Building the Capacity of Health Professionals in Monitoring and Evaluation in a Public Health Institution: Experience of the National Institute of Public Health (NIPH) of Côte d’Ivoire

Background: In the context of the fight against HIV, a lack of skills in monitoring and evaluating the personnel in charge of activities has been identified at the national level. It was the subject of a priority axis of the national plan for monitoring and evaluating the fight against HIV (2006-2010) that was aimed at strengthening the capacities of actors in this area. To increase the critical mass of competent human resources in the short term, the National Institute of Public Health (NIPH) of Côte d’Ivoire organized monitoring and evaluation training sessions for healthcare professionals from 2011 to 2016. Methods: A single case study with multiple levels of analysis was carried out, combining a qualitative survey and a literature review. An evaluation was carried out six months after each training session. In addition, the results of the pre- and post-tests and of the daily and final evaluations that accompanied the various training sessions were used to provide further information. The qualitative data collected were analyzed using INVIVO 15 software. Results: Some 89 health professionals (69% men and 31% women) working at the national level (51% at the central level, including 58% in health programs) and in development partner agencies (37%) participated in this capacity building program. Most participants were senior health managers (56%), data managers (23%), and statisticians and computer scientists (10%). Almost all the trainings were financed by 16 technical and financial partners (85%), mainly the MEASURE Evaluation project (27%). Conclusion: M&E training, despite all its imperfections, has made it possible to identify M&E training needs at the national level and to increase the critical mass of national skills and to have some culture in M&E.

Assessing healthcare workers’knowledge and confidence in the diagnosis,management and prevention of Monkeypox

BACKGROUND Monkeypox(Mpox),is a disease of global public health concern,as it does not affect only countries in western and central Africa.AIM To assess Burundi healthcare workers(HCWs)s’level of knowledge and confidence in the diagnosis and management of Mpox.METHODS We conducted a cross-sectional study via an online survey designed mainly from the World Health Organization course distributed among Burundi HCWs from June-July 2023.The questionnaire comprises 8 socioprofessional-related questions,22 questions about Mpox disease knowledge,and 3 questions to assess confidence in Mpox diagnosis and management.The data were analyzed via SPSS software version 25.0.A P value<0.05 was considered to indicate statistical significance.RESULTS The study sample comprised 471 HCWs who were mainly medical doctors(63.9%)and nurses(30.1%).None of the 22 questions concerning Mpox knowledge had at least 50%correct responses.A very low number of HCWs(17.4%)knew that Mpox has a vaccine.The confidence level to diagnose(21.20%),treat(18.00%)or prevent(23.30%)Mpox was low among HCWs.The confidence level in the diagnosis of Mpox was associated with the HCWs’age(P value=0.009),sex(P value<0.001),work experience(P value=0.002),and residence(P value<0.001).The confidence level to treat Mpox was significantly associated with the HCWs’age(P value=0.050),sex(P value<0.001),education(P value=0.033)and occupation(P value=0.005).The confidence level to prevent Mpox was associated with the HCWs’education(P value<0.001),work experience(P value=0.002),residence(P value<0.001)and type of work institution(P value=0.003).CONCLUSION This study revealed that HCWs have the lowest level of knowledge regarding Mpox and a lack of confidence in the ability to diagnose,treat or prevent it.There is an urgent need to organize continuing medical education programs on Mpox epidemiology and preparedness for Burundi HCWs.We encourage future researchers to assess potential hesitancy toward Mpox vaccination and its associated factors.

