[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.

[Evolution of antibiotic-resistance Staphylococcus aureus in Saint Camille Medical Centre in Ouagadougou]. / Evolution de la résistance de Staphylococcus aureus aux antibiotiques au Centre Médical Saint Camille de Ouagadougou.

BACKGROUND: Monitoring the antibiotic resistance of microorganisms in a specific geographic area can be useful in developing new approaches to first-intention antibiotherapy. OBJECTIVE: The purpose of this study was to describe the evolution of resistance of Staphylococcus aureus to antibiotics routinely used at Saint Camille Medical Centre in Ouagadougou, Burkina Faso from 1996 to 2006. METHOD: Strains of S. aureus, isolated from various pathologic sources were tested to determine their susceptibility to antibiotics. Sensitivity tests were performed in accordance with the guidelines of the Antibiogram Committee of the French Society for Microbiology (version 2007). RESULTS: During the study period, 1160 staphylococci strains were isolated including 73.45% identified as S. aureus. Susceptibility tests demonstrated a significant increase in resistance to beta-lactam antibiotics. The proportion of strains showing resistance to ampicillin reached 58.29% in 2000. Resistance to these antibiotics regressed significantly from 2000 to 2006. Resistance to pristinamycin and erythromycin showed a tendency to increase while resistance to gentamicin and oleandomycin showed no statistically significant change. CONCLUSION: This study demonstrated that S. aureus was the most common Staphylococcus genus present at the center and that it was resistant to several antibiotics. Reducing use of beta-lactam probably accounted for the significant decline in resistance to this type of antibiotic. Care should also be given to the use of other antibiotics such as pristinamycin and erythromycin since resistance appears to be increasing.

Outcome and predictive factors of mortality in hospitalized HIV-patients in Burkina Faso.

BACKGROUND: The aim of this study was to describe the clinical presentation and predictors of death in a HIV population hospitalized in Ouagadougou, Burkina Faso. MATERIALS AND METHODS: Baseline demographics, viro-immunological status, clinical presentations, and outcome have been analyzed by univariate analysis and a multivariate model. RESULTS: A total of 1,071 hospitalizations of HIV-positive patients was recorded between 1 January, 2004 and 31 August, 2006, the majority of whom were female (64.1%). The baseline CD4 cell count/microl was higher in the female patients than in the male ones (166.1 vs 110.9). Gastroenteric symptoms were the first cause of hospitalization (61.7%). The crude mortality rate was higher in males than females (38% vs 25.3%). Baseline World Health Organization clinical stage IV (OR 9.22), neurological syndrome (OR 3.04) or wasting syndrome at admission (OR 2.9), positive malaria film (OR 2.17), and an older age independently predicted death. Weight at admission > 40 kg and a higher platelet count at admission were independently associated with a better outcome. CONCLUSIONS: Females are admitted to hospital earlier than males, probably as an indirect result of the Prevention of Mother-to-Child Transmission (PMTCT) public health initiative. An active search of HIV status in other members of the family (PMTCT-plus) may result in the detection of asymptomatic HIV-infected patients as well. A Plasmodium falciparum-positive smear during admission significantly impacted on outcome as well as low platelet count.

Prevalence of non-adherence to highly active antiretroviral therapy and its related clinical and therapeutic factors in Ouagadougou (Burkina Faso).

