Effects of Hygiene and Defecation Behavior on Helminths and Intestinal Protozoa Infections in Taabo,C?te d’Ivoire

Background

More than 1 billion people are currently infected with soil-transmitted helminths and schistosomes. The global strategy to control helminthiases is the regular administration of anthelmintic drugs to at-risk populations. However, rapid re-infection occurs in areas where hygiene, access to clean water, and sanitation are inadequate.

Methodology

In July 2011, inhabitants from two villages and seven hamlets of the Taabo health demographic surveillance system in south-central Côte d’Ivoire provided stool and urine samples. Kato-Katz and ether-concentration methods were used for the diagnosis of Schistosoma mansoni, soil-transmitted helminths (Ascaris lumbricoides, Trichuris trichiura, and hookworm), and intestinal protozoa. Urine samples were subjected to a filtration method for the diagnosis of Schistosoma haematobium. A questionnaire was administered to households to obtain information on knowledge, attitude, practice, and beliefs in relation to hygiene, sanitation, and defecation behavior. Logistic regression models were employed to assess for associations between questionnaire data and parasitic infections.

Principal Findings

A total of 1,894 participants had complete data records. Parasitological examinations revealed prevalences of hookworm, S. haematobium, T. trichiura, S. mansoni, and A. lumbricoides of 33.5%, 7.0%, 1.6%, 1.3% and 0.8%, respectively. Giardia intestinalis and Entamoeba histolytica/E. dispar were detected in 15.0% and 14.4% of the participants, respectively. Only one out of five households reported the presence of a latrine, and hence, open defecation was common. Logistic regression analysis revealed that age, sex, socioeconomic status, hygiene, and defecation behavior are determinants for helminths and intestinal protozoa infections.

Conclusions/Significance

We found that inadequate sanitation and hygiene behavior are associated with soil-transmitted helminths and intestinal protozoa infections in the Taabo area of south-central Côte d’Ivoire. Our data will serve as a benchmark to monitor the effect of community-led total sanitation and hygiene education to reduce the transmission of helminthiases and intestinal protozoa infections.     

Census and distribution of chimpanzees in Côte D’Ivoire

Most methods of estimating chimpanzee population densities rely on nest counts. We tested the most frequently used techniques on a known chimpanzee community living in the rainforest of the Taï National Park, Côte d’Ivoire. The best density estimates are given by counts that assume groups of nests to be distributed randomly and that use the mean group size for homogenous habitat but the median for heterogenous habitats. Correction for real forest cover within the region should be made because chimpanzees make nests only in forested regions. This method gave the exact chimpanzee density for the Taï population, i.e. 1.7 nest builders/km². For the nationwide survey, we first estimated the chimpanzee density for different types of habitat (e.g. intact primary forest: 1.64 chimpanzees/km²; degraded forests: 0.4 chimpanzees/km²; human encroached forests and mosaic habitats: 0.09 chimpanzees/km²). Second, we estimated the total forest cover of the country with satellite pictures. This gave an estimated chimpanzee population in Côte d’Ivoire of about 11,676 ± 1,168 individuals, which equals the number of spectators at a soccer game in an average European town. Sadly, only three National Parks may have chimpanzee populations large enough to be viable, whereas the rest are scattered and isolated small populations that are already threatened in their survival.     

Determinants of bushmeat supply sources in rural areas of Côte d’Ivoire

The bushmeat trade provides an income to hunters, transporters, and vendors living in the vicinity of protected areas but remains a challenge to wildlife conservation objectives. The key factors driving the source, choice and use of bushmeat vary among actors in the commercial bushmeat value chain, and insights into these determinants are required to facilitate the development of conservation strategies. Therefore, we aimed to identify the socioeconomic factors that explain the source of supply and quantities of bushmeat available in households and local restaurants. We carried out a survey with 144 rural household heads and 24 restaurant owners in 20 villages in the Western part of Taï National Park in Côte d’Ivoire. We found that bushmeat quantity and species diversity were low in households, originating mainly from subsistence hunting. However, both the amount of bushmeat and the variety of species were high in restaurants and primarily supplied by commercial hunters. Furthermore, the quantity of bushmeat was lower in households with other protein sources and in restaurants in villages that had been the target of more conservation awareness campaigns. We highlight the importance of understanding the determinants of bushmeat supply to regulate the bushmeat trade by applying relevant conservation interventions.     