Contraceptive Experiences of Women of Procreation Age Who Attended Two HealthCenters in the City of Abidjan (Cote d’Ivoire)

Introduction: Maternal mortality, which is estimated at 614 deaths per 100,000 births in C&#244;te d’Ivoire, is associated with a low national contraceptive prevalence rate of 13.9%. In this study, we are interested in the contraceptive experiences of women who attend health centers to estimate their rate of contraceptive use and to assess the factors involved in the use of modern contraceptive methods among women of childbearing age who are exposed to the risk of pregnancy. Method: A descriptive cross-sectional study was conducted from December 2018 to September 2019 among 423 women, who attended two health centers in Abidjan. A bivariate analysis identified factors associated with contraceptive use by these women. A descriptive analysis determined the means for the quantitative variables and the frequencies and percentages of qualitative variables. Interpretation of results was based on significance (α = 5%, 95% CI). Results: Contraceptive prevalence was 37%. There was a significant relationship between contraceptive use and the socio-demographic and reproductive characteristics of women (p Conclusion: Women who were over 35 years age, uneducated, primary school graduates, housewives, unemployed, in the informal sector, Muslims, nulliparous, and lacking information and decision-making power were less likely to use modern contraceptive methods. They are the target population for strategic interventions to improve contraceptive prevalence.

Socio-Cultural Representations and Therapeutic Itineraries of Parents of Autistic Children Followed in the INSP’s Children’s Mental Health Services

Pervasive developmental disorders (PDD) remain little known to populations in developing countries. In black Africa their social representations remain strongly influenced by local belief systems. The general objective of this study was to understand the perceptions and representations of Ivorian parents vis-à-vis PDD. This was a mixed (qualitative and quantitative) prospective cross-sectional study with a descriptive aim that involved a sample of 49 parents. The sampling was of the qualitative type by multiple cases with reasoned choice by saturation. Our results showed that male parents were mostly aged between 40 - 49 years (48.98%) with a higher level of education (67.34%) while mothers were mostly aged between 30 - 39 (61.22%) and a higher level (30.61%). Autistic children were negatively perceived by their parents: either as a source of psychological suffering (82.85%), or as mysterious children who sacrificed their parents (44.66%), or as “bobo” children (mute children in common Ivorian language) (16.66%) or like rude children (13.34%). The supposed origin of the disorder according to the parents was mystical-religious (60.94%);natural (25%);hereditary (6.25%). In 6.25% of cases, PDD were assumed to be of unknown or iatrogenic origin attributable to vaccination (1.56%). 75.51% of parents said that in addition to conventional medical therapies, they also used traditional therapies. The use of this therapeutic alternative would be linked to the perceptions and beliefs that feed the socio-cultural representations of our respondents.

Etiological and Radiological Profile of Acute Lower Respiratory Infections during the Pre-COVID Period in the Paediatric Ward of the Teaching Hospital of Mali and in the Community Health Centre of Yirimadio in Bamako

Introduction: Every year, nearly 4 million people pass away from acute respiratory infections. 98% of such deaths are due to lower respiratory tract infections. Even though studies have been carried on lower respiratory infections x-ray aspects in Mali, very few studies have been done to reveal bacteriological and virological evidence of this disease. Materials and methods: It is about a descriptive prospective study carried out from January to December 2018 having involved patients of all ages, coming for medical consultation at the Yirimadio Community-based health center as well as children from 6 months to 15 years old coming at the pediatric department of UHC Hôpital du Mali for a lower respiratory infection. They had all undergone chest X-ray and a PCR. The purpose: of this work is to study etiological and x-ray aspects of acute lower respiratory infections at the Yirimadio Community-based Health Center and at the UHC pediatric department of Hôpital du Mali. Findings: From January to December 2018, we recorded a frequency of 1.19%. The age group 0 - 5 years was the most represented (64.5%) with a sex ratio of 0.97 for women. Cough was the most common clinical sign (98.7%) followed by fever (58.9%). Standard frontal chest X-ray was pathological in 70% of our patients. It was bronchitis in 75.4% of cases, pneumonia (13.5%), and bronchopneumonia (12.3%). PCR positive was in 83.9% of patients. It revealed a co-infection in more than half of the patients (52.5%), bacterial infection (16.1%) and viral infection (15.2%). Pathogens isolated ranked by frequency were Streptococcus pneumoniaa (87.6%) followed by Staphylococcus aureus (24.9%) and human rhinovirus (17%). The most common viral causes were human rhinovirus (17%), followed by influenza A and B virus (7%) and human parainfluenza virus (7%). Conclusion: It stemed from the study that lower respiratory infections were mainly due to Streptococcus pneumonea and human rhinovirus during pre-COVID at the Yirimadio Community-based health center and UHC Hôpital du Mali.

