Nationwide Inventory of Mosquitoes and the Distribution of Invasive Aedes (Stegomyia) albopictus (Skuse, 1894) on the Islands of Sao Tome and Principe in Central Africa.

Aedes albopictus (Skuse, 1894), a mosquito originating in Asia, has been introduced to Africa since the 2000s. The mosquito is not only a nuisance but is capable of transmitting various arboviruses. The current study summarized our entomological surveys in the Democratic Republic of Sao Tome and Principe during 2000 to 2016. Adult mosquitoes were collected by sweep nets, human landing catches, and Centers for Disease Control (CDC) light traps, and the immatures were collected from water-filled habitats at 15 sentinel sites and reared to adulthood. Species identification was performed based on morphologic characteristics. Fragments of the cytochrome C oxidase subunit I (COI) and the Wolbachia surface protein (wsp) genes were amplified for mosquitoes collected in Principe. New records of four mosquito species were reported. Aedes albopictus was identified in 2015. The larvae were found distributed over the nation and were predominately in artificial water-holding containers (488/2698, 18.1%). The highest positive rate was observed in used tires in Príncipe (114/250, 45.6%). Mitochondrial DNA analysis revealed low genetic diversity among the invasive populations, but all tested specimens were superinfected by Wolbachia. The ability of Ae. albopictus to adapt to new environments and its involvement in disease transmission make the surveillance and control of this species particularly important.

High seroreactivities to orthoebolaviruses in rural Cameroon: a case-control study on non-human primate bites and a cross-sectional survey in rural population.

BACKGROUND: Ebola (EBOV) and Sudan (SUDV) orthoebolaviruses are responsible for lethal haemorrhagic fever outbreaks in humans in Central and West Africa, and in apes that can be at the source of human outbreaks for EBOV. METHODS: To assess the risk of exposure to orthoebolaviruses through contact with non-human primates (NHP), we tested the presence of antibodies against different viral proteins with a microsphere-based multiplex immunoassay in a case-control study on bites from NHPs in forest areas from Cameroon (n=795), and in cross-sectional surveys from other rural populations (n=622) of the same country. RESULTS: Seroreactivities against at least two viral proteins were detected in 13% and 12% of the samples for EBOV and SUDV, respectively. Probability of seroreactivity was not associated with history of NHP bites, but was three times higher in Pygmies compared to Bantus. Although no neutralizing antibodies to EBOV and SUDV were detected in a selected series of highly reactive samples, avidity results indicate strong affinity to SUDV antigens. CONCLUSION: The detection of high level of seroreactivities against orthoebolaviruses in rural Cameroon where no outbreaks have been reported, raises the possibilities of silent circulation of orthoebolavirus, or of other not yet documented filoviruses, in these forested regions.

An overview of artemisinin-resistant malaria and associated Pfk13 gene mutations in Central Africa.

Malaria caused by Plasmodium falciparum is one of the deadliest and most common tropical infectious diseases. However, the emergence of artemisinin drug resistance associated with the parasite's Pfk13 gene, threatens the public health of individual countries as well as current efforts to reduce malaria burdens globally. It is of concern that artemisinin-resistant parasites may be selected or have already emerged in Africa. This narrative review aims to evaluate the published evidence concerning validated, candidate, and novel Pfk13 polymorphisms in ten Central African countries. Results show that four validated non-synonymous polymorphisms (M476I, R539T, P553L, and P574L), directly associated with a delayed therapy response, have been reported in the region. Also, two Pfk13 polymorphisms associated to artemisinin resistance but not validated (C469F and P527H) have been reported. Furthermore, several non-validated mutations have been observed in Central Africa, and one allele A578S, is commonly found in different countries, although additional molecular and biochemical studies are needed to investigate whether those mutations alter artemisinin effects. This information is discussed in the context of biochemical and genetic aspects of Pfk13, and related to the regional malaria epidemiology of Central African countries.