Introduction : Non-adherence to highly active antiretroviral therapy is deleterious in HIV/AIDS programs. This study contributes to the identification of its frequency and of the clinical and therapeutic factors that determine it. Material and methods : This cross-sectional study took place from December 15, 2013, to February 18, 2014, at the Saint Camille health care center and the Pietro Annigoni biomolecular research center in Ouagadougou. It includes adults who had been receiving antiretroviral therapy for at least three months and agreed to participate. The Chi-square test or Fisher's test was used to compare proportions in the univariate analysis. A logistic regression model was applied for the multivariate analysis. P values less than 0.05 were considered significant. RESULTS: The study included 152 patients. Their mean age was 40.7±7.8 years, and the sex-ratio 0.3. The frequency of non-adherence to antiretroviral therapy was 38.2%. In the univariate analysis, laboratory and clinical factors associated with non-adherence were severe immune depression (P=0.03), opportunistic infections (P=0.001), and lack of clinical improvement (P=0.001), while the therapeutic factors associated with it were inadequate knowledge (P=0.001), side effects (P=0.003), and using the treatment secretly (P=0.001). In the multivariate analysis, opportunistic infections (OR=13.51, 95% CI 3.15-58.82, P=0.000), lack of clinical improvement (OR=4.16, 95% CI 1.06-16.32, P=0.04), inadequate knowledge (OR=16.12, 95% CI 1.67-166.66, P=0.01), and secret treatment use (OR=11.36, 95% CI 3.18-40.00, P=0.000) remained associated with non-adherence. CONCLUSION: The study underlines the need to improve strategies for the prescription of this therapy and for reinforcing patients' education and support.

p27Kip1 accumulation is associated with retinoic-induced neuroblastoma differentiation: evidence of a decreased proteasome-dependent degradation.

Development of human neuroblastoma is due to an arrest in the differentiation program of neural crest sympathoadrenal progenitor cells. However, neuroblastomas, as well as their derived cell lines, maintain the potentiality of terminal differentiation. We investigated the molecular mechanisms by which retinoic acid, a molecule introduced in clinical trials for chemotherapy, induces differentiation in neuroblastoma cell lines. Our findings demonstrate that the retinoic acid-dependent growth arrest of LAN-5 neuroblastoma cell line is associated to a very large accumulation (>tenfold) of p27Kip1 protein, a cyclin-dependent kinase inhibitor; the protein binds and inhibits cyclin-dependent kinase 2, 4 and 6 activities, thus hampering pRb and p107 phosphorylation. p27Kip1 build-up was observable as an early phenomenon (12 - 24 h) after retinoic exposure and resulted in a time-dependent accumulation of high quantities of a free p27Kip1 form. Furthermore, retinoic treatment causes an increase of cyclin-dependent kinase 5 level and activity; however, immunoprecipitation studies proved the absence of interaction with p27kip1. No noticeable variation of other components of G1 phase cell cycle engine was observed. Pulse-chase experiments showed a remarkable elongation of p27Kip1 half-life in retinoic-treated LAN-5, while no enhancement of p27Kip1 gene expression and of the translational efficiency of its messenger RNA were demonstrated. In vivo degradation of p27Kip1 was sensitive to two highly specific proteasome inhibitors, LLnL and lactacystin, while the calpain inhibitor II ALLM and the cysteine protease inhibitor E64 did not modify the level of the protein. LLnL treatment caused a very rapid (2 h) build-up of the Cdk inhibitor content and the accumulation of higher molecular weight anti-p27Kip1 immunoreactive bands, which probably represent ubiquitinated forms of the protein. Finally, in vitro experiments demonstrated that extracts prepared from retinoic-treated LAN-5 cells degraded recombinant p27Kip1 at a rate remarkably slower than the untreated cells. Our results indicate that retinoic acid strongly increases p27Kip1 levels by down-regulating the ubiquitin-proteasome p27Kip1 degrading pathway.

Genes modulated by histone acetylation as new effectors of butyrate activity.

A wealth of evidence correlates the chemopreventive activity of a fiber-rich diet with the production of butyrate. In order to identify the genes transcriptionally modulated by the molecule, we analyzed the expression profile of butyrate-treated colon cancer cells by means of cDNA expression arrays. Moreover, the effect of trichostatin A, a specific histone deacetylase inhibitor, was studied. A superimposable group of 23 genes out of 588 investigated is modulated by both butyrate and trichostatin A. Among them, a major target was tob-1, a gene involved in the control of cell cycle. tob-1 is also up-regulated by butyrate in a neuroblastoma-derived cell line, and its overexpression in the colon cells caused growth arrest. Our findings represent an extensive analysis of genes modulated by butyrate and identify completely new effectors of its biological activities.

In vitro immune recognition of synthetic peptides from the Plasmodium falciparum CS protein by individuals naturally exposed to different sporozoite challenge.

