Geographical and sociodemographic disparities in fruit and vegetables consumption among adults in Burkina Faso: baseline results from the 2013 WHO STEPS survey.

BACKGROUND: Evidence on sociodemographic determinants and spatial variations in the fruit and/or vegetable (FV) consumption was reported. This study aimed to explore geographical and sociodemographic disparities in the level of FV consumption among adults in Burkina Faso, using the national baseline data. METHODS: This was a cross-sectional secondary study of primary data obtained by the 2013 (September to October) World Health Organization Stepwise Approach to Surveillance survey conducted in Burkina Faso. The participants were 4402 women and men aged 25-64 years and living in all 13 Burkinabè Regions. Descriptive and analytical analyses were performed using Student's t test, ANOVA, the chi-square test, Fisher's exact test and logistic regressions. RESULTS: The prevalence of a typical daily consumption of at least three servings was 4.1% (95% CI: 3.6-4.8) for fruits and 6.6% (95% CI: 5.9-7.3) for vegetables. The national prevalence of adequate FV intake was 5.1% (95% CI: 4.4-5.8), and for two Regions ("Centre-Ouest" and "Nord") the pooled prevalence was 22.4%, while in the other eleven Regions its was significantly lower, 2.4% (p = 0.0001). Using quartiles derived from the national level of consumption, each of these two Regions had a higher proportion (about 50%) of their participants in the fourth quartile (the higher level). The associated sociodemographic factors with the adequate intake were being rural residents (aOR = 1.7, p = 0.011) and women (aOR = 1.3; p = 0.03). CONCLUSION: Except for the Regions of "Centre-Ouest" and "Nord" of Burkina Faso, the prevalence of adequate consumption of FV was very low in its other eleven Regions. Measures to increase consumption in urban people are urgent while women should be the key actor in the family-based approaches implementation and the nutrition education promoting FV consumption.

A comparison of unhealthy lifestyle practices among adults with hypertension aware and unaware of their hypertensive status: results from the 2013 WHO STEPS survey in Burkina Faso.

BACKGROUND: We compared the prevalence of unhealthy lifestyle factors between the hypertensive adults who were aware and unaware of their hypertensive status and assessed the factors associated with being aware of one's hypertension among adults in Burkina Faso. METHODS: We conducted a secondary analysis of data from the World Health Organization Stepwise approach to surveillance survey conducted in 2013 in Burkina Faso. Lifestyle factors analysed were fruits and vegetables (FV) consumption, tooth cleaning, alcohol and tobacco use, body mass index and physical activity. RESULTS: Among 774 adults living with hypertension, 84.9% (95% CI: 82.2-87.3) were unaware of their hypertensive status. The frequencies of unhealthy lifestyle practices in those aware vs. unaware were respectively: 92.3% vs. 96.3%, p = 0.07 for not eating, at least, five FV servings daily; 63.2% vs. 70.5%, p = 0.12 for not cleaning the teeth at least twice a day; 35.9% vs. 42.3%, p = 0.19 for tobacco and/or alcohol use; 53.9% vs. 25.4%, p = 0.0001 for overweight/obesity and 17.1% vs, 10.3%, p = 0.04 for physical inactivity. In logistic regression analysis, older age, primary or higher education, being overweight/obese [adjusted odds ratio (aOR) = 3.2; p < 0.0001], intake of adequate FV servings daily (aOR = 2.9; p = 0.023) and non-use of alcohol and tobacco (aOR = 0.6; p = 0.028) were associated with being aware of one's hypertensive status. CONCLUSION: Undiagnosed hypertension was very high among Burkinabè adults living with hypertension. Those aware of their hypertension diagnosis did not necessarily practise healthier lifestyles than those not previously aware of their hypertension. Current control programmes should aim to improve hypertension awareness and promote risk reduction behaviour.

Associations between dental problems and underweight status among rural women in Burkina Faso: results from the first WHO Stepwise Approach to Surveillance (STEPS) survey.

