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About 86 percent of the estimated 160,000 children newly-infected with the human immunodeficiency virus (HIV) live in sub-Saharan Africa. Despite global efforts to reduce perinatal HIV transmission, this phenomenon continues to be a public health problem in sub-Saharan Africa. This paper discusses challenges associated with perinatal HIV transmission prevention in sub-Saharan Africa and offers strategies for the way forward. These strategies include safe sex education and behavioral change, increased access to integrated antenatal care, training of unskilled traditional birth attendants into formal delivery systems, access to antiretroviral therapy, and investing in virologic testing. Key words: • HIV • Perinatal • Antiretroviral Therapy • Mother to Child HIV Transmission • HIV Prevention • Sub-Saharan Africa Copyright © 2020 Armstrong-Mensah, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

The microbiota of Anopheles mosquitoes influences malaria transmission. Antibiotics ingested during a blood meal impact the mosquito microbiome and malaria transmission, with substantial differences between drugs. Here, we assessed if amoxicillin affects the mosquito microbiota . We collected Anopheles larvae in Burkina Faso, kept them in semi-field conditions and offered a blood meal to adult females. We tested the impact of blood supplementation with two alternative amoxicillin preparations on microbiota composition, determined by high-throughput sequencing in individual gut samples. Our mosquitoes harbored four main genera, Elizabethkingia, Wigglesworthia, Asaia and Serratia . The antibiotic treatment significantly affected overall microbiota composition, with a specific decrease in the relative abundance of Elizabethkingia and Asaia during blood digestion. Besides its interest on the influence of amoxicillin on the mosquito microbiota, our study proposes a thorough approach to report negative-control data of high-throughput sequencing studies on samples with a reduced microbial load.

Context and Objective: Hydrocephalus is the active abnormal dilation of the cerebral ventricular cavities and leads to a disorder of cerebrospinal fluid dynamics. Ventriculoperitoneal shunt and ventriculocisternostomy shunt are the most frequently used techniques in our context. However, a number of complications can occur. Our goal is to contribute to the improvement of the prevention of complications in the surgical management of hydrocephalus. Patients and Method: This is an observational study, over a period of five years and six months, of children aged 0-15 years who have undergone hydrocephalus surgery. All these data and their correlations were analyzed on Excel and EPI Info tables in version 7.2.3.1. The study was previously submitted to the ethics committee for approval. Anonymity and compliance with ethical rules were the norm. Results: We collected 18 cases of complications, i.e. 11.92%. Infants were the most affected with 16.70%. Most of the patients had a risk factor of neighborhood skin lesions. These were mainly infectious complications 50% and mechanical complications 33.30%. For the management of complications, equipment removal and revision/replacement were the procedures most frequently adopted, with frequencies of 50% and 22.20%. 66.70% were improved. Conclusion: The management of hydrocephalus is essentially neurosurgical and involves ventriculoperitoneal shunt and ventriculocisternostomy shunt, which, despite their effectiveness, are sometimes accompanied by various complications, including infectious ones, which were found to be at the forefront of this study. Even if the evolution has been favorable for 2/3 of the children studied, we believe that the constant search for risk factors for complications and the education of the parents of the children will limit the occurrence of the complications found.

Background: The bacterial microbiota which colonize the mosquito midgut play an important role in vector-parasite interactions and consequently can modulate the level of malaria transmission. Their characterization may contribute to new control strategies of malaria transmission. However, these bacteria may also be eliminated in areas of high antibiotics usage. In this study, we identified paratransgenesis bacteria candidate in the gut of adults female Anopheles in Burkina Faso. Methods: The gut of 73 semi-field mosquitoes and 28 laboratory-reared mosquitoes from two villages in Burkina Faso were analyzed by conventional in vitro culture techniques to isolate and identify bacteria of the microbiota. The gene 16S sequencing was used to confirm the presence of bacteria of paratransgenesis interest. Due to the effect of antibiotics on bacteria, we evaluated in vitro their susceptibility to antibiotics generally used for infectious diseases treatment. Results: In total, eleven genera of bacteria were identified: Pantoea, Sphingomonas, Escherichia, Micrococcus, Staphylococcus, Klebsiella, Serratia, Acinetobacter, Pseudomonas, Citrobacter, Asaia. Among these bacteria isolated, Asaia. sp and Pantoea. sp have already been reported as candidates for paratransgenesis. In addition, we observed pathogenic bacteria such as Escherichia coli, Klebsiella pneumonia and Pseudomonas luteola. Investigation of the correlation between the bacterial microbiota and malaria infection status showed that mosquitoes engorged with blood containing Plasmodium falciparum contained a higher bacterial load than non-blood fed mosquitoes. The antibiotic susceptibility test showed that Asaia, Pantoea and Serratia, previously proposed as paratransgenesis candidates, were susceptible to different antibiotics tested in contrast to Escherichia coli, which were resistant. Discussion: Midgut analysis shows that the composition of the bacterial microbiota in wild field mosquitoes exhibits a large variability in contrast to laboratory-reared mosquitoes. The presence of genera already proposed as paratransgenesis candidates in previous studies among bacteria isolated in our study, suggested the possible implementation of this control strategy in Burkina Faso. Nevertheless, our data indicates that an in vivo verification of the stability of these bacteria is needed, as this strategy may be impaired by mass drug administration programs and antibiotic misuse.

