Baobab Index

Limited data is available about the availability of multiple sclerosis (MS) therapies and services in Africa. We aimed to investigate the availability, affordability, frequency of usage, and insurance coverage of MS therapies and services across Africa. A comprehensive web-based survey was constructed and distributed to neurologists from different African countries. The survey addresses availability, affordability, frequency of use, and insurance coverage of different therapies and services of MS. Respondents represented 27 African countries. Intravenous methylprednisolone was always available in most countries (88.9%), while interferons were completely or partially available in 13 countries (48.1%). The most available disease-modifying therapies (DMTs) were rituximab (22 countries, 81%), followed by interferon beta 1a intramuscular type (12, 44.4%). Availability of other DMTs was variable, while specific MS services were limited. Affordability is limited in most countries, and the use of DMTs was related to insurance coverage. Most associated therapies and investigations were more available and affordable, but less insured. Neurologists were the main healthcare providers, but traditional healers had a role in 14.8% of countries. Significant challenges characterize MS care in Africa. MS therapies, particularly DMTs and services, are inaccessible and unaffordable in most African countries.

Malaria remains one of the main public health problems in Mauritania, and it is essential to identify the factors that determine the distribution and productivity of

Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259 000 (95% uncertainty interval 202 000-335 000) global deaths and 2·54 million (2·20-2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300-149 000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98 700 deaths (77 000-127 000) and 594 000 cases (514 000-686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.

Rift Valley fever (RVF) is a mosquito-borne viral zoonosis that causes severe illness in livestock and humans, with significant economic and health repercussions. Mauritania is considered an RVF focus in West Africa. A cross-sectional survey was conducted in 2023 in 12 of Mauritania's 15 provinces. Serum samples from 849 small ruminants (428 goats and 421 sheep) were analyzed by ELISA for IgG and IgM antibodies against RVF virus. Logistic regression analyses were performed to assess associations between seropositivity and species, age, sex, season, and geographic location. In total, 14.1% of the animals tested were positive for anti-RVFV IgG antibodies. There was no association between anti-RVFV IgG positivity and the ruminant species, the sex, the age and the season. Hodh El Gharbi had the highest seroprevalence (40.5%), followed by Adrar (19.8%) and Tagant (19.7%). The lowest levels were recorded in Tiris Zemmour (2%) and Inchiri (3%). Only two animals tested positive for IgM, suggesting limited recent viral activity. This nationwide survey confirms widespread exposure of small ruminants to RVFV in Mauritania. Strengthening longitudinal serological monitoring and integrating ecological and entomological data within the "One Health" approach will be essential to preventing future epidemics and protecting animal and human health.

A 29-year-old woman with a novel homozygous VPS13A frameshift variant presented with drug-resistant temporal-lobe epilepsy and severe sensory neuronopathy, but no acanthocytes on repeated blood smears-expanding the phenotypic spectrum of chorea-acanthocytosis beyond its defining haematological feature.

Chickpea is one of the most consumed legumes due to its high nutritional value and accessibility to low-income populations. However, due to climate change, chickpea cultivation is exposed to various environmental stresses affecting its production and productivity. This study evaluates the agronomic performance of 168 MAGIC subset population across two Mediterranean environments, in Marchouch (Morocco) and Terbol (Lebanon). Genome-wide association studies (GWAS) were conducted to identify potential marker-trait associations (MTAs) using the general linear model (GLM), the mixed linear model (MLM), and the fixed- and random-effect circulant probability unification (FarmCPU), with kinship and principal components used as covariates. The results revealed high genetic variation among the genotypes tested, with significant genotype-by-environment interactions for most traits studied. Genotypes with good agronomic performance (M-1407, M-2038, M-2079, M-242, M-2551, and M-987) were identified under both environments. Early flowering and maturation resulted in a significant increase in grain yield of around 66%. Grain yield varied from 151.85 to 882.7 g m-2 and from 183.59 to 365.76 g m-2 under Marchouch and Terbol conditions, respectively, showing higher genetic variation under Marchouch than under Terbol. Correlation analysis revealed strong, significant correlations among the studied traits. GWAS revealed clear genetic variation across environments, with Marchouch showing stronger and more consistent association signals than Terbol. In total, 72 reliable MTAs were detected for phenological traits, 38 for plant height, 18 for grain yield, and 197 for hundred-seed weight across both sites. A major genomic hotspot on chromosome 4 (11.97-13.63 Mbp) harbored stable and pleiotropic MTAs. Functional annotation of regions surrounding significant SNPs revealed 59 putative candidate genes, highlighting potential biological processes related to growth, signaling, and stress responses that require further validation. These results provide a foundation for further research on marker-assisted selection to improve chickpea productivity and yield stability in stressed environments.