OBJECTIVE: To explore the relationships between dental problems and underweight status among rural women in Burkina Faso by using nationally representative data. DESIGN: This was a cross-sectional secondary study of primary data obtained by the 2013 WHO Stepwise Approach to Surveillance survey conducted in Burkina Faso. Descriptive and analytical analyses were performed using Student's t test, ANOVA, the χ2 test, Fisher's exact test and logistic regression. SETTING: All thirteen Burkinabè regions were categorised using quartiles of urbanisation rates. PARTICIPANTS: The participants were 1730 rural women aged 25-64 years. RESULTS: The prevalence of underweight was 16·0 %, and 24·1 % of participants experienced dental problems during the 12-month period. The women with dental problems were more frequently underweight (19·9 % and 14·7 %; P < 0·05) and had a lower mean BMI (21·1 ± 3·2 and 21·6 ± 3·7 kg/m2, P < 0·01) than those without dental problems. More risk factors for underweight were observed in less urbanised regions among elderly individuals (> 49 years old) and smokeless tobacco users. Age > 49 years, professions with inconsistent income, a lack of education, smokeless tobacco use and low BMI were factors that were significantly associated with dental problems, while residency in a low-urbanisation area was a protective factor. CONCLUSION: The prevalence of underweight in rural Burkinabè women is among the highest in sub-Saharan Africa, and women with dental problems are more frequently affected than those without dental problems. Public health measures for the prevention of these disorders should specifically target women aged over 49 years and smokeless tobacco users.

Post-stroke Complications and Mortality in Burkinabè Hospitals: Relationships with Deglutition Disorders and Nutritional Status.

Stroke frequently causes deglutition disorders, leading to a decline in nutritional status and complications, and increasing mortality. Sub-Saharan data are scarce. The objectives of this study were to assess complications and mortality among hospitalized patients in Burkina Faso during the first two weeks after stroke, and to investigate associated factors. Patients with stroke were followed prospectively in Ouagadougou and Bobo-Dioulasso hospitals. Deglutition disorders and nutritional parameters were assessed at baseline (D0) and on Days 8 (D8) and 14 (D14). Complications and mortality were recorded up to D14. Factors associated with complications and mortality were investigated using multivariate analysis. Of the 222 patients included, 81.5% developed at least one complication, and mortality was 17.1%. At D0, D8, and D14, the rate of deglutition disorders was 37.4%, 28.4%, and 15.8%, respectively, and that of undernourishment 25.2%, 29.4%, and 31.0%, respectively. In multivariate analysis, only the presence of deglutition disorders was a risk factor for developing at least one complication (OR = 5.47, 95% CI 1.81-16.51). Factors predicting death were the presence of deglutition disorders at D0 (OR = 7.19, 95% CI 3.10-16.66), and at least one seizure during follow-up (OR = 3.69, 95% CI 1.63-8.36). After stroke, the rates of complications, death, and undernourishment were high compared to Western countries. Prevention and management of deglutition disorders, and specific follow-up of patients with seizures could reduce post-stroke mortality.

Clinical features and prognosis of amyotrophic lateral sclerosis in Africa: the TROPALS study.

OBJECTIVE: We describe and compare the sociodemographic and clinical features, treatments, and prognoses and survival times of patients with amyotrophic lateral sclerosis (ALS) in Africa. METHODOLOGY: We conducted a multicentre, hospital-based cohort study in Africa. Patients with ALS diagnosed in the neurology departments of participating hospitals from 2005 to 2017 were included. Subgroup analysis was performed by subcontinent. Survival analyses were conducted using the Cox proportional hazards model. RESULTS: Nine centres from eight African countries participated. A total of 185 patients with ALS were included: 114 from Northern Africa, 41 from Western Africa and 30 from Southern Africa. A male predominance (male to female ratio 2.9) was evident. The median age at onset was 53.0 years (IQR 44.5-64.0 years). The onset was bulbar in 22.7%. Only 47 patients (26.3%) received riluzole, mainly in Northern and Western Africa. The median survival from the time of diagnosis was 14.0 months (95% CI 10.7 to 17.2 months). The median survival was longer in Northern Africa (19.0 months, 95% CI 10.8 to 27.2 months) than in Western (4.0 months, 95% CI 0.8 to 7.1 months) and Southern (11.0 months, 95% CI 5.6 to 16.4 months) Africa (Breslow test, p<0.0001). Both subcontinental location and riluzole treatment independently affected survival. CONCLUSION: More African patients with ALS were male and younger and exhibited a lower proportion of bulbar onset compared with patients with ALS from Western nations. Survival was consistent with that in Western registers but far shorter than what would be expected for young patients with ALS. The research improves our understanding of the disease in Africa.

