Using formative research to promote antenatal care attendance and iron folic acid supplementation in Zinder,Niger

In Niger, use of antenatal care (ANC) and iron folic acid (IFA) supplements is suboptimal. The objectives of this paper are as follows: (a) to conduct formative research to understand barriers and beliefs among pregnant women related to ANC, IFA supplementation, and pregnancy outcomes; (b) assess the quality of currently provided ANC services; (c) use the findings to guide the development of programmatic interventions to improve coverage of ANC services and IFA supplementation of pregnant women. Structured in‐home interviews (n = 72) and focus groups (n = 4) were conducted with pregnant women in 4 randomly selected villages in rural Zinder. ANC consultations (n = 33) were observed in 5 randomly selected health centres, and exit interviews were conducted with all pregnant women and seven health agents following these observations. During workshops with stakeholders, results of the formative research were interpreted, and programmatic interventions were developed. In home interviews, 72% of women reported having attended at least one ANC visit. They also reported husbands (71%), mothers (40%), and friends (33%) supporting ANC attendance. Among those having attended ANC, only 65% reported taking IFA the day prior to the interview. Three of five health centres visited had IFA in stock. Health staff did not provide IFA supplements during 18 of 33 observed ANC consultations of which only 7 cases could be explained by the lack of IFA supplements in stock. Findings were used to design a 3‐pronged intervention: (a) behaviour change communication activities in communities; (b) quality improvement activities in health centres to strengthen ANC; and (c) provision of key supplies required for ANC.     

Viral Hepatitis E Outbreaks in Refugees and Internally Displaced Populations,sub-Saharan Africa, 2010–2020

Hepatitis E virus is a common cause of acute viral hepatitis. We analyzed reports of hepatitis E outbreaks among forcibly displaced populations in sub-Saharan Africa during 2010–2020. Twelve independent outbreaks occurred, and >30,000 cases were reported. Transmission was attributed to poor sanitation and overcrowding.     

Carriage of Neisseria meningitidis serogroup W135 ST-2881

Serogroup W135 ST-2881 meningococci caused a cluster of meningitis cases in Niger in 2003. Of 80 healthy persons in the patients' villages, 28 (35%) carried meningococci; 20 of 21 W135 carrier strains were ST-2881. Ten months later, 5 former carriers were still carriers of W135 ST-2881 strains. The serum bactericidal antibody activity changed according to carrier status.     

Cost analysis of the treatment of severe acute malnutrition in West Africa

We present an updated cost analysis to provide new estimates of the cost of providing community‐based treatment for severe acute malnutrition, including expenditure shares for major cost categories. We calculated total and per child costs from a provider perspective. We categorized costs into three main activities (outpatient treatment, inpatient treatment, and management/administration) and four cost categories within each activity (personnel; therapeutic food; medical supplies; and infrastructure and logistical support). For each category, total costs were calculated by multiplying input quantities expended in the Médecins Sans Frontières nutrition program in Niger during a 12‐month study period by 2015 input prices. All children received outpatient treatment, with 43% also receiving inpatient treatment. In this large, well‐established program, the average cost per child treated was €148.86, with outpatient and inpatient treatment costs of €75.50 and €134.57 per child, respectively. Therapeutic food (44%, €32.98 per child) and personnel (35%, €26.70 per child) dominated outpatient costs, while personnel (56%, €75.47 per child) dominated in the cost of inpatient care. Sensitivity analyses suggested lowering prices of medical treatments, and therapeutic food had limited effect on total costs per child, while increasing program size and decreasing use of expatriate staff support reduced total costs per child substantially. Updated estimates of severe acute malnutrition treatment cost are substantially lower than previously published values, and important cost savings may be possible with increases in coverage/program size and integration into national health programs. These updated estimates can be used to suggest approaches to improve efficiency and inform national‐level resource allocation.     