The impact of duration and intensity of sporozoite challenge on the in vitro cell immune response to synthetic peptides of the circumsporozoite (CS) protein of Plasmodium falciparum was investigated in residents of a malaria endemic area in Burkina Faso (West Africa). Lymphocyte proliferation and interferon-gamma (IFN-gamma) production were used to assess immune recognition of synthetic peptides corresponding to the polymorphic Th2R and Th3R regions, to the conserved CS.T3 sequence and to NANP and degenerate NVDP repeats. Immune responses were measured in adults and children from a village where they received more than 100 sporozoite inoculations per year and in adults living in a town, exposed to a 10-100 times lower challenge. A lifetime intense exposure apparently increased the ability to proliferate in response to most peptides in the rural adults, who all produced antibodies to NANP repeats. Surprisingly, cell cultures from these subjects seldom contained appreciable levels of IFN-gamma. In the urban adults, possibly due to the moderate challenge they are exposed to, significant differences in the proliferative potentials of the peptides could be detected. The highest stimulation indices were obtained with the genetically unrestricted CS.T3 peptide. Remarkably, proliferative responses to Th2R and Th3R appeared to be correlated with the humoral response to the CS protein, indicating a T helper significance of the epitopes. The differing proliferative potential of the polymorphic epitopes in the urban adults suggests that polymorphism might delay the development of immune responsiveness under conditions of sporadic transmission. The children from the highly malarious village displayed the lowest proliferative scores, accompanied by a high prevalence of antibodies to NANP repeats. On the basis of these findings, the hypothesis is proposed that a pure B cell reactivity to NANP repeats could ontogenetically precede the mounting of a conventional T-B cooperative immune response.

In vivo sensitivity of Plasmodium falciparum to halofantrine hydrochloride in Burkina Faso.

Plasmodium falciparum susceptibility to halofantrine hydrochloride was investigated in a small village near Ouagadougou, Burkina Faso, where the parasite was known to be chloroquine resistant. An in vivo test was carried out in July 1992 at the beginning of the rainy season in children ranging in age from two to eight years with P. falciparum monospecific infections, asexual parasitemia greater than 800/microliters of blood, and a negative result on a Bergqvist urine test for 4-aminoquinolines. Among 206 children screened, 74 were selected for study. Blood samples were collected on days 0, 2, 4, 7 and 14, and 100 microscopic fields of thick and thin blood smears were examined for parasite density and species identification. Halofantrine hydrochloride was administered under supervision at the standard dose of 24 mg/kg as 8 mg/kg given three times at 6-hr intervals with an observation period of 1 hr after each 8-mg/kg dose. Parasitemias cleared in all 74 cases by day 7, but there was a recurrence of parasitemia in six subjects (8.1%) on day 14. A second course of therapy with halofantrine resulted in prompt clearance of parasitemias in all of these children. The drug was well-tolerated and the hematologic and biochemical indices were not adversely affected by treatment.

Impact of the malaria control campaign (1993-1998) in the highlands of Madagascar: parasitological and entomological data.

Malaria transmission in the central highlands of Madagascar was interrupted in the 1960s by a national control program that used DDT indoor spraying and mass treatment with chloroquine. At the end of the 1980s in this region, epidemic malaria reappeared. Italian health authorities provided technical assistance to the National Malaria Control Program since the beginning of the resurgence of malaria in the central highlands. Yearly residual house spraying performed for 5 years (1993-1998) and the availability of antimalarial drugs reduced malaria transmission to very low levels, with improvement in parasitologic and entomologic indexes. A significant reduction of malaria prevalence was observed in the villages located at altitudes of 1,000-1,500 m, corresponding to the stratum of unstable malaria that was the main target of the antivector interventions. A significant reduction of malaria prevalence was also observed in the villages located at altitudes of 900-1,000 m, where malaria transmission is stable. The main vector Anopheles funestus was dramatically reduced in abundance and distribution in the sprayed areas.

Malaria in the highlands of Madagascar after five years of indoor house spraying of DDT.

