French-speaking African Countries Research Articles

Impact of air pollution on mortality: Geo-epidemiological study in French-speaking Africa

According to the World Health Organization, air pollution is responsible for 90 % of deaths in Africa. However, limited data on exposure to air pollution is available, and studies are rare, particularly in French-speaking Africa. This study aims to investigate the impact of air pollution on mortality in 12 French-speaking African countries (Algeria, Burkina Faso, Burundi, Cameroon, Guinea, Ivory Coast, Madagascar, Mali, Morocco, Democratic Republic of Congo, Senegal, Tunisia). Using data from the Institute for Health Metrics and Evaluation (IHME), annual concentrations of the PM2.5 pollutant from different cities were integrated into a spatial interpolation model (IDW) at the scale of each country. The interpolation was validated using cross-validation models. For each of the considered cardiorespiratory diseases (LRI, stroke, COPD, IHD), the attributable mortality fraction was estimated using literature data and population exposure calculated using demographic data from each country. Large variations in ambient PM2.5 concentration between the 12 countries are observed, with concentrations ranging from 1.76 μg/m3 in Morocco to 64.99 μg/m3 in Cameroon. Concentrations are higher in West Africa than in Central or North Africa. In 2019, 136 457 deaths attributable to air pollution were recorded in the 12 countries: 40.8 % from ischemic heart disease, 38.5 % from stroke, 13.2 % from lower respiratory infections and 7.5 % from chronic obstructive pulmonary disease. Our model allowed us to obtain a spatial distribution and the number of deaths related to air pollution. However, the estimation of the health impact from air pollution could be improved by more systematic and comprehensive local exposure assessments from a robust air quality monitoring system.

An Overview of the Management of Drug-Resistant Tuberculosis in Six French-Speaking African Countries from 2018 to 2022.

Drug-resistant tuberculosis (DR-TB) poses a significant public health challenge, particularly in resource-limited settings. The prevalence and management of DR-TB in African countries require comprehensive strategies to improve patient outcomes and control the spread of the disease. Aggregated routine data (from 2018 to 2022) on multidrug-resistant TB (MDR-TB) were collected from the National TB Programs (NTPs) from all six countries. The diagnostic capacity for MDR-TB was globally insufficient. The system for collecting and transporting samples was sometimes inoperative. A total of 2353 cases of MDR-TB were reported, with 86.4% receiving treatment. The gap between the expected number of MDR-TB cases and the number reported per country varied from 51.5% to 88.0%, depending on the year. Fifty-two extensively drug-resistant (XDR) TB cases received treatment regimens over five years, with variations across countries. All patients received free follow-up examinations, nutritional and financial support for travel expenses to the outpatient care and treatment centers. The MDR-TB treatment success rates for all regimens between 2018 and 2021 ranged from 44.4 to 90.9%, varying by country and year. The information system relied on primary tools, reporting tools, and digital solutions. Progress has been made in MDR-TB management; however, challenges persist, necessitating resources to enhance access to rapid molecular screening tests.

Analysis of opioid analgesics consumption in Africa: a longitudinal study from a 20-year continental perspective

Opioid analgesics are essential for managing acute and chronic pain in diseases such as cancer. Inadequate opioid access remains a major public health concern in low-income regions including Africa. This study aimed to provide updated and comprehensive data on changes in opioid consumption, specifically in Africa. This longitudinal study has updated and expanded upon the International Narcotics Control Board data obtained from 1999 to 2021, assessing opioid consumption trends across all African countries. The defined daily doses for statistical purposes (SDDD) was used to determine the changes in opioid consumption in Africa. In addition, we used sub-analyses of the data to delve into individual substances, income levels, cancer incidence, cancer mortality, and sub-regional cluster analysis (based on the language spoken) to identify possible disparities and inform further research and tailored solutions. Our results indicate a persistently low and stagnant trend in opioid consumption between 2001-03 and 2019-21, from 73 SDDD (95% CI 69-77) to 55 SDDD (32-79). In-depth analysis revealed a morphine consumption increase from 735 SDDD in 1999 to 1115 SDDD in 2021. Moreover, opioid consumption was closely related to country-level income levels, with most of the low-income and lower-middle-income African countries reporting low opioid consumption. Notably, the escalating incidence and mortality rates associated with cancer in Africa indicated a misalignment with the trajectory of opioid use. Additionally, French-speaking African countries exhibited lower opioid usage than the rest of the continent, suggesting avenues for research into cultural, political, and social aspects. In the context of global doubling in opioid consumption, Africa has shown insufficient and stagnant opioid consumption during the last 20 years. These findings underscore the need for policy reform to facilitate safe and responsible opioid access in Africa, particularly for legitimate indications such as cancer pain and palliative care. None. For the French translation of the abstract see Supplementary Materials section.

