Nous Avons Research Articles

Conservation as a Tool for Cultural Rights in the Democratic Republic of the Congo: The We have gaps Project

ABSTRACT This paper outlines the aim, methodology, and initial results of a joint initiative between two universities (Université de Kinshasa in Kinshasa, Democratic Republic of the Congo and Université de Liège in Liège, Belgium), two conservation training courses (Academy of Fine Arts of Kinshasa and École Supérieure des Arts Saint-Luc in Liège), and the Institute of National Museums of Congo. The Nous avons des lacunes (We have gaps) project plays on the notion of loss – both material and of knowledge – to involve communities in the construction of endogenous knowledge on the conservation of objects: a task to be carried out by the Congolese, for the Congolese. For many Congolese, concepts such as ‘museum’ and ‘conservation’ sound foreign, and the idea of cultural rights remains highly abstract and theoretical. The challenge is to transform the manifestation of these rights through conservation into a real tool for empowerment. The exhibition concept is two-fold: conservators explain what loss or material alteration has occurred in a specific object, and how they remedy it, thus arousing interest in a little-known profession. At the same time, they show and explain their own gaps in knowledge, and ask the public for information about the technique, function, use, naming, or names of the mystery object in the four national languages and numerous Congolese idioms. The Nous avons des lacunes project aims to highlight the role and involvement of communities and different social entities as active guardians of their heritage, by humbly admitting the lack of knowledge among professionals.

PERITONITE TUBERCULEUSE : CIRCONSTANCES DE DECOUVERTE, PRISE EN CHARGE ET FACTEURS PRONOSTIQUES AU SERVICE DE CHIRURGIE GENERALE DU CHU IGNACE DEEN.

Summary The aim of this study was to report our experience in the management of tuberculous peritonitis in the general surgery department of the Ignace Deen National Hospital, Conakry University Hospital. Material and method:Ten-year retrospective descriptive study (January 2013 to December 2022) carried out in the general surgery department of the Hôpital national Ignace Deen/CHU de Conakry. All complete records of patients admitted for tuberculous peritonitis and confirmed by bacteriology and anatomical pathology were included in the study. Sociodemographic, clinical, therapeutic and prognostic variables were studied. Results:In the course of this study, we collated 41 cases of tuberculous peritonitis out of 4366 hospitalizations in the general surgery department of the Ignace Deen national hospital/CHU in Conakry, representing 0.94% of the department's total activity. Mean age was 58.97 years, with extremes of 12 and 77 years. HIV was associated with TBP in 56.1% of cases. Symptoms were dominated by fever (100%), abdominal pain (100%), weight loss (97.6%) and ascites (97.6%). The diagnosis was suspected preoperatively in all cases and confirmed by bacteriology and pathological anatomy. Treatment was based on two months' RHZE and four months' RH, on a short six-month regimen in 95.1% of cases. L’évolution a été majoritairement favorable dans 97,56%. Nous avons enregistré 3 décès. The majority of cases progressed favorably (97.56%). We recorded 3 deaths. Conclusions: Tuberculous peritonitis, reputed to be rare, has seen a resurgence in incidence with the advent of HIV. Careful questioning can help avoid unnecessary laparotomies. Key words: Tuberculous peritonitis, circumstances of discovery, treatment, prognosis, Ignace Deen.

Representations of Mathematics Education in Swedish Newspapers—Part of the Structural Influence on Mathematics Teaching

There is an ongoing public debate about mathematics education. This dialogue influences policymakers as well as mathematics teachers who are affected by these public ideas. Consequently, exploring the public debate, for example, by studying news media, is relevant for understanding teaching and learning in mathematics and also pertinent for researchers to actively participate in the debate about mathematics education. Representations of mathematics education, which emerged in a study of three national newspapers in Sweden, were explored. Articles relevant to the study were found in systematic searches in a media archive every fifth year between 1992 and 2017. Findings show that the construction of mathematics education in Swedish newspapers is multifaceted and complex, foregrounded by achievements, measurements and various forms of teaching. Other parts of the construction involve teachers wanting to arouse positive feelings, but their attempts are often unsuccessful. Whilst the construction of mathematics education is increasingly varied, the resulting positive and negative feelings and the tensions between representations contribute new insights, which are important to the field.RésuméL’enseignement des mathématiques fait constamment l’objet d’un débat public. Cette discussion influence les décideurs politiques ainsi que les enseignants de mathématiques touchés par ces idées échangées dans le domaine public. Par conséquent, afin de comprendre l’enseignement et l’apprentissage des mathématiques, en plus de faciliter la participation active des chercheurs à la conversation portant sur l’enseignement des mathématiques, il est pertinent d’étudier ce débat public, par exemple en examinant les médias d’information. Ainsi, nous avons analysé les représentations faites de l’enseignement des mathématiques qui sont ressorties de l’examen de trois journaux nationaux en Suède. Des recherches systématiques effectuées dans des archives médiatiques tous les cinq ans entre 1992 et 2017 ont permis d’identifier des articles pertinents à cette étude. Les résultats montrent que la conception de l’enseignement des mathématiques dans les journaux suédois est multiforme et complexe, qu’elle met l’accent sur les réalisations, les évaluations et diverses formes d’enseignement. D’autres éléments incluent le fait que les enseignants veulent susciter des sentiments positifs, mais que leurs tentatives sont souvent infructueuses. L’accent placé sur les réalisations et les évaluations est conforme aux études antérieures menées au Canada; alors que la représentation de l’enseignement des mathématiques est de plus en plus variée, les sentiments positifs et négatifs qui en résultent, ainsi que les tensions entre les représentations, apportent de nouvelles perspectives, importantes pour le domaine.

