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Buruli ulcer (BU) is a severe necrotizing human skin disease caused by Mycobacterium ulcerans. Clinically, presentation is a sum of these diverse pathogenic hits subjected to critical immune-regulatory mechanisms. Among them, autophagy has been demonstrated as a cellular process of critical importance. Since microtubules and dynein are affected by mycolactone, the critical pathogenic exotoxin produced by M. ulcerans, cytoskeleton-related changes might potentially impair the autophagic process and impact the risk and progression of infection. Genetic variants in the autophagy-related genes NOD2, PARK2 and ATG16L1 has been associated with susceptibility to mycobacterial diseases. Here, we investigated their association with BU risk, its severe phenotypes and its progression to an ulcerative form. Genetic variants were genotyped using KASPar chemistry in 208 BU patients (70.2% with an ulcerative form and 28% in severe WHO category 3 phenotype) and 300 healthy endemic controls. The rs1333955 SNP in PARK2 was significantly associated with increased susceptibility to BU [odds ratio (OR), 1.43; P = 0.05]. In addition, both the rs9302752 and rs2066842 SNPs in NOD2 gee significantly increased the predisposition of patients to develop category 3 (OR, 2.23; P = 0.02; and OR 12.7; P = 0.03, respectively, whereas the rs2241880 SNP in ATG16L1 was found to significantly protect patients from presenting the ulcer phenotype (OR, 0.35; P = 0.02). Our findings indicate that specific genetic variants in autophagy-related genes influence susceptibility to the development of BU and its progression to severe phenotypes.

The sterilization of surgical drapes plays an important role in preventing infections associated with treatments. At the CNHU-HKM, sterilization procedure for drapes encounters problems. The purpose of this study was to examine the factors associated with the quality of sterilization of surgical drapes at the CNHU-HKM. We conducted a cross-sectional, descriptive and analytical study focusing on 20 sterile surgical drapes, 41 agents were involved in the management of drapes and 55 members of the surgical team. The probabilistic method was used for sterile surgical drapes, the non-probabilistic method for the others. Pearson's Chi-square Test and logistic regression were used to find the association, with a significant threshold and a p<0.05. Eighty six point forty six percent of subjects were males with an average age of 42 years. The quality of the process of sterilization of the operative drapes was not good in the two departments responsible for processing the drapes. Bacteriological analysis showed that, out of 20 sterile surgical drapes, 9 had Acinetobacter spp. a multidrug-resistant germ causing nosocomial infections. Multivariate analysis showed that professional experience (p=0.015) and quality control of the procedure (p=0.034) were statistically associated with the quality of sterilization. The presence of Acinetobacter spp. on the sterilized drapes demonstrates that sterilization of drapes at the CNHU-HKM is of poor quality. Measures strengthening the skills of providers are necessary to improve the quality of sterilization procedures.

Widespread resistance to pyrethroids threatens malaria control in Africa. Consequently, several countries switched to carbamates and organophophates insecticides for indoor residual spraying. However, a mutation in the ace-1 gene conferring resistance to these compounds ( ace-1 R allele), is already present. Furthermore, a duplicated allele ( ace-1 D ) recently appeared; characterizing its selective advantage is mandatory to evaluate the threat. Our data revealed that a unique duplication event, pairing a susceptible and a resistant copy of the ace-1 gene spread through West Africa. Further investigations revealed that, while ace-1 D confers less resistance than ace-1 R , the high fitness cost associated with ace-1 R is almost completely suppressed by the duplication for all traits studied. ace-1 duplication thus represents a permanent heterozygote phenotype, selected and thus spreading, due to the mosaic nature of mosquito control. It provides malaria mosquito with a new evolutionary path that could hamper resistance management.

