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Introduction: tuberculosis remains a major public health problem, with continuing high levels of prevalence, and mortality. In Niger, the incidence of tuberculosis remains high. This study aims to investigate the epidemiology of pulmonary tuberculosis at the National Anti-Tuberculosis Center of Niamey in Niger. Methods: this study used a quantitative approach with a retrospective and descriptive design. Data were obtained from positive pulmonary tuberculosis cases detected by microscopy on Ziehl-Neelsen stained sputum at the National Anti-Tuberculosis Center (NATC) in Niamey, Niger covered the period between June 2017 and January 2020. 955 pulmonary TB patients were recorded whose diagnosis was based either on clinical-radiological arguments (thus negative microscopy) or positive microscopy. This form was used to collect data recorded in the clinical case registers, registers, and Excel files of the GeneXpert platform of the NATC laboratory. Results: eighty-nine-point eleven percent (89.11%) of the patients were microscopy-positive. Among the study population, men were the most affected by tuberculosis with 80.03%. The 25-34 age group, representing 23.77%, was the most affected. 6.93% of patients were co-infected with tuberculosis and HIV. All patients were put on treatment, with a therapeutic success rate of 72.38% and a therapeutic failure rate of 10.95%. Among the cases of therapeutic failure, 80.90% had Mycobacterium tuberculosis complex detected and 27.14% were resistant to Rifampicin. Conclusion: Niger continues to have a tuberculosis epidemic which requires monitoring. Improving the diagnostic system for more effective management of the disease is important for appropriate diagnosis and treatment.
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Antituberculosos , Mycobacterium tuberculosis , Tuberculosis Pulmonar , Humanos , Estudios Retrospectivos , Masculino , Niger/epidemiología , Femenino , Adulto , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/diagnóstico , Antituberculosos/farmacología , Antituberculosos/administración & dosificación , Adulto Joven , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Mycobacterium tuberculosis/efectos de los fármacos , Adolescente , Resultado del Tratamiento , Niño , Infecciones por VIH/epidemiología , Infecciones por VIH/tratamiento farmacológico , Preescolar , Anciano , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Esputo/microbiología , Prevalencia , Coinfección/epidemiología , Coinfección/tratamiento farmacológico , Lactante , IncidenciaRESUMEN
Providing children healthy diversified diets is important for their optimal growth and development. The high prevalence of under-nourishment during the critical early life period is of serious concern in West Africa. We assessed the level of dietary diversity and associated factors for children aged 6-23 months in Côte d'Ivoire, Niger and Senegal. Prior 24 h dietary intake was assessed for 3,528 children (Côte d'Ivoire: N = 118; Niger: N = 763; Senegal: N = 2,647) using the Diet Quality Questionnaire survey tool administered to primary caregivers. Cluster random sampling was conducted for urban and rural areas in Niger and Senegal and simple random sampling was used in Côte d'Ivoire, where only rural households were selected. Survey data were analyzed to determine children's intake of items from eight food groups: breast milk; grains, roots, tubers and plantains; pulses, nuts and seeds; dairy products; flesh foods; eggs; vitamin A-rich fruits and vegetables; and other fruits and vegetables. Minimum Dietary Diversity (MDD) was assessed based on the consumption of ≥5 of the 8 food groups. In all countries, the majority of children were ≥ 12 months of age and from rural households. Children from poor/very poor households ranged from 32.4 to 41.9%. MDD prevalence was 54.2% in Côte d'Ivoire, 33.3% in Niger and 30.8% in Senegal. In all three countries, children 12-23 months had significantly higher consumption of six of the food groups, compared to those 6-11 months, and children ≥12 months had a higher likelihood of MDD, compared to infants, in Niger (aOR = 4.25; 95% CI: 2.46, 7.36) and Senegal (aOR = 2.69; 95% CI: 2.15, 3.35). MDD prevalence was higher among children in urban, compared to rural, areas in Niger (p = 0.020) and Senegal (p < 0.001) and significantly higher in the wealthiest, compared to poorest, households. This study suggests most young children in Côte d'Ivoire, Niger and Senegal are not receiving an adequately diversified diet, with a reliance on starchy staples and lower intake of high-quality protein sources. Our results highlight socio-economic barriers to attaining dietary diversity in these settings and stress the urgent and continuing need for investments in strategies that support optimal complementary feeding practices.
