The AFRIBIOTA project, aiming to better understand the underlying mechanisms of chronic malnutrition, is officially closed

1st March 2019, the official closing ceremony of the AFRIBIOTA project took place in the Central African Republic. This ceremony was preceded by scientific restitution workshops held from 28th February to 1st March 2019. The official closing of the AFRIBIOTA project brought together its service providers, representatives of the study participants and local authorities led by the Minister of Health and Population Dr Pierre Somse and the Minister of Scientific Research and Technological Innovation Ms Ginette Amara.

After four years of work, the AFRIBIOTA project funded by the Total Foundation (main founder), the Institut Pasteur, the Gates Foundation, the Odyssey Re Foundation, the Swiss National Fund, the Nutricia Foundation and the Petram Foundation has come to an end. The closing ceremony was held on 1st March 2019 at Hotel Oubangui in Bangui City, bringing together a wide audience composed of members of local and national authorities, local communities and surrounding communities, representatives of donors, NGOs and representatives of study participants in particular.

The ceremony began with the restitution of the director of the Bangui Pediatric Complex, Pr Jean Chrysostome Gody, Pr Louis Bainalilago anthropologist, Dr Gilles Tamara-Vernick anthropologist and the project coordinator, Pr Philippe Sansonetti. Subsequently, a brief presentation of the project and its major achievements was made by the principal investigator and project promoter, Dr. Pascale Vonaesch.

Speeches were delivered by the Director of the Institut Pasteur de Bangui Dr Jean-Pierre Lombart, the Mayor of the Bangui Municipality Mr Emile Gros Raymond Nakombo, the Minister of Scientific Research and Technological Innovation Ms Ginette Amara and the Minister of Public Health and Population Dr Pierre Somse.

Chronic paediatric malnutrition, a public health problem in CAR

According to the results of the National Food Security Survey (ENSA) conducted at the end of 2017, access to land does not guarantee people to practice agriculture. Due to a lack of sufficient household income, access to food and to healthy, nutritious and sufficient food remains a major challenge; 17% of the population has a poor consumption score while 28% of them have a limited food consumption score.

Up to 2.1 million people out of a population of 4.7 million are food insecure according to the National Food Security Survey (ENSA) published in January. A recent national nutrition survey (SMART) also shows alarming rates of malnutrition among very young children: 7.1% of global acute malnutrition among children aged 6 to 59 months.

The Minister of Health, Dr Pierre Somse, recalled at the inauguration of the therapeutic information centre that malnutrition is a major problem in Central Africa: "One in six children suffers from acute malnutrition. I am not talking about the other children who are moderately malnourished. One in 20 children in the Central African Republic is at risk of dying of malnutrition. So this is a crucial question."

But, as we now know, chronic malnutrition is not only linked to feeding problems, but also to immune problems and chronic inflammation of the intestine, the mechanisms of which are not yet fully understood.

Towards a new approach to malnutrition in CAR

This event celebrates five years of successful collaboration. A team effort by the Institut Pasteur de Paris, Institut Pasteur de Madagascar, and Institut Pasteur de Bangui and their hospital partners, in collaboration with the University of British Columbia (UBC in Vancouver), INSERM and the Collège de France, to review the malnutrition problem in Central Africa.

The study has borne fruit, particularly in scientific terms, with initial results published on 20th August 2018 in the international journal PNAS, which reveals the disorders suffered by the microbiota of malnourished children, as well as the existence of a surprising intestinal bacterial signature, characterized by the massive presence of bacteria from the oro-pharyngeal flora. Many other publications are planned in the coming months and years.

From a public health perspective, the study of the prevalence and the various risk factors associated with stunting suggests that there are opportunities for interventions, particularly prophylactic interventions, to eliminate this stunting syndrome.

The study resulted in recommendations to the local authorities concerned, which undertook to set up mechanisms and conditions conducive to the sustainability of the project's achievements for the benefit of the Central African populations.

Challenges still to be met

While the overall result is very positive, the most important thing to come is to translate these discoveries into effective treatments to enable all children to grow up healthy. Afribiota 1 has provided us with ideas for deciphering and understanding the disease, Afribiota 2 will be an action programme for the prevention and treatment of chronic paediatric malnutrition.

Provisions for the future

The project is coming to an end but the Institut Pasteur and its international network continue to invest in microbiotes, these human-microbe interfaces whose physiopathological role is crucial and imperfectly known.

Other studies, such as MALINEA, which aims to improve the management of moderate acute malnutrition in children aged 0 to 2 years by addressing intestinal infections and exploring the interactions between malnutrition and intestinal microbiome modification, continue to be carried out in the Central African Republic.

This article was first published by the Institut Pasteur de Bangui.


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