Moisturizing at a molecular level - The basis of Corneocare.

This review covers the last 20 years of research we and our collaborators have conducted on ethnic differences in facial skin moisturization placed in historical context with previous research. We have focussed particularly on the biochemical and cellular gradients of the stratum corneum (SC) with the aim of discovering new skin moisturization and SC maturation mechanisms, identifying new technologies and/or providing conceptual innovations for ingredients that will improve our understanding and treatment of dry skin. Specifically, we discuss gradients for corneodesmosomes and proteases, corneocyte phenotype-inducing enzymes, filaggrin and natural moisturizing factor (NMF), and barrier lipids. These gradients are interdependent and influence greatly corneocyte maturation. The interrelationship between corneodesmolysis and the covalent attachment of ω-hydroxy ceramides and ω-hydroxy fatty acids to the corneocyte protein envelope forming the corneocyte lipid envelope is especially relevant in our new understanding of mechanisms leading to dry skin. This process is initiated by a linoleoyl-ω-acyl ceramide transforming enzyme cascade including 12R lipoxygenase (12R-LOX), epidermal lipoxygenase-3 (eLOX3), epoxide hydrolase 3 (EPHX3), short-chain dehydrogenase/reductase family 9C member 7 (SDR9C7), ceramidase and transglutaminase 1. Our research has opened the opportunity of using novel treatment systems for dry skin based on lipids, humectants, niacinamide and inhibitors of the plasminogen system. It is clear that skin moisturization is a more complex mechanism than simple skin hydration.

Republication : Aliments ultra-transformés : le système NOVA est-il robuste ?

La classification NOVA répartit les aliments en quatre groupes (de 1, peu transformé à 4, le plus transformé). Sa fiabilité et sa reproductibilité ont été très peu explorées alors qu’elle est très utilisée. Nous avons étudié la cohérence entre utilisateurs (environ 170 professionnels) de l’affectation de 120 aliments du commerce et 111 aliments génériques dans les groupes NOVA. La cohérence des affectations (κ de Fleiss) était de 0,32 (aliments du commerce) et 0,34 (aliments génériques). Des clusters d’aliments présentant des distributions d’affectations similaires ont été définis par classification hiérarchique. Parmi les aliments du commerce, un cluster réunissait 90 aliments très largement affectés à NOVA4 (91 % des affectations) et, parmi les aliments génériques, trois clusters contenaient des aliments principalement affectés à NOVA 1 (79 %), NOVA2 (75 %) et NOVA4 (70 %), respectivement. Les affectations étaient particulièrement hétérogènes pour 30 aliments du commerce et 28 aliments génériques (25 % du total dans les deux cas). Les critères actuels de la classification NOVA ne permettent pas d’affecter de manière non ambiguë un aliment à un groupe. Ce système doit être amélioré, en raison de son utilisation en recherche et dans les politiques publiques. In the NOVA classification system, descriptive criteria are used to assign foods to one of four groups based on processing-related criteria. Although NOVA is widely used, its robustness and functionality remain largely unexplored. We determined whether this system leads to consistent food assignments by users. French food and nutrition specialists completed an online survey in which they assigned foods to NOVA groups. The survey comprised two lists: one with 120 marketed food products with ingredient information and one with 111 generic food items without ingredient information. We quantified assignment consistency among evaluators using Fleiss’ κ (range: 0–1, where 1 = 100% agreement). Fleiss’ κ was 0.32 and 0.34 for the marketed foods ( n = 159 evaluators) and generic foods ( n = 177 evaluators), respectively. The consistency of the assignments, as assessed by Fleiss’ κ, was 0.32 (commercial foods) and 0.34 (generic foods). Clusters of foods with similar assignment distributions were defined by hierarchical ascending classification. Among the 120 commercial foods, one cluster contained 90 foods that were predominantly assigned to NOVA4 (91% of the assignments) and, among the 111 generic foods, three clusters contained foods that were predominantly assigned to NOVA 1 (79% of the assignments), NOVA2 (75%) and NOVA4 (70%), respectively. Assignments were particularly heterogeneous for 30 commercial and 28 generic foods (25% of the total in both cases). Although assignments were more consistent for some foods than others, overall consistency among evaluators was low, even when ingredient information was available. These results suggest current NOVA criteria do not allow for robust and functional food assignments.

