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.

Prevalence of Schistosoma mono- and co-infections with multiple common parasites and associated risk factors and morbidity profile among adults in the Taabo health and demographic surveillance system, South-Central Côte d’Ivoire

Background Schistosomiasis remains an important public health problem, also among adults, and infected individuals not treated serve as a reservoir for continued transmission. Despite this fact, evidence on the epidemiology of schistosomiasis in adults in Côte d’Ivoire is scanty. This study aimed to determine the prevalence and risk factors of Schistosoma infection and co-infection with other helminth species and Plasmodium among adults in the Taabo region in the south-central part of Côte d’Ivoire. Methods A cross-sectional survey was carried out in April and May 2017 in the frame of the “Côte d’Ivoire Dual Burden of Disease Study” (CoDuBu). A total of 901 randomly selected individuals, aged 18–90 years, provided blood, stool and urine samples for the diagnosis of malaria and helminth infections. Stool samples were subjected to the Kato-Katz technique for detection of Schistosoma mansoni and soil-transmitted helminth eggs, while urine samples were examined for eggs of Schistosoma haematobium and circulating cathodic antigen of S. mansoni. Risk factors and morbidity profiles were assessed using health examination and questionnaires. Multinomial logistic regressions were employed to identify risk factors and morbidity patterns associated with S. mansoni mono- and co-infections. Results The prevalence of S. mansoni and S. haematobium was 23.2% and 1.0%, respectively. Most S. mansoni were mono-infections (81.3%). Independent determinants of S. mansoni infection were young age, low socioeconomic status (mono- and co-infection) and poor hygiene practices (co-infection) (P < 0.05). S. mansoni infection was independently associated with higher pain and symptom scores (mono-infection), poor self-rated health and low healthcare use (co-infection) (P < 0.05). Conclusions This study showed that adults represent a substantial reservoir of S. mansoni. To sustain schistosomiasis control and improve people’s wellbeing, it is important to expand preventive chemotherapy from school-aged children to adults, coupled with hygiene and health education.