Population affinities in pre-colonial West Africa: The case of the burial cave Iroungou (Gabon, 14th-15th century CE).

INTRODUCTION: Our knowledge of the populations of sub-Saharan Africa in the periods before European colonization is limited. Few archeological sites containing human remains have been identified, and written sources for these periods are rare. The discovery in 2018 of the Iroungou sepulchral cave (Gabon), whose use predates the arrival of the Portuguese (14th-15th centuries CE), is an exceptional source of information: at least 28 individuals associated with numerous metal artifacts were found there. The anthropobiological remains were left in situ, but the eight best preserved crania were digitized. OBJECTIVES: This study focuses on the population affinities of these crania, whose morphology was described using 237 landmarks. MATERIALS AND METHODS: Geometric morphometric analyses were used to compare the eight Iroungou specimens with 154 individuals representing 12 well-defined African populations. After alignment (Generalized Procrustes Analysis), morphological affinity was assessed using Euclidean and Mahalanobis distances, and posterior probabilities of population membership (discriminant analysis). RESULTS: Results indicate that the eight Iroungou crania have, on average, more affinity with Bayaka Pygmy, followed by Central African Bantu. Nevertheless, individually, the Iroungou specimens show an important morphological variation and the eight crania can be separated into different affinity groups: Bayaka and Central African Bantu, KhoeSan, and East-African Bantu. Finally, one individual presents strong affinity with Somalis. CONCLUSION: This phenetic mapping of the Iroungou sample raises questions about the profile of the individuals deposited in the cave in a geographical area known for the Loango pre-colonial kingdom, which ruling class seemed to have had privileged relationships with the Pygmy populations.

INTRODUCTION: Nos connaissances sur les populations d'Afrique sub­saharienne des périodes précédant la colonisation européenne sont limitées. Peu de sites archéologiques contenant des restes humains ont été identifiés, et les sources écrites pour ces périodes sont rares. La découverte en 2018 de la grotte sépulcrale d'Iroungou (Gabon), dont l'utilisation remonte au XIVe­XVe siècles de notre ère, avant l'arrivée des Portugais, constitue une source d'information exceptionnelle: au moins 28 individus associés à de nombreux artefacts métalliques y ont été retrouvés. Les restes anthropobiologiques ont été laissés in situ, néanmoins, les huit crânes les mieux préservés ont été numérisés. OBJECTIFS: Cette étude s'intéresse aux affinités populationnelles de ces crânes, dont la morphologie a été décrite à l'aide de 237 points­repères répartis sur le massif facial supérieur et le calvarium. MATÉRIEL ET MÉTHODES: Des analyses par morphométrie géométrique ont permis de comparer les spécimens d'Iroungou avec 154 individus représentants 12 populations africaines bien définies. Après alignement des conformations (analyse Procrustes généralisée), l'affinité morphologique a été évaluée à l'aide des distances procrustes, euclidienne et mahalanobis, ainsi que des probabilités postérieures d'appartenance à une population (analyse discriminante). RÉSULTATS: Les résultats indiquent que les huit crânes d'Iroungou présentent en moyenne plus d'affinités avec les populations pygmées Bayaka, suivies des Bantus d'Afrique centrale. DISCUSSION: Cette affinité moyenne recouvre une réalité complexe: la population d'Iroungou est la plus hétérogène de notre échantillon et les huit crânes peuvent être séparés en différents groupes d'affinités: avec les Bayakas et les Bantus d'Afrique Centrale, les KhoeSan, et avec les Bantus d'Afrique de l'est. Enfin, un individu présente une affinité très forte avec les Somalis de notre échantillon. Cette cartographie phénétique de la population d'Iroungou interroge sur le profil des individus déposés dans la grotte dans une zone géographique connue le royaume précolonial Loango dont la classe dirigeante semble avoir eu des relations privilégiées avec les populations pygmées.

Metagenomic data from gutter water in the city of Pointe-Noire, Republic of Congo.

