Establishing Surgical Care Sustainability in Sub-Saharan Africa for Global Child Health: Insights From Pediatric Cardiac Surgical Capacity-Building Programs in Ethiopia and Côte d'Ivoire

The global surgery research team of the JW LEE Center for Global Medicine, Seoul National University College of Medicine, introduced team-based health workforce training programs for pediatric cardiac surgery in Ethiopia and Côte d'Ivoire. A team-based collaborative capacity-building model was implemented in both countries, and details of the program design and delivery were documented. The research team shared their experiences and identified achievements, lessons, and challenges for cardiac surgical interventions in Sub-Saharan Africa. Future directions were put forward to advance and strengthen the low-and middle-income countries “Safe Surgery.”

Apports des images Landsat à la dynamique de l’occupation du sol et à l'analyse des conflits d’usage dans le département de Dianra au nord de la Côte d’Ivoire

Localisé dans la zone d’extension pastorale au nord de la Côte d’Ivoire, le département de Dianra subit une recomposition des formes spatiales qui structurent son territoire. L’enjeu majeur de l’analyse des mutations socio-écologiques dans ce contexte est l’identification des différents types de conflits d’usage liés à la dynamique de l’occupation du sol obtenue à partir des techniques de la télédétection. L’étude s’est effectuée d’une part sur la base de l’analyse d’images satellite Landsat à 3 dates différentes 1986, 2001 et 2016 et d’autre part sur la mobilisation de données collectées à partir de la recherche bibliographique et d’enquêtes de terrain dans le cadre d’une approche visant à comprendre l’évolution des règles, des normes et des comportements liés à l’usage des ressources naturelles. Les données recueillies ont permis de séquencer cette évolution en deux périodes : la période de 1986 à 2001 qui est caractérisée par une abondance des ressources ligneuses : 70 % de savane (savane arbustive et savane arborée) en 1986 et 16 % de forêt dense sèche et de forêt-galerie. Cette phase est marquée par une gestion communautaire des ressources naturelles. Tandis que la deuxième période de 2001 à 2016 est caractérisée par la diminution des ressources ligneuses : 37 % de savane (savane arbustive et savane arborée) et 2 % de forêt dense sèche et de forêt- galerie. La dynamique de l’occupation du sol conduit au rétrécissement des pâtures naturelles et au morcellement de l’espace. Cela engendre des conflits d’usage, de plus en plus récurrents entre agriculteurs d’anacarde et éleveurs qui ont des visions antagonistes de l’usage de l’espace et des conflits hégémoniques entre des villages pour le contrôle des espaces.

Is it possible to recruit HIV self-test users for an anonymous phone-based survey using passive recruitment without financial incentives? Lessons learned from a pilot study in Côte d’Ivoire

Background Due to the discreet and private nature of HIV self-testing (HIVST), it is particularly challenging to monitor and assess the impacts of this testing strategy. To overcome this challenge, we conducted a study in Côte d’Ivoire to characterize the profile of end users of HIVST kits distributed through the ATLAS project (AutoTest VIH, Libre d’Accéder à la connaissance de son Statut). Feasibility was assessed using a pilot phone-based survey. Methods The ATLAS project aims to distribute 221300 HIVST kits in Côte d’Ivoire from 2019 to 2021 through both primary (e.g., direct distribution to primary users) and secondary distribution (e.g., for partner testing). The pilot survey used a passive recruitment strategy—whereby participants voluntarily called a toll-free survey phone number—to enrol participants. The survey was promoted through a sticker on the HIVST instruction leaflet and hotline invitations and informal promotion by HIVST kit-dispensing agents. Importantly, participation was not financially incentivized, even though surveys focussed on key populations usually use incentives in this context. Results After a 7-month period in which 25,000 HIVST kits were distributed, only 42 questionnaires were completed. Nevertheless, the survey collected data from users receiving HIVST kits via both primary and secondary distribution (69% and 31%, respectively). Conclusion This paper provides guidance on how to improve the design of future surveys of this type. It discusses the need to financial incentivize participation, to reorganize the questionnaire, the importance of better informing and training stakeholders involved in the distribution of HIVST, and the use of flyers to increase the enrolment of users reached through secondary distribution.

The cost of tsetse control using ‘Tiny Targets’ in the sleeping sickness endemic forest area of Bonon in Côte d’Ivoire: Implications for comparing costs across different settings

Background Work to control the gambiense form of human African trypanosomiasis (gHAT), or sleeping sickness, is now directed towards ending transmission of the parasite by 2030. In order to supplement gHAT case-finding and treatment, since 2011 tsetse control has been implemented using Tiny Targets in a number of gHAT foci. As this intervention is extended to new foci, it is vital to understand the costs involved. Costs have already been analysed for the foci of Arua in Uganda and Mandoul in Chad. This paper examines the costs of controlling Glossina palpalis palpalis in the focus of Bonon in Côte d’Ivoire from 2016 to 2017. Methodology/Principal findings Some 2000 targets were placed throughout the main gHAT transmission area of 130 km2 at a density of 14.9 per km2. The average annual cost was USD 0.5 per person protected, USD 31.6 per target deployed of which 12% was the cost of the target itself, or USD 471.2 per km2 protected. Broken down by activity, 54% was for deployment and maintenance of targets, 34% for tsetse surveys/monitoring and 12% for sensitising populations. Conclusions/Significance The cost of tsetse control per km2 of the gHAT focus protected in Bonon was more expensive than in Chad or Uganda, while the cost per km2 treated, that is the area where the targets were actually deployed, was cheaper. Per person protected, the Bonon cost fell between the two, with Uganda cheaper and Chad more expensive. In Bonon, targets were deployed throughout the protected area, because G. p. palpalis was present everywhere, whereas in Chad and Uganda G. fuscipes fuscipes was found only the riverine fringing vegetation. Thus, differences between gHAT foci, in terms of tsetse ecology and human geography, impact on the cost-effectiveness of tsetse control. It also demonstrates the need to take into account both the area treated and protected alongside other impact indicators, such as the cost per person protected.