The central region of Madagascar is a vast area of highlands (altitude 700-2000 m). Malaria transmission has re-established itself here since the last epidemic of 1985-90 and has caused the deaths of 40,000 persons according to the Minister of Health. To combat the main malaria vector in the region, Anopheles funestus, annual programmes of indoor house spraying of DDT were carried out between December 1993 and January 1998 in most rural areas at altitude 1000-1500 m. A parasitological and serological study was then conducted in the highland schools to evaluate the impact of the programme and set up a database on the region. Using a cluster-sampling method 2 independent selections were conducted (one of 130 sites, the other of 40 sites). During the study, 13,462 schoolchildren were examined, 71% living in sprayed villages. Parasite prevalence among schoolchildren declined as altitude increases, from 11% at 700-900 m to 0.4% at > 1500 m. Below 1500 m, the impact of the spraying on the prevalence of the parasite was very clear (an average decrease of from 20% to 2.7% below 1000 m and of from 4.5% without spraying to 0.8% at 1000-1500 m). Geographical analysis of the data showed that the marginal regions remained the most affected by malaria (especially outside spraying zones), and persistence of 'pockets of transmission' at 1000-1500 m, essentially in areas where spraying has never been used. In 9 schools, anti-Plasmodium antibodies were sought by indirect immunofluorescence on thick smears of parasitized red blood cells. The seroprevalence ranged from 22% to 63%, which suggests that the parasite is still circulating in the region. Even though our data show that vector control continues to be very successful in the Madagascan highlands, rapid reinfection could occur and must be monitored following spraying. To this end, the Minister for Health, with the support of the Italian Co-operation, has placed the region under epidemiological surveillance since 1997. An alert system for the timely detection of the sources of epidemics and the targeting of the antivectoral campaign is also in operation. Our study suggests that this strategy should be reinforced by the spraying of DDT in the marginal zones in order to consolidate the results obtained at higher altitudes.

Susceptibility of Plasmodium falciparum to chloroquine and mefloquine in Ouagadougou area (Burkina Faso).

Plasmodium falciparum susceptibility to chloroquine in vivo and to chloroquine and mefloquine in vitro was investigated in children living in Ouagadougou area (Burkina Faso) in October 1991. The 7-day WHO in vivo field test was used, with follow-up on days 2, 4, 7 after treatment with 25 mg base of chloroquine per kg body weight given over 3 days, on children aged 2-8 years with monospecific P. falciparum infection (parasite density higher than 800 asexual parasites/microliters of blood), and negative Bergqvist urine tests. At the same time, the in vitro response was assessed using WHO standard test kits. Chloroquine treatment in vivo resulted in parasite clearance in 47 subjects (92.2%) within 7 days (S/RI responses). Parasitaemia did not clear in 4 cases (7.8% of RII responses). There were no RIII responses. The sensitivity study in vitro showed a low degree of chloroquine resistance in 2 out of 12 isolates tested and a mean 50% effective dose (EC50) and EC99 of 0.12 mumol and 1.47 mumol/litre of blood, respectively. All isolates tested were inhibited by mefloquine at 1.6 mumol/litre of blood, indicating full sensitivity. The present study demonstrates that first-line treatment with chloroquine is still satisfactorily effective in the study area of Burkina Faso.

Sensitivity to antimalarial drugs by Plasmodium falciparum in Goundry, Oubritenga province, Burkina Faso.

