Factors limiting traditional medicine integration into modern health systems in Africa: protocol for a systematic review of qualitative studies.

OBJECTIVES: It was recognised in the 1978 Alma-Ata Declaration that the integration of traditional medicine into modern health systems is a major lever for achieving universal health coverage. In several African countries, the integration of traditional medicine still faces constraints, despite the development of policies and regulations in favour of this integration. The objective of this study is to conduct a systematic review of the limitations of integrating traditional medicine in Africa. STUDY DESIGN: This is a systematic review protocol for qualitative studies. METHODS: The aim will be to conduct a systematic review of qualitative studies according to PRISMA guidelines. Given the qualitative nature of the primary studies, the COREQ guidelines will also be used to complement PRISMA. The search for primary studies will be conducted in Medline, Science Direct, Hinari and Google Scholar databases, using search equations designed based on the keywords constituting the thesauri of the search question. This will be done independently by two authors. The screening steps of the identified articles will be presented in PRISMA 2009 flowchart. The assessment of the risk of bias of the primary studies and the strength of the conclusions or recommendations will be performed by the GRADE tool. RESULTS: The results of this systematic review will consist of the primary qualitative studies on the limitations of integrating traditional medicine into conventional health systems in African countries. These will be categorised into policy, legal, organisational and sociocultural limitations. They will be reported in accordance with the PRISMA and COREQ guidelines. CONCLUSION: A systematic qualitative study of the limitations of effective integration of traditional medicine into conventional health systems in Africa is needed to guide national policies and regulations on traditional medicine. The application of PRISMA and COREQ standards to this review will ensure its quality and reproducibility. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID: CRD42022318699.

[The professions of colonial pharmacist in French West Africa]. / Les métiers de pharmacien colonial en Afrique occidentale française.

During the twentieth century, French colonial rule in West Africa was marked by the establishment of a homogeneous health organization in the colonies. It was based on the health service of the colonial troops, the hospital service under the general service and other services such as health police, epidemics and hygiene. This health system made it possible to protect the colonizers and indigenous populations from the major endemics of the time, to conduct research on new diseases hitherto unrecognized and to bring "civilization" to the overseas territories. The pharmacist's missions in the colonial health system were manifold. Our study aims to shed light on the profession of colonial pharmacist in the health history of French West Africa. To do this, it concerned the period between the creation of the Federation of French West Africa (1895) and the end of colonization (1960). Drawing on the available documentation, including archival material and bibliographic sources, this article shows that the colonial pharmacist was already exercising a multidisciplinary profession. He was in fact hospital manager, wholesaler-distributor, pharmacy, biologist, chemist, botanist, teacher, central actor in public health.

[Literature review on pharmacovigilance of medicines derived from traditional pharmacopoeias. Part I: Risks identification]. / Revue de la littérature sur la pharmacovigilance des médicaments issus des pharmacopées traditionnelles. Partie I : identification des risques.

Globally, the use of drugs from traditional pharmacopoeias is a major subject. The confidence of the populations in these drugs is linked to their presumption of safety and also to the fact that geographically and financially they are more accessible than synthetic drugs. In view of the high exposure of the world population to traditional medicines, they are subject to pharmacovigilance guaranteeing their safety in use. Thus, this review aims to take stock of the risks identified by the national pharmacovigilance systems. It is based on research referenced in PubMed, Embase, ScienceDirect and GoogleScholar. These studies indicate that the use of traditional drugs can involve risks including adverse effects, interactions with synthetic drugs, adulteration and contamination. The spontaneous notification system was the basis for their identification. Strengthening this system and making populations aware of these risks constitute the key levers for traditional medicines pharmacovigilance progress.

[Literature review on pharmacovigilance of medicines derived from traditional pharmacopoeias. Part II: Risks assessment and prevention]. / Revue de la littérature sur la pharmacovigilance des médicaments issus des pharmacopées traditionnelles. Partie II : évaluation et prévention des risques.

