[From thiamine deficiency to Wernicke encephalopathy, unknown pathology]. / Du déficit en thiamine à l'encéphalopathie de Gayet-Wernicke, pathologie méconnue.

The thiamine deficiency and its clinical consequences, especially the Wernicke encephalopathy, are still often not diagnosed. The etiologies are numerous, but the most frequent is the alcohol dependence. The diagnostic is mainly clinical and the treatment must be started as soon as possible by substituting the thiamine with intravenous injection.

Le déficit en thiamine et ses conséquences cliniques, en particulier l'encéphalopathie de Gayet-Wernicke, sont encore très souvent non diagnostiqués. Les étiologies sont multiples, la plus fréquente étant la dépendance à l'alcool. Le diagnostic est avant tout clinique et le traitement doit être débuté le plus rapidement possible en substituant la thiamine par voie intraveineuse.

A qualitative study of health professionals' uptake and perceptions of malaria rapid diagnostic tests in Burkina Faso.

BACKGROUND: Since 2012, rapid diagnostic tests (RDT) for malaria have been in use nationwide in Burkina Faso. The objective is to strengthen health professionals' diagnostic capabilities and promote good therapeutic practices. A qualitative study was conducted to learn about the adoption of this tool in the natural context of a national scale-up policy. METHODS: This study involved five health centres in two health districts. Twenty-eight individual interviews were conducted in 2013 with health professionals and members of the health district management teams. Health professionals' RDT use and drug prescription practices were observed during 278 curative care consultations over 5 weeks. RESULTS: Health professionals assessed the use of RDT positively as it allowed them to reach clear and accurate diagnoses and above all to deliver appropriate, rational care. However, the introduction of RDTs did not really change their diagnostic practices or prescribing practices for artemisinin-based combination therapy (ACT). They continued to rely predominantly on symptoms in establishing their diagnoses because of doubts regarding the reliability of the tests and the occasional stockouts of RDTs experienced by the health centres. Patients with negative RDT results continued to receive anti-malarial treatments. However, the situation remains quite heterogeneous. CONCLUSION: The use of RDTs points to the co-existence of official standards and different standards applied in practice. Setting up regular supervision activities provided an opportunity to observe and understand the various obstacles encountered by health professionals and to monitor how official directives are put into practice. For efficient use of RDTs and their results, health professionals need information and directives that are up-to-date and standardized.