Littérature scientifique sur le sujet « Case studies: Senegal. Mali. Ivory-Cost »

Abstract Introduction Growth failure has been a well-known complication of sickle cell disease (SCD) since the 70s. More recent studies show that the proportion of underweight children with SCD has decreased significantly, thanks to modern treatments (in particular hydroxyurea and iterative transfusions), with a tendency towards overweight and even obesity. However, most studies have been carried out in high-income countries, while 80% of the affected children are born in sub-Saharan Africa, where the environment and the medical care are entirely different. We carried out a case-control study nested in a multinational African cohort to study the growth of sickle cell children and the possible factors influencing growth failure. Methods We performed a case-control transversal study nested in the CADRE cohort that includes SCD patients from five African countries: Cameroon, Gabon, Côte d'Ivoire, Mali and Senegal. All children aged 5 to 21 years-old from this cohort were included in our study. Healthy controls were recruited among the patients' siblings or the children of health workers from each center. The main parameters studied were: medical history, height, weight, blood pressure; hemoglobin phenotype (SS, Sβ0, SC or Sβ +); complete blood count; hemolysis markers (LDH and bilirubin); microalbuminuria; echocardiographic parameters. The primary endpoint was growth failure, defined as a weight, height or BMI below the 5th percentile of the WHO growth charts. We described the frequency of growth failure according to hemoglobin phenotype, age and sex. Then we assessed by multivariate logistic regression in two SCD phenotypic groups (SS or Sβ0 and SC or Sβ +) the association between growth failure and the biological characteristics or the history of SCD-related complications. Results 2296 patients (1799 SS, 114 Sβ0, 287 SC, 96 Sβ+ patients and 287 controls were enrolled in Cameroon (n=735), Ivory Coast (n=380), Gabon (n=298), Mali (n=589) and Senegal (n=581). Overall, 48% of the patients were male and their median [interquartile range] age was 12 [8-16] years-old. Growth failure was diagnosed in 51% of SS, 58% of Sβ0, 44% of SC, 38% of Sβ+patients and 32% of controls, with deeper underweight than linear growth retardation. Beyond the age of 18, the mean BMI of SCD patients was again similar to that of controls in girls, but remained lower in boys, whereas the mean height was similar to that of controls regardless of sex (Figures a to d). Growth failure was more frequent in boys than in girls and maximal between 13 and 16 years-old (Figures e and f). In univariate analysis, the prevalence of growth retardation was associated with the country (highest in Senegal, lowest in Cameroon), age, male sex, hemoglobin phenotype, levels of anemia and hemolysis (p <.0001 for all comparisons). After adjusting for age and the country, the prevalence of growth failure was significantly higher in SS-Sβ0 patients compared to controls (OR = 2.55 [1.83-3.56]) but not different between SC-Sβ+ patients and controls (1.35 [0.91-2.01]). In multivariate analysis, growth failure in SCD patients was positively associated with male sex (OR=1.89, 95%IC=1.56-2.28), [12-15] years age class (OR=2.31, 95%IC=1.75-3.07), SS or Sβ0 phenotypes (OR=2.06 and 2.27, 95%IC=1.26-3.36 and 1.22-4.21, respectively), icterus, leukocytes count, and microalbuminuria (OR = 1.4 [1.1-1.8]). It was negatively associated with parents' secondary or upper education, mean blood pressure and hemoglobin level (OR = 1.96 [1.55-2.47] for the first quartile of hemoglobin level vs others). No association was found between growth failure and the history of clinical SCD-related complications (osteonecrosis, leg ulcers, stroke, priapism, pulmonary hypertension defined by echocardiography and retinopathy). Conclusion In sub-Saharan Africa, growth failure occurs in more than half of the SCD children and concerns weight more than height. Its prevalence is particularly high in SS or Sβ0 patients and during adolescence, due to pubertal delay. Growth failure in SCD children is associated with male sex, anemia and high hemolysis markers independently of the hemoglobin phenotype, but is not independently associated with the occurrence of acute or chronic vascular complications of sickle cell disease, apart from microalbuminuria. However, the long-term consequences of growth failure in sickle cell disease should be evaluated in a longitudinal study. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