After Amazonia, the Congo Basin represents the second-largest tropical rainforest area in the world. This basin harbours remarkable biodiversity, yet much of its microbiological diversity within its waters, soils, and populations remains largely unexplored and undiscovered. While many initiatives to characterize global biodiversity are being undertaken, few are conducted in Africa and none of them concern the Congo Basin specifically in urban areas. In this context, we assessed the microbial diversity present in gutter water in the city of Pointe-Noire, Congo. This town has interesting characteristics as the population density is high and it is located between the Atlantic Ocean and the forest of Mayombe in Central Africa. The findings illuminate the microbial composition of surface water in Pointe-Noire. The dataset allows the identification of putative new bacteria through the assembly of 81 meta-genome-assembled genomes. It also serves as a valuable primary resource for assessing the presence of antibiotic-resistant genes, offering a useful tool for monitoring risks by public health authorities.

Evaluating the implementation of person-centred care and simulation-based learning in a midwifery education programme in the Democratic Republic of Congo: a study protocol.

BACKGROUND: Investing in midwives educated according to international standards is crucial for achieving Sustainable Development Goals in maternal and newborn health. Applying a person-centred care approach and using simulation-based learning to improve the learning experience for midwifery students may enhance the quality of childbirth care. This protocol describes a study evaluating the implementation of person-centred approach and simulation-based learning in childbirth as part of a midwifery education programme at the Evangelical University in Africa, DRC. METHODS: The research will be exploratory and guided by an implementation research framework. Ethical approval has been obtained. Facilitators working at the programme's five clinical practice sites will be trained in: 1) Introducing person-centred childbirth care using a training programme called'Mutual Meetings'; and 2) integrating simulation-based learning, specifically by using the three courses: Essential Care of Labor, Bleeding after Birth, and Vacuum Extraction. Data will include interviews with midwifery students, facilitators and clinical preceptors, and maternal and neonatal outcomes from birth registers. DISCUSSION: By integrating a validated and culturally adapted person-centred care training programme and simulation-based learning into a midwifery education programme and clinical practice sites, the findings from the study anticipate an improvement in the quality of childbirth care. Training facilitators in these methodologies aim to effectively mitigate maternal and neonatal adverse outcomes. The findings are expected to provide valuable recommendations for governments, policymakers, and healthcare providers in the DRC and beyond, contributing to significant improvements in midwifery education and aligning with global health priorities, including the Sustainable Development Goals. TRIAL REGISTRATION: The study was registered retrospectively with the ISRCTN registry on the 23rd of February 2024. The registration number is: ISRCTN10049855.

Main findings: It is anticipated that the implementation of both person-centred care and simulation-based learning in a midwifery education programme will improve the quality of care in childbirth practice.Added knowledge: The use of facilitators has the potential to enhance the implementation of person-centred care and simulation-based learning in a midwifery education programme, both at campus and in clinic.Global health impact for policy and action: The expected findings could inform global health policy development and practice, promising advancements in midwifery education and consequently enhance the maternal and newborn health outcomes.

HIV diagnosis in Equatorial Guinea. Keys to reduce the diagnostic and therapeutic delay.

