[Hepatitis B vaccination status and associated factors among health care workers in Burkina Faso]. / Statut vaccinal contre le virus de l'hépatite B et facteurs associés parmi le personnel de santé au Burkina Faso.

INTRODUCTION: The purpose of this study was to evaluate anti-HBV vaccination status and factors associated with vaccination against HBV among health care workers in Burkina Faso. METHODS: In August and September 2010, we conducted a cross-sectional study on health care workers having practiced in a health facility for at least three months. Data were collected using a self-administered questionnaire. Blood samples were collected from consenting participants to search for anti-HBs antibodies, markers of immune status. RESULTS: A total of 452 health care workers were surveyed. Among the respondents, 47.7 % had received at least one dose of HBV vaccine. The full immunization coverage against HBV was estimated at 10.9 %. Factors associated with vaccination status were age (p = 0.005), occupation (p = 0.005), and seniority in the profession (p = 0.001). Anti-HBs was found in 61.6 % of respondents, with significant differences (p = 0.01) between subjects who received at least one dose of vaccine (76.7 %) and those who reported never having been vaccinated (50.3 %). CONCLUSION: Hepatitis B vaccination coverage among health care workers is low in Burkina Faso, hence the need to promote vaccination against HBV in health facilities.

[Self-disclosure of a HIV-positive serostatus: factors favoring disclosure and consequences for persons living with HIV/AIDS in Burkina Faso]. / Partage de l'information sur le statut sérologique VIH positif : facteurs associés et conséquences pour les personnes vivant avec le VIH/sida au Burkina Faso.

UNLABELLED: Disclosure of HIV-serostatus remains a way to avoid sexual transmission of HIV because it allows partners to take the necessary protective measures, e.g. use of condoms. Disclosure is nevertheless difficult due to the discrimination associated with HIV. The objective of this study was to analyze factors leading to self-disclosure of HIV-positive status within a sample of persons of both sexes attending different healthcare services in Burkina Faso. METHODOLOGY: Cross-sectional study conducted by interviewing 740 patients in 26 healthcare services. Univariate (Chi(2) test) and multivariate (logistic regression) analyses were performed. The significance level was 5%. Qualitative data on factors associated with self-disclosure of HIV-positive status were analyzed. RESULTS: The majority of the patients (81.4%) informed at least one person who was very often a close relative (descendant, ascendant and sibling) or the partner. At multivariate analysis, HIV-serostatus was associated with using antiretroviral treatment, (OR=0.40, 95% CI: 0.3-0.7, P<0.001), known HIV-serostatus for at least one year (OR=0.6; 95% CI: 0.4-0.9), living in couple (2.3; 95% CI: 1.4-3.8). CONCLUSION: In a context limiting HIV testing due to the fear of social stigma, these results appear to be in favor of the Voluntary Counseling Testing model with a focus on the couple and/or families.

Determinants and causes of mortality in HIV-infected patients receiving antiretroviral therapy in Burkina Faso: a five-year retrospective cohort study.

In this study, we investigated the causes of death and the factors associated with mortality in a cohort of patients receiving highly active antiretroviral therapy (HAART) in Burkina Faso, an African country with limited resources. This retrospective cohort study included patients aged 15 years and older who started HAART for the first time between January 2003 and December 2008 in 14 health districts. We used survival analyses, including the Kaplan-Meier method, to examine potential predictors of death and two Cox proportional hazard models to estimate hazard ratios for death, first from baseline covariates and then from time-dependent covariates. A total of 6641 patients initiated HAART during this period; of these, 5608 were included in the analysis. By the end of the study period, 4310 of those patients were still receiving HAART, 690 had died, 207 had been transferred and 401 were lost to follow-up. The median duration of follow-up was 23.2 months [interquartile range (IQR): 12.4-36.9], and the overall incidence of mortality was 6 per 100 person-years. The clinical stage, CD4 count, body mass index (BMI), haemoglobin level, HAART regimen, gender, age, profession and year of initiation were the primary risk factors associated with death. In the multivariate analysis, BMI, clinical stage, treatment regimen and CD4 count remained significantly associated with death. The most frequent causes of death were wasting syndrome, tuberculosis and anaemia. This result highlights the already advanced stage of immunodeficiency among patients in Burkina Faso when they start HAART. Testing patients for HIV and starting antiretroviral therapy earlier are necessary to further reduce the mortality of patients living with HIV. This study provides a solid evidence base with which future evaluations of HAART in Burkina Faso can be compared.