Knowledge, attitudes, and practices related to epilepsy in rural Burkina Faso.

OBJECTIVES: The objective of this study was to assess knowledge, beliefs, attitudes, and practices regarding epilepsy and neurocysticercosis in the rural areas of Burkina Faso. MATERIALS: The interviews were designed to assess general perception of epilepsy, cultural beliefs and practices regarding epilepsy and people with epilepsy (PWE), and knowledge about the link between human epilepsy and porcine cysticercosis. This qualitative study used in-depth interviews with different categories of community members, including PWE, healthcare providers (HCPs), and traditional healers in three villages in rural Burkina Faso. RESULTS: All respondents showed a good knowledge of epilepsy symptoms but very little knowledge on causes of the disease. In this community, epilepsy was often associated with witchcraft (commonly termed "black magic"). People with epilepsy were marginalized and denied certain rights such as school education and marriage. They also relied mainly on traditional medicine with a prominent role played by traditional healers. While medical personnel knew that controlling seizures would depend on the cause, the traditional healers reported to be able to cure all kinds of epilepsy as long as the patient adhered to taboos. The main "treatments" prescribed by traditional healers were to stay away from fire and refrain from pork consumption. Pork fat was believed to reduce the effectiveness of the traditional medicine. CONCLUSION: For effective monitoring and management of epilepsy in Burkina Faso, there is a need to promote better knowledge of the disease in the community, including HCPs, and traditional healers.

Geostatistical analysis of active human cysticercosis: Results of a large-scale study in 60 villages in Burkina Faso.

Cysticercosis is a neglected tropical disease caused by the larval stage of the zoonotic tapeworm (Taenia solium). While there is a clear spatial component in the occurrence of the parasite, no geostatistical analysis of active human cysticercosis has been conducted yet, nor has such an analysis been conducted for Sub-Saharan Africa, albeit relevant for guiding prevention and control strategies. The goal of this study was to conduct a geostatistical analysis of active human cysticercosis, using data from the baseline cross-sectional component of a large-scale study in 60 villages in Burkina Faso. The outcome was the prevalence of active human cysticercosis (hCC), determined using the B158/B60 Ag-ELISA, while various environmental variables linked with the transmission and spread of the disease were explored as potential explanatory variables for the spatial distribution of T. solium. A generalized linear geostatistical model (GLGM) was run, and prediction maps were generated. Analyses were conducted using data generated at two levels: individual participant data and grouped village data. The best model was selected using a backward variable selection procedure and models were compared using likelihood ratio testing. The best individual-level GLGM included precipitation (increasing values were associated with an increased odds of positive test result), distance to the nearest river (decreased odds) and night land temperature (decreased odds) as predictors for active hCC, whereas the village-level GLGM only retained precipitation and distance to the nearest river. The range of spatial correlation was estimated at 45.0 [95%CI: 34.3; 57.8] meters and 28.2 [95%CI: 14.0; 56.2] km for the individual- and village-level datasets, respectively. Individual- and village-level GLGM unravelled large areas with active hCC predicted prevalence estimates of at least 4% in the south-east, the extreme south, and north-west of the study area, while patches of prevalence estimates below 2% were seen in the north and west. More research designed to analyse the spatial characteristics of hCC is needed with sampling strategies ensuring appropriate characterisation of spatial variability, and incorporating the uncertainty linked to the measurement of outcome and environmental variables in the geostatistical analysis. Trial registration: ClinicalTrials.gov; NCT0309339.

Epilepsy and stigma in Africa: Viewpoint of healthcare professionals and combat strategies.