Healthcare-Associated Infections: Experiences and Perceptions of Nurses at the Ziniaré District Hospital in Burkina Faso

Introduction: Healthcare-associated infections (HAIs) are a worldwide concern because of their magnitude and their human and financial cost. While nurses’ non-compliance of hygiene and asepsis measures is questioned, the rationale behind it is not fully understood. We hypothesized that nurses’ experiences and perceptions are one of the reasons for their non-compliance with prevention recommendations. Also, nurses’ caring approach would play an important role in patient safety. The objective of this study was to describe nurses’ experiences and perceptions of HAIs in a district hospital in Burkina Faso with the aim of developing a culture of safety in health care practices. Methods: Qualitative data were collected through unstructured interviews with twenty nurses from the Ziniaré district hospital. Data analysis followed the qualitative phenomenological method according to Giorgi. Results: Phenomenological analysis yielded the following themes: “an ignored reality”;“a denied responsibility”;and “a vulnerable problem”. These results show that nurses’ perception of the extent and seriousness of HAIs is low, and that they deny responsibility for their occurrence. As a result, HAIs are not always perceived as a concern. However, nurses deplore the situation, but remain optimistic about resolving the problem. Conclusion: These nurses’ perceptions of HAIs could explain their non-compliance with prevention recommendations. Corrective action could be redirected by raising awareness, continuing training, improving working conditions and involving all players, including patients and their families, in the fight against HAIs. .

Frequency of the C677T Polymorphism of MTHFR, G20210A of Prothrombin and R506Q of Factor V Leiden in Type 2 Diabetics in Abidjan

In Africa, the prevalence of diabetes is escalating and remains a concern due to the numerous complications it causes. Vascular damage associated with diabetes leads to a prothrombotic state observed in diabetic individuals. Diabetes is a complex and multifactorial disease involving genetic components. With the aim of preventing complications and contributing to an efficient management of diabetes, we investigated genes likely to lead to a risk of thrombosis, in particular the C677T of MTHFR, G20210A of prothrombin, and R506Q of factor V Leiden in type 2 diabetics in Abidjan receiving ambulatory care. A descriptive cross-sectional study was carried out on consenting type 2 diabetic patients. Mutation detection was carried out using the PCR-RFLP method employing restriction enzymes. Hemostasis tests (fibrinogen, D-dimers, fibrin monomers, and von Willebrand factor) were performed using citrate tubes on the Stage? Star Max automated system. Plasminogen activator inhibitor was assayed by ELISA method, and biochemical parameters were determined using the COBAS C311. The study population consisted of 45 diabetic patients, 51.1% of whom presented vascular complications, mainly neuropathy. Disturbances in hemostasis parameters were observed, with 15.5% of patients showing an increase in fibrin monomers. Mutation analysis revealed an absence of factor V mutation (factor V Leiden) and of G20210A mutation of the prothrombin gene. However, 15.6% of subjects had a heterozygous C677T mutation of MTHFR, with 57% of them being anemic. The exploration of biological and genetic factors associated with thrombotic risk is of significant interest in the optimal management of African type 2 diabetics.

Effect of a Nutrition Education Intervention on Food Safety Knowledge, Attitudes and Practices of Mothers of Children under 5 Years in the Peri-Urban Areas of Bobo-Dioulasso: Before and after Study

