It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Monday, January 05, 2026
Prevalence and determinants of polypharmacy in Côte d´Ivoire: Findings from a retrospective insurance claims analysis
A study published in Pharmacoeconomics and Policy analyzed polypharmacy in Côte d'Ivoire using insurance data (2014−2018) and found a high prevalence of multiple medication use, especially among children under 15, a finding that shifts the focus away from the elderly, who are typically considered the primary at-risk group in such studies.
“While populations in developed countries are aging, the African continent is characterized by its growing young population,” shares corresponding author Jérôme Kouame. “This demographic context makes the high rates observed in those under 15, ranging from 37.8% for simultaneous use on a single day to 5.7% for continuous use, a particularly urgent concern for public health policymakers in Côte d'Ivoire and similar settings.”
The study is characterized by a detailed, three-part definition of polypharmacy. By analyzing simultaneous (5+ drugs on one day), cumulative (5+ drugs per month for three months), and continuous (5+ drugs for at least two quarters in a year) patterns, it provides a nuanced view of medication use over time. “Our methodological approach reveals that while the most acute form (simultaneous polypharmacy) decreased from 28.0% to 17.5% from 2014 to 2018, the more persistent forms linked to chronic management remain a challenge,” says Kouame.
The results shine a new light on profound geographic inequalities in healthcare practices within the country. Compared to the Abidjan-1-Grands-Ponts health region, other regions had 1.3 to 9 times higher odds of cumulative or continuous polypharmacy. This stark disparity suggests that factors like prescribing practices, healthcare access, or disease patterns vary significantly by region.
“These findings highlight the need for interventions promoting the rationale use of medicines across all regions of the country to reduce the risks and costs associated with polypharmacy,” adds Kouame.
This research also changes the conversation by providing the first major, data-driven snapshot of polypharmacy patterns in a West African population using insurance claims. “It improves the existing understanding, which largely stems from studies in elderly populations in high-income countries, by documenting a widespread issue affecting the younger population in a middle-income country,” says Kouame. “The most surprising element is the central role of children and adolescents in this narrative, coupled with the strong influence of a patient's geographic location, pointing to systemic factors that require targeted policy and clinical interventions.”
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Contact the author: Jérôme Kouame, Department of Analytical Sciences and Public Health, School of Pharmacy, University Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire. kouame.jerome@ufhb.edu.ci
The publisher KeAi was established by Elsevier and China Science Publishing & Media Ltd to unfold quality research globally. In 2013, our focus shifted to open access publishing. We now proudly publish more than 200 world-class, open access, English language journals, spanning all scientific disciplines. Many of these are titles we publish in partnership with prestigious societies and academic institutions, such as the National Natural Science Foundation of China (NSFC).
Prof. Dr. Çağan H. Şekercioğlu, co-author of the study published in the Journal of Environmental Management, conducting fieldwork as part of his long-term research on biodiversity, conservation, and human–wildlife interactions.
A long-term study examining wolf–human interactions in Türkiye reveals the delicate balance between ecology and society.
Living close to nature does not always mean living in harmony. Across many regions of Türkiye, the boundaries between wildlife habitats and human activity are becoming increasingly blurred. When large predators such as wolves are involved, these encounters can have serious consequences—for both people and animals.
By analyzing when, where, and why conflicts occur, the research sheds light not only on wildlife dynamics but also on the social and economic realities of rural life.
Why Are Conflicts Increasing?
The primary aim of the study was to determine whether encounters between wolves and humans—or their livestock—are random events or follow identifiable patterns. To answer this question, the researchers analyzed nearly two decades of nationwide data, combining records of wolf attacks with information on livestock practices, geographic features, and human settlements.
The findings are strikingly clear. Wolf–human conflicts tend to cluster in specific regions, most of which overlap with areas where rural livestock farming is widespread. Attacks increase particularly during periods when sheep and goats are grazed in open landscapes. Seasonal cycles, grazing practices, and habitat characteristics all play a direct role in shaping these encounters.