Epilepsy is a major public health problem in developing countries where eighty percent (80%) of people with epilepsy (PWE) live. Stigma has psychological consequences as well as serious repercussions on patients' quality of life. This study assesses the perception of health professionals in Africa regarding the stigmatization of PWE. METHODOLOGY: This is a multicenter descriptive, cross-sectional study, from 1st August 2020 to 1st September 2021. Medical practitioners from African countries involved in the management of epilepsy and who agreed to fill out forms were included in the study. Sampling was nonrandom and based on respondent choice. The data were analyzed using the EPI INFO 7 software. RESULTS: A total of two hundred and twenty-nine (229) health workers from twenty-six (26) African countries participated in this survey. 24.89% of the respondents were specialists and 46.72% were neurologists. Ninety-one percent (91%) of practitioners felt that PWE were stigmatised. The main forms of stigma were isolation (68.56%), celibacy (60.70%), unemployment (53.28%), divorce (44.54%) and exclusion (37.99%)%). Community, school and family were recognized as the main places of stigmatization. The fight against this stigma was carried out mainly in hospitals and in isolation in 58.4% and 55.8% of cases, respectively. Only 0.4% of practitioners opted for mass awareness. CONCLUSION: PWE are victims of various forms of stigmatization, particularly in community settings. Measures aimed at raising awareness of the public are essential to reduce this stigma and improve patients' quality of life.

Prevalence of neurocysticercosis among people with epilepsy in rural areas of Burkina Faso.

PURPOSE: To estimate the lifetime prevalence of neurocysticercosis (NCC)-associated epilepsy and the proportion of NCC among people with epilepsy in three Burkina Faso villages. METHODS: Three villages were selected to represent three types of pig-rearing methods: (1) Batondo, where pigs are left to roam; (2) Pabré, where pigs are mostly tethered or penned; and (3) Nyonyogo, where the majority of residents are Muslim and few pigs are raised. In Batondo and Nyonyogo, all concessions (a group of several households) were included. Half of the concessions in Pabré were randomly chosen. All households of selected concessions were included, and one person per household was randomly selected for epilepsy screening and serologic testing for cysticercosis. Self-reported cases of epilepsy were also examined and confirmed cases included in analyses other than the estimate of NCC-associated epilepsy prevalence. Epilepsy was defined as ever having had more than one episode of unprovoked seizures. Individuals with medically confirmed epilepsy had a computerized tomography (CT) scan of the brain before and after contrast medium injection. The diagnosis of NCC was made using a modification of the criteria of Del Brutto et al. KEY FINDINGS: Thirty-nine (4%) of 888 randomly selected villagers and 33 (94%) of 35 self-reported seizures cases were confirmed to have epilepsy by medical examination. Among the 68 participants with epilepsy who had a CT scan, 20 patients were diagnosed with definitive or probable NCC for a proportion of 46.9% (95% confidence interval [CI] 30.2-64.1) in Batondo and 45.5% (95% CI 19.0-74.1) in Pabré. No cases of NCC were identified in Nyonyogo. SIGNIFICANCE: All the definitive and probable cases of NCC were from the two villages where pig breeding is common. Prevention policies intended to reduce the burden of epilepsy in this country should include measures designed to interrupt the life cycle of Taenia solium.

[Cerebral-meningeal hemorrhage secondary to snakebite envenomation: about two cases at the Sourô Sanou Teaching Hospital in Bobo-Dioulasso, Burkina Faso]. / Hémorragie cérébro-méningée secondaire à une envenimation par morsure de serpent : à propos de deux cas au Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso, Burkina Faso.

Background: Envenomation by snakebite is a public health problem in developing countries. Neurovascular complications are uncommon. We report two cases of hemorrhagic stroke at the Sourô Sanou Teaching Hospital in Bobo-Dioulasso, which complicate an envenomation. Clinical description: The first patient was a 60-year-old woman with no history, who had been admitted 2 hours after snakebite for gingivorrhagia and consciousness disorders. Clinical examination found coma (GCS 7/15) and tetraparesis. The second patient was a 50-year-old woman with no history, who had been admitted one week after snakebite with digestive bleeding. Clinical examination found right hemiplegia and meningeal syndrome. Both patients presented hemorrhagic stroke on brain CT-scan but hemostasis assessment was normal. They received polyvalent antivenom and symptomatic treatment. The outcome was favorable for survival but with sequelae like tetraparesis for first patient and hemiparesis for second patient. Discussion - Conclusion: The hemorrhagic strokes are rare complications of snake envenomation. Venomous toxins can directly lead to the rupture of intracranial vessels apart of abnormalities of hemostasis. However, the morbidity and mortality related to envenomation by snake bite remains high in our environment.