尼日尔儿童接受针灸治疗概况

本文介绍了尼日尔儿童接受针灸治疗的现状.30多年来,中国援外医疗队分别在马拉迪省中心医院、首都尼亚美国家医院、津德尔国家医院开设针灸科,由中国医师主持治疗工作.由于多种原因,目前,仅保留了马拉迪省中心医院针灸科,且与物理、康复疗法结合,组成运动疗法与功能训练科.儿童患者是针灸科接受治疗的主体,约占门诊量的2/3,主要以神经系统、运动系统疾病为主.     

Two new media Pinus halepensis seed agar and blackberry agar for rapid identification of Cryptococcus neoformans

Cryptococcus neoformans is an encapsulated yeast‐like fungus that causes life‐threatening infections, particularly in immunocompromised patients. The formation of brown pigment on many media described in the literature, such as that in Niger seed (Guizotia abyssinica) agar, has been used to identify C. neoformans. The present study compares melanin production by clinical and environmental isolates of C. neoformans and other medically important yeast on two new media, Pinus halepensis seed (PHS) agar and blackberry (BlaB) agar, and the classic medium Niger seed agar. Results obtained after the culture of 46 strains of C. neoformans, for 4, 24 and 48 h at 37 °C on these three media, showed that at 24 h, 100% of strains were pigmented on BlaB agar, 91.3% on PHS agar but only 34.8% on Niger seed agar. In conclusion, PHS and BlaB agar are two interesting new media for the rapid identification of C. neoformans isolates.     

Traffic air pollution and other risk factors for respiratory illness in schoolchildren in the niger-delta region of Nigeria

Background: Association of childhood respiratory illness with traffic air pollution has been investigated largely in developed but not in developing countries, where pollution levels are often very high.Objectives: In this study we investigated associations between respiratory health and outdoor and indoor air pollution in schoolchildren 7–14 years of age in low socioeconomic status areas in the Niger Delta.Methods: A cross-sectional survey was carried out among 1,397 schoolchildren. Exposure to home outdoor and indoor air pollution was assessed by self-report questionnaire. School air pollution exposures were assessed using traffic counts, distance of schools to major streets, and particulate matter and carbon monoxide measurements, combined using principal components analysis. Hierarchical logistic regression was used to examine associations with reported respiratory health, adjusting for potential confounders.Results: Traffic disturbance at home (i.e., traffic noise and/or fumes evident inside the home vs. none) was associated with wheeze [odds ratio (OR) = 2.16; 95% confidence interval (CI), 1.28–3.64], night cough (OR = 1.37; 95% CI, 1.03–1.82), phlegm (OR = 1.49; 95% CI, 1.09–2.04), and nose symptoms (OR = 1.40; 95% CI, 1.03–1.90), whereas school exposure to a component variable indicating exposure to fine particles was associated with increased phlegm (OR = 1.38; 95% CI, 1.09–1.75). Nonsignificant positive associations were found between cooking with wood/coal (OR = 2.99; 95% CI, 0.88–10.18) or kerosene (OR = 2.83; 95% CI, 0.85–9.44) and phlegm compared with cooking with gas.Conclusion: Traffic pollution is associated with respiratory symptoms in schoolchildren in a deprived area of western Africa. Associations may have been underestimated because of nondifferential misclassification resulting from limitations in exposure measurement.     

改良Swenson术治疗22例先天性巨结肠临床观察

目的探讨改良Swenson术治疗非洲尼日尔先天性巨结肠（Hirschsprungcs Disease,HD）的有效性和安全性。方法对2006年11月至2008年11月在非洲尼日尔援外工作期间采用改良Swenson术治疗22例先天性巨结肠（HD）患儿进行回顾性分析,对术后并发症情况进行评价。结果本组22例患儿均达到最大限度地保留肛门括约肌,保留其正常排便功能,术后无吻合口漏、切口裂开、感染等早期并发症及术后随访患儿无复发、肠梗阻、吻合口狭窄、大便失禁、腹泻、便秘、污裤等晚期并发症。结论改良Swenson术适用于常见型、短段型及长段型先天性巨结肠,具有较高的有效性和安全性。