[Therapeutic education in Mali: a training workshop for caregivers and young type 1 diabetic patients]

In March 2021, in the framework of a partnership between the Geneva University Hospitals (HUG), the Santé Diabète Organization and the Ministry of Health of Mali, a 4-day workshop training course was organized with the objective of strengthening the skills of caregivers in Therapeutic Patient Education (TPE) for children and young people with type 1 diabetes. To ensure interprofessionalism, physician-nurse pairs already working together in health structures in 7 regions of Mali participated in the training. Beyond complementarity between health professionals, the aim was to cope with the realities of the Malian health system. All activities were co-chaired by physician-nurse pairs, specialized in diabetes and in TPE. A total of 30 professionals took part in the training, which consisted of 2 days of classroom training and 2 days of hands-on training with type 1 diabetic children and their families. To build the caregivers capacity in TPE, we chose innovative approaches with activities allowing the immediate application of skills learned with various pedagogical tools. The beneficiaries are not only the professionals, but also the children, teenagers and their families, including the trainers.

[Impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital]

The new coronavirus pandemic (COVID-19) is the main global health crisis of our time and the greatest threat we have faced in this century. According to the National Health Security Agency (ANSS), which is the national body responsible for managing epidemics and pandemics, 1927 cases of COVID-19 were confirmed, 11 deaths with more than 4000 contact subjects. The objective of this study was to assess the impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital. This was a descriptive retrospective study from January 2020 to April 2020, focusing on consultation and hospitalisation activities in the cardiology department of Ignace Deen National Hospital at Conakry University Hospital. The study consisted of assessing the impact of the pandemic on patient use of the service during the first weeks of the pandemic. We recorded the frequency of consultations and hospitalisations from March to April 2020, which we compared to the frequency of consultations and hospitalisations in January and February 2020. During this study from March to April 2020, we identified 130 patients in consultation against 450 patients for the two months preceding the official declaration of the pandemic in Guinea, a drop of 71.1% (320 patients). The same remark was made in hospitalisation with a drop of 75% (35 patients against 140 for the two months preceding the pandemic). At the start of the COVID-19 pandemic in Guinea, it is clear that there has been a rapid and significant drop in the effective use of the cardiology service.

High prevalence, low awareness, treatment and control rates of hypertension in Guinea: results from a population-based STEPS survey

Hypertension is a major and fast-growing public health problem in Africa. We determined the prevalence of hypertension and assessed the levels of awareness, treatment and control in Guinea. A cross-sectional study based on a stratified cluster random sampling was conducted. In all, 2491 adults (1351 women) aged 15-64 years were selected and screened during September-December 2009. Hypertension (systolic (and/or diastolic) blood pressure ⩾140 (90) mm Hg or use of antihypertensive medications) and diabetes mellitus (fasting capillary glucose ⩾110  mg dl(-1) or use of antidiabetic medications) were determined. Logistic regressions were used to investigate the determinants of hypertension. The mean body mass index was 22.4  kg m(-2) (s.d.=4.5). The prevalence of hypertension and diabetes was, respectively, 29.9% (95% confidence interval (CI) 29.8-30.0) and 3.5% (95%CI 3.4-3.5). The prevalence of hypertension was 29.4% (29.3-29.5) in men and 30.4% (30.4-30.6) in women. The prevalence was 62.5% in the 44-64 years age group. Overall, 75.8% of hypertensive participants were undetected before the survey and 34.9% of those aware of their hypertensive status were receiving treatment, of whom 16.3% were at target control levels. Age, education, diabetes and obesity were the main factors associated with hypertension. There was a high prevalence of hypertension among the adults in Guinea, but with low awareness, treatment and control rates. Urgent response is needed in the form of integrated and comprehensive action targeting major non-communicable diseases in the country.

[Epidemiology of bacillary pulmonary tuberculosis according to HIV status of patients followed in the department of infectious diseases Conakry (Guinea)]

Despite many efforts of prevention and the availability of free treatment, TB/HIV co-infection is still rampant in Guinea. The objective of this study was to describe the epidemiology of smear positive pulmonary tuberculosis according to HIV status among patients hospitalized in the infectious diseases department of Conakry University Hospital. This was a descriptive and analytical retrospective study of patient records admitted for pulmonary tuberculosis from January 2003 to December 2012. During this period, 1953 cases of tuberculosis were collected of which 346 (17.7%) were smear positive. There was a marked male predominance (59.7%). The average age was 38 ± 11 years. The majority of patients originated from the suburbs of Conakry and its surrounding prefectures (76.7%). People without profession were most represented (40.7%). A level of primary education was the most frequently reported (39.7%). Out of 325 patients tested for HIV, the serology was positive in 185 patients (56.9%). A contact with a TB patient was reported in 21.4% of HIV negative patients, and in 6.5% of the HIV-positive group (p = 0.0006). There was no difference between the two groups regarding clinical signs and symptoms. The mean CD4 count was comparable in both groups (p = 0.05). Lethality was higher among co-infected patients (30.4% against 15.56%; p = 0.00037). Strengthening the prevention of TB among PLWHA by the administration of isoniazide seems necessary and warrants further study on this subject in Guinea.