The immediate impact of Covid-19 infection and the resulting lockdown on nursing home residents

Following the Covid-19 epidemic affecting 76 of the 97 residents (78.3%) in a French nursing home, we assessed the impact of this cluster period on the physical and psycho-cognitive health of the residents, expecting in particular to observe effects that were dependent on their state of cognitive-behavioural dependence. We retained twenty-two variables, 5 relating to demographic data, 6 to the specific care linked to Covid-19 infection, 6 to somatic pathologies and psycho-behavioural disturbances before the epidemic and 5 to the period following it. Eleven residents among those diagnosed positive died. Nine were transferred to a Covid unit, and 35 were asymptomatic. The main consequences of the period of infections were in particular behavioural, nutritional, and motor. A history of disruptive behaviours before the appearance of the cluster increased the risk of an aggravation of these behaviours by four (RR = 3.9, IC95% = 1.38–11.02, p = 0.0042). Twenty per cent of the residents presented under-nutrition at the end of lockdown, but no specific risk factors could be identified. However, states of under-nutrition for the whole of 2020 were significantly more frequent than in 2019, in particular severe cases (χ²= 5.43, p = 0.02). A history of under-nutrition in the previous year increased twofold the likelihood of under-nutrition in the following year (RR = 2.07, IC95% = 1.14–3.74, p = 0.02). The Covid cluster period also had an effect on the functional autonomy of certain patients. Our main hypothesis relating to cognitive-behavioural dependence was not completely validated. The impact of the occurrence of the cluster remained moderate, in particular because of the care resources afforded by the nursing home. The advantages of a “medicalised” facility, and the problems associated with the restrictions of lockdown, are viewed in the light of ethical considerations.

Strengthening the Collection and Use of Disaggregated Data to Understand and Monitor the Risk and Burden of COVID-19 Among Racialized Populations

There is growing evidence that the risk and burden of COVID-19 infections are not equally distributed across population subgroups and that racialized communities are experiencing disproportionately higher morbidity and mortality rates. However, due to the absence of large-scale race-based data, it is impossible to measure the extent to which immigrant and racialized communities are experiencing the pandemic and the impact of measures taken (or not) to mitigate these impacts, especially at a local level. To address this issue, the Ottawa Local Immigration Partnership partnered with the Collaborative Critical Research for Equity and Transformation in Health lab at the University of Ottawa and the Canadians of African Descent Health Organization to implement a project to build local organizational capacities to understand, monitor, and mitigate the impact of the COVID-19 pandemic on immigrant and racialized populations. This research note describes the working framework used for this project, proposed indicators for measuring the determinants of health among immigrant and racialized populations, and the data gaps we encountered. Recommendations are made to policymakers, and community and health stakeholders at all levels on how to collect and use data to address COVID-19 health inequities, including data collection strategies aimed at community engagement in the collection of disaggregated data, improving methods for collecting and analyzing data on immigrants and racialized groups and policies to enable and enhance data disaggregation.RésuméDes plus en plus d’études montrent que le risque et le fardeau des infections à la COVID-19 ne sont pas également répartis dans la population et que les communautés racialisées connaissent des taux de morbidité et de mortalité disproportionnellement plus élevés. Cependant, en raison de l’absence de données ventilés selon le statut ethnique, il est impossible de mesurer comment les communautés immigrantes et racialisées vivent la pandémie et quel est l’impact des mesures prises (ou non) pour atténuer ces effets, surtout à un niveau local. Pour résoudre ce problème, le Partenariat local pour l’immigration d’Ottawa (PLIO) s’est associé au Laboratoire de recherche critique collaborative pour l’équité et la transformation en santé (CO-CREATH) de l’Université d’Ottawa et l’Organisation de la santé des Canadiens d’ascendance africaine (CADHO) aux fins de mettre en œuvre un projet visant à renforcer les capacités organisationnelles locales pour comprendre, surveiller et atténuer l’impact de la pandémie de la COVID-19 sur les populations immigrantes et racialisées. Cette note de recherche décrit le cadre de travail utilisé pour ce projet, les indicateurs proposés pour mesurer les déterminants de la santé chez les populations immigrantes et racialisées, et les lacunes que nous avons identifiés dans les données existants. Des recommandations sont faites aux décideurs politiques et aux acteurs communautaires et de la santé à tous les niveaux sur comment collecter et utiliser les données pour remédier aux inégalités en matière de santé liées à la COVID-19. Ces recommandations font référence aux stratégies de collecte de données visant à impliquer les communautés, à l’amélioration des méthodes de collecte et d’analyse des données sur les immigrants et les groupes racialisés, et aux politiques nécessaires pour permettre et améliorer la désagrégation des données selon le statut ethnique.