BACKGROUND: In Equatorial Guinea, only 54 % of people living with HIV know their HIV status. There are no confirmatory or molecular diagnostic techniques for early diagnosis or monitoring of infection in the country. Rapid diagnostic tests can induce false-positive diagnoses if used as a confirmatory technique. Our study aimed to identify the challenges of early HIV diagnosis in Equatorial Guinea by analyzing the rate of false positive diagnoses, diagnostic and therapeutic delays, and treatment failures among those on antiretroviral therapy. METHODS: From 2019-2022, dried blood from 341 children, adolescents and adults diagnosed in Equatorial Guinea as HIV-positive by rapid diagnostic testing, and from 54 HIV-exposed infants were collected in Bata and sent to Madrid to confirm HIV-infection by molecular (Xpert HIV-1Qual, Cepheid) and/or serological confirmatory assays (Geenius-HIV-1/2, BioRad). HIV diagnostic delay (CD4 <350cells/mm3), advanced disease at diagnosis (CD4 <200cells/mm3) and antiretroviral treatment delay and failure (viraemia >1,000RNA-HIV-1-copies/ml) were also studied after viral quantification (XpertVL HIV-1, Cepheid). RESULTS: False-positive diagnoses were identified in 5 % of analysed samples. HIV infection was confirmed in 90.5 % of previously diagnosed patients in Equatorial Guinea and 3.7 % of HIV-exposed children undiagnosed in the field. Two-thirds of each new HIV patient had delayed diagnosis, and one-third had advanced disease. Treatment delay occurred in 28.3 % of patients, being around four times more likely in adolescents/adults than children. More than half (56 %) of 232 treated patients presented treatment failure, being significantly higher in children/adolescents than in adults (82.9 %/90 % vs. 45.6 %, p < 0.001). CONCLUSION: We identified some challenges of early HIV diagnosis in Equatorial Guinea, revealing a high rate of false positive diagnoses, diagnostic/treatment delays, and treatment failures that need to be addressed. The implementation of more accurate rapid diagnostic techniques and confirmatory tests, along with improving access to care, treatment, awareness, and screening, would contribute to controlling the spread of HIV in the country.

Genetic tracing of the illegal trade of the white-bellied pangolin (Phataginus tricuspis) in western Central Africa.

The white-bellied pangolin is subject to intense trafficking, feeding both local and international trade networks. In order to assess its population genetics and trace its domestic trade, we genotyped 562 pangolins from local to large bushmeat markets in western central Africa. We show that the two lineages described from the study region (WCA and Gab) were overlapping in ranges, with limited introgression in southern Cameroon. There was a lack of genetic differentiation across WCA and a significant signature of isolation-by-distance possibly due to unsuspected dispersal capacities involving a Wahlund effect. We detected a c. 74.1-82.5% decline in the effective population size of WCA during the Middle Holocene. Private allele frequency tracing approach indicated up to 600 km sourcing distance by large urban markets from Cameroon, including Equatorial Guinea. The 20 species-specific microsatellite loci provided individual-level genotyping resolution and should be considered as valuable resources for future forensic applications. Because admixture was detected between lineages, we recommend a multi-locus approach for tracing the pangolin trade. The Yaoundé market was the main hub of the trade in the region, and thus should receive specific monitoring to mitigate pangolins' domestic trafficking. Our study also highlighted the weak implementation of CITES regulations at European borders.

Antenatal Care Utilisation among Adolescent Mothers in Ngozi Province, Burundi.

Background: Globally pregnancy and childbirth complications are the leading cause of death among adolescents, with evidence showing that antenatal care (ANC) is a very effective preventive intervention. In Burundi, there is limited information on the extent to which pregnant adolescents utilise such services. Objective: To assess the ANC utilisation and factors associated with its use among adolescent mothers in Ngozi Province, Burundi. Materials and Methods: A cross-sectional, health facility-based study among 216 adolescent mothers who had given birth within two years preceding this study, using structured questionnaires and records from previous ANC booklets. A multistage random sampling technique was used to select respondents while the utilisation of ANC was determined by the frequency of ANC visits and the time when the women enrolled for the first ANC visit. Results: The majority (98.1%) of adolescent mothers in Ngozi Province used ANC services. Most respondents (64.8%) initiated ANC services within the first trimester while 57.8% attained the minimum of four recommended ANC visits. Marital status (P = 0.001), geographical location (P = 0.009), occupation of the partner (P = 0.002) and type of the last pregnancy (P = 0.012) were associated with ANC initiation within the first trimester while marital status (P < 0.001), respondent's employment (P = 0.003) and type of last pregnancy (P < 0.001) were associated with appropriate ANC frequency. Conclusion: This study revealed a high use of ANC services among adolescent mothers, although more than one-third attended ANC late. There is therefore the need to put more effort into improving early booking for ANC.