Short-term and long-term outcomes following DOTS-based treatment for tuberculosis patients in Burkina Faso.

A cross-sectional study was initiated in Burkina Faso's National Tuberculosis Programme to confirm successful treatment results within 3 months of completing treatment and to characterise longer-term outcomes 12-24 months after completion. The sample (n = 278) included 91 patients who had completed treatment 0-3 months earlier ('short-term' sample) and 187 patients who had completed treatment 12-24 months earlier ('long-term' sample). All sputum specimens from the short-term sample were confirmed as negative. In the long-term sample, among 154 patients with available information, 13 (8%) had died, 24 were not traced, and 117 (76%) were interviewed and had sputum examinations, of which 2 (2%) were smear-positive. Recording of successful treatment outcomes shows good validity.

Une étude transversale a été conduite sur le Programme National Tuberculose du Burkina Faso afin de confirmer les résultats du traitement avec succès dans les 3 mois après l'achèvement du traitement et caractériser les résultats à long terme du traitement 12­24 mois après l'achèvement du traitement. L'échantillon (n = 278) comptait 91 patients ayant terminé le traitement 0­3 mois plus tôt (échantillon du court terme) et 187 patients ayant terminé le traitement 12­24 mois avant l'enquête (échantillon du long terme). Tous les frottis de crachat de l'échantillon du court terme ont été confirmés négatifs. Dans l'échantillon du long terme, parmi 154 patients dont les informations étaient disponibles, 13 (8%) étaient décédés, 24 n'ont pas été interviewés et 117 (76%) ont été interviewés et subi des examens de crachats, révélant 2 patients (2%) à frottis positif. L'enregistrement des résultats du traitement avec succès montre une bonne validité.

En el marco del Programa Nacional contra la Tuberculosis de Burkina Faso se llevó a cabo un estudio transversal, con el fin de confirmar los resultados de tratamiento exitoso, hasta 3 meses después de haber completado la pauta terapéutica y de caracterizar los desenlaces clínicos a largo plazo, 12 meses y 24 meses después de la compleción. Conformaron la muestra (n = 278) 91 pacientes que habían completado el tratamiento como máximo 3 meses antes, en el subgrupo 'de corto plazo', y 187 pacientes que habían completado el tratamiento entre 12 y 24 meses antes, en el subgrupo 'de largo plazo'. En la rama de corto plazo se confirmó la negatividad de todas las muestras de esputo. En el subgrupo de largo plazo se obtuvo información acerca de 154 pacientes, de los cuales 13 (8%) habían fallecido, 24 no participaron a los entrevistas y 117 (76%) respondieron entrevistas y aportaron muestras de esputo; de estos pacientes examinados, dos pacientes (2%) presentaron una baciloscopia positiva. Se confirmó la validez del registro de los desenlaces terapéuticos favorables.

User fees and access to ARV treatment for persons living with HIV/AIDS: implementation and challenges in Burkina Faso, a limited-resource country.

Access to antiretroviral (ARV) treatment remains a crucial problem for patients living with HIV/AIDS (PLWHA) in limited-resources countries. Some African countries have adopted the principle of providing ARV free of charge, but Burkina Faso opted for a direct out-of-pocket payment at the point of care delivery, with subsidized payments and mechanisms for the poorest populations to receive these services free of charge. Our objectives were to determine the proportion of PLWHA who pay for ARV and to identify the factors associated with ARV access in Burkina Faso. A cross-sectional study was performed in 13 public health facilities, 10 Nongovernmental Organizations and association health facilities, and three faith-based health facilities. In each facility, 20 outpatients receiving ARV were interviewed during a routine clinic visit. A multivariate analysis by logistic regression was performed. Among the expected 520 patients receiving ARV, 499 (96.0%) were surveyed. The majority of patients (79%) did not pay for their ARV treatment, thereby limiting cost recovery from patient payments. In a multivariate analysis, level of education and income were associated with free access to ARV. Patients with no education more frequently received free ARV than those who had received some level of education (OR 2.7, 95% CI [1.3-5.6]). Patients without any income or with less than US$10 per month were more likely to receive free ARV (OR 2.6 [95% CI 1.3-5.2]) than those who earned more than US$10 per month. However, 16% of patients without any income and 21% of those without employment paid for ARV, and the costs of drugs for opportunistic infections, food, and transport remained a burden for 85%, 91%, and 74%, respectively, of those who did not pay for ARV. Free access to a minimum care package for every PLWHA would enhance access to ARV.