Abade Pierre Fournié (1738-1825) um martinesista convicto

Abbot Pierre Fournié (1738-1825) was secretary to the enigmatic theurgist Martinès de Pasqually (1727-1774), founder of the Ordre des Chevaliers Maçons Élus Coëns de l’Univers in France. He is one of the main actors of the first Martinism. Ignoring beautiful language and a rudimentary culture, he presents himself as a simple being, full of faith and charity, to whom the supernatural world naturally manifests itself. Strange character, with a strange destiny. For some, he was a mediocre vulgarizer of Pasqually’s doctrine, an uneducated, ignorant and almost illiterate. For others, his place was as a visionary, a mystic and an illuminated. This article aims to analyze his life and his work Ce que nous avons été, ce que nous sommes, et ce que nous deviendrons (1801). Pierre Fournié is one of the first actors of martinism in the 18th century and an inescapable figure of Christian mysticism.

Nearing Death: Anticipation and Survival in Gorz, Derrida, and Ricœur

Nearing Death:Anticipation and Survival in Gorz, Derrida, and Ricœur Enda McCaffrey "La mort est maintenant si effacée de nos mœurs que nous avons peine à l'imaginer et à la comprendre."1 I WANT TO BEGIN THIS ARTICLE by referring to a four-minute clip from Xavier Beauvois's film Des hommes et des dieux.2 The film tells the story of an order of Trappist monks living within a Muslim population in Algeria during the civil war in the 1990s. Relations between the two communities deteriorate as a result of an upsurge in fundamentalist terrorism. The monks have to decide whether they should leave the community whose residents they have nurtured and supported or stay in the knowledge that they will inevitably be killed. In this particular scene (their Last Supper), they toast their decision to stay in Algeria and accept their imminent death. The scene is accompanied by the "Swan Theme" from Tchaikovsky's ballet Swan Lake, the final act of which sees Odette and Siegfried accepting their fate by drowning together rather than face, in Odette's case life forever as a swan (and the ensuing loss of love, freedom, and happiness), and for Siegfried a life consumed by guilt over his unwitting betrayal of Odette. The ballet's final apotheosis has the lovers ascend united and deified into the heavens. In both film and ballet, death is anticipated, accepted, embraced, and overcome. I will return to the significance of this scene later. Drawing on an understanding of thanatology as a practice in writing death and dying,3 I want to explore the reflections on death—or more precisely on nearing death—of three French thinkers who composed their final works on this theme. For André Gorz, Jacques Derrida, and Paul Ricœur, death was an experience that they captured in their last writings: death by suicide for Gorz three years after his love letter to his wife in Lettre à D.: Histoire d'un amour;4 death from pancreatic cancer in the case of Derrida a year after his last publication, Apprendre à vivre enfin;5 and death from old age two months after the publication of Ricœur's unfinished work Vivant jusqu'à la mort, suivi de fragments.6 These texts reveal how each writer 'imagined' (thought, forethought, anticipated) their deaths as memento mori. Central to this practice of reflection is its focus on the anticipation of death and how this anticipation reshapes their respective thinking on life and the desire to survive. I want to show how these memento mori can be thought of as memento vivere. [End Page 26] Theory and context This article first came to life as a keynote address at a conference on the theme of the medical and religious imaginary in French literature.7 At the time the focus of my paper was on anticipatory grief. We usually think of grief as that which follows rather than that which awaits. I wanted to explore this understanding of grief further and demonstrate how in the future temporality that is anticipation there exists a continuous present, ethical and religious, that is an imminence and an immanence. In addition, one of the aims of that paper, to be developed further in this article, is that in defining the axis of the medicoreligious imaginary it was helpful for me to think in terms of texts of reparation and a very specific type of reparation in Lazarean textuality where the dying writer is reborn through language. Nearing death invites these writers to question the role of writing: why write, whom to write for, and where lies the value in the act of writing. I also aim to link the experience of anticipation to immanence. Immanence comes from the Latin immanens meaning to "remain in." It is the quality of being contained within or remaining within the boundaries of a person or the mind. This meaning is common within Christian and monotheist theologies. In his Ethics, Spinoza's immanent God was the creator of the world in the same way that an essence creates its own properties.8 The history of immanence is also linked to Christology, the field within Christian theology that deals with...