After the initial stage of the pharmacovigilance process for medicines from traditional pharmacopoeias - which concerns the identification of the risks associated with their use - the risk assessment should now be approached. The latter makes it possible to detect potential signals early and to take preventive measures. We sought to understand, from a review of the literature, the steps and methods of risk assessment relating to traditional medicines, as well as the prevention strategies applied to them. All of the work carried out on the subject has shown that the steps and methods for assessing and preventing drug risks are the same for both conventional and traditional medicines. Risk assessment includes analysis of the quality of individual notifications, assessment of causality, detection and evaluation of signals. The World Health Organization method is the most widely used for causality assessment internationally, while disproportionality measures are the most applied for signal detection. Regarding prevention, risk communication is the main strategy for the risks associated with traditional medicines. This review suggests the involvement of traditional medicine practitioners both in the notification system and in the communication strategy on the risks associated with their products.

[Tropical otitis]. / Otite tropicale.

A 68-year-old patient presents with chronic right-sided otorrhea associated with hypoacousis and chronic cough. Otoscopy showed multiple perforations of the right eardrum. The search of acid-fast bacilli was positive for direct examination of sputum and negative for the examination of ear pus. A antituberculosis treatment has been initiated.

[Treatment management of a case of class I bialveolar protrusion with mouth breathing]. / Gestion du traitement d'un cas de classe I biproalvéolie avec ventilation buccale.

This is the case of a 12-year-old African young girl with bialveolar protrusion and night mouth breathing. Orthodontic treatment without dental extraction consisted after tonsillectomy in retraction of anterior teeth in the diastema spaces. The normalization of the angle of the upper incisor has improved bialveolar protrusion without alteration to the prior balance of soft tissue.

[Noma and Burkitt disease; a particular association about three observations seen in the Teaching Hospital Center Yalgado Ouedraogo (Burkina Faso)]. / Noma et maladie de Burkitt, une association exceptionnelle à propos de trois observations vues au centre hospitalier universitaire Yalgado Ouedraogo (Burkina Faso).

Cancrum oris is a gangrenous stomatitis arising from a periodontal infection and leading to severe soft tissue and bone destruction. The pathology involves numerous factors including local thrombosis, vascularitis, necrotizing gingivitis, immunodeficiency, Gram negative and anaerobic infection. It is usually a disease of infants and malnourished children in tropical areas often occurring after a debilitating disease like measles [3]. Burkitt lymphoma is a highly aggressive non-Hodgkin lymphoma first described by Burkitt in 1958 in African children from areas holoendemic for malaria. It is the first cancer of African child [6]. The association between Burkitt lymphoma and cancrum oris is non common. We report in the present study three cases of this association at the Academic Hospital Yalgado Ouedraogo of Ouagadougou. This association poses a problem of late diagnosis with difficulties in therapeutic management.

Epidemiological and Clinical Aspects and Therapy of Chronic Otitis Media in the "ENT" and Cervicofacial Surgery Ward in the University Hospital of Ouagadougou.

Objectives. The aim of this study was to analyze the epidemiological and clinical aspects of chronic otitis media and its therapeutic processes in our context. Patients and Methods. In a prospective study over a period of 1 year (March 2009-February 2010), 79 patients with chronic otitis media have been cared for in the otolaryngology ward of the University Hospital of Ouagadougou. Results. Chronic otitis media (COM) commonly occurs in the age group from 0 to 15 years (40.50%). Otorrhea was the main reason for consultation in 53 cases (67.10%); the most frequently encountered clinicopathological forms were simple COM (71%) followed by otitis media with effusion (24.30%). Intra-auricular instillations of traditional products (46.09%) were the dominant favoring factor. Treatment was essentially through medication in 59 cases with a stabilization of lesions. Endotemporal complications were noticed in 6 cases. Conclusion. The fight against chronic otitis media is carried out through preventive measures of education the of people.

[Temporomandibular Joint Ankylosis: Focus On 17 Cases And A Review Of The Literature]. / L'Ankylose Temporomandibulaire: A Propos De 17 Patients Et Revue De La Litterature.