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Dieta , Humanos , Lactante , Femenino , Masculino , Côte d'Ivoire/epidemiología , Niger/epidemiología , Dieta/estadística & datos numéricos , Senegal , Población Rural/estadística & datos numéricos , África Occidental , Encuestas sobre Dietas , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary characteristics of of peripartum cardiomyopathy (PPCM) in the internal medicine department of the Zinder National Hospital (ZNH). METHODS: This was a descriptive cross-sectional study carried out from 2018 to 2022 at the ZNH Department of Internal Medicine. Included were all patients admitted for PPCM who met National Heart Blood and Lung Institute criteria. The data collected was analyzed using Excel and EPI INFO v7. RESULTS: We had collected 100 cases of PPCM out of a total of 8706 hospitalized patients, i.e. a hospital prevalence of 1.14%. The mean age of the patients was 27.9 years ± 7.4 [17-45]. The majority of patients were from underprivileged social strata (n=64). The risk factors for PMPC found were essentially hot bath (n=66), home birth (n=40), natron porridge (n=35) and multiparity (n=57). Cardiac symptomatology appeared postpartum in 56% of patients. Dyspnea was the main symptom in 98% of cases. The physical signs were dominated by the functional systolic murmur (66%). Three quarters (75%) of the patients had congestive heart failure. Electrocardiographic signs were dominated by left ventricular hypertrophy (n=65). Cardiomegaly was present in 94% of patients. Left ventricular ejection fraction was altered in all patients. Impaired renal function was found in 31% of patients. Management was based on a low-sodium diet tripod, diuretics and converting enzyme inhibitors. Two cases of death were recorded. CONCLUSION: PPCM is common in the Zinder region. It affects young women with several risk factors and is revealed by signs of congestive heart failure. For a better understanding of this still poorly elucidated condition, it is necessary to pursue research efforts.
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Cardiomiopatías , Periodo Periparto , Complicaciones Cardiovasculares del Embarazo , Humanos , Femenino , Adulto , Estudios Transversales , Embarazo , Cardiomiopatías/epidemiología , Cardiomiopatías/diagnóstico , Cardiomiopatías/etiología , Adulto Joven , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Persona de Mediana Edad , Adolescente , Niger/epidemiología , Factores de Riesgo , Prevalencia , Trastornos Puerperales/epidemiología , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/etiología , Recursos en Salud/estadística & datos numéricosRESUMEN
BACKGROUND: Twice-yearly mass distribution of azithromycin to children is a promising intervention to reduce childhood mortality in sub-Saharan Africa. The World Health Organization recommended restricting distribution to infants 1 to 11 months of age to mitigate antimicrobial resistance, although this more limited treatment had not yet been tested. METHODS: We randomly assigned rural communities in Niger to four twice-yearly distributions of azithromycin for children 1 to 59 months of age (child azithromycin group), four twice-yearly distributions of azithromycin for infants 1 to 11 months of age and placebo for children 12 to 59 months of age (infant azithromycin group), or placebo for children 1 to 59 months of age. Census workers who were not aware of the group assignments monitored mortality twice yearly over the course of 2 years. We assessed three primary community-level mortality outcomes (deaths per 1000 person-years), each examining a different age group and pairwise group comparison. RESULTS: A total of 1273 communities were randomly assigned to the child azithromycin group (1229 were included in the analysis), 773 to the infant azithromycin group (751 included in the analysis), and 954 to the placebo group (929 included in the analysis). Among 382,586 children, 419,440 person-years and 5503 deaths were recorded. Lower mortality among children 1 to 59 months of age was observed in the child azithromycin group (11.9 deaths per 1000 person-years; 95% confidence interval [CI], 11.3 to 12.6) than in the placebo group (13.9 deaths per 1000 person-years; 95% CI, 13.0 to 14.8) (representing 14% lower mortality with azithromycin; 95% CI, 7 to 22; P<0.001). Mortality among infants 1 to 11 months of age was not significantly lower in the infant azithromycin group (22.3 deaths per 1000 person-years; 95% CI, 20.0 to 24.7) than in the placebo group (23.9 deaths per 1000 person-years; 95% CI, 21.6 to 26.2) (representing 6% lower mortality with azithromycin; 95% CI, -8 to 19). Five serious adverse events were reported: three in the placebo group, one in the infant azithromycin group, and one in the child azithromycin group. CONCLUSIONS: Azithromycin distributions to children 1 to 59 months of age significantly reduced mortality and was more effective than treatment of infants 1 to 11 months of age. Antimicrobial resistance must be monitored. (Funded by the Bill and Melinda Gates Foundation; AVENIR ClinicalTrials.gov number, NCT04224987.).