Background: This study assessed the effect of a nutrition education intervention. This intervention aimed to improve the knowledge, attitudes, and practices of mothers on food safety in the peri-urban areas of Bobo-Dioulasso in Burkina Faso. Methods: A total of 243 mothers of children under 5 years in the peri-urban of Bobo-Dioulasso were administered the FAO questionnaire for food safety knowledge, attitudes, and practices assessment during two cross-sectional surveys, before and after the intervention, in January and October 2017. The intervention included two components consisting of a theoretical phase (counselling and discussion) and cooking demonstrations implemented for ten months. To account for the before-and-after design of the study, the McNemar’s test was used to assess the effect of the intervention on food safety KAP of mothers of children under 5 years. Results: The mean age of mothers was 29 ± 6.2 years and 50.6% of them were between 20 and 29 years old. One for knowledge (cooking thoroughly with, p-value = 0.0001) and another for attitudes (perceived benefits of reheating leftovers before eating them, p-value = 0.0001), significantly increased after the intervention. In terms of food safety practices, all the indicators (cleaning of dirty surfaces, plates and utensils and storage of perishable foods) significantly increased (all p = 0.0001 Conclusion: This study provided some evidence of an effective nutrition education intervention for improving maternal KAP on food safety for their child’s feeding.

Prevalence of Work-Aggravated Asthma among Bakery Workers in Abidjan (Cote d’Ivoire)

Introduction: Work-aggravated asthma is pre-existing or concomitant asthma whose symptoms are aggravated by the work environment. The aim of this study was to determine the prevalence of this pathology and its associated factors among bakery workers in Abidjan. Materials and Methods: This descriptive and analytical cross-sectional study was conducted over a period of four (4) months from 18 December 2019 to 18 April 2020. Two questionnaires were used, one on employees and the other on the indoor environment of bakeries. In addition, a spirometry test was performed on all bakery workers. Statistical analysis was performed using stata 15.1 software. Results: A total of 599 bakery employees, including bakers (59.73%), sales assistants/ cashiers (23.52%), cleaners (6.34%) and administrative staff (10.18%), were investigated. The mean age was 30.8 ± 8 years, with a sex ratio (M/F) = 2.2. Asthma symptoms were found in 95 (15.86%) employees, of whom 74 (77.9%) had work-related asthma and 11 (14.9%) had asthma aggravated by work. The factors associated with work-aggravated asthma were personal or family history of allergy or atopy [ORa = 3.75;CI95%: 1.56 - 8.93;p = 0.003], exposure to dust [ORa = 5.01;CI95%: 1.43 - 7.50;p = 0.011] and humidity level (60% - 70%) [ORa = 1.80;CI 95%: 0.99 - 3.28;p = 0.05]. Conclusion: Work-aggravated asthma is a reality in bakeries in Abidjan, with an estimated prevalence of 14.9%. Two of the three factors associated with this condition suggest a link with indoor air pollution. Combating air pollution in these establishments must therefore be a priority for the relevant authorities, in order to provide employees with a working environment that protects their health.

In the Turmoil of the Cybercriminal Triad, Occult Practices and Toxicomania: The Case of a Young Ivorian Cyber Crook

Far from the financial gains of cyber crooks, the informed observer will see in cyber crookery a complex field of psychopathological expression where addictions and ritualistic practices intermingle. We thus carried out a qualitative observational study, focusing on a young Ivorian cyber-escroc, hard drug user and follower of mystical practices taken in charge by a multidisciplinary team during a resocialization course for children in conflict with the law from November to December 2022. The aim was to describe the difficulties experienced by a young Ivorian cyber crook in escaping the clutches of occult practices, internet addictions and psychoactive substances encountered in the field of cyber crookery. KA is confronted with the problem of cybercrime associated with occult practices and drug addiction. He is a heroin addict and secondary internet addict, undergoing de facto detoxification and presenting risky consumption behaviors. His fear is fuelled by the sudden death of his childhood friend, who introduced him to cyber-scams and occult practices, and the impossibility of returning his “Agbaladai” fetish when he can no longer honor the weekly sacrifices. Our results show an interweaving of psychopathological entities, namely cyberaddiction and addiction to psychoactive substances, against a backdrop of mystico-cultural practices and interpretations.