HIV testing and self-testing coverage among men and women in South Africa: an exploration of related factors.

Uptake of HIV testing is critical to halting the spread of HIV. Our study aimed to examine the coverage of HIV testing and self-testing and the individual-level, household-level and community-level factors associated with HIV testing and self-testing awareness. We analysed data of 12 312 men and women from 2016 SADHS and used multilevel mixed-effects models to examine the factors associated with uptake of HIV testing and self-testing awareness. About 80% of participants had ever tested for HIV, and 64% had tested in the past year. Only 49% of adolescents aged 15-19years had ever tested for HIV compared with over 80% of adults. Self-testing awareness was low (22%), and only 2.9% of respondents had ever self-tested for HIV. The odds of having ever tested for HIV were significantly higher among respondents who were aged 25-29 (AOR: 4.02; 95% CI: 3.27-4.95), had a higher level of education (AOR: 3.18; 95% CI: 2.19-4.61), were married (AOR: 1.63; 95% CI: 1.36-1.94), had high media exposure (AOR: 1.23; 95% CI: 1.06-1.44) and had ever had sex (AOR: 5.57; 95% CI: 4.67-6.64), but lower among men (AOR: 0.39; 95% CI: 0.35-0.44). In conclusion, HIV testing coverage is high in South Africa relative to most countries in sub-Saharan Africa, but falls short of the UNAIDS first 95. We found no evidence of socioeconomic and geographic inequalities in access to HIV testing. However, adolescents had a lower level of HIV testing uptake, suggesting a need for interventions to expand testing in this age group.

Implementation and operational feasibility of SAMBA I HIV-1 semi-quantitative viral load testing at the point-of-care in rural settings in Malawi and Uganda.

We monitored a large-scale implementation of the Simple Amplification-Based Assay semi-quantitative viral load test for HIV-1 version I (SAMBA I Viral Load=SAMBA I VL) within Médecins Sans Frontières' HIV programmes in Malawi and Uganda, to assess its performance and operational feasibility. Descriptive analysis of routine programme data between August 2013 and December 2016. The dataset included samples collected for VL monitoring and tested using SAMBA I VL in five HIV clinics in Malawi (four peripheral health centres and one district hospital), and one HIV clinic in a regional referral hospital in Uganda. SAMBA I VL was used for VL testing in patients who had been receiving ART for between 6months and ten years, to determine whether plasma VL was above or below 1000 copies/mL of HIV-1, reflecting ART failure or efficacy. Randomly selected samples were quantified with commercial VL assays. SAMBA I instruments and test performance, site throughput, and delays in communicating results to clinicians and patients were monitored. Between August 2013 and December 2016 a total of 60889 patient samples were analysed with SAMBA I VL. Overall, 0.23% of initial SAMBA I VL results were invalid; this was reduced to 0.04% after repeating the test once. Global test failure, including instrument failure, was 1.34%. Concordance with reference quantitative testing of VL was 2620/2727, 96.0% (1338/1382, 96.8% in Malawi; 1282/1345, 95.3% in Uganda). For Chiradzulu peripheral health centres and Arua Hospital HIV clinic, where testing was performed on-site, same-day results were communicated to clinicians for between 91% and 97% of samples. Same-day clinical review was obtained for 84.7% across the whole set of samples tested. SAMBA I VL testing is feasible for monitoring cohorts of 1000 to 5000 ART-experienced patients. Same-day results can be used to inform rapid clinical decision-making at rural and remote health facilities, potentially reducing time available for development of resistance and conceivably helping to reduce morbidity and mortality.

Insights in the pathophysiology of haemorrhagic strokes in a sub-Sahara African country, an epidemiological and MRI study.