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Antibacterianos , Azitromicina , Infecciones Bacterianas , Mortalidad del Niño , Mortalidad Infantil , Administración Masiva de Medicamentos , Preescolar , Femenino , Humanos , Lactante , Masculino , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Azitromicina/administración & dosificación , Azitromicina/efectos adversos , Infecciones Bacterianas/mortalidad , Infecciones Bacterianas/prevención & control , Quimioprevención/efectos adversos , Quimioprevención/estadística & datos numéricos , Farmacorresistencia Bacteriana , Administración Masiva de Medicamentos/efectos adversos , Administración Masiva de Medicamentos/estadística & datos numéricos , Niger/epidemiología , Población Rural/estadística & datos numéricosAsunto(s)
Antibacterianos , Azitromicina , Infecciones Bacterianas , Administración Masiva de Medicamentos , Humanos , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Azitromicina/administración & dosificación , Azitromicina/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Lactante , Preescolar , Niger/epidemiología , Mortalidad Infantil , Mortalidad del Niño , Administración Masiva de Medicamentos/efectos adversos , Administración Masiva de Medicamentos/métodos , Administración Masiva de Medicamentos/estadística & datos numéricos , Quimioprevención/efectos adversos , Quimioprevención/métodos , Quimioprevención/estadística & datos numéricos , Farmacorresistencia Bacteriana , Infecciones Bacterianas/mortalidad , Infecciones Bacterianas/prevención & controlRESUMEN
An experiment was carried out in 1985-87 against schistosomiasis using products neutralizing the intermediate stages of schistosomes. In the laboratory, it had been shown that lauryl betaines, amphoteric substances, used for children's shampoos, quickly immobilized miracidiums and cercariae. Studies in Niger in field conditions with water laden with organic matter gave similar results. This surfactant can be incorporated into ordinary soaps at a dose of 5% without changing their characteristics. Betaine soaps were put on sale in ordinary commercial channels in Niger then in Côte d'Ivoire, in hyperendemic villages for Schistosoma haematobium. Betaines diffused without external intervention into the water used by populations for washing. The soaps were well accepted by these populations. However, after one year, the results in tested villages compared to control ones were unclear on the dynamics of urinary schistosomiasis in terms of prevalence and oviuria. Anti-schistosome treatment seems necessary at the start of the procedure. The use of soap by populations needed to be measured. In conclusion, this promising laboratory action deserves to be evaluated again in the field, in addition to health education and systematic treatment actions.
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Esquistosomiasis , Jabones , Humanos , Esquistosomiasis/prevención & control , Esquistosomiasis/epidemiología , Esquistosomiasis/tratamiento farmacológico , Côte d'Ivoire/epidemiología , Niger/epidemiología , Animales , Esquistosomiasis Urinaria/prevención & control , Esquistosomiasis Urinaria/tratamiento farmacológico , Esquistosomiasis Urinaria/epidemiologíaRESUMEN
Background: The Rift Valley Fever (RVF) is an arbovirus disease responsible of regular epizootics and epidemics in sub-Saharan Africa and Arabian Peninsula. In 2016, Niger experienced its first outbreak of RVF in Tahoua region, which resulted in high consequences in animal and human health. The aim of this study was to investigate on the RVFV circulation among potential vectors of the disease. Methods: This was a cross-sectional survey carried out in Tahoua and Agadez regions in August 2021. Adult mosquitoes were collected by using the morning spray in human dwellings and the CDC light trap methods. After morphological identification, viral RNA was extracted. The RNA was extracted by using QIAamp Viral RNA Mini Kit (Qiagen). The RVFV detection was performed by using the qRT-PCR method. Results: A total of 2487 insects (1978 mosquitoes, 509 sandflies and 251 biting midges) were identified and divided into three families (Culicidae, Psychodidae and Ceratopogonidae). The Culicidae family composed of the Culex genus being the most abundant with a predominance of Cx.pipiens (31.88%; n = 793) followed by Mansonia sp (21.51%; n = 535), Anophelesgambiae s.l. (8.44%; n = 210), An. pharoensis (0.72%; n = 18), An. rufipes (0.48%; n = 12), Cx. quinquefasciatus (6.39%; n = 159), the Psychodidae with sandflies (20.46%; n = 509), and the Ceratopogonidae with Culicoides genus (10.09%; n = 251). The qRT-PCR carried out on a sample of mosquitoes (N = 96) highlighted that one individual of Cx.pipiens was found positive to RVFV. This specimen was from Tassara locality (Tahoua) and collected by CDC Light Trap method. Conclusion: This study reveals for the first time the circulation of RVFV among Cx.pipiens in Niger and highlights the possible vectorial role of this vector in the disease transmission. Further investigations should be carried out to identify the biological and ecological determinants that support the maintenance of the virus in this area in order to guide control interventions.