Plasmodium falciparum susceptibility to chloroquine in vivo and to chloroquine, mefloquine, quinine, amodiaquine and sulfadoxine/pyrimethamine in vitro was investigated in children living in Goundry village, Oubritenga Province (Burkina Faso) in November 1992. An extended WHO in vivo field test was used, with follow-up on days 2, 4, 7, 14, 21 and 28 after treatment with 25 mg chloroquine per kg body weight given over 3 days, in children from 2 to 8 years old with P. falciparum monospecific infection, asexual parasitaemia > 800 parasites/microliter of blood and negative Bergqvist urine tests. At the same time, the in vitro response was assessed using WHO standard test kits. Out of the 71 in vivo responses examined, 50 (70.4%) were classified as resistant to chloroquine at RI (43.6%) or RII (26.8%) levels. There were no RIII responses. Out of the 43 isolates tested for chloroquine susceptibility in vitro, 32 (74.4%) were resistant to the drug with mean EC50 and EC99 values of 1.41 mumol and 10.96 mumol/l of blood, respectively. Resistance to sulfadoxine/pyrimethamine in vitro was observed in one out of 19 tested cases, with mean EC50 and EC99 values of 0.00002 mumol and 35.05 mumol/l of blood, respectively. All isolates were inhibited by mefloquine at 12.8 mumol/l of blood, quinine at 51.2 mumol/l of blood and amodiaquine at 0.4 mumol/l of blood, indicating full sensitivity to these 3 drugs. The present study demonstrates the high prevalence of chloroquine-resistant strains of P. falciparum in the study area of Burkina Faso and indicates that isolates resistant to sulfadoxine/pyrimethamine may also be present.

[In vivo chemosensitivity of Plasmodium falciparum to chloroquine in Burkina Faso: development of resistance 1988-1990]. / Surveillance de la chimiosensibilite in vivo de Plasmodium falciparum a la chloroquine au Burkina Faso: evolution de la resistance 1988-1990.

A study of Plasmodium falciparum sensitivity to chloroquine was carried out in 1988 and 1990 in 5 localities, representatives of different climatic areas of Burkina Faso. The 7-day in vivo standard test performed in 1988 showed a total clearance failure of 25%. No significant difference with 1990 data was found, except for an increase of the resistance in the area of Fada N'Gourma, close to the border with Benin, Niger and Togo.

[Utilization of permethrin-impregnated curtains by the inhabitants of a rural community in Burkina Faso]. / Utilisation de rideaux impregnés de perméthrine par les habitants d'une communauté rurale du Burkina Faso.

The degree of utilisation of permethrin-impregnated curtains was assessed in a rural community near Ouagadougou, Burkina Faso. Results showed that in the first half of the night, until 11-11.30 p.m., curtains were only partially used by the community. Indeed by this time around 50% of houses had doors well protected by curtains and, over 35% of the community, children and adults, were staying outside. A very marked pattern of this behavior was found, wrong utilisation of curtains being higher in the warm season and lower in the cold season. On the one hand, this situation decreased the potential action of curtains as a barrier to avoid mosquito-man contact and, on the other hand, facilitated the exposure of community to the risk of outdoor infection. These findings may explain the variable level of efficacy showed by curtains in the prevention of malaria morbidity, which seems to be higher in the period between January and February, the winter season in Burkina Faso. The possible application of impregnated curtains as a community-based vector control method is discussed.

Control of epidemic malaria on the highlands of Madagascar.

The Malagashy national malaria control programme ('Programme National de Lutte contre le Paludisme', PNLP) has been developing, since 1996, an epidemiological early warning system for malaria epidemics in the Central Highlands with the support of the Italian Development Cooperation. The system is based on the monitoring of malaria morbidity (clinical diagnosis) in 536 peripheral health centres (CSB) of the Highlands. The intervention area corresponds to 27 districts of the Antananarivo and Fianarantsoa provinces (4.7 million inhabitants) and spans around 100,000 square km. For each CSB a monthly warning threshold, defined as the 1993-1996 monthly mean number of malaria cases plus two standard deviations, was established. Three levels of epidemic alert have been defined according to the number of times the cases of presumptive malaria surpassed the threshold and according to the reported presence of severe malaria cases. The surveillance system relies also on the monitoring, in district hospitals of the Highlands, of the Plasmodium falciparum infection rate among clinically diagnosed malaria cases. A total of 185,589 presumptive malaria cases, corresponding to a 42/1000 malaria incidence, were recorded in 1997 by the surveillance system. During the same year 184 alerts of 2nd degree were reported. During 1998 173,632 presumptive malaria cases corresponding to a 38/1000 incidence were reported and 207 alerts of 2nd degree were detected; 75 of these alerts were investigated with ad hoc surveys and 3 initial malaria epidemics identified and controlled. Out of 6884 presumptive malaria cases diagnosed in the district hospitals during 1997-1998, only 835 (12.1%) have been confirmed by microscopy (P. falciparum 81.7%, P. vivax 15.0%, P. malariae 2.5%, P. ovale 0.2%, mixed infections 0.6%); 22.4% of these infections were imported cases from coastal endemic areas. The efficiency of the system in monitoring the trend of malaria morbidity and in the rapid detection and response to malaria epidemics is still being evaluated.

