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From January 2001 to May 2002, 300 chicken carcasses from retail shops in Dakar were examined for prevalence of Salmonella and Campylobacter. Of these, 146 were fresh products, 58 were refrigerated and 96 were frozen. Salmonella was isolated from 96 (32%) of the carcasses analyzed. The most prominent Salmonella serovars were Salmonella Hadar (41.6%) and Salmonella Brancaster (20.8%). Campylobacter spp. was isolated from 168 (56%) of the samples. C. jejuni was more frequently isolated (59%) than C. coli (27%). The contamination rates for Campylobacter were significantly different in relation to the type of carcass: 76% for fresh, 53% for chilled and 28% for frozen.

Campylobacter resistance to antimicrobial agents appears as an emerging public health problem in industrialized countries, but, on the other hand, only few data on the subject are available in developing countries. To assess antibiotic susceptibility of Campylobacter strains in Senegal, skin samples were collected from 250 chicken carcasses from January 2001 to October 2002. Among 204 Campylobacter strains isolated, two species were identified: C. jejuni (59%) and C. coli (41%). In vitro susceptibility to five antimicrobial drugs (amoxicillin, amoxicillin-clavulanic acid, erythromycin, nalidixic acid and ciprofloxacin) was determined by the E-test method. Minimum inhibitory concentrations (MICs) showed 34% of Campylobacter isolates were ciprofloxacin resistant with a high level of resistance (MIC ≥ 32 mg/l) in 25% of both species. Cross-resistance between nalidixic acid and ciprofloxacin was found in 96% of quinolone-resistant strains. The level of amoxicillin resistance was statistically higher for C. coli than for C. jejuni (20.2 versus 10.8%), but all the strains were susceptible to amoxicillin combined with clavulanic acid. Both species showed low resistance to erythromycin. Multiresistant phenotype to three of the drugs tested was found in 9.8% of the strains: 15.5% of C. coli strains and 5.8% of C. jejuni strains. No strain was resistant to four or more of the drugs studied. Further studies appear necessary to evaluate antibiotic resistance of Campylobacter isolated in human and animal samples in order to control the emergence of new multidrug-resistant strains in Senegal.

Microbiological analysis of a broiler chicken carcass revealed the presence of a new Salmonella serotype. It is characterized by two genes that express resistance to antibiotics, except to the very last quinolones. This serotype poses a threat as it has been found in human samples in association with high temperature and diarrhea. The onset of this Salmonella may result from the anarchic use of antibiotics in poultry production.

Fire and Gas (F&G) detection is an essential part of the mitigation system in facilities handling and storing flammable and toxic materials. While detector reliability might be very high, safety performance of a F&G system strongly depends on layout and coverage. Current reference standards for on-shore applications do not define the plant areas to be mapped, the coverage targets, and the reference hazardous scenarios to be considered. In the present study, a methodology aimed at the F&G coverage mapping was developed. The procedure is applicable in the Front End Engineering Design phase (FEED), where limited data is typically available. The development of the methodology considered the main aspects that define F&G system performance. Coverage targets for detection were set considering risk reduction goals and actual detector capabilities. Simple strategies were developed for the determination of the reference hazardous scenarios to be considered. A Matlab code for 3D F&G coverage mapping was developed. The proposed procedure was demonstrated by a simplified case study. The methodology proved itself a valid instrument to assist detector layout assessment.

Accidental fires in Oil&Gas facilities have a significant potential for severe consequences, endangering personnel safety, environment, asset integrity, production continuity and company reputation. Moreover, in-plant accident propagation (domino effects) may further increase the outcomes of fires. Fireproofing is a crucial safety barrier in preventing the escalation of fire scenarios. Maintenance and cost considerations require the application of such protection only where an actual risk of severe fire scenarios is present. Available methodologies for the identification of fireproofing zones in on-shore installations are based on simplified assumptions and do not consider the effect of jet-fire scenarios. Experience has tragically shown though the importance of including such scenarios (e.g. Valero accident in 2007). In the present study, a risk-based methodology for the identification of fireproofing zones was developed. The procedure addresses both the prevention of domino effect and the mitigation of asset damage due to the primary fire scenario (pool and jet fires), taking into account the specific issues of on-shore applications. Specific criteria were introduced to assess escalation hazard. A risk-based identification of the reference accident scenarios was developed, allowing a more detailed definition of the plant items that should be considered for fireproofing application. The method is mainly oriented to early design application, allowing the identification of fireproofing zones in the initial lay-out definition. The potential outcomes of the methodology are investigated by applying them to case-studies of industrial interest.

