Population data and genetic structure analysis based on 29 Y-STR loci among the ethnolinguistic groups in Burkina Faso.

Burkina Faso (BF) is a landlocked Sahelian country located in the middle of West Africa. Sixty-three local languages are spoken in BF. Despite this high diversity, the BF population remains poorly investigated, and updated forensic parameters with a large number of Y chromosome short tandem repeats (Y-STRs) are still missing. Herein, 447 DNA samples were typed for a cocktail of 29 Y-STR loci. None of these 447 individuals in total shared a common haplotype. The overall Y-STR haplotypes were successfully uploaded online on the Y-STR Haplotype Reference Database (YHRD) with the accession numbers YA004690 and YA004691. The main haplotype diversity was 0.9999999965, which is much higher than that obtained with 12 Y-STRs in a previous study. Haploid Match Probability for the whole dataset was 0.002237. The phylogenetic analysis of 24 ethnic groups of BF shows that the ethnic group named BISSA is closer to Gur speakers than Mande speakers, where they belong. In addition, genetic structure analysis of 49 African subpopulations sheds light on the fact that geographic proximity turns out to be one of the best predictors of genetic affinity between populations.

Fever, abdominal pain, and lymphocytic ascites in a young immigrant from western Africa.

Tuberculous peritonitis is an uncommon disease in countries with low tuberculosis (TB) incidence, most often affecting non-white race, foreign-born individuals. We describe a case of TB with peritoneal involvement in a 32-year-old man immigrated to Italy from Burkina Faso, who presented with a history of fever, malaise, abdominal pain and abdominal swelling. Due to its nonspecific clinical presentation and paucibacillary nature, diagnosis of tuberculous peritonitis can be challenging, and requires a high index of suspicion. This report highlights the diagnostic challenges posed by tuberculous peritonitis and emphasizes the importance of imaging (computed tomography, CT) in identifying typical findings, and the value of histological examination of tissue specimens from peritoneum or any site of suspected TB as a tool for diagnosis confirmation.

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.

Traditional knowledge regarding edible insects in Burkina Faso.

BACKGROUND: Insects play an important role as a diet supplement in Burkina Faso, but the preferred insect species vary according to the phytogeographical zone, ethnic groups, and gender. The present study aims at documenting indigenous knowledge on edible insects in Burkina Faso. METHODS: A structured ethno-sociological survey was conducted with 360 informants in nine villages located in two phytogeographical zones of Burkina Faso. Identification of the insects was done according to the classification of Scholtz. Chi-square tests and principal component analysis were performed to test for significant differences in edible insect species preferences among phytogeographical zones, villages, ethnic groups, and gender. RESULTS: Edible insects were available at different times of the year. They were collected by hand picking, digging in the soil, and luring them into water traps. The edible insects collected were consumed fried, roasted, or grilled. All species were indifferently consumed by children, women, and men without regard to their ages. A total of seven edible insect species belonging to five orders were cited in the Sudanian zone of Burkina Faso. Macrotermes subhyalinus (Rambur), Cirina butyrospermi (Vuillet, 1911), Kraussaria angulifera (Krauss, 1877), Gryllus campestris (Linnaeus, 1758), and Carbula marginella (Thunberg) (35.66-8.47% of the citations) were most cited whereas Rhynchophorus phoenicis (Fabricius, 1801) and Oryctes sp. (3.41-0.27%) were least cited. Cirina butyrospermi was most cited in the South Sudanian zone, whereas Macrotermes subhyalinus and Kraussaria angulifera were most cited in the North Sudanian zone but were cited in all nine villages. Cirina butyrospermi was preferred by Bobo, Guin, Sambla, Senoufo, and Turka ethnic groups whereas Macrotermes subhyalinus was preferred by Fulani, Mossi, and Toussian ethnic groups. Oryctes sp. was cited only by the Toussian. CONCLUSION: A diversity of edible insects was consumed in both the South and North Sudanian zone of Burkina Faso with significant differences in species preferences according to phytogeographical zones, villages, ethnic groups, and gender.

Incertitude, Hepatitis B, and Infant Vaccination in West and Central Africa.

This comparative study explores incertitude about hepatitis B (HBV) and its implications for childhood vaccination in Bangui, Central African Republic, and the Cascades region, Burkina Faso. Anthropological approaches to vaccination, which counter stereotypes of "ignorant" publics needing education to accept vaccination, excavate alternative ways of knowing about illness and vaccination. We build on these approaches, evaluating different kinds of incertitude (ambiguity, uncertainty, ignorance) about infancy, HBV, health protection, and vaccination. Using interviews and participant observation, we find that Bangui and Cascades publics framed their incertitude differently through stories of infancy, illness, and protection. We locate different forms of incertitude within their historical contexts to illuminate why vaccination practices differ in the Cascades region and Bangui. A more nuanced approach to incomplete knowledge, situated in political, economic, and social histories of the state and vaccination, can contribute to more appropriate global health strategies to improve HBV prevention.

