West African Setting Research Articles

Disparities in dolutegravir utilisation in children, adolescents and young adults (0-24 years) living with HIV. An analysis of the IeDEA Paediatric West African cohort.

We describe the 24-month incidence of Dolutegravir (DTG)-containing antiretroviral treatment (ART) initiation since its introduction in 2019 in West Africa. We included all patients aged 0-24 years on ART from nine clinics in Cote d Ivoire (n=4), Ghana, Nigeria, Mali, Benin, and Burkina Faso. Baseline varied by clinic and was defined as date of first DTG prescription; patients were followed up until database closure/death/loss to follow-up (LTFU, no visit 7 ≥ months), whichever came first. We computed the cumulative incidence function for DTG initiation; associated factors were explored in a shared frailty model, accounting for clinic heterogeneity. Since 2019, 3,350 patients were included; 47.2% were female;78.9% had been on ART ≥ 12 months. Median baseline age was 12.5 years (Interquartile range[IQR]: 8.4-15.8). Median follow-up was 14 months (IQR: 7-22). The overall cumulative incidence of DTG initiation reached 22.7% (95% Confidence Interval (CI): 21.3-24.2) and 56.4% (95% CI: 54.4-58.4) at 12 and 24 months, respectively. In univariate analyses, those aged <5 years and females were overall less likely to switch. Adjusted on ART line and available viral load (VL) at baseline, females >10 years were less likely to initiate DTG compared to males of the same age (adjusted Hazard Ratio [HR] among 10-14 years: 0.62, 95% CI: 0.54-0.72; among ≥ 15 years: 0.43, 95% CI: 0.36-0.50), as were those with detectable VL (> 50 copies/mL) compared to those in viral suppression (aHR: 0.86, 95% CI: 0.77-0.97) and those on protease inhibitors compared to those on non-nucleoside reverse-transcriptase inhibitors (aHR after 12 months of roll-out: 0.75, 95% CI: 0.65-0.86). Paediatric DTG uptake was incomplete and unequitable in West African settings: DTG use was least likely in children <5years, females ≥ 10 years and those with detectable viral load. Maintained monitoring and support of treatment practices is required to better ensure universal and equal uptake.

Electroencephalography in emerging viral infections: Lessons learned from implementing an EEG unit in a Lassa fever isolation ward in Nigeria.

Electroencephalography (EEG) has been used for almost a century in well-equipped medical centers to facilitate the diagnosis of epilepsy and other brain disorders. Lassa fever (LF) and other emerging viral infections (EVI) are known to cause neurological complications, including meningitis, seizures, and encephalopathy, though to date it remains unclear whether these are secondary to metabolic disturbances caused by the disease or by direct involvement of the central nervous system (CNS). To better characterize how Lassa virus (LASV) affects the CNS, we established an EEG diagnostic unit in the LF isolation ward at Irrua Specialist Teaching Hospital in Edo State, Nigeria. Here, we report on the specific difficulties to successful implementation of EEG in this highly challenging setting. Technical artefacts due to electrical interferences and interrupted power supply, artefacts deriving from a partly improvised EEG setup within a high consequence pathogen isolation ward, and environmental factors, such as heat in the endemic West African setting are among the main difficulties encountered when setting up this diagnostic facility. It takes experienced neurophysiologists to distinguish such artefacts from actual EEG abnormalities as many of them are not commonly encountered to this extent in well-equipped EEG laboratories and can easily be confused with pathologies. The EEG recording process is further complicated by biosafety considerations and the necessity of wearing extensive personal protective equipment. Nevertheless, with the help of experienced neurophysiologists, it is possible to correctly set up the facility and interpret recordings. Taking the above into consideration, EEG is valuable in identifying CNS involvement in emerging infections, particularly regarding assessment of encephalitis, differential diagnosis of impaired consciousness and treatment adjustment in patients with symptomatic seizures. Although highly challenging under these circumstances, EEG can be an important, noninvasive diagnostic tool for neurological complications in EVI where other more advanced imaging modalities are not available.

The use of Kudoh method for culture of Mycobacterium tuberculosis and Mycobacterium africanum in The Gambia.