Intra-cerebral Haemorrhage (ICH) seems more prevalent in sub-Saharan Africa (SSA) than in High-Income Countries (HIC) with poorer clinical outcome. Higher impact of hypertension and/or amyloid angiopathy could account for this disproportion. Here, we sought to (i) retrospectively compare ICH clinical and imaging patterns in Belgium and Guinea and in a subsequent cohort (ii) prospectively compare brain MRI characteristics to seek evidence for a different proportion of amyloid angiopathy patterns. Ninety one consecutive patients admitted for spontaneous ICH at Brussels Erasme-ULB Hospital and at Conakry Ignace Deen-UGANC were retrospectively compared in terms of ICH volume estimated with the ABC/2 method, clinical characteristics and modified ranking (mRS) score at 30days. mRS was dichotomised as good outcomes (≤3) and poor outcomes (>3). A prospective cohort of 30 consecutive patients with ICH admitted at CHU Conakry Ignace Deen-UGANC was prospectively included to undergo brain MRI. Results of the Guinean MRI were compared to 30 patients randomly selected from Brussels' initial cohort. Paired Student's t-test and Mann-Whitney u-test were used for group comparisons. Age of ICH onset was higher in Belgium (68±17years vs. 56±14years, P<0.01) while ICH volume and 30-day mortality rate were higher in Guinea (20ml vs. 11ml, P<0.01 and mortality 33% vs. 10 %, P<0.01). ICH burden in survivors in Conakry and Brussels showed respectively good outcomes in 56.7% and 60.4% (P=0.09) and poor outcomes in 10.3% vs. 29.6% (P<0.001). MRI analysis of the prospective cohort failed to disclose significant differences regarding brain MRI characteristics. Intra-cerebral Haemorrhage affected patients 15years younger in Guinea with larger haematoma volumes and higher mortality than in Belgium. MRI findings did not show more prevalent amyloid angiopathy pathology suggesting that better primary prevention of hypertension could positively impact ICH epidemiology in Guinea.

Mother-child separation among women living with HIV and their children in the first four years postpartum in South Africa.

Mother-child pairs may separate during early life, yet the health impacts thereof are unclear. We explored the patterns and impact of separation among women living with HIV (WLHIV) and their children in South Africa. WLHIV who had initiated antiretroviral therapy (ART) during pregnancy received HIV viral load (VL) testing and completed a timeline questionnaire of mother-child separation since delivery at 3-5years post-partum. Health care usage was abstracted from routine medical records. We examined associations between separation and (a) maternal health outcomes (engagement in HIV care and HIV viral suppression, [VS]) and (b) child health outcomes (post-breastfeeding HIV testing and immunisation completion), using logistic regression. Of 346 mother-child pairs (median maternal age at antenatal ART initiation, 28years), 24% were ever separated (median time to first separation 20months, interquartile range [IQR] 9, 31). Most separated children were living with their grandmothers (65/83, 78%). Mothers who ever separated were younger, and more likely to be employed, and to reside in informal housing than those who never separated. Any separation reduced the odds of VS≤50 copies/mL at four years post-partum (odds ratio 0.57; 95% CI 0.34-0.93); associations were similar for VL≤1000 copies/mL and maternal engagement in care. No association was found between separation and child confirmatory HIV testing or immunisation completion. In this setting, mother-child separation is common in the first four years of life and appears associated with suboptimal maternal outcomes. Further research is required to understand the drivers and implications of mother-child separation.

Clinical and laboratory predictors of 30-day mortality in severe acute malnourished children with severe pneumonia.

To determine the predictors of mortality within 30days of hospital admission in a diarrhoeal disease hospital in Bangladesh. Cohort study of hospitalised children aged 0-59months with severe acute malnutrition (SAM) and severe pneumonia in Dhaka Hospital, icddr,b, Bangladesh from April 2015 to March 2017. Those discharged were followed up, and survival status at 30days from admission was determined. Children who died were compared with the survivors in terms of clinical and laboratory biomarkers. Multivariable logistic regression analysis was used for calculating adjusted odds ratio for death within 30days of hospital admission. We enrolled 191 children. Mortality within 30days of admission was 6% (14/191). After adjusting for potential confounders (hypoxia, CRP and haematocrit) in logistic regression analysis, independent factors associated with death were female sex (aOR=5.80, 95% CI: 1.34-25.19), LAZ <-4 (aOR=6.51, 95% CI: 1.49-28.44) and Polymorphonuclear Leucocytes (PMNL) (>6.0×109 /L) (aOR=1.06, 95% CI: 1.01-1.11). Using sex, Z-score for length for age (LAZ), and PMNL percentage, we used random forest and linear regression models to achieve a cross-validated AUC of 0.83 (95% CI: 0.82, 0.84) for prediction of 30-day mortality. The results of our data suggest that female sex, severe malnutrition (<-4 LAZ) and higher PMNL percentage were prone to be associated with 30-day mortality in children with severe pneumonia. Association of these factors may be used in clinical decision support for prompt identification and appropriate management for prevention of mortality in this population.