The International Energy Agency has projected that the total energy demand for electricity in sub-Saharan Africa (SSA) is expected to rise by an average of 4% per year up to 2040. It implies that ~620 million people are living without electricity in SSA. Going with the 2030 vision of the United Nations that electricity should be accessible to all, it is important that new technology and methods are provided. In comparison to other nations worldwide, smart grid (SG) is an emerging technology in SSA. SG is an information technology-enhanced power grid, which provides a two-way communication network between energy producers and customers. Also, it includes renewable energy, smart meters, and smart devices that help to manage energy demands and reduce energy generation costs. However, SG is facing inherent difficulties, such as energy theft, lack of trust, security, and privacy issues. Therefore, this paper proposes a blockchain-based decentralized energy system (BDES) to accelerate rural and urban electrification by improving service delivery while minimizing the cost of generation and addressing historical antipathy and cybersecurity risk within SSA. Additionally, energy insufficiency and fixed pricing schemes may raise concerns in SG, such as the imbalance of order. The paper also introduces a blockchain-based energy trading system, which includes price negotiation and incentive mechanisms to address the imbalance of order. Moreover, existing models for energy planning do not consider the effect of fill rate (FR) and service level (SL). A blockchain levelized cost of energy (BLCOE) is proposed as the least-cost solution that measures the impact of energy reliability on generation cost using FR and SL. Simulation results are presented to show the performance of the proposed model and the least-cost option varies with relative energy generation cost of centralized, decentralized and BDES infrastructure. Case studies of Burkina Faso, Cote d’Ivoire, Gambia, Liberia, Mali, and Senegal illustrate situations that are more suitable for BDES. For other SSA countries, BDES can cost-effectively service a large population and regions. Additionally, BLCOE reduces energy costs by approximately 95% for battery and 75% for the solar modules. The future BLCOE varies across SSA on an average of about 0.049 $/kWh as compared to 0.15 $/kWh of an existing system in the literature.

We studied the current management of STD-related syndromes by urban health facilities in Pikine (Senegal) in 252 consecutive patients presenting with STD-related complaints, to assess the cost and effectiveness of services and to estimate the potential benefit by introducing management protocols. Most common presenting complaints for women were vaginal discharge and low abdominal pain, reported for 122 (82.9%) and 22 (15.0%) of 147 female patients. Urethral discharge and genital ulceration were reported for 80 (76.2%) and for 17 (16.2%) of 105 male patients. The average cost was 4.01 ECU (1 European Currency Unit = 1.2 US$=334 Franc CFA) for male patients (ranging from 0.57 to 25.70 ECU) and 12.75 ECU for female patients (ranging from 0.57 to 37.60 ECU). Only 20 of 80 patients with urethral discharge (25%) received effective treatment. Effectiveness was not related to cost of therapy or qualification of staff. Utilization of management protocols improves the quality and accessibility of care for STD, by potentially doubling effectiveness and reducing the costs for patients to 12% of the current level.

The purpose of this study is to estimate the dependence between the inflation, given by the Consumer Price Index (CPI), in part of the Sub-Saharan African (SSA) countries with the CPI observed in the Euro Monetary Zone (EMZ) countries. To achieve this goal, we adopted the empirical methodology of Copulas, which was used in the analysis of the CPI, in bivariate models context. The results were controlled by the countries which adopted fixed and flexible exchange rate regimes. They suggest that the CPI in the sampled countries which adopted fixed exchange rate regimes, as Sao Tome and Principe, Benin, the countries of the West African Economic and the Monetary Union (WAEMU), Burkina Faso, Ivory Coast and Togo had more significant dependence relationship with the Euro. On the other hand, the countries which adopted flexible exchange rate regimes as Cape Verde, Burkina Faso, Guinea-Bissau, Mali, Senegal and Togo presented dependence on upper tail of the distribution, i.e., for the periods of increasing in the CPI. Maybe, it means that those countries had inelastic demands for tradable goods coming from the EMZ countries. We conclude that the imported inflation is an important issue to be considered by the policy makers of developing countries such as the studied, mainly for those which adopted fixed regimes, eventually change to flexible exchange regimes.