Cancer Pain Management in French-Speaking African Countries: Assessment of the Current Situation and Research into Factors Limiting Treatment and Access to Strong Opioid Analgesic Drugs

Cancer Pain Management in French-Speaking African Countries: Assessment of the Current Situation and Research into Factors Limiting Treatment and Access to Strong Opioid Analgesic Drugs

Long-term Bank Financing of Productive Investments and Economic Growth in French-speaking African Countries

Long-term Bank Financing of Productive Investments and Economic Growth in French-speaking African Countries

A Mutual Dependency: Postcolonial Relations between the French Athletics Federation and French-Speaking African Athletics Federations (1956–1969)

While scholars of postcolonial Franco-African relations in the field of sport regularly examine football, they have paid little attention to athletics (track and field). Yet French athletics remains closely linked to the African countries that emerged from France’s former colonies, offering financial, material and human resources to develop the sport. This connection has led some of the best African athletes to represent French clubs or even to opt for French nationality. A variety of postcolonial processes were at work in the relationship between the French Athletics Federation (FFA) and the athletics federations of French-speaking African countries that emerged after independence. The time period studied begins when the North African states under French domination gained independence in 1956 and ends in 1969, before these relations were redefined around Francophonie (the community of countries that use the French language) and took on new forms. The corpus studied included specialist press archives and reports from French and international athletics federations. The results distinguish two periods since 1956. The first reveals a loose relationship of mutual dependence: the FFA needed colonial athletes following independence, and the new African federations needed the FFA in order to develop. In the second period, from 1963 onwards, this mutual dependence became institutionalized by a more official cooperation policy supported by the French government, in which the organizations involved each had an interest. This relationship would characterize relations between the FFA and the athletics federations of French-speaking African countries in the postcolonial period.

Impact of air pollution on mortality: geo-epidemiological study in French-speaking Africa

Abstract According to the WHO, air pollution is responsible for 90% of deaths in Africa. However, few data on exposure to air pollution is available, and studies are rare, particularly in French-speaking Africa. This study aims to investigate the impact of air pollution on mortality in 13 French-speaking African countries (Algeria, Benin, Burkina Faso, Burundi, Cameroon, Ivory Coast, Guinea, Madagascar, Mali, Morocco, Democratic Republic of Congo, Senegal, Tunisia). Using data from the IHME, annual concentrations of the PM2.5 pollutant from different cities were integrated into a spatial interpolation model (IDW) at the scale of each country. The interpolation was validated using cross-validation models. For each of the considered cardiorespiratory diseases (LRI, stroke, COPD, IHD), the attributable mortality fraction was estimated using literature data and population exposure calculated using demographic data from each country. Large variations in concentration between the 13 countries are observed, with concentrations ranging from 1.76µg/m3 in Morocco to 67.03µg/m3 in Benin. Concentrations are higher in West Africa than in Central or North Africa. In 2019, 291,417 deaths attributable to air pollution were recorded in the 13 countries: 19.7% for ischemic heart disease, 6.5% for lower respiratory infections, 3.6% for chronic obstructive pulmonary disease, and 18.8% for stroke. Our model allowed us to obtain a spatial distribution and the number of deaths related to air pollution. However, the health impact of pollution could be improved by more systematic and comprehensive data collection through a system for monitoring concentrations of atmospheric pollutants. Key messages • This study estimates the number of deaths attributable to air pollution in 13 French-speaking African countries using a spatial interpolation model. • This study highlights the need for more data on air pollution exposure in French-speaking Africa.