Scope and Limits of an Anamnestic Questionnaire in a Control-Induced Low-Endemicity Helminthiasis Setting in South-Central C?te d’Ivoire

Background

Schistosomiasis and soil-transmitted helminthiasis are two high-burden neglected tropical diseases. In highly endemic areas, control efforts emphasize preventive chemotherapy. However, as morbidity, infection, and transmission begin to decrease, more targeted treatment is likely to become more cost-effective, provided that comparatively cheap diagnostic methods with reasonable accuracy are available.

Methodology

Adults were administered an anamnestic questionnaire in mid-2010 during a cross-sectional epidemiological survey in the Taabo health demographic surveillance system in south-central Côte d’Ivoire. Questions pertaining to risk factors and signs and symptoms for schistosomiasis and soil-transmitted helminthiasis were included. The individuals’ helminth infection status and their belonging to three different anthelmintic treatment groups were compared with the questionnaire results (i) to inform the local health authorities about the epidemiological and clinical footprint of locally prevailing helminthiases, and (ii) to explore the scope and limits of an anamnestic questionnaire as monitoring tool, which eventually could help guiding the control of neglected tropical diseases in control-induced low-endemicity settings.

Principal Findings

Our study sample consisted of 195 adults (101 males, 94 females). We found prevalences of hookworm, Trichuris trichiura, Schistosoma haematobium, and Schistosoma mansoni of 39.0%, 2.7%, 2.1%, and 2.1%, respectively. No Ascaris lumbricoides infection was found. Helminth infection intensities were generally very low. Seven, 74 and 79 participants belonged to three different treatment groups. Multivariable logistic regression models revealed statistically significant (p<0.05) associations between some risk factors, signs, and symptoms, and the different helminth infections and treatment groups. However, the risk factors, signs, and symptoms showed weak diagnostic properties.

Conclusions/Significance

The generally low prevalence and intensity of helminth infection in this part of south-central Côte d’Ivoire indicates that recent control efforts have turned our study area into a low endemicity setting. Our anamnestic questionnaire had low sensitivity and specificity to identify infected individuals or treatment groups.     

Multiple Pathogens Including Potential New Species in Tick Vectors in C?te d’Ivoire

BackgroundOur study aimed to assess the presence of different pathogens in ticks collected in two regions in Côte d’Ivoire.Conclusions/SignificanceFor the first time, we demonstrate the presence of different pathogens such as R. aeschlimannii, C. burnetii, Borrelia sp., A. centrale, A. marginale, and E. ruminantium in ticks in Côte d’Ivoire as well as potential new species of unknown pathogenicity.     

Pattern of the evolution of HIV-1 enν gene in C?te d?Ivoire

Cête d׳Ivoire continues to have the highest HIV-1 prevalence rate in West Africa, although the infection number is in constant decline. The external envelope protein of the viruses is a likely site of selection, and responsible for receptor binding and entry into host cells, and therefore constitutes an ideal region with which to investigate the evolutionary processes acting on HIV-1. In this study, we analyse 189 envelope glycoprotein V3 loop region sequences of viruse isolates from 1995 to 2009, from HIV-1 untreated patients living in Cête d׳Ivoire, to decipher the temporal relationship between disease diversity, divergence and selection. Our analyses show that the nonsynonymous and synonymous ratio (dN/dS) was lower than 1 for viral populations analysed within 15 years, which showed the sequences did not undergo adequate immune pressure. The phylogenetic tree of the sequences analysed demonstrated distinctly long internal branches and short external branches, suggesting that only a small number of viruses infected the new host cell at each transmission. In addition to identifying sites under purifying selection, we also identified neutral sites that can cause false positive inference of selection. These sites presented form a resource for future studies of selection pressures acting on HIV-1 enν gene in Cête d׳Ivoire and other West African countries.     