In December 2023, we observed through hospital-based surveillance a severe outbreak of enterovirus D68 infection in pediatric inpatients in Dakar, Senegal. Molecular characterization revealed that subclade B3, the dominant lineage in outbreaks worldwide, was responsible for the outbreak. Enhanced surveillance in inpatient settings, including among patients with neurologic illnesses, is needed.

In 2022, many regions around the world experienced a severe respiratory syncytial virus (RSV) epidemic with an earlier-than-usual start and increased numbers of paediatric patients in emergency departments. Here we carried out this study to describe the epidemiology and genetic characteristics of RSV infection in patients hospitalized with severe acute respiratory infections in 2022. Samples were tested for RSV by multiplex real time reverse transcription polymerase chain reaction. Subsequently, a subset of RSV positive samples was selected for NGS sequencing. RSV was detected in 16.04%, among which RSV-A was confirmed in 7.5% and RSV-B in 76.7%. RSV infection were more identified in infants aged ≤ 11 months (83.3%) and a shift in the circulation pattern was observed, with highest incidences between September-November. Phylogenetic analyses revealed that all RSV-A strains belonged to GA2.3.5 genotype and all RSV-B strains to GB5.0.5a genotype. Three putative N-glycosylation sites at amino acid positions 103, 135, 237 were predicted among RSV-A strains, while four N-linked glycosylation sites at positions 81, 86, 231 and 294 were identified in RSV-B strains. Globally, our findings reveal an exclusive co-circulation of two genetic lineages of RSV within the pediatric population in Senegal, especially in infants aged ≤ 11 months., (© 2023. The Author(s).)

Background:  Although a growing number of very elderly patients with atrial fibrillation (AF), multiple conditions, and polypharmacy receive direct oral anticoagulants (DOACs), few studies specifically investigated both apixaban/rivaroxaban pharmacokinetics and pharmacodynamics in such patients., Aims:  To investigate: (1) DOAC concentration-time profiles; (2) thrombin generation (TG); and (3) clinical outcomes 6 months after inclusion in very elderly AF in-patients receiving rivaroxaban or apixaban., Methods:  Adage-NCT02464488 was an academic prospective exploratory multicenter study, enrolling AF in-patients aged ≥80 years, receiving DOAC for at least 4 days. Each patient had one to five blood samples at different time points over 20 days. DOAC concentrations were determined using chromogenic assays. TG was investigated using ST-Genesia (STG-ThromboScreen, STG-DrugScreen)., Results:  We included 215 patients (women 71.1%, mean age: 87 ± 4 years), 104 rivaroxaban and 111 apixaban, and 79.5% receiving reduced-dose regimen. We observed important inter-individual variabilities (coefficient of variation) whatever the regimen, at C max [49-46%] and C min [75-61%] in 15 mg rivaroxaban and 2.5 mg apixaban patients, respectively. The dose regimen was associated with C max and C min plasma concentrations in apixaban ( p =  0.0058 and p =  0.0222, respectively), but not in rivaroxaban samples (multivariate analysis). Moreover, substantial variability of thrombin peak height (STG-ThromboScreen) was noticed at a given plasma concentration for both xabans, suggesting an impact of the underlying coagulation status on TG in elderly in-patients. After 6-month follow-up, major bleeding/thromboembolic event/death rates were 6.7%/1.0%/17.3% in rivaroxaban and 5.4%/3.6%/18.9% in apixaban patients, respectively., Conclusion:  Our study provides original data in very elderly patients receiving DOAC in a real-life setting, showing great inter-individual variability in plasma concentrations and TG parameters. Further research is needed to understand the potential clinical impact of these findings., Competing Interests: V.S., I.G.-T., E.Pa, E.Pu, F.M., M.D., and P.G. have received honoraria for participating in expert meetings on dabigatran (from Boehringer Ingelheim), rivaroxaban (from Bayer Healthcare AG), or apixaban (Bristol Myers Squibb-Pfizer). G.F. and E.Pu received a grant from Bayer. The other authors declare no conflicts of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Introduction: Diabetes, a high prevalence chronic disease, especially in the elderly, is a risk factor of chronic lower limb wounds, whose management involves screening and treatment of peripheral arterial obstructive disease (PAOD), which must be systematic. Aim : Evaluate the screening and the management of PAOD amongst those patients, hospitalized in a Geriatric Department., Methods: Observational, retrospective, monocentric study, including all the elderly above 75 years old, with diabetes, and a wound in the lower limb, hospitalized from 01/01/2018 to 29/02/2020 at Henri Mondor hospital in Créteil., Results: Over the study period, 2567 patients were hospitalized, including 501 diabetic patients (19,5 %). 38 patients were included. Amongst them, 66 % had a bedsore, 18 % a leg ulcer, and 24 % a diabetic foot ulcer. Concerning the screening of PAOD, 66 % was screened for peripheral pulses, 8 % had an ankle-brachial index, and 45 % at least an imaging including 39 % arterial doppler. Amongst the 21 patients with PAOD, only one had a complete medical treatment, 6 had a revascularization including 5 amputations., Conclusion: Management of PAOD in the wound of lower limb amongst diabetic elderly patients is insufficient. Although it can be difficult to revascularize them, the screening must be systematic. Educate geriatric doctors in the screening of PAOD and build an expert team amongst them would help to improve that problematic.