The study also highlights the influence of human-driven factors. Road networks, proximity to settlements, and habitat fragmentation significantly increase the risk of conflict. In other words, the issue is not solely about wolf behavior—how humans use and transform the landscape is an equally critical part of the equation.
A Keystone Species, a Source of Social Tension
Wolves are widely recognized as a keystone species, playing a crucial role in maintaining ecological balance by regulating prey populations. At the same time, for people living in rural areas, wolves can represent economic loss and a source of insecurity.
The research underscores this fundamental tension: conserving wildlife while sustaining rural livelihoods requires a carefully balanced approach. Conservation efforts that overlook the needs and concerns of local communities risk backfiring. As conflicts intensify, negative perceptions of wildlife can grow stronger, ultimately undermining conservation goals.
One of the study’s most important contributions is its demonstration that many conflicts are predictable. By developing risk maps, the researchers show that it is possible to anticipate where and under what conditions wolf–human encounters are most likely to occur. This opens the door to proactive, preventive strategies rather than reactive responses after damage has already been done.
The authors emphasize that there is no single solution. Effective coexistence depends on a combination of approaches, including:
Conservation strategies developed in collaboration with local communities
Fair compensation mechanisms for livestock losses
Education and awareness programs
Land-use planning that aligns with ecological realities
Together, these measures are critical for enabling more sustainable coexistence between people and wildlife.
Is Living with Nature Truly Possible?
This study offers valuable insights not only for academic audiences but also for people across rural Türkiye who confront the realities of living alongside wildlife every day. By integrating long-term data analysis, spatial modeling, and the experiences of local communities, the research demonstrates how bridges can be built between conservation policies and social realities.
Conducted through international collaboration led by Prof. Dr. Çağan H. Şekercioğlu, the study stands out as a meaningful contribution that enriches both the scientific understanding and the societal perspective on wildlife management in Türkiye.
Conceptual illustration showing key factors influencing wolf–human conflicts, including livestock grazing, habitat use, and human land-use patterns, as presented in the study published in the Journal of Environmental Management.
Credit
Şekercioğlu et al., Journal of Environmental Management
Postdoc collaboration at the Institute of Science and Technology Austria (ISTA). ISTA’s Nikhil Mishra and Yuting Irene Li are looking for tiny striped zebrafish hiding behind seagrass.
Life begins with a single fertilized cell that gradually transforms into a multicellular organism. This process requires precise coordination; otherwise, the embryo could develop serious complications. Scientists at ISTA have now demonstrated that the zebrafish eggs, in particular their curvature, might be the instruction manual that keeps cell division on schedule and activates the appropriate genes in a patterned manner to direct correct cell fate acquisition. These insights, published in Nature Physics, could help improve the accuracy of embryo assessments in IVF.
Nikhil Mishra opens a heavy door that leads into a unique room. Countless transparent boxes are stored on racks swarming with small striped fish. The water refracts through the containers, casting a bluish hue across the room. You could almost believe you were in the middle of the sea, and the gentle lapping of the water and the cozy warmth of 27 °C reinforce this feeling.
Mishra takes one of the boxes from the rack and points at a zebrafish.
“The zebrafish is an ideal organism for studying the earliest steps of development,” he explains passionately. “Their embryos are fertilized outside the mother, which means we can easily collect and study them—often hundreds at a time. They are also naturally transparent, so we can literally watch their cells divide, move, and change in real time.”
From one cell to many
Life begins with a single fertilized egg cell, called the zygote, which begins to divide repeatedly. First into two cells, then four, then eight, and so on. This process is very similar across most species, including in humans. “Initially, these divisions happen quickly and without the cells taking on special roles. But soon, patterns begin to emerge: some cells divide more slowly, some start activating different genes, and others move to new positions,” Mishra says.
These early differences mark the first steps of ‘symmetry-breaking,’ when the embryo stops being uniform and starts organizing itself. Over time, groups of cells specialize into the three major layers that will form all tissues and organs. “From what begins as a simple, seemingly identical cluster of cells, a structured and patterned embryo gradually takes shape—laying the foundation for the entire body plan.”