Occurrence of ochratoxin A in spices commercialized in Abidjan (Côte d’Ivoire)

Ochratoxin A (OTA) is a mycotoxin produced mostly by several species of Aspergillus and Penicillium. OTA is nephrotoxic in all animal species in which it has been tested and is cancerogenic in rodents. It is associated with Balkan endemic nephropathy. It is naturally present in many crop products such as cereals (barley, wheat, maize) and dried fruits, spices, coffee, wine, olives, and cocoa. The aim of this study was to assess the contamination of three Ivoirian spices with OTA (ginger, chili, and pepper) widely consumed by the population. A total of 90 spice samples (ginger: n?=?30; chili: n?=?30; pepper n?=?30) was taken from various sales outlets of Abidjan. OTA was quantified using an HPLC apparatus coupled with a fluorimetric detector. The chili and ginger samples were contaminated with OTA at a mean concentration of 57.48?±?174 and 0.12?±?0.15 μg/kg, respectively. No contamination of the pepper samples was detected. Eight (26.67 %) of the chili samples exceeded the maximum limit of 15 μg/kg established by European regulation. These results should serve as an alert on the risk to the consumer population of these products that are highly contaminated with OTA.     

Cost-Effectiveness of Preventing Loss to Follow-up in HIV Treatment Programs: A C?te d'Ivoire Appraisal

Background

Data from HIV treatment programs in resource-limited settings show extensive rates of loss to follow-up (LTFU) ranging from 5% to 40% within 6 mo of antiretroviral therapy (ART) initiation. Our objective was to project the clinical impact and cost-effectiveness of interventions to prevent LTFU from HIV care in West Africa.

Methods and Findings

We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model to project the clinical benefits and cost-effectiveness of LTFU-prevention programs from a payer perspective. These programs include components such as eliminating ART co-payments, eliminating charges to patients for opportunistic infection-related drugs, improving personnel training, and providing meals and reimbursing for transportation for participants. The efficacies and costs of these interventions were extensively varied in sensitivity analyses. We used World Health Organization criteria of <3× gross domestic product per capita (3× GDP per capita = US$2,823 for Côte d''Ivoire) as a plausible threshold for “cost-effectiveness.” The main results are based on a reported 18% 1-y LTFU rate. With full retention in care, projected per-person discounted life expectancy starting from age 37 y was 144.7 mo (12.1 y). Survival losses from LTFU within 1 y of ART initiation ranged from 73.9 to 80.7 mo. The intervention costing US$22/person/year (e.g., eliminating ART co-payment) would be cost-effective with an efficacy of at least 12%. An intervention costing US$77/person/year (inclusive of all the components described above) would be cost-effective with an efficacy of at least 41%.

Conclusions

Interventions that prevent LTFU in resource-limited settings would substantially improve survival and would be cost-effective by international criteria with efficacy of at least 12%–41%, depending on the cost of intervention, based on a reported 18% cumulative incidence of LTFU at 1 y after ART initiation. The commitment to start ART and treat HIV in these settings should include interventions to prevent LTFU. Please see later in the article for the Editors'' Summary     

Market Hunting in the Taï Region,Côte d’Ivoire and Implications for Monkey Populations

We studied the effect of market hunting on primate species in the Taï National Park and adjacent forests in Côte d’Ivoire. We assessed the impact of hunting by comparing the calculated maximal reproduction rate with the current off-take rate. We assessed the average bushmeat consumption per capita/per year from weekly investigations on bushmeat available in 88 bushmeat restaurants and markets over a 12-mo period in 1999. We derived data on preferences for particular game species from interviews of 162 bushmeat consumers, 25 subsistence hunters and 3 groups of professional hunters. Hunting pressure was highest on the larger primate species such red colobus (Procolobus badius), black- and- white colobus (Colobus polykomos) and sooty mangabeys (Cercocebus atys). The amount of primate bushmeat extracted from the Taï National Park and surrounding forests was 249,229 kg in 1999. We estimated population densities using line transect surveys. By referring to current population densities we calculated the maximum production of each species using the Robinson Redford model (2001) and assuming unhunted conditions. A comparison of current harvest levels with maximum production suggests that harvest of Procolobus badius is sustainable, whereas current off-take of Colobus polykomos, Cercocebus atys, Cercopithecus diana (diana monkey) and C. campbelli (Campbell’s monkeys) exceeds sustainability by ≤3 times. We recommend that wildlife managers promote programs that encourage the production of domestic animals as a substitute for wild meat.     