Contagious bovine pleuropneumonia vaccines: the current situation and the need for improvement

The control of contagious bovine pleuropneumonia (CBPP) has been clearly identified by the Organisation of African Unity/Inter-African Bureau of Animal Resources as a priority. In the first part of this article, the authors introduce the past and present vaccines, based on the two classic strains, T1, and KH3J. They describe the guidelines for vaccine production technology, and the quality control requirements for CBPP vaccines of the Office International des Epizooties. The failure of the currently used T1-SR vaccine to provoke satisfactory immunity in cattle, particularly in the newly infected areas of Africa, is pointed out. Other shortcomings of the current CBPP vaccines are also highlighted. Thus, there is a need to improve CBPP vaccines and the authors propose detailed emergency measures to address this problem. In the second part of the article, a subunit approach using immunostimulating complex technology is outlined. The authors emphasise the importance of current research in cell-mediated immunity and immunopathology, which is aimed at improving the efficacy of CBPP vaccines.

Regulatory framework and requirements for managing risks associated with veterinary biological products in Africa: present systems and future needs

Veterinary vaccines are considered to be medicinal products. As such, they are subject to assessment for managing risks associated with their marketing and use. The current risk assessment procedures used in Africa are based on the quality testing methods standardised by the Pan-African Veterinary Vaccine Centre (PANVAC). The authors examine the risk assessment procedures related to the importation of products and to the release of live products into the environment. The lack of infrastructures, specialised personnel and financial resources prevents each individual country from establishing its own system for managing the risks associated with the importation of veterinary vaccines. Regional co-operation between African countries is therefore recommended, and must be based on the existing PANVAC network for the quality testing of priority vaccines. This is justified by the results obtained by PANVAC in the standardisation of production technologies for vaccines against rinderpest and contagious bovine pleuropneumonia, and in other areas. The authors recommend that PANVAC be used to aid regional co-operation in Africa in the management of risks associated with the marketing and use of veterinary vaccines.

Contagious bovine pleuropneumonia vaccines: the need for improvements

Contagious bovine pleuropneumonia (CBPP) vaccines are routinely used only in Africa. The vaccines are usually produced from one of two strains (T1/44 and KH3J), each of which has a streptomycin-resistant variant. The necessity for a 'master seed strain' is evident. At least one manufacturer in Africa produces a broth culture vaccine, while others produce a freeze-dried product. A standardised manufacturing protocol needs to be developed, together with in-process and final product quality control procedures. Some CBPP vaccine manufacturing procedures do not allow sufficient leeway for the execution of typical quality control practices. For example, it is difficult to perform batch testing on broth culture vaccine, as the vaccine is produced in its final container. Quality control test results from the Pan African Veterinary Vaccine Centre (PANVAC) are analysed in terms of causes of batch failure and indicators for process development. Taking potency as an example, most vaccine batches tested by PANVAC pass only at the limit of the OIE minimum requirement of 10(7) colony-forming units per dose. To improve the titre of the vaccine, it will be necessary to modify the manufacturing process, either by increasing mycoplasma yield during the culture phase or by minimising losses during downstream processes, especially freeze-drying. Data on inactivated vaccines are scarce. Duration of the immunity achieved with live CBPP vaccines is relatively short, in comparison with other live vaccines. Data may be required on the molecular basis of virulence and immunogenicity, as well as on the molecular immunology of CBPP, to enable the development of improved vaccines.

[Vaccination strategies for contagious bovine pleuropneumonia in Africa]

Contagious bovine pleuropneumonia (CBPP) is regarded as the second most important disease of cattle in Africa. The disease was eradicated from Europe through drastic slaughter campaigns with quarantine and restriction of cattle movements. CBPP was mastered in Australia using these methods combined with vaccination. However, the disease remains endemic in Asia and Africa, where it inhibits livestock farming. In these continents, vaccination is the preferred means of control; the aim is to reduce incidence until complementary disease control measures can be applied. The success of a vaccination campaign depends on four main factors: good planning and good organisation; staff who are well-trained, fully equipped and highly motivated; high quality vaccines; good international co-operation. Vaccine strains recommended for use in Africa are strain T1/44 and its variant T1-SR. To improve the immunogenicity of these strains, the Pan African Rinderpest Campaign (PARC) secured financial support for research into immunostimulating complexes (ISCOM). It is hoped that this technology can improve vaccines, leading to effective eradication of the disease. In the meanwhile, systematic and repeated vaccination is the method of choice against CBPP in Africa.