Why does Africa have the lowest number of Neurologists and how to cover the Gap?

PURPOSE: Neurology is one of Africa's central and noble specialties due to the frequency of its related diseases. Through this study we: -1-described the status of neurologists in Africa in terms of numbers,-2-listed the reasons and discussed how to increase their number, and how to get the most benefit of them in healthcare coverage. METHODS: The distribution and number of neurologists in the African continent was acquired from many participants in different African countries using a survey sent between March 2020 and August 2020 by email. Further, data from the World health organization on the number of neurologists was added for the countries, from which we didn't receive answers by the survey. RESULTS: Surveys' answers were received from representatives of 50 (92%) of the 54 African nations. Authors suggest a ranking into four levels according to the number of neurologists per nation. Level A [more than 201 neurologists per country] included 2 nations. Level B [31 to 200 neurologists per country] included six nations. Level C [1 to 30 neurologists per country] including the majority of African countries (36 nations). Level D includes 10 nations without any neurologists. CONCLUSION: The need for reliable and competent neurologists with a sufficient number is considered as a crucial element to enhance the care of neurological diseases in Africa. For this, all African countries should establish new centers of excellence in neurology, by developing good south-south collaboration with supports from governmental and non-governmental institutions.

Prognostic Factors of the Lethality of Stroke at the Sourô Sanou University Teaching Hospital of Burkina Faso.

INTRODUCTION: Stroke is a major public health concern. It is a frequent pathology, 80% of which is of ischemic origin. Approximately 86% of all stroke deaths worldwide occur in low- and middle-income countries. The objective of this study was to investigate prognostic factors for in hospital lethality of stroke cases admitted in a public university hospital in Burkina Faso. METHODS: This was a retrospective cohort study with a descriptive and analytical aim on adults admitted for a stroke confirmed by a brain scan at the Sourô Sanou University Teaching Hospital (CHUSS) of Bobo-Dioulasso over the period from January 1, 2009, to December 31, 2013. RESULTS: The proportion of cases confirmed by the brain CT scan was 32% of all patients admitted for stroke in the CHUSS. The overall case fatality was 27.6%. This lethality was more pronounced in patients with hemorrhagic stroke (35.8%) compared to patients with ischemic stroke (22.4%). Median survival was higher in patients with ischemic stroke than those with hemorrhagic one (36 and 25 days, respectively) with a statistically significant difference (p value = 0.001). In multivariate analysis and hemorrhagic stroke (hazard ratio [HR]: 2.25; CI 95%: 1.41-3.61), an altered state of consciousness (HR: 1.90; CI 95%: 1.20-2.99) and the presence of central facial paralysis (HR: 1.67; CI 95%: 1.04-2.67) are factors that increased significantly the lethality. CONCLUSION: The study has identified three prognostic factors of lethality that are the hemorrhagic stroke type, the altered state of consciousness, and the central facial paralysis. Given the high case fatality, it is important to develop and implement effective prevention and management strategies adapted to the resources for the optimal control of stroke in Africa.

Clinical management and disease-modifying treatment for amyotrophic lateral sclerosis in African hospital centers: the TROPALS study.

Objective: To assess the availability of health workers and medications for clinical management of amyotrophic lateral sclerosis (ALS) in African hospital centers. Availability and affordability analyses of disease-modifying treatments were performed. Methods: A multicenter observational study involving African hospitals was conducted. A standard questionnaire was developed based on the European Federation of the Neurological Societies (EFNS) guidelines. We collected data on multidisciplinary care and availability of medicines. The availability and affordability were evaluated according to the WHO guidelines. Results: Nine hospital centers from eight African countries participated. We observed a low degree of implementation of multidisciplinary care in ALS management. Riluzole was only available in centers from South Africa, Senegal, Tunisia, and Togo. This treatment was unaffordable and the adjusted price was highly variable among countries. The cost of riluzole was partly or fully covered by patients, which implies a substantial economic burden. Conclusion: Our findings strengthen the need to promote multidisciplinary care in the clinical management of ALS in Africa. Disease-modifying medication should be both available and affordable. Local and international collaboration is needed to improve ALS health care access in Africa.