Do School Governance Factors Determine Student Performance? A Neural Network Analysis of Data From French-Speaking African Countries

Do School Governance Factors Determine Student Performance? A Neural Network Analysis of Data From French-Speaking African Countries

Psychometric properties of the French version of the Kogan’s Attitudes toward Older People scale: A cross-sectional study conducted on Cameroonian nursing students

ABSTRACT The Kogan’s Attitudes toward Older People (KOP) scale has been used worldwide to explore nursing students’ attitudes toward older adults. It has various translations with good psychometric properties. The French version of the scale was first used on a Canadian population in 2012, then on a French Cameroonian population in 2020. However, its psychometric properties, especially its factor structure, have never been determined. To determine the psychometric properties of a French version of the KOP scale on Cameroonian French-speaking nursing students. A cross-sectional study was conducted where a self-administered questionnaire in French was given to a convenience sample of 296 nursing students registered for three different nursing programs. The French version of the KOP scale demonstrated moderate psychometric properties. The internal consistency, indicated by the Cronbach’s alpha, was moderate, while the explanatory factor analysis showed two factor loadings, which explained 58.44% of the total variance. Conclusion The French version of the KOP scale can be a useful tool for studies in French-speaking African countries to assess the degree of ageism toward older adults. It is suggested that the original KOP scale be retranslated by African translators and administered to larger French-speaking populations in other countries.

Boosting ethics review capacity in public health emergency situations: Co-creation of a training model for French-speaking research ethics committees.

Ethics review preparedness is a major foundation for national effective response to public health emergencies, because it promotes pertinent research and enhances the protection of research participants and communities. In low-income countries, it can also promote equitable research partnership. However, most relevant literature is in English and not easily accessible for the members of research ethics committees in French-speaking African countries. A training module in French, addressing the issue of research ethics review during outbreaks and other public health emergencies, was designed based on a non-systematic literature review, and in order to be complementary to the Democratic Republic of Congo (DRC) national guidelines for ethics review. The module was administered to 42 members of the five ethics committees in DRC that expressed their interest for the training. This training, co-designed with local stakeholders, in the local working language and taking into account local circumstances and regulation, provided participants with up-to-date insights of research ethics (and research ethics preparedness) in public health emergencies. It resulted in rich reflection and knowledge-sharing on good practices across the ethics committees. As most participating ethics committees do not have yet explicit standard operating procedures for expedited review of protocols submitted in emergency situations, this would be a next important step to facilitate emergency reviews in the most efficient way.

Cancer Pain Management in French-Speaking African Countries: Assessment of the Current Situation and Research Into Factors Limiting Treatment and Access to Analgesic Drugs.

IntroductionThere is a dearth of research on the incidence and treatment of cancer pain in Africa. Yet Africa, with other developing countries, accounts for more than half of all cancer diagnoses, and it is estimated that cancer incidence in Africa will double by 2030.ObjectivesThis research protocol outlines an approach to investigate cancer pain in French-speaking African countries. The protocol intends to determine and describe the treatment and management of cancer pain in these countries. Barriers to treating cancer pain will be explored and the results will be collated to make a series of recommendations on policy positions, regulatory frameworks and protocols.MethodsA mixed-methods, co-creation methodology has been selected to ensure the societal impact of the research outcomes. This research will use both qualitative and quantitative data collection methods and analyses. The research will begin with a review of the policies and legislation that exist in relation to cancer pain management and the use of analgesics, in each French-speaking African country. An Experts Steering Committee will then be created to provide guidance on the protocol and research design and access to participants, as well as to execute on the administration of surveys to local structures and international experts. A series of semi-structured, qualitative interviews with experts and clinicians in the field of screening and management of cancer pain and access to treatment will follow. Purposive and snowball sampling will be used to select the respondent experts. The semi-structured interviews will be conducted to determine the main trends and barriers to the treatment of cancer pain in French-speaking African countries. From this qualitative research, two surveys will be developed and then administered: one to validate the policy and regulatory context, and the other to determine experts and healthcare professionals experience and perceptions of cancer pain.Results/ConclusionsThe results will be analyzed using quantitative and qualitative methods to determine themes and perceptions of cancer pain and treatment, from the policy level to the healthcare professional level. Evaluation of the results will lead to recommendations for a comprehensive framework for cancer pain treatment in French-speaking Africa.