Mycobacterium tuberculosis culturing remains the gold standard for laboratory diagnosis of tuberculosis. Tuberculosis remains a great public health problem in developing countries like The Gambia, as most of the methods currently used for bacterial isolation are either time-consuming or costly. To evaluate the Kudoh swab method in a West African setting in Gambia, with a particular focus on the method's performance when culturing Mycobacterium africanum West Africa 2 (MAF2) isolates. 75 sputum samples were collected in the Greater Banjul Area and decontaminated in parallel with both the standard N-acetyl-L-Cysteine-NaOH (NALC-NaOH) and the Kudoh swab method in the TB diagnostics laboratory in the Medical Research Council Unit The Gambia between 30th December 2017 and 25th February 2018. These samples were subsequently cultured on standard Löwenstein-Jensen and Modified Ogawa media respectively and incubated at 37°C for mycobacterial growth. Spoligotyping was done to determine if the decontamination and culture methods compared could equally detect Mycobacterium tuberculosis, Mycobacterium africanum West Africa 1 and Mycobacterium africanum West Africa 2. Among the 50 smear positives, 35 (70%) were culture-positive with Kudoh and 32 (64%) were culture positive with NALC-NaOH, whilst 7(28%) of the 25 smear negative samples were culture positive with both methods (Table 2). There was no significant difference in recovery between both methods (McNemar's test, p-value = 0.7003), suggesting that the overall positivity rate between the two methods is comparable. There were no differences in time-to-positivity or contamination rate between the methods. However, Kudoh yielded positive cultures that were negative on LJ and vice versa. All findings were irrespective of mycobacterial lineages. The Kudoh method has comparable sensitivity to the NALC-NaOH method for detecting Mycobacterium tuberculosis complex isolates. It is easy to perform and could be an add on option for mycobacterial culture in the field in The Gambia, since it requires less biosafety equipment.

Efficacy of chlorfenapyr-pyrethroid and piperonyl butoxide-pyrethroid long-lasting insecticidal nets (LLINs) compared to pyrethroid-only LLINs for malaria control in Côte d’Ivoire: a three group, cluster randomised trial

BackgroundThe massive scale-up of long-lasting insecticidal nets (LLIN) has led to a major reduction in malaria burden in many sub-Saharan African (SSA) countries. The World Health Organization (WHO) has recently issued a strong recommendation for the use of chlorfenapyr-pyrethroid LLINs compared to standard pyrethroid-only LLINs in areas of high insecticide resistance intensity. However, there is still a lack of conclusive evidence on the efficacy of piperonyl butoxide-pyrethroid (PBO-py) LLINs, especially in West Africa, where vector composition and resistance mechanisms may be different from vectors in East Africa.MethodsThis is a three-arm, superiority, triple-blinded, cluster randomised trial, with village as the unit of randomisation. This study conducted in Côte d’Ivoire will evaluate the efficacy on epidemiological and entomological outcomes of (1) the control arm: MAGNet® LN, which contains the pyrethroid, alpha-cypermethrin, (2) VEERALIN® LN, a net combining the synergist PBO and alpha-cypermethrin, and (3) Interceptor® G2 LN, which incorporates chlorfenapyr and alpha-cypermethrin, two adulticides with different mechanisms of action. A total of 33 villages with an average of 200 households per village will be identified, mapped, and randomised in a ratio of 1:1:1. Nets will be distributed at a central point following national guidelines with 1 net for every 2 people. The primary outcome of the trial will be incidence of malaria cases (confirmed by rapid diagnostic test (RDT)) in a cohort of 50 children aged 6 months to 10 years in each cluster, followed for 12 months (active case detection). Secondary outcomes are cross-sectional community prevalence of malaria infection (confirmed by RDT) in the study population at 6 and 12 months post-intervention (50 randomly selected persons per cluster), vector density, entomological inoculation rate (EIR), and phenotypic and genotypic insecticide resistance at baseline and 12 months post-intervention in 3 sentinel villages in each treatment arm.DiscussionIn addition to generating further evidence for next-generation LLINs, this study will also provide the first evidence for pyrethroid-PBO nets in a West African setting. This could further inform WHO recommendations on the pragmatic use of pyrethroid-PBO nets.Trial registrationClinicalTrials.gov NCT05796193. Registered on April 3, 2023.