Data-driven analyses of behavioral strategies to eliminate cysticercosis in sub-Saharan Africa.

BACKGROUND: The multi-host taeniosis/cysticercosis disease system is associated with significant neurological morbidity, as well as economic burden, globally. We investigated whether lower cost behavioral interventions are sufficient for local elimination of human cysticercosis in Boulkiemdé, Sanguié, and Nayala provinces of Burkina Faso. METHODOLOGY/PRINCIPAL FINDINGS: Province-specific data on human behaviors (i.e., latrine use and pork consumption) and serological prevalence of human and pig disease were used to inform a deterministic, compartmental model of the taeniosis/cysticercosis disease system. Parameters estimated via Bayesian melding provided posterior distributions for comparing transmission rates associated with human ingestion of Taenia solium cysticerci due to undercooking and human exposure to T. solium eggs in the environment. Reductions in transmission via these pathways were modeled to determine required effectiveness of a market-focused cooking behavior intervention and a community-led sanitation and hygiene program, independently and in combination, for eliminating human cysticercosis as a public health problem (<1 case per 1000 population). Transmission of cysticerci due to consumption of undercooked pork was found to vary significantly across transmission settings. In Sanguié, the rate of transmission due to undercooking was 6% higher than that in Boulkiemdé (95% CI: 1.03, 1.09; p-value < 0.001) and 35% lower than that in Nayala (95% CI: 0.64, 0.66; p-value < 0.001). We found that 67% and 62% reductions in undercooking of pork consumed in markets were associated with elimination of cysticercosis in Nayala and Sanguié, respectively. Elimination of active cysticercosis in Boulkiemdé required a 73% reduction. Less aggressive reductions of 25% to 30% in human exposure to Taenia solium eggs through sanitation and hygiene programs were associated with elimination in the provinces. CONCLUSIONS/SIGNIFICANCE: Despite heterogeneity in effectiveness due to local transmission dynamics and behaviors, education on the importance of proper cooking, in combination with community-led sanitation and hygiene efforts, has implications for reducing morbidity due to cysticercosis and neurocysticercosis.

[Clinical and paraclinical profile of autoimmune myasthenia gravis in Ouagadougou, Burkina Faso]. / Profil clinique et paraclinique de la myasthénie auto-immune à Ouagadougou au Burkina Faso.

Introduction: Certain differences in the epidemiological, clinical, paraclinical and evolution profiles of autoimmune myasthenia gravis (AIMG) are increasingly described in patients according to geographic origins. The present study was carried out in order to help characterize the socio-demographic, clinical and paraclinical profile of AIMG in Ouagadougou, Burkina Faso. Patients and methods: This was a cross-sectional, descriptive, multicenter, hospital study carried out in Ouagadougou (Burkina Faso), over a period of 5 years 6 months, from March 2015 to September 2019. The study concerned all patients who had a clinical symptomatology suggestive of myasthenia gravis, associated with the presence in the serum of anti-AChR Ab and / or anti-MuSK Ab and / or the presence of a >10% decrement in electroneuromyography and / or a positive therapeutic test for oral anticholinestherasics. Sociodemographic, clinical and paraclinical variables, were analyzed. Results: A total of 25 patients (15 women and 10 men), were included. The young adult form was predominant (20 cases). The median time between the first symptoms and the diagnosis was 28.4 months +/- 44.8 (2 - 217 months). Diplopia and/or ptosis (80%) and dysphonia (72%) were the most frequent revealing clinical presentations. On admission, 7 patients (28%) had a moderate generalized form (MGFA class III) and 9 patients (36%) had a severe to very severe generalized form (MGFA class IV to V). Plasma Ab assays were performed in 17 patients (68%): anti-RACh Ab were positive in 11 patients (64.7%) and anti-MuSK Ab in 3 patients (14.3%). Thoracic CT revealed thymus hyperplasia in 12 patients (48%), thymoma in 5 patients (20%). Hyperthyroidism was associated in 2 patients (8%). Conclusion: AIMG in Ouagadougou, Burkina Faso is marked by delayed diagnosis, a predominance in young women, severe generalized forms and a high frequency of plasma anti-MuSK Ab. This profile appears to be different from that of Caucasian patients. Collaborative studies in the sub-Saharan region on AIMG in general populations are needed.