ВОЕННОЕ ПРИСУТСТВИЕ ФРАНЦИИ В МАЛИ: СТРУКТУРНАЯ ВЛАСТЬ СУБИМПЕРИИ «КОЛЛЕКТИВНОГО ЗАПАДА»

The French military presence in Mali is considered in the context of other instruments of the first-level structural power (according to Suzan Strange) - in the fields of economics and law (OHADA), finance (CFA zone), distribution of knowledge (France 24 and TV5 Monde). It is shown that the former metropolitan power itself acts as a sub-empire of the «collective West» led by the United States with its own zone of influence (French-speaking African countries), and its potential is complemented by Western structural power (NATO, OECD, Bretton Woods Institutions, etc.). However, it is the military factor, including regular operations in Africa, that acts as the most important tool of French influence on the continent. The article examines the system of bilateral agreements in the military sphere between France and Mali, but the focus is on the current stage of development of the situation in the Sahel: the events after the overthrow of M. Gaddafi, when jihadist activity intensified in the region, in response to which the French operations Serval and Barkhane were launched. The phenomenon of France's «situational multilateralism» in the field of security and peacekeeping is being investigated, when the UN forces (MINUSMA), the EU forces (EUTM Mali, EUCAP Sahel, Takuba) and local actors (G5 Sahel) become its partners in the implementation of operations depending on the situation. At the first stage of the intervention, France and its partners managed to somewhat stabilize the situation, but the further build-up of the military component did not lead to a clear improvement in the situation. In the current circumstances, the military leadership of Mali has bet on the withdrawal of France from the country and on the search for new security allies, primarily Russian assistance. At the same time, other instruments of French structural power remain in place.

View of Thorax Palpation and Apex Beat Analysis in the Field Medical Practice

Despite the extraordinary performances of contemporary methods of investigation (echocardiography, scanner, magnetic resonance imaging, etc.), clinical examination retains all its importance in Cardiology, particularly in extra-hospital settings. The authors have experience of cardiological diagnosis in France and in French-speaking African countries [1-4]: Benin, Mali, Niger, Senegal and for one (CA) in Vietnam (Hanoi and Danang). They have also taught and supervised medical students, either as permanent residents (Mali, Niger), or during official educational missions.

Relational governance, equity and social spill-over of agricultural value chains: Cotton case in Cameroon and beyond

It is often claimed that cotton production is of significant economic and social importance in the French-speaking African countries (FSACs) but indicators of socio-economic impact are often not precisely measured, not based on updated data, and equity concerns are usually not addressed. Studies of the cotton value chains in Africa seldom account for the impacts of governance on value creation and income distribution. This paper showcases the relationship between governance and equity within the cotton sector in Cameroon in the 2017–18 season, through the concept of relational governance. It was found that the studied cotton chain was well-suited to the notion of relational governance. The interlinking between the key stakeholders (cotton company, cotton producers and their representative bodies, the State) was materialized by a combination of several types of coordination in which contracts prevailed, state intervention was kept minimal and market coordination restrained to the domain of interaction with the world market. Producer organizations were contractually compensated for performing many tasks that were traditionally completed by the cotton company Overall, the governance rules were favourable to the incomes of farmers, regardless of farm size and resources. The governance of the cotton sector in Cameroon, while not optimal in terms of equity, did lead to remarkable social impacts in villages through support to children’s education and the provision of cash credit to the most needy. The study findings could be valid for other FSACs because of similar governance measures and little local valuation of cotton fibre. This paper points out the policy implication that a relational governance model should be promoted in most agricultural value chains in Africa. In the specific case of the cotton value chains in Cameroon and FSACs, the involvement of donors in the enhancement of relational governance should result in improved social impacts from cotton production.