Conducting Ethical Field Research on Rape in West African Settings: Case Study of 2018 Liberian Field Survey

Background: Rape scholarship in West Africa is growing, but studies often utilize Westernized approaches. A 2018 study using a randomized survey design assessing rape among Liberian girls incorporated modified survey design methods to improve ethical data collection relevant to the cultural and contextual contexts. This article presents the findings of a thorough review of rape scholarship and design methods. Methods: Based on a qualitative analysis of field notes by the research team, we present lessons learned and best practices identified in the planning, pilot-testing, and implementation phases of the 2018 Liberian study. Results: This study helps inform innovative design methods striving to (1) avoid using obtrusively graphic language or labels prevalent in westernized studies, (2) authentically collaborate with African experts to adapt strategies to be culturally appropriate and contextually relevant, and (3) create respectfully transparent interactions with respondents and communities. Extensive research preparation and inclusive regional expertise inform compassionate methodological techniques, yielding improved Afro-centric participant experience, low participant attrition, and quality data use in policymaking. (4) Conclusions: This article offers innovative design methods to study rape, placing context, culture, and participants at the heart. Authentic collaboration with national-level experts is vital for conducting more reliable and ethical field research in the African region.

Childbearing Trajectories in a West African Setting: A Sequence Analysis Approach

The lagging fertility transition in West Africa has important repercussions for global population growth but remains poorly understood. Inspired by Caldwell and colleagues' fertility transition framework, as well as by subsequent research, we examine diversity in women's holistic childbearing trajectories in Niakhar, Senegal, between the early 1960s and 2018 using a sequence analysis approach. We evaluate the prevalence of different trajectories, their contribution to overall fertility levels, and their association with women's socioeconomic and cultural characteristics. Four trajectories were observed: “high fertility,” “delayed entry,” “truncated,” and “short.” While the high fertility trajectory was most prevalent across cohorts, delayed entry grew in importance. The high fertility trajectory was more common among women born between 1960 and 1969 and was followed less often by divorced women and those from polygynous households. Women with primary education and those from higher status groups were more likely to experience delayed entry. The truncated trajectory was associated with lack of economic wealth, polygynous households, and caste membership. A short trajectory was related to lack of agropastoral wealth, divorce, and possibly secondary sterility. Our study advances knowledge on fertility transitions in Niakhar—and Sahelian West African contexts more generally—by showing the diversity of childbearing trajectories within high fertility regional contexts.

Financing care for Severe Stigmatizing Skin Diseases (SSSDs) in Liberia: challenges and opportunities

IntroductionNeglected tropical diseases (NTDs) are an important global health challenge, however, little is known about how to effectively finance NTD related services. Integrated management in particular, is put forward as an efficient and effective treatment modality. This is a background study to a broader health economic evaluation, seeking to document the costs of integrated case management of NTDs versus standard care in Liberia. In the current study, we document barriers and facilitators to NTD care from a health financing perspective.MethodsWe carried out key informant interviews with 86 health professionals and 16 national health system policymakers. 46 participants were active in counties implementing integrated case management and 40 participants were active in counties implementing standard care. We also interviewed 16 patients and community members. All interviews were transcribed and analysed using the thematic framework approach.FindingsWe found that decentralization for NTD financing is not yet achieved – financing and reporting for NTDs is still centralized and largely donor-driven as a vertical programme; government involvement in NTD financing is still minimal, focused mainly on staffing, but non-governmental organisations (NGOs) or international agencies are supporting supply and procurement of medications. Donor support and involvement in NTDs are largely coordinated around the integrated case management. Quantification for goods and budget estimations are specific challenges, given the high donor dependence, particularly for NTD related costs and the government’s limited financial role at present. These challenges contribute to stockouts of medications and supplies at clinic level, while delays in payments of salaries from the government compromise staff attendance and retention. For patients, the main challenges are high transportation costs, with inflated charges due to fear and stigma amongst motorbike taxi riders, and out-of-pocket payments for medication during stockouts and food/toiletries (for in-patients).ConclusionOur findings contribute to the limited work on financing of SSSD services in West African settings and provide insight on challenges and opportunities for financing and large costs in accessing care by households, which is also being exacerbated by stigma.

Rejectionist Islamism in sub-Saharan Africa

Abstract This article contributes to a better understanding of the dynamics of Islamist mobilization in sub-Saharan Africa. Since the late 1980s, several African societies have witnessed significant Islamist violence. Against this background, the article provides a typology of rejectionist Islamism, a strain of Islamism that has left a major imprint both on East and West African settings. While rejectionist Islamist groups share as their common denominator the explicit negation of the nation state's legitimacy, they can be differentiated according to whether they violently challenge the state and are willing to participate in mainstream civil society. Thus, in this article I present four different types of rejectionist Islamism: ‘isolationism’, ‘militant isolationism’, ‘participatory rejectionism’ and ‘militant participatory rejectionism’. Examining rejectionist groups from four African countries, I demonstrate my typology's capacity for facilitating a fine-grained assessment of individual group trajectories over time. Finally, I present findings on the determinants of the violent radicalization of rejectionist Islamist groups.

