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Summary Background Peer-reviewed literature on health is almost exclusively published in English, limiting the uptake of research for decision making in francophone African countries. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to assess the burden of disease in francophone Africa and inform health professionals and their partners in the region. Methods We assessed the burden of disease in the 21 francophone African countries and compared the results with those for their non-francophone counterparts in three economic communities: the Economic Community of West African States, the Economic Community of Central African States, and the Southern African Development Community. GBD 2017 employed a variety of statistical models to determine the number of deaths from each cause, through the Cause of Death Ensemble model algorithm, using CoDCorrect to ensure that the number of deaths per cause did not exceed the total number of estimated deaths. After producing estimates for the number of deaths from each of the 282 fatal outcomes included in the GBD 2017 list of causes, the years of life lost (YLLs) due to premature death were calculated. Years lived with disability (YLDs) were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. All calculations are presented with 95% uncertainty intervals (UIs). A sample of 1000 draws was taken from the posterior distribution of each estimation step; aggregation of uncertainty across age, sex, and location was done on each draw, assuming independence of uncertainty. The lower and upper UIs represent the ordinal 25th and 975th draws of each quantity and attempt to describe modelling as well as sampling error. Findings In 2017, 779 deaths (95% UI 750–809) per 100 000 population occurred in francophone Africa, a decrease of 45·3% since 1990. Malaria, lower respiratory infections, neonatal disorders, diarrhoeal diseases, and tuberculosis were the top five Level 3 causes of death. These five causes were found among the six leading causes of death in most francophone countries. In 2017, francophone Africa experienced 53 570 DALYs (50 164–57 361) per 100 000 population, distributed between 43 708 YLLs (41 673–45 742) and 9862 YLDs (7331–12 749) per 100 000 population. In 2017, YLLs constituted the majority of DALYs in the 21 countries of francophone Africa. Age-specific and cause-specific mortality and population ageing were responsible for most of the reductions in disease burden, whereas population growth was responsible for most of the increases. Interpretation Francophone Africa still carries a high burden of communicable and neonatal diseases, probably due to the weakness of health-care systems and services, as evidenced by the almost complete attribution of DALYs to YLLs. To cope with this burden of disease, francophone Africa should define its priorities and invest more resources in health-system strengthening and in the quality and quantity of health-care services, especially in rural and remote areas. The region could also be prioritised in terms of technical and financial assistance focused on achieving these goals, as much as on demographic investments including education and family planning. Funding Bill & Melinda Gates Foundation.

Resume Justificatif Les donnees relatives a la pneumonie a Pneumocystis en Afrique sub-saharienne ne sont pas bien connues. La faiblesse du plateau technique et l’utilisation d’outils de diagnostic biologique peu sensibles sont parmi les raisons evoquees. L’objectif de cette etude est de reactualiser les donnees de l’affection au centre hospitalier universitaire de Fann a Dakar et d’evaluer les methodes de diagnostic biologique utilisees. Materiel et methodes Une etude prospective descriptive est realisee du 5 janvier 2009 au 31 octobre 2011 au service de parasitologie-mycologie du centre hospitalier universitaire de Fann a Dakar. Les prelevements du liquide de lavage broncho-alveolaire recus au laboratoire sont examines au microscope par immunofluorescence indirecte ou apres coloration au Giemsa ou au bleu de toluidine O pour la mise en evidence de Pneumocystis jirovecii. Resultats Cent quatre-vingt-trois prelevements de liquide de lavage broncho-alveolaire provenant de 183 patients sont recus au laboratoire. Seize sont positifs pour la recherche de P. jirovecii , soit une frequence de 9 %. Quatre parmi eux sont infectes par le VIH. L’immunofluorescence indirecte a permis de retrouver P. jirovecii chez les 16 patients alors que la coloration au Giemsa n’a detecte P. jirovecii que chez un seul patient. Aucun cas n’est diagnostique par le bleu de toluidine O. Conclusion La pneumonie a Pneumocystis au laboratoire de parasitologie-mycologie du centre hospitalier universitaire de Fann a Dakar est majoritairement diagnostiquee chez des patients infectes par le VIH.

L’histoplasmose humaine existe en Afrique sous ces 2 formes dues respectivement a H. capsulatum var capsulatum et H. capsulatum var duboisii . En Afrique de l’Ouest, la seconde semble predominante. Nous rapportons ici un cas d’histoplasmose disseminee due a H. capsulatum var capsulatum chez un patient senegalais infecte par le VIH. Le tableau clinique conduisait a une defaillance multiviscerale rapidement fatale. Le diagnostic etait initialement evoque par la mise en evidence de petites levures intracellulaires visualisees sur un frottis sanguin pratique a la recherche de paludisme. L’extraction d’ADN a partir de ce frottis permettait l’amplification d’un fragment codant pour la region des ITS dont la sequence etait identique (99 %) a celle d’ H. capsulatum presente dans GenBank. Ce cas, le premier au Senegal a notre connaissance, confirme la presence d’ H. capsulatum var capsulatum en Afrique de l’Ouest. Les cas sont peut-etre sous diagnostiques en raison des ressources economiques limitees et du fait de la forte prevalence de la tuberculose dans cette region, infection suspectee en priorite. Le frottis sanguin peut constituer une approche de screening en cas de dissemination. Les approches moleculaires permettent de confirmer le diagnostic sans avoir recours a la culture, dangereuse a realiser en l’absence de structure adaptee a la securite microbiologique.