PURPOSE: The purpose of this report was to describe the epidemiology, clinical and curative treatment of a simple interrupter resection of the temporomandibular ankylosis. MATERIALS AND METHODS: This is a retrospective descriptive study of patients who underwent surgical treatment for temporomandibular ankylosis at the university hospital of Bobo-Dioulasso. The treatment protocol comprised of a resection of the ankylosis followed by early functional rehabilitation. RESULTS: 17 patients were studied. The age of the patients at the beginning of the causal disease was between 3 and 50 years. 13 patients were younger than 15 years old. The sex ratio (men/women) was 1.4. The causes of ankylosis were dominated by noma and acute facial cellulite (76.5%), followed by facial trauma (23.5%). Transient facial paralysis, one anterior open bite and a recurrence of ankylosis were the main postoperative complications. CONCLUSION: The temporomandibular ankylosis is a serious complication in maxillofacial pathology. Actions for the prevention and for a better curative treatment are recommended.

BUT: Le but de ce rapport de série était de décrire l'épidémiologie, la clinique et les résultats du traitement curatif par une résection interruptrice simple, de l'ankylose temporo mandibulaire. MATÉRIEL ET MÉTHODE: Il s'est agit d'une étude rétrospective descriptive de patients ayant bénéficié d'un traitement chirurgical pour ankylose temporo mandibulaire au Centre Hospitalier Universitaire de Bobo-Dioulasso. Le protocole thérapeutique comprenait une résection du bloc d'ankylose suivie d'une rééducation fonctionnelle précoce. RÉSULTATS: 17 patients ont été inclus. L'âge des patients au début de la maladie causale était compris entre 3 et 50 ans. 13 patients étaient âgés au plus de 15 ans. Le sex-ratio Homme/femme était de 1,4. Les étiologies de l'ankylose étaient dominées par le noma et les cellulites aiguës de la face (76,5%), suivis des traumatismes faciaux (23,5%). Une paralysie faciale transitoire, une béance antérieure et une récidive de l'ankylose ont été les principales complications post-opératoires. CONCLUSION: L'ankylose temporo mandibulaire est une complication redoutable en pathologie maxillo-faciale. Des actions pour la prévention et pour un meilleur traitement curatif et fonctionnel sont recommandées.

[HIV and noma in Burkina Faso]. / VIH et noma au Burkina Faso.

INTRODUCTION: Noma is a "gangrenous" disease beginning in gums and spreading to other parts of the face. It usually occurs in undernourished children with bad orodental hygiene. Its incidence in adults is increasing. HIV infection is very common in African countries. We had for objective to compare noma characteristics in patients with, or without, HIV. MATERIAL AND METHODS: This retrospective and descriptive study included patients managed for noma in our unit from January 1988 to December 2007. The clinical, epidemiological, and outcome data of patients treated for noma were compared according to HIV infection status. RESULTS: Two hundred and twelve patients were included and 14 (6.6%) among them were HIV positive. In the HIV positive group, there were a male predominance and patients were older (mean age 15.3 vs. 4.7 years in the other group). HIV positive patients were less frequently operated (35.7% vs. 76.3%) and their death rate was higher (37.5% vs. 5.6%). DISCUSSION: HIV infection during the course of noma impacts the clinical and epidemiological features of this condition. It worsens the prognosis. Noma could be considered as an opportunistic infection in the WHO disease staging system.

[Bacteriological profile of chronic otitis media in the ENT and neck surgery department at the Ouagadougou University Hospital Center (Burkina Faso)]. / Profil bactériologique des otites moyennes chroniques au CHU de Ouagadougou (Burkina Faso).

UNLABELLED: The specific germs that cause chronic otitis media determine the treatment necessary. The purpose of this study was to identify the pathogens involved in this disease and to determine the sensitivity of the antibiotics commonly used in order to improve treatment. METHODS: This prospective study took place over 12 months and recorded 53 cases of chronic otorrhea in the ENT department of Ouagadougou University Hospital: 41 underwent cytologic and bacteriologic analysis. RESULTS: We identified 34 cases of bacterial infection (83%), 2 cases of fungal infection (5%) and 5 sterile cultures (12%). The bacteria isolated most frequently were Staphylococcus aureus (29%), Pseudomonas aeruginosa (26%) and Proteus mirabilis (18%). These organisms were most sensitive to fluoroquinolones (84%) and third-generation cephalosporins (77%). However, amoxicillin and tetracycline were fairly active against these pathogens, with sensitivity rates of respectively 19% and 7%. CONCLUSION: These data could help guide regional practitioners in choosing probabilistic antibiotic treatment. Sensitivity testing nonetheless remains needed in chronic otorrhea, to verify the efficacy of initial treatment and guide adequate care.