SADC and ECOWAS’S peace and security architecture preparedness and the COVID-19 pandemic

The coronavirus disease 2019 (Covid-19) pandemic remains a global security threat, as the result of the emerging and exacerbated security challenges that have impacted on the national security policies of various regional economic communities (RECs). This study analyses SADC and ECOWAS’ responses to the Covid-19 pandemic under their respective existing peace and security structures and explores if both RECs, SADC and ECOWAS have been efficient. This article discusses the Southern African and West African security setting, how its security architecture emerged and whether it has been successful in overcoming the security ramification in the region under the Covid-19 pandemic. Coincidentally, both SADC and ECOWAS have been confronted with existing and emerging human security threats, such as increased poverty, inequality, and the spread of diseases, such as Covid-19. The Covid-19 pandemic, a non-traditional security threat, has exposed how RECs, such as SADC and ECOWAS, respond to non-traditional and emerging security threats, suggesting for the transcendence of their security architecture that caters equally for non-military and emerging human security threats, alike military threats. This article explores the regional security experiences, challenges, and responses of both the SADC and ECOWAS under the Covid-19 pandemic.

The Etiology of Childhood Pneumonia in The Gambia: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study.

Pneumonia remains the leading cause of death in young children globally. The changing epidemiology of pneumonia requires up-to-date data to guide both case management and prevention programs. The Gambia study site contributed a high child mortality, high pneumonia incidence, low HIV prevalence, Haemophilus influenzae type b and pneumococcal conjugate vaccines-vaccinated rural West African setting to the Pneumonia Etiology Research for Child Health (PERCH) Study. The PERCH study was a 7-country case-control study of the etiology of hospitalized severe pneumonia in children 1-59 months of age in low and middle-income countries. Culture and nucleic acid detection methods were used to test nasopharyngeal/oropharyngeal swabs, blood, induced sputum and, in selected cases, lung or pleural fluid aspirates. Etiology was determined by integrating case and control data from multiple specimens using the PERCH integrated analysis based on Bayesian probabilistic methods. At The Gambia study site, 638 cases of World Health Organization-defined severe and very severe pneumonia (286 of which were chest radiograph [CXR]-positive and HIV-negative) and 654 age-frequency matched controls were enrolled. Viral causes predominated overall (viral 58% vs. bacterial 28%), and of CXR-positive cases respiratory syncytial virus (RSV) accounted for 37%, Streptococcus pneumoniae 13% and parainfluenza was responsible for 9%. Nevertheless, among very severe cases bacterial causes dominated (77% bacterial vs. 11% viral), led by S. pneumoniae (41%); Mycobacterium tuberculosis, not included in "bacterial", accounted for 9%. 93% and 80% of controls ≥1 year of age were, respectively, fully vaccinated for age against Haemophilus influenzae and S. pneumoniae. Viral causes, notably RSV, predominated in The Gambia overall, but bacterial causes dominated the severest cases. Efforts must continue to prevent disease by optimizing access to existing vaccines, and to develop new vaccines, notably against RSV. A continued emphasis on appropriate case management of severe pneumonia remains important.

Exploring the perspectives of members of international tuberculosis control and research networks on the impact of COVID-19 on tuberculosis services: a cross sectional survey

BackgroundThe COVID-19 pandemic has caused major disruption to healthcare services globally and has impacted on tuberculosis (TB) patients and TB diagnosis and treatment services both in low- and high-income countries. We therefore explored the perspectives of members of regional and international TB control and research networks to further understand TB service disruptions and compared the experiences of members from West African and European countries.MethodsThis cross-sectional, explorative descriptive study was conducted from May to July 2020 using an open online survey with target respondents from both West African and European countries. The survey comprised discrete questions exploring challenges faced with TB screening, diagnosis, treatment, prevention, and changes implemented. Additionally, respondents were asked to provide recommendations for remedial actions.ResultsWe analysed responses from 124 respondents based in 29 countries located in Europe and West Africa. About half of the respondents reported challenges in delivering routine TB services during the COVID-19 pandemic, with over one third reporting having some form of guidance issued regarding maintaining delivery of routine TB services. Respondents emphasised the need for strengthening TB services especially in light of COVID-19 pandemic. Considerable similarities were found between the challenges experienced by TB professionals in both West African and European settings. Responses also highlighted the hidden challenges faced in some countries prior to the COVID-19 pandemic, especially in some West African settings where staff shortages and laboratory issues predated COVID-19.Conclusions TB control and research professionals in West African and European settings experienced similar challenges to the delivery of TB diagnosis and treatment services due to the COVID-19 pandemic, and highlighted the need for clear communication of guidelines, prioritisation of routine TB service delivery, ongoing health education, and possible integration of TB and COVID-19 services to ensure that TB services are more resilient against the impact of the pandemic.