Objectives. To describe reoperative thyroid surgeries in our department. Study Design. Retrospective cross-sectional and descriptive study at the Ouakam Military Hospital in Dakar (Senegal), over a period of eight and a half years. Methods. The study involved all records of patients who had a reoperative thyroidectomy regardless of the indication and time of the second surgery. Parameters evaluated for first and reoperative surgery were time interval between the two surgeries, operative indications, surgical procedures, intraoperative findings, pathological examination, and morbidity. Results. 30 records of patients were selected out of a total of 698 thyroidectomies (4.3%). Thyroid cancers diagnosed on first surgical specimens were the first indications of reoperations (46.67%) followed by neck hematoma (20%). Completion thyroidectomy with a prophylactic central lymph nodes dissection was the most performed surgical procedure (43.33%) followed by haemostasis (20%). During reoperation, we found active bleeding (20%), textiloma (6.67%), and fourth branchial cleft fistula (3.33%). The morbidity accounted for 10%: lymphorrhea, permanent hypocalcemia, and permanent recurrent nerve palsy, in one case, respectively. There were no statistically significant differences between the morbidity in patients reoperated on and the one for patients operated on once. Conclusion. We did not find an increased risk of postoperative morbidity after reintervention.

BackgroundDespite major progress in the past decade, malaria remains a major public health problem in sub-Saharan Africa. West and Central Africa account for nearly 2/3 of the burden currently attributable to falciparum malaria. Artemisinin-based combination therapies (ACT) are a cornerstone of our strategy for controlling and eventually eliminating malaria. However, reduced responsiveness/resistance to artemisinin derivatives and to ACTs, an increasing problem in South-East Asia is a major concern. It is of utmost importance to develop new antimalarial drugs from novel chemical classes that can replace ACTs. KAF156, an imidazolepiperazine, is a leading candidate in the antimalarial drug development pipeline. Combination of KAF156 with a Solid Dispersion Formulation of lumefantrine (LUM-SDF) is expected to be fast acting, fully curative, improve patient adherence and can potentially reduce malaria transmission.MethodsWANECAM II proposes to advance the clinical development of KAF156 through clinical trials in adults and children, with integrated capacity building and infrastructure development activities. The trial programme will be undertaken in the context of networking, team-building, leadership development and community engagement schemes that will involve intra-European, European-African and intra-African collaborative activities. WANECAM II will accelerate the clinical study of children less than 2 years of age which are the key target for new antimalarial treatments.ResultsBy the end of the project, the results are expected to contribute to the registration of KAF156/LUM-SDF through stringent regulatory health authorities, increase biomedical research capacity in the consortium and effectively promote networking among the respective teams. A new clinical research team in Niger, a grossly underrepresented country in the African research landscape, will be developed and further increase capacity and infrastructure in the consortium.ConclusionProviding a new antimalarial drug combination that does not contain an artemisinin derivative and is effective against resistant P. falciparum strains as well as gametocytes and that is likely to be taken in 3 or fewer single doses will be a major advance in the field. The new combination of KAF156 with LUM-SDF is expected to provide such major advance upon successful conclusion of the WANECAM II project.

Background Artemisinin combination therapies (ACTs) are widely used for the management of malaria and even tested for chemoprevention. In single episode efficacy studies, these drugs were clinically well tolerated but cardiac effects over repeated treatment are less investigated. Methods We conducted a prospective randomised controlled trial in Bobo-Dioulasso from August to October 2013 where patients aged 6 months and over were randomly allocated to receive either dihydroartemisinin-piperaquine (DHAPQ) or artemether-lumefantrine (AL) on first and subsequent episodes. Each participant was screened against inclusion criteria including the ECG which was repeated again 2 hours after the last dose. We considered that a QTc interval more than 30 ms compared to the baseline value is abnormal, but a prolonged QTc interval over 450 ms was reported as adverse event. QTc values were categorised into less or greater or equal to 450 ms. Drug tolerance was compared using Chi-square test, and p-value of less than 0.5 is significant. Results Patients were randomised to receive DHAPQ (n=224) or AL (n=236). During the 2 years follow-up we observed a total of 130 (in 1173 electrocardiogram performed on day 2 monitoring) prolonged QTc more than 450 ms (96/548 for DHAPQ and 34/625 for AL, p Conclusions The proportion of prolonged QTc was higher in DHAPQ group compared to the AL group but decreased along with the number of retreatments. Otherwise, DHAPQ and AL were well tolerated despite repeated treatment of malaria, which seemed to improve over consecutive episodes.

Background No safe and highly effective malaria vaccine is available today. The treatment drugs currently in use remain insufficient. Moreover, resistance to these drugs makes malaria control difficult. The development of new therapeutic drugs is required. This abstract is part of a survey from the WANECAM study entitled ‘Randomised trial to assess the effect of repeated treatment of pyronaridine-artesunate (PA), dihydroartemisinin-piperaquine (DHA-PQ) and artemether-lumefantrine (AL) in patients presenting uncomplicated malaria in Bobo-Dioulasso, Burkina Faso’. We present here the analysis of the first episodes on the therapeutic efficiency of PA compared to AL, which is the first-line antimarial used in Burkina Faso. Methods A total of 448 subjects were randomised to receive treatment (224 subjects in each arm). Malaria diagnosis was assessed by microscopy. Subjects were follow-up during 42 days. Treatment response was measured according to standard of care as per WHO guidelines of 2003. The correction of the cases of treatment failure by molecular biology techniques is under analysis. Results On Day 28, the therapeutic failures were 3.35% in the PA group as against 18,10% for the AL group. On Day 42, a significant increase of the treatment failures in every group is observed with a higher rate in the AL group (31.43%), against 17.22% in the PA group. Conclusions This survey shows that less cases of treatment failure occurred in the patients9 group treated with PA compared to the group treated with AL. These findings contributed to evidence base for a change in malaria treatment policy guidelines for uncomplicated malaria in Burkina Faso.