Quality of antenatal care and obstetrical coverage in rural Burkina Faso.

Improving maternal health is one of the Millennium Development Goals of the United Nations. Despite the efforts to promote maternal and neonatal care to achieve this goal, the use of delivery care remains below expectations in Burkina Faso. This situation raises the question of the quality of care offered in maternity wards. The aim of this study was to identify primary healthcare facility and antenatal care characteristics predictive of an assisted delivery in rural Burkina Faso. A cross-sectional study was carried out in Gnagna province (North-East Burkina Faso) in November 2003. The operational capacities of health facilities were assessed, and a non-participating observation of the antenatal care (ANC) procedure was undertaken to evaluate their quality. Scores were established to summarize the information gathered. The rate of professional childbirth (obstetrical coverage) was derived from the number of childbirths registered in the health facility compared to the size of the population. The established scores were related to the obstetrical coverage using non-parametric tests (Kendall). In total, 17 health facilities were visited, and 81 antenatal consultations were observed. Insufficiencies were observed at all steps of ANC (mean total score for the quality of ANC=10.3 +/- 3.0, ranging from 6 to 16, out of a maximum of 20). Health facilities are poorly equipped, and the availability of qualified staff remained low (mean total score for the provision of care was 22.9 +/- 4.2, ranging from 14 to 33). However, these scores were not significantly related to the rate of professional childbirth (tau Kendall=0.27: p=0.14 and 0.01, p=0.93 respectively). The ability of the primary health centres to provide good antenatal care remains low in rural Burkina Faso. The key factors involved in the limited use of professional childbirth relating to maternal health services may be the quality of ANC.

Insulin Growth Factor-I in Protein-Energy Malnutrition during Rehabilitation in Two Nutritional Rehabilitation Centres in Burkina Faso.

Objective. To investigate the relationship between IGF-I and the nutritional status of West-African children hospitalised for nutritional rehabilitation. Patients and methods. A cohort study was performed in two centres for nutritional rehabilitation and education (CREN) in Burkina Faso. Children were followed and the anthropometric data as well as the capillary blood samples were taken on the 7th and on the 14th days after their admission. IGF-I levels were determined from dried blood spots on filter paper on IGF-I RIA, after separation of the IGF-I from its binding proteins, using Sep-Pak chromatography. Results. A total of 59 children was included in the cohort. The IGF-I mean geometric values (SD) were 6.3 (1.4) mug/L on admission, 8.6 (1.8) mug/L at day 7 and 13.6 (2.0) mug/L at day 14. The differences between these values were statistically significant (P < .001). There is a significant correlation between the changes of IGF-I with the change of weight for height Z-score (P = .01). Conclusion. These results suggest that IGF-I can be considered as a potential marker to follow the nutritional status of children admitted in hospital for protein and energy malnutrition.

Reference values of IGF-I in children from birth to 5 years of age, in Burkina Faso, using blood samples on filter paper.

OBJECTIVES: The aims of this study were to validate the use of filter paper to measure insulin-like growth factor-I (IGF-I) and to establish normal levels of IGF-I in children appearing healthy, from birth to 5 years of age in an African population. METHODS: We determined IGF-I from blood collected on filter paper. We validated this method by comparing the IGF-I values from dried blood spots on filter paper (kept at 4 degrees C and ambient temperature) and from serum among 13 children under 5. IGF-I were measured by the classical IGF-I RIA, after separation of the IGF-I from its binding proteins, using Sep-Pak chromatography. To establish normal levels of IGF-I, we conducted a cross-sectional study and collected blood samples with filter paper among 360 children in Ouagadougou (Burkina Faso). RESULTS: IGF-I determined from dried blood spots on filter paper were in good agreement with IGF-I levels obtained from blood serum, whether the filter papers were kept at 4 degrees C or at ambient temperature. The results of IGF-I-levels in apparently healthy children showed that geometric mean IGF-I ranged from 27 microg/l in boys younger than five months to 31 microg/l in 5-year-old boys. In girls, mean IGF-I ranged from 29 microg/l for girls younger than five months to 45 microg/l at the age of 5. From birth to 24 months, IGF-I decreased by 0.32+/-0.08 microg/l/month in boys and by 0.27+/-0.06 microg/l/month in girls and these decreases were not significantly different (p=0.95). After the age of 24 months, there was an increase in IGF-I of 4.9+/-1.3 microg/l/year in boys and of 8.4+/-0.8 microg/l/year in girls. This increase was indeed significantly different (p<0.001). CONCLUSIONS: Reference values of IGF-I for African boys and girls were determined. They will be used for endocrine evaluations and nutritional monitoring.

