AFRICSanté

Identifying molecular alterations specific to advanced lung adenocarcinomas could provide insights into tumour progression and dissemination mechanisms. We analysed tumour samples, either from locoregional lesions or distant metastases, from patients with advanced lung adenocarcinoma from the SAFIR02-Lung trial by targeted sequencing of 45 cancer genes and comparative genomic hybridisation array and compared them to early tumours samples from The Cancer Genome Atlas. Differences in copy-number alterations frequencies suggest the involvement in tumour progression of LAMB3, TNN/KIAA0040/TNR, KRAS, DAB2, MYC, EPHA3 and VIPR2, and in metastatic dissemination of AREG, ZNF503, PAX8, MMP13, JAM3, and MTURN. Conversely, no meaningful difference was found in pathogenic single-nucleotide variant frequencies, reinforcing the notion that they are early events in tumorigenesis. CDKN2A homozygous deletion was linked to poor clinical outcome in patients with early tumours (overall survival hazard ratio 2.17, 95% CI: 1.43-3.28, corrected p-value = 0.01). Furthermore, we found that KRAS mutant allele specific imbalance, i.e. focal amplification of the mutant allele, is more prevalent in locoregional or distant samples of metastatic patients than in early lesions (8.4%, 13% and 2.8% respectively). This observation was replicated in three public cohorts. Tumours with KRAS mutant allele specific imbalance show specific patterns of co-occurrence and mutual exclusion with alterations in key cancer genes like CDKN2A, TP53, STK11 and NKX2-1, often in a tumour type dependent manner. Advanced LUAD tumours exhibit higher copy-number alteration burden, with distinct alterations associated with tumour progression and metastasis. CDKN2A homozygous deletions predict poor prognosis in early disease, while KRAS mutant allele-specific imbalance is enriched in advanced tumours.

Objectives: A two-arm cluster randomized trial was designed to compare 2 approaches of behavior change communication for improved nutrition and women’s empowerment practices. Both intervention arms received monthly training sessions using village saving and loans associations (VSLA) as main delivery platform, while in one arm, influential men’s groups (called EBENE) were also trained to promote improved nutrition and women’s empowerment practices. Methods: Data were collected after one year of implementation in June and August 2023 through phone surveys in a composite sample of women pre-identified before the intervention including members of VSLA, women interested in VSLA and women of the general population. Mixed-effects regression models using fixed effects for treatment exposure and random effects at cluster level, were used to assess differential effects of the interventions on program participation, and knowledge and practices related to diets and women’s empowerment. Adjusted models estimated the effects of insecurity and of the EBENE intervention in the context of insecurity, adjusting for baseline characteristics associated to insecurity prior to its onset, to account for its non-random nature. Results: Unadjusted analyses found participation rates of 44% and 38% for training on nutrition and gender respectively, with no significant differences between intervention groups. The EBENE intervention was found to increase the likelihood that women felt encouraged by men to improve dietary practices and that women and children consumed poultry and eggs. Adjusted analyses suggested that though insecurity had a negative effect on program participation and diet diversity, the EBENE intervention had a protective effect on diet diversity in areas with higher insecurity. The EBENE intervention was found to have protective effects on women’s mobility, group membership and participation in decisions related to poultry production. Conclusions: In the context of increasing insecurity, nutrition and women’s empowerment behavior change promoted through VSLA platforms can be boosted by engaging influential men’s to promote improved practices. Further research is needed to better understand the costs and mechanisms involved. Funding Sources: Bill & Melinda Gates Foundation and CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by IFPRI.

Cysticercosis is a neglected tropical disease caused by the larval stage of the zoonotic tapeworm (Taenia solium). While there is a clear spatial component in the occurrence of the parasite, no geostatistical analysis of active human cysticercosis has been conducted yet, nor has such an analysis been conducted for Sub-Saharan Africa, albeit relevant for guiding prevention and control strategies. The goal of this study was to conduct a geostatistical analysis of active human cysticercosis, using data from the baseline cross-sectional component of a large-scale study in 60 villages in Burkina Faso. The outcome was the prevalence of active human cysticercosis (hCC), determined using the B158/B60 Ag-ELISA, while various environmental variables linked with the transmission and spread of the disease were explored as potential explanatory variables for the spatial distribution of T. solium. A generalized linear geostatistical model (GLGM) was run, and prediction maps were generated. Analyses were conducted using data generated at two levels: individual participant data and grouped village data. The best model was selected using a backward variable selection procedure and models were compared using likelihood ratio testing. The best individual-level GLGM included precipitation (increasing values were associated with an increased odds of positive test result), distance to the nearest river (decreased odds) and night land temperature (decreased odds) as predictors for active hCC, whereas the village-level GLGM only retained precipitation and distance to the nearest river. The range of spatial correlation was estimated at 45.0 [95%CI: 34.3; 57.8] meters and 28.2 [95%CI: 14.0; 56.2] km for the individual- and village-level datasets, respectively. Individual- and village-level GLGM unravelled large areas with active hCC predicted prevalence estimates of at least 4% in the south-east, the extreme south, and north-west of the study area, while patches of prevalence estimates below 2% were seen in the north and west. More research designed to analyse the spatial characteristics of hCC is needed with sampling strategies ensuring appropriate characterisation of spatial variability, and incorporating the uncertainty linked to the measurement of outcome and environmental variables in the geostatistical analysis. Trial registration: ClinicalTrials.gov; NCT0309339.