Costs of Schizophrenia at Psychiatric Hospital of Bingerville (Ivory Coast)

Schizophrenia is classified as a priority mental disorder by the World Health Organization (WHO) and accounts for around 35% of diagnoses at the Bingerville Psychiatric Hospital (HPB). The aims of the study were to identify the cost drivers for hospitalization and to calculate the costs of managing schizophrenia in hospital, with a view to planning household expenditure on care. This pilot cross-sectional study involved 31 patients with schizophrenia who had been hospitalized in the various third-category wards at the HPB between 1st January 2019 and 31st May 2020. Sampling was accidental. The methods used to estimate costs were based on the actual costs of drugs, hospitalization and additional examinations which prices were known, and on patients’ estimations for certain expenses such as food and transport. Results: The sex ratio was 3.42, the mean age was 29.52 years. The mean length of stay was 46.19 days, and the most frequent clinical forms were paranoid schizophrenia (41.9%) and schizoaffective disorder (29%). The combination of haloperidol and chlorpromazine was the most common medications for initial treatment (67.8%) and maintenance treatment (41.9%). The average cost of hospitalization at HPB for schizophrenia was XOF 164,412 (€249.90). The average direct medical cost was XOF 105,412 (€160.226) and the average direct non-medical cost was XOF 59,000 (€89.68). The average daily cost of antipsychotic treatment was XOF 795/day (€1.2084). The high cost of drugs as a proportion of hospitalization costs suggested the need of a reflection on the simplification of prescribing practices, assistance in psychiatric emergencies and the development of other alternatives to psychiatric hospitalization in Côte d’Ivoire.

Evolution of Viral Load in Patients Infected with HIV-1 at Point G University Hospital

Introduction: HIV, the human immunodeficiency virus, is the etiological agent of acquired immunodeficiency syndrome (AIDS). The aim of this study was to assess the evolution of the viral load in patients under treatment. Methodology: This was a study carried out from July 2017 to June 2022 at the Point G University Hospital laboratory. The determination of the viral load of patients was carried out by PCR on the ABOTT M2000sp/rt platform. Results: A total of 129 patients infected with HIV-1, aged 19 to 72 years with a mean age of 40.05 years ± 10.71;all on antiretroviral chemotherapy. The female gender predominated among our patients. The most common treatment regimen was 2INTI + 1INNTI with 72.9% followed by 2INTI + 1INI with 13.2%. As for the combinations of molecules, the combination TDF + 3TC + EFV and TDF + 3TC + DTG predominated, respectively 65.1% and 13.2%. 89.9% of our patients had undetectable viremia after 12 months of treatment (p < 0.005) with an average viral load which had evolved from 681315.65 copies/ml ± 1616908.484 to M0 at 5742.36 copies /ml ± 35756.883 at M12 (p Conclusion: Generally speaking, antiretroviral treatment had contributed to controlling viral loads, however the therapeutic combination TDF + 3TC + DTG had made it possible to obtain more patients with undetectable viremia instead.

Cytotoxic Properties on Cervical and Liver Cancer Cells of Two Plant Recipes from Burkina Faso

Cancer is one of the deadliest diseases in developing countries. In recent years, natural plant-based compounds have been used in the search for drugs to combat numerous diseases, including cancer. In this study, we evaluate the cytotoxic properties of paanfo tiben 1 and paanfo tiben 2, two traditional herbal formulations from Burkina Faso used in the treatment of cancer in Burkina Faso. To this end, the recipes were infused and freeze-dried. The dry extracts obtained were used to determine total phenolics and flavonoids content, assess antioxidant activity using the DPPH, ABTS and FRAP methods, evaluate anti-inflammatory properties by inhibiting 15-LOX, COX 1 and 2, and assess cytotoxic activity on HeLa cervical cancer and HePG2 liver cancer cell lines using the MTT test. The paanfo tiben 1 recipe showed the highest levels of total phenolics and flavonoids, as well as the best antioxidant activities, with IC50 values of 21.020 ± 0.6 µg/ml and 22.94 ± 0.57 µg/ml for DPPH and ABTS, and 165.15 mM EAA/mg dry extract for FRAP. It also exhibited the best cytotoxic activity with IC50 values of 112.02 ± 0.025 µg/ml on HeLa cells and 80.67 ± 6.08 µg/ml on HepG2 cells. On the other hand, paanfo tiben 2 exhibited the best anti-inflammatory activities through inhibition of 15-LOX and COX 1, with inhibition percentages at 100 µg/ml of 32.523% and 24.717 % respectively. These results could justify the traditional use of these two recipes by traditional health practitioners in the treatment of cancer sufferers in Burkina Faso.