Infection and Co-infection with Helminths and Plasmodium among School Children in C?te d’Ivoire: Results from a National Cross-Sectional Survey

Background

Helminth infection and malaria remain major causes of ill-health in the tropics and subtropics. There are several shared risk factors (e.g., poverty), and hence, helminth infection and malaria overlap geographically and temporally. However, the extent and consequences of helminth-Plasmodium co-infection at different spatial scales are poorly understood.

Methodology

This study was conducted in 92 schools across Côte d’Ivoire during the dry season, from November 2011 to February 2012. School children provided blood samples for detection of Plasmodium infection, stool samples for diagnosis of soil-transmitted helminth (STH) and Schistosoma mansoni infections, and urine samples for appraisal of Schistosoma haematobium infection. A questionnaire was administered to obtain demographic, socioeconomic, and behavioral data. Multinomial regression models were utilized to determine risk factors for STH-Plasmodium and Schistosoma-Plasmodium co-infection.

Principal Findings

Complete parasitological and questionnaire data were available for 5,104 children aged 5-16 years. 26.2% of the children were infected with any helminth species, whilst the prevalence of Plasmodium infection was 63.3%. STH-Plasmodium co-infection was detected in 13.5% and Schistosoma-Plasmodium in 5.6% of the children. Multinomial regression analysis revealed that boys, children aged 10 years and above, and activities involving close contact to water were significantly and positively associated with STH-Plasmodium co-infection. Boys, wells as source of drinking water, and water contact were significantly and positively associated with Schistosoma-Plasmodium co-infection. Access to latrines, deworming, higher socioeconomic status, and living in urban settings were negatively associated with STH-Plasmodium co-infection; whilst use of deworming drugs and access to modern latrines were negatively associated with Schistosoma-Plasmodium co-infection.

Conclusions/Significance

More than 60% of the school children surveyed were infected with Plasmodium across Côte d’Ivoire, and about one out of six had a helminth-Plasmodium co-infection. Our findings provide a rationale to combine control interventions that simultaneously aim at helminthiases and malaria.     

Associations between Exposure to Intimate Partner Violence,Armed Conflict,and Probable PTSD among Women in Rural C?te d’Ivoire

Background

Objectives were to assess associations between intimate partner violence (IPV), violence during armed conflict (i.e. crisis violence), and probable post-traumatic stress disorder (PTSD).

Methods

Using a sample of 950 women in rural Côte d’Ivoire, logistic generalized estimating equations assessed associations between IPV and crisis violence exposures with past-week probable PTSD.

Results

Over one in 5 (23.4%) women reported past-year IPV, and over one in 4 women (26.5%) reported experiencing IPV prior to the past year (i.e. remote IPV). Crisis violence was experienced by 72.6% of women. In adjusted models including demographics, crisis violence (overall and specific forms), and IPV (remote and past-year), women who reported past-year IPV had 3.1 times the odds of reporting probable past-week PTSD (95%CI: 1.8–5.3) and those who reported remote IPV had 1.6 times the odds (95%CI: 0.9–2.7). Violent exposures during the crisis were not significantly associated with probable PTSD (any crisis violence: aOR: 1.04 (0.7–1.5); displacement: aOR: 0.9 (95%CI: 0.5–1.7); family victimization during crisis: aOR: 1.1 (95%CI: 0.8–1.7); personal victimization during crisis: aOR: 1.7 (95%CI: 0.7–3.7)).