IntroductionLes patients hospitalisés en Afrique intertropicale sont exposés à un risque des infections nosocomiales. La rareté des données publiées sur le sujet limite l’analyse descriptive de la situation. L’objectif de ce travail était de déterminer l’incidence, les germes en cause et les facteurs de risque des infections nosocomiales urinaires et des sites opératoires à la maternité de l’HGR Katuba de Lubumbashi en République Démocratique du Congo(DRC).MéthodesNous avons réalisé une étude descriptive longitudinale de la période allant du 1er octobre 2014 au 1er Janvier 2015. Notre population d’étude était constituée de 207 femmes ayant séjourné dans cette maternité. La collecte de données était réalisée d’une manière exhaustive.RésultatsL’incidence de ces infections nosocomiales était de 15,5%. Les parturientes ayant passé plus de trois jours à l'hôpital avaient trois fois plus de risque de développer une infection nosocomiale (p = 0,003) tandis que celles qui ont eu un accouchement avec complication avaient quatre fois plus de risque de contracter une infection nosocomiale (p = 0,000). Escherichia coli était l'agent causal le plus isole (38,1%), suivi de Citrobacter freundii (23,8%), Acinobacter baumannii (18, 2%), Staphylococcus aureus (18,2%), Enterococcus feacalis (14,3%) et Pseudomonas aeruginosa (9,1%). L'ampicilline était l'antibiotique le plus prescrit auquel tous les microbes isoles ont été résistants.ConclusionIl faut améliorer des conditions d’hygiène hospitalière; mais aussi une étude ultérieure pour étudier la ressemblance entre les souches des germes de l’environnement et celles trouvés dans les liquides biologiques.

Health information systems in developing countries are often faulted for the poor quality of the data generated and for the insufficient means implemented to improve system performance. This study examined data quality in the Routine Health Information System in Benin in 2012 and carried out a cross-sectional evaluation of the quality of the data using the Lot Quality Assurance Sampling method. The results confirm the insufficient quality of the data based on three criteria: completeness, reliability and accuracy. However, differences can be seen as the shortcomings are less significant for financial data and for immunization data. The method is simple, fast and can be proposed for current use at operational level as a data quality control tool during the production stage. Les systèmes d’information sanitaire des pays en développement sont souvent blâmés pour la mauvaise qualité des données générées et l’insuffisance des moyens mis en œuvre pour améliorer les performances du système Cette étude a examiné la qualité des données dans le système d’information sanitaire de routine au Bénin en 2012 et a effectué une évaluation transversale de la qualité des données en utilisant la méthode du contrôle par échantillonnage de la qualité des lots. Les résultats confirment la qualité insuffisante des données en se basant surtrois critères: exhaustivité, fiabilité et précision. Toutefois, des différences peuvent apparaître puisque les lacunes sont moins notables pour les données financières et les données de vaccination. La méthode est simple, rapide et peut être proposée pour une utilisation courante au niveau opérationnel comme un outil de contrôle de la qualitédes données au cours de la phase de production. 在发展中国家医疗信息系统经常因为收集的数据质量低和改 善系统的方法不充足而被诟病。本研究检查了 2012 年在贝宁 常规医疗信息系统的数据质量，并使用批质量检验抽样方法 对这些数据的质量进行了一项代表性评估。研究结果根据完 整性、可靠性和准确性这三个指标肯定了数据质量的确不够 优质。然而，数据之间是有差别的，可以看到资金数据和免 疫数据的缺陷较为不显著。本方法简单，快速，可以作为一 个在产出阶段的数据质量控制工具在操作层面使用。 Los sistemas de información de la salud en países en vía de desarrollo son a menudo criticados por la mala calidad de la información que se genera y por los insuficientes recursos que se aplican para mejorar el desempeño del sistema. Este estudio examinó la calidad de los datos en el Sistema Rutinario de Información de la Salud en Benín en 2012 y ejecutó una evaluación transversal de la calidad de la información utilizando el método de Muestreo de Garantía de la Calidad del Lote. Los resultados confirman la insuficiente calidad de la información basada en tres criterios: integridad, fiabilidad y precisión. Sin embargo, las diferencias pueden ser vistas ya que las deficiencias son menos significativas para la información financiera y para los datos de inmunización. El método es sencillo, rápido y puede ser propuesto para su uso actual a niveles operacionales como una herramienta de control de la calidad de la información durante la etapa de producción.