Objective: To evaluate the implementation of the maternal and neonatal death surveillance and response (MNDSR) system at county level in Liberia., Methods: Secondary analysis of data from a cross-sectional study carried out in March 2016, using both quantitative and qualitative methods to collect data in five counties based on set criteria. Three health facilities were selected in each county through the Health Management Information System (HMIS) by random sampling. The evaluation was also carried out in one catchment community per health facility and at the county referral hospital. Primary data were collected through individual interviews and a review of MNDSR tools and structure. Data were analyzed using thematic analysis., Results: Implementation of the MNDSR system was very low in the five counties. Only two out of the five counties were currently conducting MNDSR. MNDSR guidelines and standard operating procedures were not available at the county level. Only 12 (23.5%) health facilities had a maternal and neonatal death review committee. Less than a quarter of the assessed community members could correctly give the definition of a maternal or neonatal death., Conclusion: The MNDSR system is weak in Liberia, at county, health facility, and community levels. Strong national commitment is needed in collaboration with diverse partners for successful implementation of the system., (© 2022 International Federation of Gynecology and Obstetrics.)

Objective: To assess the current system of maternal death review (MDR) in Ghana and identify the achievements, challenges, and gaps that will assist in transitioning to the maternal death surveillance and response system (MDSR)., Methods: A secondary analysis of data from a cross-sectional study on MDSR implementation was conducted between September and October 2018. The MDSR cycle served as an analytical framework to measure the country's performance in implementing MDSR. Common facilitating or hindering factors were also identified., Results: The MDR system is moderately strong at regional level with timely receipt of data and regular review meetings and reports in most regions. At district level the MDR system is less well implemented, although there is evidence of good communication with regional teams in providing timely data. Communication between districts and communities about maternal deaths seemed to be poor in general. There was no MDR committee at national level and the recommendations made were poorly implemented., Conclusion: MDRs in Ghana were structurally sound, but recommendations were poorly implemented. Leadership at the national level needs to be developed to ensure that the current system could transition to an MDSR system., (© 2022 International Federation of Gynecology and Obstetrics.)

The study aimed to analyse the challenges and solutions for maintaining the continuity of essential health services during the COVID-19 pandemic in Francophone West Africa. A cross-sectional study involving the managers of Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) and vaccination programmes in Francophone West Africa was designed. The challenges that limited the supply and use of RMNCAH services included: lack of standardized guides and procedures for appropriate care, limited knowledge of health workers on the new coronavirus disease, lack of diagnostic materials and kits, ineffective organization of services, anxieties of health workers and populations, and postponement of immunisation mass campaigns. The solutions proposed to address these challenges, included better organization of services to respect the physical distance, provision of adapted guides and care procedures, enhanced communication, training of health workers, effective use of social media and information and communication technologies. This study showed that the managers of RMNCAH programmes are aware of the challenges that could limit the supply and use of essential services during the COVID-19 pandemic.

Background: Increasingly, WHO recommendations are defined by context-specific factors and WHO is developing strategies to ensure that recommendations are successfully adapted and implemented at country level. This manuscript describes the development of a toolkit to support governments to adapt the WHO recommendations on antenatal care (ANC) for a positive pregnancy experience for their context in a systematic manner., Methods: The toolkit was developed in three steps. It was created with input from methodologists and regional implementation experts (Step 1) followed by a user-testing phase (Step 2), implemented during country stakeholder meetings. User testing consisted of stakeholder interviews that were transcribed, and data was categorised according to the content analysis method. Suggestions for toolkit improvement and issues identified during the interviews were assessed as serious, moderately serious or minor/cosmetic., Results: A total of 22 stakeholders - comprising five Ministry of Health (MoH) consultants, four MoH policy-makers, and 13 advisors/implementers - from Burkina Faso, India, Rwanda and Zambia participated in user-testing interviews during stakeholder meetings held in each country between August 2018 and February 2019. Most stakeholders had a medical or nursing background and half were women. Overall, responses to the toolkit were positive, with all stakeholders finding it useful and desirable. User testing interviews highlighted four serious, four moderately serious and five minor/cosmetic issues to be managed. These were addressed in the final step (Step 3), an updated version of the WHO ANC Recommendations Adaptation Toolkit, comprised of two main components - a baseline assessment tool with spreadsheets for data entry and a Slidedoc ® , a dual-purpose document for reading and presentation, outlining the qualitative data that shaped the women-centred perspective of the guidelines, accompanied by an instruction manual detailing the components' use., Conclusions: The WHO ANC Recommendations Adaptation Toolkit was developed to support countries to systematically adapt the WHO ANC recommendations for country contexts. Using this approach, similar tools can be developed to support guideline implementation across different health domains and the continuum of care.