The Demography of Slavery in the Coffee Districts of Angola, c. 1800–70

AbstractThis article uses demographic data from nineteenth-century Angola to evaluate, within a West Central African setting, the widely accepted theory that sub-Saharan Africa's integration within the Atlantic world through slave and commodity trading caused significant transformations in slavery in the subcontinent. It specifically questions, first, whether slaveholding became more dominant in Angola during the last phase of the transatlantic slave trade; second, whether Angolan slave populations were predominantly female; and third, whether slavery in Angola expanded further during the cash crop revolution that accompanied the nineteenth-century suppression of the Atlantic slave trade. Besides making a significant contribution to understanding the demographic context of slavery in the era of abolition, the article aims to display ways in which historians can use the population surveys the Portuguese Empire carried out in Africa from the late eighteenth century.

The modernity/coloniality of love: Individualist lifeways and charismatic christianity in Ghanaian worlds

AbstractA manifestation of coloniality in psychological science concerns the modern individualist lifeways that inform mainstream research. We report results of a multi‐method research project that investigated implications of these ways of being for the experience of love in Ghanaian settings. In particular, we investigated the hypothesis that engagement with Pentecostal Charismatic Churches (PCCs)—an important carrier of individualist lifeways in many West African settings—would be associated with a growth orientation to love as a means for mutual self‐expansion and fulfillment. In Study 1 (n = 61), growth themes and a conception of love as feeling were more evident, but sustainability themes and a conception of love as doing less evident, in interview responses of participants who reported engagement with PCCs versus Traditional Western Mission Churches (TWMCs). In Study 2 (n = 1120), family obligation, relationship harmony, and (among participants who reported daily church attendance) perception of a social norm to prioritize mother over spouse were weaker for members of PCCs than TWMCs. Results help to reveal the colonial dark side of the modern individualist lifeways that mainstream research tends to regard as a just‐natural standard.

Phytochemical Screening and Anti-inflammatory Properties of Henna Leaves (Lawsonia inermis)

In traditional West African setting, plants are commonly used for cosmetic and medicinal benefits such as antibacterial, antifungal, anti-inflammatory, antioxidant and antiparasitic effect of which Henna (Lawsonia inermis), a natural occurring plant of the lythraceae family is not an exception. A preliminary qualitative phytochemical screening and anti-inflammatory properties of Lawsonia inermis leaves extracted with N-butanol and ethyl acetate was investigated. Standard analytical procedures were observed, and statistical analysis using ANOVA version 20.0 was conducted to analyze for mean ± standard deviation (SD) and the least significant difference (LSD) obtained from the study. Results revealed the presence of flavonoids, tannins, terpenes, cyanogenic and cardiac glycosides; while In vivo anti-inflammatory activity wasobserved on a week old cockerel chicks induced carrageenan inflammation post extract administration, using aspirin tablet as control. The anti-inflammatory activity of the extract as portrayed could be attributed to the plants rich phytochemical potential.

Epistemic Violence in Research on Eldercare

Decolonial perspectives challenge the notion that standard knowledge in hegemonic psychology is productive of progress and enlightenment. They instead emphasise its association with the colonial violence that constitutes the darker underside of modern development. Our contribution to the special issue applies a decolonial perspective to theory and research on obligation to an elderly parent. Thinking from the standpoint of West African epistemic locations not only illuminates the culture-bound character of standard models but also reveals their foundations in modern individualist selfways. Although modern individualist selfways can liberate well-endowed people to pursue fulfilling relationships and avoid unsatisfying connections with burdensome obligations, these ways of being pose risks of abandonment for people—like many elders—whose requirements for care might constitute a constraint on others’ satisfaction. In contrast, the cultural ecologies of embedded interdependence that inform everyday life in many West African settings afford selfways that emphasise careful maintenance of existing connections. Although these selfways may place constraints on the self-expansive pursuit of satisfying relationships, they provide elders and other vulnerable people with some assurance of support.

