[Clinical and parasitological aspects of severe malaria in adults in an urban area of Bobo-Dioulasso (Burkina Faso)]. / Aspects cliniques et parasitologiques du paludisme grave de l'adulte en milieu urbain de Bobo-Dioulasso (Burkina Faso).

From March to December 2000, we carried out a prospective study in the emergency and the internal medicine wards of Bobo-Dioulasso central hospital (Burkina Faso). Among 280 adults with clinical diagnosis of severe malaria, only 60 were confirmed to have severe forms of malaria after the laboratory investigations. Most of these patients (49 cases) were living in the city. The average age was 29.2 years +/- 13.1. At hospital admission, the average temperature was 39.1 degrees C +/- 1 and signs of severe malaria were dominated by impaired consciousness (43 cases), multiple convulsions (6 cases) and severe anaemia (6 cases). Two of these signs were associated in the third of patients. The average parasite density at admission was 11,660 parasites per microliter. 85% of patients hospitalized recovered, 8% died and 7% escaped. The control thick smear at day 3 showed that 23% of patients were still positive. At day 7 none of them was positive. Malaria in adults in urban area is a phenomenon which needs to be assessed and followed in African big towns.

[Severe malaria and HIV in adult patients in Bobo-Dioulasso, Burkina Faso]. / Paludisme grave et infection à VIH chez l'adulte a Bobo-Dioulasso, Burkina Faso.

The purpose of this prospective study conducted from March to December 2000 in the Internal Medicine Department of the Sanou Souro University Hospital in Bobo-Dioulasso, Burkina Faso was to evaluate the epidemiological, clinical, biological and prognostic features of severe malaria in adult patients according to their HIV status. During the study period HIV testing was performed in 37 of the 72 adults with confirmed severe malaria. Findings were positive in 12 cases and negative in 25. The mean age of the 12 seropositive patients with severe malaria was 32.4 +/- 2.8 years and most (50%) had used self-prescribed antimalarial treatment. The most common reasons for seeking medical care were fever, headache and deterioration of general health. The main manifestations of severe malaria were coma (n=4), generalized seizure (n=4) and circulatory collapse (n=4). Six patients (50%) presented two severe manifestations. Mean parasitemia at the time of admission was 4066 parasites/microl for seropositive subjects versus 8563 parasites/microl for seronegative subjects. Outcome of malaria included 4 deaths and 8 recoveries in the seropositive group versus 2 deaths and 23 recoveries in the seronegative group. Comparison with the group of 25 seronegative patients presenting severe malaria demonstrated no significant difference in mean age (p=0.96), self-prescribed antimalarial treatment (p=0.50), parasitemia upon admission (p=0.28), or mortality (p=0.07). However co-infected patients were found to have a higher incidence of anemia (P=0.01) and never presented certain manifestations of severe malaria. Further studies of co-infection by HIV infection and malaria (especially severe malaria) is needed given the high human and economic impact of these two diseases in sub-Saharan Africa.

A prospective study on neonatal mortality and its predictors in a rural area in Burkina Faso: can MDG-4 be met by 2015?

OBJECTIVE: To measure the neonatal mortality rate (NMR) and investigate its predictors in a rural area of Burkina Faso. STUDY DESIGN: A cohort of infants born in 24 villages in Banfora region was followed until the children were 6 months old. We estimated the risk of neonatal death and used logistic regression to identify its predictors. RESULT: Among 864 live births followed to day 28, there were 40 neonatal deaths, a NMR of 46.3 per 1000 live births (95% confidence intervals (CI): 22 to 70). Multivariable regression identified twin birth (OR=11.5, 95% CI: 4.5 to 29.8), having a nulliparous mother (odds ratio (OR)=4.3, 95% CI: 1.5 to 12.1), and birth into a polygynous household (OR=2.1, 95% CI: 1.0 to 4.7) as main predictors of neonatal death. CONCLUSION: The burden of neonatal mortality in rural Burkina Faso is very high and the observed NMRs in a predominantly rural country suggest that it is unlikely Burkina will meet fourth Millennium Development Goal (MDG-4) by 2015.