Introduction: Surgical site infections (SSI) are frequent and dangerous in the surgical ward. They represent an obsession for the surgeon. The objectives were to determine the frequency of ISOs and risk factors, to identify the germs and to study their sensitivity to different antibiotics., Materials and Methods: This was a cross-sectional study with prospective data collection, performed at the general surgery department of the Bocar Sidy Sall University Hospital Center (Kati CHU) from January 2015 to December 2018., Results: During this period of study we recorded 55 cases of ISO out of 650 operated patients with a frequency of 8.46%. 450 patients were operated on the cold operating program (69.23%) and 200 patients on emergency (30.77%). The average age was 39, the sex ratio was 2.66. Among the 55 cases of ISO, 60% of these patients were operated in emergency and 40% in the operating program. The most common strains found were Escherichia coli (E. coli) in 38.3% of cases, Staphylococcus aureus in 23.4% and Klebsiella pneumonia in 13.3%. Hemoglobin levels were normal in 70% of cases. 4 of our patients or 7.27% were diabetic. We did not have any cases of obesity. Of the 55 cases of ISO, 66% were of class 3 and 4 of Altemeier, 59% were of ASA score 2 and ASA 3, 55% were of score 2 of NNISS (National Nosocomial Infection Surveillance System), 5.45% were NNISS score 3 or 3 cases and these 3 cases developed ISO. The ISOs were parietal in 49 cases, ie 89%. The recovered germs were 100% sensitive to imipenem. The most informative interventions of the ISOs were peritonitis 25 cases (45.45%), intestinal occlusions 12 cases (21.82%), appendicular abscess 8 cases (14.55%). We had 2 death cases, 3.64%, the average hospital stay was 13 days., Conclusion: Escherichia coli was the common germ found in the ISO in general surgery at Kati BSS Hospital. The usual resistance to antibiotics must provoke effective preventive actions., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Problem: In Burkina Faso, the coverage of services for family planning is low due to shortage of qualified health staff and limited access to services., Approach: Following the launch of the Ouagadougou Partnership, an alliance to catalyse the expansion of family planning services, the health ministry created a consortium of family planning stakeholders in 2011. The consortium adopted a collaborative framework to implement a pilot project for task sharing in family planning at community and primary health-care centre levels in two rural districts. Stakeholders were responsible for their areas of expertise. These areas included advocacy; monitoring and evaluation; and capacity development of community health workers (CHWs) to offer oral and injectable contraceptives to new users and of auxiliary nurses and auxiliary midwives to provide implants and intrauterine devices. The health ministry implemented supportive supervision cascades involving relevant planning and service levels., Local Setting: In Burkina Faso, only 15% (2563/17 087) of married women used modern contraceptives in 2010., Relevant Changes: Adoption of new policies and clinical care standards expanded task sharing roles in family planning. The consortium trained a total of 79 CHWs and 124 auxiliary nurses and midwives. Between January 2017 and December 2018, CHWs provided injectables to 3698 new users, and auxiliary nurses or midwives provided 726 intrauterine devices and 2574 implants to new users. No safety issues were reported., Lessons Learnt: The pilot project was feasible and safe, however, financial constraints are hindering scale-up efforts. Supportive supervision cascades were critical in ensuring success., ((c) 2019 The authors; licensee World Health Organization.)