Knowledge and attitudes of ultrasonography physicians regarding the biological effects of ultrasound in French-speaking sub-Saharan Africa.

To assess the knowledge and practical attitudes of ultrasonography physicians regarding the biological effects of ultrasound in French-speaking sub-Saharan Africa. A descriptive cross-sectional study carried out over a period of 03months (from 1st August to 31st October 2019) which included doctors carrying out ultrasound examinations in French-speaking sub-Saharan African countries via an electronic survey form. The 137 ultrasonography physicians came from 13 different countries and included 58% radiologists, 15% gynecologists, 14% cardiologists and 13% general practitioners. The majority of ultrasonography physicians had less than 10years of professional experience (87.60%) and performed more than 25 ultrasonographies per week (65.69%). The biological effects of ultrasound were known by 69.34% of ultrasonography physicians. Only 44% were able to cite the two biological effects of ultrasounds; 59.13% were unaware of the existence of thermal and mechanical indexes and 66.42% had no idea about the normal values of these indexes. They were unaware that their devices showed mechanical or thermal index in 48.91% of cases, consulted these indexes at the beginning of ultrasound explorations in 26.92%, and had no idea about the practical attitudes to adopt in the face of an increase in these indexes in 54.74% of cases. Half of the gynecologists and general practitioners and 55% of the radiologists affirmed that they avoid using Doppler as much as possible to explore the embryo. The level of knowledge of ultrasonography physicians about the biological effects of ultrasound was unsatisfactory in French-speaking sub-Saharan Africa and good attitudes to ultrasound safety were not always adopted.

The Programme d'Appui aux Stratégies Sociales (PASS), a handshake between mutualists from North and South (Europe-Africa)

ResumeLe Programme d'Appui aux Stratégies Sociales, (PASS), est un pôle d'expertise en santé et protection sociale à but non lucratif qui prolonge les activités du Programme d'appui aux stratégies mutualistes de santé, géré par Expertise France de 2015 à 2020. La structure est opérationnelle depuis août 2019 grâce au soutien de deux groupements mutualistes français, le Groupe Vyv et la Fédération Nationale de la Mutualité Française (FNMF), sous la forme d'une société par actions simplifiées à but non lucratif. Partant de son socle originel d'appui au développement des couvertures santé mutualistes, le PASS élargit son domaine d'intervention aux projets, politiques et systèmes de santé et de protection sociale avec une attention particulière sur les problématiques liées aux femmes et aux enfants. Le PASS propose ainsi une expertise construite autour de 3 domaines d'activité stratégiques qui sont: (1) l'appui aux mécanismes solidaires de financement de la santé de type mutualiste (audit, études, conseil, formation); (2) l'appui au renforcement des services de santé bâtis en lien avec les politiques publiques et (3) l'apport en expertise et en capacités opérationnelles en réponse à diverses problématiques ponctuelles de santé et de protection sociale. Basé à Abidjan en Côte d'Ivoire, le PASS étend l'ensemble de ses activités aux autres pays d'Afrique francophone.

Role of national dermatology societies: A perspective from Tunis

Dermatology in French-speaking African countries is facing many challenges. Dermatology societies, if they exist, are relatively young and have limited financial resources to provide regular training opportunities for their members and those in training. In several sub-Saharan nations, the small number of dermatologists is truly alarming with the prevalence of such major skin diseases as cutaneous leishmaniasis, AIDS, mycetoma, leprosy, and the consequences of skin bleaching procedures, reaching catastrophic figures.

African School of Pediatric Oncology Initiative: Implementation of a Pediatric Oncology Diploma Program to Address Critical Workforce Shortages in French-Speaking Africa.