[Keloid scars of the head and neck]. / Cicatrices chéloïdes de la tête et du cou.

A keloid scar is a benign proliferative lesion of dermic collagen. It is predominant in black skin patients. It is most commonly located on the head and neck. Skin trauma and a genetic predisposition may be responsible for the keloid scar. Nevertheless, the pathogenesis of keloid scar is still unclear, and no currently available treatment is 100% effective. The authors had for aim to review the current data on keloid scar pathogenesis and treatment for an optimal management of this condition.

Experience with head and neck missile injuries at the yalgado university teaching hospital, ouagadougou, burkina faso.

BACKGROUND: To report the diagnostic and therapeutic options of missile head and neck injuries. AIM AND OBJECTIVES: To present our experience in the management of head and neck missile injuries as seen in our centre. METHODOLOGY: All the patients with head and neck missile injuries who were managed in the ENT and Dental services of Yalgado University Teaching Hospital, in Ouagadougou, the capital of Burkina Faso between January 2003 and December 2012 were reviewed. The data obtained from medical records included demographic data, history, physical findings, and site of injury, diagnosis, type of treatment/surgery, complications and outcome. RESULTS: Out of a total of 32 patients in this study, there were 26 males and 6 females with a sex ratio of 4.3:1. Their ages ranged from 18 to 63 years with a mean of 32 years ± 5.2. The age range of 20-40 accounted for 68.7% of the patients. The injury was accidental in 37.5%, assault in 56.3 and self inflicted/suicide in 6.3%. Most (59.4%) of the patients had multiple injuries while in 50 % of the cases, the injuries affected the face. Surgical intervention was done in 59.4% of the patients and conservative treatment in 40.6 % of the patients. Complications were noted in 52% of the patients. Seven patients died given a mortality rate of 21.9%. CONCLUSION: The head and neck missile injuries are not uncommon in our environment with a high mortality and morbidity rates.

[Rhinoscleroma: two cases in Bobo-Dioulasso in Burkina Faso]. / Le rhinosclérome: deux observations à Bobo-Dioulasso au Burkina Faso.

INTRODUCTION: Rhinoscleroma is a chronic granulomatous infection of the respiratory tract due to Klebsiella rhinoscleromatis (K. rhinoscleromatis). PATIENTS AND METHOD: We observed two cases of rhinoscleroma in the Souro-Sanou university hospital of Bobo-Dioulasso, Burkina Faso, over a 9-year period (2009 to 2010). RESULTS: A 19-year-old man and a 38-year-old woman both consulted with obstructive granuloma of the nasal fossae; one also had a velar localization. The treatment consisted of surgical debridement and antibiotic therapy (ciprofloxacin). Good results followed the surgery. On follow-up after two and one and a half years, we observed no relapse. CONCLUSION: The diagnosis of rhinoscleroma should be considered for any obstructive tumor of the nasal fossae. Histopathological examination contributes to the diagnosis.

[Cervicofacial cellulitis in Ouagadougou, Burkina Faso: report of 26 cases]. / Cellulites cervico-faciales a Ouagadougou (Burkina Faso): 26 observations.

Cervicofacial cellulitis is still observed in Burkina Faso and can be severe. The aim of this study was to review diagnostic and therapeutic challenges associated with management of cericofacial cellulitis in our region where medical facilities are poor. A retrospective study of patients treated between January 1999 and December 2008 was performed. A total of 26 cases of cervicofacial cellulites were compiled. All patients underwent broad spectrum antibiotherapy associated imidazols. Surgical treatment was performed in 60% of the cases. Early diagnosis and treatment is essential for favorable outcome.

[Conidiobolomycosis, a rare fungal tumor: a case report in Ouagadougou, Burkina Faso]. / Conidiobolomycose, une tumeur fongique rare: un cas a Ouagadougou, Burkina Faso.