Conclusion

Past-year IPV was more strongly associated with past-week probable PTSD than remote IPV and violence directly related to the crisis. IPV must be considered within humanitarian mental health and psychosocial programming.     

Socio-Environmental Factors Associated with the Risk of Contracting Buruli Ulcer in Tiassalé, South C?te d’Ivoire: A Case-Control Study

Background

Buruli ulcer (BU) is a cutaneous infectious disease caused by Mycobacterium ulcerans. The exact mode of transmission remains elusive; yet, some studies identified environmental, socio-sanitary, and behavioral risk factors. The purpose of this study was to assess the association of such factors to contracting BU in Tiassalé, south Côte d’Ivoire.

Methodology

A case-control study was conducted in 2012. Cases were BU patients diagnosed according to clinical definition put forth by the World Health Organization, readily confirmed by IS2404 polymerase chain reaction (PCR) analysis prior to our study and recruited at one of the health centers of the district. Two controls were matched for each control, by age group (to the nearest 5 years), sex, and living community. Participants were interviewed after providing oral witnessed consent, assessing behavioral, environmental, and socio-sanitary factors.

Principal Findings

A total of 51 incident and prevalent cases and 102 controls were enrolled. Sex ratio (male:female) was 0.9. Median age was 25 years (range: 5–70 years). Regular contact with unprotected surface water (adjusted odds ratio (aOR) = 6.5; 95% confidence interval (CI) = 2.1–19.7) and absence of protective equipment during agricultural activities (aOR = 18.5, 95% CI = 5.2–66.7) were identified as the main factors associated with the risk of contracting BU. Etiologic fractions among exposed to both factors were 84.9% and 94.6%, respectively. Good knowledge about the risks that may result in BU (aOR = 0.3, 95% CI = 0.1–0.8) and perception about the disease causes (aOR = 0.1, 95% CI = 0.02–0.3) showed protection against BU with a respective preventive fraction of 70% and 90%.

Conclusions/Significance

Main risk factors identified in this study were the contact with unprotected water bodies through daily activities and the absence of protective equipment during agricultural activities. An effective strategy to reduce the incidence of BU should involve compliance with protective equipment during agricultural activities and avoidance of contact with surface water and community capacity building through training and sensitization.     

Year-round longitudinal monitoring of a bushmeat market in central-western Côte d’Ivoire: Implication for wildlife conservation

Hunting for bushmeat in the tropics has become a major issue in terms of conservation and human health, especially in western and central Africa. In Côte d’Ivoire, despite a ban on hunting since 1974, the bushmeat trade is widespread. This situation has been exacerbated by the long-term socio-political unrest in Côte d’Ivoire, resulting in the lack of effective protection of protected areas (PAs). Our study was carried out in the central-west Department of Daloa. We conducted standard interviews with the six main traders of the markets to trace the geographical origin of the bushmeat, and quantify the number of animals sold by direct observations twice a week during 52 weeks. We used multiple regression analyses to identify combinations of variables (proportion of animals killed, mean body mass, total biomass, price of carcass, price per body mass) that influenced poaching pressure.A total of 955 carcasses were recorded in the central market of Daloa. This number includes 948 mammals (99 %), six reptiles (0.6 %), and one bird (0.1 %). Rodentia were the most frequently sold taxons by number of individuals (58 %), followed by Artiodactyla (35 %), Carnivora (4 %), and Primates (1 %). Almost half of the game originated from the Department of Zoukougbeu (42 %; N = 404), followed by the Departments of Daloa (29 %; N = 275) and Séguéla (13 %; N = 123). Over 75 % of all the carcasses appearing in the market consisted of greater cane rats and bushbuck. In contrast, over 68 % of the total biomass (23028.75 kg) entering the market was supplied by Bushbuck and Common warthog. Game diversity by catchment area was the highest in Séguéla and Grégbeu and the lowest in Guezon and Maminigui. Our data indicated that hunting was unequally distributed throughout the central-western region of Côte d’Ivoire or markets are unequally provisioned by hunters. Human population density of the catchment areas affected the quantity and the quality of bushmeat observed at the urban market. Increasing hunting pressure in the Departments of Zoukougbeu proximate to the Haut Sassandra forest reserve indicates that the local authority in charge of the surveillance of this reserve has to reinforce its protection to avoid further faunal depletion. Because most of the ungulates and rodents found on the market occur at high density in disturbed habitats, their relative frequencies in the carcasses provisioning the market could be used as indicators of site over-exploitation.     