In vitro sensitivity of Plasmodium falciparum to amodiaquine compared with other major antimalarials in Madagascar.

Chloroquine has been used in Madagascar since 1945 and remains the first-line treatment for uncomplicated cases of malaria. Low-grades of resistance type R1 and R2 have been reported. Thus, in vitro tests were performed in order to monitor the drug sensitivity of Plasmodium falciparum from different study sites, with the aim of identifying alternatives to chloroquine. Chloroquine IC50 values ranged from 0.2 nM to 283.4 nM (n = 190, mean IC50 = 52.6 nM; 95% CI = 46.1-59.1 nM). Fifteen isolates (7.9%) were chloroquine-resistant. One mefloquine-resistant isolate was detected (1/139). The test isolates were sensitive to amodiaquine (n = 118), quinine (n = 212), pyrimethamine (n = 86) and cycloguanil (n = 79). The median IC50 for amodiaquine was 12.3 nM (mean IC50 = 15.3 nM, 95% CI = 13.3-17.3 nM). Amodiaquine was 3.4 times as active as chloroquine in vitro and 7 times as active as quinine against P. falciparum. These results indicate that amodiaquine may be a potent alternative to chloroquine in Madagascar. There was positive correlation between tested quinoline-containing drugs activities, which suggests in vitro cross-susceptibility.

A decade of follow-up and therapeutic drug monitoring in HIV-2 immunocompromised patients at St Camille and General Lamizana Military Medical Centers, Burkina Faso, West Africa.

Although, HIV-2 is generally less pathogenic than HIV-1 and its progression towards AIDS occurs less frequently. HIV-2 remains an important cause of disease in West Africa. This study aimed to evaluate HIV-1 and HIV-2 prevalence among pregnant women and to describe the demographic and clinical profile of patients with HIV-2 infection from 2003-2013 at St Camille and General Lamizana Military Medical Centers. A retrospective investigation was conducted using 12,287 medical records from patients screened for HIV. To respond to the lack of data available regarding HIV-2 treatment and also to address the approach to clinical, biological as well as therapeutic monitoring, 62 HIV-2 infected patients' medical records were studied. Seroprevalence of 10.6 and 0.14% were obtained, respectively for HIV-1 and HIV-2 among 12,287 women screened during the study period. From the sixty two (62) HIV-2 patients, the average age was 49.2 years (sex ratio was 0.65). The weight loss and diarrhea were the major clinical manifestations observed, respectively 54.8 and 25.8%. Fungi and herpes zoster (shingles) infections were reported as major opportunistic infections. Also, nearly half of the patients had more than 60 kg, less than 2% were in WHO stage IV and about 2/3 had a CD4 count bellow 250 cells mm(-3). AZT-3TC-IDV/LPV/R was the most prescribed combination. The gain in weight gain the Body Mass Index (BMI) improvement and the non-significant increase of the rate of CD4 between 1st (M1) and 24th month (M24) were observed after treatment with antiviral.

[Prevalence of intestinal parasites at Saint-Camille medical center in Ouagadougou (Burkina Faso), 1991 to 2010]. / Prévalence des parasites intestinaux de 1991 à 2010 au centre médical Saint-Camille de Ouagadougou (Burkina Faso).