PURPOSEIn 2012, the French African Pediatric Oncology Group established the African School of Pediatric Oncology (EAOP), a training program supported by the Sanofi Espoir Foundation’s My Child Matters program. As part of the EAOP, the pediatric oncology training diploma is a 1-year intensive training program. We present this training and certification program as a model for subspecialty training for low- and middle-income countries.METHODSA 14-member committee of multidisciplinary experts finalized a curriculum patterned on the French model Diplôme Inter-Universitaire d’Oncologie Pédiatrique. The program trained per year 15 to 25 physician participants committed to returning to their home country to work at their parent institutions. Training included didactic lectures, both in person and online; an onsite practicum; and a research project. Evaluation included participant evaluation and feedback on the effectiveness and quality of training.RESULTSThe first cohort began in October 2014, and by January 2019, 72 participants from three cohorts had been trained. Of the first 72 trainees from 19 French-speaking African countries, 55 (76%) graduated and returned to their countries of origin. Four new pediatric oncology units have been established in Niger, Benin, Central African Republic, and Gabon by the graduates. Sixty-six participants registered on the e-learning platform and continue their education through the EAOP Web site.CONCLUSIONThis training model rapidly increased the pool of qualified pediatric oncology professionals in French-speaking countries of Africa. It is feasible and scalable but requires sustained funding and ongoing mentoring of graduates to maximize its impact.

Pierre Richet (1904-1983), fighting onchocerciasis and totalitarism.

While Eugène Jamot's name is associated with the combat against sleeping sickness, Pierre Richet is permanently linked to the battle against river blindness, which he first reported in 1936 in two neighboring households in Garango (Burkina Faso). Onchocerciasis remained a continuous interest, through his last article "The OCCGE and Onchocerciasis", written in 1983. Nonetheless over the course of these five decades, Richet's trajectory was far from that of a specialist dedicating his life to a single disease. After a decade essentially spent fighting trypanosomiasis, came a decade of war in which the specialist in endemism joined the Free French Army and put his organizational know-how at General Lerclerc's disposal, from Morocco to Indochina, via Germany. On his return to Africa in 1953, he extended the principle of mobile teams to the other major endemic diseases accessible to treatment and to vaccines. Richet organized first the combat against leprosy and launched vaccination programs. In 1955, he returned to the battle against onchocerciasis and deployed the first large-scale insecticide program in Chad. The intermediate term failure of this prototype fermented his scientific, interdisciplinary, and organizational thought, which flourished at Bobo-Dioulasso. At the dawn of the independence of French-speaking African countries, and against the political tides of the time, he obtained in 1960 the creation of a supranational organization, the OCCGE, common to 8 countries of West Africa, and he headed it for a decade. Drawing lessons from the past and in the absence of effective pharmaceutical treatment, Richet the physician played the entomological card with one hand, with technical support from Orstom (IRD); this detailed work enabled the development of a strategy. With the other hand, he played the multilateral card, which led in 1974 to the launching of the extraordinary Onchocerciasis Control Program (OCP). If it is Jamot who awakened Africa, Richet is the person who restored its view but also millions of hectares of cultivable land.

The history of accounting standards in French-speaking African countries since independence

PurposeThe purpose of this paper is to focus on circumvolutions taken by the accounting standard-setting process in French-speaking African countries which have delayed convergence toward IFRS standards and to identify how different factors shape accounting standards in a context in which post-colonial hysteresis interact with globalization.Design/methodology/approachThis study uses archival data and interviews with key individual actors. Two case studies from two successive periods are contrasted: the design of the OCAM accounting standards in the 1970s, and the development of the SYSCOA/OHADA accounting standards during the 1990s before the partial adoption of IFRS.FindingsThe study shows the convergence toward international accounting standards in French-speaking African countries emerged from a complex, multimodal process mingling competition with collaboration and negotiation. They have followed a different path from most English-speaking African countries, where convergence to IAS/IFRS took place earlier and faster. The evidence indicates the significance of the interaction between the ex-colonization and the indigenous accounting standards, the importance of key actors and the level of the educational institutions.Research limitations/implicationsNo African written sources were located. Most of the sources used were French.Practical implicationsThe paper includes implications for the standards setting in developing countries. The examination of the development of accounting rules in French-speaking African countries between 1960 and 2010 shows the complexity of the accounting standards’ diffusion dynamic.Originality/valueThis study provides novel insights over a 30-year period of accounting standards in French-speaking African countries. This research explains why IFRS have not yet adopted in French-speaking African countries as it was in English-speaking African countries.