Background Identification of variation in Ace - 1 copy number and G119S mutation genotype from samples of Anopheles gambiae and Anopheles coluzzii across West Africa are important diagnostics of carbamate and organophosphate resistance at population and individual levels. The most widespread and economical method, PCR–RFLP, suffers from an inability to discriminate true heterozygotes from heterozygotes with duplication. Methods In addition to PCR–RFLP, in this study three different molecular techniques were applied on the same mosquito specimens: TaqMan qPCR, qRTPCR and ddPCR. To group heterozygous individuals recorded from the PCR–RFLP analysis into different assumptive genotypes K-means clustering was applied on the Z-scores of data obtained from both the TaqMan and ddPCR methods. The qRTPCR analysis was used for absolute quantification of copy number variation. Results The results indicate that most heterozygotes are duplicated and that G119S mutation must now be regarded as a complex genotype ranging from primarily single-copy susceptible Glycine homozygotes to balanced and imbalanced heterozygotes, and multiply-amplified resistant Serine allele homozygotes. Whilst qRTPCR-based gene copy analysis suffers from some imprecision, it clearly illustrates differences in copy number among genotype groups identified by TaqMan or ddPCR. Based on TaqMan method properties, and by coupling TaqMan and ddPCR methods simultaneously on the same type of mosquito specimens, it demonstrated that the TaqMan genotype assays associated with the K-means clustering algorithm could provide a useful semi-quantitative estimate method to investigate the level of allele-specific duplication in mosquito populations. Conclusions Ace - 1 gene duplication is evidently far more complex in An. gambiae and An. coluzzii than the better-studied mosquito Culex quinquefasciatus , which consequently can no longer be considered an appropriate model for prediction of phenotypic consequences. These require urgent further evaluation in Anopheles . To maintain the sustained effectiveness carbamates and organophosphates as alternative products to pyrethroids for malaria vector control, monitoring of duplicated resistant alleles in natural populations is essential to guide the rational use of these insecticides.

Background Malaria is endemic in sub-Saharan Africa with considerable burden for human health. Major insecticide resistance mechanisms such as kdr R and ace-1 R alleles constitute a hindrance to malaria vector control programs. Anopheles gambiae bearing both kdr and ace-1 resistant alleles are increasingly recorded in wild populations. In order to maintain the efficacy of vector control strategies, the characterization of concomitant kdr and ace-1 resistance, and their pleiotropic effects on malaria vector phenotype on insecticide efficacy are important. Methods Larval and adult bioassays were performed with different insecticide classes used in public health following WHO standard guidelines on four laboratory Anopheles gambiae strains, sharing the same genetic background but harboring distinct resistance status: KISUMU with no resistance allele; ACERKIS with ace-1 R allele; KISKDR with kdr R allele and ACERKDRKIS with both resistance alleles’ ace-1 R and kdr R . Results Larval bioassays indicate that the homozygote resistant strain harboring both alleles (ACERKDRKIS) displayed slightly but significantly higher resistance level to various insecticides like carbamates (bendiocarb, p  < 0.001; propoxur, p  = 0.02) and organophosphates (chlorpyriphos-methyl, p  = 0.002; fenitrothion, p  < 0.001) when compared to ACERKIS strain. However, no differences were recorded between ACERKDRKIS and KISKDR resistance level against permethrin (Pyrethroid, p  = 0.7) and DDT (Organochlorine, p  = 0.24). For adult bioassays, the percentages of mosquitoes knocked down were significantly lower for ACERKDRKIS than for KISKDR with permethrin ( p  = 0.003) but not with deltamethrin. The percentage of mortality from adult bioassays was similar between ACERKDRKIS and ACERKIS with carbamates and organophosphates, or between ACERKDRKIS and KISKDR with pyrethroid and DDT. Concerning acetylcholinesterase enzyme, ACERKDRKIS strain showed similarAChE1 activity than that of ACERKIS. Conclusion The presence of both kdr R and ace-1 R alleles seems to increase the resistance levels to both carbamate and organophosphate insecticides and at operational level, may represent an important threat to malaria vector control programs in West Africa.