O objetivo deste projeto consiste em avaliar a disparidade de estudos de autismo entre mulheres e homens, as consequências dos estereótipos que foram formados por conta dessa disparidade de pesquisas e também o preconceito único que a mulher autista sofre. O artigo também discute maneiras positivas para prestar apoio a mulheres autistas de acordo com seus traços e experiências únicas, divergindo de tratamentos padronizados e buscando uma forma acolhedora de viver como autista; sem considerar o autismo como um absoluto de negativos ou positivos, mas uma parte do indivíduo da sociedade que sempre esteve e estará presente. Além disso, promove uma mudança de paradigma em relação ao autismo em si, visando eliminar estereótipos que omitem e/ou demonizam a existência da mulher autista e oferecendo uma versão inclusiva, objetiva e fácil de entender. O artigo contém a revisão de literatura específica sobre o autismo, desde sua origem como um traço de esquizofrenia infantil até os dias atuais no DSM-5; revisando os artigos de nomes conhecidos como Hans Aspergers e Leo Kanner, e também Grunya Sukhareva Efimovna, doutora judia que descreveu traços autistas duas décadas antes dos autores mencionados anteriormente. O artigo também explica a interseccionalidade da misoginia e capacitismo que a mulher autista sofre, com esse preconceito único lhe alienando de seus colegas.

Optimal nutrition is crucial during the critical period of the first 1,000 days from conception to 2 years after birth. Prenatal and postnatal supplementation of mothers with multimicronutrient-fortified balanced energy-protein (BEP) supplements is a potential nutritional intervention. However, evidence on the long-term effects of BEP supplementation on child growth is inconsistent. We evaluated the efficacy of daily fortified BEP supplementation during pregnancy and lactation on infant growth in rural Burkina Faso. A 2 × 2 factorial individually randomized controlled trial (MISAME-III) was implemented in 6 health center catchment areas in Houndé district under the Hauts-Bassins region. From October 2019 to December 2020, 1,897 pregnant women aged 15 to 40 years with gestational age <21 completed weeks were enrolled. Women were randomly assigned to the prenatal intervention arms receiving either fortified BEP supplements and iron-folic acid (IFA) tablets (i.e., intervention) or IFA alone (i.e., control), which is the standard of care during pregnancy. The same women were concurrently randomized to receive either of the postnatal intervention, which comprised fortified BEP supplementation during the first 6 months postpartum in combination with IFA for the first 6 weeks (i.e., intervention), or the postnatal control, which comprised IFA alone for 6 weeks postpartum (i.e., control). Supplements were provided by trained village-based project workers under direct observation during daily home visits. We previously reported the effect of prenatal BEP supplementation on birth outcomes. The primary postnatal study outcome was length-for-age z-score (LAZ) at 6 months of age. Secondary outcomes were anthropometric indices of growth (weight-for length and weight-for-age z-scores, and arm and head circumferences) and nutritional status (prevalence rates of stunting, wasting, underweight, anemia, and hemoglobin concentration) at 6 months. Additionally, the longitudinal prevalence of common childhood morbidities, incidence of wasting, number of months of exclusive breastfeeding, and trajectories of anthropometric indices from birth to 12 months were evaluated. Prenatal BEP supplementation resulted in a significantly higher LAZ (0.11 standard deviation (SD), 95% confidence interval (CI) [0.01 to 0.21], p = 0.032) and lower stunting prevalence (-3.18 percentage points (pp), 95% CI [-5.86 to -0.51], p = 0.020) at 6 months of age, whereas the postnatal BEP supplementation did not have statistically significant effects on LAZ or stunting at 6 months. On the other hand, postnatal BEP supplementation did modestly improve the rate of monthly LAZ increment during the first 12 months postpartum (0.01 z-score/month, 95% CI [0.00 to 0.02], p = 0.030), whereas no differences in growth trajectories were detected between the prenatal study arms. Furthermore, except for the trend towards a lower prevalence of underweight found for the prenatal BEP intervention at 6 months (-2.74 pp, 95% CI [-5.65 to 1.17], p = 0.065), no other secondary outcome was significantly affected by the pre- or postnatal BEP supplementation. This study provides evidence that the benefits obtained from prenatal BEP supplementation on size at birth are sustained during infancy in terms of linear growth. Maternal BEP supplementation during lactation may lead to a slightly better linear growth towards the second half of infancy. These findings suggest that BEP supplementation during pregnancy can contribute to the efforts to reduce the high burden of child growth faltering in low- and middle-income countries. ClinicalTrials.gov: NCT03533712.