Conidiobolomycosis is a deep, rare mycosis, due to Conidiobolus coronatus which is a saprophyte of vegetation in decomposition. We report one case in Burkina Faso. A 17 years old man, shepherd, consulted for tumefactions on the face. It could date back insidiously to a traumatism, one year before. A month later some painless tumefactions appeared on the cheekbone, the right eyelid, the nose with epistaxis. The upper lip then the lower one had swollen. Dermatological exam revealed multiple, painless, hard, sub-cutaneous swellings, affecting the cheekbone, the eyelids, the root and the ala of the nose. This tumefaction sometimes adhered to underlying tissues and to the overlying skin, sometimes mobile; painless and hard swelling of the two lips was also noted. ENT exam showed an inflammation of the nasal mucous without ulceration and the permeability of the nasal tracts was subnormal. The cephalic tomodensitometry showed a thickness of the soft tissues of the lips and the nose with an infectious feature associated to a pansinusitis without bone lesion. Histology was in favour of conidiobolomycosis. The patient was treated with fluconazole and the swelling progressively disappeared. Conidiobolomycosis is a disease generally reported in some humid tropical countries. It begins in the nasal cavities leading then to a nasal obstruction. This case was singular by the fact it happened in a dry Sudano-Sahelian climate and by its clinical features.

[Mandibular fractures in children. Apropos of 20 cases]. / Les fractures mandibulaires de l'enfant. A propos de 20 cas.

Authors report their experiences about the caring for child mandible fractures at Yalgado Ouedraogo University Hospital Centre, CHUYO. These fractures constitute day-to-day relative immediate emergencies. The techniques of retention used after bone setting are various. Ligatures with steel thread are frequently used. The retention is shortened because of the quick strengthening noticed in child. The satisfying results reveal the necessity of classical retention and ligatures with steel thread in jawbone fractures.

[Oro-facial manifestations during AIDS/HIV infection. Apropos of 60 cases seen at the Ambulatory Treatment Center in Ouagadougou and at the Yalgado University Hospital Center]. / Les manifestations bucco-faciales au cours de l'infection VIH/SIDA. A propos de 60 cas vus au Centre de Traitement Ambulatoire de Ouagadougou et au Centre Hospitalier Universitaire Yalgado (CHU-YO).

The opportinistics complaints of the AIDS occur all along the episode of the infection and depend on the individual's body immunity and on the existence or no of an anti-retroviral treatment. The buccal appearences on the face are relatively frequent. They are dominated by the buccal mycosis, the lymphatic ganglion's complaints, the inflammation of gums and buccal mucous, and the tooth decay in our context. Some authors suggest a classification that can make easy their study and treatment. Complaints like the herpes simplex infection, the herpes zoster infection, are usually found during the symptomatic stage non AIDS, whereas others like KAPOSI's disease are typical to AIDS disease. The availlability of an anti-retroviral treatment and a specialized one strenghten the efficiency of the reimbursement and improve the prognosis.

[Laryngo-tracheo-bronchial foreign bodies in children at the University Hospital Center of Ouagadougou (analysis of 96 cases)]. / Les corps étrangers laryngo-trachéo-bronchiques chez l'enfant au CHU de Ouagadougou (une analyse de 96 observations).

Over a 10-year period, a series 96 patients were treated for laryngotracheal and bronchial foreign bodies in the ENT department of the Ouagadougou University Hospital Center (Burkina Faso). The purpose of this study was to analyze the epidemioclinical features and therapeutic pitfalls encountered in that series and to propose measures to improve management. The age of patients ranged from 10 months to 14 years. The male-female ratio was 1.7. Anamnesis documented foreign body aspiration was obtained in 77% of cases. The foreign body was organic in 78 cases (81.2%) including vegetal material in 56 cases. Management was delayed due to late diagnosis since only 59.3% of the patients were admitted to the hospital within the 48 first hours. Endoscopic removal was performed in all cases but such procedures remain challenging in developing countries due to a lack of proper anesthetic facilities, skilled personnel and adequate equipment. Tracheostomy was performed in 10.4% of cases mainly in patients with foreign bodies located in larynx. One patient died during extraction. In addition to providing more information and education on prevention of laryngotracheal and bronchial foreign bodies, better management requires better training of medical personnel and improvement of technical facilities.