Systemic sclerosis (SSc) is a heterogeneous autoimmune disease associated with several antinuclear autoantibodies useful to diagnosis and prognosis. The aim of the present multicentric study was to determine the clinical relevance of antifibrillarin autoantibodies (AFA) in patients with SSc. The clinical features of 37 patients with SSc positive for AFA (AFA+) and 139 SSc patients without AFA (AFA-) were collected retrospectively from medical records to enable a comparison between AFA- and AFA+ patients. Antifibrillarin autoantibodies were screened by an indirect immunofluorescence technique using HEp2 cells and identified by an in-house Western blot technique and/or an EliA test. Comparing AFA+ and AFA- patients, AFA+ patients were significantly younger at disease onset (36.9 versus 42.9; P = 0.02), more frequently male (P = 0.02) and of Afro-Caribbean descent (65% versus 7.7%; P < 0.001). At diagnosis, the Rodnan skin score evaluating the cutaneous manifestations was higher (13.3 versus 8.7; P = 0.01) and myositis was also more common in the AFA+ group (31.4% versus 12.2%; P < 0.01). Patients with AFA+ were not associated with diffuse cutaneous SSc or with lung involvement and no difference in survival was observed. Antifibrillarin autoantibodies are associated with patients of Afro-Caribbean origin and can identify patients with SSc who are younger at disease onset and display a higher prevalence of myositis., (© 2016 The Foundation for the Scandinavian Journal of Immunology.)

Object: Studying the Epidemiological and clinical profile of accidents on public ways at the welcome service of emergencies, CHU Gabriel Touré within the scope of accident reduction on public ways and an improvement of their taking in charge., Methodology: Retro prospective study over a three-year- period including all the files of any patient emitted for accident happening on public ways without regard to race and sex., Result: Over a three-year-period (from January 2007 to December 2009). Our team has analized 2450 hospitalization files with a follow-up going from 0 to 45 days. The most concerned ages range from 15 to 29 years (43 per cent) with a male predominance (81 per cent). The mechanism motorcycles-pedestrians (30.9 per cent) was the most represented. The mains lesions observed were cranial traumatisms (58.9 per cent), followed with fractures of limbs (13.5 per cent). Death-rate has been risen at the level of young men above all (from 15 to 29 years) and it was mainly due to cranial traumatisms., Conclusion: Accidents on public ways represent a keen problem in matter of public health. The taking in charge of the curse should be very urgent. Information, communication and education of all the professional and social stratums seem necessary.

In this study, topoisomerase mutations in ciprofloxacin-resistant and -susceptible Campylobacter jejuni were analysed by DNA sequencing. In certain ciprofloxacin-resistant C. jejuni, the mechanism of resistance was complex. The Thr86-Ala substitution in the GyrA protein appears to play a role in increasing the minimum inhibitory concentration of nalidixic acid only. In addition, isolates with this amino acid change and those resistant to quinolones but lacking a mutation in the GyrA quinolone resistance-determining region could be derived from two different clones. Based on gyrA and gyrB polymorphisms, C. jejuni isolates from the Dakar region of Senegal appeared to be less diverse than those from other countries. Moreover, C. jejuni isolates in Senegal appeared to differ from European isolates by lack of a silent mutation at codon 120 of the gyrA gene.

We used the multilocus sequence typing (MLST) method to study the genetic diversity of Campylobacter coli isolated from chickens in Senegal, and to check the presence of genetic exchange with Campylobacter jejuni. In addition, we assessed the resistance of the isolates to ciprofloxacin and nalidixic acid, and their gyrA sequences. MLST revealed a low level of diversity and the absence of lineages among C. coli isolates. In addition, an exchange of alleles with C. jejuni was found. Twenty percent of the ciprofloxacin-resistant isolates lacked mutations within the quinolone resistance-determining region (QRDR) of GyrA. There was no link between quinolone resistance and sequence type (ST).

We used the multilocus sequence typing (MLST) method to evaluate the genetic diversity of 46 Campylobacter jejuni isolates from chickens and to determine the link between quinolone resistance and sequence type (ST). There were a total of 16 ST genotypes, and the majority of them belonged to seven clonal complexes previously identified by using isolates from human disease. The ST-353 complex was the most common complex, whereas the ST-21, ST-42, ST-52, and ST-257 complexes were less well represented. The resistance phenotype varied for each ST, and the Thr-86-Ile substitution in the GyrA protein was the predominant mechanism of resistance to quinolone. Nine of the 14 isolates having the Thr-86-Ile substitution belonged to the ST-353 complex. MLST showed that the emergence of quinolone resistance is not related to the diffusion of a unique clone and that there is no link between ST genotype and quinolone resistance. Based on silent mutations, different variants of the gyrA gene were shown to exist for the same ST. These data provide useful information for understanding the epidemiology of C. jejuni in Senegal.