Frequency of recurrent stroke in Burkina Faso: an observational hospital based study of 6 months.

INTRODUCTION: studies on stroke recurrence are rare in sub-Sahara Africa. The aim to this study is to determine the prevalence and risk factors for recurrent stroke in two University Teaching Hospital in Burkina Faso. METHODS: this prospective cross-sectional study was carried on 266 stroke patients admitted in two hospitals in the city of Ouagadougou from September 1, 2017 to February 28, 2018. Patients with stroke recurrence (ischemic or hemorrhagic) were included. RESULTS: of 266 acute stroke patients included, 44 (16.4%) had recurrent stroke. The mean age of patients was 66.5 ± 11.49 years with male predominance. Hypertension was the most vascular risk factors (81.8%). Previous stroke was ischemic in 61.4%, hemorrhagic in 22.7% and unknown in 15.9% of cases. Poor compliance (< 60%) was determined in patients taking antiagregant (43.6%) and statins (50%). At admission, the most neurological disorders was motor deficit (100%), aphasia (84.1%), and deglutition disorders (15.9%). CT scan showed ischemic in 82% and hemorrhagic stroke in 18% of cases. With the analysis of second stroke, recurrent stroke after intracerebral hemorrhage was hemorrhagic in 77.8% and ischemic in 22.2%. Recurrent stroke after ischemic stroke was ischemic in 100%. CONCLUSION: stroke recurrence is common in our context. Hypertension was the most common vascular risk factor in recurrent stroke. Poor compliance was determined in patients taking antiagregant agents and statins in previous stroke.

Neurocysticercosis and epilepsy in sub-Saharan Africa.

Neurocysticercosis is a public health problem and the leading cause of epilepsy in developing countries especially in sub-Saharan Africa (SSA). In this paper, the authors review the epidemiology of cysticercosis and neurocysticercosis, as well as the non-specific clinical manifestations which render clinical diagnosis challenging especially in the sub-Saharan African context. Special attention is given to the association of epilepsy and neurocysticercosis, the former being the most common symptom of the later, and the role of the later in epileptogenesis is discussed. The state of the art guidelines regarding diagnostic tests and treatment options are discussed and proposals for prevention are made, given the specific socio-culturaland economic context of the endemic countries, mostly in SSA.

The impact of imperfect screening tools on measuring the prevalence of epilepsy and headaches in Burkina Faso.

BACKGROUND: Epilepsy and progressively worsening severe chronic headaches (WSCH) are the two most common clinical manifestations of neurocysticercosis, a form of cysticercosis. Most community-based studies in sub-Saharan Africa (SSA) use a two-step approach (questionnaire and confirmation) to estimate the prevalence of these neurological disorders and neurocysticercosis. Few validate the questionnaire in the field or account for the imperfect nature of the screening questionnaire and the fact that only those who screen positive have the opportunity to be confirmed. This study aims to obtain community-based validity estimates of a screening questionnaire, and to assess the impact of verification bias and misclassification error on prevalence estimates of epilepsy and WSCH. METHODOLOGY/PRINCIPAL FINDINGS: Baseline screening questionnaire followed by neurological examination data from a cluster randomized controlled trial collected between February 2011 and January 2012 were used. Bayesian latent-class models were applied to obtain verification bias adjusted validity estimates for the screening questionnaire. These models were also used to compare the adjusted prevalence estimates of epilepsy and WSCH to those directly obtained from the data (i.e. unadjusted prevalence estimates). Different priors were used and their corresponding posterior inference was compared for both WSCH and epilepsy. Screening data were available for 4768 individuals. For epilepsy, posterior estimates for the sensitivity varied with the priors used but remained robust for the specificity, with the highest estimates at 66.1% (95%BCI: 56.4%;75.3%) for sensitivity and 88.9% (88.0%;89.8%) for specificity. For WSCH, the sensitivity and specificity estimates remained robust, with the highest at 59.6% (49.7%;69.1%) and 88.6% (87.6%;89.6%), respectively. The unadjusted prevalence estimates were consistently lower than the adjusted prevalence estimates for both epilepsy and WSCH. CONCLUSIONS/SIGNIFICANCE: This study demonstrates that in some settings, the prevalence of epilepsy and WSCH can be considerably underestimated when using the two-step approach. We provide an analytic solution to obtain more valid prevalence estimates of these neurological disorders, although more community-based validity studies are needed to reduce the uncertainty of the estimates. Valid estimates of these two neurological disorders are essential to obtain accurate burden values for neglected tropical diseases such as neurocysticercosis that manifest as epilepsy or WSCH. TRIAL REGISTRATION: ClinicalTrials.gov NCT03095339.