There is considerable variability in the clinical presentation of COVID-19 among patients infected with SARS-CoV-2. Genome-wide association studies (GWASs) have identified the 12q24.13 and 3p21.31 regions, derived from Neanderthal DNA, as the human genetic loci most strongly associated with COVID-19 severity. We examined in this study the 3p locus in the Moroccan population by analysing allele and haplotype frequencies at the LZTFL1 gene and their associations with COVID-19 outcomes. Three SNPs at LZTFL1, tagging the Neanderthal-derived COVID-19 risk haplotype, were sequenced by Sanger's method in 102 ambulatory participants and 105 hospitalized patients and have been compared to 118 controls negative for SARS-CoV-2 infection using logistic regression analysis. Results showed that the prevalence of the lead variant rs11385942 in this locus was 8.9%, whereas the variants rs35044562 and rs13078854, which tag the Neanderthal haplotype, were present in only 6.3%. Our study showed that only the rs35044562-T and rs13078854-A alleles were associated with a 2.5-fold increased risk of severe COVID-19 (p = 0.028). These two alleles, in LD with the rs11385942-AA one, form the haplotype inherited from the Neanderthal, the only haplotype associated with COVID-19 severity in the Moroccan population (p = 0.030), whereas sub-Saharan African and the rare local haplotype also containing the rs11385942 variant do not influence the COVID-19 outcomes 19 (p > 0.05). Furthermore, our study showed that the Neanderthal haplotype at 3p21 locus exists in the inhabitants of Morocco at a frequency close to that of Europeans and suggests a close connection between North Africa and Eurasia.

Crucial unmet needs for standardization and clinical integration of actionable biomarkers persist across the bladder cancer disease spectrum. To address these gaps, the International Bladder Cancer Group (IBCG) convened a global multidisciplinary panel to develop evidence-based consensus recommendations on biomarker use in bladder cancer. Recommendations were formulated across the disease spectrum using a modified Delphi process. In patients with asymptomatic microhaematuria, biomarker use should be guided by a risk-stratified approach. For patients with established non-muscle-invasive bladder cancer, no biomarker prospectively validated is available to guide intravesical therapy selection, although approved commercial tests might aid in adjudicating equivocal cytology or cystoscopy findings in patients with high-grade disease. In muscle-invasive bladder cancer, no validated biomarkers exist to guide the choice between bladder preservation and radical cystectomy, or to inform the choice of neoadjuvant therapy. Circulating tumour DNA is prognostic following neoadjuvant therapy and radical cystectomy, and provides predictive value for selecting patients who are most likely to benefit from adjuvant treatment with approved immunotherapy regimens. In addition, circulating tumour DNA has prognostic value in patients with metastatic urothelial carcinoma. The IBCG recommends assessing FGFR3 genomic alterations and HER2 immunohistochemistry in patients with locally advanced and/or metastatic bladder cancer to inform therapeutic selection. The IBCG consensus recommendations provide practical, stage-specific guidance on the use of biomarkers for diagnosis, risk stratification and treatment selection in patients with bladder cancer and define priorities for future validation and trial design.

Inborn errors of immunity are rare, genetically heterogeneous disorders requiring coordinated clinical, laboratory, and genetic evaluation over time. Data are often fragmented across records, laboratory systems, and genomic reports, limiting longitudinal analysis and coordinated care, particularly in the Middle East and North Africa, where structured rare disease data infrastructures remain limited. To develop a Research Electronic Data Capture-based data management framework for inborn errors of immunity and demonstrate its use in a prospective multi-site setting. A Research Electronic Data Capture-based framework was developed at the College of Medicine and Health Sciences, United Arab Emirates University. Modular instruments captured consent, demographics, biospecimen processing, laboratory workflows, and genetic findings within a longitudinal structure. Data dictionaries, validation rules, and conditional logic ensured data quality. The framework was deployed across participating sites for prospective data collection. The framework enabled integrated longitudinal documentation of enrollment, biospecimens, and genetic testing. It was implemented across two clinical sites and used to enroll patients with suspected or confirmed inborn errors of immunity. The platform supported standardized cross-site data capture and monitoring of genetic findings, including automated flagging of variants of uncertain significance. This study demonstrates the development and early multi-site implementation of a Research Electronic Data Capture-based framework for inborn errors of immunity. By enabling standardized integration of clinical, laboratory, and genetic data, the platform supports data quality, cross-site collaboration, and tracking of evolving diagnoses. It provides a scalable foundation for rare disease research and may support improved clinical decision-making.