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Culex , Fiebre del Valle del Rift , Virus de la Fiebre del Valle del Rift , Animales , Virus de la Fiebre del Valle del Rift/aislamiento & purificación , Virus de la Fiebre del Valle del Rift/genética , Culex/virología , Estudios Transversales , Fiebre del Valle del Rift/epidemiología , Fiebre del Valle del Rift/transmisión , Fiebre del Valle del Rift/virología , Niger/epidemiología , Mosquitos Vectores/virología , Humanos , Insectos Vectores/virologíaRESUMEN
The general aim of this study is to analyse the risk factors for gastrointestinal parasitosis in small ruminants in order to contribute to the emergence of targeted treatment methods, at herd and agro-climatic zone levels, for the integrated and sustainable management of parasitic diseases in Sahelian livestock systems. The methodology was based on a questionnaire survey conducted in 37 villages and coprological analysis using the McMaster method on faecal samples from 968 small ruminants, including 555 goats and 413 sheep. Multiple logistic regression was used to highlight the risk factors associated with each type of parasitosis encountered. The results showed that the most widespread farming system remained 100% traditional, with feeding based essentially on natural grazing. Coprological results showed the prevalence of nematodosis (70.2%), Cestodosis (4.1%) and Coccidiosis (79.9%), with an average prevalence of coinfection of 56.9%. These parasite loads were significantly higher during the rainy season and in the more arid northern Sahelian zone, with a marked reduction at the end of the season. Average parasitic egg excretions were 1089 EPG of nematodes and 6864 EPG of coccidia. Parasite loads were higher in the wetter southern strip and varied significantly by breed. Of the five breeds of small ruminants studied, the ara-ara sheep had the highest parasitic loads and prevalences for nematodosis (78.6%), coccidiosis (89,3%) and coinfection (70.9%), appears to be the most susceptible to parasitosis. As for risk factors for severe parasite pressure, animals at the end of the rainy season, older animals and those with poor body condition were at risk of nematodiasis or coinfection. On the other hand, animals at the beginning of the rainy season, farms located in less arid southern Sahelian zones and male subjects were the groups at significant risk of coccidiosis. In these extensive Sahelian farming conditions, the control of these parasitoses by selective treatment of animals could be developed, targeting in particular the risk groups highlighted in this study.
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Enfermedades de las Cabras , Cabras , Enfermedades de las Ovejas , Animales , Factores de Riesgo , Prevalencia , Enfermedades de las Ovejas/epidemiología , Enfermedades de las Ovejas/parasitología , Ovinos , Enfermedades de las Cabras/parasitología , Enfermedades de las Cabras/epidemiología , Cabras/parasitología , Masculino , Femenino , Niger/epidemiología , Heces/parasitología , Coccidiosis/veterinaria , Coccidiosis/epidemiología , Coccidiosis/parasitología , Estaciones del Año , Parasitosis Intestinales/veterinaria , Parasitosis Intestinales/epidemiología , Parasitosis Intestinales/parasitología , Crianza de Animales Domésticos/métodos , Enfermedades Gastrointestinales/veterinaria , Enfermedades Gastrointestinales/parasitología , Enfermedades Gastrointestinales/epidemiología , Encuestas y Cuestionarios , Infecciones por Nematodos/veterinaria , Infecciones por Nematodos/epidemiología , Infecciones por Nematodos/parasitología , Recuento de Huevos de Parásitos/veterinariaRESUMEN
On January 30, 2020, the WHO declared COVID-19 a global health emergency. Children were affected in less severe forms. Niger had implemented measures in a context where children were a source of contamination. The aim was to determine the factors associated with COVID-19 in children in Niger from February to August 2020 through an analysis of the national database. We conducted an analytical cross-sectional study including all COVID-19 suspects in the database. We used Excel and Epi Info 7.2.4. software for data extraction and analysis. Frequencies and proportions were calculated, and in a logistic regression, we estimated the ORs of association with their 95% confidence intervals, the factors associated with COVID-19 at the threshold of p<0.05. Of 572 notified cases of suspected COVID-19 in children aged 0-15, 11.36% were positive. The median age of infected children was 10 years [IQR: 5- 13 years]. The male/female sex ratio was 2.1. Children aged 11 to 15 accounted for 49.2%, 61.5% lived in Niamey, 4.6% had comorbidities. The notion of travel was 12.3% and 40% had a notion of contact, 24.4% had a fever, 23.2% had a cough, 18% were hospitalized, and a case-fatality rate of 1.5%. In etiological analysis, the factors associated with COVID-19 were sex ORa=0.51 [0.28-0.93] p=0.028, presence of symptoms ORa=2.29 [1.23-4.25] p=0.008 and notion of contact ORa=0.32 [0.13-0.77] p=0.011. Exposed children were sensitive to COVID-19, and all age groups were affected, with a predominance of males. We recommend barrier measures adapted to young people, and early detection and management of infected children.