IgG1 and IgG4 antibody responses to the Anopheles gambiae salivary protein gSG6 in the sympatric ethnic groups Mossi and Fulani in a malaria hyperhendemic area of Burkina Faso.

Human antibody response to the Anopheles gambiae salivary protein gSG6 has recently emerged as a potentially useful tool for malaria epidemiological studies and for the evaluation of vector control interventions. However, the current understanding of the host immune response to mosquito salivary proteins and of the possible crosstalk with early response to Plasmodium parasites is still very limited. We report here the analysis of IgG1 and IgG4 subclasses among anti-gSG6 IgG responders belonging to Mossi and Fulani from Burkina Faso, two ethnic groups which are known for their differential humoral response to parasite antigens and for their different susceptibility to malaria. The IgG1 antibody response against the gSG6 protein was comparable in the two groups. On the contrary, IgG4 titers were significantly higher in the Fulani where, in addition, anti-gSG6 IgG4 antibodies appeared in younger children and the ratio IgG4/IgG1 stayed relatively stable throughout adulthood. Both gSG6-specific IgG1 and IgG4 antibodies showed a tendency to decrease with age whereas, as expected, the IgG response to the Plasmodium circumsporozoite protein (CSP) exhibited an opposite trend in the same individuals. These observations are in line with the idea that the An. gambiae gSG6 salivary protein induces immune tolerance, especially after intense and prolonged exposure as is the case for the area under study, suggesting that gSG6 may trigger in exposed individuals a Th2-oriented immune response.

[HIV/AIDS care and international migrations in the rural district of Nanoro, Burkina Faso]. / Prise en charge du VIH/sida et migrations internationales dans le district rural de Nanoro, Burkina Faso.

West African Countries account for almost half of the estimated 20 000 000 international migrants in the continent. In the frame of the scaling up of HAART, our study aims to identify specific features and constraints of access to care for HIV migrant patients returning to Burkina Faso. From January 2007 to August 2011, the Nanoro District Hospital, serving a rural area in the Centre-West of Burkina Faso, followed 437 HIV/AIDS adult patients. Migrants were 139/437 (31.8 %), of whom 108/139 (77.7 %), declared they returned to Burkina Faso to seek care, because the area they migrated to did not offer specific HIV health assistance. At baseline, 113/139 (81,3 %) migrants and 181/298 (60,7 %) residents were in WHO clinical stages III or IV (p< 0.01). For every 100 patients/ year under HAART, 25.5 migrants (91.4 % of whom to foreign countries) and 5.7 Burkina residents were transferred to other centers (p<0.01). 21.8 migrants and 8.5 residents were dead or lost to follow up (p<0.05). For migrant patients, access to HIV screening and care seems to be delayed. The high frequency of migrants under HAART working abroad requires an improved cooperation among the health systems of the African Countries.

Religious differences in female genital cutting: a case study from Burkina Faso.

The relationship between religious obligations and female genital cutting is explored using data from Burkina Faso, a religiously and ethnically diverse country where approximately three-quarters of adult women are circumcised. Data from the 2003 Burkina Faso Demographic and Health Survey are used to estimate multilevel models of religious variation in the intergenerational transmission of female genital cutting. Differences between Christians, Muslims, and adherents of traditional religions are reported, along with an assessment of the extent to which individual and community characteristics account for religious differences. Religious variation in the intergenerational transmission of female genital cutting is largely explained by specific religious beliefs and by contextual rather than individual characteristics. Although Muslim women are more likely to have their daughters circumcised, the findings suggest the importance of a collective rather than individual Muslim identity for the continuation of the practice.

Cutaneous leishmaniasis in a Japanese returnee from West Africa successfully treated with liposomal amphotericin B.

Leishmaniasis has been occasionally reported in returnees from endemic areas. Here, we report a case of cutaneous leishmaniasis in a 33-year-old Japanese man who presented with a skin nodule after returning from an 8-year stay in West Africa including Burkina Faso. He was successfully treated with liposomal amphotericin B with no significant adverse effects. This is the first Japanese case of cutaneous leishmaniasis treated successfully with liposomal amphotericin B.

Bottlenecks for high coverage of intermittent preventive treatment in pregnancy: the case of adolescent pregnancies in rural Burkina Faso.