Objective: To identify factors predicting uptake of voluntary HIV counselling and testing in pregnant women., Methods: All pregnant women receiving ante-natal group health education at St Camille Medical Center, Ouagadougou, Burkina Faso from 1 May 2002 to 30 April 2004 were offered voluntary HIV counselling and testing. If they consented, the women were pre-test counselled, tested by two rapid tests giving immediate results and post-test counselled., Results: Less than one-fifth of pregnant women [1,216/6,639 (18.3%, CI 17.4-19.3%)] accepted voluntary HIV counselling and testing, mainly at the first ante-natal visit (83.4%) and at early gestational age (73.4% before week 24). The HIV seroprevalence rate was 10.6% (8.8-12.5%). The uptake rate was independently associated with age, the number of previous pregnancies and the number of previous miscarriages., Conclusions: Our two-step approach of group education followed by voluntary HIV counselling and testing yielded a low uptake rate in this setting. However, the drop-out rate after enrolling in the programme was nearly zero. The timing of programme uptake would permit implementation of earlier prophylactic courses. Effective scaling-up of voluntary HIV counselling and testing outside the clinical trial requires a mass sensibilization campaign pointing out the programme's benefits and addressing the stigma of HIV. The independent value of age and previous obstetrical episodes show how important social factors are in influencing the voluntary HIV counselling and testing uptake rate.

Aims: The main objectives of this study were to investigate the diversity of Campylobacter genotypes circulating in Senegal and to determine the frequency of antibiotic resistance., Methods and Results: Strains of Campylobacter jejuni isolated from poultry (n = 99) and from patients (n = 10) and Campylobacter coli isolated from poultry (n = 72) were subtyped by pulsed-field gel electrophoresis (PFGE). The pulsotypes obtained after digestion by SmaI and KpnI revealed a significant genetic diversity in both species, but without any predominant pulsotypes. However, farm-specific clones were identified in the majority of poultry houses (76.5%). Human and poultry isolates of C. jejuni had common PFGE patterns. High quinolone-resistance rates were observed for C. jejuni (43.4%) and C. coli (48.6%) isolates obtained from poultry., Conclusions: The results showed a genetic diversity of Campylobacter between farms indicating multiple sources of infection; but specific clones had the ability to colonize the broiler farms. The antimicrobial resistance patterns were not related to any specific PFGE pattern suggesting that resistance was due to the selective pressure of antibiotic usage. Campylobacter with similar genotypes were circulating in both human and poultry., Significance and Impact of the Study: This study is important for the understanding of the epidemiology of Campylobacter in broiler farms in Senegal. It also emphasizes the need for a more stringent policy in the use of antimicrobial agents in food animals.

Our objective was to investigate the Salmonella and Campylobacter contamination of traditional ready-to-eat street-vended poultry dishes and to assess the association of some restaurant characteristics and cooking practices with the contamination of these meals. One hundred and forty-eight street-restaurants were studied from January 2003 to April 2004 in Dakar. A questionnaire was submitted to the managers, and samples of ready-to-eat poultry dishes were taken. Salmonella spp. was isolated in 20.1% of the 148 street-restaurants studied and in 10.1% samples of poultry dishes. The most prevalent serovars isolated were Salmonella hadar, Salmonella enteritidis and Salmonella brancaster. Campylobacter jejuni was detected in only 3 restaurants and 3 poultry dishes. Not peeling and not cleaning vegetables and other ingredients during meal preparation (OR=3.58), dirty clothing for restaurant employees (OR=4.65), reheating previously cooked foods (OR=5.2), and no kitchen and utensils disinfection (OR=3.47) were associated with an increasing risk of Salmonella contamination. Adequate cooking procedures decreased the risk of Salmonella contamination (OR=0.15).

The objective of this study was to identify the risk factors for Salmonella spp. contamination of Senegalese chicken carcases during slaughtering. One hundred and twenty traditional slaughterhouses were studied from January 2000 to December 2002 in and around Dakar. A questionnaire was administered to the slaughterers and samples of breast skin were taken to assess the Salmonella spp. status of chicken carcases. Results showed that 43.3% of the chicken batches were contaminated with Salmonella spp., with Salmonella Hadar and Salmonella Brancaster as the two main serovars. Salmonella spp. contamination of the live birds before slaughtering was related to contamination of the carcases after slaughtering. Feed withdrawal before slaughtering and thorough cleaning and disinfection procedures decreased the risk of Salmonella contamination. One individual worker for each slaughtering stage was also associated with a decreased risk of Salmonella contamination. Using scalding water for plucking increased the risk of contamination. These results will help slaughterers to produce safer products for local consumers.