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COVID-19 , Humanos , COVID-19/epidemiología , Niger/epidemiología , Niño , Femenino , Estudios Transversales , Masculino , Preescolar , Lactante , Adolescente , Recién Nacido , Factores de Riesgo , Bases de Datos FactualesRESUMEN
Dengue fever is a growing worldwide public health concern. In mid-October 2023, multiple cases of uncommon febrile illness were reported among patients in Niamey, Niger. Fifteen samples were tested by using molecular methods, from which 7 (46.66%) were confirmed positive for mosquitoborne dengue virus belonging to serotypes 1 and 3.
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Virus del Dengue , Dengue , Humanos , Dengue/epidemiología , Dengue/virología , Niger/epidemiología , Virus del Dengue/genética , Masculino , Femenino , Adulto , Serogrupo , Adolescente , Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/virología , Persona de Mediana Edad , Adulto Joven , Niño , Filogenia , Historia del Siglo XXIRESUMEN
Girls aged 10-19 currently represent 12% of Niger's population (2020). And this number continues to grow as the fertility rate is higher while mortality is declining faster. Using Niger's demographic and health surveys carried out between 1992 and 2012, the study investigated adolescent fertility, its trends and associated factors. It mobilised descriptive methods (Total cohort fertility in adolescence (TCFA) computation, distribution of the number of adolescent births, and computation of adolescent cohort childbearing mean age) and multivariate Logistic and Poisson models. The result shows the TCFA went from 1.29 in 1992 to 1.17 in 2012. Early sexual intercourse and marriage, infant mortality, the desire for a large family, and urbanisation are among the factors significantly associated with adolescent fertility in Niger. The study concludes that the high level of adolescent fertility in Niger does not seem to be changing.
Les adolescentes représentent 12 % de la population Nigerienne (2020). Ce chiffre continue de croître car la fécondité reste elevée alors que la mortalité diminue rapidement. Utilisant les enquêtes démographiques et de santé du Niger entre 1992 et 2012, cette étude s'est intéressée aux tendances et facteurs de la descendance finale à l'adolescence (DFA). Elle a mobilisé des méthodes descriptives (calcul de la DFA, distribution du nombre de naissances adolescentes, calcul de l'âge moyen à la maternité adolescente) et des modèles multivariés de régression logistique et de Poisson. Les résultats montrent que la DFA est passée de 1,29 en 1992 à 1,17 en 2012. Les rapports sexuels et le mariage précoces, la mortalité infantile, le désir d'une famille nombreuse et l'urbanisation sont parmi les facteurs significativement associés à la fécondité adolescente au Niger. L'étude conclut que le niveau élevé de la fécondité des adolescentes au Niger ne semble pas évoluer.
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Tasa de Natalidad , Fertilidad , Lactante , Femenino , Adolescente , Humanos , Niger/epidemiología , Dinámica Poblacional , Matrimonio , Encuestas EpidemiológicasRESUMEN
INTRODUCTION: Congenital malformations of the central nervous system (CNS) are morphological abnormalities of the brain and spinal cord that occur during fetal development. They constitute the second most common congenital disability, after congenital cardiac defects. Many risk factors have been identified; however, these studies included various types of congenital abnormality. Furthermore, there is a lack of information on risk factors for congenital CNS malformation, and notably in the Zinder region of Niger. OBJECTIVE: This study aimed to identify the risk factors associated with congenital CNS malformations in the Zinder region. METHODS: In a case-control design, patients with congenital CNS malformation were enrolled between June 2022 and April 2023 in the Department of Neurosurgery of the National Hospital of Zinder. RESULTS: Family history of malformation (aOR:3.31, 95% CI:1.25-8.78) and consanguine marriage (aOR:2.28, 95% CI:1.23-4.20) were significantly associated with congenital CNS malformation. In contrast, folic acid supplementation (aOR:0.34, 95% CI:0.13, 0.89), multiparity (aOR:0.34, 95% CI:0.13, 0.89), and grand multiparity (aOR, 0.47; 95% CI:0.23, 0.97) had a protective effect. CONCLUSION: Risk factors such as family malformation history and consanguine marriage increased the risk of developing congenital malformations of the central nervous system. In contrast, folic acid supplementation in the index period and multiparity had a significant protective effect.