The roles of social economic status and undernutrition in regional disparities of the under‐five mortality rate in Vietnam

From 2005 to 2017, the prevalence of mortality in Vietnamese children under five years old showed large regional disparities. In 2017, mortality in the wealthiest region was 12.6‰, whereas the most disadvantaged region it was three times as high, at 36‰. This study aims to identify factors affecting regional disparities of the under-five mortality rate (U5MR) in Vietnam. We applied Structural Equation Modelling to estimate the degree and the pathway through which undernutrition and socio-economic status (SES) contributed to the under-five mortality disparities. SES is estimated as a common latent factor of three socio-economic measures, that is, education, poverty and income. The direct effect of SES on U5MR is at 2.16 through the underweight pathway, which is 5 times higher than the effect of underweight on U5MR. Through the stunting channel, this direct impact is 1.43, nearly twice as high as the impact of the stunting rate. SES also has an indirect effect on U5MR through these undernutrition pathways. In total, we estimate that an increase in SES index will make the U5MR increase by 2.73‰. Among the three indicators of SES, poverty conveys the strongest signal of a considerable change in SES, thus to a subsequent change in U5MR. Among two types of undernutrition, the effect of stunting on U5MR is dominant, more than 3 times as high as that of underweight. These findings have important implications for socio-economic and health interventions: those that strongly focus on the reduction of regional poverty and stunting rates would be effective in bridging the regional gap in the U5MR in Vietnam.

Effect of a free healthcare policy on health services utilisation for non‐malarial febrile illness by children under five years in Burkina Faso: an interrupted time series analysis

To assess the effect of a free healthcare policy for children under five years old implemented in Burkina Faso since April 2016, on the use of health care of non-malarial febrile illnesses (NMFI). To assess the immediate and long-term effect of the free healthcare policy in place, we conducted an interrupted time series analysis of routinely collected data on febrile illnesses from three urban primary health centres of Ouagadougou between 1 January 2015 and 31 December 2016. Of the 39046 febrile cases reported in the study period, 17017 NMFI were included in the study. Compared to the period before the intervention, we observed an immediate, non-statistically significant increase of 7% in the number of NMFI (IRR=1.07; 95% CI=0.75, 1.51). Compared to the trend that would have been expected in absence of the intervention, the results showed a small but sustained increase of 6% in the trend of monthly number of NMFI during the intervention period (IRR=1.06; 95%CI=1.01, 1.12). Our study highlighted an increase in the uptake of healthcare services, specifically for NMFI by children under five years of age, after the implementation of a free care policy. This analysis contributes to informing decision makers on the need to strengthen the capacities of healthcare centres and to anticipate the challenges of the sustainability of this policy.

Factors associated with purchasing pesticide from shops for intentional self‐poisoning in Sri Lanka

In South Asia, up to one in five individuals who ingest pesticides for self-poisoning and survive purchased them from a shop immediately prior to the event. Thus far, no research has taken place to determine whether interventions implemented through the pesticide sellers might be acceptable or effective, despite the hundreds of thousands of such risk purchases each year. We aimed to investigate factors associated with purchasing pesticides for self-poisoning in Sri Lanka. We used a case-control study. Cases (n=50) were individuals who ingested pesticides after purchasing them for the act, and controls (n=200) were customers who bought pesticides but did not use them for self-harm. Logistic regression analysis was used to assess socio-demographic and purchase-specific risk factors. Alcohol intoxication (adjusted odds ratios [AOR] 36.5, 95% confidence intervals [CI] 1.7-783.4) and being a non-farmer AOR 13.3, 95% CI 1.8-99.6 were the main distinguishing factors when purchasing pesticides for self-poisoning. The positive predictive values were 93.3% (95% CI 68.0-99.8%) and 88.2% (95% CI 72.5-96.7%), respectively. One and/or other of these factors characterised 72.0% of cases but only 2.5% controls. While results need to be interpreted cautiously, sales restrictions to prevent alcohol-intoxicated persons and non-farmers purchasing pesticides for self-poisoning may be effective.

Neurocognitive functioning in MDR-TB patients with and without HIV in KwaZulu-Natal, South Africa.