Aims: Salmonella Hadar, Salmonella Brancaster and Salmonella Enteritidis are the main Salmonella enterica ssp. enterica serovars isolated from poultry in Senegal. Our objective was to analyse the pulsed-field gel electrophoresis (PFGE) and antibioresistance patterns of strains belonging to these serovars and to assess the significance of broiler-chicken meat as a source of human infection., Methods and Results: A total of 142 Salmonella isolates were analysed: 79 were isolated from Senegalese patients with sporadic diarrhoea (11 S. Hadar, nine S. Brancaster and 59 S. Enteritidis) and 63 from poultry (30 S. Hadar, 17 S. Brancaster and 16 S. Enteritidis). The PFGE of XbaI- and SpeI-digested chromosomal DNA gave 20 distinct profiles for S. Hadar, nine for S. Brancaster and 22 for S. Enteritidis. Each serovar was characterized by a major pulsotype which was X3S1 in 42% of S. Hadar, X8S1 in 53.8% of S. Brancaster and X1S2 in 43% of S. Enteritidis isolates. Human and poultry isolates of Salmonella had common PFGE patterns. Antibiosensitivity tests showed multiresistance (more than two drugs) was encountered in 14.5% of S. Hadar and in 5% of S. Enteritidis isolates. Resistance to quinolones was considered to be of particular importance and 14.5% of S. Hadar isolates were found to be resistant to nalidixic acid. CONLCUSIONS: The sharing of similar PFGE profiles among isolates from humans and poultry provided indirect evidence of Salmonella transmission from contaminated broiler meat. But most of the Salmonella isolates remained drug sensitive., Significance and Impact of the Study: Efforts are needed to eliminate Salmonella from poultry meat intended for human consumption. This study has also highlighted the importance of continuous surveillance to monitor antimicrobial resistance in bacteria associated with animals and humans.

In order to study the therapeutic and developing aspect the child's noma in Burkina Faso, we have undertaken a retrospective study on a ten-years-period, with the files of 59 children hospitalized in the hospital of Bobo-Dioulasso, completed with a visit to the children's families after their leaving the hospital. The medical treatment has allowed to reach a recovery rate of 79.6% at the cost of aesthetic and functional after-effects which aren't negligible. The death rate in hospital was 13.7%. 31 children have profited from the restoring surgery of lesions. The care out of hospital has showed that the surgical results were mitigated.

Our objective was to identify the risk factors for Campylobacter infection in Senegalese broiler flocks. Seventy broiler farms were studied around Dakar from January 2000 to December 2001 around Dakar. A questionnaire was administered to the farmers, and samples of fresh droppings were taken to assess the flocks' Campylobacter status. About 63% of the flocks were infected by Campylobacter spp.; Campylobacter jejuni was the most-prevalent species (P < 0.05). An elevated risk of Campylobacter infection was associated with other animals (mainly laying hens, cattle and sheep) being bred in the farm, the farm staff not wearing their work clothing exclusively in the poultry houses, uncemented poultry-house floors and the use of cartons that transport chicks from the hatchery to the farm as feed plates (rather than specifically designed feed plates). Alternatively, thorough cleaning and disinfection of poultry-house surroundings and manure disposal outside the farm were associated with decreased flock risk.

Our objective was to assess the association of managerial practices, general hygiene and Salmonella infection in Senegalese broiler flocks. Seventy broilers farms were studied from January 2000 to December 2001 around Dakar. A questionnaire was submitted to the farmers and samples of fresh broiler droppings were taken. A 28.6% of the flocks were infected by Salmonella (mainly Hadar and Brancaster serovars). Salmonella infection of the previous flock (OR = 6.82) and of day-old chicks (OR = 3.73), frequent poultry farmers' visits (OR = 5.38) and keeping sick birds inside the farm (OR = 5.32) increased the risk of Salmonella infection. But, using antibiotics on day-old chicks (OR = 0.17) and a detergent for cleaning (OR = 0.16) decreased the risk.

Genetic predisposition to malaria has been shown by epidemiological, case-control and linkage studies. In particular, case-control studies have recently shown association between hemoglobin C and resistance to severe malaria in Mali and to clinical malaria in Burkina Faso. In a longitudinal study of families living in an endemic area, we investigated whether hemoglobin C is associated with reduced Plasmodium falciparum parasitemia and low risk of mild malaria attack. We surveyed 256 individuals (71 parents and 185 sibs) from 53 families during 2 years. Hemoglobin C carriers had less frequent malaria attacks than AA individuals within the same age group (P=0.01). Since age correlated with malaria attack and parasitemia (P<0.0001), we took age into account in association analyses. We performed combined linkage and association analyses, which avoid biases due to population structure. Using multi-allelic tests, we evidenced association between hemoglobin genotype and phenotypes related to malarial infection and disease (P<0.001). We further analyzed individual hemoglobin alleles and detected negative association between hemoglobin C and malaria attack (P=0.00013). Analyses that took into account confounding factors confirmed the negative association of hemoglobin C with malaria attack (P=0.0074) and evidenced a negative correlation between hemoglobin C and parasitemia (P=0.0009). These associations indicate that hemoglobin C reduces parasitemia and confers protection against mild malaria attack.