Estimating the association between being seropositive for cysticercosis and the prevalence of epilepsy and severe chronic headaches in 60 villages of rural Burkina Faso.

BACKGROUND: Individuals diagnosed with neurocysticercosis often present with epilepsy and sometimes with progressively worsening severe chronic headaches (WSCH). While cross-sectional associations between seropositivity to cysticercal antigens and epilepsy have been reported, few large scale studies have been conducted in West Africa and none have measured the association between seropositivity to cysticercal antigens and headaches. This study aimed at filling these knowledge gaps by estimating the strength of the cross-sectional association between seropositivity to cysticercal antigens and the prevalence of epilepsy and WSCH in 60 villages of Burkina Faso, West Africa. METHODOLOGY/PRINCIPAL FINDINGS: Baseline data from a cluster randomized controlled trial collected from January 2011 to February 2012 in 60 villages across three provinces in Burkina Faso were used. Between 78 and 80 individuals were screened for epilepsy and WSCH in each village, and those screened positive were confirmed by a physician. Seventy-five percent of all participants were asked to provide a blood sample to test for Taenia solium cysticercus circulating antigens. Hierarchical multivariable logistic models were used to measure the association between seropositivity to cysticercal antigens and epilepsy (lifetime and active) as well as WSCH. Among 3696 individuals who provided a blood sample, 145 were found to have epilepsy only, 140 WSCH only and 19 both. There were positive associations between seropositivity to cysticercal antigens and active epilepsy (prevalence odds ratio (POR): 2.40 (95%CI: 1.15-5.00)) and WSCH (POR: 2.59 (1.34-4.99)). CONCLUSIONS/SIGNIFICANCE: Our study is the first to demonstrate a cross-sectional association between seropositivity to cysticercal antigens and WSCH in a large community-based study conducted in West Africa. The measured cross-sectional association had a strength similar to the ones previously observed between seropositivity to cysticercal antigens and lifetime or active epilepsy. As a result, preventing new cysticercosis cases in communities may reduce the prevalence of these two important neurological disorders.

Changes in nutritional state and dysphagia in stroke patients monitored during a 14-d period in a Burkina Faso hospital setting.

INTRODUCTION: Dysphagia and undernourishment are common in cerebrovascular accident (stroke) patients in developed countries. Despite the dietary transition, there is little information available in Africa on this topic. This study aims to assess the prevalence of undernourishment and dysphagia in stroke patients in two Burkina Faso teaching hospitals at a starting point (D0), on the eighth day, and on the 14th (D14) and to specify factors related to undernourishment at day 14. METHODOLOGY: The nutritional state of the patients was assessed using body mass index, triceps skinfold thickness, and mid-upper arm circumference. Dysphagia was identified using the Practical Aspiration Screening Schema. RESULTS: A total of 222 patients were included in the study. From D0 to D14, the prevalence of undernourishment increased from 25.2% to 31.0% and the prevalence of dysphagia decreased from 37.4% to 15.8%. All nutritional criteria worsened. In a multivariate analysis, undernourishment was more present at D14 for women (odds ratio [OR] = 7.01; 95% confidence interval [CI]: 1.51-32.56, P = 0.01) and was less present if weight (OR = 0.69; 95% CI: 0.60-0.79, P = 0.0001) or triceps skinfold thickness (OR = 0.85; 95% CI: 0.74-0.99, P = 0.03) were high at D0. CONCLUSION: The prevalence of undernourishment was high at D0 and increased during the monitoring period. It would be advisable to monitor patients' weight and triceps skinfold thickness, to optimize care for women and patients with low weight or triceps skinfold thickness at D0, to monitor dysphagia, and to inform patients, families, and relevant staff of nutritional concerns after a cerebrovascular accident.