The writing’s on the wall: spaces for language-independent and language-based literacies

ABSTRACT This article investigates what is commonly called multilingual writing. Based on case studies from Mali, and drawing on a number of West African settings, it argues that in fact, not all ‘multilingual’ writing is in effect multilingual. The article proposes a two-tiered classification of types of writing, based on linguistic properties of texts and the differing perspectives of writers and readers. This analysis contrasts writers’ intentions to write (in) a particular language vs. to mobilise linguistic resources in a more holistic manner. The latter type of writing, it is argued, is better characterised as language-independent, since writers do not draw borders between what can be analysed as different languages from a code-based perspective often applied by analysts. The co-existence, spaces, and potentials of language-based and language-independent writing are examined in detail. This type of writing is invisible to language planners and often taken to be unreadable, akin to the mythical writing on the wall inspiring the title of the paper. Yet, in contexts with low educational resources and great linguistic diversity, language-independent writing presents a resilient and underappreciated alternative to language-based literacies.

Chronic kidney disease and HIV in the era of antiretroviral treatment: findings from a 10-year cohort study in a west African setting

BackgroundIt has been reported that people living with HIV in West Africa exhibited the highest risks for chronic kidney disease (CKD) in the world. Here, we aimed at determining the CKD frequency and changes in kidney function during antiretroviral treatment (ART) in a large cohort of HIV-patients followed in Burkina Faso.MethodsWe included ART-naive adults who initiated ART at the Day Care Unit of the Souro Sanou University Hospital between 01/01/2007 and 12/31/2016. We assessed the estimated glomerular filtration rate (eGFR) by serum creatinine using the Modification of Diet in Renal Disease (MDRD) equation. Following the K/DOQI recommendations, CKD was defined as eGFR < 60 ml/min/1.73m2 at two consecutive measurements at least 3 months apart. The factors associated with eGFR decline or CKD were identified by mixed linear regression and Cox regression, respectively.ResultsThree thousand, one hundred and thirty-eight patients (72% women) were followed for a median (IQR) of 4.5(2.2–6.9) years. At baseline, median eGFR (IQR) was 110.7(94.4–128.4) ml/min/1.73m2 and 93 (3%) patients exhibited eGFR < 60 ml/min/1.73m2. The lowest-performing progressions of eGFR during the first year of ART were observed in patients with 40-49 yr. age range (− 8.3[− 11.7;-5.0] ml/min/1.73m2, p < 0.001), age ≥ 50 yr. (− 6.2[− 10.7;-1.8] ml/min/1.73m2, p = 0.006) and high blood pressure (HBP) (− 28.4[− 46.9;-9.9] ml/min/1.73m2, p = 0.003) at ART initiation. Regarding the ART exposure in patients with normal baseline eGFR, zidovudine (AZT) with protease inhibitor (PI) (− 4.7[− 7.7;-1.6] ml/min/1.73m2, p = 0.002), tenofovir (TDF) + PI (− 13.1[− 17.4;-8.7] ml/min/1.73m2, p < 0.001), TDF without PI (− 3.2[− 5.0;-1.4] ml/min/1.73m2, p < 0.001), stavudine (d4T) + PI (− 8.5[− 14.6–2.4] ml/min/1.73m2, p = 0.006) and d4T without PI (− 5.0[− 7.6–2.4] ml/min/1.73m2, p < 0.001) were associated with poorer eGFR progression. The prevalence of CKD was 0.5% and the incidence was 1.9 [1.3; 2.7] cases/1000 person-years. The risk of CKD was higher in patients with HBP (4.3[1.8;9.9], p = 0.001), 40-49 yr. patients (4.2[1.6;11.2], p = 0.004), ≥50 yr. patients (4.5[1.5;14.1], p = 0.009) and patients exposed to abacavir (ABC) or didanosine (ddI) based ART (13.1[4.0;42.9], p < 0.001).ConclusionsOur findings do not confirm the high risk of CKD reported in previous studies of West Africans with HIV, but support the recommendations for early initiation of ART and close kidney function monitoring in patients with HBP or aged ≥40 yr.