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Malformaciones del Sistema Nervioso , Humanos , Niger/epidemiología , Malformaciones del Sistema Nervioso/epidemiología , Factores de Riesgo , Ácido FólicoRESUMEN
A series of patients affected by neural tube defects have been studied in Niamey (Niger). This population is highly consanguineous and we try estimating the number of cases in which a previous identical malformation has been reported in the family. We found only 4 families indicating that the percentage of such families is not increased in our population. However, we think that studying genetic factors in this specific population could allow to demonstrate susceptibility genes that can act on this pathology.
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Defectos del Tubo Neural , Humanos , Niger/epidemiologíaRESUMEN
BACKGROUND: Malaria remains a significant public health concern in Niger, with the number of cases increasing from 592,334 in 2000 to 3,138,696 in 2010. In response, a concerted campaign against the disease has been initiated. However, the implementation of these malaria interventions and their association with epidemiological behaviour remains unclear. METHODS: A time-series study was conducted in Niger from 2010 to 2019. Multiple data sources concerning malaria were integrated, encompassing national surveillance data, Statistic Yearbook, targeted malaria control interventions, and meteorological data. Incidence rate, mortality rate, and case fatality ratio (CFR) by different regions and age groups were analysed. Joinpoint regression models were used to estimate annual changes in malaria. The changes in coverage of malaria interventions were evaluated. RESULTS: Between 2010 to 2019, the incidence rate of malaria decreased from 249.43 to 187.00 cases per 1,000 population in Niger. Niamey had a high annual mean incidence rate and the lowest CFR, while Agadez was on the contrary. Joinpoint regression analysis revealed a declining trend in malaria incidence for all age groups except the 10-24 years group, and the mortality rate and the CFR initially decreased followed by an increase in all age groups. Niger has implemented a series of malaria interventions, with the major ones being scaled up to larger populations during the study period. CONCLUSIONS: The scale-up of multi-interventions in Niger has significantly reduced malaria incidence, but the rise in mortality rate and CFR addresses the challenges in malaria control and elimination. Malaria endemic countries should enhance surveillance of malaria cases and drug resistance in Plasmodium, improve diagnosis and treatment, expand the population coverage of insecticide-treated bed nets and seasonal malaria chemoprevention, and strengthen the management of severe malaria cases.
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Mosquiteros Tratados con Insecticida , Malaria , Humanos , Niño , Adolescente , Adulto Joven , Adulto , Niger/epidemiología , Malaria/epidemiología , Malaria/prevención & control , Proyectos de Investigación , IncidenciaRESUMEN
BACKGROUND: Malaria, a disease transmitted by Anopheles mosquitoes, is a major public health problem causing millions of deaths worldwide, mostly among children under the age of 5 years. Biotechnological interventions targeting parasite-vector interactions have shown that the microsporidian symbiont Microsporidia MB has the potential to disrupt and block Plasmodium transmission. METHODS: A prospective cross-sectional survey was conducted in Zinder City (Zinder), Niger, from August to September 2022, using the CDC light trap technique to collect adult mosquitoes belonging to the Anopheles gambiae complex. The survey focused on collecting mosquitoes from three neighborhoods of Zinder (Birni, Kangna and Garin Malan, located in communes I, II and IV, respectively). Collected mosquitoes were sorted and preserved in 70% ethanol. PCR was used to identify host species and detect the presence of Microsporidia MB and Plasmodium falciparum infection. RESULTS: Of the 257 Anopheles mosquitoes collected and identified by PCR, Anopheles coluzzii was the most prevalent species, accounting for 97.7% of the total. Microsporidia MB was exclusively detected in A. coluzzii, with a prevalence of 6.8% (17/251) among the samples. No significant difference in prevalence was found among the three neighborhoods. Only one An. coluzzii mosquito tested PCR-positive for P. falciparum. CONCLUSIONS: The results confirm the presence of Microsporidia MB in Anopheles mosquitoes in Zinder, Niger, indicating its potential use as a biotechnological intervention against malaria transmission. However, further studies are needed to determine the efficacy of Microsporidia MB to disrupt Plasmodium transmission as well as its impact on vector fitness.