Inquiry Based on Evidence and its Practices in Two Healthcare Facilities of Bujumbura

Background: Inquiry evidence-based practice (IBP) improves healthcare quality, reliability, and patient outcomes as well as reduces variations in care and costs. IBP and its practice in health care promote also many advantages, such as improvements of practices based on the attitudes and cognitive ideas. This study aims to assess the inquiry based on evidence (IBP) and its practices in two Health Care Facilities (HCFs) of Bujumbura to help the practitioners to understand its importance. Methods: A cross-sectional study design was used to analyze the importance of IBP and its practice in these two hospitals. The probability-sampling technique was used also to select 104 nurses from the Military Hospital of Kamenge and 55 nurses from the Van Norman Clinic. A questionnaire was used to collect data with two mains components, demographic data and knowledge and attitudes addressing the following parameters: evidence practice during inquiry, nursing theory, current analysis in nursing care oriented the evidence, prioritization of care, rational diagnostic, monitoring and assessment. Results: The findings from this study revealed a poor knowledge and attitude among participants towards Inquiry Based Practice. In all variables, participants were scoring less than 10%. However, majority of participants (76.5%) know the indicators of patients’ satisfaction with nursing interventions through survey-based practice and 74.1% argued to analyze their information collected. Conclusion: This study revealed a weak awareness on IBP and its importance during nursing practice among participants as for almost all variables, participants were scoring less than 10%, except for the indicators of patients’ satisfaction with nursing interventions through survey-based practice (76.5%). Therefore, in-service training and curriculum revision had been highlighted and recommended another to provide the best rational diagnosis and achieve the patient’s outcomes.

Results of National Colorectal Cancer Screening Program in Croatia(2007-2011)

AIM:To study the epidemiologic indicators of uptake and characteristic colonoscopic findings in the Croatian National Colorectal Cancer Screening Program.METHODS:Colorectal cancer(CRC) was the second leading cause of cancer mortality in men(n = 1063,49.77/100 000),as well as women(n = 803,34.89/100 000) in Croatia in 2009.The Croatian National CRC Screening Program was established by the Ministry of Health and Social Welfare,and its implementation started in September,2007.The coordinators were recruited in each county institute of public health with an obligation to provide fecal occult blood testing(FOBT) to the participants,followed by colonoscopy in all positive cases.The FOBT was performed by hypersensitive guaiac-based Hemognost card test(Biognost,Zagreb).The test and short questionnaire were delivered to the home addresses of all citizens aged 50-74 years consecutively during a 3-year period.Each participant was required to complete the questionnaire and send it together with the stool specimen on three test cards back to the institute for further analysis.About 4% FOBT positive cases are expected in normal risk populations.A descriptive analysis was performed.RESULTS:A total of 1 056 694 individuals(born between 1933-1945 and 1952-1957) were invited to screening by the end of September 2011.In total,210 239(19.9%) persons returned the envelope with a completed questionnaire,and 181 102 of them returned it with a correctly placed stool specimen on FOBT cards.Until now,12 477(6.9%),FOBT-positive patients have been found,which is at the upper limit of the expected values in European Guidelines for Quality Assurance in CRC Screening and Diagnosis [European Union(EU) Guidelines].Colonoscopy was performed in 8541 cases(uptake 66%).Screening has identified CRC in 472 patients(5.5% of colonoscopied,3.8% of FOBT-positive,and 0.26% of all screened individuals).This is also in the expected range according to EU Guidelines.Polyps were found and removed in 3329(39% of colonoscopied) patients.The largest number of polyps were found in the left half of the colon:64%(19%,37% and 8% in the rectum,sigma,and descendens,respectively).The other 36% were detected in the proximal part(17% in the transverse colon and 19% in ceco-ascending colon).Small polyps in the rectum(5-10 mm in diameter),sigmoid and descending colon were histologically found to be tubular adenomas in 60% of cases,with a low degree of dysplasia,and 40% were classified as hyperplastic.Polyps of this size in the transverse or ceco-ascending colon in almost 20% had a histologically villous component,but still had a low degree of dysplasia.Polyps sized 10-20 mm in diameter were in 43% cases tubulovillous,and among them,32% had areas with a high degree of dysplasia,especially those polyps in the cecoascending or transverse part.The characteristics of the Croatian CRC Screening National Program in the first 3 years were as follows:relatively low percentage of returned FOBT,higher number of FOBT-positive persons but still in the range for population-based programs,and higher number of pathologic findings(polyps and cancers).CONCLUSION:These results suggest a need for intervention strategies that include organizational changes and educational activities to improve awareness of CRC screening usefulness and increase participation rates.