[Management of severe acute malnutrition in an urban nutritional rehabilitation center in Burkina Faso]. / Prise en charge de la malnutrition aiguë sévère dans un centre de réhabilitation et d'éducation nutritionnelle urbain au Burkina Faso.

BACKGROUND: Management of acute severe malnutrition greatly contributes to the reduction of childhood mortality rate. In developing countries, where malnutrition is common, number of acute severe malnutrition cases exceeds inpatient treatment capacity. Recent success of community-based therapeutic care put back on agenda the management of acute severe malnutrition. We analysed key issues of inpatient management of severe malnutrition to suggest appropriate global approach. METHODS: Data of 1322 malnourished children, admitted in an urban nutritional rehabilitation center, in Burkina Faso, from 1999 to 2003 were analyzed. The nutritional status was assessed using anthropometrics indexes. Association between mortality and variables was measured by relative risks. Kaplan-Meier survival curves and Cox model were used. RESULTS: From the 1322 hospitalized children, 8.5% dropped out. Daily weight gain was 10.18 (+/-7.05) g/kg/d. Among hospitalized malnourished children, 16% died. Patients were at high risk of early death, as 80% of deaths occurred during the first week. The risk of dying was highest among the severely malnourished: weight-for-height<-4 standard deviation (SD), RR=2.55 P<0,001; low MUAC-for-age, RR=2.05 P<0.001. Kaplan-Meier survival curves and Cox model showed that the variables most strongly associated with mortality were weight-for-height and MUAC-for-age. Among children discharged from the nutritional rehabilitation centre, 10.9% had weight-for-height<-3 SD. CONCLUSION: The nutrition rehabilitation centre is confronted with extremely ill children with high risk of death. There is need to support those units for appropriate management of acute severe malnutrition. It is also important to implement community-based therapeutic care for management of children still malnourished at discharge from nutritional rehabilitation centre. These programs will contribute to reduce mortality rate and number of severely malnourished children attending inpatient nutrition rehabilitation centers, by prevention and early management.

Are patients who present spontaneously with PTB symptoms to the health services in Burkina Faso well managed?

SETTING: Six health districts selected from a total of 53 in Burkina Faso. OBJECTIVE: To evaluate the performance of the health services in identifying infectious pulmonary tuberculosis (PTB) cases in Burkina Faso. DESIGN: Retrospective review of initial consultation registers in the first level health centres and the laboratory and treatment registers kept at the Centres for TB Diagnosis and Treatment (CDTs) in 2001. RESULTS: The rate of detection of sputum-positive cases of PTB was 11.7 cases per 100000 population. Cough was the reason for consulting for 10.6% of 248,730 adults; 1.1% had chronic cough. Among patients with chronic cough, 66% had been referred for smear microscopy, 69.7% of whom were registered at the CDT to which they were referred. A positive diagnosis was made in 22.5% of the suspects referred and traced to the CDT. Among those with a positive diagnosis, 87.1% were put on treatment in the same CDT. CONCLUSIONS: The PTB case detection rate in Burkina Faso is low, due to the loss of cases at each of the stages leading to the diagnosis of TB. Case detection depends on the operational effectiveness of the staff working in the health services, as well as the referral of suspect patients to the CDT.

[Factors for non-observance of the extended program timetable for vaccination in health districts: the case of Boussé in Burkina Faso]. / Déterminants du non-respect du calendrier vaccinal du programme élargi de vaccination au niveau district sanitaire: cas du district sanitaire de Boussé, Burkina Faso.

