biodiversity, focusing on forest conversion to land uses (e.g. agricultural and silvicultural systems).