Pheromone traps and climate variations influence populations of Sahlbergella singularis (Hemiptera: Miridae) and associated damage of cocoa in Cameroon.

Knowledge of insect pest ecology and biology is important for maximizing crop protection and reducing crop losses. Currently, we lack an efficient control program for the cocoa mirid Sahlbergella singularis Haglund (Hemiptera: Miridae), the principal insect pest of cocoa in West and Central Africa. A 2-yr study was conducted in 11 plantations across Ayos and Konye, two of the largest cocoa growing areas of Cameroon. We evaluated the effects of mirid sex pheromone and climatic variations on mirid population dynamics and their associated cocoa damage. Sex pheromone traps caught 1.5-fold higher mirids in Ayos than in Konye, with more overall counts in 2015 than in 2016. Cocoa pod counts were also significantly higher in 2015 than in 2016 and were negatively correlated with temperature and relative humidity. In both localities, mirid populations and associated cocoa pod damage were suppressed in plantations where sex pheromone traps were used. Damage incidence was positively correlated with mirid counts, confirming that the cocoa pod is the preferential site for mirid feeding and reproduction. As such, damage incidence could be used as proxy for comparative mirid population level due to the mirid's cryptic habit. Of the recorded weather variables, only relative humidity was correlated (negatively) with damage severity. Our data on the relationships between damage caused by mirids and their population dynamics and sex pheromone trap catches suggest that an effective control strategy using mass trapping could be developed for mirid management in cocoa plantations.

Concurrent Clade I and Clade II Monkeypox Virus Circulation, Cameroon, 1979-2022.

During 1979-2022, Cameroon recorded 32 laboratory-confirmed mpox cases among 137 suspected mpox cases identified by the national surveillance network. The highest positivity rate occurred in 2022, indicating potential mpox re-emergence in Cameroon. Both clade I (n = 12) and clade II (n = 18) monkeypox virus (MPXV) were reported, a unique feature of mpox in Cameroon. The overall case-fatality ratio of 2.2% was associated with clade II. We found mpox occurred only in the forested southern part of the country, and MPXV phylogeographic structure revealed a clear geographic separation among concurrent circulating clades. Clade I originated from eastern regions close to neighboring mpox-endemic countries in Central Africa; clade II was prevalent in western regions close to West Africa. Our findings suggest that MPXV re-emerged after a 30-year lapse and might arise from different viral reservoirs unique to ecosystems in eastern and western rainforests of Cameroon.

Newly Identified Mycobacterium africanum Lineage 10, Central Africa.

Analysis of genome sequencing data from >100,000 genomes of Mycobacterium tuberculosis complex using TB-Annotator software revealed a previously unknown lineage, proposed name L10, in central Africa. Phylogenetic reconstruction suggests L10 could represent a missing link in the evolutionary and geographic migration histories of M. africanum.

Availability of the current and future water resources in Equatorial Central Africa: case of the Nyong forest catchment in Cameroon.

To anticipate disasters (drought, floods, etc.) caused by environmental forcing and reduce their impacts on its fragile economy, sub-Saharan Africa needs a good knowledge of the availability of current water resources and reliable hydroclimatic forecasts. This study has an objective to quantify the availability of water resources in the Nyong basin and predict its future evolution (2024-2050). For this, the SWAT (Soil and Water Assessment Tool) model was used. The performance of this model is satisfactory in calibration (2001-2005) and validation (2006-2010), with R2, NSE, and KGE greater than 0.64. Biases of - 11.8% and - 13.9% in calibration and validation also attest to this good performance. In the investigated basin, infiltration (GW_RCH), evapotranspiration (ETP), surface runoff (SURQ), and water yield (WYLD) are greater in the East, probably due to more abundant rainfall in this part. The flows and sediment load (SED) are greater in the middle zone and in the Southwest of the basin, certainly because of the flat topography of this part, which corresponds to the valley floor. Two climate models (CCCma and REMO) predict a decline in water resources in this basin, and two others (HIRHAM5 and RCA4) are the opposite. However, based on a statistical study carried out over the historical period (2001-2005), the CCCma model seems the most reliable. It forecasts a drop in precipitation and runoff, which do not exceed - 19% and - 18%, respectively, whatever the emission scenario (RCP4.5 or RCP8.5). Climate variability (CV) is the only forcing whose impact is visible in the dynamics of current and future flows, due to the modest current (increase of + 102 km2 in builds and roads) and future (increase of + 114 km2 in builds and roads) changes observed in the evolution of land use and land cover (LULC). The results of this study could contribute to improving water resource management in the basin studied and the region.