UNLABELLED: Prevention through vaccination is a strong means to fight pediatric lethal diseases. In Burkina Faso, one of the main problems for vaccination is the non-respect of the vaccination timetable bringing about a significant reduction of validity of administered doses. OBJECTIVES: The authors had for aim to assess reasons for the non-compliance to the timetable. A transversal study was carried out in the Boussé health district to: 1) analyze the qualitative and organizational factors of the vaccination services linked to this non compliance; 2) analyze community factors accounting for this situation. POPULATION AND METHOD: The study target group included mothers of children aged 0 to 11 months vaccinated by the vaccination team of the Boussé health district from August 1st, 2003 to June 30th, 2004, and the vaccination team. Variables covered in this study included sociodemographic factors, the organization of vaccination campaigns, the mothers' perception of health service organization, the vaccination team's experience, vaccinal safety, knowledge of vaccination timetable. RESULTS: The following were identified as key factors for the non-observance of the vaccination timetable: poor organization of the vaccination services, inadequate competence of the vaccination team, poor educational level of mothers, poor communication level with mothers, postvaccination side effects. CONCLUSION: The study recommends the following: training of vaccination providers, a better organization of vaccination services, and the implementation of a communication plan.

[Schistosomiasis endemic in Burkina Faso]. / L'endémie bilharzienne au Burkina Faso.

Burkina Faso, through the works of many teams of the OCCGE based in Bobo-Dioulasso, has signi-ficant data on several tropical endemics of which schistosomiasis. With the complementary works, it appears to be possible to establish a distribution of the schistosomiasis which reveals its importance. It will be the first stage of the planned national control program. The parasitologic data-gathering which covers the period of 1951 to 2000, used all the standard techniques. It is about Kato-Kartz and MIF for the intestinal schistosomiasis, centrifugation, filtration, serology reagent strips, macroscopy of urines and echography of the urinary system for the urinary schistosomiasis. All the eleven medical areas of the country have many sites submitted to parasitologic investigation. As regard the distribution of the two parasites involved with man (Schistosoma haematobium and S. mansoni), the data of prevalence (1% to 100%) and their distribution confirm their endemicity and the focal transmission. S. mansoni is located in eight medical areas particularly in the South and the West. S. haematobium is present in all the eleven medical areas of the country. In hydraulic planning as Sourou where the prevalences went from 23% to 70% for S. haematobium and from 0% to 69% for S. mansoni between 1987 and 1998. The situation requires a continuous monitoring. The spatial distribution of the six species of intermediate hosts shows that Bulinus truncatus and B. senegalensis Soudano-Sahelian species are present in all the ecological zones. B. globosus and Biomphalaria pfeifferi meet preferentially in the southern half of the country which reinforces the observation according to which the 14th northern parallel is often considered as the limit of septentrional extension of these two species. The other species Bulinus forskalii and B umbilicatus could have preference areas. All the species show a certain affinity with a type of biotope. The rarity and temporary aquatic systems lead to a concentration of the domestic and especially entertaining children activities around these biotopes very often contaminated. The phenomenon is amplified by the increase of contacts man-water, whose frequency and intensity are themselves dependent on activities related to hydro-agricultural planning. The analysis of the data shows, that in terms of colonization of the biotopes by molluscs and the relations between parasites and intermediate and final hosts, hydraulic planning turns out to be an amplifying factor of the species proliferation and parasitic flux host-parasite.

[Secondary school teachers' smoking in Ouagadougou, Burkina Faso]. / Le tabagisme chez les enseignants du secondaire de la ville de Ouagadougou, Burkina Faso.

This study was carried out among teachers of 10 secondary schools in Ouagadougou, Burkina Faso, in order to contribute to the development and implementation of a tobacco control programme in the school setting. The study had the following objectives: 1) to determine the extent of teachers' smoking addiction in the secondary schools in the city of Ouagadougou, 2) to describe the perceptions, attitudes and behaviour of teachers in the secondary school setting when confronted with smoking in the city's schools, 3) to determine the teachers' level of knowledge with respect to the harmful effects of smoking. The study was carried out from May 25 to June 30, 2001, and it included 300 teachers, 218 of which were men and 82 women. The study demonstrated that it is important to inform and sensitise teachers based upon their attitudes and perceptions with respect to tobacco.

[Assessment of management of patients with sexually transmitted infections in Burkina Faso]. / Evaluation de la prise en charge des cas d'infections sexuellement transmissibles au Burkina Faso.