Bayesian Risk Mapping and Model-Based Estimation of Schistosoma haematobium–Schistosoma mansoni Co-distribution in C?te d′Ivoire

Background

Schistosoma haematobium and Schistosoma mansoni are blood flukes that cause urogenital and intestinal schistosomiasis, respectively. In Côte d′Ivoire, both species are endemic and control efforts are being scaled up. Accurate knowledge of the geographical distribution, including delineation of high-risk areas, is a central feature for spatial targeting of interventions. Thus far, model-based predictive risk mapping of schistosomiasis has relied on historical data of separate parasite species.

Methodology

We analyzed data pertaining to Schistosoma infection among school-aged children obtained from a national, cross-sectional survey conducted between November 2011 and February 2012. More than 5,000 children in 92 schools across Côte d′Ivoire participated. Bayesian geostatistical multinomial models were developed to assess infection risk, including S. haematobium–S. mansoni co-infection. The predicted risk of schistosomiasis was utilized to estimate the number of children that need preventive chemotherapy with praziquantel according to World Health Organization guidelines.

Principal Findings

We estimated that 8.9% of school-aged children in Côte d′Ivoire are affected by schistosomiasis; 5.3% with S. haematobium and 3.8% with S. mansoni. Approximately 2 million annualized praziquantel treatments would be required for preventive chemotherapy at health districts level. The distinct spatial patterns of S. haematobium and S. mansoni imply that co-infection is of little importance across the country.

Conclusions/Significance

We provide a comprehensive analysis of the spatial distribution of schistosomiasis risk among school-aged children in Côte d′Ivoire and a strong empirical basis for a rational targeting of control interventions.     

Change in termite communities along a chronosequence of mango tree orchards in the north of Côte d’Ivoire

Termites constitute the major component of the macrofauna of the soil, and influence the structure of the soil, in tropical regions. This study aimed to estimate their assemblages in a chronosequence of mango tree orchards in the north of Côte d’Ivoire and compare them with those in unmanaged savanna. Using a standardized method of rapid biodiversity estimation, termites were collected in seven age classes of mango tree orchards (class 1: <5 years; class 2: 5–9 years; class 3: 10–14 years; class 4: 15–19 years; class 5: 20–24 years; class 6: 25–29 years; class 7: 30 years and over) and compared with termites collected from the savanna. Results show that the species richness was lowest in the young orchards of class 1 (9 species), and increased with the age of the orchards to reach its maximum in the old orchards of class 7 (28 species); these latter were comparable in richness with the savanna (26 species). The Shannon index (H’) and the evenness (E) follow the same trend as the species richness. The orchards of classes 1 and 2 were more dissimilar to the savanna. In contrast, termites were well represented in the savanna and in the old orchard of classes 6 and 7. Rhinotermitinae and Cubitermitinae subfamilies, absent in the young orchards of classes 1 and 2, were very abundant in the old orchards (classes 6 and 7). Overall, the findings of this study show that only the old mango orchards sustain termite diversity that comes close to that of the savanna. In this region, the cessation of agricultural activities in mango orchards favors the reconstitution of termite communities and presumably the restoration of the ecosystem services provided by termites. Thus it would be possible to combine agriculture and the conservation soil biodiversity.     

Sustaining Control of Schistosomiasis Mansoni in Western C?te d’Ivoire: Results from a SCORE Study,One Year after Initial Praziquantel Administration

Background

The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) has launched several large-scale trials to determine the best strategies for gaining and sustaining control of schistosomiasis and transitioning toward elimination. In Côte d’Ivoire, a 5-year cluster-randomized trial is being implemented in 75 schools to sustain the control of schistosomiasis mansoni. We report Schistosoma mansoni infection levels in children one year after the initial school-based treatment (SBT) with praziquantel and compare with baseline results to determine the effect of the intervention.