BACKGROUND: While IPTp-SP is currently being scaled up in sub-Saharan Africa (SSA), the coverage with the required>or=2 doses of SP remains considerably short of the Roll Back Malaria (RBM) goal of 80%, not to mention of the recently advocated universal coverage. METHODS: The study triangulates quantitative data from a health center randomized community-based trial on IPTp-SP effectiveness and the additional benefit of a promotional campaign with qualitative data from focused ethnography. FINDINGS: In rural Burkina Faso, despite the significantly higher risk of malaria infection among adolescent primigravidae (PG) (OR 2.44 95%CI 1.81-3.28, p<0.001), making them primary target beneficiaries of IPTp-SP, adolescents adhered to the required three or more ANC visits significantly less (PG: 46.6%; SG 43.7%) than adults (PG: 61.9%; SG 54.9%) and had lower SP uptake during the malaria transmission season, further showing the difficulty of reaching this age group. Adolescents' structural constraints (such as their social position and household labor requirements) and needs (such as anonymity in the health encounter) leave them highly vulnerable during their pregnancies and, especially, during the high malaria transmission season. CONCLUSION: Our study shows that adolescents need to be targeted specifically, prior to their first pregnancy and with measures adapted to their social context, addressing their structural constraints and needs and going beyond standard health promotion campaigns. Unless such specific measures are taken, adolescents' social vulnerability will present a serious bottleneck for the effectiveness of IPTi-SP.

Ethnic differences in the frequency of the cardioprotective C679X PCSK9 mutation in a West African population.

PCSK9 is a liver-secreted blood protein that promotes the degradation of low-density lipoprotein receptors, leading to reduced hepatic uptake of plasma cholesterol. Nucleotide variations in its gene have been linked to hypo- and hyper-cholesterolemia. Two nonsense mutations, Y142X and C679X, are associated to lifelong hypocholesterolemia and a remarkable protection against coronary heart disease (CHD) in African Americans. The aim of this study was to determine the frequency of these cardioprotective mutations in West Africans. Subjects (n = 520) from different ethnic groups were recruited in Burkina-Faso, Benin, and Togo. Only the C679X mutation was detected. All carriers were heterozygous. The overall heterozygosity frequency was 3.3%. It varied significantly among ethnic groups, ranging from 0% to 6.9%. The overall high frequency of the cardioprotective C679X mutation in Africa may contribute to the lower incidence of CHD on this continent. The interethnic frequency differences may reflect historical settlement and migration patterns in the region, possibly combined with positive selection for the mutation driven by yet-unknown environmental factors.

Interferon regulatory factor-1 polymorphisms are associated with the control of Plasmodium falciparum infection.

We describe the haplotypic structure of the interferon regulatory factor-1 (IRF-1) locus in two West African ethnic groups, Fulani and Mossi, that differ in their susceptibility and immune response to Plasmodium falciparum malaria. Both populations showed significant associations between IRF-1 polymorphisms and carriage of P. falciparum infection, with different patterns of association that may reflect their different haplotypic architecture. Genetic variation at this locus does not therefore account for the Fulani-specific resistance to malaria while it could contribute to parasite clearance's ability in populations living in endemic areas. We then conducted a case-control study of three haplotype-tagging single nucleotide polymorphisms (htSNPs) in 370 hospitalised malaria patients (160 severe and 210 uncomplicated) and 410 healthy population controls, all from the Mossi ethnic group. All three htSNPs showed correlation with blood infection levels in malaria patients, and the rs10065633 polymorphism was associated with severe disease (P=0.02). These findings provide the first evidence of the involvement in malaria susceptibility of a specific locus within the 5q31 region, previously shown to be linked with P. falciparum infection levels.

Use of medicinal plants for the treatment of oral diseases in Burkina Faso.

This paper presents the findings of an investigation into the treatment of oral diseases with medicinal plants in the Kadiogo province, Burkina Faso. Although the region is mainly urban, it appears that traditional healers who live there, and the general population, continue to rely on plant products when dealing with a broad range of oral health concerns. Sixty-two relevant species belonging to 29 families were identified, and each was documented with regard to its local name, part used, indication, mode of administration, and the collection and storage procedure used (when those data were available). A number of ideas for research topics emerged from this work, some of which promise to help selection and prescription of improved traditional remedies for oral diseases at the primary health care level in Burkina Faso.

Genetic complexity of Plasmodium falciparum in two ethnic groups of Burkina Faso with marked differences in susceptibility to malaria.