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Anopheles , Asteraceae , Malaria Falciparum , Malaria , Microsporidios , Plasmodium , Animales , Niño , Humanos , Preescolar , Plasmodium falciparum , Microsporidios/genética , Niger/epidemiología , Estudios Transversales , Estudios Prospectivos , Mosquitos Vectores , Malaria Falciparum/epidemiologíaRESUMEN
Niger is afflicted with high rates of poverty, high fertility rates, frequent environmental crises, and climate change. Recurrent droughts and floods have led to chronic food insecurity linked to poor maternal and neonatal nutrition outcomes in vulnerable regions. We analyzed maternal and neonatal nutrition trends and subnational variability between 2000 and 2021 with a focus on the implementation of policies and programs surrounding two acute climate shocks in 2005 and 2010. We used four sources of data: (a) national household surveys for maternal and newborn nutritional indicators allowing computation of trends and differences at national and regional levels; (b) document review of food security reports; (c) 30 key informant interviews and; (d) one focus group discussion. Many food security policies and nutrition programs were enacted from 2000 to 2020. Gains in maternal and neonatal nutrition indicators were more significant in targeted vulnerable regions of Maradi, Zinder, Tahoua and Tillabéri, from 2006 to 2021. However, poor access to financial resources for policy execution and suboptimal implementation of plans have hindered progress. In response to the chronic climate crisis over the last 20 years, the Nigerien government and program implementers have demonstrated their commitment to reducing food insecurity and enhancing resilience to climate shocks by adopting a deliberate multisectoral effort. However, there is more that can be achieved with a continued focus on vulnerable regions to build resilience, targeting high risk populations, and investing in infrastructure to improve health systems, food systems, agriculture systems, education systems, and social protection.
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Abastecimiento de Alimentos , Estado Nutricional , Recién Nacido , Humanos , Niger/epidemiología , Seguridad Alimentaria , PolíticasRESUMEN
BACKGROUND: By 1987, onchocerciasis in Niger had been successfully controlled in the six endemic river basins. In 2017, onchocerciasis elimination mapping (OEM) was carried out to determine if there was any ongoing transmission in the country as a whole. METHODS: The recommended OEM procedures were implemented. RESULTS: Ten districts, that included 35 villages, required field investigation as sites of possible transmission. None of these were found capable of supporting black fly breeding, nor was there any evidence of the presence of Simulium sp. flies. CONCLUSIONS: The implementation of OEM indicates that there is no transmission of onchocerciasis currently taking place in these newly assessed sites in Niger.
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Oncocercosis , Simuliidae , Animales , Humanos , Oncocercosis/epidemiología , Oncocercosis/prevención & control , Niger/epidemiología , África Occidental/epidemiología , IvermectinaRESUMEN
Improving the quality of malaria clinical case management in health facilities is key to improving health outcomes in patients. The U.S. President's Malaria Initiative Impact Malaria Project has supported implementation of the Outreach Training and Supportive Supervision (OTSS) approach in 11 African countries to improve the quality of malaria care in health facilities through the collection and analysis of observation-based data on health facility readiness and health provider competency in malaria case management. We conducted a secondary analysis of longitudinal data collected during routine supervision in Cameroon (April 2021-March 2022), Mali (October 2020-December 2021), and Niger (November 2020-September 2021) using digitized checklists to assess how service readiness affects health worker competencies in managing patients with fever correctly and providing those with confirmed uncomplicated malaria cases with appropriate treatment and referral. Linear or logistic regression analyses were conducted to assess the effect of facility readiness and its components on observed health worker competencies. All countries demonstrated significant associations between health facility readiness and malaria case management competencies. Data from three rounds of OTSS visits in Cameroon, Mali, and Niger showed a statistically significant positive association between greater facility readiness scores (including the availability of commodities, materials, and trained staff) and health worker competency in case management. These findings provide evidence that health worker performance is likely affected by the tools and training available to them. These results reinforce the need for necessary tools and properly trained staff if high-quality malaria case management services are to be delivered at health facilities.