Genomic insights into Plasmodium vivax population structure and diversity in central Africa.

BACKGROUND: Though Plasmodium vivax is the second most common malaria species to infect humans, it has not traditionally been considered a major human health concern in central Africa given the high prevalence of the human Duffy-negative phenotype that is believed to prevent infection. Increasing reports of asymptomatic and symptomatic infections in Duffy-negative individuals throughout Africa raise the possibility that P. vivax is evolving to evade host resistance, but there are few parasite samples with genomic data available from this part of the world. METHODS: Whole genome sequencing of one new P. vivax isolate from the Democratic Republic of the Congo (DRC) was performed and used in population genomics analyses to assess how this central African isolate fits into the global context of this species. RESULTS: Plasmodium vivax from DRC is similar to other African populations and is not closely related to the non-human primate parasite P. vivax-like. Evidence is found for a duplication of the gene PvDBP and a single copy of PvDBP2. CONCLUSION: These results suggest an endemic P. vivax population is present in central Africa. Intentional sampling of P. vivax across Africa would further contextualize this sample within African P. vivax diversity and shed light on the mechanisms of infection in Duffy negative individuals. These results are limited by the uncertainty of how representative this single sample is of the larger population of P. vivax in central Africa.

Protecting an artificial savanna as a nature-based solution to restore carbon and biodiversity in the Democratic Republic of the Congo.

A large share of the global forest restoration potential is situated in artificial 'unstable' mesic African savannas, which could be restored to higher carbon and biodiversity states if protected from human-induced burning. However, uncertainty on recovery rates in protected unstable savannas impedes science-informed forest restoration initiatives. Here, we quantify the forest restoration success of anthropogenic fire exclusion within an 88-ha mesic artificial savanna patch in the Kongo Central province of the Democratic Republic of the Congo (DR Congo). We found that aboveground carbon recovery after 17 years was on average 11.40 ± 0.85 Mg C ha-1 . Using a statistical model, we found that aboveground carbon stocks take 112 ± 3 years to recover to 90% of aboveground carbon stocks in old-growth forests. Assuming that this recovery trajectory would be representative for all unstable savannas, we estimate that they could have a total carbon uptake potential of 12.13 ± 2.25 Gt C by 2100 across DR Congo, Congo and Angola. Species richness recovered to 33.17% after 17 years, and we predicted a 90% recovery at 54 ± 2 years. In contrast, we predicted that species composition would recover to 90% of old-growth forest composition only after 124 ± 3 years. We conclude that the relatively simple and cost-efficient measure of fire exclusion in artificial savannas is an effective nature-based solution to climate change and biodiversity loss. However, more long-term and in situ monitoring efforts are needed to quantify variation in long-term carbon and diversity recovery pathways. Particular uncertainties are spatial variability in socio-economics and growing conditions as well as the effects of projected climate change.

Effect of COVID-19 on immunization coverage of children aged 0-11 months in the center region of Cameroon.