We have characterized Plasmodium falciparum genotypes among the Mossi and Fulani sympatric ethnic groups in villages in Burkina Faso during the rainy season. Differences in clinical malaria presentation and in immune responses to malaria occur between the two groups. Asexual parasite rate, density, and gametocyte rate were higher among the Mossi than the Fulani. There was no difference in frequencies of alleles of the P. falciparum merozoite surface protein 1 (msp-1), msp-2, and glutamate-rich protein (glurp) genes among the parasites in each group. However, there were significant differences in the mean number of P. falciparum clones in the two populations, with there being more in the Mossi than in the Fulani. This effect was especially marked in older children. These differences can most probably be attributed to genetic differences in immune responsiveness to malaria between the two ethnic groups.

IgE antibodies to Plasmodium falciparum and severity of malaria in children of one ethnic group living in Burkina Faso.

Plasmodium falciparum malaria infection induces elevated blood levels of both total immunoglobulin and anti-plasmodial antibodies belonging to different isotypes. We have previously shown that donors living in areas of malaria transmission develop malaria-specific IgE antibodies that are present at highest concentrations in patients with severe disease, suggesting a role for this isotype in malaria pathogenesis. To establish the possible importance of IgE in the course and severity of this disease, we have analyzed a large and homogenous group of African children (age range = 6 months to 15 years) belonging to one ethnic group (Mossi) living in identical epidemiologic conditions in the same urban area (Ougadougo) of Burkina Faso. While IgG antibodies to P. falciparum increased to high concentrations in very young children and then remained at these levels in older patients, IgE antibodies increased with age, becoming most significantly elevated in children more than four years of age. In older children, those with severe malaria had significantly higher IgE antibody levels than those with non-severe disease. No significant differences between the patient groups were seen for IgG antibodies to P. falciparum. However, when the patients with severe malaria were divided into two groups distinguished by the presence of absence of coma, both IgG and IgE antibodies against malaria were lower in the comatous patients than in the non-comatous patients. The results support the conclusion that IgE antibodies against malaria, regardless of their possible protectivity, also contribute to disease severity in this large and homogenous group of African children.

The bloodsucking arthropod bite as possible cofactor in the transmission of human herpesvirus-8 infection and in the expression of Kaposi's sarcoma disease.

Based on a review of the literature on human herpesvirus-8 (HHV8) and Kaposi's sarcoma (KS) and on the distribution of KS in Italy (Veneto region particularly), we hypothesize that the bite of bloodsucking arthropods is a cofactor in the seroconversion to HHV8 positivity and probably in the pathogenesis of KS. The bloodsucking arthropod releases with saliva powerful antihaemostatics and immunomodulators which may favour the replication and the establishment of the pathogen. Transmission would depend on the close contact of the child with a seropositive mother (or relatives) whose infective saliva is used to relieve itching and scratching at the arthropod bite's sites. During any deregulation of the immune system (e.g. ageing), local immune responses to new insect bites may induce virus activation which could prelude KS insurgence. The pathogen is not directly transmitted by the arthropod which merely prepares the cutaneous microenvironment for the virus. We have therefore introduced a new category of medically important arthropods, "promoter arthropods", besides those already defined as biological or mechanical vectors. Promoter arthropods are species able to induce in the host long-lasting, immediate or delayed-type hypersensitivity responses as well as local immunosuppression due to substances injected with their saliva. The striking variability of ORF-K1 gene of HHV8 could be due to the adaptation of the virus to the specific microenvironments resulting from the immune response to the salivary antigens characteristic of the bloodsucking arthropod species prevalent in each geographical area. It is worth noting that other viruses (especially Hepatitis B Virus) may exploit the same non-sexual transmission route.

[Febrile coma and multiple organ failure: suspected hemoglobinopathy SC]. / Coma fébrile et défaillance multiviscérale: suspicion d'hémoglobinopathie SC.

We report the case of febrile fatal coma in a 51-year-old man from Burkina Faso. Magnetic resonance imaging (MRI) shows cerebral fat embolism. Haemoglobin electrophoresis shows probably haemoglobinopathy SC. A short review of the literature demonstrate the need to consider this complication in patients with neurological or respiratory disorders, in areas where this disease is highly prevalent, irrespective of age. It also emphasizes the diagnostic contribution of MRI and discusses the mechanism, the diagnosis as well as the difficulty of choosing the appropriate therapeutic course.

Hospital-acquired malaria transmitted by contaminated gloves.

We describe two cases of malaria occurring in a malaria-free zone in two in-patients, two weeks after a case of Plasmodium falciparum malaria, acquired in Burkina Faso, had been admitted to the same ward. After reviewing the techniques used by nursing staff, we conclude that transmission probably occurred via gloves contaminated following manipulation of venous cannulae and drip lines of the patient with Burkina Faso-acquired malaria and which had not been discarded before manipulating the intravenous lines of the other two patients. Nosocomial transmission of unusual and potentially life-threatening infections should be taken into consideration in those settings where compliance with universal precautions is not rigorous.