Malaria remains a major global health challenge, particularly in low-resource settings where access to expert microscopy may be limited. Deep learning-based computer-aided diagnosis (CAD) systems have been developed and demonstrate promising performance on thin blood smear images. However, their clinical deployment may be hindered by limited generalization across sites with varying conditions. Yet very few practical solutions have been proposed. In this work, we investigate continual learning (CL) as a strategy to enhance the robustness of malaria CAD models to domain shifts. We frame the problem as a domain-incremental learning scenario, where a YOLO-based object detector must adapt to new acquisition sites while retaining performance on previously seen domains. We evaluate four CL strategies, two rehearsal-based and two regularization-based methods, on real-life conditions thanks to a multi-site clinical dataset of thin blood smear images. Our results suggest that CL, and rehearsal-based methods in particular, can significantly improve performance. These findings highlight the potential of continual learning to support the development of deployable, field-ready CAD tools for malaria.
OBJECTIVE:There is limited information concerning pediatric neuro-oncology in French-speaking Africa. The aim of this work was to assess the status of this specialty in member institutions of the Franco-African Group of Pediatric Oncology (GFAOP). METHODS:Data pertaining to pediatric brain tumors in the GFAOP registry were analyzed. A short questionnaire was sent to the GFAOP centers to collect information regarding the neuro-oncology activity. Recordings and minutes of the 17 teleconferences that took place between 01/2023 and 03/2025 were reviewed and analyzed. RESULTS:Only 331 patients were registered between 2016 and 2025. This suggests a considerable gap in terms of diagnosis. Most units manage between one and ten patients annually, with low-grade glioma and medulloblastoma being the most common tumors. In most units, the costs of treatment are borne by families. The review of the minutes of the teleconferences highlights important gaps in knowledge and obvious deficiencies in communication between the different teams involved. CONCLUSIONS:This work highlights the challenges associated with the development of pediatric neuro-oncology in French-speaking Africa. The implementation of multidisciplinary programs is a critical step to improve the care of children with brain tumors.
Men engaged in transactional sex (METS) represent a neglected key population in sub-Saharan Africa (SSA), yet little is known about their burden of sexually transmitted infections (STIs) and associated factors. This study assessed the prevalence of self-reported STIs (SR-STI) and identified individual, community, and country-level determinants among this group. We analyzed pooled recent nationally representative Demographic and Health Survey (DHS) data from 26 SSA countries. This study included 10,128 men who reported engagement in transactional sex within the past 12 months. Weighted prevalence estimates were calculated, and multilevel logistic regression models were applied to examine individual-, community-, and country-level determinants of SR-STI symptoms, adjusting for survey year. AIC and BIC were used as comparative model selection criteria to identify the best-fitting model among the sequential multilevel models built. The participants’ mean (± SD) age was 29.8 (± 10.2) years. The overall weighted prevalence of SR-STIs among METS was 19.5
At the stage of kidney failure, hemodialysis, peritoneal dialysis, and kidney transplantation are the therapeutic alternatives for prolonging patients' lives. In Togo, in-center hemodialysis is the only treatment option available to patients. This study aimed to evaluate the direct cost of in-center hemodialysis treatment and to understand the challenges faced by patients with kidney failure in Togo in 2024. We conducted a sequential exploratory mixed-methods study. The qualitative study included patients who had been undergoing hemodialysis in a center from March 1 to June 31, 2024. In the quantitative study, a linear regression model was used to describe the factors associated with the cost of hemodialysis. From 15 interviews, four themes were identified: 1) patients' perception of the disease and its management, 2) the burden of the disease and hemodialysis on the patient and their family and friends, 3) financial difficulties, and 4) geographical challenges in accessing a hemodialysis center. For the quantitative study, 88 patients were included (41.0% female), and 84.0% were hypertensive. The median age of patients was 51 years old (interquartile range [IQR]: 40-58). The median monthly income of patients was 45,000 CFA francs (franc de la Communauté Financière Africaine, the currency in Togo) (approximately €69; IQR: 0-162,500 CFA francs). The median overall cost of hemodialysis per month was 276,000 CFA (approximately €421; IQR: 163,600-527,000). Being male and living alone were associated with the overall cost of hemodialysis. This study mainly reports on the financial difficulties that patients face in accessing hemodialysis. Advocacy is needed for better subsidization of hemodialysis care in Togo.
Objectif Évaluer la prise en charge en radiothérapie des cancers gynéco-mammaires au Togo. Matériel et méthodes Il s’agissait d’une étude rétrospective descriptive portant sur la prise en charge des cancers gynéco-mammaires par radiothérapie dans les structures sanitaires spécialisées au Togo, allant du 1er janvier 2021 au 31 décembre 2023. Résultats Au total, 119 patientes d’âges compris entre 29 et 82 ans, d’âge moyen de 53,24 ans, mariées, de profession informelle, respectivement, dans 74,8 %, 54,6 % des cas et prise en charge dans des structures sanitaires spécialisées étaient concernées. Le cancer du sein (65,6 %) était le plus fréquent, suivi du cancer du col de l’utérus (22,6 %). Ces cancers étaient diagnostiqués au stade III et IV dans 48,7 % des cas. Les cancers mammaires étaient plus fréquents chez les patientes mariées et de profession formelle (p˂0,05). La radiothérapie externe était utilisée dans tous les cas et aucune patiente n’avait bénéficié de curiethérapie ni de radiothérapie interne vectorisée. La radiothérapie externe (seule ou associée à d’autres traitements anticancéreux) était utilisée à but curatif dans 80,7 % des cas et à but palliatif dans 19,3 %. Le traitement curatif était de 50Gy en 25 fractions de 2Gy sur 5 semaines pour les cancers du sein et 45Gy en 25 fractions de 1,8Gy sur 5 semaines pour ceux gynécologiques. La radiothérapie externe était exclusive dans 14,0 % des cas, associée à la chimiothérapie dans 28,6 %, à la chimiothérapie et la chirurgie dans 40,3 %, à la chirurgie seule dans 18,5 %. La radiochimiothérapie utilisée dans 65,9 % de cancers gynécologiques était plus sollicitée chez les patientes de profession informelle (p<0,05). La radiochimiothérapie associée à la chirurgie utilisée dans 51,3 % des cas de cancers du sein était plus sollicitée pour des cancers non métastatiques (p<0,05). Six mois après le traitement, la survie sans progression était de 47,9 % et 22,69 % décédées. Le décès à six mois de cancer du sein était plus noté chez les patientes présentant des métastases (p<0,05). Conclusion Le profil socioclinique des cancers gynéco-mammaires traités par radiothérapie était varié. Les protocoles thérapeutiques étaient majoritairement l’association radiothérapie externe à la chimiothérapie et/ou la chirurgie. Des efforts restent à faire pour une meilleure efficacité thérapeutique.