A knowledge gap
In its early stages, the zygote depends on information provided by the mother. Only after reaching a developmental milestone called the midblastula extension (MBT) does the embryo begin to develop independently. At that point, the embryo needs to activate the appropriate genes at the right times in the correct cells. But how does it determine when and where to activate its genes? This is a fundamental question and a major knowledge gap that Mishra and the Heisenberg group at ISTA are investigating. However, they are not the only ones exploring this mystery.
ISTA’s Hannezo group is also attempting to understand how the position and timing of individual cell behavior are coordinated. These two research teams have been collaborating for some time. In particular, Yuting Irene Li, a postdoc in the Hannezo group, has greatly aided Mishra’s research with valuable expertise in theoretical physics, mathematical modeling, and statistical approaches to complex biological systems.
Geometry – the instruction manual
This collaborative research tested a largely ignored hypothesis—that the embryo’s geometry drives its development. The ISTA scientists demonstrated that the embryo “reads” and correctly interprets the zygote’s geometry during the initial few minutes of its existence. When the researchers manipulated the early embryo geometry, it changed how cells developed later.
Think of the zygote’s geometry as an instruction manual that the embryo must read and follow as it patterns itself. If there is an error in that manual or the embryo does not read it correctly, it could lead to major problems—imagine having an intestine where your head should be.
Like a stadium wave
Mishra explains that geometry sets off a series of highly consequential events causing cells to divide asymmetrically in an organized manner and thereby creating a gradient of cell size. These size differences create a gradient of cell cycle periods; smaller cells take longer to complete one cycle and divide into two cells.
Within the transparent embryo, this gradient is clearly visible under a microscope. Cells follow a repeating cycle, almost like a tiny internal clock, ticking through division and rest. “This repeating cycle, known as oscillation, varies slightly for each cell based on its size, which is determined by the fertilized egg’s geometry,” explains Li, an expert in oscillations. “Consequently, these varied ‘clocks’ align in a sweeping pattern across the embryo. What you see is a mitotic phase wave—a wave formed by different cells reaching the ‘division moment’ of their internal clocks one after another.”
Improving IVF outcomes
For the ISTA scientists, the next step is to determine how universal these principles are. If similar geometric rules are also found in mammals—and especially in humans—the implications could be very significant. This is relevant as more and more people turn to assisted reproductive technologies like IVF. Even for young, healthy individuals, fewer than half of IVF embryos reach the stage where they can be implanted and lead to viable pregnancies.
“Many embryos that fail during development show abnormalities in early division patterns or in how they activate their genes but we still don’t fully understand why. Our work suggests that the geometry of the early embryo—the physical shape and layout of its first cells—may play an important role in keeping development on track,” Mishra concludes.
In the long run, understanding these principles could help recognize early geometric “warning signs” in IVF embryos and perhaps design ways to correct or compensate for them. This could eventually contribute to more reliable embryo assessment and improved IVF outcomes.
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Information on animal studies
To better understand fundamental processes, for example, in the fields of neuroscience, immunology, or genetics, the use of animals in research is indispensable. No other methods, such as in silico models, can serve as an alternative. The animals are raised, kept, and treated according to strict regulations.
Zebrafish. Humans and zebrafish are more alike than one might think, especially when it comes to embryonic development. In science, zebrafish (Danio rerio) often reveal principles that apply much more broadly, making them both practical and biologically relevant for understanding how early embryos develop. ISTA’s Aquatics Facility
Aquatics Facility of the Institute of Science and Technology Austria (ISTA). Nikhil Mishra takes out a transparent box filled with zebrafish. Research team. ISTA’s Carl-Philipp Heisenberg, Nikhil Mishra, and Yuting Irene Li (from left to right). Not pictured: Edouard Hannezo.
Embryo representation. At the top is a normal embryo with a single lobe, which is a hemispherical cluster of cells (shown in different colors). The cells near the top of this lobe are usually the largest, and this is where the mitotic waves begin. Below is a bi-lobed embryo, which is the result of a mechanically manipulated zygote, resulting in two lobes and consequently two mitotic waves. When Mishra first observed this during his postdoctoral research, he considered it a groundbreaking moment.