Optimising medication adherence is one of the essential factors in reversing the tide of a TB-HIV syndemic in sub-Saharan Africa, especially South Africa. Impairment in key neurocognitive domains may impair patients' ability to maintain adherence to treatment, but the level of cognition and its relationship to HIV status has not been examined in individuals with drug-resistant TB. We therefore investigated performance on several key neurocognitive domains in relationship to HIV status in a multidrug-resistant tuberculosis patients (MDR-TB) sample. We enrolled microbiologically confirmed MDR-TB inpatients at a TB-specialist referral hospital in KwaZulu-Natal province, South Africa. We collected cross-sectional data on sociodemographic, clinical and neurocognitive function (e.g. attention, memory, executive functioning, language fluency, visual-spatial, eye-hand coordination). For the primary analysis, we excluded participants with major depressive episode/substance use disorder (MDE/SUD). We fitted adjusted Poisson regression models to explore the association between HIV and neurocognitive function. We enrolled 200 people with MDR-TB; 33 had MDE/SUD, and data of 167 were analysed (151 HIV+, 16 HIV-). The mean age of participants was 34.2years; the majority were female (83%), and 53% had not completed secondary school. There was evidence of impaired neurocognitive functioning across all domains in both HIV+/- study participants. Based on the regression analyses, individuals with co-infection (MDR-TB/HIV+), as well as those who had longer duration of hospital stays experienced significantly lower cognitive performance in several domains. Poor cognitive performance was significantly related to older age and lower educational attainment. The presence of major depression or substance use disorders did not influence the significance of the findings. Adults with MDR-TB have significant neurocognitive impairment, especially if HIV positive. An integrated approach is necessary in the management of MDR-TB as cognitive health influences the ability to adhere to chronic treatment, clinical outcomes and functionality.

4-month moxifloxacin containing regimens in the treatment of patients with sputum-positive pulmonary tuberculosis in South India - a randomised clinical trial.

Shortening tuberculosis (TB) treatment duration is a research priority. We tested the efficacy and safety of 3- and 4-month regimens containing moxifloxacin in a randomised clinical trial in pulmonary TB (PTB) patients in South India. New, sputum-positive, adult, HIV-negative, non-diabetic PTB patients were randomised to 3- or 4-month moxifloxacin regimens [moxifloxacin (M), isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E)] or to a control regimen (2H3 R3 Z3 E3 /4R3 H3 ) [C]. The 4 test regimens were 3R7 H7 Z7 E7 M7 [M3], 2R7 H7 Z7 E7 M7 /2R7 H7 M7 [M4], 2R7 H7 Z7 E7 M7 /2R3 H3 M3 [M4-I] or 2R7 H7 Z7 E7 M7 /2R3 H3 E3 M3 [M4-IE]. Treatment was directly observed. Clinical and bacteriological assessments were done monthly during treatment and for 24months post-treatment. The primary end point was TB recurrence post-treatment. Of 1371 patients, randomised, modified intention-to-treat (ITT) analysis was done in 1329 and per-protocol (PP) analysis in 1223 patients. Regimen M3 was terminated due to high TB recurrence rates. 'Favourable' response at end of treatment was 96-100% in the moxifloxacin regimensand 93% in the control regimen. Among these, the TB recurrence occurred in 4.1% in the M4 regimen and in 4.5% in the control regimen and demonstrated equivalence within a 5% margin (95% CI -3.68, 4.55). Similar findings were observed in modified ITT analysis. The TB recurrence rates in the M4-I and M4-IE regimens did not show equivalence with the control regimen. Sixteen (1.4%) of 1087 patients in the moxifloxacin regimens required treatment modification. The 4-month daily moxifloxacin regimen [M4] was found to be equivalent and as safe as the 6-month thrice-weekly control regimen.

Unfavourable treatment outcomes in tuberculosis patients with different vitamin D status and blood glucose levels in a programme setting in China.

Tuberculosis (TB) treatment success rates are high in China, but there are still a considerable number of cases who have unfavourable treatment outcomes (UTO). We aimed to determine the proportion of TB patients with UTO and to assess whether baseline characteristics that included glycaemic status [normal fasting blood glucose (FBG), transient hyperglycaemia and diabetes mellitus (DM)] and vitamin D status were associated with UTO. Prospective cohort study conducted between November 2015 and July 2016 at six clinics within routine TB services in Jilin province, where persons with TB were consecutively recruited. Data analysis was performed using the chi-squared test and multivariate logistic regression. Of the306 recruited TB patients, 96 (31.4%) had smear-positive pulmonary TB, 187 (61.1%) had smear-negative pulmonary TB and 23 (7.5%) had extrapulmonary TB (EPTB). Of these, 95 (31.1%) had normal blood glucose, 83 (27.1%) had transient hyperglycaemia and 128 (41.8%) had DM. 227 (74.2%) patients had vitamin D deficiency/severe deficiency. There were 125 (40.8%) patients with UTO of whom the majority were lost to follow-up (57.6%) or not evaluated (28.8%). UTO was significantly associated with smear-negative pulmonary TB (P=0.009), EPTB (P<0.001) and DM (P=0.007). The proportion of TB patients with UTO increased with smear-negative pulmonary TB, EPTB and DM. TB programmes need to pay more attention to these issues and ensure intensive patient support to those at risk and early detection of DM.