BACKGROUND: Intestinal parasitoses continue to be a major public health problem in developing countries. OBJECTIVES: This study sought to evaluate the prevalence of intestinal parasites and their coinfection rates in patients attending the Saint-Camille medical center in Ouagadougou. Methodology. This retrospective study covers the period from 1991 through 2010. RESULTS: In all, 292,148 stool samples were analyzed, and 177,672 contained at least one parasite, for a prevalence rate of 60.82%. Protozoans accounted for 90.53% of the parasites identified (160,838) and helminthes 9.47% (16,834). The most common protozoans were Entamœba histolytica/dispar (39.88%), Trichomonas intestinalis (25.78%) and Giardia intestinalis (24.83%). The helminthes encountered most frequently were Hymenolepis nana (3.99%) and Ancylostoma spp (3.65%). Globally, the prevalence of parasites decreased over the 20-year study period. The prevalence of E. histolytica/dispar decreased while that of Giardia intestinalis became more frequent. The most common parasitic associations were E. histolytica/dispar-G. intestinalis (26.24%) and G. intestinalis-T. intestinalis (20.09%). CONCLUSION: Our results indicate that Burkina Faso is a zone at high prevalence of intestinal parasitosis, even though this prevalence appears to be decreasing. Appropriate strategies should be developed to accelerate the reduction in the incidence of these parasites.

Prevalence of HBV and HCV markers among patients attending the Saint Camille Medical Centre in Ouagadougou.

HCV and HBV cause annually, 2000 deaths from liver cancer in Burkina Faso. In this country, serological screening of hepatitis viruses B and C is only systematic among blood donors. The aims of this study were; (1) to investigate the reasons for the prescription of the screening for hepatitis B and C; (2) to determine HCV and HBV prevalence among 462 patients attending the Saint Camille Centre and (3) to identify patients with acute hepatitis or with chronic hepatitis for better monitoring. From February to May 2012, 462 patients attending the laboratory of the Saint Camille Medical Centre with viral hepatitis suspicion were screened. The hepatitis B and C serological markers were detected through Enzyme Immuno Assay (EIA) technique using commercial reagent kits. The clinical symptoms were also recorded for each patient. The results revealed that, the main clinical symptoms that prompted physicians to request HBV and HCV screenings were: asthenia (39.4%), anorexia (21.2%), abdominal pains (19.0%), nausea (10.4%), others (10.0%). The prevalence of HbsAg was 29.4% among the screened people. Patients with acute hepatitis B, active chronic hepatitis B and non-active chronic hepatitis B represented 11.2, 2.2 and 16.0%, respectively. The acquisition of immunity against HBV after vaccination was attempted for 11.7% people. HCV prevalence was 3.9% and its coinfection with HBV was 2.2%. This study showed a high prevalence for hepatitis B and C among patients attending Saint Camille Medical Centre. Without hygiene education and HBV/HCV prevention, viral hepatitis infection will become a serious public health problem in Burkina Faso.

Knowledge, attitudes and practice (KAP) regarding newborn feeding modalities in HIV-infected and HIV-uninfected pregnant women in sub-Saharan Africa: a multicentre study.

Exclusive formula feeding, exclusive breastfeeding (EBF) with early weaning or the administration of antiretroviral therapy to lactating mothers and/or to breastfed newborns may lower postnatal HIV transmission. The aim of this study was to assess mothers' knowledge, attitudes and practice (KAP) on lactation in various real-life settings in sub-Saharan Africa. A questionnaire survey investigating KAP with regard to breastfeeding in pregnant women of unknown status (Questionnaire A, 16 items) or HIV-infected women (Questionnaire B, 37 items) was administered. Associations between newborn feeding KAP and demographic, socioeconomic, cultural and obstetric variables were investigated. From January 2007 to January 2008, 2112 pregnant women answered Questionnaire A in Burkina Faso, Cameroon, Chad, Tanzania, Uganda and Zambia. Most women (53.0%) declared EBF as the preferred feeding modality. The practice of strictly defined EBF in previous pregnancies was only 11.4%, which was inversely correlated with education and parity. Questionnaire B was answered by 225 HIV-infected pregnant women in Burkina Faso, Tanzania and Uganda. Knowledge about the lactation-associated risk was associated with previous dead children. Significant variability was observed among collaborating sites. The introduction of fluids other than maternal milk within 6 months of age is common practice in sub-Saharan Africa, requiring intensive health education efforts if strictly defined EBF is to be adopted to decrease HIV postnatal transmission. Significant variation in newborn feeding determinants was observed.