Our study aims to take a phenomenological approach to examining the interaction between entrepreneurial passion and the internationalization of Sub-Sahara African SMEs. This will entail the exploration of four concrete cases studies of SMEs from Ivory-Coast, Mali, and Senegal. Given the context of study selected, we also considered the potential impact of the institutional gaps that characterize the markets involved in this relationship. Two important results can be highlighted. First, entrepreneurs who are passionate about developing their country and continent and who are motivated by a social mission are more likely to engage their SME in a dynamic internationalization effort. Secondly, it would appear that the institutional gaps do not prevent the internationalization of SMEs in those instances where directors are passionate about their business developing in that direction.

Abstract Introduction The COVID-19 pandemic unveiled huge challenges in health workforce governance in the context of public health emergencies in Africa. Several countries applied several measures to ensure access to qualified and skilled health workers to respond to the pandemic and provide essential health services. However, there has been limited documentation of these measures. This study was undertaken to examine the health workforce governance strategies applied by 15 countries in the World Health Organization (WHO) Africa Region in responding to the COVID-19 pandemic. Methods We extracted data from country case studies developed from national policy documents, reports and grey literature obtained from the Ministries of Health and other service delivery agencies. This study was conducted from October 2020 to January 2021 in 15 countries - Angola, Burkina Faso, Chad, Eswatini, Ghana, Guinea, Guinea Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal and Togo. Results All 15 countries had national multi-sectoral bodies to manage the COVID-19 response and a costed national COVID-19 response plan. All the countries also reflected human resources for health (HRH) activities along the different response pillars. These activities included training for health workers, and budget for the recruitment or mobilization of additional health workers to support the response, and for provision of financial and non-financial incentives for health workers. Nine countries recruited additional 35,812 health workers either on a permanent or temporary basis to respond to the COVID-19 with an abridged process of recruitment implemented to ensure needed health workers are in place on time. Six countries redeployed 3671 health workers to respond to the COVID-19. The redeployment of existing health workers was reported to have impacted negatively on essential health service provision. Conclusion Strengthening multi-sector engagement in the development of public health emergency plans is critical as this promotes the development of holistic interventions needed to improve health workforce availability, retention, incentivization, and coordination. It also ensures optimized utilization based on competencies, especially for the existing health workers.

Abstract Background The use of applications involving single nucleotide polymorphisms (SNPs) has greatly increased since the beginning of the 2000s, with the number of associated techniques expanding rapidly in the field of molecular research. Tetra-primer amplification refractory mutation system—PCR (T-ARMS-PCR) is one such technique involving SNP genotyping. It has the advantage of amplifying multiple alleles in a single reaction with the inclusion of an internal molecular control. We report here the development of a rapid, reliable and cost-effective duplex T-ARMS-PCR assay to distinguish between three Schistosoma species, namely Schistosoma haematobium (human parasite), Schistosoma bovis and Schistosoma curassoni (animal parasites), and their hybrids. This technique will facilitate studies of population genetics and the evolution of introgression events. Methods During the development of the technique we focused on one of the five inter-species internal transcribed spacer (ITS) SNPs and one of the inter-species 18S SNPs which, when combined, discriminate between all three Schistosoma species and their hybrid forms. We designed T-ARMS-PCR primers to amplify amplicons of specific lengths for each species, which in turn can then be visualized on an electrophoresis gel. This was further tested using laboratory and field-collected adult worms and field-collected larval stages (miracidia) from Spain, Egypt, Mali, Senegal and Ivory Coast. The combined duplex T-ARMS-PCR and ITS + 18S primer set was then used to differentiate the three species in a single reaction. Results The T-ARMS-PCR assay was able to detect DNA from both species being analysed at the maximum and minimum levels in the DNA ratios (95/5) tested. The duplex T-ARMS-PCR assay was also able to detect all hybrids tested and was validated by sequencing the ITS and the 18S amplicons of 148 of the field samples included in the study. Conclusions The duplex tetra-primer ARMS-PCR assay described here can be applied to differentiate between Schistosoma species and their hybrid forms that infect humans and animals, thereby providing a method to investigate the epidemiology of these species in endemic areas. The addition of several markers in a single reaction saves considerable time and is of long-standing interest for investigating genetic populations. Graphical Abstract