The occurrence of epidemics is known to contribute in reducing the capacity of health facilities to deliver care and the predisposition of populations to seek care through several mechanisms. The objective was to assess the effect of the COVID-19 on vaccination coverage of the expanded program of immunization (EPI) vaccines in children aged 0-11 months. The study involved a descriptive and case control designs exhaustively targeting health facilities in health areas from selected health districts. The descriptive part explored the distribution of immunization coverage 12 months before and during COVID-19. Data were extracted from monthly EPI reports of health areas. Cases were months with immunization coverages of Bacille Calmette-Guerin (BCG), Measles Mumps-Rubella 1 (MMR1) or Diphtheria-Pertussis-Tetanus Hepatitis B + Hemophilus influenzae type b dose 3 (DPT-Hi+Hb3) less than 80%. The exposure were months belonging to the pandemic period. Of the 78 targeted health areas, 74 (94.87%) were reached. The monthly immunization coverage of BCG, RR1, DPT-Hi+Hb 1 and 3 decreased during the pandemic period by minimum 30%. Being a health-area month belonging to the COVID-19 pandemic period was found to be significantly associated to lower BCG [OR=2.00 (1.61; 2.50); P#x003C;0.001], MMR1 [OR=2.45 (1.76; 3.41); P#x003C;0.001] and DPT-Hi+Hb3 [OR=2.11 (1.68; 2.640); P#x003C;0.001] immunisation coverage. COVID-19 had a significant effect on the decrease of immunization coverages of antigens offered in the EPI program. This raises the need to develop interventions during health emergencies to prevent disruption of health services access.

Simulation-Based Training in Emergency Obstetric Care in Sub-Saharan and Central Africa: A Scoping Review.

Background: Every day approximately 810 women die from complications related to pregnancy and childbirth worldwide. Around two thirds of these deaths happen in sub-Saharan Africa. One of the strategies to decrease these numbers is improving the quality of care by emergency obstetric simulation-based training. The effectiveness of such training programs depends on the program's instructional design. Objective: This review gives an overview of studies about emergency obstetric simulation-based training and examines the applied instructional design of the training programs in sub-Saharan and Central Africa. Methods: We searched Medline, Embase and Cochrane Library from inception to May 2021. Peer-reviewed articles on emergency obstetric, postgraduate, simulation-based training in sub-Saharan and Central Africa were included. Outcome measures were categorized based on Kirkpatrick's levels of training evaluation. The instructional design was evaluated by using the ID-SIM questionnaire. Findings: In total, 47 studies met the inclusion criteria. Evaluation on Kirkpatrick level 1 showed positive reactions in 18 studies. Challenges and recommendations were considered. Results on knowledge, skills, and predictors for these results (Kirkpatrick level 2) were described in 29 studies. Retention as well as decay of knowledge and skills over time were presented. Results at Kirkpatrick level 3 were measured in 12 studies of which seven studies demonstrated improvements of skills on-the-job. Improvements of maternal and neonatal outcomes were described in fifteen studies and three studies reported on cost-estimations for training rollout (Kirkpatrick level 4). Instructional design items were heterogeneously applied and described. Conclusions: Results of 47 studies indicate evidence that simulation-based training in sub-Saharan and Central Africa can have a positive impact across all four levels of Kirkpatrick's training evaluation model. However, results were not consistent across all studies and the effects vary over time. A detailed description of instructional design features in future publications on simulation-based training will contribute to a deeper understanding of the underlying mechanisms that determine why certain training programs are more effective in improving maternal and neonatal healthcare outcomes than other.

A 43-year of human thermal comfort in Central Africa.