Methodology

The baseline cross-sectional survey was conducted in late 2011/early 2012 and the first follow-up in May 2013. Three consecutive stool samples were collected from 9- to 12-year-old children in 75 schools at baseline and 50 schools at follow-up. Stool samples were subjected to duplicate Kato-Katz thick smears. Directly observed treatment (DOT) coverage of the SBT was assessed and the prevalence and intensity of S. mansoni infection compared between baseline and follow-up.

Principal Findings

The S. mansoni prevalence in the 75 schools surveyed at baseline was 22.1% (95% confidence interval (CI): 19.5–24.4%). The DOT coverage was 84.2%. In the 50 schools surveyed at baseline and one year after treatment, the overall prevalence of S. mansoni infection decreased significantly from 19.7% (95% CI: 18.5–20.8%) to 12.8% (95% CI: 11.9–13.8%), while the arithmetic mean S. mansoni eggs per gram of stool (EPG) among infected children slightly increased from 92.2 EPG (95% CI: 79.2–105.3 EPG) to 109.3 EPG (95% CI: 82.7–135.9 EPG). In two of the 50 schools, the prevalence increased significantly, despite a DOT coverage of >75%.

Conclusions/Significance

One year after the initial SBT, the S. mansoni prevalence had decreased. Despite this positive trend, an increase was observed in some schools. Moreover, the infection intensity among S. mansoni-infected children was slightly higher at the 1-year follow-up compared to the baseline situation. Our results emphasize the heterogeneity of transmission dynamics and provide a benchmark for the future yearly follow-up surveys of this multi-year SCORE intervention study.     

Ecosystem services for conservation finance: applying the TEEB stepwise approach in Côte d’Ivoire

Ecosystem service (ES) evidence and arguments can mobilize support for biodiversity conservation. However, the ES concept’s impact on the ground seems unclear: It is reliant upon a range of pre-requisites at the science-policy nexus and it tends to be science-driven and demanding in terms of data and required capacity. The TEEB stepwise approach (The Economics of Ecosystems and Biodiversity for Local and Regional Policy Makers, Earthscan, London, 2012) guides purpose-driven ES assessments and seeks to enhance the usefulness of the ES concept in difficult real-world settings. An application of this approach has not yet been appraised. Also, beyond the instrumental use of ES data (e.g. for the design of payment schemes for ES), there is little documented experience with strategically using ES arguments for mobilizing financial resources for conservation. As many other countries, Côte d’Ivoire does not have a strong knowledge base on ecosystem services (ES). Such circumstances can preclude the use of the ES concept for convincing potential donors to co-finance conservation. We examine the recent ES assessment for the Parc national de Taï (PNT), Côte d’Ivoire, which followed the TEEB stepwise approach. We look at process, results and outcomes to address three questions: (i) How did study results contribute to mobilizing funds for the PNT? (ii) In which ways was the TEEB stepwise approach useful in practice? (iii) What lessons can be drawn for ES assessments geared to conservation finance?     

Mapping malaria risk among children in Côte d’Ivoire using Bayesian geo-statistical models