Asunto(s)
Manejo de Caso , Malaria , Humanos , Camerún/epidemiología , Malí , Niger/epidemiología , Malaria/tratamiento farmacológico , Instituciones de SaludRESUMEN
Since 2015, countries in the Sahel region have implemented large-scale seasonal malaria chemoprevention (SMC). However, the mass use of sulfadoxine-pyrimethamine (SP) plus amodiaquine impacts the genetic diversity of malaria parasites and their sensitivity to antimalarials. This study aimed to describe and compare the genetic diversity and SP resistance of Plasmodium falciparum strains in Mali and Niger. We collected 400 blood samples in Mali and Niger from children aged 3-59 months suspected of malaria. Of them, 201 tested positive (Niger, 111, 55.2%; Mali, 90, 44.8%). Polymorphism of merozoite surface protein 1 (msp1) genetic marker showed 201 allotypes. The frequency of the RO33 allotype was significantly higher in Niger (63.6%) than in Mali (39.3%). There was no significant difference in the frequency of the K1 and MAD20 allotypes between the 2 countries. The multiplicity of infection was 2 allotypes per patient in Mali and one allotype per patient in Niger. The prevalence of strains with the triple mutants Pfdhfr51I/Pfdhfr59R/Pfdhps436A/F/H and Pfdhfr51I/Pfdhfr59R/Pfdhps437G was 18.1% and 30.2%, respectively, and 7.7% carried the quadruple mutant Pfdhfr51I/Pfdhfr59R/Pfdhps436A/F/H/Pfdhps437G. Despite the significant genetic diversity of parasite populations, the level of SP resistance was comparable between Mali and Niger. The frequency of mutations conferring resistance to SP still allows its effective use in intermittent preventive treatment in pregnant women and in SMC.
Asunto(s)
Antagonistas del Ácido Fólico , Malaria Falciparum , Malaria , Proteína 1 de Superficie de Merozoito , Niño , Femenino , Humanos , Embarazo , Antagonistas del Ácido Fólico/uso terapéutico , Malaria Falciparum/tratamiento farmacológico , Malí/epidemiología , Proteína 1 de Superficie de Merozoito/genética , Niger/epidemiología , Plasmodium falciparum/genética , Polimorfismo Genético/genética , Resistencia a Medicamentos/genéticaRESUMEN
Importance: The MORDOR (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) trial demonstrated that mass azithromycin administration reduced mortality by 18% among children aged 1 to 59 months in Niger. The identification of high-risk subgroups to target with this intervention could reduce the risk of antimicrobial resistance. Objective: To evaluate whether distance to the nearest primary health center modifies the effect of azithromycin administration to children aged 1 to 59 months on child mortality. Design, Setting, and Participants: The MORDOR cluster randomized trial was conducted from December 1, 2014, to July 31, 2017; this post hoc secondary analysis was conducted in 2023 among 594 clusters (communities or grappes) in the Boboye and Loga departments in Niger. All children aged 1 to 59 months in eligible communities were evaluated. Interventions: Biannual (twice-yearly) administration of a single dose of oral azithromycin or matching placebo over 2 years. Main Outcomes and Measures: A population-based census was used to monitor mortality and person-time at risk (trial primary outcome). Community distance to a primary health center was calculated as kilometers between the center of each community and the nearest health center. Negative binomial regression was used to evaluate the interaction between distance and the effect of azithromycin on the incidence of all-cause mortality among children aged 1 to 59 months. Results: Between December 1, 2014, and July 31, 2017, a total of 594 communities were enrolled, with 76â¯092 children (mean [SD] age, 31 [2] months; 39â¯022 [51.3%] male) included at baseline, for a mean (SD) of 128 (91) children per community. Median (IQR) distance to the nearest primary health center was 5.0 (3.2-7.1) km. Over 2 years, 145â¯693 person-years at risk were monitored and 3615 deaths were recorded. Overall, mortality rates were 27.5 deaths (95% CI, 26.2-28.7 deaths) per 1000 person-years at risk in the placebo arm and 22.5 deaths (95% CI, 21.4-23.5 deaths) per 1000 person-years at risk in the azithromycin arm. For each kilometer increase in distance in the placebo arm, mortality increased by 5% (adjusted incidence rate ratio, 1.05; 95% CI, 1.03-1.07; P < .001). The effect of azithromycin on mortality varied significantly by distance (interaction P = .02). Mortality reduction with azithromycin compared with placebo was 0% at 0 km from the health center (95% CI, -19% to 17%), 4% at 1 km (95% CI, -12% to 17%), 16% at 5 km (95% CI, 7% to 23%), and 28% at 10 km (95% CI, 17% to 38%). Conclusions and Relevance: In this secondary analysis of a cluster randomized trial of mass azithromycin administration for child mortality, children younger than 5 years who lived farthest from health facilities appeared to benefit the most from azithromycin administration. These findings may help guide the allocation of resources to ensure that those with the least access to existing health resources are prioritized in program implementation. Trial Registration: ClinicalTrials.gov Identifier: NCT02047981.