In this study, the human thermal stress was quantified across Central Africa (C.A.) using the Universal Thermal Climate Index (UTCI). Although many of the documented studies on the use of UTCI in relation to human health are currently restricted to countries in the northern hemisphere, this contribution constitutes a prerequisite of information for future research in the region. To mitigate the problem of lack of field data in the Central African sub-region, we downloaded UTCI data via the ERA5 reanalysis portal. Based on this data source, we have explored the spatiotemporal characteristics and the resulting behaviour at annual, seasonal and monthly scales in Central Africa over the period 1982 to 2022. On these different scales, 4 of the 10 UTCI thermal stress categories were experienced, ranging from mild cold stress to strong heat stress. Spatially, cases of moderate heat stress were the most widespread, with cases of strong intensity occurring in a few isolated areas in the centre, east and west. Slight cold stress is confined to the south-east domain, particularly in autumn and winter. From 1982 to 2022, heat stress has increased significantly in the region, with peaks observed in January and October; very few areas have been spared the phenomenon of thermal stress. However, a slight decreasing trend was noticed along coastal regions and the south of C.A. Thereafter, the trend values showed the degree of C.A. vulnerability to global warming, and thus appropriate measures should be taken in relation to outdoor occupations and its impacts on the population of this region.

Molecular epidemiology of antimicrobial resistance in central africa: A systematic review.

Background: In Central Africa, it is difficult to tackle antibiotic resistance, because of a lack of data and information on bacterial resistance, due to the low number of studies carried out in the field. To fill this gap, we carried out a systematic review of the various studies, and devised a molecular epidemiology of antimicrobial resistance from humans, animals and the environmental samples. Method: A systematic search of all publications from 2005 to 2020 on bacterial resistance in Central Africa (Gabon, Cameroon, Democratic Republic of Congo, Central African Republic, Chad, Republic of Congo, Equatorial Guinea, São Tomé and Príncipe, Angola) was performed on Pubmed, Google scholar and African Journals Online (AJOL). All circulating resistance genes, prevalence and genetic carriers of these resistances were collected. The study area was limited to the nine countries of Central Africa. Results: A total of 517 studies were identified through a literature search, and 60 studies carried out in eight countries were included. Among all articles included, 43 articles were from humans. Our study revealed not only the circulation of beta-lactamase and carbapenemase genes, but also several other types of resistance genes. To finish, we noticed that some studies reported mobile genetic elements such as integrons, transposons, and plasmids. Conclusion: The scarcity of data poses difficulties in the implementation of effective strategies against antibiotic resistance, which requires a health policy in a 'One Health' approach.

"Stronger with Breastmilk Only" Initiative in 5 African Countries: Case Study on the Implementation Process and Contribution to the Enabling Environment for Breastfeeding.

Background: The practice of giving water before 6 mo of age is the biggest barrier to exclusive breastfeeding in West and Central Africa. To address this challenge, a regional initiative, "Stronger with Breastmilk Only" (SWBO), was rolled out at country level in several countries of the region. Objective: We examined the implementation process of the SWBO initiative and the contribution of its advocacy component to a more supportive environment for breastfeeding policies and programs. Methods: This study was based on 2 assessments at the national level carried out in 5 countries (Burkina Faso, Chad, Democratic Republic of the Congo, Senegal, and Sierra Leone) using qualitative methods. We combined 2 evaluative approaches (contribution analysis and outcome harvesting) and applied 2 theoretical lenses (Breastfeeding Gear Model and Consolidated Framework for Implementation Research) to examine the implementation process and the enabling environment for breastfeeding. Data sources included ∼300 documents related to the initiative and 43 key informant interviews collected between early 2021 and mid-2022. Results: First, we show how a broad initiative composed of a set of combined interventions targeting multiple levels of determinants of breastfeeding was set up and implemented. All countries went through a similar pattern of activities for the implementation process. Second, we illustrate that the initiative was able to foster an enabling environment for breastfeeding. Progress was achieved notably on legislation and policies, coordination, funding, training and program delivery, and research and evaluation. Third, through a detailed contribution story of the case of Burkina Faso, we illustrate more precisely how the initiative, specifically its advocacy component, contributed to this progress. Conclusion: This study shed light on how an initiative combining a set of interventions to address determinants of breastfeeding at multiple levels can be implemented regionally and contributes to fostering an enabling environment for breastfeeding at scale.