Le travail que nous présentons porte sur « les conflits armés ouest-africains : Sénégal, Mali, Côte-d'Ivoire ». Nous contribuons à analyser ces conflits sous une perspective nouvelle des « guerres pour la reconnaissance ».Notre travail de recherche apporte deux innovations majeures dans le champ d'étude des conflits armés internes. A travers des études de cas, nous explorons plusieurs problèmes. Celui d'abord de la manifestation de ces conflits. Nous avons ainsi consacré un intérêt particulier à distinguer des formes de violences politiques - violences sécessionnistes, violences opportunistes- qui caractérisent les conflits dont l'interprétation est demeurée homogénéisant. Une telle démarche a permis de démontrer la diversité motivationnelle dans l'engagement violent des mouvements rebelles contre les gouvernements centraux. Nous analysons les violences sécessionnistes en Casamance (Sénégal) et dans l'Azawad (Mali), que nous distinguons des violences rebelles pour la conquête du pouvoir central en Côte-d'Ivoire, conceptualisées comme des "violences opportunistes".Ensuite, nous proposons une lecture nouvelle et critique de ces conflits en défendant la thèse que les mouvements rebelles s'engagent en guerre pour la reconnaissance d'une égale dignité au sein de l'État-nation. Cet engagement est fait au nom de groupes sociaux auxquels ils s'identifient et qui évoluent dans des territoires dont ils revendiquent l'indépendance et/ou l'autonomie. La thèse des guerres pour la reconnaissance est valable pour les cas des conflits armés au Sénégal et au Mali.Nous interprétons les conflits armés qui opposent des mouvements rebelles au gouvernement central, comme des effets de violences symboliques. Les frustrations, les dénis d'autonomie, l'indifférence, les dénis de droits civiques constituent des sources de conflictualités. Les comportements violents des mouvements rebelles sont analysés comme caractéristiques d'une guerre pour la reconnaissance. Notre lecture des conflits ouvre un regard critique par rapport à une grille classique dominée par des paradigmes économicistes et rationalistes
The thesis we propose focuses on "West African armed conflicts: Senegal, Mali, Ivory Coast". We contribute to analyze these conflicts toward a new perspective of "wars for recognition".Our research brings two major innovations to the field of internal armed conflicts study. Through case studies, we explore several problems, first the manifestation of these conflicts. We have thus devoted particular interest to distinguish forms of political violence - secessionist violence, opportunistic violence - that characterize conflicts whose interpretation has remained homogenous. Such an approach has allowed us to demonstrate the diversity of rebel movements violence's motivations against central governments. We analyze secessionist violence in Casamance (Senegal) and Azawad (Mali), which we distinguish from rebel violence for the conquest of central power in Côte d'Ivoire, conceptualized as "opportunistic violence”.Second, we propose a new and critical reading of these conflicts by arguing that rebel movements engage in war for the recognition of equal dignity within the state. This commitment is made in the name of social groups with which they identify and which evolve in territories whose independence and/or autonomy they claim. The thesis of wars for recognition is applicable to the cases of armed conflict in Senegal and Mali.We consider the armed conflicts that oppose rebel movements to the central government as effects of symbolic violence. Frustration, denial of autonomy, lack of empathy, denial of civil rights are sources of conflict. The violent behavior of rebel movements is analyzed as characteristic of a war for recognition. Our reading of the conflicts opens a critical view regarding a classical framework dominated by economist and rationalist paradigms