Dans l’enseignement, les outils d’évaluation de la qualité, notamment ceux qui donnent la parole aux étudiants, se sont largement répandus ces dernières années. Ces outils, et les processus dans lesquels ils s’inscrivent, visent à évaluer la qualité de divers objets : l’enseignement, les programmes, les apprentissages, etc. Si l’évaluation est pensée dans une perspective formative, visant le développement professionnel de l’objet évalué (formateur ou filière de formation par exemple), alors il est légitime de se demander si les outils évaluatifs utilisés servent effectivement ce développement. Dans cet article, nous nous interrogeons sur la qualité de la formation dans une institution de l’enseignement supérieur et commençons par identifier trois niveaux d’éléments qui sont supposés l’influencer. Nous proposons ensuite une démarche d’analyse d’outils évaluatifs visant à déterminer dans quelle mesure ceux-ci interrogent la perception des étudiants sur ces éléments d’influence. En présentant cette démarche de manière aussi générale que possible, nous visons sa transférabilité à divers contextes de formation supérieure. En illustrant enfin cette approche par une mise en pratique dans le contexte d’une haute école pédagogique suisse, destinée à former des enseignants, nous montrons en quoi elle améliore la compréhension de l’outil évaluatif étudié, en favorise son évolution ou encore soutient le pilotage d’une filière de formation. Nous finissons par identifier certaines limites de cette démarche et en esquissons quelques pistes d’évolution possibles.

Balanced energy protein (BEP) supplementation for pregnant and lactating women in low‐ and middle‐income countries is a promising strategy to improve birth outcomes and child growth. The objective of this study was to assess and compare the acceptability of new formulations of two fortified BEP supplements, a lipid‐based peanut paste and a vanilla biscuit, among 80 pregnant women in rural Burkina Faso, prior to an efficacy trial. A 10‐week individually randomized cross‐over study was designed, in which women received a weekly supply of each supplement for 4 weeks, and a daily choice between the supplements in the last 2 weeks. Questionnaires to assess daily consumption and supplement acceptability (n = 80) and home observations (n = 20) were combined with focus group discussions (n = 6) and in‐depth interviews with women (n = 80) and stakeholders (n = 24). Results showed that the two supplements were well accepted. Quantitative findings indicated high compliance (>99.6%) and high overall appreciation (Likert score >6 out of 7) of both supplements. The assessment of preferred choice in Weeks 9 and 10 indicated a slight preference for the vanilla biscuit. Qualitative findings indicated that perceived health benefits, support from household members and educational messages from health professionals were important drivers for acceptance and compliance. Sharing was not often reported but was identified during interviews as a possible risk. We recommend that future studies use a combination of methods to identify appropriate food supplements and context‐specific factors that influence acceptability, compliance and subsequent impact of nutritious food supplements.

ObjectiveAlthough distance has been identified as an important barrier to care, evidence for an effect of distance to care on child mortality is inconsistent. We investigated the association of distance to care with self‐reported care seeking behaviours, neonatal and post‐neonatal under‐five child mortality in rural areas of Burkina Faso.MethodsWe performed a cross‐sectional survey in 14 rural areas from November 2014 to March 2015. About 100 000 women were interviewed on their pregnancy history and about 5000 mothers were interviewed on their care seeking behaviours. Euclidean distances to the closest facility were calculated. Mixed‐effects logistic and Poisson regressions were used respectively to compute odds ratios for care seeking behaviours and rate ratios for child mortality during the 5 years prior to the survey.ResultsThirty per cent of the children lived more than 7 km from a facility. After controlling for confounding factors, there was a strong evidence of a decreasing trend in care seeking with increasing distance to care (P ≤ 0.005). There was evidence for an increasing trend in early neonatal mortality with increasing distance to care (P = 0.028), but not for late neonatal mortality (P = 0.479) and post‐neonatal under‐five child mortality (P = 0.488). In their first week of life, neonates living 7 km or more from a facility had an 18% higher mortality rate than neonates living within 2 km of a facility (RR = 1.18; 95%CI 1.00, 1.39; P = 0.056). In the late neonatal period, despite the lack of evidence for an association of mortality with distance, it is noteworthy that rate ratios were consistent with a trend and similar to or larger than estimates in early neonatal mortality. In this period, neonates living 7 km or more from a facility had an 18% higher mortality rate than neonates living within 2 km of a facility (RR = 1.18; 95%CI 0.92, 1.52; P = 0.202). Thus, the lack of evidence may reflect lower power due to fewer deaths rather than a weaker association.ConclusionWhile better geographic access to care is strongly associated with increased care seeking in rural Burkina Faso, the impact on child mortality appears to be marginal. This suggests that, in addition to improving access to services, attention needs to be paid to quality of those services.