Mycobacterium ulcerans disease (Buruli ulcer) is the most widespread mycobacterial disease in the world after leprosy and tuberculosis. How M. ulcerans is introduced into the skin of humans remains unclear, but it appears that individuals living in the same environment may have different susceptibilities. This study aims to determine whether frequent contacts with natural water sources, family relationship or the practice of consanguineous marriages are associated with the occurrence of Buruli ulcer (BU). Case control study. Department of Atlantique, Benin. BU-confirmed cases that were diagnosed and followed up at the BU detection and treatment center (CDTUB) of Allada (Department of the Atlantique, Benin) during the period from January 1st, 2006, to June 30th, 2008, with three matched controls (persons who had no signs or symptoms of active or inactive BU) for age, gender and village of residence per case. Contact with natural water sources, BU history in the family and the practice of consanguineous marriages. A total of 416 participants were included in this study, including 104 cases and 312 controls. BU history in the family (p<0.001), adjusted by daily contact with a natural water source (p = 0.007), was significantly associated with higher odds of having BU (OR; 95% CI = 5.5; 3.0-10.0). The practice of consanguineous marriage was not associated with the occurrence of BU (p = 0.40). Mendelian disorders could explain this finding, which may influence individual susceptibility by impairing immunity. This study suggests that a combination of genetic factors and behavioral risk factors may increase the susceptibility for developing BU.

Background Routine health information systems (RHIS) are crucial to the acquisition of data for health sector planning. In developing countries, the insufficient quality of the data produced by these systems limits their usefulness in regards to decision-making. The aim of this study was to identify the factors associated with poor data quality in the RHIS in Benin. Methods This cross-sectional descriptive and analytical study included health workers who were responsible for data collection in public and private health centers. The technique and tools used were an interview with a self-administered questionnaire. The dependent variable was the quality of the data. The independent variables were socio-demographic and work-related characteristics, personal and work-related resources, and the perception of the technical factors. The quality of the data was assessed using the Lot Quality Assurance Sampling method. We used survival analysis with univariate proportional hazards (PH) Cox models to derive hazards ratios (HR) and their 95% confidence intervals (95% CI). Focus group data were evaluated with a content analysis. Results A significant link was found between data quality and level of responsibility (p = 0.011), sector of employment (p = 0.007), RHIS training (p = 0.026), level of work engagement (p < 0.001), and the level of perceived self-efficacy (p = 0.03). The focus groups confirmed a positive relationship with organizational factors such as the availability of resources, supervision, and the perceived complexity of the technical factors. Conclusion This exploratory study identified several factors associated with the quality of the data in the RHIS in Benin. The results could provide strategic decision support in improving the system’s performance.

We investigated the possible relationship between the agricultural use of insecticides and the emergence of insecticide resistance. Bioassays were conducted using simulated mosquito larval habitats and well known Anopheles gambiae strains. Soil samples were collected from vegetable production areas in Benin, including one site with insecticide use, one site where insecticides had not been used for two months, and a third where insecticides had not been used. Pupation and emergence rates were very low in pyrethroid-susceptible strains when exposed to soil that had been recently exposed to insecticides. Pupation and emergence rates in strains with the kdr mutation alone or both the kdr and Ace-1 mutations were much higher. Overall, strains with the kdr mutation survived at higher rates compared to that without kdr mutation. Although this study is observational, we provide indirect evidence indicating that soils from agricultural areas contain insecticide residues that can play a role in the emergence of insecticide resistance in Anopheles. This aspect should be taken into account to better utilize the insecticide in the context of integrated pest management programs.