Knowledge and Management of Hypertension in a West African Setting: Abidjan, Côte d’Ivoire

Knowledge and Management of Hypertension in a West African Setting: Abidjan, Côte d’Ivoire Brou Kouame Aristide, Esse Diby Clemence, Jasmina Saric, Abe N’doumy Noel Abstract Hypertension is one of the public health problems in Côte d'Ivoire after malaria and HIV / AIDS. Thus, in view of the growing prevalence of this disease, a study was therefore conducted in the community of Port-Bouët in Abidjan, with the general objective to understand the social representation of hypertension and to identify the means of treatment and prevention applied by the population assessed. From a quantitative and qualitative approach including a household survey (N=325), individual interviews (N=3) and group discussions (N=6), it appears that the consumption of salt and cubes Maggi was perceived as the main cause with (44.38%). Dizziness (38.52%) is the most common symptom of the disease. In addition, (68.21%); some people resort to modern medicine however; a use of traditional medicine has been reported with (30.26%).Apart from drug treatment, non-pharmaceutical therapeutic approaches appeared essential in the care of patients with hypertension. As preventative measures the measure, population seem to advocate reducing the consumption of salt and extremely fatty foods and the practice of regular physical activity. However, it seems that the implementation of this knowledge is not yet effective, hence the need to intensify awareness campaigns on hypertension and its social representation. Full Text: PDF DOI: 10.15640/jssw.v7n2a5

Bushmeat consumption in large urban centres in West Africa

AbstractThere is an unprecedented demand for bushmeat in large cities in sub-Saharan Africa, and this is a major threat to many species. We conducted 2,040 interviews in six cities in four West African countries, in forest and savannah settings. We analysed age- and sex-related differences in the frequency of bushmeat consumption. Overall, we found similar patterns in all cities: 62.2% of men and 72.1% of women said they would never eat bushmeat, whereas 12.8% of men and 8.8% of women said they liked bushmeat and ate it regularly. Younger generations of both sexes tended not to eat bushmeat, regardless of their city of origin. This study of the effects of age, gender and geographical location on bushmeat consumption in African cities provides insights regarding which population groups to target in campaigns to change behaviours.

Diagnostic accuracy in field conditions of the sickle SCAN\xae rapid test for sickle cell disease among children and adults in two West African settings: the DREPATEST study

BackgroundSickle cell disease (SCD) accounts for 5% of mortality in African children aged < 5 years. Improving the care management and quality of life of patients with SCD requires a reliable diagnosis in resource-limited settings. We assessed the diagnostic accuracy of the rapid Sickle SCAN® point-of-care (POC) test for SCD used in field conditions in two West-African countries.MethodsWe conducted a case-control study in Bamako (Mali) and Lomé (Togo). Known cases of sickle cell disease (HbSS, HbSC), trait (HbAS), HbC heterozygotes (HbAC) and homozygous (HbCC), aged ≥6 months were compared to Controls (HbAA), recruited by convenience. All subjects received both an index rapid POC test and a gold standard (high-performance liquid chromatography in Bamako; capillary electrophoresis in Lomé). Personnel conducting tests were blinded from subjects’ SCD status. Sensitivity and specificity were calculated for each phenotype. Practicality was assessed by local healthcare professionals familiar with national diagnostic methods and their associated constraints.ResultsIn Togo, 209 Cases (45 HbAS, 39 HbAC, 41 HbSS, 44 HbSC and 40 HbCC phenotypes) were compared to 86 Controls (HbAA). 100% sensitivity and specificity were observed for AA Controls and HbCC cases. Estimated sensitivity was 97.7% [95% confidence interval: 88.0–99.9], 97.6% [87.1–99.9%], 95.6% [84.8–99.5%], and 94.9% [82.7–99.4], for HbSC, HbSS, HbAS, and HbAC, respectively. Specificity exceeded 99.2% for all phenotypes. Among 160 cases and 80 controls in Mali, rapid testing was 100% sensitive and specific. Rapid testing was well accepted by local healthcare professionals.ConclusionRapid POC testing is 100% accurate for homozygote healthy people and excellent (Togo) or perfect (Mali) for sickle cell trait and disease patients. In addition to its comparable diagnostic performance, this test is cheaper, easier to implement, and logistically more convenient than the current standard diagnostic methods in use. Its predictive value indicators and diagnostic accuracy in newborns should be further evaluated prior to implementation in large-scale screening programs in resource-limited settings where SCD is prevalent.