Assessing the Influence of Climate Extremes on Ecosystems and Human Health in Southwestern Amazon Supported by the PULSE-Brazil Platform

The complexity of multi-dimensional climate, environmental and human health information complicates bringing together scientists, civil society, and decision makers to provide adequate mitigation and adaptation options for the consequences of global environmental change. To provide an effective pathway to conciliate (integrate) these datasets, we present PULSE-Brazil as the Platform for Understanding Long-term Sustainability of Ecosystems and human health. The overarching aim of this paper is to focus on two study cases in the Brazilian state of Acre, 1) analyzing recent socio-environmental disasters such as the impacts of droughts and consequent increases in fire detections on the incidence of respiratory diseases, and 2) evaluating the impacts of temperature increases in combination with rainfall seasonality upon the incidence of Dengue fever. Based on data available in PULSE-Brazil platform, we also aim to provide insights on the consequences of future climate variability on ecosystems and human health. Finally, we provide a discussion on the collaborative process between scientists and policymakers that defined the PULSE-Brazil platform specifications and datasets and propose a conceptual pathway for promoting the interaction between science and policy during the process of producing a tool that allows the understating of climate-relate processes. Our results clearly demonstrated that ecosystems are under increased fire risk in the future that will, in turn, affect the health of human populations. Moreover, humans are also exposed to critical Dengue fever outbreaks with the projected increase in minimum temperatures. Therefore, minimizing the impacts of these potentially ascending socio-environmental problems is the first step for adapting to a changing climate in the Amazon region. We expect that PULSE-Brazil will serve not only as a technical tool for supporting governance, management, mitigation and long-term adaptation plans for climate impacts and natural disasters, but also will take advantage of its graphical capabilities to be an instructive vehicle that facilitates information flow for societal governance.

Direct Cost of Severe Malaria Treatment Borne by the Families of Children Aged 0 - 5 Years at the Fana Reference Health Centre, Mali

Introduction: Malaria is both a disease caused by poverty and a cause of poverty. Malaria is the leading cause of morbidity and mortality in Mali and is among the ten countries with the highest number of malaria cases and deaths. The objective was to estimate the direct economic cost borne by families in the treatment of severe malaria in children aged 0 - 5 years at the CSREF in Fana. Methodology: The study was cross-sectional, conducted from July 2017 to June 2018 with inclusion criteria and prospective data collection. The methodology was based on estimating the direct economic cost of severe malaria. Results: The sample consisted of 109 cases out of a total of 944 hospitalizations;59% of whom were boys and the 25 - 36 month age group was the most affected. The complications frequently encountered were severe anemia (50 cases) or 45.8%;convulsions (35 cases) or 32.1% and finally severe sepsis (8 cases) or 7.3%. The average direct cost was 25,324 Franc CFA (58.95 US Dollars) of which 66% represented the costs of medicines and consumables against 4% for the consultation. This cost was more than half the minimum wage in Mali. Conclusion: Despite the difficulties in estimating the cost in hospitals, the results obtained give us an estimate of the economic burden borne by families in the management of severe malaria cases among children in the district of Fana. Support is needed for parents in the fight against malaria in rural Mali.