To assess fluoroquinolone susceptibility of Campylobacter strains in Senegal, skin samples were collected from 250 chicken carcasses from January 2001 to October 2002. Among 205 isolated Campylobacter strains, 59% and 41% were identified as Campylobacter jejuni and C. coli, respectively; the overall ciprofloxacin-resistance rate was 34%.

A retrospective study covering ten years (1987-1996) was conducted to assess the epidemiology, clinical features and management of cancrum oris (noma) in children from Burkina Faso. Fifty nine (59) children were admitted with cancrum oris at the paediatrics and maxillo-facial surgery units of Bobo-Dioulasso, the second town of Burkina Faso. The hospital prevalence of noma is 1.5/1000. 81% of the cases were in the 1 to 5 years age group and 58% were females. Predisposing factors include poverty, lack of immunization, malnutrition, bad oral hygiene, measles and parasitic diseases. The cheek was involved in 31% of the cases. Cure was obtained in 80% of patients after medical and surgical treatment. However, many sequels were observed. Post operative outcome is complicated by the children's growth and often results in retractions, recurrence of ulcers or constriction. Psychological and social problems are associated. Management is difficult in our setting because of the lack of information, cost of the treatment and the absence of well-equipped plastic surgery units.

There is accumulating evidence for a role of immunoglobulin G (IgG) in protection against malarial infection and disease. Only IgG1 and IgG3 are considered cytophilic and protective against P. falciparum, whereas IgG2 and IgG4 were thought to be neither and even to block protective mechanisms. However, no clear pattern of association between isotypes and protection has so far emerged. We analyzed the isotypic distribution of the IgG response to conserved epitopes and P. falciparum blood-stage extract in 283 malaria-exposed individuals whose occurrence of infection and malaria attack had been monitored for about 1 year. Logistic regression analyses showed that, at the end of the season of transmission, high levels of IgG2 to RESA and to MSP2 epitopes were associated with low risk of infection. Indeed, IgG2 is able to bind FcgammaRIIA in individuals possessing the H131 allele, and we showed that 70% of the study subjects had this allele. Also, high specific IgG4 levels were associated with an enhanced risk of infection and with a high risk of malaria attack. Moreover, specific IgG2 and IgG3 levels, as well as the IgG2/IgG4 and IgG3/IgG4 ratios, increased with the age of subjects, in parallel with the protection against infection and disease. IgG4 likely competes with cytophilic antibodies for antigen recognition and may therefore block cytotoxicity mediated by antibody-activated effector cells. In conclusion, these results favor a protective role of IgG3 and IgG2, which may activate effector cells through FcgammaRIIA, and provide evidence for a blocking role of IgG4 in malarial infection and disease.

The authors report three observations of trypanosomiasis in children aged 3 to 13 years from Ivory Coast and Burkina Faso. Two cases were imported from Côte d'Ivoire and one originated from an old endemic area of Bobo-Dioulasso region in Burkina Faso. Clinical features were comparable to classical descriptions in adults but neurological findings were dominant. Two children were at the lymphatic stage. Treatment with melarsoprol in two cases and eflornithine in one case led to complete recovery. Active epidemiologic surveillance of this zoonosis should be maintained and the devastating pandemic of the beginning of the century should be remembered.

Background: On March 21, 1998, the Regional Health Authority of Bobo-Dioulasso, Burkina Faso, asked the Centre Muraz to investigate an unexplained outbreak of epidemic fatal encephalopathy (EFE). We aimed to identify the cause of this epidemic., Methods: We identified cases retrospectively through review of health-service records and interviews of family members, village chiefs, and local healers. Active surveillance was started in administrative divisions within the study area in April, 1998, to identify further EFE cases. We did a case-control study of households to investigate the risk from various environmental and health factors. Blood and urine samples were collected if possible and urine dicarboxylic acid concentrations measured by gas chromatography., Findings: 29 cases of EFE were identified from January to May, 1998. Estimated age-specific attack rates (2-6 years) ranged from 31 to 847 per 100,000 population (p<0.001). The most common symptoms were hypotonia, vomiting, convulsions, and coma. All children died in 2-48 h. The only factor associated with EFE was the presence of ackee trees (Blighia sapida) within 100 m of households (odds ratio 5.1 [95% CI 1.8-14.7] p=0.001). Poisoning with unripe ackee fruits was suggested by urine concentrations of dicarboxylic acids four to 200 times higher in cases (n=2) than in controls (n=3)., Conclusion: Consumption of unripe ackee fruit probably caused this epidemic and may lead to a substantial number of unexplained deaths in preschool children in west Africa every year. Educational campaigns have the potential to prevent these deaths.