BACKGROUND: In order to offer wide and efficient health care to patients, Burkina Faso has instituted the syndromic approach to sexually transmitted infections (STIs) since 1996. The current assessment has been carried out in view of measuring the degree of application of this approach in the management of the STIs in the health centres of the country. The assessment should specifically allow to: i) analyse the quality of the clinical health care of the patients coming in the health services with STI symptoms;ii) to determine the proportions of those patients to whom the care-provider give basic counselling on the use of condoms and the information of their sexual partners. METHODS: The study has been carried out from the 1(st) to the 28(th) July 2001 in all the 53 health districts and the two national hospitals of Burkina Faso. A one-day cross-section survey per health centres was used. The data were collected from a direct observation of the provider-patient relationship; and the handling of the anamnesis, the physical examination, the diagnosis and the prescriptions were analysed. RESULTS: During the survey, 358 patients had been consulted in the health centres. Only 4% of the patients who came in the health centres with STI or for STI consultation had been assessed and treated in accordance with national algorithm or WHO recommendations (Prevention indicator n degrees 6=4%); and 13% of those who came to consult with or for STI in the health centres had received basic counselling on condoms and the notification to their sexual partners (Prevention indicator n degrees 7=13%). CONCLUSION: These prevention indicators remain of a very weak level, showing therefore a poor quality of the management of STIs. Meanwhile, they show the areas of deficiencies on which a supervision and a recycling of the providers might bear.

[A study of the unmet needs for major obstetric interventions: the experience of Burkina Faso]. / Etude des besoins obstétricaux non couverts pour les interventions obstétricales majeures: l'expérience du Burkina Faso.

The fight against maternal mortality requires strategies adapted to every socio-economic and geographic context. To define these strategies, it is essential to have relevant information and to obtain the participation of the various actors involved. One of the indicators which summarizes the maternal mortality level and which it the basis for the mobilization of resources is the maternal mortality ratio. This ratio remains difficult to measure especially in countries with limited resources. Based on the major obstetric interventions for absolute maternal indications, the unmet needs for major obstetric intervention approach is an opportunity for developing countries. We applied this approach in Burkina Faso i) to determine the number of major obstetric interventions for absolute maternal indications carried out in 1998; ii) to quantify the deficit in major obstetric interventions for absolute maternal indications carried out in 1998. In order to do this, we conducted a retrospective study based on files in four sanitary regions. Once the data was collected, we listed 610 major obstetric interventions for absolute maternal indications (IOM/IMA). For the same period, the expected number of IOM/IMA was of 1,470, i.e. a relative global deficit of 58.5%. The analysis per sanitary district revealed disparities with deficits going from 87.5% to 15.5%. The lack of qualified personnel and of surgical infrastructures, the low economic level of the populations and the high cost of the services were identified as factors having favoured these deficits.

[Nutritional status on admission and hospital mortality of under-five year old children with infectious diseases in Ouagadougou, Burkina Faso]. / Etat nutritionnel à l'admission et mortalité hospitalière des enfants de moins de 5ans atteints de maladies infectieuses à Ouagadougou, Burkina Faso.

BACKGROUND: It is known that malnutrition in childhood interacting with infectious diseases contributes to increase mortality. In Burkina Faso, infectious pathologies and malnutrition are public health problems. We examined the impact of malnutrition status, using the Weight-for-age (WA) index, on mortality of children hospitalized for infectious diseases. METHODS: This retrospective study uses a systematic sample derived from the year 1999 hospital register. In total data of 1573 children from 0 to 59 months were analyzed. The association between mortality and dependent variables was measured by relative risks (RR) in univariate analysis. A logistic regression was realized and attributable risk percent (etiologic fraction among exposed) of death was calculated. RESULTS: The total intra-hospital lethality amounted to 15.3%. Age, diagnosis, type of care recourse and malnutrition (low WA index) on admission were associated to mortality. The logistic regression model confirmed the high risks of deaths for young children (0-11m), children in malnutrition (low WA index) and those with severe malaria. The attributable risk percent of death indicates that, 87% of deaths are statically attributable to severe malnutrition (WA Z-score<=-3) and 64.3% of deaths are statically attributable to moderate malnutrition (WA Z-score]-3, -2]). CONCLUSION: Nutritional status evaluation would allow to select children at risk and reduce mortality by including nutritional intervention in standard treatment of children hospitalized for infectious diseases.

[Writing quality of medical prescriptions at the Social Security System of Ouagadougou]. / Etude de la qualité rédactionnelle des ordonnances médicales à la Caisse de sécurité sociale de Ouagadougou.