The Perception of Health Workers and Stakeholders Involved in the Process of Selecting Indigent in Burkina Faso

Background: Indigent selected for their health care is complex and poses enormous challenges. The actors involved have an influence on health actions and their perception is decisive for better care for the indigent. Little evidence exists on these perceptions and this paper has captured this. Methods: A case study involved 163 participants with a questionnaire and an interview guide. The quantitative responses were classified according to a measurement scale, proportions and overall indices of perception (Ip) and satisfaction (CSAT) were calculated. The relationship between variables was investigated using chi-square. Thematic analysis was used with qualitative data. The study met ethical requirements. Results: The participants had a positive perception of the selection: Ip = 0.77, but a minority (1/5) were dissatisfied with the selection. The perception of selection did not differ significantly depending on the experience of the actors. For the vast majority, the definition of indigent was satisfactory (CSAT = 91.4). The selection was done in a top down fashion and steps such as setting up committees, informing stakeholders, had shortcomings which negatively impacted the effectiveness of the selection. The needs of the participants included transparency in the indigent select process, matching the tools for selecting the indigent to the context, strengthening of local action, deconstruction of prejudices in terms of the indigent, power of actors to act, and importance for health services to reach out to the indigent. Conclusion: Considering the perception of the actors as well as their needs will improve the selection for effective care of the indigent.

Clinical Preceptor’s Role in the Development of Nursing Training Based on Professional and Competency Frameworks in Two Health Care Facilities of Bujumbura

Background: The aim of clinical preceptors is to support the development of expertise related to the preceptorship of groups of trainees among nurses in clinical settings by the acquisition and use of theoretical knowledge, know-how and know-that. The support of students remains a major problem in hospitals, because the requirements of the preceptors according to the standards are not considered. The lack of guidelines on nursing preceptorships, theoretical application based on the professional curriculum, and professional expertise were the main problems assessed in the two Health Care (HUCK, VNC) in this study. The purpose of this study is to assess the knowledge of nurses and learners during their preceptorship practices and to contribute to the direction of evidence-based preceptorship. Method: A descriptive cross-sectional study design was used in this study during the 3-month period. A sample of 121 nurses as well as 56 learners were selected from 381 nurses and 80 learners using Alain Bouchard’s formula. A questionnaire developed according to the guidelines of Ernestine Wiedenbach’s theory of care, was distributed. The data were analyzed using the Microsoft Excel and the software program version 16 (SPSS-16). Results: The current study found that the majority of nurses do not know the importance of the clinical tutor. The results state that students experience clinical practice problems, thus clinical preceptorship is required. Nurses showed that there are different barriers often encountered during their practices. The overall nurse preceptorship process is not optimal and the average of 97.6% of nurses does not have expertise in coaching interns in clinical settings. Conclusion: Although that nurses have some experience at work, they express their weakness based on a low level of education, a lack of knowledge and trained professionals on the job, and clinical preceptorship guidelines.

International Comparison of Data from International Clinical Trials Registry Platform-Registered Clinical Trials

Objectives: Our aim was to clarify the study characteristics of countries that have registered clinical trials studies and to calculate the percentage of clinical trials that were registered in each country’s registry, and try to find and evaluate the factors determining that percentage. Design and Methods: The present study is a cross-sectional study using data from clinical trials registered from January 1, 2011, to December 31, 2015. Only countries with more than 2000 registered trials were included for further study. Ten countries met that criterion: United States, Japan, Iran, Australia, New Zealand, China, India, Germany, United Kingdom, and Netherland. The percentage of clinical trials that were registered in each country’s registry was calculated, and the factors determining that percentage were sought and analyzed through an exploratory approach. Results: The chi-squared test of independence indicated that the rate of clinical trial registration significantly differed between countries. From the adjusted standardized residuals, the percentage of clinical trials that were registered in the country of origin was higher in the United States, India, Japan, and Australia/New Zealand than in the European Union and China. Conclusion: The United States requires that informed consent documents for clinical trials contain clinical trial registration numbers from ClinicalTrials.gov, which could be the reason for the extremely high percentage of registered clinical trials (94%). Since the European Union does not have this requirement, clinical trials conducted in the European Union do not have to be registered in the countries in which they are conducted.