ABSTRACT: BACKGROUND: In Cote d'Ivoire, an estimated 767,000 disability-adjusted life years are due to malaria, placing the country at position number 14 with regard to the global burden of malaria. Risk maps are important to guide control interventions, and hence, the aim of this study was to predict the geographical distribution of malaria infection risk in children aged <16 years in Cote d'Ivoire at high spatial resolution. METHODS: Using different data sources, a systematic review was carried out to compile and georeference survey data on Plasmodium spp. infection prevalence in Cote d'Ivoire, focusing on children aged <16 years. The period from 1988 to 2007 was covered. A suite of Bayesian geo-statistical logistic regression models was fitted to analyse malaria risk. Non-spatial models with and without exchangeable random effect parameters were compared to stationary and non-stationary spatial models. Non-stationarity was modelled assuming that the underlying spatial process is a mixture of separate stationary processes in each ecological zone. The best fitting model based on the deviance information criterion was used to predict Plasmodium spp. infection risk for entire Cote d'Ivoire, including uncertainty. RESULTS: Overall, 235 data points at 170 unique survey locations with malaria prevalence data for individuals aged <16 years were extracted. Most data points (n = 182, 77.4%) were collected between 2000 and 2007. A Bayesian non-stationary regression model showed the best fit with annualized rainfall and maximum land surface temperature identified as significant environmental covariates. This model was used to predict malaria infection risk at nonsampled locations. High-risk areas were mainly found in the north-central and western area, while relatively low-risk areas were located in the north at the country border, in the northeast, in the south-east around Abidjan, and in the central-west between two high prevalence areas. CONCLUSION: The malaria risk map at high spatial resolution gives an important overview of the geographical distribution of the disease in Cote d'Ivoire. It is a useful tool for the national malaria control programme and can be utilized for spatial targeting of control interventions and rational resource allocation.     

Effect of Fee on Cervical Cancer Screening Attendance—ScreenFee,a Swedish Population-Based Randomised Trial

Background

Attendance in the cervical cancer screening programme is one of the most important factors to lower the risk of contracting the disease. Attendance rates are often low in areas with low socioeconomic status. Charging a fee for screening might possibly decrease attendance in this population. Screening programme coverage is low in low socio-economic status areas in Gothenburg, Sweden, but has increased slightly after multiple interventions in recent years. For many years, women in the region have paid a fee for screening. We studied the effect of abolishing this fee in a trial emanating from the regular cervical cancer screening programme.

Method

Individually randomised controlled trial. All 3 124 women in three low-resource areas in Gothenburg, due for screening during the study period, were randomised to receive an offer of a free test or the standard invitation stating the regular fee of 100 SEK (≈11 €). The study was conducted during the first six months of 2013. Attendance was defined as a registered Pap smear within 90 days from the date the invitation was sent out.

Results

Attendance did not differ significantly between women who were charged and those offered free screening (RR 0.93; CI 0.85–1.02). No differences were found within the districts or as an effect of age, attendance after the most recent previous invitation or previous experience of smear taking.

Conclusion

Abolishment of a modest screening fee in socially disadvantaged urban districts with low coverage, after previous multiple systematic interventions, does not increase attendance in the short term. Other interventions might be more important for increasing attendance in low socio-economic status areas.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT02378324","term_id":"NCT02378324"}}NCT02378324     

Low Rates of Antimicrobial-Resistant Enterobacteriaceae in Wildlife in Ta? National Park,C?te d’Ivoire,Surrounded by Villages with High Prevalence of Multiresistant ESBL-Producing Escherichia coli in People and Domestic Animals

Antimicrobial resistance genes can be found in all ecosystems, including those where antibiotic selective pressure has never been exerted. We investigated resistance genes in a collection of faecal samples of wildlife (non-human primates, mice), people and domestic animals (dogs, cats) in Côte d’Ivoire; in the chimpanzee research area of Taï National Park (TNP) and adjacent villages. Single bacteria isolates were collected from antibiotic-containing agar plates and subjected to molecular analysis to detect Enterobacteriaceae isolates with plasmid-mediated genes of extended-spectrum beta-lactamases (ESBLs) and plasmid-mediated quinolone resistance (PMQR). While the prevalence of ESBL-producing E. coli in the villages was 27% in people (n = 77) and 32% in dogs (n = 38), no ESBL-producer was found in wildlife of TNP (n = 75). PMQR genes, mainly represented by qnrS1, were also present in human- and dog-originating isolates from the villages (36% and 42% in people and dogs, respectively), but no qnrS has been found in the park. In TNP, different variants of qnrB were detected in Citrobacter freundii isolates originating non-human primates and mice. In conclusion, ESBL and PMQR genes frequently found in humans and domestic animals in the villages were rather exceptional in wildlife living in the protected area. Although people enter the park, the strict biosecurity levels they are obliged to follow probably impede transmission of bacteria between them and wildlife.