A medical prescription may sometimes include errors which might have a negative impact on the patient's health. The objective of this study was to analyse the key elements of medical prescriptions given to patients covered by the Ouagadougou social security health insurance system. The population of practitioners included in the study comprises all of the medical doctors practicing in Ouagadougou. The study consisted of a review of all prescriptions registered by the family benefits and professional hazards service branches dating from January 1st to December 31st 1997. The identification of the doctors and patients was satisfactory in more than 97% of the prescriptions. However, certain errors were frequent such as the omission of the treatment's duration, the medication's dosage, and the form. The oversights observed were comparable to those described in the literature. Repeating similar periodic evaluations with a systematic feedback relayed to the practitioners will bring about an improvement of medical prescriptions.

[The use of contraceptive methods by the Mossi in a rural health district of Kaya, Burkina Faso]. / L'utilisation des méthodes contraceptives par les Mossi d'un district sanitaire rural de Kaya, Burkina Faso.

We investigated contraceptive practices in the rural health district of Kaya in Burkina Faso with the aim of a) comparing the sociodemographic and cultural characteristics of individuals who were well and poorly informed concerning contraceptive methods; b) analyzing the pattern of use of these contraceptive methods by the populations. We carried out a two-level cluster survey by the Hendersen method. For each household investigated, the chief, his wife (or one wife selected at random in polygamous families) and an adolescent (or one adolescent selected at random if there was more than one adolescent) were interviewed. Significantly more men than women were well informed concerning contraceptive methods. Similarly, a higher proportion of male adolescents than of female adolescents were well informed concerning contraceptive methods. The individuals who were well informed concerning contraceptive methods differed from those who were not well informed in terms of age, religion, level of education and radio listening habits. The prevalence of use of contraceptive methods in this study was found to be 4 to 36%, depending on the group studied. The majority of individuals expressed an intention to use contraceptive methods in the future: 59 to 78%, depending on the group studied. The contraceptive methods chosen for current and future use were, in order: the pill, condoms and contraceptive implants and the intrauterine device. Current patterns of contraceptive use favor, in decreasing order of preference, abstinence, the pill, condoms and contraceptive implants. There was also a strong tendency for individuals to experiment with diverse contraceptive methods. Thus, in the future, there is likely to be a trend towards the abandoning of abstinence in favor of the pill, condoms and contraceptive implants. Of these newer methods, condoms are likely to be the least popular and their relegation to a lower level of importance is likely to have disastrous consequences in terms of the prevention of HIV transmission by the sexual route. The results of this study indicate that information campaigns concerning contraceptive methods should be refocused on women and adolescent girls, condom promotion and maintaining the use of the methods chosen in the population.

[Parasitological profile of urinary schistosomiasis of the Sourou hydroagricultural complex of Burkina Faso]. / Profil parasitologique de la schistosomose urinaire du complexe hydroagricole du Sourou au Burkina Faso.

In the Sourou area of Burkina Faso, parasitological and malacological surveys of urinary schistosomiasis have been carried out in the constructed sites of Guédougou, Niasan and Débé dating respectively from 1967, 1986 and 1996. The investigations covered also the traditional villages of Lanfiera, Di, Poro, Tiao and Mara situated in the middle of the hydroagricultural planning for the first, very close to the lake for the second and about twenty kilometres distant for the three last. These towns represent the main sites in the Sourou area. The results of the parasitological surveys showed that urinary schistosomiasis was present in all sites. The levels of prevalence varied considerably: 70.3% in Guiédougou, 40.8% in Niassan, 8.5% in Débè in the irrigated zone, 55.6% in Lanfiéra, 56.8% in Di, 13.2% in Poro, 83.3% in Tiao and 64.7% in Mara. Concerning the malacological investigation, two species (Bulinus senegalensis and B. truncatus) were shown to be intermediate hosts of Schistosoma haematobium. The first was endemic to the area while the second was compatible with S. haematobium from the Sourou and other zones. Compared to the results of earlier investigations, the endemic had worsened with differences according to sites. This disparity of prevalence levels which has already been observed in other hydroagricultural area results from many factors, among which the impact of irrigation activities, the aquatic biotope system (irrigation canals, natural lake, pools and temporary rivers) and the type of contact of human communities with water rank high. Schistosomiasis expansion is amplified by the intermediate host dynamics and the introduction of new schistosomes carried by the new workers arriving from all over the country. In these conditions, in order to reduce rapidly prevalence levels, preventive measures should be centred on chemotherapy for the population. The treatment should be administered during a period of weak intermediate host density and be directed towards in-coming workers. Such an approach should be able to check the spread of schistosomiasis naturally occurring with the irrigation of new sites.